Using business/law negotiation techniques in response to a ‘difficult’ family

Effective communication between clinicians, patients, and families at end of life is associated with better clinical outcomes. A large body of literature describes the key skills needed for effective communication. We believe that clinicians could also benefit from communication skills more commonly associated with business or law negotiations. We will demonstrate via analogy (i.e. buying a house) how four key business/law negotiation techniques – 1. Determine your Reservation and Aspiration Value; 2. Separate People from their Positions; 3. Separate Positions from Interests; and 4. Logrolling of Interests – can be applied to a difficult family meeting in a home hospice patient.     

微信小程序合并时间管理器在眼科患儿监护人出院宣教中的应用效果

目的 探讨微信小程序合并时间管理器在眼科患儿出院宣教中的应用效果,为眼科护士出院宣教干预提供借鉴。方法 采用便利抽样法,选取98例眼科患儿监护人作为研究对象,将2021年2月-5月住院的49例患儿的监护人作为对照组,进行眼科常规出院宣教,将2021年6月-9月住院的49例患儿的监护人作为观察组,使用微信小程序合并时间管理器进行出院宣教干预。比较2组患儿监护人对疾病相关知识知晓情况、满意度及按时复诊人数。结果 干预1个月后,观察组疾病相关知识问卷得分、满意度得分及按时复诊率均高于对照组(t=-5.223,P=0.001;t=-5.419,P=0.001;χ²=6.874,P=0.009)。结论 使用微信小程序合并时间管理器在眼科病房进行出院宣教,能有效提高患儿监护人出院后疾病相关知识水平、按时就诊率及监护人满意度,提升护理服务质量。     

Introducing dental students to clinical patient care: The complete denture prosthodontics transition clinic

Using complete denture treatment as an introduction to clinical patient care for dental students, the purposes of the Complete Denture Prosthodontics Transition Clinic at the University of Colorado School of Dentistry are to reduce the time lapse between the preclinical complete denture prosthodontics course and the first denture patient experience, and to encourage development of student self-confidence and skills. In the 2002 spring semester, faculty at the University of Colorado School of Dentistry initiated the Complete Denture Prosthodontics Transition Clinic for DS-II (second-year) dental students, as an introduction to clinical patient care. Each patient was assigned to a team of two dental students. Three Division of Prosthodontics faculty members staffed each clinic session, providing a student-to-faculty ratio of approximately 6.6:1 and a patient-to-faculty ratio of approximately 3.3:1. All DS-II students in the Class of 2004 delivered their first complete dentures no later than 8 months (average, 184 days) after the last day of the preclinical complete denture prosthodontics course. The time from the diagnostic appointment through the denture placement appointment averaged 39 days for patients treated in this program, compared with an average of 98 days or more for previous classes. The program was successful in achieving the goal of reducing the time lapse between the preclinical complete denture prosthodontics course and the first denture patient experience.     

小切口胆囊切除术中胆道损伤的预防

目的探讨预防小切口胆囊切除术（MC）中胆道损伤的方法。方法对本组15131例MC中发生的18例胆道损伤进行回顾分析。结果1994年12月前施行MC2321例，发生胆道损伤9例（0．39％），1995年以来实施MC12810例，发生胆道损伤9例（0．07％）。结论思想上高度重视、规范手术适应证、规范手术操作是预防MC中胆道损伤的关键。     

An exploration of gifted programs

This article presents findings on an exploration of gifted programs in the state of Missouri. Over 60 percent of the state supported public school gifted programs participated in the study. The study concludes that the guidelines for gifted education in Missouri create extreme variability in the standards of the programs. Strong national policy for gifted education is needed to insure gifted children are properly served and protected by law.     

Kindergarten and first grade: A time for developing and nurturing gifted behaviors in young children

This article concludes that there is a tremendous need for gifted programs at the kindergarten and first grade levels. A review of the literature suggests that it is difficult to identify young gifted children through traditional screening techniques. The author concludes that Renzulli's Enrichment Triad Model may prove useful for identifying young gifted children.     

