Miracle-dz/UniFAR-FTUs huggingface dataset:
Is there an opportunity to reduce urinary catheter-related infections? Exploring variation in catheterisation rates in care homes

rinary catheterisation in care homes is associated with increased morbidity, hospitalisation and mortality. The authors aimed to determine whether staffing, resident underlying illness or nursing band, or use of other toileting methods were responsible for the wide variation in urinary catheterisation rates found in English care homes. The authors approached randomly-selected registered care homes in three former health districts in England. A questionnaire survey was used to determine the number of residents in each nursing care band and with different medical conditions that were catheterised, and the home's management of residents' continence. The number of residents or staffing did not influence catheterisation rate. Higher catheterisation rate homes had a lower proportion of high band nursing residents and residents with incontinence, severe physical disability and dementia than the other homes. Only urinary retention (3 per cent of residents) was significantly more common in the higher catheterisation rate homes. There was no difference in continence care before inserting a catheter. The authors suggest that care culture and staff attitudes to catheterisation should be explored in greater depth using structured interviews or focus groups. This may allow the identification of key factors that can be targeted in order to reduce catheterisation rates and the associated morbidity.
Verification of performance specifications for a US Food and Drug Administration-approved molecular microbiology test: Clostridium difficile cytotoxin B using the Becton, Dickinson and Company GeneOhm Cdiff assay.

CONTEXT US Food and Drug Administration (FDA)-approved diagnostic tests based on molecular genetic technologies are becoming available for an increasing number of microbial pathogens. Advances in technology and lower costs have moved molecular diagnostic tests formerly performed for research purposes only into much wider use in clinical microbiology laboratories. OBJECTIVE To provide an example of laboratory studies performed to verify the performance of an FDA-approved assay for the detection of Clostridium difficile cytotoxin B compared with the manufacturer's performance standards. DESIGN We describe the process and protocols used by a laboratory for verification of an FDA-approved assay, assess data from the verification studies, and implement the assay after verification. RESULTS Performance data from the verification studies conducted by the laboratory were consistent with the manufacturer's performance standards and the assay was implemented into the laboratory's test menu. CONCLUSION Verification studies are required for FDA-approved diagnostic assays prior to use in patient care. Laboratories should develop a standardized approach to verification studies that can be adapted and applied to different types of assays. We describe the verification of an FDA-approved real-time polymerase chain reaction assay for the detection of a toxin gene in a bacterial pathogen.
The Effects of a Stooped Work Task on the Muscle Activity and Kinematics of the Lower Back

Working in a stooped posture is an important risk factor for low back disorders (LBDs) that requires special focus. Spinal flexion increases the loading on the passive tissues of the lumbar spine compared to neutral postures, yet sustained or repeated flexion reduces the load bearing capability of these tissues. The objective of this study is to assess the effect of performing a stooped work task on the passive tissues of the low back. Passive tissue response is assessed by measuring trunk sagittal range of motion and the occurrence of the flexion-relaxation (F-R) phenomenon at specific times during the work period. Fourteen subjects (10 female and 4 male) were instrumented with a portable data collection system while performing the stooped work task of fresh-market tomato harvest for one hour in the morning and one hour in the afternoon. Results indicate significant changes in the trunk and lumbar sagittal range of motion and F-R after only 11 minutes of stooped work, with few changes for durations up to 55 minutes of work. The potential benefits of short, frequent rest breaks on recovery of passive tissue response are also demonstrated. The data collection device developed for this study allows for further investigation of the effects of stooped work on the lower back, which could lead to improved interventions to reduce LBD risk.
Laboratory performance in albumin and total protein measurement using a commutable specimen: results of a College of American Pathologists study.

