Miracle-dz/UniFAR-FTUs huggingface dataset:
Emergency physician intershift handover - can a dINAMO checklist speed it up and improve quality?

BACKGROUND Physician intershift handover has been identified as an area of high risk for adverse events, representing a critical step in patient care transition. Due to frequent shift changes and high patient numbers, emergency departments offer an ideal study setting. AIM OF THE STUDY At a tertiary care hospital emergency department we aimed to reduce the time needed for patient handover while maintaining or improving quality of information passed between shifts. METHODS Between 31 March and 20 June 2008 we observed intershift handovers in all non-surgical patients at 8 a.m. between nightshift and dayshift. We collected data on handover characteristics and patient demographics. After the usual clinical rounds following each handover, we asked senior physicians about missing or wrong information and possible implications for patient management. From 31 March to 9 May pre-interventional observation took place. On 13 May the dINAMO checklist with five items and a standardised feedback following each handover was introduced. Post-interventional observation lasted until 20 June. RESULTS 61 handovers totalling 23.4 hours of observation time covered 1011 patients. The intervention using the dINAMO checklist reduced mean handover time by 26% from 99 ± 3.3 to 73 ± 2.8 seconds per individual patient (p <0.0001). This resulted in a reduction of morning handover duration from 30 to 20 minutes. Senior physicians reported insignificant improvement of quality of handover. A significant decline in missing or wrong information from 194 incidents in 496 patients to 78 in 470 patients was recorded. CONCLUSIONS An intervention consisting of a simple checklist of five items (dINAMO) and an immediate feedback on quality not only contributes to a significant shortening of time needed for physician intershift handover in a university hospital emergency department, but simultaneously helps to improve quality of information and therefore patient management.
The polarity and stability of microtubule capture by the kinetochore

We have studied the capture of microtubules by isolated metaphase chromosomes, using microtubules stabilized with taxol and marked with biotin tubulin to distinguish their plus and minus ends. The capture reaction is reversible at both the plus and minus ends. The on rate of capture is the same for both polarities but the dissociation rate from the kinetochore is seven times slower with microtubules captured at their plus ends than those captured at their minus ends. At steady state this disparity in off rates leads to the gradual replacement of microtubules captured at their minus ends with those captured at their plus ends. These results suggest that the kinetochore makes a lateral attachment near the end of the microtubule in the initial capture reaction and shows a structural specificity that may be important in proper bipolar attachment of the chromosome to the spindle.
Airway obstruction in asthmatic and healthy individuals: inspiratory and expiratory thin-section CT findings.

PURPOSE To determine differences in computed tomographic (CT) findings in asthmatic and healthy individuals and to correlate the findings with severity of airway obstruction. MATERIALS AND METHODS Thirty-nine asthmatic patients and 14 healthy subjects were prospectively evaluated with thin-section CT. Inspiratory CT scans were subjectively evaluated for presence of bronchial wall thickening, bronchial dilatation, and mosaic lung attenuation; expiratory scans were subjectively evaluated for presence of air trapping. Objective measurement of bronchoarterial-diameter ratio was performed on inspiratory scans. CT findings were compared with pulmonary function test results. RESULTS Bronchial wall thickening, severe air trapping, and reduced bronchoarterial-diameter ratio were observed more commonly in asthmatic patients than in healthy subjects. Bronchial wall thickening was more prevalent among patients with severe airflow obstruction (10 of 12 readings [83%]) than in patients with normal airflow (15 of 40 readings [38%]) or mild obstruction (nine of 26 readings [35%]). Other subjectively determined CT findings did not correlate with pulmonary function test results. The mean bronchoarterial-diameter ratios +/- 1 standard deviation were 0.65 +/- 0.16 in healthy subjects and 0.60 +/- 0.16, 0.60 +/- 0.18, and 0.48 +/- 0.11 in patients with normal airflow and mild and severe obstruction, respectively. CONCLUSION Thin-section CT is of limited value in distinguishing asthmatic patients with normal airflow or mild airflow obstruction from healthy subjects.
Twenty Years after Tarasoff: Reviewing the Duty to Protect

&NA; Since the Tarasoff decision by the California Supreme Court in 1974, mental health clinicians have struggled to balance their duty of confidentiality to their patients against the duty to protect third parties from potential violence. This article explores the development of this issue over the last 20 years, with a focus on ways that Tarasoff has and has not affected clinical practice. Reviewing the evolution of case and statutory law, we discuss appropriate clinical responses for the mental health practitioner who faces a potential “duty to protect” situation.
Influence of residential environment and lifestyle on multiple primary malignancies in Taiwan.

