AfterWards:A Narrative Medicine Program at Johns Hopkins Medicine and in China

Narrative medicine is a multidisciplinary field of inquiry and practice based on the premise that medical care takes place in the context of stories.Research on narrative medicine training suggests that it conveys benefits such as improved communication skills and personal and professional growth to physicians,medical students,and other health care providers.Narrative medicine can promote empathy and trust between patients and physicians and foster self-care.In 2014,the author and a colleague started an ongoing inter-disciplinary narrative medicine program in the Children’s Center of the Johns Hopkins Hospital called AfterWards.The program,which meets monthly,is open to all on a volunteer basis.Through literature,art,and writing,AfterWards nurtures empathy,encourages reflective practice,and builds community among a diverse group of health care providers.Through a series of lectures and workshops at Johns Hopkins Medicine,Peking Union Medical College,and Fudan Hospital in Shanghai,the author has introduced AfterWards to Chinese medical educators and clinicians.Working with Dr.Marta Hanson,she created an AfterWards Facilitator’s Guide for the use of Chinese practitioners.A recent White Paper on Chinese health care indicates that an infusion of humanities-based education,of which narrative medicine forms a part,can help rebuild patient-physician trust.Recently,there has been an increase in interest in narrative medicine in the United States and China.However,more research is needed to demonstrate the impact of programs like AfterWards.Challenges to the implementation of narrative medicine programs remain,most significantly in terms of expertise,resources,and time.

Johns Hopkins循证护理实践模式的研究进展

系统介绍了Johns Hopkins循证护理实践模式,包括3大关键要素,即实践、教育和研究;其核心是证据,分为研究型证据和非研究型证据;以及众多内因和外因。阐述了循证实践的3阶段流程即实践问题、证据生成和证据转化以及国内外应用进展,旨在为我国护理人员开展循证护理实践、教育和研究提供思路和方法指导。另一方面,在实践过程中加强该模式与其他循证护理实践模式的相互比较,并根据我国国情对该模式进行不断地测试和修订,加强该模式理解、应用和实践项目成效报道,并根据不同研究目的和临床情景来发展其概念框架是未来发展方向。

Enzalutamide Associated with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) Overlap: A Case Report

Enzalutamide is a hormonal therapy that blocks the action of androgens, such as testosterone in the treatment of metastatic castration-resistant prostate cancer. Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) overlap and are part of an adverse drug reaction continuum of disease, in which there is a 10% - 30% involvement of the skin surface with mucositis, blisters, skin slough, and a macular rash. A 66-year-old male was treated with enzalutamide for metastatic prostate cancer and developed SJS/TEN overlap with 25% total body surface area skin involvement. The patient received a seven-day course of cyclosporine to which he responded by re-epithelialization but succumbed to multi-organ failure. While SJS/TEN has been reported with apalutamide, to our knowledge, this is the first case of SJS/TEN overlap with enzalutamide.

From "Genes to Society":The logic and process of the New Johns Hopkins University School of Medicine curriculum

Johns Hopkins University School of Medicine (JHUSOM) has been a leader in medical education since its inception in 1893. The influence of John Dewey on the founders of the school is evident in the design of the curriculum,which included serious study of basic science for two years,followed by 'learning by doing' in the 3d and 4th clinical years. After the Flexner report in 1910 which lauded the school as an exemplary model,this became the standard curricular structure of undergraduate medical education in the US. Since its founding Hopkins,like other medical schools,has struggled with burgeoning biomedical knowledge and the tension between time and content. The last curricular revision was implemented in 1992,and had several themes,including:(1) decreased lecture time and increased small group learning; (2) early clinical experience and more ambulatory clinical experience; (3) integration of the basic sciences to improve learning and reduce redundancy; (4) development of a longitudinal course for the social sciences,(named 'The Physician and Society' course); (5) a required thesis project for graduation. All but the last were implemented. Our students have done well in this curriculum. 98-100% pass the licensing board exams,and over 90% obtain their first choice for residency positions,often in highly competitive programs such as Dermatology,Neurosurgery and Ophthalmology. Approximately 30% of graduates are listed in the AAMC faculty roster-one of the highest percentages of graduates going to academic medicine in the country.

