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制作、听音两不误——评析四款“两进两出”专业音频卡

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微型计算机 2004年第16期24卷 25-30页

作者： musiXboy mc

Assessing cultural competency skills in gastroenterology fellowship training

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World Journal of Gastroenterology 2015年第6期21卷 1887-1892页

作者： Sophie Balzora Benjamin Abiri Xiao-Jing Wang James mc Keever Michael Poles Sondra Zabar Colleen Gillespie Elizabeth Weinshel Division of Gastroenterology Department of Medicine NYU School of Medicine NYU School of Medicine Division of General Internal Medicine Department of Medicine NYU School of Medicine

AIM:To assess and teach cultural competency skills at the fellowship training level through the use of objective structured clinical examinations(OSCEs).METHODS:We revised four scenarios to infuse a specific focus on cross-cultural care,and to render them appropriate for gastroenterology *** are discussed here:(1)Poor Health Literacy;(2)Disclosing/Apologizing for a Complication to a Patient Who Mistrusts the Healthcare System;and(3)Breaking Bad News to a Fatalistic Patient.A fourth case emphasizing shared decision-making will be described *** stations were completed by fellows and observed live by four faculty members,and the fellows’performance was ***:Eleven fellows from four programs participated in the four *** the"Poor Health Literacy"case,18%(2/11)of participants recognized that the standardized patient(SP)had below-basic health *** successfully evaluated the SP’s reading skills in a culturally-sensitive ***"Disclosing/Apologizing for a Complication",4/11(36%)personally apologized for the complication.1/11 recognized the SP’s mistrust of the medical ***"Breaking Bad News",27%(3/11)explored the patient’s values to identify her fatalistic ***:OSCEs can be used to assess deficiencies in culturally-competent care at the fellowship *** also afford fellowships the opportunity to inform future training curricula.

关键词： Patient care Physician-patient relations Gastroent

Management and prevention of acute and chronic lateral ankle instability in athletic patient populations

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World Journal of Orthopedics 2015年第2期6卷 161-171页

作者： Brendan J mc Criskin Kenneth L Cameron Justin D Orr Brian R Waterman Department of Orthopaedic Surgery and Rehabilitation William Beaumont Army Medical Center the John A. Feagin Jr Sports Medicine Fellowship Keller Army HospitalUS Military AcademyWest Point

Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significantlong-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and nonanatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance.

关键词： Ankle instability Athlete Treatment Epidemiology Prevention Lateral Sprain

Pancreatic endometrial cyst mimics mucinous cystic neoplasm of the pancreas

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World Journal of Gastroenterology 2017年第6期23卷 1113-1118页

作者： Michael A Mederos Nicole Villafane Sadhna Dhingra Carlos Farinas Amy mc Elhany William E Fisher George Van Buren II Department of General Surgery Baylor College of Medicine Department of Pathology Baylor College of Medicine Department of Radiology Baylor College of Medicine

Pancreatic cysts include a variety of benign, premalignant, and malignant lesions. Endometrial cysts in the pancreas are exceedingly rare lesions that are difficult to diagnose pre-operatively. This report describes the findings in a 43-year-old patient with a recent episode of acute pancreatitis who presented with a large cyst in the tail of the pancreas. Imaging demonstrated a loculated pancreatic cyst, and cyst fluid aspiration revealed an elevated amylase and carcinoembryonic antigen. The patient experienced an interval worsening of abdominal pain, fatigue, diarrhea, and a 15-pound weight loss 3 mo after the initial episode of pancreatitis. With concern for a possible pre-malignant lesion, the patient underwent a laparoscopic distal pancreatectomy with splenectomy, which revealed a 16cm×12cm×4cm lesion. Final histopathology was consistent with an intra-pancreatic endometrial cyst. Here we discuss the overlapping imaging and laboratory features of pancreatic endometrial cysts and mucinous cystic neoplasms of the pancreas.

