Test–retest reliability of health state valuation techniques: the time trade off and person trade off

Economic analysis is increasingly being employed in formal resource allocation decision‐making processes in health care. As a consequence, the methods employed by economic analysts are increasingly subject to close scrutiny. One such area of methodology concerns the instruments used to elicit preferences for various health states for use in the construction of quality‐adjusted life years. There are a number of techniques which may be used to elicit preferences and different techniques produce different results. The objective of this study was to explore the test–retest reliability of two techniques: Time Trade Off (TTO) and Person Trade Off (PTO) valuations were collected by a general population postal survey. A total of 798 respondents returned questionnaires. The intra class correlation coefficients ranged from 0.40 to 0.88 for TTO and, ?0.17 to 0.82 for PTO, with the majority of coefficients being >0.50. The reliability coefficients varied between techniques and health states, with the TTO technique tending to produce higher coefficients. While the reliability results for TTO were generally positive, the reliability results for PTO are less clear. Copyright © 2010 John Wiley & Sons, Ltd.     

Use of Acticoat™ dressings in burns: What is the evidence?

The virtues of silver as an antimicrobial agent have been known for some time. Various silver containing dressings are currently used for the treatment of wounds. Introduced in the late 1990s, Acticoat™ is a nanocrystalline silver dressing developed to overcome some shortcomings of the older dressings by providing sustained release of silver up to 7 days. We aim to determine the level of evidence available in the literature in view of recent increased usage of Acticoat™.     

Practical model description of peripheral neural excitation in cochlear implant recipients: 3. ECAP during bursts and loudness as function of burst duration

In this, the third paper of the series, the loudness of low-rate bursts of electrical pulses was measured as a function of the burst duration, in subjects implanted with the Nucleus^® 24 cochlear implant system (three with straight and two with Contour™ electrode arrays). In order to help distinguish between the contributions of peripheral and more central effects, the ECAP was recorded to the individual pulses comprising the bursts, using the Neural Response Telemetry™ (NRT™) system. At a pulse rate of 250 pulses/s, the ECAP amplitude did not decrease greatly during the bursts: the mean reduction factor was 0.89. The time-constant for summation of the loudness contributions from the pulses comprising a burst was found to be larger than that associated with normal hearing. In addition, the first pulse of a pulse train was found to contribute much more to the overall loudness than did the subsequent pulses, although a corresponding difference was not observed in the ECAP recordings. These results establish a necessary connection between the essentially single-pulse model, developed in the fourth and fifth papers of the series, and the psychophysical data for pulse bursts, but they also have broader implications.     

Fos and Jun potentiate individual release sites and mobilize the reserve synaptic-vesicle pool at the Drosophila larval motor synapse

In all nervous systems, short-term enhancement of transmitter release is achieved by increasing the weights of unitary synapses; in contrast, long-term enhancement, which requires nuclear gene expression, is generally thought to be mediated by the addition of new synaptic vesicle release sites. In Drosophila motor neurons, induction of AP-1, a heterodimer of Fos and Jun, induces cAMP- and CREB-dependent forms of presynaptic enhancement. Light and electron microscopic studies indicate that this synaptic enhancement is caused by increasing the weight of unitary synapses and not through the insertion of additional release sites. Electrophysiological and optical measurements of vesicle dynamics demonstrate that enhanced neurotransmitter release is accompanied by an increase in the actively cycling synaptic vesicle pool at the expense of the reserve pool. Finally, the observation that AP-1 mediated enhancement eliminates tetanus-induced forms of presynaptic potentiation suggests: (i) that reserve-pool mobilization is required for tetanus-induced short-term synaptic plasticity; and (ii) that long-term synaptic plasticity may, in some instances, be accomplished by stable recruitment of mechanisms that normally underlie short-term synaptic change.     

针灸易化技术对脑卒中患者上肢瘫及ADL的影响

目的探讨针灸配合易化技术在偏瘫上肢康复训练中的疗效。方法80例脑卒中患者被随机分成针灸配合易化技术组（治疗组）40例和常规康复组（时照组）40例。采用Fugl-Meyer（FMA）积分评测患者的上肢运动功能．Barthel（BI）指数评测日常生活能力（ADL）。结果治疗后，2组FMA积分、B1积分都有提高，但治疗组的改善情况优于对照组；2组FMA、BI积分改善的差值比较P〈0.01。结论针灸配合易化技术在脑卒中患者康复训练中，对偏瘫上肢运动功能及日常生活能力方面（尤其是偏瘫上肢运动功能方面）疗效好.     