The REDS program in China:a collaboration on blood safety with Chinese blood centers and Johns Hopkins Medicine

The Retrovirus Epidemiology Donor Study (REDS) was established in 1989 with funding from the National Heart,Lung,and Blood Institute ( NHLBI ) of the National Institutes of Health in the United States.The initial program coordinated activities in five large US blood centers in San Francisco,Los Angeles,Oklahoma City,Detroit,and Baltimore with a coordinating center Westat in Rockville MD.

The glaucoma service at Johns Hopkins University

Glaucoma service of Johns Hopkins University is currently involved in a range of research projects.This overview will cover the major clinical activities currently underway.

John Deere柴油机的电子控制

用于John Deere400系列7.6L和500系列10.1L柴油机的电控系统已研制成功,在对道路、非道路及固定作业用的发动机的控制方面,这些独具特色的微机控制系统的性能优于机械控制系统。其功能包括:限时提高功率、不带歧管传感器的瞬态排烟控制、开关选择扭矩曲线、调速、特殊油门选择、自适应油门校正、温度补偿及出厂编程。

Prevalence of Flatfoot and Its Correlation with Age,Gender and BMI among Undergraduates at the Faculty of Allied Health Sciences,General Sir John Kotelawela Defence University

Pes planus or flatfeet is a postural deformity which leads the entire sole of the foot to completely or near-completely touch the ground.Pes planus deformity occurs due to collapse of foot arches which can be congenital or pathological.The objective of this study was to determine the prevalence of flatfoot condition among undergraduates at the Faculty of Allied Health Sciences(FAHS),General Sir John Kotelawala Defence University(KDU)and its correlation with age,gender and BMI.A cross sectional study was conducted among 533 participants(Male=131,Female=402).Interviewer-administered questionnaire was used to collect the demographic data.BMI was calculated by obtaining height and weight measurements.Arch index method was used to determine the foot type taken using the Modified Harris Mat.The data analysis was done using SPSS software version 23.P value of less than 0.05 was considered as statistically significant.The study was done among people aged 19 to 26.The prevalence of flatfoot among this age group was 34.7%(n=185).Most of them are bilateral flat feet(73.5%),only 26.5%are unilateral flat feet.The proportion of patients with flat footedness was significantly higher in women(75%)than in men(25%).BMI in the overweight and obese categories(BMI>23)was statistically significant(p<0.05),which is 164(52.4%).Study shows a statistically significant association between flatfoot and increasing BMI beyond normal(p<0.05).There is no significant association between flatfoot with age and gender.Prevalence of flatfoot among allied health undergraduates was seemingly high requiring screening for early detection and appropriate referral for corrective measures.

喷水式超声检测的声−流耦合模型

为研究超声波在射流水柱中的传播特性,提出了喷水式超声检测的声−流耦合建模方法。使用计算流体动力学方法得到喷水探头内部流场的湍动能、速度和压力,并通过弱形式偏微分方程将其映射到声学网格作为声场分析的边界条件,用线性纳维−斯托克斯方程求解湍动能、流速等引起的声学变化,建立了喷水式超声检测的声−流耦合模型。仿真计算了不同流速时工件内部的声压分布,进水口流速的变化不会改变工件中声压的分布规律,但空间声压幅值随着流速的增大而减小。仿真计算了不同流速时的平底孔回波,回波幅值随着流速的增大而减小,通过与实验结果对比,验证了本文方法的准确性。