CONTEXT Discrepant results for serum constituents were observed among peer groups in the College of American Pathologists Comprehensive Chemistry Survey. OBJECTIVES To assess the performance of serum albumin and total protein measurement procedures and to evaluate the commutability of the conventional survey specimens. DESIGN A fresh frozen, off-the-clot serum sample was included along with 4 conventional survey specimens. The fresh frozen, off-the-clot serum sample was prepared in a manner expected to confer commutability with native clinical samples. RESULTS For the fresh frozen, off-the-clot serum sample, the mean values for 17 peer-groups were -0.07 to 0.32 g/dL from the bromocresol green albumin designated comparison method, whereas 4 VITROS (Ortho Clinical Diagnostics, Rochester, New York) peer groups differed by -0.29 to -0.37 g/dL (15 of 21 differences [71%] had P < .001). For bromocresol purple albumin methods, the mean differences from the designated comparison method from 8 peer groups were 0.25 to 0.47 g/dL (all had P < .001). For total protein methods, 23 peer group mean values were -0.07 to 0.15 g/dL from the reference measurement procedure (12 of 24 [50%] had P < .001). The Beckman (Fullerton, California) Synchron LX20 had a bias of -0.30 g/dL (P <.001). The commutability of the conventional specimens was acceptable for 23 of 24 bromocresol green method-material combinations (96%) and 13 of 16 bromocresol purple albumin method-material combinations (81%). All (100%) of the 36 method-material combinations had acceptable commutability for total protein. CONCLUSIONS One (2.2%) of the instrument systems (Synchron) using bromocresol green and none (0%) of the instrument systems using bromocresol purple had satisfactory total-error performance for albumin measurement. Differences in results between bromocresol green and bromocresol purple methods precluded using common reference intervals for interpreting results for serum albumin. Eight of 9 instrument systems (86.5%) had satisfactory total-error performance for total protein measurement.
Lack of standards for the detection of melanoma in sentinel lymph nodes: a survey and recommendations.

CONTEXT Detection of microscopic melanoma metastases in sentinel lymph nodes drives clinical care; patients without metastases are observed, and patients with metastases are offered completion lymphadenectomy and adjuvant therapy. OBJECTIVE We sought to determine common elements in currently used analytic platforms for sentinel lymph nodes in melanoma patients. DESIGN An electronic survey was distributed to 83 cancer centers in North America. RESULTS Seventeen responses (20%) were received. The number of sentinel lymph node mapping procedures for melanoma ranged from less than 11 to more than 100 patients per year, with 72% of institutions mapping more than 50 melanoma patients a year. Uniform practices included (1) processing all of the lymph node tissue rather than submitting representative sections and (2) use of immunohistochemical stains if no tumor was identified on the hematoxylin-eosin-stained sections. Significant variability existed regarding the method of sectioning lymph nodes at grossing and in the histology laboratory; most bisected nodes longitudinally (94%) and performed deeper levels into the block (67%), but these were not uniform practices. S-100 was the most commonly used immunohistochemical stain (78%), followed by Melan-A (56%), MART-1 (50%), HMB-45 (44%), tyrosinase (33%), MiTF (11%), and pan-melanoma (6%). CONCLUSIONS There is a need for a standardized platform for detecting melanoma in sentinel lymph nodes. Current practices by a majority of laboratories and findings in the reported literature support the following: histologic evaluation of all lymph node tissue, use of immunohistochemical stains, bisecting lymph nodes longitudinally, and performing deeper levels into the tissue block.
Molecular testing guideline for selection of lung cancer patients for EGFR and ALK tyrosine kinase inhibitors: guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology.

OBJECTIVE To establish evidence-based recommendations for the molecular analysis of lung cancers that are required to guide EGFR- and ALK-directed therapies, addressing which patients and samples should be tested, and when and how testing should be performed. PARTICIPANTS Three cochairs without conflicts of interest were selected, one from each of the 3 sponsoring professional societies: College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology. Writing and advisory panels were constituted from additional experts from these societies. EVIDENCE Three unbiased literature searches of electronic databases were performed to capture articles published from January 2004 through February 2012, yielding 1533 articles whose abstracts were screened to identify 521 pertinent articles that were then reviewed in detail for their relevance to the recommendations. Evidence was formally graded for each recommendation. CONSENSUS PROCESS Initial recommendations were formulated by the cochairs and panel members at a public meeting. Each guideline section was assigned to at least 2 panelists. Drafts were circulated to the writing panel (version 1), advisory panel (version 2), and the public (version 3) before submission (version 4). CONCLUSIONS The 37 guideline items address 14 subjects, including 15 recommendations (evidence grade A/B). The major recommendations are to use testing for EGFR mutations and ALK fusions to guide patient selection for therapy with an epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) inhibitor, respectively, in all patients with advanced-stage adenocarcinoma, regardless of sex, race, smoking history, or other clinical risk factors, and to prioritize EGFR and ALK testing over other molecular predictive tests. As scientific discoveries and clinical practice outpace the completion of randomized clinical trials, evidence-based guidelines developed by expert practitioners are vital for communicating emerging clinical standards. Already, new treatments targeting genetic alterations in other, less common driver oncogenes are being evaluated in lung cancer, and testing for these may be addressed in future versions of these guidelines.
Adverse Pregnancy Outcomes: Prevalence in the North of Jordan