BACKGROUND Multiple primary malignancies (MPM) have become increasingly prevalent worldwide. This investigation was aimed at establishing the clinicopathological characteristics of MPM patients and evaluating the impact of the living environment on MPM in the Taiwanese population. MATERIALS AND METHODS From January 2009 to December 2013, a total of 8,268 cancer patients were identified in our institutional center. Of these, 125 were diagnosed as MPM and thus enrolled. Data for clinicopathological features and treatment approaches for these MPM patients living in urban or suburb zone were obtained. Findings for the air pollution status in Taiwan were also collected. RESULTS The most common cancer match of MPM was esophageal cancer with hypopharyngeal cancer (12.8%), followed by colorectal cancer with gastric cancer (6.4%) and colorectal cancer with breast cancer (5.6%). The air quality was significantly worse in the urban than in the suburban zone and there was a remarkably higher portion of MPM patients in the urban zone suffering from grade III and IV post-chemotherapeutic neutropenia (30.8% vs 15.1%, P=0.036). CONCLUSIONS The tumor frequency and site distribution should be taken into the clinical evaluation because there is a relatively high risk of developing MPM. This study also highlighted the potential influence of environmental factors on post-chemotherapeutic neutropenia for patients with MPM.
The high‐novelty–seeking, impulsive subtype of generalized social anxiety disorder

This study examined potential subgroups of patients with generalized social anxiety disorder (SAD) based on novelty‐seeking tendencies. Eighty‐two outpatients with DSM‐IV generalized SAD were recruited from an outpatient anxiety clinic and assessed with the Tridimensional Personality Questionnaire. The novelty‐seeking subscales, reflecting risk‐prone and disinhibited behavior tendencies, served as dependent measures in a series of cluster analysis procedures. Two qualitatively different SAD subgroups were identified: (1) low novelty‐seeking tendencies and (2) high‐novelty–seeking tendencies. These groups did not differ in social anxiety symptom severity. Women were less likely to be classified in the high‐novelty–seeking group. Clinician severity ratings for comorbid substance use disorders were greater in the high‐novelty–seeking group. These findings contribute to growing evidence for the heterogeneity of SAD. High‐novelty–seeking, risk‐prone, and disinhibited behavior tendencies are a characteristic feature of a distinct subgroup. Depression and Anxiety 0:1–7, 2007. Published 2007 Wiley‐Liss, Inc.
Outcome of modern shunt therapy in patients with idiopathic normal pressure hydrocephalus 6 years postoperatively.

OBJECTIVE Shunt therapy in idiopathic normal pressure hydrocephalus (iNPH) can improve symptoms in 84% of patients 1 year postoperatively. Therefore, implantation of a ventriculoperitoneal shunt (VPS) prevents or at least prolongs the time during which patients are not dependent on care from others because of gait disorder or dementia. In this study, the medium-term results of modern shunt therapy were evaluated. METHODS The authors retrospectively studied outcome in iNPH patients in whom VPSs were implanted. At yearly follow-up examinations over at least 6 years, clinical symptoms were recorded according to the NPH recovery rate (NPH-RR): (preoperative Kiefer Scale [KS] score - postoperative KS score)/(preoperative KS score × 10). Time and cause of death over this period were also analyzed. RESULTS Among the 147 patients treated for iNPH in the period between 1997 and 2006, 69 had died at the time of the authors' survey. Sixty-one patients reached the 6-year examination. The median age was 64 years (range 33-83 years) at the time of VPS implantation and 73 years (range 41-91 years) at the time of this study. Six years after shunt implantation, the median KS score was significantly lower than the preoperative score (4.3 vs 8.1 points). Fifty-nine percent of 61 patients had an excellent outcome, 15% had satisfactory benefit, and 26% had unsatisfactory results 6 years postoperatively. Three of the 147 patients who underwent implantation of a VPS died of cerebral diseases 4-10 years postoperatively. CONCLUSIONS Implantation of a VPS is a safe procedure and can improve symptoms in 74% of patients with iNPH in the longer term.
Self-emulsifying drug delivery system and the applications in herbal drugs

