Miracle-dz/UniFAR-FTUs huggingface dataset:
Simulation Training for Pediatric Residents on Central Venous Catheter Placement: A Pilot Study*

Objective: To assess the effect of simulation training on pediatric residents’ acquisition and retention of central venous catheter insertion skills. A secondary objective was to assess the effect of simulation training on self-confidence to perform the procedure. Design: Prospective observational pilot study. Setting: Single university clinical simulation center. Subjects: Pediatric residents, postgraduate years 1–3. Interventions: Residents participated in a 60- to 90-minute ultrasound-guided central venous catheter simulation training session. Video recordings of residents performing simulated femoral central venous catheter insertions were made before (baseline), after, and at 3-month following training. Three blinded expert raters independently scored the performances using a 24-item checklist and 100-mm global rating scale. At each time point, residents rated their confidence to perform the procedure on a 100-mm scale. Measurements and Main Results: Twenty-six residents completed the study. Compared with baseline, immediately following training, median checklist score (54.2% [interquartile range, 40.8–68.8%] vs 83.3% [interquartile range, 70.0–91.7%]), global rating score (8.0 mm [interquartile range, 0.0–64.3 mm] vs 79.5 mm [interquartile range, 16.3–91.7 mm]), success rate (38.5% vs 80.8%), and self-confidence (8.0 mm [interquartile range, 3.8–19.0 mm] vs 52.0 mm [interquartile range, 43.5–66.5 mm]) all improved (p < 0.05 for all variables). Compared with baseline, median checklist score (54.2% [interquartile range, 40.8–68.8%] vs 54.2% [interquartile range, 45.8–80.4%], p = 0.47), global rating score (8.0 mm [interquartile range, 0.0–64.3 mm] vs 35.5 mm [interquartile range, 5.3–77.0], p = 0.62), and success rate (38.5% vs 65.4%, p = 0.35) were similar at 3-month follow-up. Self-confidence, however, remained above baseline at 3-month follow-up (8.0 mm [interquartile range, 3.8–19.0 mm] vs 61.0 mm [interquartile range, 31.5–71.8 mm], p < 0.01). Conclusions: Simulation training improved pediatric residents’ central venous catheter insertion procedural skills. Decay in skills was found at 3-month follow-up. This suggests that simulation training for this procedure should occur in close temporal proximity to times when these skills would most likely be used clinically and that frequent refresher training might be beneficial to prevent skills decay.
Recovering functional independence after a stroke through Modified Constraint-Induced Therapy.

BACKGROUND Population ageing and changes in the epidemiological profile of neurological pathologies has resulted in an increase in patients with disabilities. Rehabilitation strategies such as Modified Constraint-Induced Movement Therapy (CIMTm) play a key role in treating patients with neurologic deficiencies and motor impairments. This intervention is intended to mitigate disability, promote maximum functional independence, and optimize social and economic participation of patients with upper extremity weakness. Our goal was to assess the recovery of functional independence in patients after a stroke using to CIMTm. PATIENTS AND METHOD Thirty-six subjects who had suffered stroke took part in a randomised clinical trial. The treatment was applied through either collective or individual modalities for three hours per day for a period of ten days. Participant's functional independence was assessed using the Functional Independence Measure (FIM) scale at the before and after of the intervention. RESULTS An analysis of covariance carried out on the pre-test assessments indicates that the dependent variable presents significant differences (F1.31 = 42.78, p < 0.001, η2p = 0.72) in favour of the collective intervention modality. CONCLUSION Both modalities of CIMTm intervention promote functional independence. However, the greatest improvements were observed in participants in the collective modality. Improvements in functional independence pursue a reduction in learned non-use behaviours through greater use of the paretic upper extremity in everyday activities.
Back Pain in the German Adult Population: Prevalence, Severity, and Sociodemographic Correlates in a Multiregional Survey

