Your child is dead.

OBJECTIVE--To determine parent''s views on how death of their children should have been handled. DESIGN--Retrospective questionnaire survey of parents who had experienced death of their child. SETTING--Charitable organisation of bereaved parents. SUBJECTS--150 bereaved parents, all members of the organisation, of whom 120 (80%) participated voluntarily in the study. MAIN OUTCOME MEASURES--Child''s age; date and cause of death; details of person breaking the news and handling of the interview; time parents spent with dead child, their attitude to requests for organ donation, and follow up support received. RESULTS--122 children''s deaths were described; the largest single group was due to road traffic accidents, 16 were suicides, and eight were murders. Twice as many interviews were rated as sympathetically or reasonably handled as badly or offensively handled (68 v 34). The interview ratings depended on the sensitivity and personal skills of the interviewers rather than on their previous contact or professional position; police were rated as more sympathetic than doctors and nurses. Of 109 respondents, 81 had seen their child''s body, 44 of whom thought that sufficient time had been denied. Of the 28 parents who did not see the body, 17 subsequently stated their regret. In 82 parents organ donation had not been discussed. Only 16 parents recorded any follow up support from hospital staff and very few support at the time. CONCLUSIONS--The consistency of the responses suggests a serious need to revise the in service training and education of the police and health professionals in their approach to informing of death; organ donation should be discussed sensitively and parents allowed time with their dead child with fewer restrictions.     

Increasing the effectiveness of clinical supervision.

Effective use of preceptors in the clinical training and supervision of residents involves four essential steps: careful screening of the preceptor''s practice to ensure it reflects the goals of the residency program and teaching the preceptor about the goals; setting a realistic contract for learning between resident and preceptor; teaching the preceptor to use constructive feedback techniques in the day-to-day supervision of residents; and developing the preceptor''s skills in the reliable and valid evaluation of the resident''s performance. Clinical preceptors must be trained to become effective teachers and evaluators in residency programs.     

Intention Understanding in Autism

When we observe a motor act (e.g. grasping a cup) done by another individual, we extract, according to how the motor act is performed and its context, two types of information: the goal (grasping) and the intention underlying it (e.g. grasping for drinking). Here we examined whether children with autistic spectrum disorder (ASD) are able to understand these two aspects of motor acts. Two experiments were carried out. In the first, one group of high-functioning children with ASD and one of typically developing (TD) children were presented with pictures showing hand-object interactions and asked what the individual was doing and why. In half of the “why” trials the observed grip was congruent with the function of the object (“why-use” trials), in the other half it corresponded to the grip typically used to move that object (“why-place” trials). The results showed that children with ASD have no difficulties in reporting the goals of individual motor acts. In contrast they made several errors in the why task with all errors occurring in the “why-place” trials. In the second experiment the same two groups of children saw pictures showing a hand-grip congruent with the object use, but within a context suggesting either the use of the object or its placement into a container. Here children with ASD performed as TD children, correctly indicating the agent''s intention. In conclusion, our data show that understanding others'' intentions can occur in two ways: by relying on motor information derived from the hand-object interaction, and by using functional information derived from the object''s standard use. Children with ASD have no deficit in the second type of understanding, while they have difficulties in understanding others'' intentions when they have to rely exclusively on motor cues.     

Psychiatry in General Practice

Psychiatrists should include the family doctor in their plans for future psychiatric services. The general practitioner now treats most of the patients who seek help for psychiatric disorder and he could not give up his psychiatric practice even if he wanted to. Furthermore, there are not now nor will there ever be enough psychiatrists to take over all patients with mental ills. Most emotionally disturbed patients can be better handled by their family physicians than by a specialist.To provide the best care for emotionally disturbed people the communication between family doctors and psychiatrists must be improved. The specialist must acknowledge the importance of the general practitioner''s role in psychiatric diagnosis and treatment and give him more help. Medical schools must provide better undergraduate and postgraduate psychiatric training for the students who will become family doctors. Health plans and other prepayment agencies should properly compensate the general practitioner for giving psychiatric treatment. The specialist in psychiatry should consult more readily with the general practitioner and help him carry out some of the therapy. General hospitals should permit family doctors to admit mental patients to psychiatric wards in a general hospital and to carry out psychiatric treatment with the help of the specialist in psychiatry.     

