Computers in the Examining Room: Evaluating the Social Impact on Practice Patterns

This paper uses social network analysis to examine the impacts on practice patterns of the introduction of CompuHx, an Interactive Health Appraisal System (IHAPS), used in the examining roomat Kaiser Permanente\u27s San Diego Department of Preventive Medicine. The system is used to record patient information, assist in diagnosis, and provide a summary of findings. Twenty-two physician assistants and nurse practitioners responded to detailed surveys after the system was implemented. Findings indicate practitioners who used the computer system interacted more frequently with the other physician assistants and nurse practitioners, with physicians, and with individuals in other departments. Overall,the study points to the value of using network analysis to investigate the impact of computer technology on individuals\u27 attitudes and behaviors

Molecular typing of Mycobacterium tuberculosis isolated from adult patients with tubercular spondylitis

Background/PurposeTuberculosis (TB) is endemic in Taiwan and usually affects the lung, spinal TB accounting for 1–3% of all TB infections. The manifestations of spinal TB are different from those of pulmonary TB. The purpose of this study was to define the epidemiological molecular types of mycobacterial strains causing spinal TB.MethodsWe retrospectively reviewed the medical charts of adult patients diagnosed with spinal TB from January 1998 to December 2007. Patients with positive culture results and/or pathological findings characteristic of TB were enrolled in this study. Spoligotyping was performed to type the Mycobacterium tuberculosis isolates.ResultsA total of 38 patients with spinal TB were identified. Their mean age was 68 years, and their median duration of symptoms was 60 days (range 3–720 days). The lumbar and thoracic spine accounted for 76% of the sites involved. Thirteen specimens (from seven male and six female patients) were available for typing. Spoligotyping of these 13 specimens revealed three Beijing (23%) and 10 non-Beijing types (77%). The non-Beijing types included two EAI2 Manilla (15%), two H3 (15%), two unclassified (15%), and one each of BOVIS1, U, T2, and orphan type. No significant predominant strain was found in this study, and no drug-resistant Beijing strains were identified.ConclusionTB spondylitis was found to occur in older patients. Spoligotyping results showed that most of the TB spondylitis cases were caused by non-Beijing type Mycobacterium tuberculosis

Antimicrobial Activity of Lactobacillus Species Against Carbapenem-Resistant Enterobacteriaceae

ObjectiveThis study aims to identify suitable lactobacilli that have anti-carbapenem-resistant Enterobacteriaceae (CRE) activity with in vitro tolerance to pepsin and bile salts.MethodsFifty-seven Lactobacillus spp. strains encompassing nine species were collected for investigation. Their viabilities in the presence of pepsin and bile salts were tested using tolerance tests. Their anti-CRE effects were assessed by agar well diffusion and broth microdilution assay, as well as time-kill test.ResultsOf the 57 Lactobacillus isolates collected, 31 had a less than 2-log reduction in their viability in both pepsin and bile salt tolerance tests. Of these 31 isolates, 5 (LUC0180, LUC0219, LYC0289, LYC0413, and LYC1031) displayed the greatest anti-CRE activity with a CRE zone of inhibition greater than 15 mm in agar well diffusion assays. The minimal inhibitory percentages of supernatants from these five strains against CREs ranged from 10 to 30%. With the exception of LUC0180, which had a minimal bactericidal percentage ≥ 40%, the bactericidal percentage of all the strains ranged from 20 to 40%. The inhibitory effect of the cell-free culture supernatants from these Lactobacillus strains did not change after heating but was abolished as the pH changed to 7.0. After a 24-h incubation, five of the Lactobacillus strains at a concentration of 108 CFU/ml totally inhibited the growth of carbapenem-resistant Escherichia coli (CRE316) and Klebsiella pneumoniae (CRE632). After a 48-h incubation, the growth of CRE316 was completely inhibited under each concentration of lactobacilli based on time-kill test. Furthermore, when the concentration of lactobacilli was at 108 CFU/ml, the decline in pH was faster than at other concentrations.ConclusionSome Lactobacillus strains exhibit anti-CRE activity, which suggests potential applications for controlling or preventing CRE colonization or infection