Abstract Herbal drugs have been used for thousands of years in the east and have had a recent resurgence in popularity among consumers in the west. However, most of herbal drug are poorly soluble and have hydrophobic properties and poor distribution, leading to reduced bioavailability and hence decreased treatment efficacy, requiring repeated administration or increased dose. In the past few decades, considerable attention has been focused on the development of self-emulsifying drug delivery system (SEDDS) for herbal drugs. SEDDS is isotropic and thermodynamically stable solutions consisting of oil, surfactant, co-surfactant and drug that can spontaneously form oil-in-water micro/nanoemulsion when mixed with water under gentle stirring. The formulation can be a viable alternative to classical formulations to take advantage of their lipophilic nature and to solve their problems of poor solubility, poor bioavailability, low oral absorption and instability. The mechanism of self-emulsification, solubility studies, construction of phase diagram, optimization and characterization of herbal drugs-loaded SEDDS formulation and in situ absorption evaluation of herbal drugs in rat intestine are presented in our article.
A Neural Wiskott-Aldrich Syndrome Protein-mediated Pathway for Localized Activation of Actin Polymerization That Is Regulated by Cortactin*

Activation of the epidermal growth factor (EGF) receptor can stimulate actin polymerization via the Arp2/3 complex using a number of signaling pathways, and specific stimulation conditions may control which pathways are activated. We have previously shown that localized stimulation of EGF receptor with EGF bound to beads results in localized actin polymerization and protrusion. Here we show that the actin polymerization is dependent upon activation of the Arp2/3 complex by neural Wiskott-Aldrich Syndrome protein (N-WASP) via Grb2 and Nck2. Suppression of Grb2 or Nck2 results in loss of localization of N-WASP at the activation site and reduced actin polymerization. Although cortactin has been found to synergize with N-WASP for Arp2/3-dependent actin polymerization in vitro, we find that cortactin can restrict N-WASP localization around EGF-bead-induced protrusions. In addition, cortactin-deficient cells have increased lamellipod dynamics but show reduced net translocation, suggesting that cortactin can contribute to cell polarity by controlling the extent of Arp2/3 activation by WASP family members and the stability of the F-actin network.
Serotonin reverts age-related capillarization and failure of regeneration in the liver through a VEGF-dependent pathway

The function of the liver is well-preserved during the aging process, although some evidence suggests that liver regeneration might be impaired with advanced age. We observed a decreased ability of the liver to restore normal volume after partial hepatectomy in elderly mice, and we identified a pathway that rescued regeneration and was triggered by serotonin. 2,5-dimethoxy-4-iodoamphetamine (DOI), a serotonin receptor agonist, reversed the age-related pseudocapillarization of old liver and improved hepatosinusoidal blood flow. After hepatectomy, the open fenestrae were associated with a restored attachment of platelets to endothelium and the initiation of a normal regenerative response, including the up-regulation of essential growth mediators and serotonin receptors. In turn, hepatocyte proliferation recovered along with regain of liver volume and animal survival. DOI operates through the release of VEGF, and its effects could be blocked with anti-VEGF antibodies both in vitro and in vivo. These results suggest that pseudocapillarization in the aged acts as a barrier to liver regeneration. DOI breaks this restraint through an endothelium-dependent mechanism driven by VEGF. This pathway highlights a target for reversing the age-associated decline in the capacity of the liver to regenerate.
Apolipoprotein E•dipalmitoylphosphatidylcholine particles are ellipsoidal in solutions⃞ Published, JLR Papers in Press, February 17, 2007.

