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Emergency department visits:Why adults choose the emergency room over a primary care physician visit during regular office hours?

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World Journal of Emergency Medicine 2012年第2期3卷 91-97页

作者： courtney Rocovich Trushnaa Patel Department of Emergency Medicine Henry Ford Macomb Hospital

BACKGROUND:It has been estimated that up to one third of all emergency department(ED)visits may be"inappropriate"or *** that have been speculated to be associated with non-emergent use have been noted to include low socioeconomic status,lack of access to primary care,lack of insurance,convenience of"on demand care"and the patient's individual perception of their complaint *** objective of this study is to identify the reasons contributing to self-perceived non-emergent adult emergency department visits during primary care physician office hours of ***:This study was a single-center,descriptive study with *** questionnaire was collected from patients meeting exclusion/inclusion criteria who were triaged into an acute or fast track part of the emergency department during regular business hours on Monday through Friday,8:00 am-5:00 pm during the months of July 2011 and August *** data were categorical and summarized using counts and *** collected included patient demographics,information about the patient's primary care provider,and information about the emergency department visit in *** responses were compared among patients with visits considered to be non-emergent to those considered to be emergent by using individual chi-square ***:There were 262 patients available for the *** patients were grouped according to their perception of the severity of their *** half of the patients placed themselves into the non-emergent category(n=129),whereas the other half of the patients categorized themselves into the emergent group(n=131).There were statistically significant differences in marital status and employment status between the two *** was found that 61.5%of the non-emergent patients were single,while 58.3%of the emergent patients were *** the non-emergent group,59.7%were unemployed,but in the emergent group 60.3%were employed(P<0.05).Howe

关键词： Emergency department United States Overcrowding Primary care physician

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Quality Improvement Project of Pharmacist-Assisted Medication Reconciliation and Regimen Review Following Veteran Discharge to Hospice

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Journal of Pharmacy and Pharmacology 2014年第8期2卷 489-500页

作者： courtney Kominek Sandra DiScala Pharmaey Service West Palm Beach Veterans Affairs Medical Center West Palm Beach 33410 USA

The Joint Commission NPSG （National Patient Safety Goals） requires that medication reconciliation be performed upon any transition of care （NPSG 03.06.01）. The hospice clinical pharmacist, in delivering pharmaceutical care, performs medication regimen reviews to identify medication-related problems. This project aims to improve the medication reconciliation process upon transition from inpatient units to non-VA （Veterans Affairs） hospice care by identifying and resolving medication discrepancies and medication-related problems. Patients discharged from inpatient to non-VA hospice care from October 2013-March 2014 were included. Medication reconciliation was performed by the pharmacist via telephone with the patient/caretaker and the hospice agency within two weeks of discharge. The patient＇s primary care provider was contacted via telephone when changes were recommended, and upon agreement, medication lists were updated electronically. A total of 18 patients were included. The results found that following medication reconciliation and regimen review, the mean number per patient of VA medications discontinued and non-VA medication documented was 5.7 and 10.8 respectively. The mean number per patient of medication discrepancies and medication-related problems was 14.4 and 8.6 respectively. This quality improvement project demonstrates the vulnerability of patients to medication discrepancies and medication-related problems and highlights the role of pharmacists in resolving these issues during this transition of care.

关键词： Medication reconciliation hospice veterans medication regimen review.

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Identifying migrant remains in South Texas:policy and practice

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Forensic Sciences Research 2019年第1期4卷 60-68页

作者： M.Katherine Spradley Nicholas P.Herrmann courtney B.Siegert Chloe P.McDaneld Department of Anthropology Texas State UniversitySan Marcos(TX)USA

