盆底功能失调型便秘的生物反馈治疗

目的:探讨盆底功能失调型便秘的生物反馈治疗的效果。方法:回顾性分析46例盆底功能失调型便秘行生物反馈治疗患者的资料。结果:44例坚持完成治疗的患者中，35例肛管直肠压力测定示直肠感觉阈值、最大耐受容量、直肠肛门抑制反射较治疗前降低，盆底肌的反常收缩消失，恢复正常排便;6例排便次数，排便不尽感，肛门坠胀感较治疗前有所改善;3例无效。2例终止治疗后失访。总有效率为93.2 %。结论:盆底功能失调型便秘生物反馈治疗近期疗效满意，具有无创、费用低、无需住院等特点。     

Dynamical model of salience gated working memory, action selection and reinforcement based on basal ganglia and dopamine feedback

A simple working memory model based on recurrent network activation is proposed and its application to selection and reinforcement of an action is demonstrated as a solution to the temporal credit assignment problem. Reactivation of recent salient cue states is generated and maintained as a type of salience gated recurrently active working memory, while lower salience distractors are ignored. Cue reactivation during the action selection period allows the cue to select an action while its reactivation at the reward period allows the reinforcement of the action selected by the reactivated state, which is necessarily the action which led to the reward being found. A down-gating of the external input during the reactivation and maintenance prevents interference. A double winner-take-all system which selects only one cue and only one action allows the targeting of the cue–action allocation to be modified. This targeting works both to reinforce a correct cue–action allocation and to punish the allocation when cue–action allocations change. Here we suggest a firing rate neural network implementation of this system based on the basal ganglia anatomy with input from a cortical association layer where reactivations are generated by signals from the thalamus. Striatum medium spiny neurons represent actions. Auto-catalytic feedback from a dopamine reward signal modulates three-way Hebbian long term potentiation and depression at the cortical–striatal synapses which represent the cue–action associations. The model is illustrated by the numerical simulations of a simple example — that of associating a cue signal to a correct action to obtain reward after a delay period, typical of primate cue reward tasks. Through learning, the model shows a transition from an exploratory phase where actions are generated randomly, to a stable directed phase where the animal always chooses the correct action for each experienced state. When cue–action allocations change, we show that this is noticed by the model, the incorrect cue–action allocations are punished and the correct ones discovered.     

Recovery from withdrawal of inhaled nitric oxide and kinetics of nitric oxide-induced inhibition of nitric oxide synthase activity in vitro

Objective: To examine the kinetics of successful nitric oxide (NO) withdrawal in vivo and in vitro.¶Design and setting: Prospective study in a university pediatric intensive care ward and research laboratory.¶Patients and materials: Nineteen patients with acute respiratory distress syndrome (ARDS) or persistent pulmonary hypertension of the newborn (PPHN). Primary porcine pulmonary artery cells in vitro.¶Interventions: NO inhalation and withdrawal in patients; exposure to NO donor sodium nitroprusside (SNP) and gaseous NO in vitro.¶Measurements and results: In patients: a slight, but significant, increase of oxygenation index (OI) from 4.57 ± 0.24 cmH₂O/torr (mean ± SEM) to 4.90 ± 0.26 cmH₂O/torr after withdrawal of NO (p < 0.001). Recovery of OI (4.43 ± 0.23 cmH₂O/torr) 30 min after weaning, a significant drop after 4 h (3.72 ± 0.17 cmH₂O/torr; p < 0.001), values restored after 12 h.¶In vitro: NO synthase (NOS) activity was significantly lower in SNP-incubated cells (20.0 ± 4.0 μm/min) than in control cells (37.6 ± 7.0 μm/min; p < 0.05). Thirty minutes after SNP withdrawal there was NOS activity of 35.8 ± 10.0 μm/min with a significant increase by 4 h (p < 0.05). No alteration of endothelial NOS (ENOS) mRNA expression by NO (Northern Blot).¶Conclusion: In patients there is a slight, but significant, reversible increase of OI after successful weaning from NO. In vitro, NO leads to a reversible decrease of ENOS activity on a post mRNA level, resembling clinical observations.     

Direct Observation of Clinical Skills Feedback Scale: Development and Validity Evidence

