Limiting factors to oxygen transport on Mount Everest 30 years after: a critique of Paolo Cerretelli’s contribution to the study of altitude physiology

In 1976, Paolo Cerretelli published an article entitled Limiting factors to oxygen transport on Mount Everest in the Journal of Applied Physiology . The paper demonstrated the role of cardiovascular oxygen transport in limiting maximal oxygen consumption (O_2max). In agreement with the predominant view of O_2max limitation at that time, however, its results were taken to mean that cardiovascular oxygen transport does not limit O_2max at altitude. So it was argued that the limiting factor could be in the periphery, and muscle blood flow was proposed as a possible candidate. Despite this suggestion, the conclusion generated a series of papers on muscle structural characteristics. These experiments demonstrated a loss of muscle oxidative capacity in chronic hypoxia, and thus provided an unambiguous refutation of the then widespread hypothesis that an increased muscle oxidative capacity is needed at altitude to compensate for the lack of oxygen. This analysis is followed by a short account of Cerretellis more recent work, with a special attention to the subject of the so-called lactate paradox.     

10种中药材及饮片亚硫酸盐残留检测结果分析

目的 对市场上抽取的10种中药材及其饮片进行二氧化硫残留量测定,并对结果进行统计分析,提出标准建议和监管建议.方法 采用《中国药典》2010年版第一增补本中二氧化硫残留量测定法,按照《中国药典》2010年版第二增补本中的限量要求对检测结果进行统计分析.结果与结论 共检测10个品种896批中药材及饮片,开展过中药饮片无硫化专项整治工作地区的样品结果满意.建议应加强对二氧化硫残留量限度标准的实施,严格市场监管,加大政策扶持力度,指导规范加工方法的转化,进而保证中药饮片质量安全.     

Are economic recessions at the time of leaving school associated with worse physical functioning in later life?

PurposeTo examine whether economic conditions at the time of leaving school or college are associated with physical functioning in later life among cohorts in 11 European countries.MethodsData came from 10,338 participants in the Survey of Health, Ageing and Retirement in Europe (SHARE) aged 50–74 who left school or college between 1956 and 1986. Data on functional limitations, as well as employment, marriage, and fertility retrospective histories were linked to national unemployment rates during the year individuals left school. Models included country-fixed effects and controls for early-life circumstances.ResultsGreater unemployment rates during the school-leaving year were associated with fewer functional limitations at ages 50–74 among men (rate ratio 0.63, 95% confidence interval 0.47–0.83), but more physical functioning limitations among women (rate ratio 1.30, 95% confidence interval 1.13–1.50), particularly among those with (post-)secondary education. Economic conditions at the age of leaving school were associated with several labor market, marriage, fertility, and health behavior outcomes, but controlling for these factors did not attenuate associations. Results were similar in models that controlled for selection into higher education due to measured covariates.ConclusionsWorse economic conditions during the school-leaving year predicted better health at later life among men but worse health among women. Both selection and causation mechanisms may explain this association.     

那格列奈片的高效液相色谱分析

目的:建立那格列奈片中主药那格列奈及杂质的高效液相色谱测定方法。方法:采用Shim-Pack CLC-ODS(150mm×6.0mm)色谱柱,甲醇-0.02mol.L~(-1)磷酸盐缓冲液(pH6.6)(75:25)作流动相,检测波长210nm,含量测定采用外标法, 杂质检查采用面积归一化法。考察了不同流动相下那格列奈的色谱行为及其与杂质的分离情况。结果:在优化的色谱条件下,片剂辅料不干扰测定,有关杂质与主药那格列奈分离良好,那格列奈线性范围5.1～101.0 mg·L~(-1),最低检测限0.2 mg·L~(-1),含量测定的回收率99.4％～100.4％,RSD<1.7％。结论:此法简便,准确,专属性强,重现性好,可用于那格列奈片的质量控制、稳定性考察和有效期预测。     

Public entrance accessibility: Psychometric approach to the development of a new assessment instrument

BackgroundThe accessibility of public facilities for all is an issue increasingly gaining focus in policy debates, especially regarding the ageing population.ObjectiveThis paper describes a psychometric approach to the development of a new instrument for assessing the accessibility of public entrances.MethodsItems to include were selected by means of literature review and classified according to a typology of person-environment fit that uses the International Classification of Functioning, Disability and Health (ICF) as theoretical framework. Content validity was assessed by a scientific panel approach and construct validity by using simulation techniques and correlation analysis with a related construct. Reliability was evaluated by inter-rater agreement analysis, where 15 strategically selected public entrances were assessed by five rater pairs.ResultsContent validity was assessed as high (3.6 on a scale from 1 to 4) and correlation indicating convergent validity between instrument scores and a related construct was moderate (r_s = 0.60, p < 0.001). Inter-rater reliability was acceptable to good (kappa 0.42, overall agreement 81%). After an iterative process including review of validity and reliability results, the resulting assessment instrument consisted of 56 items in 7 sections.ConclusionsThis study demonstrated good content validity and acceptable to good inter-rater reliability. Though initial results were promising, user involvement and further testing of construct validity is needed. The goal of the new instrument is a feasible tool for planning, evaluation and accomplishment of policies intended to make public entrances accessible for all. The extent to which the instrument succeeds remains to be tested by practical use.     

