Enhancing Strain Capacity by the Introduction of Pearlite in Bainite and Polygonal Ferrite Dual-Phase Pipeline Steel

In this study the strain capacity and work-hardening behavior of bainite (B), bainite + polygonal ferrite (B + PF), and bainite + polygonal ferrite + pearlite (B + PF + P) microstructures are compared. The work hardening exponent (n), instantaneous work hardening value (n_i), and differential Crussard-Jaoul (D_C-J) analysis were used to analyze the deformation behavior. The best comprehensive mechanical properties were obtained by the introduction of the pearlite phase in B + PF dualphase with the tensile strength of 586 MPa and total elongation of 31.0%. The additional pearlite phase adjusted the strain distribution, which increased the initial work hardening exponent and then maintained the entire plastic deformation at a high level, thus delayed necking. The introduction of pearlite reduced the risk of micro-void initiation combined with the high frequency of high angle grain boundaries (HAGBs) in triple-phase steel, which led to a low crack propagation rate.     

Accelerating Alzheimer's disease drug innovations from the research pipeline to patients

In June 2017, a diverse group of experts in Alzheimer's disease convened to discuss how to accelerate getting new drugs to patients to both prevent and treat the disease. Participants concluded that we need a more robust, diversified drug development pipeline. Strategic policy measures can help keep new Alzheimer's disease therapies (whether to treat symptoms, prevent onset, or cure) affordable for patients while supporting innovation and facilitating greater information sharing among payers, providers, researchers, and the public, including a postmarket surveillance study system, disease registries, innovative payment approaches, harmonizing federal agency review requirements, allowing conditional coverage for promising therapeutics and technology while additional data are collected, and opening up channels for drug companies to communicate with payers (and each other) about data and outcomes. To combat reimbursement issues, policy makers should address the latency time between potential treatment—which may be costly and fall on private payers—and societal benefits that accrue elsewhere.     

在23G微创玻璃体切割系统中应用自制管道取出硅油的护理

目的回顾性总结自制管道23G微创玻璃体切割系统主动吸引硅油取出术的护理配合要点及手术特点。方法对2011年9月~2013年3月收治的38例硅油眼患者施行自制管道的23G微创玻璃体切割系统联合主动吸引方法取出硅油手术,并对配合过程进行总结分析。结果 38例手术均在护士及时有效的手术配合护理下顺利完成,手术效果满意。结论自制23G取油管道可快速顺利取出硅油。术前熟悉手术仪器器械、手术步骤,对患者有效的心理护理,术后器械的维护保养等,为微创玻璃体切割系统硅油取出手术的成功提供了有效保证。     

一次性使用的医用塑料输液管辐照灭菌的安全性研究

本文按1985年版中国药典所规定的细菌检测方法及Ames法对用⁶⁰Co源辐照灭菌后的医用塑料输液管进行了灭菌效果、有效期及致突变研究。结果表明,辐照灭菌的效果可靠,有效期一年以上,对人体无致突变作用。因此,辐照灭菌后的塑料输液管是一种值得推广的新型医疗用具。     

Overreporting of smokeless tobacco use by adolescent males

This study evaluates the impact of a pipeline assessment (salivary cotinine determination) on the accuracy of self-reported use of cigarettes and smokeless tobacco by 160 rural seventh-and eighth-grade males ranging in age from 12 to 16. Half of them were randomly assigned to complete a questionnaire on tobacco use prior to revealing the biochemical validation materials and collecting samples. The others had the samples collected prior to receiving and completing the questionnaires. The questionnaire-first group reported significantly greater smokeless tobacco use than did the pipeline-first group. Only for the latter were their self-reports significantly corroborated by the cotinine results. These results suggest that the utilization of a biochemical pipeline not only can improve self-reported tobacco use but also may help identify perceptions about the social desirability of using harmful substances.This research was supported by Grant PHS 1 RO1 CA38337 from the National Cancer Institute.     