Expression of ezrin is associated with invasion and dedifferentiation of hepatitis B related hepatocellular carcinoma

<p>Abstract</p> <p>Background</p> <p>Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the world and constitutes the leading cause of cancer-related death among men, and second among women in Taiwan. Liver cirrhosis and HCC are relatively prevalent, and 80% to 85% of the patients with these conditions have positive results for hepatitis B surface antigen in Taiwan. Only 5% of the general population is seronegative for all hepatititis B virus (HBV) markers. This is the first study to determine the role of ezrin upon HBV HCC cell and patients with HBV HCC undergoing hepatectomy</p> <p>Methods</p> <p>Immunohistochemical study with ezrin in 104 human HBV-HCC cases were carried out to investigate its association with the clinicopathological features and the outcomes of 104 HBV-HCC patients undergoing hepatetomy. In addition, DNA constructs including the wild type ezrin (wt-ezrin) and mutant ezrin Tyr353 (Y353) were transfected into Hep3B cell to study its role in tumor invasion and differentiation.</p> <p>Results</p> <p>HBV HCC patients with ezrin over-expression independently have smaller tumor size, cirrhotic liver background, poor tumor differentiation, and more vascular invasion. Ezrin expression status has no impact on survival for HBV-HCC patients undergoing hepatectomy. The in vitro assay showed that wt-ezrin Hep3B cells have a significant higher level of AFP secretion and higher invasion ability as compared with the control and Y353- ezrin Hep3B cells.</p> <p>Conclusion</p> <p>Ezrin over-expression contributed to de-differentiation and invasion of HBV-HCC cell. HBV-HCC patients with ezrin over-expression were independently associated with tumor with smaller size, cirrhotic liver background, poor differentiation, and vascular invasion.</p

Large-scale association analysis provides insights into the genetic architecture and pathophysiology of type 2 diabetes

To extend understanding of the genetic architecture and molecular basis of type 2 diabetes (T2D), we conducted a meta-analysis of genetic variants on the Metabochip involving 34,840 cases and 114,981 controls, overwhelmingly of European descent. We identified ten previously unreported T2D susceptibility loci, including two demonstrating sex-differentiated association. Genome-wide analyses of these data are consistent with a long tail of further common variant loci explaining much of the variation in susceptibility to T2D. Exploration of the enlarged set of susceptibility loci implicates several processes, including CREBBP-related transcription, adipocytokine signalling and cell cycle regulation, in diabetes pathogenesis

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The impact of gatekeeping on physician practice patterns

This study is the first study to examine the effectiveness of gatekeeping performed by cardiovascular surgeons. It is designed to evaluate the effectiveness of gatekeeping using social network analysis as a guiding theoretical framework and the concept of gatekeeping. Data are collected from 447 Medicare patients who underwent coronary artery bypass graft (CABG) surgery from January 1, 1993 to January 1995. The study uses social network theory to conceptualize and generate hypotheses concerning the effects of cardiovascular surgeons acting as gatekeepers in providing care over an extended period of time. Also, the study explores the effect of patients\u27 characteristics on gatekeeping. Time series analyses and SEM analyses are utilized to examine the effectiveness of gatekeeping. This study finds that the effectiveness of gatekeeping increases over time. Gatekeeping results in a reduction in resource utilization and hospital costs whereas physician charges increase over time. Gatekeeping appears to have weaker effects on controlling resources and costs for older, female, and sicker patients. Finally, there are minor differences in the way that cardiovascular surgeons perform the gatekeeping function

Trauma and Narrative Strategies in The Bluest Eye: The Political Meaning in Toni Morrison's Novel

