Randomized evaluation of a web-based tool for designing function-based behavioral intervention plans

Challenging behaviors are prevalent in children with autism and can have a negative impact on a variety of child outcomes. The creation of good-quality behavior intervention plans is critical to decreasing challenging behaviors but little previous research has developed or evaluated practical tools for designing intervention plans. This study consisted of a randomized evaluation of a web-based tool designed to aid clinicians in choosing treatment procedures for inclusion in behavior intervention plans. The effects of the tool were assessed on the inclusion of three types of intervention components that likely contribute to the quality of intervention plans: (1) function-based intervention components, (2) evidence-based intervention components, and (3) non-punishment-based intervention components. Use of the web-based behavior intervention plan builder produced a statistically significant increase in the inclusion of function-based intervention components but no statistically significant effect was observed on the other two measures. Results are discussed in terms of the implications for improving the quality of behavior intervention plans, as well as the dissemination of knowledge of best practices in behavioral intervention.     

河北省4个地区广泛焦虑症的流行病学调查

目的:了解广泛焦虑症的患病率及人口学特点。方法:于2004-10/2005-03随机抽取河北省邯郸、保定、秦皇岛、承德4个地级市18岁以上人口进行全省精神疾病流行病学现场抽样调查工作,总样本24000人。调查筛选工具采用改编后的一般健康问卷12项,以《DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查》病人版为调查的诊断工具。根据被调查者一般健康问卷12项总分,把被调查者分为高危人群、中危人群、低危人群3类。根据预试验调查结果确定三段危险人群的分界分:总分≥4分属于高危人群,高危人群全部进行DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查;总分为2分或3分即属中危人群,中危人群约40%需进行DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查,总分为0分或1分即属低危人群,低危人群中10%需进行DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查。改编后的一般健康问卷12项分数及内容不变,另外增加8个问题均为高危因素,并进行DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查。结果:①实际完成调查20716人,其中男10343人(49.9%),女10373人(50.1%)。共诊断焦虑症患者127例。②按高中低危因素调整后时点患病率为7.69/1000(95%CI6.50/1000～8.88/1000)。城市患病率4.87/1000,农村患病率8.10/1000,两者差异无显著性意义(u=1.78,P>0.05)。女性患病率明显高于男性,差异有显著性意义(分别为10.42/1000,4.97/1000,u=4.49,P<0.01),男女患病率比例为1:2.10。按不同年龄阶段的人口计算出各年龄段的时点患病率,20～29岁患病率较低(3.17/1000),50～59岁患病率较高(15.56/1000)。③通过12个因素的Logistic回归分析发现,影响广泛焦虑症的危险因素有年龄50～59岁(OR=1.713);保护性因素男性(OR=0.431),年龄20～29岁(OR=0.393),收入10001～20000元(OR=0.568),收入20001～40000元(OR=0.117)。结论:广泛焦虑症的流行病学特征为女性、中老年人患病率较高,男性、青年、收入中等者患病率较低。     

纳米羟基磷灰石/硫酸庆大霉素缓释系统的制备及体内释放实验

目的:制备纳米羟基磷灰石/硫酸庆大霉素缓释系统(drug delivery system,DDS),观察其体内释药特性,为慢性骨髓炎的治疗寻找更好的方法。方法:实验于2004-05/2005-03在南方医科大学珠江医院中心实验室和华南理工大学生物工程与材料学院实验室完成。实验材料:纳米羟基磷灰石(nano-hydroxypatite,nano-HA)、聚羟基丁酸酯-羟基戊酸酯共聚物[poly(3-hydroxybutyrate-hydroxyvalerate),PHBV]、聚乙二醇(polyethylene glycol,PEG)、硫酸庆大霉素(gentamicin,GM)。新西兰大白兔24只。实验方法:①nano-HA/PHBV-PEG-GM-DDS的制备:以nano-HA为载药核心,外包裹生物相容性好且降解可调控的PHBV、PEG,承载GM制成。②采用SPSS10.0统计软件包绘制庆大霉素浓度与抑菌环直径的半对数标准曲线。③体内释放实验:在新西兰大白兔左股骨外上髁钻孔,刮除部分骨质和骨髓,将nano-HA-PHBV/PEG-GM微球自骨窗内植入,分别于术后1,3,5,7,10,14,21,28d8个时间点各选3只大白兔,麻醉后取干骺端松质骨及骨干皮质骨标本。用标准曲线计算出各标本药物浓度,用SPSS10.0统计软件包绘制nano-HA/PHBV-PEG-GM-DDS的释药浓度与时间关系曲线。实验评估:①扫描电镜下观察nano-HA/PHBV-PEG-GM-DDS的微球形态。②nano-HA/PHBV-PEG-GM-DDS的释药浓度与时间的关系。结果:纳入兔24只,均进入结果分析。①nano-HA/PHBV-PEG-GM-DDS微球形态:大小均匀规整,微球平均粒径为345μm,小微球粒径为78μm,微球表面形态一致,为多孔皱缩结构。②nano-HA/PHBV-PEG-GM-DDS释药浓度与时间的关系:术后第1天nano-HA/PHBV-PEG-GM-DDS周围皮质骨和松质骨中庆大霉素质量浓度分别为(110.10±11.70),(97.30±9.60)mg/L,其后逐渐下降,至术后第28天时皮质骨和松质骨中庆大霉素质量浓度仍可分别达(7.30±1.40),(6.80±1.10)mg/L,局部骨组织中庆大霉素质量浓度仍在金黄色葡萄球菌最小抑菌浓度(2mg/L)以上。结论:nano-HA/PHBV-PEG-GM-DDS具有较好的体内缓释作用。     