Construct: This article describes the development and validity evidence behind a new rating scale to assess feedback quality in the clinical workplace. Background: Competency-based medical education has mandated a shift to learner-centeredness, authentic observation, and frequent formative assessments with a focus on the delivery of effective feedback. Because feedback has been shown to be of variable quality and effectiveness, an assessment of feedback quality in the workplace is important to ensure we are providing trainees with optimal learning opportunities. The purposes of this project were to develop a rating scale for the quality of verbal feedback in the workplace (the Direct Observation of Clinical Skills Feedback Scale [DOCS-FBS]) and to gather validity evidence for its use. Approach: Two panels of experts (local and national) took part in a nominal group technique to identify features of high-quality feedback. Through multiple iterations and review, 9 features were developed into the DOCS-FBS. Four rater types (residents n = 21, medical students n = 8, faculty n = 12, and educators n = 12) used the DOCS-FBS to rate videotaped feedback encounters of variable quality. The psychometric properties of the scale were determined using a generalizability analysis. Participants also completed a survey to gather data on a 5-point Likert scale to inform the ease of use, clarity, knowledge acquisition, and acceptability of the scale. Results: Mean video ratings ranged from 1.38 to 2.96 out of 3 and followed the intended pattern suggesting that the tool allowed raters to distinguish between examples of higher and lower quality feedback. There were no significant differences between rater type (range = 2.36–2.49), suggesting that all groups of raters used the tool in the same way. The generalizability coefficients for the scale ranged from 0.97 to 0.99. Item-total correlations were all above 0.80, suggesting some redundancy in items. Participants found the scale easy to use (M = 4.31/5) and clear (M = 4.23/5), and most would recommend its use (M = 4.15/5). Use of DOCS-FBS was acceptable to both trainees (M = 4.34/5) and supervisors (M = 4.22/5). Conclusions: The DOCS-FBS can reliably differentiate between feedback encounters of higher and lower quality. The scale has been shown to have excellent internal consistency. We foresee the DOCS-FBS being used as a means to provide objective evidence that faculty development efforts aimed at improving feedback skills can yield results through formal assessment of feedback quality.     

母婴同室使用反馈式健康宣教法的临床应用与分析

目的研究分析母婴同室在使用反馈式健康宣教法护理后的临床效果。方法将本院2011年6～12月入院产妇240例,随机分为两组。使用常规方法进行护理的为对照组,使用反馈式健康宣教法进行护理的为观察组。对比两组产妇的身体恢复情况、母乳喂养情况、新生儿及出院后自身护理知识掌握情况。结果观察组产妇对以上知识的应用掌握情况与对照组相比,差异具有统计学意义（P〈0.05）,观察组满意度高于对照组。结论使用反馈式健康宣教法不仅可以大大提高新生儿的优生率,还可以加快产妇的身体恢复速度,在母婴同室产后护理中起着极其重要的作用。     

A sex difference in the response to fasting

We determined whether women and men would alter their pattern of food intake after they had deprived themselves of food. We found that women consumed 12% less food after fasting and that men ate 28% more food after fasting. Serving more food on the test day did not increase food intake of women. Women, who ate at a nearly constant rate (linear eaters), consumed less food than those eating at an initially high speed which decreased over the course of the meal (decelerated eaters). Women decreased their food intake after fasting as their eating pattern became more linear. After fasting, men increased their food intake, and the rate at which they ate became more decelerated. Food intake of both women and men was normalized after fasting by providing feedback that encouraged them to eat according to the pattern they showed in the non-fasted condition. The results support the hypothesis that linear eating, and the dieting that elicits linear eating, are risk factors for the development of the abnormal linear eating pattern that characterizes patients with anorexia nervosa. The data also provide additional support for the use of behavioral feedback to normalize the pattern of eating for individuals who have difficulty maintaining their body weight.     

Woulda, coulda, shoulda: the evaluation and the impact of the alternative outcome

The alternative outcome refers to the outcome of the unselected option in decision-making tasks, which has significant influence on the chosen outcome evaluation. Most paradigms have presented the alternative outcome either after or simultaneous with the chosen outcome, which complicates the observation on the brain activity associated with the alternative outcome. To circumvent this perceived shortcoming, we modified the classic paradigm designed by Yeung and Sanfey (2004) such that the alternative outcome was presented before the chosen outcome in each trial while an electroencephalogram was recorded. The feedback-related negativity (FRN) elicited by the positive alternative outcome was larger than that elicited by the negative alternative outcome, suggesting that the participants evaluated the positive alternative outcome as negative feedback. Moreover, the FRN and the P3 elicited by the chosen outcome were influenced by the valence of the alternative outcome. The current study reveals that the alternative outcome is treated as important information even though it is economically neutral.     

This ought to be good: brain activity accompanying positive and negative expectations and outcomes

The current study employed a modified gambling task, in which probabilistic cues were provided to elicit positive or negative expectations. Event-related potentials (ERPs) to "final outcome" and "probabilistic cues" were analyzed. Difference waves between the negative condition and the corresponding positive condition were examined. The results confirm that feedback related negativity (FRN) amplitude is modulated by the interaction of outcome valence and expectancy by showing larger FRN difference waves for unexpected than expected outcomes. More interestingly, the difference wave between ERPs elicited by positive and negative expectations showed a negative deflection, with a frontal midline source density around 280 ms after onset of the predictive cue. Negative expectations were associated with larger FRN amplitudes than positive expectations. This suggests that FRN is elicited by probabilistic cues to pending outcomes.