Women's journey to safety – The Transtheoretical model in clinical practice when working with women experiencing Intimate Partner Violence: A scientific review and clinical guidance

ObjectiveReview the applicability of the Transtheoretical model and provide updated guidance for clinicians working with women experiencing intimate partner violence.MethodsCritical review of related primary research conducted from 1990 to March 2013.ResultsWomen's experiences of creating change within abusive relationships can be located within a stages of change continuum by identifying dominant behavioral clusters. The processes of change and constructs of decisional-balance and turning-points are evident in women's decision-making when they engage in change.ConclusionClinicians can use the stages of change to provide a means of assessing women's movement toward their nominated outcomes, and the processes of change, decisional-balance and turning-points, to enhance understanding of, and promote women's movement across stages in their journey to safety.Practice implicationsClinicians should assess women individually for immediate and ongoing safety and well-being, and identify their overarching stage of change. Clinicians can support women in identifying and implementing their personal objectives to enhance self-efficacy and create positive change movement across stages.The three primary objectives identified for clinician support are: 1. Minimizing harm and promoting well-being within an abusive relationship, 2. Achieving safety and well-being within the relationship; halting the abuse, or 3. Achieving safety by ending/leaving intimate relationships.     

Leishmania donovani eukaryotic initiation factor 5A: Molecular characterization,localization and homology modelling studies

Eukaryotic translation initiation factor 5A (eIF5A) is a small acidic protein highly conserved from archaea to mammals. eIF5A is the only protein which undergoes a unique lysine residue modification to hypusine. Hypusinylation is important for the function of eIF5A which is reported to be essential for cell viability. eIF5A promotes formation of the first peptide bond at the onset of protein synthesis. However, its function in Leishmania donovani is unclear. The present study focuses on the characterization and localization of L. donovani eIF5A protein. The eIF5A gene contains an ORF of 501×bp encoding 166 amino acid residues with a predicted molecular mass and isoelectric point of 17.8 kDa and 4.83 respectively. A phylogenetic tree analysis revealed its close proximity to trypanosomes however it is distantly located from Trichomonas vaginalis and Plasmodium falciparum. The L. donovani eIF5A was expressed as a 6× His tagged protein whose identity was confirmed by western blot and MALDI. Biophysical investigation by CD revealed the predominant presence of 49% β sheet structure which correlated well with secondary structure prediction. To gain insight into the role of eIF5A in L. donovani, we investigated the subcellular distribution of eIF5A. A GFP-fusion of L. donovani eIF5A was found to be localized in cytoplasm as confirmed by subcellular fractionation. Our studies indicated that eIF5A is primarily localized to cytoplasm and is undetectable in nuclear fraction. The homology model of eIF5A of L. donovani was built and the resulting model showed acceptable Ramachandran statistics. The model is reliable and can be used to study eIF5A binding with its effector molecules.     

Evaluation of an intragastric challenge model for Shigella dysenteriae 1 in rhesus monkeys (Macaca mulatta) for the pre‐clinical assessment of Shigella vaccine formulations

Shigellosis is a worldwide disease, characterized by abdominal pain, fever, vomiting, and the passage of blood‐ and mucus‐streaked stools. Rhesus monkeys and other primates are the only animals that are naturally susceptible to shigellosis. A suitable animal model is required for the pre‐clinical evaluation of vaccines candidates. In this study, the minimal dose of Shigella dysenteriae1 1617 strain required to produce dysentery in four of five (80% attack rate) monkeys using an escalating dose range for three groups [2 × 10⁸, 2 × 10⁹ and 2 × 10¹⁰ colony forming unit (CFU)] was determined. In addition, the monkeys were re‐infected. The identified optimal challenge dose was 2 × 10⁹ CFU; this dose elicited 60% protection in monkeys when they were re‐challenged with a one log higher dose (2 × 10¹⁰ CFU). The challenge dose, 2 × 10¹⁰ CFU, produced severe dysentery in all monkeys, with one monkey dying within 24 h, elicited 100% protection when re‐challenged with the same dose. All monkeys exhibited immune responses. This study concludes that the rhesus monkey model closely mimics the disease and immune response seen in humans and is a suitable animal model for the pre‐clinical evaluation of Shigella vaccine candidates. Prior infection with the 1617 strain can protect monkeys against subsequent re‐challenges with homologous strains.     

