简介:Itisestimatedthatmorethanonemillionheartfailurehospitalizationsoccureachyear.Systolicheartfailureandheartfailurewithpreservedejectionfractioncontributeequallytoheartfailurehospitalizations.Heartfailurereadmissionratescontinuetobeabout25%.Strategiestoreduceheartfailurereadmissionarekeytoreducinghospitalizationrates.Thestrategiestoreduceheartfailurehospitalizationareasfollows:(1)Duringhospitalization,diuresistotheeuvolemicstateisessential.Fiftypercentofdischargedheartfailurepatientshaveminimalweightlossduringthehospitalization,representingminimaldiuresis,butstillfluidoverload.(2)Duringhospitalization,interrogatethedefibrillatororbiventricularpacemaker(ifapplicable)toensurethatthereisnorightventricularpacingandthereisappropriatebiventricularpacing.Interrogationofdevicescanidentifyarrhythmiaorsuboptimalbiventricularpacing,whichcancontributetodecompensation.(3)Beforedischarge,identifythereasonfordecompensation,suchasatrialfibrillation,infection,pulmonaryembolism,ornoncompliance.(4)Beforedischargeamultidisciplinaryteamisneededtoeducatethepatientondiet,medications,fluidweightsurveillance,andexercise.(5)Apostdischargevisitshouldoccurwithin10daysandwithemphasisonuptitrationofneurohormonalblockersandcontinuedcongestionmanagement.Suchinterventionsconductedbyamultidisciplinaryteamhavethepotentialtoreduceheartfailurehospitalizationrates.
简介:Thisworkispartofaprojectwhoseobjectiveistostudycurricularchangesinteachertrainingprogramsfromacomparativeapproach.Westudiedthecurriculumofthreeuniversities(HarvardUniversity,UniversityofMinho,andUniversidadeFederaldoTrianguloMineiro[UFTM])fromthreedifferentcountries(USA,Portugal,andBrazil)inthelasttwodecades.Toachievethegoals,inadditiontoliteraturereviewanddocumentanalysis,wevisitedtheuniversities,madeobservations,andinterviewedteachersandstudents.Weusedcontentanalysisandcomparativeeducationmethodologiestoanalyzedata.Resultshighlightedthat:1.Practice-centeredprogramprevailsinAmericaneducation;2.Apraxis-focusedapproachisemphasizedinPortugal;and3.Thereisapursuitofahistorical-criticalguidanceinBrazil(mainlyrevealedinteachers’discourses)withstrongmulticulturaltrendincurrentcurricularpolicies.Thefindingshelpedustounderstandhowthosethreeuniversitiesmakelinksbetweentheoryandpracticeinthetrainingoftheirteachers,anddrewattentiontoHarvardTeachersFellows(HTF)Programforitsschoolpracticeimmersionsincetheverybeginningoftheprogram.Studyingthoseexperiencesfromacomparativepointofviewcanhelpcurriculumplanners,highereducationmanagers,andpolicy-makersdevotedtothefieldofteachereducationtodevelopcourses/programsthatareneitherexcessivelypragmatic,noridealizedanddetachedfromschoolroutine.
简介:煽动性的肠疾病(IBD)包括二个实体,Crohn的疾病和ulcerative。两个是有经常的复杂并发症和外科的过程的长期的条件,一个伟人影响病人生命的质量。thiopurine抗代谢物azathioprine和6-mercaptopurine广泛地在IBD病人被使用。当前的指示包括维护治疗,类固醇家属疾病,管闭合,infliximabimmunogenicity的预防和Crohn的疾病复发的预防。令人惊讶地,在最后十年的抑制免疫力的药的宽使用没减少外科的需要,可能因为这些治疗在疾病路线在太迟了的阶段被介绍。immunossupressants的更早的使用现在被一些作者倡导。合理包括:(1)修改现在的治疗学的途径的IBD自然科学的失败,(2)那个azathioprine罐头导致粘膜的愈合的示范,为Crohn的疾病和ulcerative的一个相关预示的因素,并且(3)早immunossupression有的示范很积极的影响在上小儿科,最近诊断的Crohn的疾病病人。我们现在正在等候新研究的结果,诊断了成年Crohn的疾病病人(阿兹台克人学习),与infliximab(声音的学习)相比澄清azathioprine的贡献,并且在最近表明azathioprine的实用性。
简介:Hopewasathemethroughoutmychildhood.UntilIwastwelveyearsold,IlivedinTaiwanwithmymotherandyoungerbrother.Myfatherwasanengineerandmyunclewasachemist.TheycouldhavestayedinTaiwanandpursuedcareersthroughthebureaucraticnetwork,buttheydreamedofgreaterintellectualandprofessionalchallenges.TheywenttotheUnitedStates
简介:HepatitisB(HB)virus(HBV)infection,whichcauseslivercirrhosisandhepatocellularcarcinoma,isendemicworldwide.HepatitisBvaccinesbecamecommerciallyavailableinthe1980s.TheWorldHealthOrganizationrecommendedtheintegrationoftheHBvaccineintothenationalimmunisationprogramsinallcountries.HBVpreventionstrategiesareclassifiedintothreegroups:(1)universalvaccinationalone;(2)universalvaccinationwithscreeningofpregnantwomenplusHBimmuneglobulin(HBIG)atbirth;and(3)selectivevaccinationwithscreeningofpregnantwomenplusHBIGatbirth.Mostlow-incomecountrieshaveadopteduniversalvaccineprogramswithoutscreeningofpregnantwomen.However,HBvaccinesarenotwidelyusedinlow-incomecountries.TheGlobalAllianceforVaccineandImmunizationwaslaunchedin2000,andby2012,theglobalcoverageofathree-doseHBvaccinehadincreasedto79%.Thenextchallengesaretofurtherincreasethecoveragerate,closethegapbetweenrecommendationsandroutinepractices,approachhighriskindividuals,screenandtreatchronicallyinfectedindividuals,andpreventbreakthroughinfections.ToeradicateHBVinfections,strenuouseffortsarerequiredtoovercomesocioeconomicbarrierstotheHBvaccine;thistaskisexpectedtotakeseveraldecadestocomplete.