An analysis of the deep social structure preventing the development of a national policy for children and families in the United States

The United States is one of the few economically developed nations without a national policy supporting children and their families. This paper suggests that the United States has a unique national ideology, based on the “Calvinistic Ethic,” which results in opposition to not only social programs for children and families, but to all government supported welfare programs. Such an ethic is not found in European countries. Finally, since the United States does not have a national family policy, millions of children and their families go without health care, lack social services, and suffer from inadequate economic supports.     

The social sciences and successful aging: Issues for Asia–Oceania

Aim:   This paper presents social science understandings of successful aging for a broad audience in multidisciplinary gerontology in Asia–Oceania.
Methods:   The international literature on social science aspects of successful aging is reviewed with a focus on Asia and social improvement.
Results:   New positive approaches to aging research are identifying opportunities for maintaining capacities and well-being over the life course. Successful aging, productive aging, and active aging are key concepts. Increasing life expectancy and fertility control are major social achievements that underpin population aging as the mainstream social transformation facing the world. Asia will be at the forefront of this change and the consequences will vary greatly between cultures, nations, and subgroups within them. Older people generally maintain good quality of life and the capacity to 'age well' is influenced by life-long maturation and emotional, social, and economic resources. Good health can be enhanced through positive actions such as physical activity, good nutrition, and not smoking. Mental capacities can also be improved and maintained throughout old age. In advanced old age, the 'fourth age', the focus turns to ameliorating the effects of loss and to maintaining dignity.
Conclusions:   The social sciences contribute knowledge useful for improving life experiences for older people and aging societies. Population aging is central to national economic development. Public policy and individual action concerning aging can benefit all age groups. To better inform these developments it is important to address the serious shortfall of social science research on aging in the Asia–Oceania region.     

Cerebellar subjects show impaired coupling of reach and grasp movements

We examined how cerebellar deficits in isolated reaching or grasping movements contribute to abnormalities in a combined reach and grasp movement, and whether people with cerebellar damage show abnormalities in the spatiotemporal relationships of reach and grasp movements. We studied subjects with cerebellar damage and matched controls as they performed a combined reach and grasp, an isolated reach, and an isolated grasp. These movements were performed under slow-accurate and fast speed conditions. Subjects were also tested for their ability to correctly estimate the target size based on visual information. We measured the three-dimensional position of the index finger, thumb and wrist joint during all tasks. Results showed that cerebellar subjects overestimated the target size to a greater extent than did controls. During movement testing, cerebellar subjects were impaired on isolated reach and isolated grasp. However, they did not worsen parameters of reach or grasp movements during the combined reach and grasp. Instead there were distinct deficits in the coupling of the reach and grasp movement. Compared with controls, cerebellar subjects showed abnormalities in the sequence of the reach and grasp movement and highly variable timing of peak grip aperture. In the slow-accurate condition, cerebellar subjects decomposed the reach and grasp movement into separate reach then grasp components, and produced multiple peaks in grip aperture. In the fast condition, cerebellar subjects did not decompose, produced a single peak grip aperture, and dropped the target more often. These results indicate that cerebellar damage can cause a specific breakdown in the coupling of reach and grasp movements. The cerebellum may be involved in combining reach and grasp movements into a single motor program.     

巴马小型猪脑死亡状态下血清炎症介质的改变及在肝脏损伤中的作用

目的：探讨巴马小型猪在脑死亡状态下血清炎症介质的变化及对肝脏损伤的作用。方法:巴马小型猪10只，随机分脑死亡组与对照组，每组5只。用颅内加压法建立脑死亡模型，对照组仅开颅麻醉维持，分别于3、6、12、18和24h取血清测丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）及IL-1β、IL-6和TNF-α水平。结果:（1）炎症介质变化：脑死亡组动物血清IL-1β、IL-6和TNF-α水平均自脑死亡后3h开始升高，并随时间的延长而继续升高；脑死亡后3、6、12、18和24 h脑死亡组明显高于对照组（P<0.05）。（2）肝脏酶学变化：血清ALT、AST水平自脑死亡后12 h开始升高，并随时间的延长而继续升高；脑死亡后12、18和24 h脑死亡组明显高于对照组（P<0.05）。结论：巴马小型猪脑死亡状态下血清炎症介质升高，并随时间的延长而继续升高。脑死亡状态下肝脏功能的损伤可能与这些炎症介质的水平升高有关。