Wild Animal Training: A Glance at Circuses and Hediger's Viewpoint

Historically, zoos have shared common features with circuses despite recent animosity toward them: Exhibition of wild animals in captivity. Experienced circus professionals can provide insight into the nature of wild animals from their sensitivity to man-made environmental components, potentially dangerous human errors, to animal escapes. These are told in numerous behind-the-scenes episodes. Zoos and circuses also have common needs such as improved animal husbandry and breeding. Moreover, both institutions face the public's naivete about animal life, and accusation about alleged cruelty to animals, often focusing on animal training. Professor Heini Hediger explained animal training from a scientific viewpoint. We can learn from his wisdom, for instance, the theoretical basis on training. Although traditional animal training has received adverse responses in recent years, accomplishments by trainers from the earlier era must be given a proper historical recognition.     

Making Smart Social Judgments Takes Time: Infants' Recruitment of Goal Information When Generating Action Predictions

Previous research has shown that young infants perceive others'' actions as structured by goals. One open question is whether the recruitment of this understanding when predicting others'' actions imposes a cognitive challenge for young infants. The current study explored infants'' ability to utilize their knowledge of others'' goals to rapidly predict future behavior in complex social environments and distinguish goal-directed actions from other kinds of movements. Fifteen-month-olds (N = 40) viewed videos of an actor engaged in either a goal-directed (grasping) or an ambiguous (brushing the back of her hand) action on a Tobii eye-tracker. At test, critical elements of the scene were changed and infants'' predictive fixations were examined to determine whether they relied on goal information to anticipate the actor''s future behavior. Results revealed that infants reliably generated goal-based visual predictions for the grasping action, but not for the back-of-hand behavior. Moreover, response latencies were longer for goal-based predictions than for location-based predictions, suggesting that goal-based predictions are cognitively taxing. Analyses of areas of interest indicated that heightened attention to the overall scene, as opposed to specific patterns of attention, was the critical indicator of successful judgments regarding an actor''s future goal-directed behavior. These findings shed light on the processes that support “smart” social behavior in infants, as it may be a challenge for young infants to use information about others'' intentions to inform rapid predictions.     

A metacommunity framework for enhancing the effectiveness of biological monitoring strategies

Because of inadequate knowledge and funding, the use of biodiversity indicators is often suggested as a way to support management decisions. Consequently, many studies have analyzed the performance of certain groups as indicator taxa. However, in addition to knowing whether certain groups can adequately represent the biodiversity as a whole, we must also know whether they show similar responses to the main structuring processes affecting biodiversity. Here we present an application of the metacommunity framework for evaluating the effectiveness of biodiversity indicators. Although the metacommunity framework has contributed to a better understanding of biodiversity patterns, there is still limited discussion about its implications for conservation and biomonitoring. We evaluated the effectiveness of indicator taxa in representing spatial variation in macroinvertebrate community composition in Atlantic Forest streams, and the processes that drive this variation. We focused on analyzing whether some groups conform to environmental processes and other groups are more influenced by spatial processes, and on how this can help in deciding which indicator group or groups should be used. We showed that a relatively small subset of taxa from the metacommunity would represent 80% of the variation in community composition shown by the entire metacommunity. Moreover, this subset does not have to be composed of predetermined taxonomic groups, but rather can be defined based on random subsets. We also found that some random subsets composed of a small number of genera performed better in responding to major environmental gradients. There were also random subsets that seemed to be affected by spatial processes, which could indicate important historical processes. We were able to integrate in the same theoretical and practical framework, the selection of biodiversity surrogates, indicators of environmental conditions, and more importantly, an explicit integration of environmental and spatial processes into the selection approach.     

