Lessons from the eradication of smallpox: an interview with D. A. Henderson

It has been more than 35 years since the last naturally occurring case of smallpox. Sufficient time has passed to allow an objective overview of what were the key factors in the success of the eradication effort and what lessons smallpox can offer to other campaigns. Professor D. A. Henderson headed the international effort to eradicate smallpox. Here, we present a summary of D. A. Henderson''s perspectives on the eradication of smallpox. This text is based upon the Unither Baruch Blumberg Lecture, delivered by D. A. Henderson at the University of Oxford in November 2012 and upon conversations and correspondence with Professor Henderson.     

手术室术前访视应用ipad对访视效果影响的研究

目的：探讨术前访视应用ipad在术前访视中对手术患者心理状态的影响。方法：将300例择期手术患者随机分为对照组（150例）和实验组（150例）,对照组采用常规术前访视方案;实验组在此基础上结合ipad展示围术期相关信息,采用焦虑自量表评估两组病人入院时和入手术室时的焦虑状况及血压、心率等指标,并且进行术后并发症和满意度的调查。结果：改良术前访视后焦虑评分、收缩压、舒张压、心率实验组明显低于对照组。结论：术前访视应用ipad可明显减轻手术病人术前的焦虑。     

Food choices and eating difficulty among elderly edentate patients in Greece

Aims: To evaluate food choice and eating difficulty experienced by older Greek edentate patients. Subjects: Three samples of patients seeking provision of replacement dentures were studied. A primary study of urban mainland U1 (n=54) and island rural R1 samples (n=84) was followed by a mainland urban U2 sample (n=119) in the Secondary study. Setting: Greek dental clinics. Intervention: Semi‐structured interviews (SSI) were employed, using both open and closed questions. Design: The primary study used SSI to identify eating difficulty experienced by two culturally different Greek groups. The secondary study established patterns of difficulty for comparisons between an urban Greek population and northern European urban studies. Main Outcome Measures: The prevalence of eating difficulty, the degree of difficulty eating specified foods and the exclusion of foods because difficult. Results: Most patients expressed difficulty eating at least one type of food, a high percentage of these patients were willing to eat foods found difficult, while others use particular methods of food preparation that make food easier to eat. Chicken illustrated the importance of specifying the method of cooking when questioning eating difficulties. Roast meats provided insight into the more difficult end of the food range. Raw vegetables were rated difficult. Apples and oranges were also food of particular interest. Conclusions: The semi‐structured interview method provides a succesful method to identify eating difficulty and food choices by older Greek complete denture wearers. Differences, probably largely cultural, were identified between Greek island rural and mainland urban communities. Greek food choices differed favourably from an English sample, strikingly in that Greek patients report continuing to eat difficult foods despite difficulty eating them. This may be relevant to health data on Greek populations that show better mortality statistics despite adverse factors such as high prevalence of smoking.     

Looking to the future with optimism: An interview with Glenn Nierman on the occasion of the recent end of his appointment as NAfME president

The author interviewed Glenn Nierman on the occasion of the recent conclusion of his term as National Association for Music Education (NAfME) president. Topics included the current state of music education and advocacy of music education in the United States, the role of NAfME, and the recently revised national music education standards.     

Has the rising placebo response impacted antidepressant clinical trial outcome? Data from the US Food and Drug Administration 1987‐2013

More than fifteen years ago, it was noted that the failure rate of antidepressant clinical trials was high, and such negative outcomes were thought to be related to the increasing magnitude of placebo response. However, there is considerable debate regarding this phenomenon and its relationship to outcomes in more recent antidepressant clinical trials. To investigate this, we accessed the US Food and Drug Administration (FDA) reviews for sixteen antidepressants (85 trials, 115 trial arms, 23,109 patients) approved between 1987 and 2013. We calculated the magnitude of placebo and antidepressant responses, antidepressant‐placebo differences, as well as the effect sizes and success rates, and compared these measures over time. Exploratory analysis investigated potential changes in trial design and conduct over time. As expected, the magnitude of placebo response has steadily grown in the past 30 years, increasing since 2000 by 6.4% (r=0.46, p<0.001). Contrary to expectations, a similar increase has occurred in the magnitude of antidepressant response (6.0%, r=0.37, p<0.001). Thus, the effect sizes (0.30 vs. 0.29, p=0.42) and the magnitude of antidepressant‐placebo differences (10.5% vs. 10.3%, p=0.37) have remained statistically equivalent. Furthermore, the frequency of positive trial arms has gone up in the past 15 years (from 47.8% to 63.8%), but this difference in frequency has not reached statistical significance. Trial design features that were previously associated with a possible lower magnitude of placebo response were not implemented, and their relationship to the magnitude of placebo response could not be replicated. Of the 34 recent trials, two implemented enhanced interview techniques, but both of them were unsuccessful. The results of this study suggest that the relationship between the magnitude of placebo response and the outcome of antidepressant clinical trials is weak at best. These data further indicate that antidepressant‐placebo differences are about the same for all of the sixteen antidepressants approved by the FDA in the past thirty years.     