Leveraging population‐based exome screening to impact clinical care: The evolution of variant assessment in the Geisinger MyCode research project

Exome and genome sequencing are increasingly utilized in research studies and clinical care and can provide clinically relevant information beyond the initial intent for sequencing, including medically actionable secondary findings. Despite ongoing debate about sharing this information with patients and participants, a growing number of clinical laboratories and research programs routinely report secondary findings that increase the risk for selected diseases. Recently, there has been a push to maximize the potential benefit of this practice by implementing proactive genomic screening at the population level irrespective of medical history, but the feasibility of deploying population‐scale proactive genomic screening requires scaling key elements of the genomic data evaluation process. Herein, we describe the motivation, development, and implementation of a population‐scale variant‐first screening pipeline combining bioinformatics‐based filtering with a manual review process to screen for clinically relevant findings in research exomes generated through the DiscovEHR collaboration within Geisinger's MyCode® research project. Consistent with other studies, this pipeline yields a screen‐positive detection rate between 2.1 and 2.6% (depending on inclusion of those with prior indication‐based testing) in 130,048 adult MyCode patient‐participants screened for clinically relevant findings in 60 genes. Our variant‐first pipeline affords cost and time savings by filtering out negative cases, thereby avoiding analysis of each exome one‐by‐one, as typically employed in the diagnostic setting. While research is still needed to fully appreciate the benefits of population genomic screening, MyCode provides the first demonstration of a program at scale to help shape how population genomic screening is integrated into routine clinical care.     

呼吸机消毒与灭菌

呼吸机作为生命支持类设备,是医院内最常见的医疗器械,尤其在抢救重症肺炎患者中已经成为了早期治疗的重要手段。而在针对病毒性肺炎患者的治疗中,呼吸机的消毒灭菌及有效管理对防止呼吸性传染疾病在院内传播有着很重要的意义。     

The ‘rural pipeline’ and retention of rural health professionals in Europe's northern peripheries

The major advance in informing rural workforce policy internationally over the past 25 years has been the recognition of the importance of the ‘rural pipeline’. The rural pipeline suggests that people with ‘rural origin’ (who spent some childhood years in rural areas) and/or ‘rural exposure’ (who do part of their professional training in rural areas) are more likely to select rural work locations. What is not known is whether the rural pipeline also increases the length of time professionals spend in rural practice throughout their careers. This paper analyses data from a survey of rural health professionals in six countries in the northern periphery of Europe in 2013 to examine the relationship between rural origin and rural exposure and the intention to remain in the current rural job or to preference rural jobs in future. Results are compared between countries, between different types of rural areas (based on accessibility to urban centres), different occupations and workers at different stages of their careers. The research concludes that overall the pipeline does impact on retention, and that both rural origin and rural exposure make a contribution. However, the relationship is not strong in all contexts, and health workforce policy should recognise that retention may in some cases be improved by recruiting beyond the pipeline.     

A Study of Zero Tolerance Policies in Schools: A Multi‐Integrated Systems Approach to Improve Outcomes for Adolescents

PROBLEM: School officials throughout the United States have adopted zero tolerance policies to address student discipline, resulting in an increase in out‐of‐school suspensions and expulsions. The introduction of police on school campuses also increased the referral of students to the juvenile courts. Although school personnel generally view zero tolerance policies as a constructive measure, this approach denies recent research on adolescent brain development that mischief is a foreseeable derivative of adolescence. METHODS: A case study method examined one juvenile court's innovative multi‐integrated systems approach related to the adverse trends associated with zero tolerance policies. FINDINGS: A multi‐disciplinary protocol resulted in more effective youth assessments that reduced out‐of‐school suspensions and school referrals; increased graduation rates by 20%; and decreased delinquent felony rates by nearly 50%. The resulting protocol changed how the system responds to disruptive students by significantly reducing out‐of‐school suspensions and school referrals, and putting into place alternatives as well as providing community resources to address the underlying causes of the behavior. CONCLUSION: A multi‐systems approach that targets the reasons for disruptive behavior improves student educational and behavioral outcomes.