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Storylines of family medicine Ⅻ:family medicine and the healthcare system

Family Medicine and Community Health 2024年第S3期12卷 109-118页

作者： William B Ventres Leslie A Stone jeannette e south-paul Kendall M Campbell Aerial R Petty Hima ekanadham Kurt C Stange Rebecca S etz William L Miller Robert L Ferrer Marianna Kong Thomas Bodenheimer Roger Strasser Sharon C M Reece Joshua Freeman John M Westfall Family and Preventive Medicine University of Arkansas for Medical Sciences College of MedicineLittle RockArkansasUSA Meharry Medical College NashvilleTennesseeUSA Family Medicine University of Texas Medical Branch at Galveston School of MedicineGalvestonTexasUSA Family Medicine Residency Program New York-Presbyterian Columbia University Medical CenterNew YorkNew YorkUSA Center for Family and Community Medicine Columbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA Center for Community Health Integration Case Western Reserve University School of MedicineClevelandOhioUSA Family Medicine and Population Health Virginia Commonwealth University School of MedicineRichmondVirginiaUSA Family Medicine Lehigh Valley Health NetworkAllentownPennsylvaniaUSA University of south Florida Morsani College of Medicine TampaFloridaUSA Family and Community Medicine UT Health San Antonio Long School of MedicineSan AntonioTexasUSA Family and Community Medicine University of California San Francisco School of MedicineSan FranciscoCaliforniaUSA Northern Ontario School of Medicine University SudburyOntarioCanada Family Medicine Baylor Scott and White HealthTempleTexasUSA Family Medicine University of Kansas School of MedicineKansas CityKansasUSA DARTNet Insitute AuroraColoradoUSA

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine,as interpreted by individual family physicians and medical educators in the USA and elsewhere around the ***‘Ⅻ:Family medicine and the future of the healthcare system’,authors address the following themes:‘Leadership in family medicine’,‘Becoming an academic family physician’,‘Advocare—our call to act’,‘The paradox of primary care and three simple rules’,‘The quadruple aim—melding the patient and the health system’,‘Fit-for-purpose medical workforce’,‘Universal healthcare—coverage for all’,‘The futures of family medicine’and‘The 100th essay.’May readers of these essays feel empowered to be part of family medicine’s exciting future.

关键词： system illustration family

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乳房肿块与乳房疼痛

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中国全科医学 2002年第6期5卷 426-428页

作者： Lori J.Heim jeannette e.south-paul 梁万年曹红霞 Department of Family Medicine Director University Health CenterUniformed Services University of the Health Sciences Bethesda Department of Family Medicine Uniformed Services University of the Health Science.Bethesda 首都医科大学公共卫生与家庭医学院北京市100054

Mary Smith,32岁,已婚,无子女,发现其右侧乳房有一轻度触痛的肿块后前来就诊.她作为Ivy Robin-son医生的病人已有8年.昨夜,Mary在做乳房自我检查时注意到了这个肿块.

关键词：病理诊断治疗乳房肿块乳房疼痛

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Diagnosis of CAH in a Sub Saharan Country: Visible Part of Iceberg

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Open Journal of Pediatrics 2024年第2期14卷 227-233页

作者： Suzanne Sap Ritha Mbono Hélène Kamo Jocelyn Tony Charlotte eposse jeannette epée Isabelle Mekone Adele Bodieu Gaelle Ntsoli paul Olivier Koki Mother and Child Center of the Chantal Biya Foundation University of Yaoundé I Yaoundé Cameroon Laquintinie Hospital University of Douala Douala Cameroon Genral Hospital of Garoua University of Garoua Garoua Cameroon Human Reproductive Center and Research on Fertility of Yaoundé University of Yaoundé I Yaoundé Cameroon Yaounde General Hospital University of Yaoundé I Yaoundé Cameroon Yaounde Central Hospital Yaoundé Cameroon Laquintiinie Hospital Douala Cameroon