美国智库对中国周边跨境水资源安全影响的战略评估

[研究目的]在中美战略竞争的大背景下,水资源议题已成为美国对华竞争的重要场域,这其中美国智库的推手作用不可忽视。以美国智库为核心研究视角,分析美国对中国周边水资源安全的认知及影响,为相关议题研究提供借鉴,为决策者研判中国跨境水资源治理态势提供可靠的信息支持及应对之策。[研究方法]选取美国8家智库22篇具有代表性的核心研究报告和分析文章进行文本分析,梳理美国智库对中国周边跨境水资源安全现状及安全手段的认知和评估,就其核心观点的特点、动因及内外部影响展开讨论。[研究结果]研究发现,美国智库对中国周边水资源安全的战略评估多以负面为主,认为中国“控制”了其周边流域的水资源,并依托此展开地缘竞争。这一负面认知扩散到了美国的政府外交、公众舆论中,中国逐渐被塑造为“水霸权国”。中国应从健全情报建设体系、加强周边跨境河流跨学科研究、舆论管控等方面,对有关认知加以鉴别,科学应对。

基于络病理论探讨辛润通络法治疗泻剂结肠的理论内涵

络病理论重视脏腑虚实及其络脉的盈亏通滞,基于络病理论探讨辛润通络法治疗泻剂结肠的理论内涵。泻剂结肠的基本病机为大肠络瘀,耗气伤阴,虚实夹杂,治宜益气养阴、活血通络。在此基础上,结合脏腑气血阴阳与大肠及其络脉系统的关系,灵活运用补肺理气、健脾温中、疏肝养血、补肾益精等辛润通络之法,润燥而不呆补,行气而不破气,常获良效。并附验案1则。

微内核操作系统互斥量模块功能正确性的形式化验证

操作系统在许多安全攸关领域为软件系统提供关键性底层支撑,操作系统中一个微小的错误或漏洞都可能引起整个软件系统的重大故障,造成巨大经济损失或危及人身安全.为了减少此类安全事故的发生,对操作系统正确性进行验证十分必要.传统测试手段无法穷尽系统中的所有潜在错误,因而操作系统验证有必要使用具有严格数学理论基础的形式化方法.在操作系统中,互斥量可协调多任务对资源的访问,是一种常用的任务同步方式,其功能正确性对于保障多任务应用的正确性十分关键.基于定理证明方法,在交互式定理证明器Coq中对某抢占式微内核操作系统的互斥量模块进行代码级形式化建模,给出其接口函数的形式化规范,并实现这些接口函数的功能正确性验证.

Mechanism of Cu entry into the brain:many unanswered questions

Brain tissue requires high amounts of copper(Cu)for its key physiological processes,such as energy production,neurotransmitter synthesis,maturation of neuropeptides,myelination,synaptic plasticity,and radical scavenging.The requirements for Cu in the brain vary depending on specific brain regions,cell types,organism age,and nutritional status.Cu imbalances cause or contribute to several life-threatening neurologic disorders including Menkes disease,Wilson disease,Alzheimer’s disease,Parkinson’s disease,and others.Despite the well-established role of Cu homeostasis in brain development and function,the mechanisms that govern Cu delivery to the brain are not well defined.This review summarizes available information on Cu transfer through the brain barriers and discusses issues that require further research.