Psychodynamic sources of resistance among student nurses: some observations in a human relations context

Psychodynamic sources of resistance among student nurses: some observations in a human relations context The nurse-patient relationship is considered to be a crucial part of the daily routine for many nurses; however, little evidence is available regarding how student nurses cope with learning human skills. Few researchers have considered how students engage with or resist the learning process. The aim of this study is to examine interpersonal matters and explore psychodynamic sources of resistance encountered among student nurses in an interpersonal skills context. A qualitative approach was adopted with a focus on individual case studies, using the in-depth interview as the major mode of data collection combined with observation. The four types of student that emerged from the data are emphasized, ranging from type 1 who were extremely reluctant to self-disclose, to type 4 who were more confident and free-flowing. The major characteristics pertaining to each type of student are outlined. While some characteristics seem to be related to childhood struggles and years of over-adaptation, others relate to factors that influence the learning climate. Particular attention is given to the psychological understanding of their predicament, including accounts of childhood and self-image. The implications for nurse education and limitations of this study are also considered.     

Repolarization of the presynaptic action potential and short-term synaptic plasticity in the chick ciliary ganglion

Stimulation-induced increases in synaptic efficacy have been described as being composed of multiple independent processes that arise from the activation of distinct mechanisms at the presynaptic terminal. In the chick ciliary ganglion, four components of short-term synaptic plasticity have been described: F1 and F2 components of facilitation, augmentation, and potentiation. In the present study, intracellular recording from the presynaptic calyciform nerve terminal of the chick ciliary ganglion revealed that the late repolarization and afterhypolarization (AHP) phases of the presynaptic action potential are affected by repetitive stimulation and that the time course of these effects parallel that of facilitation. The effects of these changes in the presynaptic action potential time course on calcium influx were tested by using the recorded action potential waveforms as voltage command stimuli during whole-cell patch-clamp recordings from acutely isolated chick ciliary ganglion neurons. The "facilitated" action potential waveform (slowed repolarization, decreased AHP amplitude) evoked calcium current with slightly but significantly greater total calcium influx. Taken together, these results are consistent with the hypothesis that activity-dependent changes in the presynaptic action potential are one of several mechanisms contributing to the facilitation phase of stimulation-induced increases in transmitter release in this preparation.     

Choice of stratification in Poisson process analysis of recurrent event data with environmental covariates

The Poisson process approach for studying the association between environmental covariates and recurrent events depends on the stratification of study period into intervals within which the baseline intensities are assumed constant. In this work we investigate the problem of bias and variance due to misspecification of this stratification. We suggest a cross-validation approach to choosing a stratification model to balance the trade-off between bias and variance. We also establish a connection between the Poisson process approach and case cross-over studies.     

Postexercise facilitation of motor evoked potentials following transcranial magnetic stimulation: a study in normal subjects

The size of the motor evoked potential (MEP) elicited by transcranial magnetic stimulation increases soon after a nonexhaustive voluntary contraction of the target muscle (postexercise facilitation). Our aim was to determine whether the duration or intensity of voluntary muscle contraction influenced postexercise facilitation in normal subjects. We recorded the MEP from the thenar muscles following contractions of different durations (5, 15, and 30 s) and intensities (10%, 25%, and 50% of maximal voluntary contraction). We found that every combination of the tested intensities and durations of physical effort could induce postexercise MEP facilitation. Although the degree of postexercise MEP facilitation was comparable across the different durations and intensities, the maximal facilitation was observed with the shortest and strongest muscle contraction. Our study thus defines the optimal setting to study postexercise facilitation for clinical purposes.     

浙江省医药国际贸易应用型人才需求探析

本文从全国及浙江省近年来医药国际贸易的发展状况出发,对浙江省医药国际贸易应用型人才的需求进行了多方位的深入分析,为新建专业奠定基础,并深入了解医药国际贸易这一具有一定特殊性的人才类型。研究结果显示,医药国际贸易应用型人才在浙江省的市场中需求大,供应紧缺。