关键词： Pancreatic cyst Pancreatic endometrial cyst Endometriosis Mucinous cystic neoplasm of the pancreas Distal pancreatectomy

Updated Digital Map of Mafic Dyke Swarms and Large Igneous Provinces in Western Australia

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Acta Geologica Sinica(English Edition) 2016年第S1期90卷 13-14页

作者： Michael T.D.WINGATE David mc B.MARTIN Geological Survey of Western Australia

Since 1894,the Geological Survey of Western Australia(GSWA)has released 14 versions of the‘Geological Map of Western Australia’.The latest in this series,published in December 2015,is the first bedrock geology map

关键词： Updated Digital Map of Mafic Dyke Swarms and Large Igneous Provinces in Western Australia

A multilocus molecular phylogeny for the avian genus Liocichla(Passeriformes:Leiothrichidae:Liocichla)

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Chinese Birds 2015年第3期6卷 140-152页

作者： Herman L Mays Bailey D mc Kay Dieter Thomas Tietze Cheng-Te Yao Lindsey N Miller Kathleen N Moreland Fumin Lei Department of Biological Sciences Marshall University Cincinnati Museum Center American Museum of Natural History Institute of Pharmacy and Molecular Biotechnology Heidelberg University Endemic Species Research Institute Biotechnology Program Loveland High School Institute of Zoology Chinese Academy of Sciences

Background:Historically the babblers have been assigned to the family Timaliidae but several recent studies have attempted to rest the taxonomy of this diverse passerine assemblage on a more firm evolutionary *** result has been a major rearrangement of the group.A well?supported and comprehensive phylogeny for this widespread avian group is an important part of testing evolutionary and biogeographic hypotheses,especially in Asia where the babblers are a key component of many forest ***,the genus Liocichla is poorly represented in these prior studies of babbler ***:We used a multilocus molecular genetic approach to generate a phylogenetic hypothesis for all five cur?rently recognized species in the avian genus *** DNA sequence data was used to construct individ?ual gene trees using maximum likelihood and species trees were estimated from gene trees using Bayesian *** dates were obtained using a molecular clock ***:Molecular data estimate a probable window of time for the origin for the Liocichla from the mid to late Miocene,between 5.55 and 12.87 *** plumage similarities between the insular Taiwan endemic,***,and the continental *** and ***,molecular data suggest that *** is the sister taxon to all continen?tal *** continental Liocichla are comprised of two lineages;a lineage containing *** and *** and a lineage comprised of *** and *** comparatively early divergence of *** within the Liocichla may be illusory due to extinct and therefore unsampled *** and *** are parapatric with a Pleistocene split(0.07–1.88 Ma) occurring between an Eastern Himalayan *** and a Northern Indo?china distributed *** and *** underwent a similar split between the Eastern Himalaya(***) and Central China(***) divided by the Hengduan ***

关键词： Biogeography Himalayas Leiothrichidae Liocichla Phylogenetics Phylogeography Taiwan

Does bilateral otosclerosis make pre-operative bone conduction more inaccurate?

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Journal of Otology 2021年第1期16卷 1-5页

作者： Fiona mcClenaghan Jeremy Lavy The Royal National Throat Nose and Ear Hospital 330 Grays Inn RoadLondonWC1X 8DAUnited Kingdom

Objectives:To assess whether bilateral otosclerosis renders pre-operative bone conduction more inaccurate by increasing the Carhart ***:Retrospective review of a database of pre and post-operative audiograms of 745 ears with otosclerosis treated with stapedectomy from 2013 to 2020 in a tertiary *** outcome measures:Change in bone conduction after stapedectomy for otosclerosis in:unilateral otosclerosis(U1);bilateral otosclerosis undergoing first side surgery(B1);bilateral otosclerosis undergoing second side surgery(B2).The magnitude of change in bone conduction post-operatively within and between each ***:The average difference in pre and post-operative bone conduction was significant within in all groups(T-stat>2 and P-value<0.05)with the greatest change observed in the U1 *** of average change in bone conduction between groups did not reach statistical significance(Pvalue=0.37).Analysis of change per frequency demonstrated the greatest change in bone conduction post-operatively at 2000 Hz in all *** magnitude of change at 2000 Hz was the greatest in the bilateral groups;however,it did not reach statistical significance when compared to the unilateral group(P-value=0.36).Conclusions:This is the first study in the literature to assess the accuracy of pre-operative bone conduction in bilateral versus unilateral *** is no evidence that pre-operative bone conduction in bilateral otosclerosis is more inaccurate than in unilateral *** order to assess accuracy of pre-operative bone conduction in otosclerosis a reliable method of assessing post-operative bone conduction is required,without assumption of its equivalence to cochlear reserve.

