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Disruptive behavior in the workplace: Challenges for gastroenterology fellows

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World Journal of Gastroenterology 2017年第18期23卷 3315-3321页

作者： Nalinee Srisarajivakul Catherine Lucero Xiao-Jing Wang michael poles Colleen Gillespie Sondra Zabar Elizabeth Weinshel Lisa Malter Division of Gastroenterology VA New York Harbor Healthcare System Division of General Internal Medicine NYU School of Medicine Division of Gastroenterology and Hepatology Weill Cornell Medical College Department of Internal Medicine Emory University School of Medicine

AIM To assess first-year gastroenterology fellows' ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations(OSCE).METHODS Two OSCEs("distracted care team" and "frazzled intern") were created to assess response to disruptive behavior. In case 1, a fellow used a colonoscopy simulator while interacting with a standardized patient(SP), nurse, and attending physician all played by actors. The nurse and attending were instructed to display specific disruptive behavior and disregard thefellow unless requested to stop the disruptive behavior and focus on the patient and procedure. In case 2, the fellow was to calm an intern managing a patient with massive gastrointestinal bleeding. The objective in both scenarios was to assess the fellows' ability to perform their duties while managing the disruptive behavior displayed by the actor. The SPs used checklists to rate fellows' performances. The fellows completed a selfassessment *** Twelve fellows from four gastrointestinal fellowship training programs participated in the OSCE. In the "distracted care team" case, one-third of the fellows interrupted the conflict and refocused attention to the patient. Half of the fellows were able to display professionalism despite the heated discussion nearby. Fellows scored lowest in the interprofessionalism portion of post-OSCE surveys, measuring their ability to handle the conflict. In the "frazzled intern" case, 68% of fellows were able to establish a calm and professional relationship with the SP. Despite this success, only half of the fellows were successfully communicate a plan to the SP and only a third scored "well done" in a domain that focused on allowing the intern to think through the case with the fellow's *** Fellows must receive training on how to approach disruptive behavior. OSCEs are a tool that can assess fellow skills and set a culture for open discussion.

关键词：造成分裂的行为交情教育并且训练客观结构化的临床的考试

Design of 16S rRNA gene primers for 454 pyrosequencing of the human foregut microbiome

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World Journal of Gastroenterology 2010年第33期16卷 4135-4144页

作者： Carlos W Nossa William E Oberdorf Jφrn A Aas Bruce J Paster Todd Z DeSantis Eoin L Brodie Daniel Malamud michael a poles Zhiheng Pei Department of Medicine New York University School of Medicine Department of Molecular Genetics The Forsyth Institute Faculty of Dentistry University of Oslo Harvard School of Dental Medicine Lawrence Berkeley National Laboratory Center for Environmental Biotechnology New York University College of Dentistry Depar tment of Pa thology and Medicine New York University School of MedicineNew YorkNY 10016United States Department of Veterans Affairs New York Harbor Health SystemNewYorkNY 10010United States

AIM:To design and validate broad-range 16S rRNA primers for use in high throughput sequencing to classify bacteria isolated from the human foregut ***:A foregut microbiome dataset was constructed using 16S rRNA gene sequences obtained from oral,esophageal,and gastric microbiomes produced by Sanger sequencing in previous studies represented by 219 bacterial *** primers evaluated were from the European rRNA *** assess the effect of sequence length on accuracy of classification,16S rRNA genes of various lengths were created by trimming the full length *** spanning various hypervariable regions were selected to simulate the amplicons that would be obtained using possible primer *** sequences were compared with full length 16S rRNA genes for accuracy in taxonomic classification using online software at the Ribosomal Database Project (RDP).The universality of the primer set was evaluated using the RDP 16S rRNA database which is comprised of 433 306 16S rRNA genes,represented by 36 ***:Truncation to 100 nucleotides(nt)downstream from the position corresponding to base 28 in the Escherichia coli 16S rRNA gene caused misclassification of 87(39.7%)of the 219 sequences,compared with misclassification of only 29(13.2%)sequences with truncation to 350 *** 350-nt sequence reads within various regions of the 16S rRNA gene,the reverse read of an amplicon generated using the 343F/798R primers had the least(8.2%)effect on *** comparison,truncation to 900 nt mimicking single pass Sanger reads misclassified 5.0%of the 219 *** 343F/798R amplicon accurately assigned 91.8%of the 219 sequences at the species *** by abundance of the species in the esophageal dataset,the 343F/798R amplicon yielded similar classification accuracy without a significant loss in species coverage(92%).Modification of the 343F/798R primers to 347F/803R increased their universality among foregut ***

关键词： Foregut Microbiome 16S 454 sequencing Primer

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

Systemic inflammatory markers in elderly patients undergoing transcatheter aortic valve replacement

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Journal of Geriatric Cardiology 2022年第11期19卷 811-821页