Cancer Patients' and their Physicians' Perceptions of the Formers' need for Occupational Therapy

To support occupations outside the home for older people with functional limitations it is important to understand how the person, environment, and occupations influence performance. Therefore the purpose of this study was to describe how very old people experience occupational performance outside the home. Twenty-one single-living, very old persons, above 80 years, were strategically selected and interviewed. A phenomenographic approach was used for this study and the interviews were analyzed using contextual analysis. The findings showed a variation in the experience of occupational performance described in three referential aspects: keeping on doing as before, drawing on available resources, and living in constrained circumstances. Referring to everyday occupations the participants described how they continued to do what they had done before, but decline in functional capacity made it more difficult to overcome environmental barriers. They also described how they sometimes could put functional limitations aside and use their utmost capacity to reach their goals. When they could not do that any more, they had to find possibilities for occupations close to home. In order to support very old people's occupational performance outside the home, outdoor mobility has to be facilitated, including the design of the physical environment as well as possibilities for social interaction.     

Housing accessibility for senior citizens in Sweden: Estimation of the effects of targeted elimination of environmental barriers

Abstract

Aim: To estimate the effects of targeted elimination of environmental barriers (EB) in the ordinary housing stock in Sweden, and to explore the estimated effects on accessibility at a population level in relation to (a) residents with different functional profiles, (b) different housing types and (c) building periods.

Method: Data on dwellings from existing Swedish research databases were utilized. EB and accessibility were assessed by means of the Housing Enabler instrument. In simulations of EB removal, five items that correspond to the most common housing adaptations were selected. The simulations were applied to four functional profiles of different complexity.

Result: EB known to be commonly removed by housing adaptations exist in large proportions of the existing ordinary housing stock. Estimated targeted elimination of selected barriers would have the largest accessibility effects for the more complex functional profiles. The effects would be consistently larger for one-family houses, and for all types of dwellings built before 1960.

Conclusions: The elimination of the EB most commonly addressed by housing adaptations could result in a reduction of the housing accessibility problems that community-living older people are facing. For society to solve the housing situation for the ageing population well-informed and efficient upgrading of ordinary housing is imperative.     

替代指标在临床试验中的应用与局限性

本文依据国内外临床试验中结局指标选择的现状，论述了替代指标与终点指标的概念及其关系，以及在临床试验中结局指标选择基本方法及其当前存在的问题。强调只有对患者有直接影响的终点指标才能够证实干预措施的真正疗效，而以实验室为主的生物学指标和患者的临床症状或体征等替代指标，只有被证实与真正临床结局具有因果关系且能客观反映临床措施对临床结局净效应的情况下，才能够作为代替终点指标的评价指标使用。     

The Global Activity Limitation Index mainly measured functional disability,whereas self-rated health measured physical morbidity

ObjectivesAs the Global Activity Limitation Index (GALI) has only recently been created and it is not yet known whether it adds any additional information to self-rated health (SRH), two hypotheses were tested: (1) GALI is primarily correlated with functional disability and secondarily with morbidity and (2) SRH is primarily correlated with morbidity and secondarily with functional disability.MethodsThe data source used was a subsample of the 2006 Spanish National Health Survey comprising people aged more than 64 years (N = 7,835). Age, sex, social class, physical and mental morbidities, and functional disability were selected as predictors in multinomial logistic regression models, in which GALI and SRH were the outcome variables. Fractional polynomials were used to handle the continuous predictors.ResultsThe results supported, generally, both hypotheses: functional disability was the main correlate of GALI and physical morbidity, rather than mental morbidity, was the main correlate of SRH. Furthermore, mental morbidity was as strong a correlate of GALI as SRH, but physical morbidity was notably less strong a correlate for GALI than for SRH.ConclusionIn older people, GALI mainly measured functional disability, whereas SRH mainly measured physical morbidity.     

某院门诊超量取药处方调查与思考

目的:了解我院门诊超量取药处方的实际情况。方法:统计2015年7月1~31日门诊超量取药处方共计1 107张,采用回顾性研究方法分析评价超量取药处方的实际情况。结果:共调查16 063张处方,超量取药处方1 107张,占总处方的6.89%。涉及902例患者,存在同一患者在同一天开具多张超量处方的情况。随着年龄的增加,患者的人数也在逐渐增加。处方金额在101~200元之间的处方数量最多,占所有超量取药处方的34.51%。按医嘱数排名前10位的药品与排名前10位的诊断基本相符。且这10种药品中,中成药有5种。结论:超量取药处方是医保制度下政策的产物,超量取药处方的管理不应是单纯药物数量的叠加,应根据疾病、药物以及患者的特点,个体化制定策略,达到更合理的管理策略,其最终目标是让患者获益,使医疗资源分配更加合理。