In 2012, Texas surpassed Arizona in migrant deaths. The majority of deaths occurred in the Rio Grande Valley, specifically in Brooks County, Texas. Brooks County is one of the poorest in the state and was overwhelmed with deaths, without appropriate resources to follow the state laws pertaining to the investigation of unidentified human remains. Until 2013, most remains that were not immediately identified were buried without collecting DNA samples and the location of burials was not recorded. Our paper outlines the difficulties searching for these burials, the struggles of the families of the missing, and the collaborative approaches to facilitating identifications in South Texas. Community outreach combined with geophysical surveys guide which cemeteries are in need of exhumations. Once ceme-teries are surveyed, archaeological methods are employed to exhume remains and docu-ment burials. Remains are taken to the Forensic Anthropology Center at Texas State for processing, analysis, and identification efforts. Undergraduate and graduate students clean remains and wash clothing and personal *** skeletal analysis, all information regarding the remains, including photographs of per-sonal effects, are uploaded to the National Missing and Unidentified Persons System (NamUs) and a DNA sample is submitted to the University of North Texas for inclusion in the Combined DNA Index System (CODIS) DNA database. However, CODIS lacks DNA family reference samples from many families of the missing due to families living outside the US or because they do not feel comfortable providing a DNA sample in the presence of law enforcement. Therefore, it is necessary to work with non-governmental organizations who specialize in collecting missing persons reports and DNA samples from the families of the missing. Working collaboratively with multiple agencies, identification of migrant remains is possible.

关键词： Forensic anthropology migrant migration positive identification geophys-ical survey

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Early vs late oral nutrition in patients with diabetic ketoacidosis admitted to a medical intensive care unit

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World Journal of Diabetes 2019年第1期10卷 57-62页

作者： Kirill Lipatov Kevin K Kurian courtney Shaver Heath D White Shekhar GhamANDe AlejANDro C Arroliga Salim Surani Department of Internal Medicine Division of Pulmonary Critical Care and Sleep MedicineBaylor Scott and White Health Department of Biostatistics Baylor Scott and White Health Department of Medicine Texas A and M University

BACKGROUND Diabetic ketoacidosis(DKA) has an associated mortality of 1% to 5%. Upon admission, patients require insulin infusion and close monitoring of electrolyte and blood sugar levels with subsequent transitioning to subcutaneous insulin and oral nutrition. No recommendations exist regarding the appropriate timing for initiation of oral *** To assess short-term outcomes of oral nutrition initiated within 24 h of patients being admitted to a medical intensive care unit(MICU) for *** A retrospective observational cohort study was conducted at a single academic medical center. The patient population consisted of adults admitted to the MICU with the diagnosis of DKA. Baseline characteristics and outcomes were compared between patients receiving oral nutrition within(early nutrition group) and after(late nutrition group) the first 24 h of admission. The primary outcome was 28-d mortality. Secondary outcomes included 90-d mortality, MICU and hospital lengths of stay(LOS), and time to resolution of *** There were 128 unique admissions to the MICU for DKA with 67 patientsreceiving early nutrition and 61 receiving late nutrition. The APACHE(Acute Physiology and Chronic Health Evaluation) IV mortality and LOS scores and DKA severity were similar between the groups. No difference in 28-or 90-d mortality was found. Early nutrition was associated with decreased hospital and MICU LOS but not with prolonged DKA resolution, anion gap closure, or greater rate of DKA *** In patients with DKA, early nutrition was associated with a shorter MICU and hospital LOS without increasing the rate of DKA complications.

关键词： Diabetes mellitus Diabetic ketoacidosis Diabetic complications Acidosis Ketosis Critical care

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Patient prompting of their physician resulted in increased colon cancer screening referrals

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World Journal of Gastrointestinal Oncology 2014年第7期6卷 257-262页

作者： Vu Le Saqib Syed Kenneth J Vega Tushar Sharma Mohammad F Madhoun Nakumar Srinivasan courtney W Houchen Division of Digestive Disease and Nutrition Univer-sity of Oklahoma Health Sciences Center Oklahoma City OK 73104 United States College of Public Health University of Okla-homa Health Sciences Center Oklahoma City OK 73104 United States