Introduction :Congenital adrenal hyperplasia (CAH) is the most common cause of primary adrenal insufficiency. It is a rare monogenic recessive disorder. In African setting in absence of neonatal screening, the diagnosis is still late, based on a clinical approach. During this clinical enquiry, information from past history or pedigree of the patient is of a huge importance and may revealed surprises. Patients and Methods: In this observational study, we retrospectively included all patients with a diagnosis of CAH. The diagnosis of CAH was retained based on a high 17 hydroxyprogesterone level in addition to clinical and morphological findings. From patients’ files, we extracted data on family history of disease, pedigree, clinical findings and genetics when available of 39 patients from two endocrinopeadiatric centers. Results: In 13 (30%) families, we found 20 reported deaths of infant less than 12 months. In these 13 families, half of the patients followed had 21 hydroxylase deficiencies and had 11 hydroxylase deficiencies. Unsurprisingly, we suspected adrenal insufficiency in these patients at verbal autopsy even in families with a patient with 11 hydroxylase deficiency. Other non DSD malformations or genetic disorders with apparently no link with CAH were reported in 3 families. The father of a patient reported to have hypospadias. Conclusion: each diagnosis of CAH made in our context is visible part of an iceberg. Behind a diagnosis of CAH made in our setting, is a long course of care, a dramatic past history revealing access to appropriate care disparity. Neonatal screening should thus be considered as an emergency.

关键词： Congenital Adrenal Hyperplasia

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Acceptance and experience of HIV-Infected Adolescents in Two Hospitals in Yaoundé

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Open Journal of Pediatrics 2024年第2期14卷 435-443页

作者： Isabelle Mekone Nkwele Nelly Kamgaing Pierrette Amanda emah Manga jeannette Épée Ngoué Hélène Kamo Sélangai Claude Audrey Meguieze Nsoh Ndeh-Fofang Serge Tchoukoua Jean-Baptiste Fotso Djemo paul Koki Ndombo Department of Pediatrics Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Institut Supérieur des Sciences de la Santé de Bangangté Université des Montagnes Bangangté Cameroon Faculty of Medicine and Biomedical Sciences University of Garoua Garoua Cameroon

Introduction: Access to antiretroviral drugs has improved the survival of children infected with the Human Immunodeficiency Virus (HIV). As they reach adolescence, they are confronted with various constraints related to the infection and its treatment, in addition to those of the growth period they are going through. The main aim of the study was to assess the acceptance and describe the experience of HIV infection by infected adolescents but also to investigate the factors associated with good acceptance and a positive experience. Methodology: The cross-sectional analytic study concerned HIV-infected adolescents aged 15 to 19 followed up at the Chantal Biya Foundation-Mother and Child Centre (CMe-FCB) and the Yaoundé University Hospital Centre (CHUY) between February 2020 and June 2020. The study saw participants complete a questionnaire containing socio-demographic data and assessing acceptance and experience with the infection. Data analysis was accomplished using epi info software version 7.***.2.6. Results: One hundred and thirteen HIV-infected adolescents were included in the study. The sex ratio was 0.68 and the mean age was 17 years. More than half of the adolescents had a good acceptance and positive experience with the infection. Related factors were the adolescent’s perception of good health and participation in an association with other infected adolescents. Conclusion: emphasizing the psychological and educational follow-up of infected adolescents and encouraging their participation in associations for adolescents living with HIV could reduce the consequences of poor acceptance and ensure a better transition to adulthood. .

关键词： HIV Adolescent Acceptance experience

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The great catastrophe: causes of the Permo-Triassic marine mass extinction

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National Science Review 2024年第1期11卷 37-50页

作者： paul B.Wignall David P.G.Bond School of earth & environment University of Leeds School of environmental Sciences University of Hull

The marine losses during the Permo-Triassic mass extinction were the worst ever experienced. All groups were badly affected, especially amongst the benthos(e.g. brachiopods, corals, bryozoans, foraminifers,ostracods). Planktonic populations underwent a fundamental change with eukaryotic algae being replaced by nitrogen-fixing bacteria, green-sulphur bacteria, sulphate-reducing bacteria and prasinophytes. Detailed studies of boundary sections, especially those in south China, have resolved the crisis to a ～55 kyr interval straddling the Permo-Triassic boundary. Many of the losses occur at the beginning and end of this interval painting a picture of a two-phase extinction. Improved knowledge of the extinction has been supported by numerous geochemical studies that allow diverse proposed extinction mechanisms to be studied. A transition from oxygenated to anoxic-euxinic conditions is seen in most sections globally, although the intensity and timing shows regional variability. Decreased ocean ventilation coincides with rapidly rising temperatures and many extinction scenarios attribute the losses to both anoxia and high *** kill mechanisms include ocean acidification for which there is conflicting support from geochemical proxies and, even less likely, siltation(burial under a massive influx of terrigenous sediment) which lacks substantive sedimentological evidence. The ultimate driver of the catastrophic changes at the end of the Permian was likely Siberian Trap eruptions and their associated carbon dioxide emissions with consequences such as warming, ocean stagnation and acidification. Volcanic winter episodes stemming from Siberian volcanism have also been linked to the crisis, but the short-term nature of these episodes(ecades) and the overwhelming evidence for rapid warming during the crisis makes this an unlikely cause. Finally, whilst the extinction is well studied in equatorial latitudes, a different history is found in northern Boreal latitudes

