Miracle-dz/UniFAR-FTUs huggingface dataset:
Aortic stenosis, atherosclerosis, and skeletal bone: is there a common link with calcification and inflammation?

AIMS The pathophysiology of aortic stenosis shares many similarities with atherosclerosis and skeletal bone formation. Using non-invasive imaging, we compared aortic valve calcification and inflammation activity with that measured in atherosclerosis and bone. METHODS AND RESULTS Positron emission and computed tomography was performed using 18F-sodium fluoride (18F-NaF, calcification) and 18F-fluorodeoxyglucose (18F-FDG, inflammation) in 101 patients with calcific aortic valve disease (81 aortic stenosis and 20 aortic sclerosis). Calcium scores and positron emission tomography tracer activity (tissue-to-background ratio; TBR) were measured in the aortic valve, coronary arteries, thoracic aorta, and bone. Over 90% of the cohort had coexistent calcific atheroma, yet correlations between calcium scores were weak or absent (valve vs. aorta r(2) = 0.015, P = 0.222; valve vs. coronaries r(2) = 0.039, P = 0.049) as were associations between calcium scores and bone mineral density (BMD vs. valve r(2) = 0.000, P = 0.766; vs. aorta r(2) = 0.052, P = 0.025; vs. coronaries r(2) = 0.016, P = 0.210). 18F-NaF activity in the valve was 28% higher than in the aorta (TBR: 2.66 ± 0.84 vs. 2.11 ± 0.31, respectively, P < 0.001) and correlated more strongly with the severity of aortic stenosis (r(2) = 0.419, P < 0.001) than 18F-NaF activity outwith the valve (valve vs. aorta r(2) = 0.167, P < 0.001; valve vs. coronary arteries r(2) = 0.174, P < 0.001; valve vs. bone r(2) = 0.001, P = 0.806). In contrast, 18F-FDG activity was lower in the aortic valve than the aortic atheroma (TBR: 1.56 ± 0.21 vs. 1.81 ± 0.24, respectively, P < 0.001) and more closely associated with uptake outwith the valve (valve vs. aorta r(2) = 0.327, P < 0.001). CONCLUSION In patients with aortic stenosis, disease activity appears to be determined by local calcific processes within the valve that are distinct from atherosclerosis and skeletal bone metabolism.
Cutaneous Adnexal Neoplasms With Eccrine or Apocrine Differentiation: Diagnostic Distinction, and Does It Really Matter?

Cutaneous adnexal neoplasms are a large and diverse group of tumors that have historically been classified according to their state of appendageal differentiation, showing features of follicular, sebaceous, eccrine, or apocrine structures, or an admixture thereof. Neoplasms of follicular and sebaceous differentiation are generally histologically distinctive, while determination of apocrine or eccrine ductal/glandular lineage is controversial. These lesions pose more difficulty due to the fact that they have overlapping histologic features and often cannot be distinguished. In particular, ducts of either apocrine or eccrine lineage have essentially the same histologic, histochemical, and immunohistochemical features. While decapitation secretion is taken as the sine qua non of apocrine glandular differentiation, definitive features of eccrine glands are often lacking. This review will focus on the hypothesis that most adnexal tumors derive from the folliculosebaceous apocrine unit (FSAU); in this approach, any neoplasm with areas of sebaceous or follicular differentiation, in addition to sweat duct/glandular differentiation, would logically be placed in the apocrine category. We also present a case of a cylindroma with sebaceous differentiation as an illustrative example of a neoplasm (formerly considered eccrine) showing FSAU differentiation. Precise classification of adnexal tumors is primarily an academic pursuit, as clinical and prognostic considerations essentially rely on benign versus malignant determination. However, to provide a better understanding and more logical classification of these tumors, continued investigation into the origin and differentiation of these neoplasms is worthwhile.
Adjunctive risperidone treatment for antidepressant-resistant symptoms of chronic military service-related PTSD: a randomized trial.

CONTEXT Serotonin reuptake-inhibiting (SRI) antidepressants are the only FDA-approved pharmacotherapies for the treatment of posttraumatic stress disorder (PTSD). OBJECTIVE To determine efficacy of the second-generation antipsychotic risperidone as an adjunct to ongoing pharmacologic and psychosocial treatments for veterans with chronic military-related PTSD. DESIGN, SETTING, AND PARTICIPANTS A 6-month, randomized, double-blind, placebo-controlled multicenter trial conducted between February 2007 and February 2010 at 23 Veterans Administration outpatient medical centers. Of the 367 patients screened, 296 were diagnosed with military-related PTSD and had ongoing symptoms despite at least 2 adequate SRI treatments, and 247 contributed to analysis of the primary outcome measure. INTERVENTION Risperidone (up to 4 mg once daily) or placebo. MAIN OUTCOME MEASURES The Clinician-Administered PTSD Scale (CAPS) (range, 0-136). Other measures included the Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Scale (HAMA), Clinical Global Impression scale (CGI), and Veterans RAND 36-Item Health Survey (SF-36V). RESULTS Change in CAPS scores from baseline to 24 weeks in the risperidone group was -16.3 (95% CI, -19.7 to -12.9) and in the placebo group, -12.5 (95% CI, -15.7 to -9.4); the mean difference was 3.74 (95% CI, -0.86 to 8.35; t = 1.6; P = .11). Mixed model analysis of all time points also showed no significant difference in CAPS score (risperidone: mean, 64.43; 95% CI, 61.98 to 66.89, vs placebo: mean, 67.16; 95% CI, 64.71 to 69.62; mean difference, 2.73; 95% CI, -0.74 to 6.20; P = .12). Risperidone did not reduce symptoms of depression (MADRS mean difference, 1.19; 95% CI, -0.29 to 2.68; P = .11) or anxiety (HAMA mean difference, 1.16; 95% CI, -0.18 to 2.51; P = .09; patient-rated CGI mean difference, 0.20; 95% CI, -0.06 to 0.45; P = .14; observer-rated CGI mean difference, 0.18; 95% CI, 0.01 to 0.34; P = .04), or increase quality of life (SF-36V physical component mean difference, -1.13, 95% CI, -2.58 to 0.32; P = .13; SF-36V mental component mean difference, -0.26; 95% CI, -2.13 to 1.61; P = .79). Adverse events were more common with risperidone vs placebo, including self-reported weight gain (15.3% vs 2.3%), fatigue (13.7% vs 0.0%), somnolence (9.9% vs 1.5%), and hypersalivation (9.9% vs 0.8%), respectively. CONCLUSION Among patients with military-related PTSD with SRI-resistant symptoms, 6-month treatment with risperidone compared with placebo did not reduce PTSD symptoms. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00099983.
Long-term clinical follow-up of the multicentre, randomized study to test immunosuppressive therapy with oral prednisone for the prevention of restenosis after percutaneous coronary interventions: Cortisone plus BMS or DES veRsus BMS alone to EliminAte Restenosis (CEREA-DES).