Apolipoprotein E (apoE) is a major protein component of cholesterol-transporting lipoprotein particles in the central nervous system and in plasma. Polymorphisms of apoE are associated with cardiovascular disease and with a predisposition to Alzheimer's disease and other forms of neurodegeneration. For full biological activity, apoE must be bound to a lipoprotein particle. Complexes of apoE and phospholipid mimic many of these activities. In contrast to a widely accepted discoidal model of apoA-I bound to dimyristoylphosphatidylcholine, which is based on solution studies, an X-ray diffraction study of apoE bound to dipalmitoylphosphatidylcholine (DPPC) indicated that apoE•DPPC particles are quasi-spheroidal and that the packing of the phospholipid core is similar to a micelle. Using small-angle X-ray scattering, we show that apoE•DPPC particles in solution are ellipsoidal and that the shape of the phospholipid core is compatible with a twisted-bilayer model. The proposed model is consistent with the results of mass spectrometric analysis of products of limited proteolysis. These revealed that the nonlipid-bound regions of apoE in the particle are consistent with an α-helical hairpin.
Effects of H‐reflex up‐conditioning on GABAergic terminals on rat soleus motoneurons

To explore the role of spinal cord plasticity in motor learning, we evaluated the effects of H‐reflex operant conditioning on GABAergic input to rat spinal motoneurons. Previous work indicated that down‐conditioning of soleus H‐reflex increases GABAergic input to soleus motoneurons. This study explored the effect of H‐reflex up‐conditioning on GABAergic input. Of nine rats exposed to H‐reflex up‐conditioning, up‐conditioning was successful (H‐reflex increase ≥ 20%) in seven and failed (change < 20%) in two. These rats and eight naive control (i.e. unconditioned) rats were injected with cholera toxin subunit B‐conjugated Alexa fluor 488 into the soleus muscle to retrogradely label soleus motoneurons. Sections containing soleus motoneurons were processed for GAD67 [one of the two principal forms of the GABA‐synthesizing enzyme glutamic acid decarboxylase (GAD)] with an ABC‐peroxidase system. Two blinded independent raters counted and measured GABAergic terminals on these motoneurons. Unlike successful down‐conditioning, which greatly increased the number of identifiable GABAergic terminals on the motoneurons, up‐conditioning did not significantly change GABAergic terminal number. Successful up‐conditioning did produce slight but statistically significant increases in GABAergic terminal diameter and soma coverage. These results are consistent with other data indicating that up‐ and down‐conditioning are not mirror images of each other, but rather have different mechanisms. Although the marked changes in GABAergic terminals with down‐conditioning probably contribute to H‐reflex decrease, the modest changes in GABAergic terminals associated with up‐conditioning may be compensatory or reactive plasticity, rather than the plasticity responsible for H‐reflex increase. As a variety of spinal and supraspinal GABAergic neurons innervate motoneurons, the changes found with up‐conditioning may be in terminals other than those affected in successful down‐conditioning.
Origin of rotational kinematics in the globular cluster system of M31: a new clue to the bulge formation

We propose that the rotational kinematics of the globular cluster system (GCS) in M31 can result from a past major merger event that could have formed its bulge component. We numerically investigate kinematical properties of globular clusters (GCs) in remnants of galaxy mergers between two discs with GCs in both their disc and halo components. We find that the GCS formed during major merging can show strongly rotational kinematics with the maximum rotational velocities of ∼140–170 km s−1 for a certain range of orbital parameters of merging. We also find that a rotating stellar bar, which can be morphologically identified as a boxy bulge if seen edge-on, can be formed in models for which the GCSs show strongly rotational kinematics. We thus suggest that the observed rotational kinematics of GCs with different metallicities in M31 can be closely associated with the ancient major merger event. We discuss whether the formation of the rotating bulge/bar in M31 can be due to the ancient merger.
Dexmedetomidine as a total intravenous anesthetic agent.

DEXMEDETOMIDINE is a highly selective α 2 adrenoceptor agonist that has sedative and analgesic properties with associated reduction in opioid and anesthetic requirements. 1-11 One significant advantage of dexmedetomidine is that in the clinical dose range there is no respiratory depression. 12-14 The agonistic action on the α 2 adrenoceptors in the sympathetic ganglia modulates the release of catecholamines, resulting in a sympatholytic effect and reports of bradycardia and hypotension. 15-19 As the dose of dexmedetomidine is increased, there is a direct action on the blood vessels causing vasoconstriction and a possible increase in blood pressure. 3,18 This report describes three patients who presented for surgery with potential airway management challenges. Dexmedetomidine was administered to these patients in increasing doses until general anesthesia was attained. The effects of these high doses of dexmedetomidine on respiratory function and hemodynamics are described. The rate of dexmedetomidine infusion was administered based on actual patient body weights.
Longitudinal Change in Happiness during Aging: The Predictive Role of Positive Expectancies