Equine Welfare in England and Wales: Exploration of Stakeholders' Understanding

Investigating how those responsible for the care of nonhuman animals understand the concept of animal welfare is important for animal welfare improvement. In-depth interviews with 31 equine stakeholders were used to explore their perceptions and understanding of welfare. The results showed the stakeholders understood the concept of welfare in 4 ways. Firstly, welfare was understood in terms of the provision of resources—for example, food. Secondly, a “horse-centered” understanding of welfare was articulated; this understanding included the horses' mental state and was linked to natural behavior. Thirdly, the word welfare had negative connotations, and for some, good welfare was achieved through avoidance of negative states. Finally, interviewees discussed incidents that occurred in their own familiar contexts but suggested that these were not welfare problems. Evidence indicated that the ways in which equine stakeholders understood the concept of welfare might have been acting as a barrier to the alleviation of some equine welfare problems. There is a need for strategies aimed at improving equine welfare to consider stakeholder constructs of welfare and the ways in which these constructs are generated and acted upon.     

An Epidemiological Analysis of 28 Vivax Malaria Cases in Gimpo-si,Korea, 2020

Since 1993, vivax malaria has been recognized as a public health burden in Korea. Despite of pan-governmental malaria-control efforts and the dramatic reduction in the burden of this disease over the last 10 years, vivax malaria has not been well controlled and has remained continuously endemic. We focused interviewed and examined the charts of 28 confirmed vivax malaria patients given malarial therapy for whom daily records were kept from Gimpo-si, Gyeonggi-do of Korea. Various epidemiological characteristics of vivax malaria, including the incubation period, medication used, and recurrence, and an evaluation of the parasitic characteristics from the focused interviews of patients from this region are described here. Most of the participants indicated the 3 most common symptoms of malaria (headache, chills and fever). Of the 28 cases, 2 experienced a second attack and there were 17 and 11 cases with short- and long-term incubation periods, respectively, yielding a short-term to long-term ratio of 1.5. Based on the parasitemia stages, most of the participants were tested at 5 to 7 days (11 cases) and 7 to 15 days (11 cases) after initial wave of asexual parasites. In conclusion, public health authorities should consider developing management measures to decrease the time lag for diagnosis and drafting unified and robust guidelines for drug use for malaria and drawing up unified and robust guidelines on the use of medication for malaria. It also suggests that routine monitoring, surveillance, and precise medical surveys in high-risk vivax malaria endemic areas are pivotal to controlling this persistent public disease and finally eliminating it from Korea.     

四川东南地区云豹(Neofelis nebulosa)分布区变化及其成因

物种的分布变化是衡量生物多样性变化的一个重要层面,也是生物多样性变化研究领域备受关注的热点。根据对四川省东南地区6县14个乡镇的访问调查,分析了四川省东南部云豹（Neofelis nebulosa）分布区的变化趋势,并对近10年潜在有无云豹分布的区域在1988年和2017年的景观格局进行对比分析,探讨了四川东南地区云豹分布区变化的原因。结果显示：（1）40年前云豹曾在调查区域广泛分布,近40年来云豹分布范围呈现逐渐缩减的趋势,到近10年潜在有云豹分布的仅3个县3个乡镇;（2）天然阔叶林是云豹适宜的生境,潜在有云豹分布地区阔叶林在近30年里均是面积最大的景观类型,30年间增加了18.13%。潜在无云豹分布地区阔叶林在30年前占比为13.67%,30年间减少了39.29%,其主要景观类型在30年间由农业用地转换为竹林类型;（3）30年间,潜在有无云豹分布地区阔叶林破碎化程度均加剧,而潜在无云豹分布地区的破碎化程度较潜在有云豹分布地区严重;（4）潜在有无云豹分布区域居民野生动物保护意识均不强烈,在潜在无云豹分布区域的保护意识和意愿稍高;（5）本研究认为,早在40年前由于人为捕杀和土地开垦,就导致云豹种群在研究区域内衰退,近30年虽然农业用地大幅转换为竹林使森林总面积增加,但并未对云豹的保护起到积极作用,阔叶林的生境退变则使前期已经衰退的云豹种群分布区持续缩减,以致难觅踪迹。     

The residency application abyss: insights and advice

Most medical students apply for residency training upon completion of medical school. The choice of specialty is one of a student's first major career decisions, and the application process often results in considerable anxiety, as it is competitive, unpredictable, and requires a significant investment of time and money. This article, which addresses several important facets of the residency application using both experiential and evidence-based data, is organized chronologically into sections that describe a logical approach to applying for residency: choice of a specialty, the personal statement, the interview day, and developing a rank list. A list of relevant websites is also included. This paper is a resource that provides timely and tangible guidance to medical students applying for residency training.