John P. Peters and the committee of 430 physicians

John Peters and his committee had a few basic goals. One was that local, state, and federal governments needed to provide money to construct facilities, support medical research and education, and care for the poor. And they wanted experts to call the shots. Over time, Peters and the committee got what they wanted for the most part: Hill-Burton money for building the hospitals, the rise of the National Institutes of Health, Medicare, Medicaid, a Veterans Administration system, and new and expanded medical schools. The experts calling the shots included David Kessler at the Food and Drug Administration and Surgeon General C. Everett Koop. In the halcyon days of American health system reform, back in 1993, Yale''s Paul Beeson wrote about the Committee of 430 Physicians and its goals in the Pharos of Alpha Omega Alpha. Beeson was optimistic and he quoted from my 1991 JAMA health system reform editorial as a sharp contrast to what Fishbein had written - although coincidentally, we both quote Lincoln. My editorial began, "''with malice toward none, with charity for all...'' so spoke Abraham Lincoln in his second inaugural address recognizing that he had no political consensus regarding either the constitutionality of states seceding or the morality of slavery being abolished. Nonetheless, he knew what was right and was able, through persuasive, often inspiring rhetoric, to conclude a bloody and decisive Civil War and constitute the foundation for this great republic.... Yet access to basic medical care for all of our inhabitants is still not a reality in this country. There are many reasons for this, not the least of which is a long-standing, systematic, institutionalized racial discrimination.... An aura of inevitablitiy is upon us. It is not acceptable morally, ethically, or economically for so many of our people to be medically uninsured or seriously underinsured. We can solve this problem. We have the knowledge and the resources, the skills, the time, and the moral prescience. We need only clear-cut objectives and proper organization of existing resources. Have we now the national will and leadership?" Beeson''s answer to that question in 1993 was, "Yes, but not by one comprehensive act." He quoted Peters from his 1938 Annals of Internal Medicine article: "a sweeping program suddenly imposed in this country as a whole out of the head of any Jove would undoubtedly create confusion if not chaos. Thoughtful investigation and experiment promises more than grandiose projects born of emotional preconceptions. The programs must be built of an evolutionary manner, step by step." Very wise, very valid. But how long must our people wait?     

视觉功能训练联合托吡卡胺滴眼液治疗假性近视的临床疗效观察

摘要 目的：探讨视觉功能训练联合托吡卡胺滴眼液在治疗假性近视中的临床疗效。方法：选取中国人民解放军陆军特色医学中心眼科和重庆佑佑宝贝妇儿医院眼科2019年2月至2019年8月收治的400例假性近视患儿作为研究对象,将其随机分为对照组和观察组(n=200)。对照组给予滴眼液缓解眼疲劳治疗,观察组则采用视觉功能训练联合托吡卡胺滴眼液治疗。比较两组患儿治疗前及治疗2个月、6个月后裸眼视力、眼轴长度、屈光度、正相对调节量和视疲劳评分的变化。结果：治疗2个月和6个月后,观察组患儿裸眼视力分别为(0.75±0.05)和(0.81±0.04),较对照组显著上升(P<0.05);屈光度分别为(+0.05±0.50)和(+0.06±0.48),明显高于对照组(P<0.05);正相对调节量检测结果依次是(-1.98±0.07)和(-2.51±0.24),较对照组明显增加(P<0.05)。两组患儿视觉感知双眼视功能均有明显改善,其中观察组视觉功能恢复显著高于对照组(P<0.05)。视疲劳调查显示观察组患儿视疲劳评分分别为(6.90±0.89)分和(3.91±0.89)分,显著低于对照组(P<0.05)。结论：视觉功能训练联合托吡卡胺滴眼液治疗能有效提高患儿裸眼视力、改善屈光度、正相对调节量和视觉感知功能,从而减少视疲劳,预防近视。     

The Neural Bases of Directed and Spontaneous Mental State Attributions to Group Agents

In daily life, perceivers often need to predict and interpret the behavior of group agents, such as corporations and governments. Although research has investigated how perceivers reason about individual members of particular groups, less is known about how perceivers reason about group agents themselves. The present studies investigate how perceivers understand group agents by investigating the extent to which understanding the ‘mind’ of the group as a whole shares important properties and processes with understanding the minds of individuals. Experiment 1 demonstrates that perceivers are sometimes willing to attribute a mental state to a group as a whole even when they are not willing to attribute that mental state to any of the individual members of the group, suggesting that perceivers can reason about the beliefs and desires of group agents over and above those of their individual members. Experiment 2 demonstrates that the degree of activation in brain regions associated with attributing mental states to individuals—i.e., brain regions associated with mentalizing or theory-of-mind, including the medial prefrontal cortex (MPFC), temporo-parietal junction (TPJ), and precuneus—does not distinguish individual from group targets, either when reading statements about those targets'' mental states (directed) or when attributing mental states implicitly in order to predict their behavior (spontaneous). Together, these results help to illuminate the processes that support understanding group agents themselves.     