简介:Ithasbeenshownthattheprogressinthedeterminationofmembraneproteinstructuregrowsexponentially,withapproximatelythesamegrowthrateasthatofthewater-solubleproteins.Inordertoinvestigatetheeffectofthis,ontheperformanceofpredictionalgorithmsforbothα-helicalandβ-barrelmembraneproteins,weconductedaprospectivestudybasedonhistoricalrecords.WetrainedseparatehiddenMarkovmodelswithdifferentsizedtrainingsetsandevaluatedtheirperformanceontopologypredictionforthetwoclassesoftransmembraneproteins.Weshowthattheexistingtop-scoringalgorithmsforpredictingthetransmembranesegmentsofα-helicalmembraneproteinsperformslightlybetterthanthatofβ-barreloutermembraneproteinsinallmeasuresofaccuracy.Withthesamerationale,ameta-analysisoftheperformanceofthesecondarystructurepredictionalgorithmsindicatesthatexistingalgorithmictechniquescannotbefurtherimprovedbyjustaddingmorenon-homologoussequencestothetrainingsets.Theupperlimitforsecondarystructurepredictionisestimatedtobenomorethan70%and80%ofcorrectlypredictedresiduesforsinglesequencebasedmethodsandmultiplesequencebasedones,respectively.Therefore,weshouldconcentrateoureffortsonutilizingnewtechniquesforthedevelopmentofevenbetterscoringpredictors.
简介:Substratecharacterizationisthemainstayofablationforventriculartachycardia(VT).Althoughtheuseofelectroanatomicvoltagemapping(EAVM)intheelectrophysiology(EP)laboratoryhasenabledreal-timeapproximationofmyocardialscar,ithaslimitations.Thisisrelatedtothesubjectiveandtediousnatureofvoltagemappingandthechallengesofdefiningthetransmuralityofscar.Variousnoninvasivemethodsofscarassessmenthaveemerged,withmagneticresonanceimaging(MRI)beingthemostaccurate.IntegratedMRIandelectroanatomicvoltagemappingstudiesdemonstrategoodcorrelation.Nonetheless,MRIhasadvantages.Theseinclude(1)preprocedureidentificationofepicardialandintramuralscar,(2)assessmentofablativelesionformationafterunsuccessfulablations,(3)identifi-cationofheterogeneousregionsofscar,wherecriticalconductingchannelsarelikelytooccur,and(4)predictivevalueintheassessmentofsuddencardiacdeath(SCD).Integrationofscarimaginginventriculartachycardiaablationandriskstratificationhasgreatpotentialtoadvancethepracticeofarrhythmiamanagement.
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简介:OnDecember2,2014,theWorldFamilySummit+10washeldinZhuhai,GuangdongProvince.ItwasjointlyorganizedbyNationalHealthandFamilyPlanningCommission(NHFPC)andWorldFamilyOrganization,withthethemeof'FamiliesinBalanceBuildingtheFutureWeWant'.LiuYandong,MemberofthePoliticalBureauoftheCentralCommitteeoftheCPCandVicePremieroftheStateCouncildeliveredakeynotespeech.GuXiulian,ViceChairwomanoftheStandingCommitteeoftheTenthNationalPeople'sCongressand
简介:First,letmestatetheobvious:ecologistshavebeentoopolitetotolerateintrusionbycolleaguesfromotherfields(mostlyfrommolecularbiology)whofeltitnecessarytopontificateabouttheecologicalimpactsoftransgeniccrops.Suchpiecesusuallypresent,ofteninforcefullanguage,theauthor'sbeliefthattransgenictechnologyisbeneficial,withoutnegativeeffects,