AIM:To determine whether a communication instru-ment provided to patients prior to their primary carephysician(PCP)visit initiates a conversation with theirPCP about colorectal cancer screening(CRC-S),impact-ing screening referral rates in fully insured and underin-sured ***:A prospective randomized control studywas performed at a single academic center outpatient internal medicine(IRMC,underinsured)and fam-ily medicine(FMRC,insured)resident clinics prior to scheduled *** the intervention group,a pamphlet about the benefit of CRC-S and a reminder card were given to patients before the scheduled visit for prompt-ing of CRC-S referral by their *** main outcome measured was frequency of CRC-S referral in each clinic after ***:In the IRMC,148 patients participated,a control group of 72 patients(40F and 32M)and 76 patients(48F and 28M)in the intervention ***-ferrals for CRC-S occurred in 45/72(63%)of control vs 70/76(92%)in the intervention group(P≤0.001).In the FMRC,126 patients participated,66(39F:27M)con-trol and 60(33F:27M)in the intervention ***-S referrals occurred in 47/66(71%)of controls vs 56/60(98%)in the intervention group(P≤0.001).CONCLUSION:Patient initiated physician prompting produced a significant referral increase for CRC-S in un-derinsured and insured patient *** investigation aimed at increasing CRC-S acceptance is warranted.

关键词： Colon cancer Screening Primary care Physician patient relationship Referral

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A pediatrician-friendly review of three common behavioral health screeners in pediatric practice: Findings and recommendations

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Pediatric Investigation 2021年第1期5卷 58-64页

作者： Sandra Trafalis courtney Giannini Jeremy Joves Saige Portera Hannah Toyama Anika Mehta Krista Basile Robert D.Friedberg Center for the Study and Treatment of Anxious Youth Palo Alto UniversityPalo AltoCAUSA

Behavioral health concerns are surging in pediatric ***,integrated behavioral/medical health clinics are growing and child psychiatrists/psychologists are increasingly embedded in these care settings to help shoulder the clinical *** screening of behavioral health problems in primary care facilities enables early identification and ***,deciding on sound,efficient,and scalable screening measures is sometimes ***,this article presents a clinician-friendly review of three common instruments useful in screening pediatric behavioral health concerns including anxiety,depression,and conduct *** findings and clinical applications of the Pediatric Symptom Checklist-17(PSC-17),the Patient Health Questionnaire-9(PHQ-9),and the Screen for Child Anxiety Related Emotional Disorders(SCARED)are ***,clinical implications and recommendations for practicing pediatricians and child psychiatrists are offered.

关键词： Pediatricians Behavioral health Screeners

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Lipopolysaccharide triggers nuclear import of Lpcat1 to regulate inducible gene expression in lung epithelia

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World Journal of Biological Chemistry 2012年第7期3卷 159-166页

作者： Bryon Ellis Leah Kaercher courtney Snavely Acute Lung Injury Center of Excellence Division of Pulmonary Allergyand Critical Care MedicineDepartment of MedicineUniversity of Pittsburgh School of Medicine PittsburghPA 15213United States

AIM:To report that Lpcat1 plays an important role in regulating lipopolysaccharide (LPS) inducible gene tran-scription. METHODS:Gene expression in Murine Lung Epithelial MLE-12 cells with LPS treatment or Haemophilus influenza and Escherichia coli infection was analyzed by employing quantitative Reverse Transcription Polymerase Chain Reaction techniques. Nucleofection was used to deliver Lenti-viral system to express or knock down Lpcat1 in MLE cells. Subcellular protein fractionation and Western blotting were utilized to study Lpcat1 nuclear relocation. RESULTS:Lpcat1 translocates into the nucleus from thecytoplasm in murine lung epithelia (MLE) after LPS treatment. Haemophilus influenza and Escherichia coli , two LPS-containing pathogens that cause pneumonia, triggered Lpcat1 nuclear translocation from the cytoplasm. The LPS inducible gene expression profile was determined by quantitative reverse transcription polymerase chain reaction after silencing Lpcat1 or overexpression of the enzyme in MLE cells. We detected that 17 out of a total 38 screened genes were upregulated, 14 genes were suppressed, and 7 genes remained unchanged in LPS treated cells in comparison to controls. Knockdown of Lpcat1 by shRNA dramatically changed the spectrum of the LPS inducible gene transcription, as 18 genes out of 38 genes were upregulated, of which 20 genes were suppressed or unchanged. Notably, in Lpcat1 overex-pressed cells, 25 genes out of 38 genes were reduced in the setting of LPS ***:These observations suggest that Lpcat1 relocates into the nucleus in response to bacterial infection to differentially regulate gene transcriptional repression.