体能训练对宜昌市西陵区儿童体质发育的影响

目的:评价体能训练对儿童体质发育的影响,探索能促进儿童体质发育的训练模式。方法:整群随机抽取宜昌市西陵区4所幼儿园,将儿童随机分成试验组和对照组,最终纳入试验组312人,对照组301人。试验组儿童进行为期1年的各项体质训练干预,对照组儿童给予常规教学。比较训练前后儿童各项体质指标、出勤率及近视率。结果:经过1年干预训练后,两组各年龄组儿童在身高、体重形态指标上无显著性差异(P0.05);素质指标中,与对照组相比,试验组各年龄组儿童在10 m折返跑、立定跳远、网球掷远、双脚连续跳、坐位前体屈5个项目上组间差异均有统计学意义(均P0.05);而在走平衡木项目上,只有7岁年龄段组间差异有统计学意义(P0.05);试验组出勤优秀率显著高于对照组(P0.05);两组近视率在干预前后差异均无统计学意义(P0.05)。结论:开展儿童体质训练能够促进儿童体质发育,应在各幼儿园广泛推广。     

Endurance Training Per Se Increases Metabolic Health in Young,Moderately Overweight Men

Health benefits of physical activity may depend on a concomitant weight loss. In a randomized, controlled trial, we compared the effects of endurance training with or without weight loss to the effect of weight loss induced by an energy‐reduced diet in 48 sedentary, moderately overweight men who completed a 12‐week intervention program of training (T), energy‐reduced diet (D), training and increased diet (T‐iD), or control (C). An energy deficit of 600 kcal/day was induced by endurance training or diet in T and D and a similar training regimen plus an increased dietary intake of 600 kcal/day defined the T‐iD group. Primary end point was insulin sensitivity as evaluated by HOMA‐IR (mainly reflecting hepatic insulin sensitivity) and hyperinsulinemic, isoglycemic clamps (primarily reflecting peripheral insulin sensitivity). Body mass decreased in T and D by 5.9 ± 0.7 and 5.3 ± 0.7 kg, respectively, whereas T‐iD and C remained weight stable. Total and abdominal fat mass were reduced in an additive manner in the T‐iD, D, and T groups by 1.9 ± 0.3/0.2 ± 0.1, 4.4 ± 0.7/0.5 ± 0.1, and 7.7 ± 0.8/0.9 ± 0.1 kg, respectively. HOMA‐IR was improved in T, D, and T‐iD, whereas insulin‐stimulated glucose clearance and suppression of plasma nonesterified fatty acids (NEFAs) were increased only in the two training groups. Thus, loss of fat mass (diet or training induced) improves hepatic insulin sensitivity, whereas peripheral insulin sensitivity in skeletal muscle and adipose tissue is increased by endurance training only. This demonstrates that endurance training per se increases various metabolic health parameters and that endurance training should preferably always be included in any intervention regimen for improving metabolic health in moderately overweight men.     

The Effects of a 6-Week Strength Training on Critical Velocity,Anaerobic Running Distance, 30-M Sprint and Yo-Yo Intermittent Running Test Performances in Male Soccer Players

The objectives of this study were to examine the effects of a moderate intensity strength training on changes in critical velocity (CV), anaerobic running distance (D''), sprint performance and Yo-Yo intermittent running test (Yo-Yo IR1) performances. Methods: two recreational soccer teams were divided in a soccer training only group (SO; n = 13) and a strength and soccer training group (ST; n = 13). Both groups were tested for values of CV, D'', Yo-Yo IR1 distance and 30-m sprint time on two separate occasions (pre and post intervention). The ST group performed a concurrent 6-week upper and lower body strength and soccer training, whilst the SO group performed a soccer only training. Results: after the re-test of all variables, the ST demonstrated significant improvements for both, YoYo IR1 distance (p = 0.002) and CV values (p<0.001) with no significant changes in the SO group. 30-m sprint performance were slightly improved in the ST group with significantly decreased performance times identified in the SO group (p<0.001). Values for D'' were slightly reduced in both groups (ST -44.5 m, 95% CI = -90.6 to 1.6; SO -42.6 m, 95% CI = -88.7 to 3.5). Conclusions: combining a 6-week moderate strength training with soccer training significantly improves CV, Yo-Yo IR1 whilst moderately improving 30-m sprint performances in non-previously resistance trained male soccer players. Critical Velocity can be recommended to coaches as an additional valid testing tool in soccer.     