This study employed hierarchical linear modeling to document the time course of happiness across 20 years from average ages of 66 to 86 among 717 members of the Terman Study of the Gifted. In addition, the study examined the role of positive expectancies about aging, assessed at an average age of 61, in enhancing happiness in aging. The results showed a small decline in happiness over time. Higher age was associated with less happiness at baseline and with a greater decline in happiness. At the same time, the general level of happiness in this sample was moderately high, with a large majority of respondents relatively happy into later aging. Moreover, positive expectancies about aging, assessed at an average age of 61, predicted greater happiness at ages 70, 75, and 80. These results held controlling for prior happiness, as well as for prior self-rated health and income.
Muscle involvement in limb-girdle muscular dystrophy with GMPPB deficiency (LGMD2T)

Objective: In this study, muscle involvement assessed by MRI and levels of GMPPB and glycosylation of α-dystroglycan expression in muscle were examined in patients with limb-girdle muscular dystrophy (LGMD) type 2T. Methods: Six new patients with genetically verified mutations in GMPPB were studied. T1-weighted magnetic resonance images were obtained in 4 participants. Muscle strength and potential involvement of extramuscular organs were examined. Glycosylation of α-dystroglycan in muscle was studied, and GMPPB and α-dystroglycan expression was analyzed by Western blotting. Prevalence of LGMD2T was calculated from the total LGMD population in Denmark. GMPPB was sequenced in all unclassified cases. Results: Two patients carried 3 new mutations in GMPPB. The other 4 patients carried previously described pathogenic mutations in GMPPB. MRI showed that the paraspinal muscles were the most affected, followed by involvement of hamstrings. Our results showed a loss of glycosylation of α-dystroglycan as well as secondary loss of merosin expression on Western blotting. The prevalence of LGMD2T in the Danish cohort of patients with LGMD is 1.5%. Conclusions: The new findings of this study are (1) the consistent finding of a preferential affection of paraspinal and hamstring muscles in LGMD2T, (2) 3 new mutations in GMPPB, (3) variable loss of glycosylation tested with IIH6 and VIA4 antibodies, and (4) a prevalence of LGMD2T of 1.5% in a well-characterized Danish LGMD cohort.
Community, heritage, identity :constructing, performing and consuming Welsh identities in the US

This thesis examines relationships between community, heritage and identity in a diasporic context, exploring how national identities are imagined, expressed and sustained outside the nation. It is based on case studies of four Welsh American community heritage sites in the US, which involved detailed surveys with visitors to the sites, interviews with curators and managers, and in-depth analyses of their collections, exhibitions and events. The thesis starts from the assertion that heritage is a cultural and social communicative process (Dicks 2000a, 2000b; Smith 2006). It investigates how and why self-identifying Welsh Americans use community heritage sites to construct, perform and consume a range of personal and collective identities. Narratives of Welsh identities expressed by visitors are analysed using theories of symbolic ethnicity (Gans 1979) and elective belonging (Savage, Bagnall and Longhurst 2005). It is argued that the construction, performance and consumption of Welsh identities in the US are sustained by social groups and networks. The case study sites are further maintained to belong to a transnational heritage network incorporating a variety of community, academic and professional stakeholders from Wales and the global Welsh diasporic community. This challenges the division found in much museological theory between community initiatives in the "official" and "unofficial" heritage sectors. This thesis suggests that community heritage initiatives in both sectors are influenced by a mixture of "bottom-up" community and "top-down" professional interests and agendas. Acknowledging the inter-relationships between these sectors prompts a re-examination of processes of production and consumption. Rather than a linear continuum of performer/audience (Abercrombie and Longhurst 1998) or self/other (Dicks 2003), this thesis argues that processes of production and consumption are more usefully conceptualised as a network. It develops an audience network model as a means through which to create a better understanding of the variety of different ways in which individuals can engage with heritage narratives.