Study Design. A population-based cross-sectional multiregion postal survey. Objective. To provide a descriptive epidemiology of the prevalence and severity of back pain in German adults and to analyze sociodemographic correlates for disabling back pain within and across regions. Summary of Background Data. Back pain is a leading health problem in Germany. However, comprehensive population-based evidence on the severity of back pain is still fragmentary for this country. Despite earlier findings concerning large prevalence differences across regions, systematic explanations remain to be ascertained. Methods. Questionnaire data were collected for 9263 subjects in 5 German cities and regions (population-based random samples, postal questionnaire). Point, 1-year, and lifetime prevalence were assessed using direct questions, and graded back pain was determined using the Graded Chronic Pain Scale. Poststratification was applied to adjust for cross-regional sociodemographic differences. Results. Point-prevalence was 37.1%, 1-year prevalence 76.0%, and lifetime prevalence 85.5%. A substantial minority had severe (Grade II, 8.0%) or disabling back pain (Grade III–IV, 11.2%). Subjects with a low educational level reported substantially more disabling back pain. This variable was an important predictor for large cross-regional differences in the burden of back pain. Conclusion. Back pain is a highly prevalent condition in Germany. Disabling back pain in this country may be regarded as part of a social disadvantage syndrome. Educational level should receive greater attention in future cross-regional comparisons of back pain.
Faculty perceptions of the ACGME resident duty hour regulations in family medicine.

BACKGROUND AND OBJECTIVES Accreditation Council for Graduate Medical Education (ACGME) duty hour regulations have significantly changed residency education. Initial research focused heavily on resident experiences, while changes in faculty roles and effects on patient care and resident education have received less attention. This survey examines faculty perceptions of the effect of duty hour changes in academic family medicine. METHODS Family medicine faculty members from 15% of ACGME-accredited residencies were surveyed. The survey included demographic information and Likert-type questions about changes in faculty duties, patient care, resident education, and satisfaction with academic medicine. RESULTS A total of 368 of 672 surveys were returned; 97% of the 69 surveyed programs were represented. The average faculty workweek was 66 hours, including call. Of respondents, 81% felt that weekly faculty hours were unchanged since duty hours; 19% thought work hours had increased. Faculty felt that residency education and patient care were not positively affected by duty hours. Statistically significant differences were found between perceptions of faculty who did and did not deliver babies. Twenty percent of faculty members are considering leaving academic medicine in relation to duty hours. CONCLUSIONS Consistent with research from other specialties, many faculty members perceive that their work roles have increased in certain areas. Resident performance and patient care are not seen to be improved as a result of duty hours. Further research into the unexpected findings involving labor and delivery responsibilities is needed.
Daclizumab induction and maintenance steroid‐free immunosuppression with mycophenolate mofetil and tacrolimus to prevent acute rejection of hepatic allografts

Steroid‐free immunosuppressive regimens reduce corticosteroid‐related side effects in liver transplant recipients although their efficacy is very variable. We evaluated the efficacy and safety of a steroid‐free regimen in a 6‐month, open‐label, multicenter, pilot study, which involved 102 liver transplant patients treated with daclizumab (2 mg/kg within 6 h following transplant and 1 mg/kg on day 7), mycophenolate mofetil (MMF, 1 g b.i.d) and tacrolimus (trough levels of 5–15 ng/ml in the first month and 5–10 ng/ml thereafter). One intra‐operative dose of methylprednisolone was administered. At 6 months, the acute rejection rate was 9.8%, and patient and graft survival rates were 96% and 95%, respectively. Acute rejection rates were similar for hepatitis C‐positive patients (8.6%) and hepatitis C‐negative patients (10.4%). Infections occurred in 22% of patients; most cases were considered mild or moderate. Post‐transplantation hypertension and diabetes mellitus developed in 37% and 14% of patients, respectively, during the study period, but were markedly less frequent (8% and 6%, respectively) at 6 months. Hypercholesterolemia was observed in only 2% of patients. In conclusion, the steroid‐free immunosuppressive regimen of daclizumab, MMF, and tacrolimus effectively prevents acute rejection after liver transplantation without decreasing safety.
The role of thrombin in preterm parturition.