Objective: The aim of the study was to estimate the prevalence of the adverse pregnancy outcomes among Jordanian women. Methods: A cross sectional study was carried out in five major hospitals in the north of Jordan. Women who gave birth in the five Hospitals during the period from April to June 2007 were included in the study. Data were collected within 24 hours of delivery; the mother answered a pilot tested structured questionnaire administered by trained personnel on the maternity ward through face to face interview, which lasted for 10 to 15 minutes. Result: This study included a total of 3,269 women. More than half of them (57%) were living in urban areas, and 41.3% had an education of higher than high school. Only 1% gave birth to a very low birth weight baby and 10.9% gave birth to a moderately low birth weight baby. The prevalence of low birth weight baby was the highest for women aged above 40 years. Only 1.4% gave stillbirth with the rate being the lowest for those aged between 20 and 34 years. Prevalence of giving birth with any congenital anomaly was more evident for the oldest age group where about 40% of cases occurred among women aged above 40 years. Conclusions: Adverse pregnancy outcomes including preterm delivery, low birth weight delivery, congenital anomalies, and stillbirth are common among Jordanian women compared with those in developed countries. Older women (age > 40) are at high risk of such adverse pregnancy outcomes.
Touch preparations for the intraoperative evaluation of sentinel lymph nodes after neoadjuvant therapy have high false-negative rates in patients with breast cancer.

CONTEXT The use of a touch preparation for intraoperative sentinel lymph node diagnosis has become a preferred method of many pathologists because of its reported high sensitivity and rapid turnaround time. However, after neoadjuvant chemotherapy many lymph nodes have significant treatment-related changes that may affect the diagnostic accuracy of the intraoperative evaluation. OBJECTIVE To determine the accuracy of touch preparation for the intraoperative diagnosis of metastatic breast carcinoma in the neoadjuvant setting. DESIGN We reviewed retrospectively the results of intraoperative evaluations for 148 different sentinel lymph nodes from 63 patients who had undergone neoadjuvant chemotherapy for invasive breast cancer at our institution. The intraoperative touch preparation results were compared with the final pathology reports in conjunction with relevant clinical data. RESULTS Use of touch preparation for the evaluation of sentinel lymph nodes intraoperatively after neoadjuvant therapy was associated with a low sensitivity of 38.6% (95% confidence interval [CI], 24.4-54.5) but high specificity of 100% (95% CI, 96.5-100). There was no difference in sensitivity rates between cytopathologists and noncytopathologists in this cohort (P = .40). Patients with invasive lobular carcinoma and those who had a clinically positive axilla before the initiation of neoadjuvant therapy were the most likely to have a false-negative result at surgery. CONCLUSIONS Intraoperative touch preparations should not be used alone for the evaluation of sentinel lymph nodes in the setting of neoadjuvant therapy for breast cancer because of low overall sensitivity.
HER2/neu testing in gastric cancer by immunohistochemistry: assessment of interlaboratory variation.