Pretraining and learning: Are “adaptable” monkeys “bright”?

Two groups of rhesus (Macaca mulatta),two groups of cynomolgus (M. fascicularis),and one group of stumptailed monkeys (M. arctoides)were adapted to testing in the Wisconsin General Test Apparatus using a standardized procedure that produced an objective measure of the speed of adaptation (pretraining). Four of the groups were then given standard object-discrimination learning-set training. The fifth group, one of the groups of rhesus monkeys, was given delayed response training before the learning-set training and delayed matching-to-sample learning-set training after. Only performance on the delayed response task was correlated with speed of pretraining. The results suggest that differences in pretraining performance reflect primarily emotional and/or temperamental differences, whereas differences in learning-set performance reflect primarily differences in cognitive functioning.     

Leadership in Moving Human Groups

How is movement of individuals coordinated as a group? This is a fundamental question of social behaviour, encompassing phenomena such as bird flocking, fish schooling, and the innumerable activities in human groups that require people to synchronise their actions. We have developed an experimental paradigm, the HoneyComb computer-based multi-client game, to empirically investigate human movement coordination and leadership. Using economic games as a model, we set monetary incentives to motivate players on a virtual playfield to reach goals via players'' movements. We asked whether (I) humans coordinate their movements when information is limited to an individual group member''s observation of adjacent group member motion, (II) whether an informed group minority can lead an uninformed group majority to the minority''s goal, and if so, (III) how this minority exerts its influence. We showed that in a human group – on the basis of movement alone – a minority can successfully lead a majority. Minorities lead successfully when (a) their members choose similar initial steps towards their goal field and (b) they are among the first in the whole group to make a move. Using our approach, we empirically demonstrate that the rules of swarming behaviour apply to humans. Even complex human behaviour, such as leadership and directed group movement, follow simple rules that are based on visual perception of local movement.     

Exploring the bovine rumen bacterial community from birth to adulthood

The mammalian gut microbiota is essential in shaping many of its host''s functional attributes. One such microbiota resides in the bovine digestive tract in a compartment termed as the rumen. The rumen microbiota is necessary for the proper physiological development of the rumen and for the animal''s ability to digest and convert plant mass into food products, making it highly significant to humans. The establishment of this microbial population and the changes occurring with the host''s age are important for understanding this key microbial community. Despite its importance, little information about colonization of the microbial populations in newborn animals, and the gradual changes occurring thereafter, exists. Here, we characterized the overall bovine ruminal bacterial populations of five age groups, from 1-day-old calves to 2-year-old cows. We describe the changes occurring in the rumen ecosystem after birth, reflected by a decline in aerobic and facultative anaerobic taxa and an increase in anaerobic ones. Some rumen bacteria that are essential for mature rumen function could be detected as early as 1 day after birth, long before the rumen is active or even before ingestion of plant material occurs. The diversity and within-group similarity increased with age, suggesting a more diverse but homogeneous and specific mature community, compared with the more heterogeneous and less diverse primary community. In addition, a convergence toward a mature bacterial arrangement with age was observed. These findings have also been reported for human gut microbiota, suggesting that similar forces drive the establishment of gut microbiotas in these two distinct mammalian digestive systems.     

医患沟通技能培养在生殖医学教育中的实践及体会

目的：探讨医患沟通技能培养对生殖医学教育的作用及效果。方法：选择2010 级临床本科专业两个班级共30 人作为观察 组,进行医患沟通技能培养;另选取同年级的两个班级共28 人作为对照组,进行传统生殖医学教学模式培养。运用自行编制的教 学效果调查问卷及SEGUE 量表对两组学生的教学效果及医患沟通技能进行评价及比较。结果：与对照组相比,观察组的教学效 果有明显优势,学生对生殖医学更感兴趣,使生殖医学的教学更富有启发性,学生处理问题的能力显著增强,学生对生殖医学的 知识掌握程度及综合应用能力显著提高,差异具有统计学意义（P<0.05）;与对照组相比,观察组学生在信息收集、信息给予、理解 病人及沟通结束等四个维度的医患沟通能力显著增强,差异具有统计学意义（P<0.05）。结论：在生殖医学教育中加强医患沟通技 能的培养是一种行之有效的教学方法,值得推广。