Heart health inequalities in Canada: modules, theory and planning

It is well known that prevalence and incidence rates of cardiovasculardisease (CVD) and CVD risk factors are not equally distributedamong socioeconomic groups. Known risk factors account for part,but not all of unequally distributed CVD rates. Socioeconomicconditions and psychosocial dynamics may explain another pareof the increased CVD rates. Theoretically, it may be possibleto lower CVD rates and CVD risk factor prevalence among lowersocioeconomic status (SES) groups by using a community development(socio-environment) strategy directed towards changes in socioenvrronmentalrisk conditions and psychosocial risk factors, rather than CVDrisk factors per Se. This article describes a protocol for sucha strategy based upon the planning work of Canadian health professionals,loosely organized under a project titled ‘Heart HealthInequalities in Canada’ This protocol incorporates baselinedata on CVD and CVD risk factor prevalence, but is premisedon actions negotiated between community organizations and healthauthorities, rather than defined unilaterally by health authorities.As such, program design activities and evaluation will differfrom a more general population-based risk factor reduction strategy.     

运用现代教育理论思想 提高医学课堂教学质量

本文依据三种现代教育理论思想的有益启示,围绕医学高等专科学校课堂教学质量的提升问题,提出以加强教育理论思想研修为突破口,进而采取更新教育观念、狠抓移植应用和改进教法学法来有效提高医学高等专科学校课堂教学质量的新思路。     

Adaptive group sequential design for phase II clinical trials: A Bayesian decision theoretic approach

Bayesian decision theoretic approaches (BDTAs) have been widely studied in the literature as tools for designing and conducting phase II clinical trials. However, full Bayesian approaches that consider multiple endpoints are lacking. Since the monitoring of toxicity is a major goal of phase II trials, we propose an adaptive group sequential design using a BDTA, which characterizes efficacy and toxicity as correlated bivariate binary endpoints. We allow trade‐off between the two endpoints. Interim evaluations are conducted group sequentially, but the number of interim looks and the size of each group are chosen adaptively based on current observations. We utilize a loss function consisting of two components: the loss associated with accruing, treating, and monitoring patients, and the loss associated with making incorrect decisions. The performance of our Bayesian modeling, and the operating characteristics of decision rules under a wide range of loss function parameters are evaluated using seven scenarios in a simulation study. Our method is illustrated in the context of a single‐arm phase II trial of bevacizumab, gemcitabine, and oxaliplatin in patients with metastatic pancreatic adenocarcinoma. Copyright © 2009 John Wiley & Sons, Ltd.     

后现代心理学概观

后现代心理学家反对以往的心理学理论和流派把心理或行为看作是一个独立于研究者的“实体”。后现代心理学的典型特征是反对基础主义和本质主义。它认为心理现象并不是一种“精神实在” ,而是一种文化的社会建构。后现代心理学的理论基础是社会建构论 ,多元文化论、后现代女性心理学都是后现代心理学的重要形式。     

建立具有中国特色的临床医学工程体系势在必行

我们提出了一个建立具有中国特色的临床医学工程体系新理念，并且提出了一些具体建设性的意见。它涉及到政府行政管理、医学院校教育、医院科室人员配置以及传统观念的管理模式等，由于理念新、涉及面广，会有许多问题，仅供各界人士共同去探讨。     

Caring and cancer nursing: framing the reality using selected social science theory

Caring and cancer nursing: framing the reality using selected social science theory Despite the recent interest in caring for both academic and clinical nursing, the theoretical basis of this concept may appear somewhat elusive as the research and debate vary widely in their focus. As a result, the available literature may fail to consider the specific contextual issues which characterize caring as it is understood across different health care settings. Consideration of theory from disciplines close to nursing, it is suggested, may be useful in understanding the nature of such 'real world' caring. In this discussion the concept of caring within cancer nursing is explored by drawing on a number of social science and nursing sources. It is known that cancer provokes unique caring demands for nurses practising in this area. By examining the context of cancer, it is argued that effective caring deserves to be recognized as an important clinical variable which can influence a diverse range of issues such as patient satisfaction or therapeutic outcome. It is suggested that other nursing specialisms should also explore the psychosocial dimensions of caring in relation to their own role.     