OBJECTIVE Previous reports from our laboratory have shown that thrombin is a potent uterotonic agonist; those studies have suggested a role for thrombin during parturition, especially with regard to intrauterine bleeding. Thrombin activation can be quantified in peripheral blood by measurement of thrombin-antithrombin III (TAT) complex levels. This study sought to determine whether thrombin activation, as measured by thrombin-antithrombin III levels, is associated with premature labor. STUDY DESIGN Thrombin-antithrombin III levels were measured in patients and control subjects with preterm labor. Quantitative TAT levels were determined by use of an enzyme-linked immunoassay with a working range from 0 to 60 ng/mL. All patients were monitored for pregnancy outcome. Receiver operating curve analysis was performed to determine the optimal TAT cutoff values. Further statistical analyses with one-way ANOVA, the chi2 test, or the Fisher exact test were performed to determine statistical significance (P <.05). RESULTS Patients admitted with preterm labor who were subsequently delivered within 3 weeks had significantly higher mean TAT levels (7.80 +/- 2.86 ng/mL; P <.05) than control subjects (5.77 +/- 1.43 mL) or patients with preterm labor who were not delivered within 3 weeks of presentation with preterm labor (5.57 +/- 1.69 ng/mL; P <.05). Given a diagnosis of preterm labor, a TAT level of 8.0 ng/mL had a positive predictive value of 80% for delivery within 3 weeks of enrollment. CONCLUSIONS This study showed that TAT levels are elevated in patients with preterm labor who are destined to deliver before term. These results suggest that preterm labor resulting in premature delivery is associated with the activation of thrombin. Future studies will further elucidate the role of thrombin in preterm parturition and confirm whether tests for thrombin activation can accurately identify those patients destined for preterm delivery.
THERMAL INJURY ELEVATES THE INFLAMMATORY MONOCYTE SUBPOPULATION IN MULTIPLE COMPARTMENTS

Recent publications have demonstrated that human resident and inflammatory monocyte (IM) subpopulations have equivalents in rodents. The effect of thermal injury upon these subpopulations has not been studied. Mice were given a scald burn and killed on postburn days (PBDs) 2, 4, and 8. Bone marrow, blood, and spleen white cells were isolated, and the percentage of resident monocytes (CD11b+ LY6C+), IMs (CD11b+ LY6C++), and monocyte progenitors (macrophage-colony-forming unit [M-CFU]) were determined. The ability of each monocyte population to make TNF-α was determined by intracellular cytokine staining. Finally, the ability of sorted fractions from PBD 8 spleen to inhibit lymphocyte proliferation was performed. We noted that there was an increase in M-CFU in the blood and spleen at PBD 8, but the marrow only had a nonsignificant increase in M-CFU. All compartments showed a significant increase in the number of IMs by PBD 8, but no significant changes in resident monocytes were seen. In all compartments, IMs were a major source of TNF-α. The postburn increase in IMs and monocyte progenitors in the spleen was accompanied by an increase in the monocyte chemokine monocyte chemoattractant protein 1 and constitutively high levels of the progenitor chemokine stromal-derived factor 1α. After burn injury, mice deficient in the receptor for soluble TNF-α had equal levels of splenic M-CFU and monocytes, as did wild-type mice, suggesting that this cytokine is not essential for this effect. We conclude that in this model, IMs are a significant source of in vivo TNF-α.
Cerebral acetylcholine esterase activity in mild cognitive impairment

Mild cognitive impairment may be an early clinical manifestation of Alzheimer's disease, but there are also patients who remain stable or remit. In-vivo measurements of cortical acetylcholine esterase activity by positron emission tomography have shown that it is reduced in Alzheimer's disease, and we investigated whether there is also a reduction in mild cognitive impairment. A significant reduction was observed in three of eight patients, and a significant association was found with progression to Alzheimer's disease within 18 months. These results suggest that low cortical acetylcholine esterase activity may be an indicator of impending dementia in patients with mild cognitive impairment.
Cognitive coping and depressive symptoms in the elderly: A longitudinal study

The objective of the present longitudinal study was to examine the relationship between cognitive coping strategies and depressive symptoms at old age. At the two and a half year follow-up study, a community sample of 99 people aged 67 years and older filled out a self-report questionnaire comprising the Geriatric Depression Scale, the Cognitive Emotion Regulation Questionnaire and a negative life events checklist. Cognitive coping strategies seemed to play an important role in relation to depressive symptoms in late life. Elderly persons with more depressive symptoms reported to use acceptance, rumination and catastrophizing to a significantly higher extent and positive reappraisal to a significantly lower extent than those with lower depression scores. After controlling for negative life events and prior depressive symptoms, acceptance and positive reappraisal retained their significant relationship with current depressive symptoms. It is suggested that intervention programs should pay attention to these aspects by challenging the 'maladaptive' strategies, and by supplying the more 'adaptive' strategies. This could be linked to the well-established cognitive therapies.
Cancer Risks in U.S. Radiologic Technologists Working With Fluoroscopically Guided Interventional Procedures, 1994-2008.

