Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar

Postural orthostatic tachycardia syndrome (POTS), the most common form of orthostatic intolerance in young people, affects approximately 500,000 people in the United States alone, typically young women at the peak of their education and the beginning of their working lives. This is a heterogeneous disorder, the pathophysiology and mechanisms of which are not well understood. There are multiple contributing factors and numerous potential mimics. This review details the most current views on the potential causes, comorbid conditions, proposed subtypes, differential diagnoses, evaluations, and treatment of POTS from cardiological and neurological perspectives.     

Comparison of NITAG policies and working processes in selected developed countries

BackgroundVaccines are specific medicines characterized by two country-specific market access processes: (1) a recommendation by National Immunization Technical Advisory Group (NITAG), and (2) a funding policy decision.ObjectivesThe objective of this study was to compare and analyze NITAGs of 13 developed countries by describing vaccination committees’ bodies and working processes.MethodsInformation about NITAGs bodies and working processes was searched from official sources from June 2011 to November 2012. Retrieved information was completed from relevant articles identified through a systematic literature review and by information provided by direct contact with NITAGs or parent organizations. An expert panel was also conducted to discuss, validate, and provide additional input on obtained results.ResultsWhile complete information, defined as 100%, was retrieved only for the UK, at least 80% of data was retrieved for 9 countries out of the 13 selected countries. Terms of references were identified in 7 countries, and the main mission for all NITAGs was to provide advice for National immunization programs. However, these terms of references did not fully encompass all the actual missions of the NITAGs. Decision analysis frameworks were identified for 10 out of the 13, and all NITAGs considered at least four criteria for decision-making: disease burden, efficacy/effectiveness, safety and cost-effectiveness. Advices were published by most NITAGs, but few NITAGs published meeting agendas and minutes. Only the United States had open meetings.ConclusionsThis study supports previous findings about the disparities in NITAGs processes which could potentially explain the disparity in access to vaccinations and immunization programs across Europe. With NITAGs recommendations being used by policy decision makers for implementation and funding of vaccine programs, guidances should be well-informed and transparent to ensure National Immunization Programs’ (NIP) credibility among the public and health care professionals.     

Claims in vapour device (e-cigarette) regulation: A Narrative Policy Framework analysis

BackgroundThe electronic cigarette or e-cigarette (vapour device) is a consumer product undergoing rapid growth, and governments have been adopting regulations on the sale of the devices and their nicotine liquids. Competing claims about vapour devices have ignited a contentious debate in the public health community. What claims have been taken up in the state arena, and how have they possibly influenced regulatory outcomes?MethodsThis study utilized Narrative Policy Framework to analyze the claims made about vapour devices in legislation recommendation reports from Queensland Australia, Canada, and the European Union, and the 2016 deeming rule legislation from the United States, and examined the claims and the regulatory outcomes in these jurisdictions.ResultsThe vast majority of claims in the policy documents represented vapour devices as a threat: an unsafe product harming the health of vapour device users, a gateway product promoting youth tobacco uptake, and a quasi-tobacco product impeding tobacco control. The opportunity for vapour devices to promote cessation or reduce exposure to toxins was very rarely presented, and these positive claims were not discussed at all in two of the four documents studied.ConclusionThe dominant claims of vapour devices as a public health threat have supported regulations that have limited their potential as a harm reduction strategy. Future policy debates should evaluate the opportunities for vapour devices to decrease the health and social burdens of the tobacco epidemic.     

The Effects of Guanfacine and Phenylephrine on a Spiking Neuron Model of Working Memory

We use a spiking neural network model of working memory (WM) capable of performing the spatial delayed response task (DRT) to investigate two drugs that affect WM: guanfacine (GFC) and phenylephrine (PHE). In this model, the loss of information over time results from changes in the spiking neural activity through recurrent connections. We reproduce the standard forgetting curve and then show that this curve changes in the presence of GFC and PHE, whose application is simulated by manipulating functional, neural, and biophysical properties of the model. In particular, applying GFC causes increased activity in neurons that are sensitive to the information currently being remembered, while applying PHE leads to decreased activity in these same neurons. Interestingly, these differential effects emerge from network-level interactions because GFC and PHE affect all neurons equally. We compare our model to both electrophysiological data from neurons in monkey dorsolateral prefrontal cortex and to behavioral evidence from monkeys performing the DRT.     

