Community Control of Alcohol and Drug Risk Environments: The California Experience

This article describes California community (city, county) uses of local powers and resources to prevent alcohol and other drug (AOD) problems by managing AOD risk environments in retail, public, and social domains. The article presents a promising framework used in several counties dedicated to community environment approaches to prevention. A case example of its application is provided. The framework has developed locally since the mid 1980s through AOD prevention demonstration grant research, policy advocacy, and state support for local initiatives. Data for this article come from the author's experience observing and consulting with California cities and counties over 25 years.     

IGF-1和IGFBP-3在生长激素治疗中的安全性和有效性的研究

基因重组人生长激素(recombinant human growth hormone,rhGH)已广泛应用于儿科临床治疗生长激素缺乏症,并已取得较满意的疗效.生长激素(growth hormone,GH)通过刺激肝脏细胞产生胰岛素样生长因子(insulin-like growth actor,IGF-1)来介导GH的促生长作用.血浆中大部分IGF-1与胰岛素样生长因子结合蛋白3结合,IGF-1具有促进细胞有丝分裂抑制细胞凋亡的作用,近年来发现IGF-1与肿瘤的发生发展有一定相关性,因而引发了对rhGH治疗的安全性和有效性的关注.     

损伤家兔动脉后外膜成纤维细胞增殖、表型变化与TGF-β1表达的关系

目的:观察损伤家兔动脉后外膜成纤维细胞增殖、表型变化与TGF-β1表达的关系。方法:采用免疫组化、透射电镜和原位杂交技术,观察兔腹主动脉损伤后外膜细胞增殖、细胞表型、超微结构和TGF-β1 mRNA表达水平的变化。结果: 损伤后3 d和7 d血管外膜PCNA 阳性细胞显著增多, 14 d接近正常。外膜细胞在损伤后逐渐获得α-actin表达 ,3 d呈弱阳性,7 d和14 d呈强阳性改变。损伤后7 d和14 d外膜细胞发生了显著的超微结构改变:大量的微丝出现和粗面内质网明显扩张,呈现出肌成纤维细胞的特征。损伤后3 d,外膜开始出现TGF-β1 mRNA表达,7 d和14 d表达持续上调,至28 d表达开始下调。 结论: 提示动脉损伤后外膜成纤维细胞增殖水平和表型变化与TGF-β1表达水平具有相关性。     

The evolution and future of haemophilia therapy

Summary. Lane (1840) first noted the beneficial effect of blood transfusion in controlling haemophilic bleeding following ophthalmic surgery. The appreciation that haemophilia is due to a plasma defect, at first thought to be prothrombin, coincided with the discovery of blood groups. This led in due course to the discovery of citrate anti-coagulant and the ability to store blood. The beneficial effect of citrated plasma in haemophilia led to the exploitation of stored blood, fresh frozen plasma, and the subsequent development of cryoprecipitate and factor concentrates. All this would not have been possible, however, without the selfless contribution of blood donors and the development of an organized blood transfusion service. In the United Kingdom, P. L. Oliver pioneered the development of blood donor panels, the London Blood Transfusion Service and the British Red Cross Society Blood Transfusion Service leading directly to the National Blood Transfusion Service; recognized as the World's senior service. The development of haemophilia therapy owes much, therefore, to Oliver's energetic and pioneering work and it is entirely appropriate that the first Oliver Memorial Lecture be directed to the evolution and future of haemophilia therapy. It is indeed an honour to be invited to deliver this Oliver Memorial Lecture at the combined meeting of the British Blood Transfusion Society and the British Society for Haematology here in Wembley.     

The dispositions of things: the non‐human dimension of power and ethics in patient‐centred medicine

This article explores power relations between clinicians, patients and families as clinicians engage in patient‐centred ethical work. Specifically, we draw on actor‐network theory to interrogate the role of non‐human elements in distributing power relations in clinical settings, as clinicians attempt to manage the expectations of patients and families. Using the activities of a multidisciplinary team providing deep brain stimulation to children with severe movement disorders as an example, we illustrate how a patient‐centred tool is implicated in establishing relations that constitute four modes of power: ‘power over’, ‘power to’, “power storage” and “power/discretion”. We argue that understanding the role of non‐human elements in structuring power relations can guide and inform bioethical discussions on the suitability of patient‐centred approaches in clinical settings.     

Why do organisations implement automated external defibrillators?

Automated external defibrillators are becoming ubiquitous in public space, with a wide variety of organisations adopting this technology as a way of dealing with the risk of cardiac arrest to staff or users of the organisation. In this article, we examine why organisations had purchased defibrillators. We explore how organisations perceive their responsibilities to staff and visitors in an emergency, and why organisations believe a defibrillator is an appropriate technology. This article draws on data from a qualitative, interview-based study of five large public-sector organisations (universities) in the United Kingdom, in 2011–2012. We found that the organisations perceived the risk of cardiac arrest to be substantial, though the available epidemiological evidence did not support this. They perceived the defibrillator to be an effective technology for managing this risk, as part of a wider first aid system. Instances where a cardiac arrest had occurred in the organisation were likely to persuade them to adopt the defibrillator. Our study indicated that the organisations were unaware of (or chose to ignore) the available ‘scientific’ evidence, which cast doubt on both of the scale of the risk of cardiac arrest and the effectiveness of the defibrillator in dealing with it. In this case, the symbolic power of the defibrillator to address a risk perceived to be serious enough to warrant substantial expenditure was sufficient to persuade organisations to adopt it.