CONTEXT Immunohistochemical (IHC) testing for HER2/neu is becoming the standard of care for guiding adjuvant treatment of gastric carcinoma with trastuzumab. OBJECTIVE To assess interlaboratory variation in IHC staining and interpretation across multiple laboratories. DESIGN A tissue microarray consisting of 45 cores from 28 gastric cancers was distributed to 37 laboratories for HER2/neu assessment. The IHC results were compared against expert scores at an academic institution and correlated with in situ hybridization results from the originating specimen. Interlaboratory agreement was calculated using Cohen κ statistic. RESULTS The survey demonstrated several variations in IHC methods, including the primary antibodies in use. There was excellent agreement among laboratories in HER2/neu(+) (IHC 3(+)) cases (κ = 0.80 ± 0.01) and very good agreement among laboratories in HER2/neu(-) (IHC 0 or 1(+)) cases (κ = 0.58 ± 0.01). Less agreement was observed among laboratories when scoring equivocal (IHC 2(+)) cases (κ = 0.22 ± 0.01). Sensitivity and specificity of HER2/neu IHC were 99% and 100%, respectively, when measured against expert review and consensus score as a reference standard. CONCLUSIONS There is substantial interlaboratory agreement in the interpretation of HER2/neu IHC despite variability in protocols. Although HER2/neu IHC is a highly sensitive and specific test, primary antibody selection may significantly affect IHC results. Furthermore, gastric tumors require a unique scoring system and expertise in interpretation. Intratumoral heterogeneity has a significant effect on HER2/neu scoring by IHC. Ongoing quality assurance exercises among laboratories will help ensure optimized HER2/neu testing.
Childhood and adult sexual abuse: relationships with alcohol and other psychoactive drug use

Questions concerning sexual abuse before and after the age of 16 years were included in a general population survey of a representative sample of 1052 UK women and 975 UK men. A total of 12.5% of women reported experiencing some form of sexual abuse before the age of 16 years. The corresponding ﬁgures for men in this category were 11.7%. After the age of 16, the ﬁgure for women remained at this level. However, the proportion of men reporting these traumatic experiences dropped to 3.2%. Sexual abuse both pre and post age 16 was associated with being single or cohabiting, with higher levels of cigarette-smoking, alcohol consumption, experience of alcohol-related problems and use of illicit drugs. The relationship between drinking and other forms of psychoactive drug use and sexual abuse is complex. Some possible explanations for this connection and its therapeutic and practical implications are discussed. Copyright © 2004 John Wiley & Sons, Ltd.
A Comparison of Costs to Patients with Tuberculosis Treated in a DOTS Programme with Those in a Non-DOTS Programme in South India

Tuberculosis is a curable disease, yet it is the largest single infectious cause of death among adults in the world. India accounts for one-third of the global TB burden. Its economic burden in India is enormous as it perpetuates and exacerbates poverty. The revised national Tuberculosis Control Programme (the DOTS Strategy) is currently being implemented in India. The purpose of this study was to compare the costs to tuberculosis patients treated in a DOTS Programme with the costs to patients treated in a non-DOTS Programme in south India. Patients registered between June and December 2000 (455 in DOTS area, 441 in non-DOTS area) in Tiruvallur district were interviewed, collecting information on demographics, socio-economic characteristics of patients, expenditure incurred due to illness, and effect of illness on employment. Results showed that in the DOTS area, treatment success rate was higher, patient costs were less, and patients returned to work early. These findings establish the economic benefits to patients treated under DOTS and lend support to rapid expansion of the programme, particularly in low-income countries.
MicroRNA-375 Suppresses Extracellular Matrix Degradation and Invadopodial Activity in Head and Neck Squamous Cell Carcinoma.