关键词： ocean anoxia ocean acidification siltation productivity collapse volcanic winter

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Plant-available water capacity of soils at a regional scale:Analysis of fixed and dynamic field capacities

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Pedosphere 2024年第3期34卷 590-605页

作者： Vinod PHOGAT paul RPeTRIe Casandra COLLINS Marcos BONADA south Australian Research and Development Institute GPO Box 397Adelaide SA 5001(Australia) School of Agriculture Food and WineWaite Research InstituteUniversity of AdelaideWaite CampusPMB1Glen Osmond SA 5064(Australia) College of Science and engineering Flinders UniversityBedford Park SA 5042(Australia) The University of New south Wales Sydney NSW 2052(Australia) ARC Training Centre for Innovative Wine Production University of AdelaidePMB1Glen Osmond SA 5064(Australia)

estimation of the plant-available water capacity(PAWC)of soils at a regional scale helps in adopting better land use planning,developing suitable irrigation schedules for crops,and optimizing the use of scarce water *** the current study,72 soil profiles were sampled from the Barossa region of south Australia to estimate pedo-transfer functions deduced from easily estimated soil *** functions were then used to estimate the fixed(10 and 33 kPa)and dynamic pressure head(h_(fc))water contents at field capacity(FC)for minimum drainage flux(0.01 and 0.001 cm d^(-1)),which serves as the upper boundary for plant-available water in *** estimated residual water content was corrected for subsoil constraints,especially the exchangeable sodium percentage(eSP).The results showed that the mean values of h_(fc)in sand-dominated light and medium textured soils(i.e.,sand,loamy sand,sandy loam,and loam)varied in a narrow range(15.8-18.2 kPa),whereas those in the clay-dominated heavy textured soils(i.e.,clay loam)showed a wide range(11.3-49.3 kPa).There were large differences in PAWC for dynamic FC(PAWC_(fc))and fixed FC at 10 kPa(PAWC10),33 kPa(PAWC33),and a mix of 10and 33 kPa(PAWC_(10,33))pressure heads depending on soil ***,the difference between PAWC at 10 kPa and h_(fc)(ΔPAWC_(10))was positive,whereas that between 33 kPa and h_(fc)(ΔPAWC_(33))was negative across all ***,the estimation of PAWC assuming a fixed FC at 10 and 33 kPa pressures(i.e.,PAWC_(10,33))for sandy,clay,and silty soils reduced the difference between fixed and dynamic pressure PAWCs toe *** estimation of PAWC was improved by incorporating the impact of subsoil constraints,such as high eSP,which was more pronounced for clay and silty *** findings demonstrate the inherent inconsistencies between static pressure and flux-based dynamic FC estimations in *** heterogeneity,intra-texture variability,subsoil constraints,and swell

关键词： crop lower limit drained upper limit pedo-transfer function soil hydraulic parameter soil texture

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Optimizing photorespiration for improved crop productivity

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Journal of Integrative Plant Biology 2018年第12期60卷 1217-1230页

作者： paul F.south Amanda P.Cavanagh Patricia e.Lopez-Calcagno Christine A.Raines Donald R.Ort Global Change and Photosynthesis Research Unit United States Department of Agriculture/Agricultural Research ServiceUrbana Carl R.Woese Institute for Genomic Biology University of IllinoisUrbana School of Biological Sciences University of Essex Department of Crop Sciences University of IllinoisUrbana Department of Plant Biology University of IllinoisUrbana