关键词： Otosclerosis Stapedectomy Hearing loss Bone conduction

Total pancreatectomy with islet cell transplantation vs intrathecal narcotic pump infusion for pain control in chronic pancreatitis

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World Journal of Gastroenterology 2016年第16期22卷 4160-4167页

作者： Mohamad Mokadem Lama Noureddine Thomas Howard Lee mc Henry Stuart Sherman Evan L Fogel James L Watkins Glen A Lehman Division of Gastroenterology and Hepatology Roy J. and Lucille A. Carver College of Medicine University of Iowa Iowa IA 52242 United States Division of Nephrology and Hypertension Roy J. and Lucille A. Carver College of Medicine University of Iowa Iowa IA 52242 United States Community Health Network Indianapolis IN 46219 United States Division of Gastroenterology and Hepatology Indiana University Medical Center Indianapolis IN 46202 United States

AIM: To evaluate pain control in chronic pancreatitis patients who underwent total pancreatectomy with islet cell transplantation or intrathecal narcotic pump ***: We recognized 13 patients who underwent intrathecal narcotic pump(ITNP) infusion and 57 patients who underwent total pancreatectomy with autologous islet cell transplantation(TP + ICT) for chronic pancreatitis(CP) pain control between 1998 and 2008 at Indiana University Hospital. All patients had already failed multiple other modalities for pain control and the decision to proceed with either intervention was made at the discretion of the patients and their treating physicians. All patients were evaluated retrospectively using a questionnaire inquiring about their pain control(using a 0-10 pain scale), daily narcotic dose usage, and hospital admission days for pain control before each intervention and during their last follow-up. RESULTS: All 13 ITNP patients and 30 available TP + ICT patients were evaluated. The mean age was approximately 40 years in both groups. The median duration of pain before intervention was 6 years and 7 years in the ITNP and TP + ICT groups, respectively. The median pain score dropped from 8 to 2.5(on a scale of 0-10) in both groups on their last follow up. The median daily dose of narcotics also decreased from 393 mg equivalent of morphine sulfate to 8 mg in the ITNP group and from 300 mg to 40 mg in the TP + ICT group. No patient had diabetes mellitus(DM) before either procedure whereas 85% of those who underwent pancreatectomy were insulin dependent on their last evaluation despite ICT. CONCLUSION: ITNP and TP + ICT are comparable for pain control in patients with CP however with high incidence of DM among those who underwent TP + ICT. Prospective comparative studies and longer follow up are needed to better define treatment outcomes.

关键词： Chronic pancreatitis Intractable pain Total pancreatectomy Islet cell transplantation Intrathecal narcotic pump infusion

Credentialing in radiology:Current practice and future challenges

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World Journal of Radiology 2016年第5期8卷 506-512页

作者： Adam Youssef Paul mc Coubrie Department of Radiology Southmead Hospital

Radiology has changed significantly in recent years. The volume of work has increased dramatically as has its complexity. Future radiologists need an adequate training and expertise in conventional practice as well as new techniques. This comes at a time when other stakeholders outside of radiology are voicing their own concerns. The rightly justified increasing focus on patient safety has placed even more emphasis on the demonstration of competent practice by all health care professionals. Credentialing has been put forward as a way to ensure a doctor is competent in specific areas. Credentialing may be an alien concept to many radiology trainees but moves are afoot in the United Kingdom to bring it to the forefront of its postgraduate medical training. Credentialing began in 20 th century North America where it was linked to the process of privileging. It subsequently garnered a strong patient safety focus and has become a part of the international healthcare agenda. Not everyone agrees with credentialing, it has many criticisms including the risk of speciality "turf wars" and the stifling of medical excellence to name just a couple. Is credentialing in radiology here to stay or will it pass by quietly? This paper reviews the global credentialing movement and discusses how this may impact on future radiology training, using the United Kingdom as its case example.

关键词： Credentialing Medical education Patient safety Radiology Accreditation