关键词： Lipopolysaccharide Nuclear import Lysophosphatidylcholine acyltransferase 1 Gene expression Lung epithelia Epigenetic code Quantitative reverse transcription polymerase chain reaction Haemophilus influenza Escherichia coli

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针刺在辅助生殖技术中的作用的调查研究

针刺在辅助生殖技术中的作用的调查研究

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作者： Alison courtney 广州中医药大学

学位级别：硕士

目的研究的目的是明确英国运用针灸疗法在辅助受孕过程(ACP)中的效果。本课题研究了ACP的诊疗规范,其使用的程度,和在两性生殖问题上针灸应用的广度。本研究的理论基础在既往的研究中,针灸能提高ACP成功率,特别是在受精卵移植前后的... 详细信息

目的研究的目的是明确英国运用针灸疗法在辅助受孕过程(ACP)中的效果。本课题研究了ACP的诊疗规范,其使用的程度,和在两性生殖问题上针灸应用的广度。本研究的理论基础在既往的研究中,针灸能提高ACP成功率,特别是在受精卵移植前后的一段时间里(ET)。有证据表明,针灸在ACP过程中起到了积极的作用;例如,改善卵巢功能,提高卵子质量;协同促排药物调节激素水平,增加子宫血液循环,增加子宫内膜厚度,并防止宫缩。在英国主要有BOVEY等人进行了这方面的研究。在2010年针对英国针灸师对不孕症治疗的观点进行了一次大规模的调查。一项由英国针灸协会(BACC)资助的调查显示,不孕症的标准化治疗在英国比较罕见,且针灸疗法诊疗规范一般应用于生殖医学。笔者希望进一步探讨英国针灸师如何成功的将针灸疗法与ACP结合,及怎样开发出最行之有效的方法。笔者也希望能进一步增进中西医学对ACP的认识。假说如下： 1.就女性不孕症而言,针刺的临床疗效较单一ACP高,而与针刺联合ACP的疗效无异。 2.就男性不育症而言,针刺联合ACP的临床疗效高于单一针刺或ACP。 3.就针刺与ACP联合而言,基于“辨证”的临床疗效高于常规的诊疗规范。研究的唯一限制在于异性伴侣无法获得精子或卵子捐赠。方法采用定性和定量相结合的混合研究方法。定量法同时论证问题和假说,并提供数据来验证针灸是否对ACP产生积极影响。定量研究方面,发放在线调查问卷予英国针协成员(约1000名);附属国家网络Zita West成员(140名)以及中国医学会注册成员(150名)。调查数据的收集通过SurveyMonkey公司,进行统计和绘图。并将这些数据下载到电子表格进行更多的分析。从访谈的资料中分析主题,确定观点和趋势。定性法则增加了研究的深度和广度。研究的问题集中在：英国针灸师利用针刺治疗介入ACP的程度;针刺联合ACP对临床受孕率的影响;针刺疗法作为诊疗规范的临床效应;ACP过程中针刺的治疗规范;对六位英国针灸师进行了半结构式访谈,并综合各方建议和个人经验,以进一步了解针刺在生殖健康方面的作用。结果问卷发给了1,234名英国针灸师,收到回馈64份。其中98.4%均主治不孕症,这些中有87.5%采用针灸联合ACP的治疗方法。大多数针灸师在整个ACP阶段使用针刺疗法,同时有6.6%的治疗师在胚胎移植前后使用针刺疗法。访谈内容主要强调几个主题——针灸在降低压力水平;调节月经周期,有助生育;改善体质和治疗习惯性流产等均有优势。大部分受访的针灸师认为针刺可以减少促排药物的副作用。调查结果显示,对女性而言,接受单纯针刺治疗的受孕率(75%)往往较单一ACP(33.4%)高;而针刺联合ACP的受孕率约为57%。而对男性而言,评估发现单纯针刺治疗的受孕率最高(50%),比单一ACP(33.4%)和针刺联合ACP的受孕率(30%)都高。基于中医辨证论治的受孕率约57%,高于在ACP过程中遵循诊疗规范的受孕率(33.4%)约23.4%。然而,基于Paulus诊疗指南的治疗则达到了更高的受孕率(75%),这比规定的受孕率33.4%高了41.6%。受访者认为针刺疗法在ACP过程中大有裨益,能有效减轻压力,并极大的协助了ACP。多数人认为针灸治疗最好在启动ACP前至少1-3个月内介入。受访者认为女性不孕的最常见问题在于：排卵障碍,月经失调,多囊卵巢综合征,子宫内膜异位症和痛经。仅有50%的受访者经治男性不育症。从收集的数据来看,688名患者接受了针刺治疗,其中499名成功妊娠。499例患者接受了针刺联合ACP疗法,其中282例妊娠。进行卡方检验P=0.003077674,具有统计学意义。结论虽然研究结果有统计学意义,但需要进行进一步研究来探讨为何Paulus诊疗指南较中医联合ACP疗法更为成功。半结构式访谈有效划分了具体问题并增加了数据的丰富性。本研究得出的结论如下： 1.单一针刺治疗女性不孕症能获得更高的受孕率(75%),高于单纯的ACP(33.4%);和针刺联合ACP的57%。 2.针刺联合ACP的受孕率仅为30%,均低于针刺疗法(50%),或ACP(33.4%)。 3.遵照诊疗规范的ACP往往获得较高的受孕率(75%),较传统中医疗法高(57%)。 4.调查结果预示着英国的从业者将受益于对ACP诊疗规范的新认识。调查数据显示,一些从业者对本调查中提出的问题不了解,将通过接受系统的学习和加深对中医与ACP相结合的复杂性过程的了解而受益匪浅。