In C3 plants, photorespiration is an energyexpensive process, including the oxygenation of ribulose-1,5-bisphosphate(RuBP) by ribulose 1,5-bisphosphate carboxylase/oxygenase(Rubisco) and the ensuing multiorganellar photorespiratory pathway required to recycle the toxic byproducts and recapture a portion of the fixed carbon. Photorespiration significantly impacts crop productivity through reducing yields in C3 crops by as much as 50%under severe conditions. Thus, reducing the flux through, or weive R improving the efficiency of photorespiration has the potential of large improvements in C3 crop ***, we review an array of approaches intended to engineer photorespiration in a range of plant systems with the goal of increasing crop productivity. Approaches include optimizing flux through the native photorespiratory pathway, installing non-native alternative photorespiratory pathways, and lowering or even eliminating Rubiscocatalyzed oxygenation of RuBP to reduce substrate entrance into the photorespiratory cycle. Some proposed designs have been successful at the proof of concept level.A plant systems-engineering approach, based on new opportunities available from synthetic biology to implement in silico designs, holds promise for further progress toward delivering more productive crops to farmer’s fields.

关键词： Optimizing photorespiration for improved crop productivity Figure

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A randomized controlled trial of Promoting Physical Activity in Regional and Remote Cancer Survivors(PPARCS)

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Journal of Sport and Health Science 2024年第1期13卷 81-89页

作者： Sarah J.Hardcastle Chloe Maxwell-Smith Vinicius Cavalheri Terry Boyle Marta Leyton Román Cameron Platell Michael Levitt Christobel Saunders Frank Sardelic Sophie Nightingale Jacob McCormick Craig Lynch paul A.Cohen Max Bulsara Dana Hince Sport and Physical Activity Research Centre Sheffield Hallam UniversitySheffieldS102BPUK Institute for Health Research The University of Notre DameFremantleWA 6959Australia Curtin School of Population Health Curtin UniversityPerthWA 6845Australia Curtin School of Allied Health Curtin UniversityPerthWA 6845Australia Allied Health South Metropolitan Health ServiceMurdochWA 6150Australia Australian Centre for Precision Health University of South AustraliaAdelaideSA 5001Australia Department of Didactics of Musical Plastic and Body ExpressionUniversity of ExtremaduraCaceres 10071Spain St.John of God Subiaco Hospital PerthWA 6008Australia Department of Surgery University of MelbourneMelbourneVIC 3010Australia Tamara Private Hospital TamworthNSW 2340Australia Peter MacCallum Cancer Centre MelbourneVIC 3000Australia College of Health and Medicine Australian National UniversityCanberraACT 2600Australia Division of Obstetrics and Gynaecology Medical SchoolUniversity of Western AustraliaPerthWA 6009Australia

Background:Physical activity(PA)is important for cancer *** of remotely delivered interventions are needed to assist in reaching under-served non-metropolitan cancer *** objective of this study was to ascertain whether wearable technology,coupled with health coaching was effective in increasing PA in breast and colorectal cancer survivors living in regional and remote areas in ***:Cancer survivors from 5 states were randomized to intervention and control *** participants were given a Fitbit Charge 2TMand received up to 6 telephone health coaching *** participants received PA print *** assessments at baseline and 12 weeks measured moderate-to-vigorous PA(MVPA),light PA,and sedentary ***:eighty-seven participants were recruited(age=63±11 years;74(85%)female).There was a significant net improvement in MVPA of 49.8 min/week,favoring the intervention group(95%confidence interval(95%CI):13.6-86.1,p=0.007).There was also a net increase in MVPA bouts of 39.5 min/week(95%CI:11.9-67.1,p=0.005),favoring the intervention *** groups improved light PA and sedentary behavior,but there were no between-group ***:This’s the first study to demonstrate that,when compared to standard practice(i.e.,PA education),a wearable technology intervention coupled with distance-based health coaching,improves MVPA in non-metropolitan cancer *** results display promise for the use of scalable interventions using smart wearable technology in conjunction with phone-based health coaching to foster increased PA in geographically disadvantaged cancer survivors.

