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This paper revisits a 2003 publication in Nursing Philosophy: The need for accurate perception and informed judgement in determining the appropriate use of the nursing resource: hearing the patient's voice. The author suggests that the basic ideas and focus of this 16‐year‐old paper are still topical and relevant in considerations of nursing care. However, it is also suggested that greater attention to the importance of the nurse–patient relationship in considerations of resource allocation, and potential rationing of nursing care, would have strengthened the original paper.  相似文献   
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ABSTRACT

Each year, over 600 youth under the age of 25 experience literal homelessness in Austin, Texas. Of these youth, 76% have a history of involvement with foster care or the juvenile justice system—far exceeding the rates of system involvement observed among homeless youth in other large communities in the United States (approximately 54%; Voices of Youth Count, 2017). Recently, Austin was selected by the U.S. Department of Housing & Urban Development as one of ten communities nationwide to participate in the Youth Homelessness Demonstration Program (YHDP), a federal initiative designed to effectively end youth homelessness by 2020. Youth with lived experience are central players in the development and implementation of Austin's response to the youth homelessness crisis. A group of twelve of these youth (the “Austin Youth Collective to End Youth Homelessness,” or AYC) serve as key decision-making partners within the Austin YHDP team. Representatives of the AYC are deeply involved at every level of the community planning process, from the development of youth-centric housing options to system redesign efforts to ensure that youth do not exit the foster care or juvenile justice systems to homelessness. The article provides an overview of the development and contributions of the AYC—including their programmatic recommendations and advocacy work—as well as key recommendations for communities looking to leverage youth voice at the systems level.  相似文献   
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ObjectiveWe used a smartphone to construct three-dimensional (3D) models of keloids, then quantitatively simulate and evaluate these tissues.MethodsWe uploaded smartphone photographs of 33 keloids on the chest, shoulder, neck, limbs, or abdomen of 28 patients. We used the parallel computing power of a graphics processing unit to calculate the spatial co-ordinates of each pixel in the cloud, then generated 3D models. We obtained the longest diameter, thickness, and volume of each keloid, then compared these data to findings obtained by traditional methods.ResultsMeasurement repeatability was excellent: intraclass correlation coefficients were 0.998 for longest diameter, 0.978 for thickness, and 0.993 for volume. When measuring the longest diameter and volume, the results agreed with Vernier caliper measurements and with measurements obtained after the injection of water into the cavity. When measuring thickness, the findings were similar to those obtained by ultrasound. Bland–Altman analyses showed that the ratios of 95% confidence interval extremes were 3.03% for longest diameter, 3.03% for volume, and 6.06% for thickness.ConclusionSmartphones were used to acquire data that was then employed to construct 3D models of keloids; these models yielded quantitative data with excellent reliability and validity. The smartphone can serve as an additional tool for keloid diagnosis and research, and will facilitate medical treatment over the internet.  相似文献   
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肝内胆管癌(ICC)可切除率低,进展期ICC的治疗有效率不高,预后很差。转化治疗在多种晚期肿瘤中有一定的疗效,是目前晚期肿瘤治疗的研究热点。随着对ICC基因组的深入了解和新的治疗药物的开发及组合,基于系统化疗的联合治疗策略,精准靶向治疗,免疫检查点抑制剂等显示出较好的疗效,使得部分进展期ICC病人能降期转化手术,获得长期生存。  相似文献   
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Intonation, the modulation of pitch in speech, is a crucial aspect of language that is processed in right‐hemispheric regions, beyond the classical left‐hemispheric language system. Whether or not this notion generalises across languages remains, however, unclear. Particularly, tonal languages are an interesting test case because of the dual linguistic function of pitch that conveys lexical meaning in form of tone, in addition to intonation. To date, only few studies have explored how intonation is processed in tonal languages, how this compares to tone and between tonal and non‐tonal language speakers. The present fMRI study addressed these questions by testing Mandarin and German speakers with Mandarin material. Both groups categorised mono‐syllabic Mandarin words in terms of intonation, tone, and voice gender. Systematic comparisons of brain activity of the two groups between the three tasks showed large cross‐linguistic commonalities in the neural processing of intonation in left fronto‐parietal, right frontal, and bilateral cingulo‐opercular regions. These areas are associated with general phonological, specific prosodic, and controlled categorical decision‐making processes, respectively. Tone processing overlapped with intonation processing in left fronto‐parietal areas, in both groups, but evoked additional activity in bilateral temporo‐parietal semantic regions and subcortical areas in Mandarin speakers only. Together, these findings confirm cross‐linguistic commonalities in the neural implementation of intonation processing but dissociations for semantic processing of tone only in tonal language speakers.  相似文献   
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An important part of fundamental research in catalysis is based on theoretical and modeling foundations which are closely connected with studies of single-crystalline catalyst surfaces. These so-called model catalysts are often prepared in the form of epitaxial thin films, and characterized using advanced material characterization techniques. This concept provides the fundamental understanding and the knowledge base needed to tailor the design of new heterogeneous catalysts with improved catalytic properties. The present contribution is devoted to development of a model catalyst system of CeO2 (ceria) on the Cu(111) substrate. We propose ways to experimentally characterize and control important parameters of the model catalyst—the coverage of the ceria layer, the influence of the Cu substrate, and the density of surface defects on ceria, particularly the density of step edges and the density and the ordering of the oxygen vacancies. The large spectrum of controlled parameters makes ceria on Cu(111) an interesting alternative to a more common model system ceria on Ru(0001) that has served numerous catalysis studies, mainly as a support for metal clusters.  相似文献   
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