Correcting forensic DNA errors

DNA mixture interpretation can produce opposing conclusions by qualified forensic analysts, even within the same laboratory. The long-delayed publication of the National Institutes of Standards and Technology (NIST) study of 109 North American crime laboratories in this journal demonstrates this most clearly. This latest study supports earlier work that shows common methods such as the Combined Probability of Inclusion (CPI) have wrongly included innocent people as contributors to DNA mixtures. The 2016 President's Council of Advisors on Science and Technology report concluded, “In summary, the interpretation of complex DNA mixtures with the CPI statistic has been an inadequately specified—and thus inappropriately subjective—method. As such, the method is clearly not foundationally valid” [7]. The adoption of probabilistic genotyping by many laboratories will certainly prevent some of these errors from occurring in the future, but the same laboratories that produced past errors can also now review old cases with their new software—without additional bench work. It is critical that laboratories adopt procedures and policies to do this.     

基于文献的失眠症中医证候和证素分布规律研究

目的基于文献研究,探讨失眠症的中医证候要素分布规律。方法通过检索中国知网数据库(CNKI)、万方数据库、维普全文期刊数据库2009年1月至2018年12月中医药期刊文献所报道的治疗失眠症相关文献,收集统计失眠症中医证候并提取证素信息,利用SPSS 23.0软件进行统计描述分析。结果(1)共检出文献653篇,符合要求317篇,整理后规范证名得到44种中医证候,其中以心脾两虚证、痰热内扰证、肝郁化火证、阴虚火旺证、心肾不交证等频次较高。(2)证素组合规律中以两证素、三证素、四证素组合为主。(3)在单一病性证素中以热(火)、气虚、血虚、阴虚等频次较高;病位证素以肝、心、脾、肾等频次较高。(4)在证素组合时以热(火)+肝、气虚+血虚+心+脾、热(火)+痰、热(火)+阴虚等频次较高。结论失眠症的主要病理因素以热(火)、气虚、血虚、阴虚为主,病位主要以肝、心、脾、肾为主。     

Ethical,legal and professional accountability in emergency nursing practice: An ethnographic observational study

IntroductionAccountability in nursing practice is a concept that influences quality care, decision-making, safety standards and staff values. Therefore, understanding accountability and how it affects nursing practice could improve patient care and nurses’ working conditions.AimThe aim of this study was to find factors that influenced ethical, legal and professional accountability in emergency nursing practice.MethodsA qualitative ethnographic approach using participant observation through convenience sampling was employed as the data collection method, while ethnographic content analysis was used for data analysis.ResultsThe factors linked to nursing accountability found were classified into four main themes: daily dynamics, work environment evolution, customs and routines and bioethics principles’ application.DiscussionThe long-term effect of chronic high workload and crowding, which affects nursing accountability, could promote burnout in a junior ED workforce. Changes in the nurses’ working conditions need to be implemented to limit the workload to which an ED nurse is subjected to.ConclusionED nurses have to manage their accountability in difficult situations regularly, which followed patterns of four main themes across the majority of situations. Nonetheless, all those factors were influenced by nursing workload, an ever-present factor that was always considered by ED nurses during decision-making.     

情景式营养教育对婴儿喂养状况的影响

目的探讨情景式营养教育，对婴儿监护人的营养知识水平和婴儿喂养状况的影响，以探索婴儿食物转换指导新模式。 方法选择2014年4月至12月，于江苏省淮安市妇幼保健院儿童保健门诊进行健康体检的272例1～2个月龄婴儿为研究对象。采用随机数字表法，将其分别纳入干预组(n＝140)和对照组(n＝132)。干预组婴儿于3～4个月龄时，由儿童营养专科医师和营养师，在营养厨房内，对婴儿监护人以10～15人小组形式，进行情景式营养教育；对照组则由门诊体检医师进行常规营养指导。2组婴儿12个月龄时，对其监护人采用本研究自行设计的《淮安市妇幼保健院婴儿喂养状况调查表》进行调查。采用χ²检验，对2组婴儿喂养状况，如母乳喂养率、食物转换合理率等，进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求，并与受试儿监护人签署临床研究知情同意书。 结果①2组婴儿4个月龄时纯母乳喂养率、混合喂养率及人工喂养率比较，差异均无统计学意义(P>0.05)。干预组婴儿6、12个月龄时，继续母乳喂养率分别为88.6%、37.1%，均显著高于对照组的78.0%、23.5%，并且差异均有统计学意义(χ²＝5.468、P＝0.022，χ²＝5.977、P＝0.018)。②干预组婴儿监护人对食物转换指导模式的满意度、食物转换合理率，以及3类补充食品(谷类、果蔬类、动物性食物)均合理添加率，添加动物性食物合理率及监护人专用料理机使用率分别为90.0%、87.1%、77.1%、82.9%、50.0%，均显著高于对照组的77.3%、60.6%、54.5%、65.2%、25.8%，并且差异均有统计学意义(χ²＝8.116、P＝0.005，χ²＝25.033、P<0.001，χ²＝15.500、P<0.001，χ²＝11.114、P＝0.001，χ²＝16.908、P<0.001)。 结论情景式营养教育的婴儿食物转换指导新模式，可提高婴儿监护人的营养知识水平，改善婴儿喂养状况。     