CONTEXT Head and neck squamous cell carcinoma (HNSCC) is a highly invasive cancer with an association with locoregional recurrence and lymph node metastasis. We have previously reported that low microRNA-375 (miR-375) expression levels correlate with poor patient survival, increased locoregional recurrence, and distant metastasis. Increasing miR-375 expression in HNSCC cell lines to levels found in normal cells results in suppressed invasive properties. HNSCC invasion is mediated in part by invadopodia-associated degradation of the extracellular matrix. OBJECTIVE To determine whether elevated miR-375 expression in HNSCC cell lines also affects invadopodia formation and activity. DESIGN For evaluation of the matrix degradation properties of the HNSCC lines, an invadopodial matrix degradation assay was used. The total protein levels of invadopodia-associated proteins were measured by Western blot analyses. Immunoprecipitation experiments were conducted to evaluate the tyrosine phosphorylation state of cortactin. Human protease arrays were used for the detection of the secreted proteases. Quantitative real time-polymerase chain reaction measurements were used to evaluate the messenger RNA (mRNA) expression of the commonly regulated proteases. RESULTS Increased miR-375 expression in HNSCC cells suppresses extracellular matrix degradation and reduces the number of mature invadopodia. Higher miR-375 expression does not reduce cellular levels of selected invadopodia-associated proteins, nor is tyrosine phosphorylation of cortactin altered. However, HNSCC cells with higher miR-375 expression had significant reductions in the mRNA expression levels and secreted levels of specific proteases. CONCLUSIONS MicroRNA-375 regulates invadopodia maturation and function potentially by suppressing the expression and secretion of proteases.
Telepathology Impacts and Implementation Challenges: A Scoping Review.

CONTEXT Telepathology is a particular form of telemedicine that fundamentally alters the way pathology services are delivered. Prior reviews in this area have mostly focused on 2 themes, namely technical feasibility issues and diagnosis accuracy. OBJECTIVES To synthesize the literature on telepathology implementation challenges and broader organizational and societal impacts and to propose a research agenda to guide future efforts in this domain. DATA SOURCES Two complementary databases were systematically searched: MEDLINE (PubMed) and ABI/INFORM (ProQuest). Peer-reviewed articles and conference proceedings were considered. The final sample consisted of 159 papers published between 1992 and 2013. CONCLUSIONS This review highlights the diversity of telepathology networks and the importance of considering these distinctions when interpreting research findings. Various network structures are associated with different benefits. Although the dominant rationale in single-site projects is financial, larger centralized and decentralized telepathology networks are targeting a more diverse set of benefits, including extending access to pathology to a whole region, achieving substantial economies of scale in workforce and equipment, and improving quality by standardizing care. Importantly, our synthesis reveals that the nature and scale of encountered implementation challenges also varies depending on the network structure. In smaller telepathology networks, organizational concerns are less prominent, and implementers are more focused on usability issues. As the network scope widens, organizational and legal issues gain prominence.
Placental Pathology of Zika Virus: Viral Infection of the Placenta Induces Villous Stromal Macrophage (Hofbauer Cell) Proliferation and Hyperplasia.

CONTEXT -The placenta is an important component in understanding the fetal response to intrauterine Zika virus infection, but the pathologic changes in this organ remain largely unknown. Hofbauer cells are fetal-derived macrophages normally present in the chorionic villous stroma. They have been implicated in a variety of physiological and pathologic processes, in particular involving infectious agents. OBJECTIVES -To characterize the fetal and maternal responses and viral localization in the placenta following Zika virus transmission to an 11 weeks' gestation fetus. The clinical course was notable for prolonged viremia in the mother and extensive neuronal necrosis in the fetus. The fetus was delivered at 21 weeks' gestation after pregnancy termination. DESIGN -The placenta was evaluated by using immunohistochemistry for inflammatory cells (macrophages/monocytes [Hofbauer cells], B and T lymphocytes) and proliferating cells, and an RNA probe to Zika virus. The fetal brain and the placenta were previously found to be positive for Zika virus RNA by reverse transcription-polymerase chain reaction. RESULTS -The placenta demonstrated prominently enlarged, hydropic chorionic villi with hyperplasia and focal proliferation of Hofbauer cells. The degree of Hofbauer cell hyperplasia gave an exaggerated immature appearance to the villi. No acute or chronic villitis, villous necrosis, remote necroinflammatory abnormalities, chorioamnionitis, funisitis, or hemorrhages were present. An RNA probe to Zika virus was positive in villous stromal cells, presumably Hofbauer cells. CONCLUSIONS -Zika virus placental infection induces proliferation and prominent hyperplasia of Hofbauer cells in the chorionic villi but does not elicit villous necrosis or a maternal or fetal lymphoplasmacellular or acute inflammatory cell reaction.