哀牢山构造带新元古代双峰式岩浆岩的锆石U-Pb年代学、元素-同位素地球化学特征及构造意义

分布于扬子克拉通西缘的新元古代岩浆岩对研究华南陆块的前寒武纪演化及其与Rodinia超大陆的关系意义重大,但由于该区域后期构造-热历史的复杂性,关于一些重要岩石单元的时代、属性和构造背景仍存在诸多争议。本文聚焦哀牢山构造带南段的桃家寨岩体,报道了来自该岩体的一套变基性岩和钠长花岗岩组合的年代学和地球化学组成,以期为解决现存争议提供新的证据和约束。SHRIMP原位锆石U-Pb同位素测年表明变基性岩和钠长花岗岩的结晶年龄分别为756±9 Ma和763±23 Ma,表明二者为同期岩浆作用的产物,其合并加权平均年龄759±7 Ma(MSWD=0.88,n=8)代表了岩浆事件年龄;同时,来自两件样品的锆石都记录了~730 Ma的岩浆后热扰动事件。变基性岩具有低碱(Na2O+K2O=0.17%~0.36%),高Mg#(76~79)的地球化学特征,略富集轻稀土元素(LREEs),并具有弱的Nb-Ta负异常和正的ε_(Nd)(t)值(+2.67~+3.10),表明其来自E-MORB型富集地幔岩浆源区,可能经历了俯冲板片流体或者熔体的改造。钠长花岗岩显示高碱(Na_(2)O+K_(2)O=6.70%~8.30%)、富集LREEs和大离子亲石元素(LILEs)、亏损重稀土元素(HREEs)等特点,具有负的ε_(Nd)(t)值(-2.43~-1.26),表明其母岩浆可能源自下地壳物质部分熔融与基性熔体的混合。综合前人研究,发现桃家寨岩体的岩石组合具有双峰式特点,并在地球化学特征上显示典型的弧-弧后盆地属性;岩浆作用峰期~760 Ma,指示其为新元古代扬子克拉通西缘的洋陆俯冲构造体系的一部分,从而为将华南陆块置于Rodinia外围的超大陆重建模式提供了新的证据。

Anatomical Retrofitting:Pi(脾)as Spleen and the Persistence of Ontological Ambivalence

Over the past decade,medical researchers in China have debated whether the Pi(脾)corresponds to the biomedical spleen or pancreas.This debate exemplifies a broader phenomenon of“anatomical retrofitting”,or the anachronistic imposition of contemporary categories onto living historical objects.“Anatomical retrofitting”as a means of rectifying cases of mistranslation further positions the biomedical spleen and pancreas as representing ahistorical,universal truths.This framework gives rise to a conceptual binary:while the biomedical spleen is universalized as what philosophers may describe as“logical”ontology,the Pi connects to a different nature of reality,or“metaphysical”ontology.Far from being an object of imprecision,the Pi was a dynamic vessel that also shared characteristics with the humoral spleen.Given that scholars in China have already subjected Pi to historical scrutiny,this paper urges scholars to do the same with biomedical anatomy.For instance,historically situating the humoral spleen demonstrates that it became less known and less articulated as it transformed into the biomedical spleen.Meanwhile,the pancreas remained an unstable epistemic object that took on the dynamic functions of the humoral spleen in nineteenth-century organotherapy.Through primary source analysis and literature review,this paper contends that the apparent ontological incommensurability between Pi and spleen is neither mutually exclusive nor irreconcilable.Instead,the dynamic nature of internal viscera,their many functions,and their participation in epistemic practices contribute to an ongoing ontological ambivalence that persists despite the forced certainty of anatomical retrofitting.

机器的觉醒:生成式AI溯源、演进与展望

自2018年GPT—1问世以来,生成式人工智能的迅猛发展给全球企业和组织的管理实践带来了巨大冲击。A I生成内容的研究迅速成为国内外学者关注的热点问题之一。先前AIGC研究聚焦于核心技术突破、应用场景融合、数据安全保护等方面,研究主题分散且尚未形成统一的研究框架。因此,本研究基于对AIGC概念的界定,选取了407篇国内外核心期刊上的文献作为研究对象,并结合LDA模型和人工编码的方法,对这些文献进行分析,最终得出8个子主题和3个主题,系统梳理了AIGC研究的相关内容。首先,从AIGC的兴起缘由、构建基石和驱动能力等方面进行溯源。其次,基于研究主题分析和溯源过程,结合“技术—组织—环境”(TOE)理论模型提炼出AIGC研究演进的知识框架,并在此基础上就技术与商业价值、管理实践与理论、负面影响与组织环境三个维度展开论述。最后,论述AIGC技术与管理的结合会如何影响管理实践、研究理论与方法,并据此提出未来可行的研究方向与建议,拓展研究视角。本研究结果有助于厘清AIGC的发展与演化脉络,对于了解和推动AIGC相关研究具有重要意义。

