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101.
Built environments in rural settings may provide greater challenges than those in urban settings due to physical characteristics inherent to low-density population areas. Multiuse recreational trails, such as those that repurpose abandoned railroad lines, may provide a physical activity resource that is well suited to rural areas. However, the direct impact of trail availability on physical activity behavior is not generally known because it is unclear whether activity reported in most trail research represents increases in physical activity or displacement of activity in individuals who previously exercised in other locations. This research, initiated by a group of students in a graduate seminar, represents to our knowledge, the first instance in which PA was assessed prior to the availability of an entirely new rails-to-trails facility. The research was implemented using a nonequivalent dependent variable design to counter the lack of a control group; the nonequivalent dependent variable chosen was weekly servings of fruit and vegetables. Participants responding to intercept interviews classified days of activity during the prior week as mild, moderate or vigorous. Baseline results for 244 participants suggested generally low levels of activity prior to trail availability; number of reported days of activity decreased with described intensity. We also discuss several issues encountered in planning and implementing this group project including those related to data collection, variable levels of commitment among student members, and inconsistent project management, and offer potential solutions to these concerns.  相似文献   
102.
Facial fillers play an important role in the correction of facial changes associated with ageing. They offer quick treatments in the outpatient setting with minimal subsequent downtime that provide predictable, natural‐looking, long‐lasting results. Adverse reactions after hyaluronic acid injections tend to be mild or moderate and rather temporary. However, as with all injected or implanted biomaterials, severe adverse events can occur and patients must be fully informed of potential risks prior to undergoing treatment. A panel of experts from Germany (D), Austria (A) and Switzerland (CH) developed recommendations, and this study provides the ‘DACH Consensus Recommendations’ from this group specifically on the use of hyaluronic acid fillers. The aim is to help clinicians recognize potential risks and to provide guidance on how best to treat adverse events if they arise. Contraindications to hyaluronic acid fillers are also detailed, and ways to prevent adverse events occurring are discussed. Hyaluronic acid‐based products are claimed to be very close to an ideal tissue augmentation agent; nevertheless, profound medical, anatomical and product knowledge are of paramount importance to minimize the occurrence of adverse reactions.  相似文献   
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Shortly after the death of Albert von Schrenck-Notzing (1862–1929), the doyen of early twentieth century German para psychology, his former colleague in hypnotism and sexology Albert Moll (1862–1939) published a treatise on the psychology and pathology of parapsychologists, with Schrenck-Notzing serving as a prototype of a scientist suffering from an ‘occult complex’. Moll’s analysis concluded that parapsychologists vouching for the reality of supernormal phenomena, such as telepathy, clairvoyance, telekinesis and materialisations, suffered from a morbid will to believe, which paralysed their critical faculties and made them cover obvious mediumistic fraud. Using Moll’s treatment of Schrenck-Notzing as an historical case study of boundary disputes in science and medicine, this essay traces the career of Schrenck-Notzing as a researcher in hypnotism, sexology and parapsychology; discusses the relationship between Moll and Schrenck-Notzing; and problematises the pathologisation and defamation strategies of deviant epistemologies by authors such as Moll.  相似文献   
106.

Objectives

Although hospital clinicians strive to effectively refer patients who require post-acute care (PAC), their discharge planning processes often vary greatly, and typically are not evidence-based.

Design

Quasi-experimental study employing pre-/postdesign. Aimed at improving patient-centered discharge processes, we examined the effects of the Discharge Referral Expert System for Care Transitions (DIRECT) algorithm that provides clinical decision support (CDS) regarding which patients to refer to PAC and to what level of care (home care or facility).

Setting and participants

Conducted in 2 hospitals, DIRECT data elements were collected in the pre-period (control) but discharging clinicians were blinded to the advice and provided usual discharge care. During the postperiod (intervention), referral advice was provided within 24 hours of admission to clinicians, and updated twice daily. Propensity modeling was used to account for differences between the pre-/post patient cohorts.

Measures

Outcomes compared between the control and the intervention periods included PAC referral rates, patient characteristics, and same-, 7-, 14-, and 30-day readmissions or emergency department visits.