关键词： Behavior change exercise Health disparities Oncology Wearable technology

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Comparison of the Clinical Profile and Severity Factors of COVID-19 during the First 4 Waves in a Paediatric Population of Yaounde

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Open Journal of Pediatrics 2023年第1期13卷 125-137页

作者： Jocelyn Tony Nengom Suzanne Sap Ngo Um Louis Serge Tang Nlend Bonaventure Hollong jeannette epée Ngoué paul Olivier Koki Ndombo Faculty of Medicine and Biomedical Sciences Department of Pediatrics University of Yaounde I Yaounde Cameroon Mother and Child Center of Chantal Biya’s Foundation Yaounde Cameroon Specialized Center for COVID-19 Patients Annex Number II of the Yaounde Central Hospital (ORCA) Yaounde Cameroon

Introduction: COVID-19 is an infectious disease that has been causing a global pandemic since 2019. Although clinical forms are generally less severe in children than in adults, children nevertheless present polymorphous clinical forms and severe cases that can lead to death. Objective: To describe the clinical presentations found in the different waves of COVID-19, and to highlight the different factors of severity. Materials and Methods: We conducted a cross-sectional study with retrospective and prospective data collection which lasted 7 months (from November 2021 to June 2022) and covered a study period from 6 March 2020 to 22 June 2022, i.e. 27 months. All patients aged 0 to 18 years, suspected of having COVID-19, confirmed by real-time RT-PCR or an antigenic Rapid Diagnostic Test or antibody were included. These patients were to be managed in the Mother and Child Centre of the Chantal Biya Foundation, as well as in the Specialised Centre for the Management of COVID patients, annex number II of the Yaoundé Central Hospital. The results were analysed using IBM SPSS.23 software. Results: We included 163 patients in our study. No paediatric patients were registered during the 3rd wave. The mean age of the patients in the study population was 13 ± 5 years with extremes from 15 days to 18 years. We had a female predominance with a sex ratio of 0.83. The most common comorbidity was asthma. The first wave presented mainly with respiratory symptoms such as dry cough and signs of respiratory distress. The second wave presented mainly with digestive symptoms such as diarrhoea, abdominal pain and vomiting. The fourth wave presented with eNT signs such as sore throat, and rhinorrhea. Factors associated with severity were mainly age less than five years (OR = 17.69), vomiting (OR = 6.50), presence of comorbidities (OR = 3.39), and alteration of vital parameters such as bradypnoea (OR = 19.68), bradycardia (OR = 6.34), tachycardia (OR = 3.73), oxygen saturation Co

关键词： COVID-19 Children Waves Clinical Profile Severity Cameroon

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Three-dimensional mapping and comparative analysis of the distal human corpus cavernosum and the inflatable penile prosthesis

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Asian Journal of Andrology 2013年第4期15卷 567-570,I0012页

作者： Tariq S Hakky Daniel Ferguson Philippe e Spiess paul Bradley Tom FLue Rafael e Carrion Department of Urology University of South Florida Tampa General Circle Tampa FL 33602 USA 23D3Solutions Burnaby BCV5J 5M8 Canada and Department of Urology University of Southern California San Francisco 400 Parnassus Ave San Francisco CA 94143 USA

The intricate anatomy of the corpus cavernosum in both the flaccid and tumescent state has not been fully elucidated. We report our experience using a three-dimensional （3D） scanner to reconstruct cadaveric casts and compare them with 3D images of two prototypes of penile prosthesis. Two different models of the Titan Coloplast inflatable penile prosthesis were analyzed using a 3D scanner. The first was the standard model and the second was a newer model with a rounder silicone tip. Two cadaveric phalluses were harvested using Smooth-Cast 300Q polyurethane molding. The molds were excised and scanned along side the penile prosthesis. 3D scans were completed and analyzed using Leios Mesh software, and GOM Inspect software. The 3D scans demonstrated the mean human corporal radii 2 mm from the distal tip to be 36.51 mm （36.01-37.0 mm）, which is an obtuse angle. The standard Titan penile prosthesis spherical radius at the same level was 202.52 mm, while the new silicone tip prosthesis had a radius of 139.33 mm. 3D mapping further demonstrated the trajectory of the cavernosa appeared curvilinear and the distal ends appeared blunt. The use of cadaveric cavernosal molds in combination with the 3D scanner allowed us to accurately image the corpus cavernosum for the first time. Our findings suggest that anatomically accurate corporal tips appear to be relatively blunt and that the new Titan silicone tip penile prosthesis more closely resembles the human corporal tip.

关键词： corpus cavernosum penile prosthesis three-dimensional analysis

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