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Emergency department and hospital crowding: causes, consequences, and cures
Peter Mckenna,Samita M Heslin,Peter Viccellio,William K Mallon,Cristina Hernandez,Eric J Morley 대한응급의학회 2019 Clinical and Experimental Emergency Medicine Vol.6 No.3
Overcrowding with associated delays in patient care is a problem faced by emergency departments (EDs) worldwide. ED overcrowding can be the result of poor ED department design and prolonged throughput due to staffing, ancillary service performance, and flow processes. As such, the problem may be addressed by process improvements within the ED. A broad body of literature demonstrates that ED overcrowding can be a function of hospital capacity rather than an ED specific issue. Lack of institutional capacity leads to boarding in the ED with resultant ED crowding. This is a problem not solvable by the ED and must be addressed as an institution-wide problem. This paper discusses the causes of ED overcrowding, provides a brief overview of the drastic consequences, and discusses possible cures that have been successfully implemented.
Biphasic Effect of Curcuminoids on Oxidation of Postprandial Chylomicrons
Peter A.C. McPherson,Niamh McKenna,Dílis Clare 한국식품영양과학회 2021 Journal of medicinal food Vol.24 No.12
Chylomicrons are large, triglyceride-rich lipoproteins that transport dietary lipids and lipophilic micronutrients through the lymphatic system and into the venous circulation. They therefore represent a valuable means of investigating the bioavailability of a range of bioactive molecules. Curcuminoids have a complex reputation, with most in vitro studies suggesting a beneficial effect (e.g., as an antioxidant), while in vivo work is often, at best, equivocal. We have prepared a curcuminoid extract from fresh turmeric and investigated the transfer of curcuminoids to chylomicrons by rapid ultracentrifugation. We subsequently characterized the chylomicrons in terms of their susceptibility to oxidation. There was a dose-dependent relationship between the curcuminoid level in chylomicrons and decreased levels of preformed lipid hydroperoxides (P < .05), which was broadly mirrored by paraoxonase arylesterase activity. At lower dosages (1000–3000 mg), curcuminoids protected chylomicrons against copper(II)-mediated oxidation, but at higher levels (4000–5000 mg), a pro-oxidant effect was observed. In conclusion, we report a clear biphasic (hormetic) effect of curcuminoids on lipid oxidation, which supports the theory that low dosages of bioactive compounds can have beneficial effects, while higher dosages may have an equivocal or negative impact on the disease.