阶梯培训法在肿瘤专科医院新护士带教中的应用

目的探讨阶梯培训法在肿瘤专科医院新护士带教中的应用与效果。方法以我院2012年和2013年新入职的新护士（150名）作为实验组,采用阶梯培训法,以2010年和2011年新入职的采用传统导师跟班式带教法的新护士（100名）作为对照组,从新护士理论与操作考核,心理状态和工作情况三个方面进行评价。结果实验组理论成绩、操作成绩显著优于对照组（P〈0.01）,自我效能得分优于对照组（P〈0.01）;实验组焦虑自评得分、工作适应障碍得分均低于对照组（P〈0.01）。结论应用阶梯带教法带教,明显提高了新护士的综合素质,减轻了肿瘤专科新护士入职时的紧张、焦虑、适应困难等状况,是肿瘤专科新护士入职培训的较好方法。     

The safety and tolerability of alkaloids from Alstonia scholaris leaves in healthy Chinese volunteers: a single-centre,randomized, double-blind,placebo-controlled phase I clinical trial

ContextCapsule of alkaloids from the leaf of Alstonia scholaris (L.) R.Br. (Apocynaceae) (CALAS) is a new investigational botanical drug (No. 2011L01436) for bronchitis, post-infectious cough and asthma.ObjectiveTo observe the clinical safety and tolerability of CALAS.Materials and methodsSubjects were assigned to eight cohorts, and each received randomly CALAS or placebo in one of single ascending dose (SAD) of 8, 40, 120, 240, 360, 480, or in one of multiple ascending dose (MAD) of 40 or 120 mg, three times daily for 7 days. Each cohort contained two placebo subjects.ResultsSixty-two enrolled volunteers completed the study and no serious adverse events and clinically significant changes in vital signs, electrocardiography, and upper abdominal Doppler ultrasonography were observed. The ratios of treatment-emergent adverse events (TEAEs) were reported in 11/46 (23.91%) of CALAS groups and 3/16 (18.75%) of the placebo group (p > 0.05), respectively, based on the results of SAD and MAD. All TEAEs were mild, transient, and disappeared without any intervention. The TEAEs possibly related to CALAS treatment were as followings: hiccups (4/46: 8%), dry mouth and nausea (3/46: 6%), increased sleep (2/46: 4%), abdominal distension (1/46: 2%), bilirubin elevated (1/46: 2%).Discussion and conclusionsCALAS is safe and well-tolerated with no unexpected or clinically relevant safety concerns up to a single dose of 360 mg and three times daily for 7 days up to 120 mg in healthy Chinese volunteers, supporting further Phase II studies.     

我国高校图书馆知识服务现状及我馆的探索与思考

本文阐述了国内高校图书馆知识服务产生的背景及发展现状,对知识服务的服务模式、知识服务团队架构及主要服务内容进行了简要的分析,介绍了重庆医科大学图书馆开展知识服务的情况及开展知识服务工作的思考。     

Lamotrigine does not prolong QTc in a thorough QT/QTc study in healthy subjects

AIM

To characterize the effects of lamotrigine on QT interval in healthy subjects.

METHODS

Healthy subjects received a single oral dose of moxifloxacin (400 mg) or placebo in crossover design, followed by a dose-escalating regimen of lamotrigine (n = 76) over a 77-day period, or matched placebo (n = 76). Blood samples were taken for determination of moxifloxacin and lamotrigine concentrations and digital 12-lead ECGs were recorded. The relationships between individual QT values and respective individual moxifloxacin or lamotrigine concentrations were explored using population pharmacokinetic–pharmacodynamic (PK–PD) modelling.

RESULTS

Moxifloxacin was associated with a maximum mean increase from baseline in QTcF of 14.81 ms [90% confidence interval (CI) 13.50, 16.11] 2.5 h after dosing. Steady-state exposure to lamotrigine (50, 150 or 200 mg b.d.) was not associated with an increase in QTc interval. Small reductions in QTcF (maximum mean difference from placebo −7.48 ms, 90% CI −10.49, −4.46) and small increases in heart rate (maximum mean difference from placebo 5.94 bpm, 90% CI 3.81, 8.06) were observed with lamotrigine 200 mg b.d. vs. placebo. No effect of lamotrigine on QRS duration or blood pressure was observed. No outliers with QTcF > 450 ms, or with an increase from baseline of >60 ms were observed in the lamotrigine group. PK–PD modelling indicated statistically significant decreases in individually corrected QT intervals for lamotrigine and statistically significant increases in individually corrected QT intervals for moxifloxacin over the concentration ranges studied.

CONCLUSIONS

Therapeutic doses of lamotrigine (50–200 mg b.d.) were not associated with QT prolongation in healthy subjects.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Drugs that inhibit the human cardiac delayed rectifier potassium current may lead to prolongation of the cardiac QT interval and are associated with a fatal, polymorphic, ventricular tachycardia known as torsades de pointes.
• Lamotrigine is indicated in the treatment of epilepsy and the prevention of mood episodes in patients with bipolar disorder.
• Lamotrigine inhibits the human cardiac delayed rectifier potassium current in vitro, and it has been hypothesized that QT prolongation may contribute to the risk of sudden unexpected death in epilepsy patients.

WHAT THIS STUDY ADDS

• This is the first reported thorough QT/QTc study with lamotrigine conducted to International Conference on Harmonization guidelines.
• The mean QTc interval was not prolonged by lamotrigine in healthy subjects, as assessed by the standard heart rate correction methods (Fridericia''s and Bazett''s).
• The in vitro inhibition of the delayed rectifier potassium current does not translate into an effect on QT in man.