作者： Haitham Abu Khadija Mechael Welt Gera Gendelman Ahamd Hamode Lion poles michael Jonas Mustafa Jaber Gal Sella Omar Ayyad Sagi Tshori Alex Blatt Jacob George Kaplan Heart Center Kaplan Medical CenterRehovotaffiliated with the Hebrew UniversityJerusalemIsrael

BACKGROUND Transcatheter aortic valve replacement(TAVR)provokes an early injury response,partially represented by dynamic changes in inflammatory *** greatly benefits the elderly and we aimed to determine whether increased inflammatory markers post-TAVR in octagenerians were different than their younger counterparts and whether it was associated with adverse clinical *** Patients with severe symptomatic aortic stenosis who underwent transfemoral TAVR from January 2010 to December 2021 were *** white blood cells(WBC)count and subpopulation dynamics were *** Five-hundred and seven patients were finally included in the study,65%of these patients were 80 or more years old(54%female,median age 84[82-87])years,with severe symptomatic aortic *** patients aged above 80 years(patients≥80),we noticed significant kinetic changes in the WBC and their differential cellular subpopulations(P<0.0001)between admission and early days *** was evident by a significant increase in total WBC(median 7.1 to 9.4)and absolute neutrophil count(median 4.7 to 7.4),neutrophil-lymphocyte(NL)ratio(median 2.82 to 7.21),and a meaningful decrease in absolute lymphocyte count(median 1.5 to 1.0).Implantation of self-expandable valves(SEVs)was associated with a more pronounced inflammatory response than balloon-expandable valves(BEVs).Higher WBC and neutrophil counts were associated with higher mortality and major vascular complications at 30 days,in addition,higher neutrophil counts and NL ratios were found to be correlated to arrhythmia at 30 days with P values of 0.04 and 0.028,*** This is the first description of a differential age-related inflammatory response in patients after TAVR,which shows an association between inflammatory markers post procedure and clinical ***,survival rates were similar in the elderly population and in younger patients,despite the presence of comorbid conditions.

关键词： patients younger absolute

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Challenge of liver disease in systemic lupus erythematosus:Clues for diagnosis and hints for pathogenesis

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World Journal of Hepatology 2014年第6期6卷 394-409页

作者： Ferno Bessone Natalia poles Marcelo G Roma Gastroenterology and Hepatology Department University of Rosario School of Medicine Institute of Experimental Physiology (CONI-CET-UNR) Faculty of Biochemical and Pharmaceutical SciencesUniversity of Rosario

Systemic lupus erythematosus(SLE) encompass a broad spectrum of liver diseases. We propose here to classify them as follows:(1) immunological comorbilities(overlap syndromes);(2) non-immunological comorbilities associated to SLE; and(3) a putative liver damage induced by SLE itself, referred to as "lupus hepatitis". In the first group, liver injury can be ascribed to overlapping hepatopathies triggered by autoimmune mechanisms other than SLE occurring with higher incidence in the context of lupus(e.g., autoimmune hepatitis, primary biliary cirrhosis). The second group includes non-autoimmune liver diseases, such as esteatosis, hepatitis C, hypercoagulation state-related liver lesions, hyperplasic parenchymal and vascular lesions, porphyria cutanea tarda, and drug-induced hepatotoxicity. Finally, the data in the literature to support the existence of a hepatic disease produced by SLE itself, or the occurrence of a SLE-associated prone condition that increases susceptibility to acquire other liver diseases, is critically discussed. The pathological mechanisms underlying each of these liver disorders are also reviewed. Despite the high heterogeneity in the literature regarding the prevalence of SLE-associated liver diseases and, in most cases, lack of histopathological evidence or clinical studies large enough to support their existence, it is becoming increasingly apparent that liver is an important target of SLE. Consequently, biochemical liver tests should be routinely carried out in SLE patients to discard liver disorders, particularly in those patients chronically exposed to potentially hepatotoxic drugs. Diagnosing liver disease in SLE patients is always challenging, and the systematization of the current information carried out in this review is expected to be of help both to attain a better understanding of pathogenesis and to build an appropriate work-up for diagnosis.

关键词：全身的豺狼座 erythematosus 豺狼座肝炎 Esteatosis 再生榴状的增生丙肝自体免疫的肝炎 Hepatotoxicity Nonsteroidal 反煽动性的药 Methotrexate

Intensity Modulated Radiotherapy (IMRT) in the Planning of Hypofractionated Treatment in Head and Neck Tumors

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International Journal of Clinical Medicine 2018年第9期9卷 675-683页

作者： Misleidy Nápoles Morales Rogelio Díaz Moreno University of Medical Sciences National Institute of Oncology and Radiobiology (INOR) Havana Cuba University of Havana Higher Institute of Technologies and Applied Sciences (InSTEC) Havana Cuba

