Minimal Risk in Pediatric Research: A Philosophical Review and Reconsideration

Despite more than thirty years of debate, disagreement persists among research ethicists about the most appropriate way to interpret the U.S. regulations on pediatric research, specifically the categories of “minimal risk” and a “minor increase over minimal risk.” Focusing primarily on the definition of “minimal risk,” we argue in this article that the continued debate about the pediatric risk categories is at least partly because their conceptual status is seldom considered directly. Once this is done, it becomes clear that the most popular strategy for interpreting “minimal risk”—defining it as a specific set of risks—is indefensible and, from a pragmatic perspective, unlikely to resolve disagreement. Primarily this is because judgments about minimal risk are both normative and heavily intuitive in nature and thus cannot easily be captured by reductions to a given set of risks. We suggest instead that a more defensible approach to evaluating risk should incorporate room for reflection and deliberation. This dispositional, deliberative framework can nonetheless accommodate a number of intellectual resources for reducing reliance on sheer intuition and improving the quality of risk evaluations.     

儿科护理学临床见习模式改革探讨

为了解决传统临床见习模式存在的弊端,提高临床教学质量,对2003级护理本科生和2004级护理专科生采用"电教、讨论与集中见习"的模式进行临床教学,并与2002级护理本科生和2003级护理专科生进行对照,结果显示该模式提高了教学效果,节约了开支,减少了浪费,具有可行性。     

Protocol for student replication of published research

Subpart D of the Common Rule establishes 4 categories of research that may be conducted on children. One category, 45 CFR 46.406, permits research posing a minor increase over minimal risk and no prospect of direct benefit but expected to yield vital knowledge about the subjects' disorder or condition. To include other children in research posing a minor increase over minimal risk and no prospect of direct benefit requires federal review and approval of the Secretary of Health and Human Services under 45 CFR 46.407. It is widely held that children generally should not be exposed to more than minimal risk in research without the prospect of direct benefit. To justify deviating from this norm, as 406 allows, two claims must be true: (1) When there is vital knowledge to be gained from studying children, it is permissible to expose some children to a minor increase over minimal risk with no prospect of direct benefit; (2) It is permissible for locally reviewed and approved research to expose only children with the disorder or condition under investigation to greater risk with no prospect of direct benefit. The justification for (1) appears to be grounded in the magnitude of benefit to society combined with the need to study children. This article demonstrates that, even if the necessity and magnitude of benefit to society justify exposing children to increased risk, the decision to categorically restrict participation in such research to children with the disorder or condition under investigation (unless the study is federally reviewed and approved) is not justified. Subpart D should be revised.     

小儿烧伤原因及临床特点

目的分析小儿烧伤原因及临床特点,以预防和减少小儿烧伤的发生。方法对我院2005～2009年999例0～12岁小儿烧伤住院病例的发病率,患儿的年龄,性别,致伤原因,季节分布,城乡分布,烧伤程度等进行了回顾总结及分析。结果小儿烧伤占我院同期烧伤患者的59.32%,婴幼儿期发病率最高,为76.28%,夏秋季发病率为57.26%,农村患儿占89.19%,致伤原因主要以热液烫伤为主,占92.29%,烧伤程度以轻、中度烧伤为主,二者占总数的85.89%。结论重视小儿烧伤的预防,普及烧伤的安全教育,可降低小儿烧伤的发病率。     

浅析磨削烧伤

磨削烧伤在磨削过程中容易出现 ,严重降低磨削质量 文中分析了影响磨削烧伤的因素 ,并提出了解决磨削加工中磨削烧伤的措施     

What Pediatric Subspecialists Need to Know About Sexual and Reproductive Health: A Review of the American Board of Pediatrics Content Outlines for Subspecialty Certifying Examinations

ABSTRACT

Many adolescents with complex medical conditions regard their subspecialty providers as an important source of clinical information including sexual and reproductive health information related to their medical condition. Thus, training for pediatric subspecialty providers should include clinically relevant sexual and reproductive content. The purpose of this study is to understand what disease-relevant sexual and reproductive health information is currently included in content outlines for each of the available pediatric subspecialty certifying examinations. The American Board of Pediatrics (ABP) offers 17 subspecialty certifying examinations; 13 content outlines are available on the ABP website which defines the body of knowledge to be tested. Each available outline underwent content analysis for sexual and reproductive health information. A team of adolescent medicine physicians identified seven thematic areas including: 1) puberty; 2) sexual behavior and identity; 3) fertility; 4) contraception; 5) sexually transmitted infections; 6) other genital pathology; 7) pregnancy. Across disciplines, learning objectives related to sexual behavior, sexual identity, fertility, contraception and pregnancy were the most limited. However, content related to puberty, sexually transmitted infections and other genital pathology was better represented. Overall, disease-and treatment-specific sexual and reproductive health information was sparse. Most subspecialty content outlines contain very little disease-specific sexual and reproductive health information despite the growing adolescent and young adult population with complex medical conditions in the care of pediatric subspecialists. Further studies are needed to explore if lack of sexual and reproductive information on board exams relates to the knowledge base and skill set of pediatric subspecialists.     

山民下坝的文化适应——苦聪人定居问题研究

从 2 0世纪 50年代开始 ,政府就投入大量人力、物力、财力 ,动员中越边境地区迁徙游耕的苦聪人走出森林 ,下坝定居定耕 ,但苦聪人在定居与迁徙的选择中不断出现反复 ,历经 50年 ,到 2 0世纪末 ,苦聪人仍然没有全部定居下来。通过田野调查 ,笔者分析了苦聪人“屡定不居”的各种原因、定居后存在的问题及定居模式的选择等     

火烧圆明园时间小考

在传统教材中,火烧圆明园一般被描述成被烧了一次,即1860年10月18日那次。笔者认为火烧圆明园分两个阶段进行,第一阶段是在10月6日开始,第二阶段是10月18日开始。     

Children's Emotional Responses to a Paediatric Hospital Atrium

This paper illuminates children's emotional responses to an atrium in a contemporary Canadian paediatric hospital. It draws on a focused analysis of data elicited in a qualitative study that explored patients' perspectives on the design and architecture of the atrium. Children were involved in all phases of the project either as consultants on the research methods or participating in interviews and taking photographs of the space. The atrium consists of a main lobby with a high windowed ceiling, brightly coloured elevators with exposed mechanisms, information desks, a large fountain and food venues. Children expressed a range of emotions associated with the space. The findings demonstrate children's ability to identify multi‐faceted issues related to hospital design and affirm their rights to participate in decisions regarding spaces that purportedly are designed for them.     

Neural Network Expert System Approach for Analog Circuits Fault Diagnosis

提出了一种用于模拟电路故障诊断的神经网络专家系统（ＮＮＥＳ）方法。利用神经网络、专家系统两种技术的互补性，采用紧密耦合的ＮＮＥＳ方法实现模拟电路的故障诊断。同时给出并讨论了该方法的一般结构。实验结果说明了这一方法是可行、有效的。