OBJECTIVE The purpose of this study was to examine risks of cancer incidence and mortality among U.S. radiation technologists performing or assisting with fluoroscopically guided interventional procedures. SUBJECTS AND METHODS A nationwide prospective cohort of 90,957 radiologic technologists, who responded to a 1994-1998 survey that collected information on whether they had ever worked with fluoroscopically guided interventional procedures, was followed through completion of a subsequent cohort survey during 2003-2005 (for cancer incidence) or December 31, 2008 (for cancer mortality). Sex-adjusted hazard ratios (HRs) and 95% CIs were calculated by use of Cox proportional hazards models for incidence and mortality from all cancers other than nonmelanoma skin cancer and for specific cancer outcomes in participants who reported ever performing fluoroscopically guided interventional procedures compared with technologists who never performed these procedures. RESULTS The analysis showed an approximately twofold increased risk of brain cancer mortality (HR, 2.55; 95% CI, 1.48-4.40) and modest elevations in incidence of melanoma (HR, 1.30; 95% CI, 1.05-1.61) and in breast cancer incidence (HR, 1.16; 95% CI, 1.02-1.32) but not mortality (HR, 1.07; 95% CI, 0.69-1.66) among technologists who performed fluoroscopically guided interventional procedures compared with those who never performed these procedures. Although there was a small suggestive increase in incidence of all cancers combined, excluding nonmelanoma skin cancers (HR, 1.08; 95% CI, 1.00-1.17), mortality from all cancers combined, excluding nonmelanoma skin cancers, was not elevated (HR, 1.00; 95% CI, 0.88-1.14). We similarly observed no elevated risk of cancers of the thyroid, skin other than melanoma, prostate, lung, or colon and rectum or of leukemia that was not chronic lymphocytic leukemia among workers who performed fluoroscopically guided interventional procedures. CONCLUSION We observed elevated risks of brain cancer, breast cancer, and melanoma among technologists who performed fluoroscopically guided interventional procedures. Although exposure to low-dose radiation is one possible explanation for these increased risks, these results may also be due to chance or unmeasured confounding by nonradiation risk factors. Our results must be confirmed in other studies, preferably with individual radiation dose data.
Agrin Binds to the N-terminal Region of Lrp4 Protein and Stimulates Association between Lrp4 and the First Immunoglobulin-like Domain in Muscle-specific Kinase (MuSK)*

Background: How Agrin binds Lrp4 and stimulates MuSK kinase activity is poorly understood. Results: We identify domains in Lrp4 important for Agrin to bind Lrp4 and MuSK and stimulate MuSK phosphorylation. Conclusion: Different domains in Lrp4 bind Agrin and MuSK and stimulate MuSK phosphorylation. Significance: Lrp4 functions as a ligand for MuSK, whereas Agrin promotes association between Lrp4 and MuSK. Neuromuscular synapse formation depends upon coordinated interactions between motor neurons and muscle fibers, leading to the formation of a highly specialized postsynaptic membrane and a highly differentiated nerve terminal. Synapse formation begins as motor axons approach muscles that are prepatterned in the prospective synaptic region in a manner that depends upon Lrp4, a member of the LDL receptor family, and muscle-specific kinase (MuSK), a receptor tyrosine kinase. Motor axons supply Agrin, which binds Lrp4 and stimulates further MuSK phosphorylation, stabilizing nascent synapses. How Agrin binds Lrp4 and stimulates MuSK kinase activity is poorly understood. Here, we demonstrate that Agrin binds to the N-terminal region of Lrp4, including a subset of the LDLa repeats and the first of four β-propeller domains, which promotes association between Lrp4 and MuSK and stimulates MuSK kinase activity. In addition, we show that Agrin stimulates the formation of a functional complex between Lrp4 and MuSK on the surface of myotubes in the absence of the transmembrane and intracellular domains of Lrp4. Further, we demonstrate that the first Ig-like domain in MuSK, which shares homology with the NGF-binding region in Tropomyosin Receptor Kinase (TrKA), is required for MuSK to bind Lrp4. These findings suggest that Lrp4 is a cis-acting ligand for MuSK, whereas Agrin functions as an allosteric and paracrine regulator to promote association between Lrp4 and MuSK.
Domestic violence in pregnancy in North Indian women.