Maternal and procedural factors associated with estimated blood loss in second trimester surgical uterine evacuation: a retrospective cohort analysis

BackgroundPrior studies examining bleeding with uterine evacuation have focused on high-volume centers performing over 1100 procedures annually. The aim of this study was to examine associations between blood loss and patient and procedural characteristics in a center performing fewer than 50 procedures annually.MethodsThis retrospective cohort study, with institutional review board approval, utilized procedural codes to identify patients undergoing uterine evacuation procedures between 14 weeks’ and 24 weeks’ gestational age across a 50-month period. The primary outcome was estimated blood loss; secondary outcomes were hemorrhage, transfusion and hospital re-admission. Associations between blood loss and other variables were examined using linear regression models.ResultsCharts of 161 women met inclusion criteria. Median estimated blood loss was 400 mL (IQR 300 mL) with 37% of patients having blood loss of ≥500 mL. In univariate analyses, increased blood loss was associated with later gestational age (P <0.001) and pregnancy termination (P <0.001). In a multiple linear regression model, both remained significant. Each one-week increase in gestational age was associated with a 7.1% mean increase in estimated blood loss (95% CI 2.47% to 11.9%; P=0.003). Patients whose uterine evacuation was indicated for pregnancy termination had an 80.6% increase in blood loss compared with those with pre-operative fetal demise (95% CI 37.5% to 137.2%; P <0.001). Rates of peri-operative transfusion and re-admission for bleeding were <4%.ConclusionWhile blood loss may be greater in low volume centers, our transfusion and re-admission rates were low following second trimester uterine evacuation.     

Toxic tau: structural origins of tau aggregation in Alzheimer's disease

Alzheimer’s disease is characterized by the extracellular accumulation of the amyloidβin the form of amyloid plaques and the intracellular deposition of the microtubule-associated protein tau in the form of neurofibrillary tangles.Most of the Alzheimer’s drugs targeting amyloidβhave been failed in clinical trials.Particularly,tau pathology connects greatly in the pathogenesis of Alzheimer’s disease.Tau protein enhances the stabilization of microtubules that leads to the appropriate function of the neuron.Changes in the quantity or the conformation of tau protein could affect its function as a microtubules stabilizer and some of the processes wherein it is involved.The molecular mechanisms leading to the accumulation of tau are principally signified by numerous posttranslational modifications that change its conformation and structural state.Therefore,aberrant phosphorylation,as well as truncation of tau protein,has come into focus as significant mechanisms that make tau protein in a pathological entity.Furthermore,the shape-shifting nature of tau advocates to comprehend the progression of Alzheimer’s disease precisely.In this review,we emphasize the recent studies about the toxic and shape-shifting nature of tau in the pathogenesis of Alzheimer’s disease.     

Twelve years after abortion decriminalization in Mexico City: Can we still remain an island of liberties?

Latin America hosts the most restrictive abortion legislation globally. In 2007, Mexico, the second largest Catholic country in the world, decriminalized elective abortion within the first twelve weeks of pregnancy in the capital: Mexico City (also known as Federal District of Mexico). Following the reform, the Mexico City Ministry of Health (MX-MOH) implemented safe and legal services. Free services are provided to Mexico City residents and a sliding fee of up to $100 is applied to women from other Mexican states. Conscientious objection (CO) was addressed and included in service provision guidelines. Since 2007, 18 of 32 states amended their penal codes to restrict abortion. The road toward increasing access to abortion services at the MX-MOH included a shift from dilation and curettage (D&C) to medical abortion (MA), first with the misoprostol-alone regimen, followed by the combined mifepristone-misoprostol regimen. Manual vacuum aspiration is offered to out-of-state-women or to those beyond the gestational age where MA is less effective. Contraceptive uptake among abortion seekers is high (up to 95% of them prefer a free method of their choice). The Legal Interruption of Pregnancy program at the MX-MOH continues to provide effective, safe, reliable, and free services. However, women from indigenous groups residing in rural areas, those with low schooling, and adolescents with an unintended pregnancy who live in rural, urban, peri-urban districts, and at the state level are underserved despite being legally eligible to receive abortion services. Therefore, information and services for the disadvantaged groups need to be strengthened.     

冻融胚胎移植周期的黄体支持方案

恰当的黄体支持方案有利于子宫内容受性的建立和胚胎早期发育，是决定冻融胚胎移植（FET）妊娠成功的关键因素。FET常用的内膜准备方案包括自然周期、激素替代周期及卵巢温和刺激周期。激素替代周期常规进行黄体支持目前已无异议，但自然周期及温和刺激周期是否需要进行黄体支持尚存争议。对于黄体支持的药物选择、开始及持续时间目前仍缺乏统一标准。文章将围绕近年来FET不同内膜准备方案的黄体支持进行综述，希望可以为临床FET时黄体支持方案的制定和选择提供参考。