RN staffing time and outcomes of long-stay nursing home residents: pressure ulcers and other adverse outcomes are less likely as RNs spend more time on direct patient care

OBJECTIVE: A clear link has been demonstrated between lower nurse staffing levels in hospitals and adverse patient outcomes, but the results of studies of such relationships in long-term care facilities haven't been as clear. This study explored the time nurses spent in direct care and how it affected outcomes in long-stay (two weeks or longer) nursing home residents. METHODS: In a retrospective study of data collected as part of the National Pressure Ulcer Long-Term Study (NPULS), we analyzed data on 1,376 residents of 82 long-term care facilities whose lengths of stay were 14 days or longer, who were at risk of developing pressure ulcers but had none at study entry, and who had a Braden Scale score of 17 or less. Primary data came from residents' medical records during 12-week periods in 1996 and 1997. Dependent variables included development of pressure ulcer or urinary tract infection (UTI), weight loss, deterioration in the ability to perform activities of daily living (ADLs), and hospitalization. Independent variables included resident demographics, severity of illness, nutritional and incontinence interventions, medications, and nurse staffing time. RESULTS: More RN direct care time per resident per day (examined in 10-minute increments up to 30 to 40 minutes per resident per day) was associated with fewer pressure ulcers, hospitalizations, and UTIs; less weight loss, catheterization, and deterioration in the ability to perform ADLs; and greater use of oral standard medical nutritional supplements. More certified nursing assistant and licensed practical nurse time was associated with fewer pressure ulcers but did not improve other outcomes. CONCLUSIONS: The researchers controlled for important variables in long-stay nursing home residents at risk for pressure ulcers and found that more RN direct care time per resident per day was strongly associated with better outcomes. There's an urgent need for further research to confirm these findings and, if confirmed, for improving RN staffing in nursing homes to decrease avoidable adverse outcomes and suffering.     

Bacteria are different: observations, interpretations, speculations, and opinions about the mechanisms of adaptive evolution in prokaryotes

To some extent, the genetic theory of adaptive evolution in bacteria is a simple extension of that developed for sexually reproducing eukaryotes. In other, fundamental ways, the process of adaptive evolution in bacteria is quantitatively and qualitatively different from that of organisms for which recombination is an integral part of the reproduction process. In this speculative and opinionated discussion, we explore these differences. In particular, we consider (i) how, as a consequence of the low rates of recombination, "ordinary" chromosomal gene evolution in bacteria is different from that in organisms where recombination is frequent and (ii) the fundamental role of the horizontal transmission of genes and accessory genetic elements as sources of variation in bacteria. We conclude with speculations about the evolution of accessory elements and their role in the adaptive evolution of bacteria.     

Multisecond oscillations in firing rate in the globus pallidus: synergistic modulation by D1 and D2 dopamine receptors.

The firing rates of many basal ganglia neurons recorded in awake rats oscillate at seconds-to-minutes time scales, and the D1/D2 agonist apomorphine has been shown to robustly modulate these oscillations. The use of selective D1 and D2 antagonists suggested that both these receptor subfamilies are involved in apomorphine's effects. In the present study, spectral analysis revealed that baseline multisecond oscillations were significantly periodic in 71% of globus pallidus neurons. Baseline oscillations had a wide range of periods within the analyzed range, with a population mean of 32 +/- 2 s. Administration of the D1 agonist SKF 81297 (6-chloroPB) at 1.0 or 5.0 mg/kg significantly changed these oscillations, reducing means of spectral peak periods to 14 to 16 s (i.e., increasing oscillatory frequency). This effect was attenuated by D2 antagonist pretreatment. The D2 agonist quinpirole did not cause a significant population change in multisecond periodicities. The strongest effects on multisecond periodicities occurred after combined treatment with SKF 81297 and quinpirole. Low, ineffective doses of SKF 81297 and quinpirole, when combined, produced a significant increase in oscillatory frequency. Also, when quinpirole was administered after an already effective dose of SKF 81297, quinpirole shifted oscillations to an even faster range (typically to periods of <10 s). The dopaminergic control of multisecond periodicities in globus pallidus firing rate demonstrates D1/D2 receptor synergism, in that the effects of D1 agonists are potentiated by and partially dependent on D2 receptor activity. Modulation of multisecond oscillations in firing rate represents a novel means by which dopamine can influence globus pallidus physiology.     

A dancer with rheumatoid arthritis: a role for biologics

A case study is presented in which a student dancer who developed rheumatoid arthritis during her degree course was able to complete her course with meticulous treatment including the use of biologics. She describes her own reactions to the disease occurring at this crucial phase in her career.