     

Review of the Captain America Graphic Novel ‘TRUTH: Red,White and Black’ Focusing on Parallels with the Infamous USPHS Syphilis Study at Tuskegee

This review presents the first detailed presentation of the parallelism between the Tuskegee Syphilis Study and the Captain America graphic novel ‘TRUTH: Red, White and Black’, published as a graphic novel by Marvel Comics in 2004 as a paperback, and then in 2009 as a hardcover. First written, published and distributed monthly in 2003 as pre-sequel seven comic book series to tell the story of the origins of the WWII superhero Captain America. In 2003, Marvel Comics chose to tell a ‘very dark story’ to explain the origins of Captain America, a half century after the initial introduction of Captain America as a WWII action hero in 1940. By detailing—for the first time—nine parallel aspects between these two storylines, this review demonstrates how Marvel Comics brought the tragic Tuskegee Syphilis Study story into the popular press, thus reaching an audience far beyond traditional bioethics academicians. This review is intended to stimulate and guide classroom discussions on the ethical issues at the core of the infamous Tuskegee Syphilis Study allowing bioethical issues to be made more accessible to the general public, via school curriculums, by the use of graphic novels.     

Challenges of Recruiting Minority Populations for Research

Scientific Inquiry Provides a forum to facilitate the ongoing process of questioning and evaluating practice, presents informed practice based on available data, and innovates new practices through research and experimental learning.     

针灸影像学--针灸作用机理及其穴位配伍研究的新学科

本文首次提出了针灸影像学(Imaging—Pharmacology)的概念,并对其分类、研究内容、方法及范畴作了论述。针对目前中药及其复方研究存在的不足,探讨了针灸影像学在针灸经络和穴位研究中应用的优势及所解决的问题。旨在提倡引进现代科学新技术,以推动中药现代化的发展。     

Brain dynamics in ASD during movie‐watching show idiosyncratic functional integration and segregation

To refine our understanding of autism spectrum disorders (ASD), studies of the brain in dynamic, multimodal and ecological experimental settings are required. One way to achieve this is to compare the neural responses of ASD and typically developing (TD) individuals when viewing a naturalistic movie, but the temporal complexity of the stimulus hampers this task, and the presence of intrinsic functional connectivity (FC) may overshadow movie‐driven fluctuations. Here, we detected inter‐subject functional correlation (ISFC) transients to disentangle movie‐induced functional changes from underlying resting‐state activity while probing FC dynamically. When considering the number of significant ISFC excursions triggered by the movie across the brain, connections between remote functional modules were more heterogeneously engaged in the ASD population. Dynamically tracking the temporal profiles of those ISFC changes and tying them to specific movie subparts, this idiosyncrasy in ASD responses was then shown to involve functional integration and segregation mechanisms such as response inhibition, background suppression, or multisensory integration, while low‐level visual processing was spared. Through the application of a new framework for the study of dynamic experimental paradigms, our results reveal a temporally localized idiosyncrasy in ASD responses, specific to short‐lived episodes of long‐range functional interplays.     

Spatio‐temporal dynamics of resting‐state brain networks improve single‐subject prediction of schizophrenia diagnosis

Correlation in functional MRI activity between spatially separated brain regions can fluctuate dynamically when an individual is at rest. These dynamics are typically characterized temporally by measuring fluctuations in functional connectivity between brain regions that remain fixed in space over time. Here, dynamics in functional connectivity were characterized in both time and space. Temporal dynamics were mapped with sliding‐window correlation, while spatial dynamics were characterized by enabling network regions to vary in size (shrink/grow) over time according to the functional connectivity profile of their constituent voxels. These temporal and spatial dynamics were evaluated as biomarkers to distinguish schizophrenia patients from controls, and compared to current biomarkers based on static measures of resting‐state functional connectivity. Support vector machine classifiers were trained using: (a) static, (b) dynamic in time, (c) dynamic in space, and (d) dynamic in time and space characterizations of functional connectivity within canonical resting‐state brain networks. Classifiers trained on functional connectivity dynamics mapped over both space and time predicted diagnostic status with accuracy exceeding 91%, whereas utilizing only spatial or temporal dynamics alone yielded lower classification accuracies. Static measures of functional connectivity yielded the lowest accuracy (79.5%). Compared to healthy comparison individuals, schizophrenia patients generally exhibited functional connectivity that was reduced in strength and more variable. Robustness was established with replication in an independent dataset. The utility of biomarkers based on temporal and spatial functional connectivity dynamics suggests that resting‐state dynamics are not trivially attributable to sampling variability and head motion.     

Intra‐subject variability in muscle activity and co‐contraction during jumps and landings in children and adults

We investigated muscle activity, intra‐subject variability in muscle activity and co‐contraction during vertical jumps and landings in children and adults. Ten male children and 10 male adults completed 10 countermovement jumps (CMJ), 10 drop jumps (DJ) from 30 cm, 10 low and high landings from 30 and 60 cm for the children and 60 and 90 cm for the adults. The adults also performed ten DJ from 60 cm. EMG was recorded from nine lower limb muscles in the right leg and normalized to isometric MVC. Statistical parametric mapping was used to reveal differences in the muscle activity and intra‐subject variability in the muscle activity. Co‐contraction was quantified for two thigh muscle pairs and one plantar flexor/dorsiflexor muscle pair and group differences were assessed (two‐way ANOVA). No significant differences were observed in the less eccentric demanding CMJ while significantly higher muscle activity magnitude and intra‐subject variability were observed for the children during the initial part of the contact phase of DJ and landings, indicating a less consistent muscle activity pattern in the children. This may indicate that vertical jumps/landings involving a high amount of eccentric muscle contraction constrain the muscle activation in children, possibly because of immature motor control.