英国初级卫生保健质量与结果框架解析

目的 了解英国初级卫生保键质量与结果框架,为改善我国全科服务质量提供经验借鉴.方法 文献综述与定性访谈.结果 质量与结果框架作为全科服务合同的一部分,目的是通过引进激励机制改进服务质量,制定一套反映全科医疗服务质量的指标和评分体系,通过综合打分对全科医生的服务进行衡量.结论 在完善的组织管理、疾病登记体系和信息系统的支撑下,质量与结果框架有利于对全科服务进行标准化评估,统一的定价和支付体系有利于减少不同地区初级卫生保健的服务差异,激励了全科诊所服务的积极性.但也有专家学者指出了其中的一些弊端,有待进一步修正和完善.     

Client-centred occupational therapy with children: A critical perspective

Abstract

Background: Client-centredness is a central theme within occupational therapy; however, its application within clinical practice has not been thoroughly examined within the literature. Aim: The aim of this practice reflection is to provide a critical perspective on client-centredness in occupational therapy practice with children. Methods: Two action points of the Canadian Practice Process Framework (CPPF): Set the Stage and Agree on Objectives and Plan are applied to examine the concept of client-centred practice using a common practice example. Results: There are multiple benefits to using a client-centred approach to goal setting and developing a therapy plan. Practical challenges to client-centred practice include a lack of time, organizational support, and professional autonomy. Therapists may exert power over clients by enforcing institutional policies that prioritize the client diagnosis and organizational processes. Conclusion: The authors support a client-centred approach to occupational therapy practice with children but suggest that therapists may feel conflicted in trying to apply these principles within the current context of rehabilitation for children. Occupational therapists are encouraged to identify opportunities where they can advocate for a client-centred approach to services.     

支撑角度对选择性激光熔覆制作下颌双侧游离端牙列缺损可摘局部义齿支架适合性的影响

目的评价选择性激光熔覆(selective laser melting,SLM)技术制作下颌双侧游离端牙列缺损可摘局部义齿支架过程中支撑角度对支架适合性的影响。方法以下颌双侧游离端牙列缺损石膏模型为原始模型,设置对照组排除系统误差后,使用钛合金粉末,SLM制作支撑角度分别为0°(水平组)、45°(45°组)和90°(垂直组)的可摘局部义齿支架(每组6个)。将支架戴入原始模型,通过复模法获得具备支架组织面形态的石膏模型。用三维扫描仪分别扫描原始模型和复模得到的石膏模型,数据导入Geomagic Qualify软件,通过目测法以及分析支架组织面与模型的间隙评价支架的适合性。结果3组可摘局部义齿支架与石膏模型紧密贴合,无明显翘动。水平组支架与模型间的总体偏差[(0.146±0.017)mm]显著小于45°组和垂直组[分别为(0.182±0.015)和(0.185±0.022)mm](P<0.05),45°组与垂直组间差异无统计学意义(P>0.05)。水平组支托处偏差显著小于45°组(P<0.05),垂直组支托处偏差与水平组、45°组间差异均无统计学意义(P>0.05);水平组卡环处偏差显著小于45°组和垂直组(P<0.05),45°组与垂直组卡环处偏差差异无统计学意义(P>0.05);3组支架舌杆处偏差差异均无统计学意义(P>0.05)。结论通过3种支撑角度SLM制作的下颌双侧游离端牙列缺损可摘局部义齿支架的适合性均可满足临床要求,推荐优先选择水平向支撑角度制作义齿支架。