NEC诱导的SIRS模型大鼠肠道中组织因子mRNA表达水平的变化

目的研究SIRS模型肠组织中TFmRNA的表达,探讨TF在SIRS发生中的作用。方法40只新生Wistar大鼠,出生36h～48h,随机分成正常对照组（A组）10只及模型组（B组）30只。48小时后处死动物,根据血液白细胞总数及呼吸改变确定为SIRS。将B组分为未发生SIRS组（B1组）和发生SIRS组（B2组）。实时荧光定量聚合酶链反应（QRT—PCR）检测肠组织TFmRNA的表达。结果肠组织Ⅱ1瑚RNA表达水平（2-△△Ct值）：A组1．01±0．04,B1组2．14±0．19,B2组3．78±1．2,三组间比较差异有显著性（P〈0．05）。结论从转录水平证实,SIRS新生大鼠模型中,TF水平增加．提示TF参与炎症反应。     

Predicting dyslipidemia after liver transplantation:A significant role of recipient metabolic inflammation profile

BACKGROUND Post-transplant dyslipidemia(PTDL) is a common complication in liver recipients and can cause morbidity and threaten graft function. The crosstalk between metabolic inflammation and dyslipidemia has been recently revealed. However,the role of grafts' and recipients' metabolic status in the development of PTDL has not been evaluated.AIM To investigate the association of recipients' metabolic inflammation status with PTDL and construct a predictive model.METHODS A total of 396 adult patients who received primary liver transplantation between2015 and 2017 were enrolled. Metabolomics and cytokines were analyzed using recipients' pre-transplant peripheral blood in a training set(n = 72). An integrated prediction model was established according to the clinical risk factors and metabolic inflammation compounds and further verified in a validation set(n = 144).RESULTS The serum lipid profile took 3 mo to reach homeostasis after liver transplantation.A total of 278(70.2%) liver recipients developed PTDL during a follow-up period of 1.78(1.00, 2.97) years. The PTDL group showed a significantly lower tumorfree survival and overall survival than the non-PTDL group in patients with hepatocellular carcinoma(n = 169). The metabolomic analysis showed that metabolic features discriminating between the PTDL and non-PTDL groups were associated with lipid and glucose metabolism-associated pathways. Among metabolites and cytokines differentially expressed between the two groups,interleukin-12(p70) showed the best diagnostic accuracy and significantly increased the predictive value when it was incorporated into the clinical model in both training and validation sets.CONCLUSION Recipients' pre-transplant serum interleukin-12(p70) level is associated with the risk of PTDL and has potential clinical value for predicting PTDL.     

公立医院PF医师费的年资积分模型设计

年资积分是PF医师费制度中体现医疗团队合作、实践经验传承的重要部分。作者以清华大学附属北京清华长庚医院为样本,以医师职业进阶路径为基础,结合培养年限,架构出公立医院年资积分设计的基本模型。该模型既体现尊师重教的基本职业伦理,又激励年轻医师追求卓越。     

Two Evidence-Based Acupuncture Models

Modern clinical trials have produced controversial data interpretation which refutes conventional standard teachings and practices. Acupuncture scholars and practitioners have been stimulated to scrutinize these trials and analyze conventional practices. This paper presents two acupuncture models which address these issues. One rationalizes the clinical trial results with newer understanding of acupuncture points and techniques, while the other reconciles these results with rediscovered techniques of palpating points and performing needling. These two models indicate that acupuncture is in transition from classical model to evidence-based models.