劳动姿势对流量－容积曲线的影响─—波速学说的进一步验证

用“点值法”对健康工人４７３例［轻体力劳动工人（简称轻工）２４８例，重体力劳动工人（简称重工）２２５例］。作了流量一容积曲线和常规通气功能检查。结果表明：重工男女在４０岁以后其高肺容积流量下降，３０岁以后低肺容积流量上升，而且这些改变有随年龄增长而更加明显的倾向；轻工仅有个别年龄组的低肺容积流量上升。对７名健康坐位工作者模拟劳动的前倾姿势作多次通气功能检查，亦有明显高肺容积流量下降和低肺容积流量上升的现象，这一事实提示波速学说亦可应用于颈和躯干前倾进行重体力劳动工人的通气行为。     

An Electron Microscopic Study on the Process of Acid Demineralization of Cortical Bone

Demineralization has been shown to foster osteoinductive properties of cortical bone grafts, yet little is known about the process of demineralization and how to control it. The purpose of this study was to investigate the process of cortical bone demineralization by using scanning electron microscopy to evaluate how hydrochloric acid demineralizes cortical bone. Results showed that in the demineralization of diaphyseal cortical bone specimens using hydrochloric acid, a uniformly thick circumferential band of demineralized bone matrix surrounds an inner undecalcified bone core as the process of demineralization occurs. The interface between the demineralized and mineralized section of the bone specimens was extremely sharp. This interface between demineralized and undemineralized bone was noted to advance as a reaction front with increasing demineralization which resulted in continuous shrinkage of the inner cortical bone core. This study suggests that cortical bone demineralization can be best described using an advancing reaction front theory, and this explanation can be used for implementation of the concept of controlled demineralization. Received: 19 December 1996 / Accepted: 25 April 1997     

厄尔·迈纳的跨文化阐释

厄尔·迈纳的《比较诗学》从跨文化的角度对诗学作比较探讨 ,他以基础文类形成原创诗学为理论基础 ,以基础文类的分析作为跨文化阐释的切入点 ,以基础文类同异关系的把握作为诗学比较的可比性的基础 ,以一种宽容平等的对话精神作为跨文化阐释的态度 ,显示了比较诗学发展的一个必然的成熟过程。但科学的相对主义态度 ,注定了从事比较诗学面临着“诗学”“跨文化”“阐释”等因素的制约 ,这也同时为比较诗学的开拓提供了更多的空间。     

Building a relationship: communications and relationships between staff and stroke patients on a rehabilitation ward

Communications among staff and patients on a stroke rehabilitation ward form the focus of this article, which reports on some aspects of a larger study using a grounded theory approach. Tape-recorded interviews were transcribed and analysed concurrently according to recommendations for the approach. A main theme entitled building a relationship was identified, and this process was found to occur in a context varying from participative at one end of a continuum to hierarchical at the other. Building a relationship was found to be influenced by role, personal qualities and organizational context. Appropriate relationships between role-holders were subject to negotiation, leading to a resulting congruence or incongruence between participants' expectations of each other and their roles. Personal qualities were brought into play in the process, with patients' views of staff and staff views of patients both being influential. Some of these views seemed to parallel what has been described in earlier literature as ‘the sick role’ and the labelling of patients as ‘good’ or ‘bad’. Responses to personal qualities led to nurses ascribing meaning to patients' behaviour in terms of adjustment to their stroke, giving time to them to help them to adjust, and withdrawal and handing over to other staff if this strategy failed. Organizational context also had an influence on building a relationship, with time constraints being identified particularly by nurses, and the need to fit in the most essential aspects of care. Place was also important, in that nurses were confined to the ward as a work location, whereas other therapists and doctors worked in other places and sometimes had the facility to take patients off the ward to concentrate on therapy. The findings are discussed against the background of related literature and the conclusion is drawn that the crucial role of nurses in rehabilitation is not recognized and valued, and that shortages of resources - especially suitably qualified and trained nursing staff- are a negative influence on building the relationships which are vital to successful rehabilitation.