在《最藍的眼睛》中，湯妮．莫莉森再現黑人在美國社會中的集體經驗。由於白人文化的宰制，文化創傷滲透在黑人的生活當中。身為一個黑人女性作家，莫莉森深刻感受黑人在美國社會的附屬地位，以及普羅大眾對於黑皮膚人種的刻板印象。她在小說中，她選擇以「美麗」當作中心主題，揭露黑人集體經驗底下複雜又矛盾的社會脈絡，看似連貫的黑人歷史源於不可或知的創傷，使得他們無可避免地再製相同的歷史。透過抒寫黑人的故事，莫莉森重新檢視黑人的經驗與歷史，試圖喚醒集體潛藏的意識，去重新思考黑人在美國歷史當中的位置。 這篇論文主要分成兩個章節分別討論《最藍的眼睛》的故事與形式，探討莫莉森的論述如何替黑人發聲，如何去挑戰白人的宰制文化，並尋求重新改寫黑人歷史的可能性。在這本小說中，作者莫莉森在故事中再現了黑人的生活（black reality），呈現出黑人群落附屬於白人文化的單一面貌，羞愧與罪惡感滲透在每一個黑人角色的主體當中，並同時投射於小女孩琵可拉 (Pecola)的身上，使其成為黑人群落的代罪羔羊，導致她最後的瘋狂。在形式上，莫莉森透過刻意的安排，展現了對於主宰文化的抗議，並置不同的論述（narrative）、文本（text）、文類（genre）以及刻意誇張的手法去挑戰傳統的文學形式，變相地挑戰主流文化。同時她也將黑人的集體經驗個人化，透過書中每個角色的不同論述，強調黑人的集體認同與個人經驗的相互穿透，呈現出不同的個人歷史，瓦解黑人穩定又連貫的共同歷史。在這本小說中，莫莉森結合內容與形式去呈現黑人文學的潛在能量，其坦承黑人歷史與白人文化的無法切割，並非強勢地與白人文化作區隔，而是接受其為歷史的一部份，真實面對黑人群落的矛盾與困境，企圖喚醒黑人集體的認知，並尋找重寫黑人歷史的可能性。In The Bluest Eye, Toni Morrison represents Afro-American's traumatic experiences in American society. The cultural trauma, which is the consequence of the white culture's domination, penetrates the black's collective experiences. As an Afro-American writer, Morrison is aware of the black's subordinate position in America and the negative characteristics of black stereotype rooting in the public's conception. In The Bluest Eye, Morrison selects “beauty” as the motif to disclose the complicated and ambivalent social context underneath the black's collective experience. While the inescapable consequence for the black to reproduce their history of subordination actually results from the inaccessible trauma, Morrison knows the need to re-examine the black's history by retelling the black's story and expects the possibility to awaken the black's consciousness and to reclaim their position in American history. The thesis is divided into two chapters to respectively discuss the story and the form in The Bluest Eye and further look for the political meaning in Morrison's narrative. In the story, Morrison represents the black's collective experience of subjecting to the white values and being confined to the cultural trauma which results in the black's shame and guilt. Every protagonist in the story projects his/her shame on Pecola, who eventually becomes the scapegoat of the black community, and determines Pecola's madness. However, in the form of the novel, Morrison shows her protest against the dominant power by challenging the traditional literary form, such as the juxtapositions of different narratives, texts and genres in the novel. By combining the content and form in the novel, Morrison displays the potential of the black writing which never asserts its entire separation from the white culture but rather accepts the influence of the white's ideological domination in the black's history. The political meaning in the novel lies in its exposition of the black's ambivalence of being an American with the black skin and its attempt to challenge the white's domination by the formal devices. By juxtaposing the different narratives in the story, Morrison tries to emphasize that every black's personal experience is enwound with their cultural trauma and results in different personal meaning. It is Morrison's strategy to challenge the black's history is collective and unchangeable.Acknowledgment I English Abstract II Chinese Abstract IV Table of Content V Introduction 1 Chapter One: Cultural Trauma in Afro-American Community 7 Chapter Two: Toni Morrison's Narrative Strategies in The Bluest Eye 28 Conclusion 54 Works Cited 6