BACKGROUND Domestic violence against pregnant women in the Indian context, violence against women is frequently by family members other than the spouse/intimate partner/husband. AIMS To study the incidence of domestic violence in pregnant North Indian women and the demographic features which put women at high risk for domestic violence. STUDY DESIGN A prospective study at the Government Medical College and Hospital, Chandigarh from January 2004 to December 2004. PARTICIPANTS Nine hundred and ninety-one pregnant women admitted to the pregnant women admitted to the antenatal ward were interviewed. STATISTICAL ANALYSIS Test of significance used was Chi-square test. Odds ratio (OR) and 95% confidence interval (CI) was calculated. RESULTS The incidence of domestic violence in this study was 28.4%. The violence was more when the husband was educated up to Class 10 level or lower (OR 2.07 (95%) CI 1.54 to 2.79), was habituated to alcohol (OR 2.31 (95%) CI 1 - 71 to 3.11) or to chewing tobacco (OR 2.77 (95%) CI 1.46 to 3.27) or to smoking cigarettes (OR 2.23 (95%) CI 1.59 to 3.11). The incidence of domestic violence was drastically high in women who were socially unsupported (OR 98.9 (95%) CI 43.65 to 235.68). The level of education and employment of the woman had no effect on the incidence of the abuse. The perpetrator of the abuse was the intimate partner (husband) in 48.2%, the husband's mother in 61.3%, and the husband's sister in 22.6%. Most often the abuse was by more than one person. CONCLUSIONS The incidence of abuse was more when the male partner was less educated or in the habit of taking alcohol, opium or tobacco and in socially unsupported women. The level of education and employment of the woman had no effect on the incidence of abuse.
Biological variations of leukocyte numerical and morphologic parameters determined by UniCel DxH 800 hematology analyzer.

CONTEXT The Coulter DxH 800 hematology analyzer can determine leukocyte numerical parameters (total leukocyte counts and differentials). It also measures intrinsic biophysical properties of these cells in their near-native state. These morphologic measurements are known as cell population data (CPD). OBJECTIVE To study, for the first time, the biological variations of morphologic parameters or CPD and reinvestigate numerical parameters using the newest Coulter hematology analyzer. Design. -Forty adult volunteers (21 women, 19 men) were included. All participants maintained their normal lifestyles. Blood samples were drawn in duplicate by a single experienced phlebotomist and analyzed within 2 hours using a single analyzer. Before each batch analysis, the instrument quality controls were performed using the same lots of reagents. RESULTS Within-subject (CV(I)) and between-subjects (CV(G)) biological variations for numerical parameters are smaller than previously reported. Cell population data have much smaller overall CV(I) and CV(G) compared to numerical parameters, suggesting that these parameters are less variable around the homeostatic set point intraindividually and interindividually. Index of individuality (ratio of CV(I)/CV(G)) for CPD was low. In addition, intraday and interday biological variations of all parameters are fairly constant. CONCLUSIONS These observations are clinically valuable. Data on CV(I) and analytical precision may be used to generate objective delta-check values for use in quality management. Comparing CV(I) and CV(G) on CPD may allow us to decide the utility of traditional population-based reference ranges. Documentation of CPD on biological variations is an essential prerequisite in the development of any new application clinically.
Assessment of the capability to target cerebellar sub-regions with high-definition transcranial direct current stimulation high-definition transcranial direct current stimulation (HD-tDCS) over the cerebellum

The increasing interest in the application of tDCS over different cerebral regions has induced increasing efforts into the optimization of specific electrodes montages to selectively target the desired volumes. In order to increase the stimulation focusing, High-Definition (HD) tDCS electrodes have been proposed and their efficacy was firstly assessed by computational methods. In this paper, we optimized the deployment of HD-tDCS bipolar electrodes montages designed to target three different neural clusters in the cerebellum. The assessment of the electric field generated by and the focusing capability of the montages was evaluated through computational techniques on an anatomical high-definition head model. Results show the possibility to reach even deep target in the cerebellum with an electric field able to induce neuromodulation, while in parallel limiting its field distribution spread.