Head and neck cancer (HNCC) is the sixth most common cancer with an incidence of approximately 600,000 cases per year and 300,000 annual deaths worldwide1y2. In Cuba, cancer of the larynx is the fourth cause in incidence, being the fourth cause of cancer death in men. Radiotherapy constitutes an important modality in the control of these tumors and the Intensity Modulated Radiotherapy (IMRT) is a new advance in this field. With it, it is possible to improve dose distribution, decreasing the dose in adjacent healthy tissues and escalating dose in tumor. In this work we present 33 patients of National Institute of Oncology and Radiobiology in Cuba (INOR), in whom the IMRT was used as a treatment technique with a hypofractionation of the dose. Their response was observed at the end of the treatment and one month later. 56% (19) of the patients had a complete response to treatment at the primary site of the tumor and neck. 10% (3) had no response, progressed. 11 of the patients had no response at the lymph node site at the end of treatment, 8 of these 11 had complete remission one month after radiotherapy ended.

关键词： IMRT Hypofractionation Response

新型高吸收铬-阳离子合成鞣剂结合鞣及其鞣制废液的回收再利用

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中国皮革 2017年第9期46卷 59-63页

作者： Eric poles Lorenzo Tribuzio 余跃(译) 许维星(校) 意大利施华公司、圣米凯莱蒙多夫伊皮革部 12080 四川大学制革清洁技术国家工程实验室四川成都610065

研究通过引入阳电荷对双砜合成鞣剂进行改性制备阳离子合成鞣剂(CAT),旨在增强合成鞣剂的反应活性和弥补铬鞣过程存在的缺陷。与传统的阴离子合成鞣剂DDS相比,CAT为阳离子型,具有一定的鞣性,能单独作为鞣剂鞣革,也能同铬鞣剂以不同的比... 详细信息

研究通过引入阳电荷对双砜合成鞣剂进行改性制备阳离子合成鞣剂(CAT),旨在增强合成鞣剂的反应活性和弥补铬鞣过程存在的缺陷。与传统的阴离子合成鞣剂DDS相比,CAT为阳离子型,具有一定的鞣性,能单独作为鞣剂鞣革,也能同铬鞣剂以不同的比例复配参与鞣革。CAT对铬鞣剂可以产生一定的蒙囿作用并且可以增强铬鞣剂的固定,从而实现铬鞣剂的较高吸收,因而CAT同铬鞣剂之间呈现出一定的协同效应。鞣后废液由于Cr_2O_3含量低且含盐量丰富,可以经回收处理后再利用。

关键词：结合鞣铬吸收阳离子合成鞣剂废液回收

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Apparent Polar Wander Path from the Tarim Block in China

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Acta Geologica Sinica(English Edition) 1990年第1期64卷 1-13页

作者： Robert Sharps michael McWilliams Geophysics Dept. Stanford Univ.StanfordCA94305

The apparent polar wander (APW) path from the Tarim block consists of palaeo-magnetic poles ofDevonian (λ=16°N, ψ= 165° E. A_(95)=4°). Late Carboniferous (λ=41° N, ψ=160° E, A_(95)=4°).Permian (λ=61°N, ψ=177° E. A_(95)=9°). Early Triassic (λ=69° N. ψ=183° E. A_(95)=11°) andJurassic/Cretaceous (λ=65° N, ψ=214° E. A_(95)=6°) times. On the basis of this APW path, it is con-cluded that the Tarim block was subducted beneath the Kazakstan plate between Devonian and Permiantimes. The Tarim, North China and South China blocks were sutured between the Early Triassic and EarlyCretaceous. Tarim had moved eastward some 2000 km relative to Siberia since the Cretaceous.

关键词： Apparent Polar Wander Path from the Tarim Block in China Path

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IBA规则对证据出示的贡献——尤其是对方当事人持有的文件

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北师大法律评论 2020年第1期 203-218页

作者： Pedro Metello de Nápoles 陈帝先葡萄牙PLMJ律所 2. 国际商会(ICC)葡萄牙仲裁中心 3. 国际律师协会(IBA) 4. 西班牙仲裁协会 5. 葡萄牙律师协会葡萄牙里斯本大学法学院

引言本文与葡萄牙工商会商事仲裁中心第九次大会中以"国际仲裁中的取证现状"为主题的座谈会相对应。本文并不打算对国际律师协会(IBA)制定的取证规则做批判性分析,而仅仅是对其做一介绍,同时针对笔者认为对葡萄牙仲裁实践有所裨益的一...

引言本文与葡萄牙工商会商事仲裁中心第九次大会中以"国际仲裁中的取证现状"为主题的座谈会相对应。本文并不打算对国际律师协会(IBA)制定的取证规则做批判性分析,而仅仅是对其做一介绍,同时针对笔者认为对葡萄牙仲裁实践有所裨益的一些方面提请更多注意。尤其是对文件证据在对方当事人持有下如何要求出示的情况加以关注。

关键词：