关键词：试管婴儿辅助生殖技术针刺卵胞浆内单精子注射技术

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African-American Women＇s Perceptions of Constitutive Meanings of Good Hair Articulated in Black Hair Magazine Advertisements

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Journalism and Mass Communication 2012年第1期2卷 279-293页

作者： Eletra S. Gilchrist courtney Thompson The University of Alabama in Huntsville USA

Hair has historically reflected material consequences in the Black community; thus, research has begun to investigate how the power/privilege matrix that is propagated throughout the media permeates society and impacts African-Arnerican women＇s perceptions of hair. This research joins the discussion by exploring how Black hair magazine advertisements influence Black women＇s hair decisions and their percepfious of what constitutes beautiful Black hair. Findings reveal that the images African-American women consume from Black hair magazine advertisements do impact what they consider to be beautiful and, subsequently, influence their day-to-day styling and hair care mechanisms, lending further support to the idea that the media serve as powerful sources of knowledge. This study culminates by theorizing about the constitutive meanings and importance of Black hair as conveyed through magazine advertisements and considers how Black women use social comparisons to make everyday hair decisions to achieve what they identify as good hair.

关键词： body politics hair politics social comparison theory Black hair magazine advertisements

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The world meteorological organization Tenth International Workshop on tropical cyclones(IWTC-10):A summary

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Tropical Cyclone Research and Review 2023年第1期12卷 1-9页

作者： Robert Rogers Joseph courtney Kimberly Wood NOAA/AOML Hurricane Research Division MiamiFLUSA Bureau of Meteorology West PerthAustralia Mississippi State University MSUSA

The Tenth International Workshop on Tropical Cyclones(IWTC-10)occurred from 5 to 9 December 2022 in Bali,*** workshop continued the goal of the original IWTC,held in 1985 in Bangkok,Thailand,to bring together forecasters and researchers from countries around the world that are impacted by tropical cyclones(TCs)to discuss the latest research and forecast advances and share best practices to improve TC forecasts *** workshops have continued as a regular feature of WMO efforts to encourage the advancement of TC forecasting and improve ways of communicating TC hazards to the general *** TC forecasting efforts in the past 10–15 years have emphasized hazards and impacts of landfalling TCs beyond just track and ***,there has been a growing interest in improving the communication of these hazards and impacts,using concepts from social and behavioral sciences,in ways that can lead to effective decision-making from stakeholders(e.g.,government officials,emergency managers,media,general public).As such,the theme for IWTC-10 was“Improved TC science and services for better decision-making.”More about this theme,how the workshop was structured around it,and key outcomes from the workshop are discussed in this summary article.©2023 The Shanghai Typhoon Institute of China Meteorological *** services by Elsevier *** behalf of KeAi Communication *** is an open access article under the CC BY license(http://***/licenses/by/4.0/).

关键词： Tropical cyclone workshop Forecasters and researchers Warning value cycle

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