Conditioned medium from human dental pulp stem cells treats spinal cord injury by inhibiting microglial pyroptosis

Human dental pulp stem cell transplantation has been shown to be an effective therapeutic strategy for spinal cord injury.However,whether the human dental pulp stem cell secretome can contribute to functional recovery after spinal cord injury remains unclear.In the present study,we established a rat model of spinal cord injury based on impact injury from a dropped weight and then intraperitoneally injected the rats with conditioned medium from human dental pulp stem cells.We found that the conditioned medium effectively promoted the recovery of sensory and motor functions in rats with spinal cord injury,decreased expression of the microglial pyroptosis markers NLRP3,GSDMD,caspase-1,and interleukin-1β,promoted axonal and myelin regeneration,and inhibited the formation of glial scars.In addition,in a lipopolysaccharide-induced BV2 microglia model,conditioned medium from human dental pulp stem cells protected cells from pyroptosis by inhibiting the NLRP3/caspase-1/interleukin-1βpathway.These results indicate that conditioned medium from human dental pulp stem cells can reduce microglial pyroptosis by inhibiting the NLRP3/caspase-1/interleukin-1βpathway,thereby promoting the recovery of neurological function after spinal cord injury.Therefore,conditioned medium from human dental pulp stem cells may become an alternative therapy for spinal cord injury.

Origins of perturbations in dayside equatorial ground magnetograms

To determine the cause(s)of perturbations seen in dayside equatorial ground magnetograms,we conducted a systematic survey of simultaneous ground-based and geosynchronous satellite-based observations during the 90-day period from December 1,2020 to February 28,2021.We examined Huancayo ground magnetometer observations from 14:00:00 to 20:00:00 UT each day,during which Huancayo passed through local noon.From those data we chose perturbation events selected on the basis of large(>20 nT)event amplitude and classified the selected events as responding primarily to solar wind pressure,or to variations in the north/south component of the interplanetary magnetic field(IMF Bz),or perhaps in part to both.The results show that an equivalent number of events were identified for each model during this 90-day period.Variations in the lagged solar wind dynamic pressure routinely correspond to nearly simultaneous sudden impulses recorded at both geosynchronous orbit and on the ground.Variations in IMF Bz produce erosion signatures at geosynchronous orbit and can correspond to ground events if lag times for reconnection to enhance convection in the magnetosphere are taken into account.

Unlocking the potential-vitamin D in prostate cancer prevention

Prostate cancer poses a significant health challenge globally,demanding proactive prevention strategies.This editorial explores the emerging role of vitamin D in prostate cancer prevention.While traditionally associated with bone health,vitamin D is increasingly recognized for its broader impact on immune function,cellular signaling,and cancer prevention.Epidemiological studies suggest an intriguing link between vitamin D deficiency and elevated prostate cancer risk,particularly in regions with limited sunlight exposure.Mechanistically,vitamin D regulates cellular processes,inhibiting unchecked cancer cell growth and bols-tering immune surveillance.Personalized prevention strategies,considering individual factors,are deemed essential for harnessing the full potential of vitamin D.To unlock this potential,the future calls for robust research,public awareness campaigns,dietary improvements,and vigilant medical guidance.Collaborative efforts are poised to pave the way toward a future where vitamin D stands as a sentinel in prostate cancer prevention,ushering in hope and improved health for men worldwide.

“保险+期货”模式在农业风险管理中的优化路径探索

近年来,“保险+期货”在农业经济管理中迅速发展,但依然存在一些亟待解决的问题。“保险+期货”各参与主体之间权责不对等;保险品种单一;保费补贴分担机制不健全;场外期权定价不精准且复制成本高等。因此,现有“保险+期货”模式要从多方面进行优化,要形成标准化的产品和体系;理清各参与主体的权责分配;构建稳定的保费补贴机制;完善期货市场运作机制等,充分发挥金融服务实体经济的功能,促进农业经济高质量发展。