Results

Although 24%–25% more patients were recommended for PAC referral by DIRECT algorithm advice, the proportion of patients receiving referrals for PAC did not significantly differ between the control (3302) and intervention (5006) periods. However, the characteristics of patients referred for PAC services differed significantly and inpatient readmission rates decreased significantly across all time intervals when clinicians had DIRECT CDS compared with without. There were no differences observed in return emergency department visits. Largest effects were observed when clinicians agreed with the algorithm to refer (yes/yes).

Conclusions/Implications

Our findings suggest the value of timely, automated, discharge CDS for clinicians to optimize PAC referral for those most likely to benefit. Although overall referral rates did not change with CDS, the algorithm may have identified those patients most in need, resulting in significantly lower inpatient readmission rates.  相似文献   
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This article summarizes essential implications of the papers within this special issue and discusses directions for future prevention and intervention research on conceptual issues, methodological and transfer-related challenges and opportunities. We identify a need to move from programs to principles in intervention research and encourage the implementation of research on potential mechanisms underlying intervention effectiveness. In addition, current methodological issues in intervention research are highlighted, including advancements in methodology and statistical procedures, extended outcome assessments, replication studies, and a thorough examination of potential biases. We further discuss transfer-related issues, for example the need for more research on the flexibility and adaptability of programs and intervention approaches as well as more general problems in knowledge translation reasoning the need for enhanced communication between practitioners, policy makers, and researchers. Finally, we briefly touch on the need to discuss the relation between single intervention programs, the mental health system, and changes of contextual conditions at the macro level.  相似文献   
109.
School suspension is associated with school dropout, crime, delinquency, and alcohol and other drug use for the suspended student. Important research questions are how academic and related factors are relevant to the school suspension process and the generality of the process in different sites. State‐representative samples of Grade 7 students (N = 1,945) in Washington State, United States and Victoria, Australia were followed from 2002 to 2004. In both states, Grade 7 school suspension was associated with higher rates of nonviolent antisocial behavior and suspension 24 months later, before Grade 8 factors were entered into the model. Relevant factors were Grade 8 low school grades and association with antisocial peers, as well as Grade 8 antisocial behavior in Washington State only. The implications of these findings for the ways in which suspension is used in schools are outlined.  相似文献   
110.
IntroductionPsychopathological origins of personally distressing, hypoactive sexual desire disorder (HSDD) in women are unknown, but are generally attributed to an inhibitory neural regulator, serotonin (5‐HT). Flibanserin, a 5‐HT1A agonist and 5‐HT2A antagonist, shows promise as a treatment for HSDD.AimTo test the hypothesis that female marmoset sexual behavior is enhanced by flibanserin and diminished by 8‐OH‐DPAT, in order to evaluate the efficacy of serotonergic modulation of female sexual behavior in a pairmate social setting comparable to humans.MethodsSexual and social behavior were examined in eight female marmoset monkeys receiving daily flibanserin (15 mg/kg), 8‐OH‐DPAT (0.1 mg/kg), or corresponding vehicle for 15–16 weeks in a counterbalanced, within‐subject design, while housed in long‐term, stable male–female pairs.Main Outcome MeasuresMarmoset pairmate interactions, including sexual and social behavior, were scored during weeks 5–6 of daily flibanserin, 8‐OH‐DPAT or vehicle treatment. 24‐hour pharmacokinetic profiles of the drugs and their metabolites, as well as drug‐induced acute symptoms of the 5‐HT behavioral syndrome were also assessed.ResultsTwo‐way analysis of variance reveals that flibanserin‐treated females attract more male sexual interest (P = 0.020) and trigger increased grooming (P = 0.001) between partners. In contrast, 8‐OH‐DPAT‐treated females show increased rejection of male sexual advances (P = 0.024), a tendency for decreased male sexual interest (P = 0.080), and increased aggression with their male pairmates (P = 0.049).ConclusionsWhile 8‐OH‐DPAT‐treated female marmosets display decreased sexual receptivity and increased aggressive interactions with their male pairmates, flibanserin‐treated female marmosets demonstrate increased affiliative behavior with their male pairmates. Such pro‐affiliation attributes may underlie flibanserin's effectiveness in treating HSDD in women. Aubert Y, Gustison ML, Gardner LA, Bohl MA, Lange JR, Allers KA, Sommer B, Datson NA, and Abbott DH. Flibanserin and 8‐OH‐DPAT implicate serotonin in association between female marmoset monkey sexual behavior and changes in pair‐bond quality. J Sex Med 2012;9:694–707.  相似文献   
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