AIMS To analyse the clinical outcome at 4 years in patients with coronary artery disease treated with bare metal stents (BMS) vs. BMS and oral prednisone, or drug-eluting stents (DES), all assuming similar adjunctive medical treatment. METHODS AND RESULTS Five Italian hospitals enrolled 375 non-diabetic, ischaemic patients without contraindications to dual anti-platelet treatment or corticosteroid therapy in a randomized controlled study. The primary endpoint was the event-free survival of cardiovascular death, myocardial infarction, and recurrence of ischaemia needing repeated target vessel revascularization at 1 year, and this was significantly lower in the BMS group (80.8%) compared with the prednisone (88.0%) and DES group (88.8%, P = 0.04 and 0.006, respectively). The long-term analysis of the primary endpoint was a pre-specified aim of the trial, and was performed at 1447 days (median, IQ range = 1210-1641). Patients receiving BMS alone had significantly lower event-free survival (75.3%) compared with 84.1% in the prednisone group (HR: 0.447; 95% CI: 0.25-0.80, P = 0.007) and 80.6% in DES patients (HR: 0.519; 95% CI: 0.29-0.93, P = 0.03). Prednisone-treated patients did not develop new treatment-related clinical problems. Drug-eluting stents patients suffered more very late stent thrombosis as a cause of spontaneous myocardial infarction. The need for target vessel revascularization remained lower in the prednisone and DES groups (13.6 and 15.2%, respectively), compared with BMS (23.2%). CONCLUSIONS The clinical benefits of prednisone compared with BMS only persisted almost unchanged at 4 years. Drug-eluting stents performed better than BMS at long-term, although the advantages observed at 1 year were in part attenuated because of the occurrence of very late stent thrombosis and late revascularizations. Clinical Trial NCT 00369356.
[Epidemiology and care of mentally ill prison inmates in Europe].

OBJECTIVE To provide a standardised description of psychiatric care and epidemiology of mentally disordered inmates of jails and prisons in 24 European countries. METHODS Analysis of administrative national data, provided by national experts via detailed questionnaire. RESULTS Most frequent model of care for mentally disordered prison inmates is a mixed provision of treatment by medical prison services and general psychiatric services from the national health services. However, the contribution of the latter is quantified nowhere. Psychiatric screening and assessment routines in prisons and jails are deficient. Specific treatment programs are lacking. Prevalence or incidence data is rarely collected on a national level. CONCLUSION The awareness of responsible authorities across Europe does not match the seriousness and urgency of the problem. An European standardisation and regular update of basic indicators of mental ill health in prison systems is essential.
Writing a research proposal: A workshop course developed for Pharm D students

Background: Students typically need substantial assistance in writing research proposals since few have relevant experience. Aims: To describe a course for assisting students to write a research proposal. Method: Workshops consisted of a short lecture on writing a specific proposal component, a proposal outline, and an interactive class format using worksheets. Advising individual student groups was shared between the course instructor and project adviser. Rating scales were used for summative evaluation. Results: Proposals written during the course were rated higher ( p <0.05) than were proposals written without the course. The mean knowledge rating was substantially higher on the post-test (4.3 on a scale of 0 to 5) than on the retrospective pretest (1.4; p <0.001). Conclusion: A course developed to enable students to write a proposal for a research study in which mentoring was shared between the project adviser and the course instructor, a focus on the writing aspects of proposal development, and a workshop class format, was associated with higher ratings of quality as well as higher ratings of knowledge learned.
Aspectos epidemiológicos da Leishmaniose Tegumentar Americana na região Noroeste do Estado do Paraná

No Estado do Parana, a primeira notificacao de leishmaniose tegumentar americana ocorreu em 1917 e a partir de 1980 observou-se um aumento do numero de casos, mantendo-se endemica e acometendo pessoas de todas as faixas etarias e em ambos os sexos. Este estudo teve como objetivo realizar um levantamento epidemiologico sobre a ocorrencia de LTA em pacientes atendidos no Laboratorio de Ensino e Pesquisa em Analises Clinicas da Universidade Estadual de Maringa (LEPAC/UEM). Foi realizado um estudo retrospectivo e descritivo em base de dados secundario de 1986 a 2005, com 1656 pacientes segundo as variaveis: sexo, idade, ocupacao, procedencia, local de moradia, forma clinica e diagnostico. A maioria dos pacientes era do sexo masculino (72,6%) e adquiriu a infeccao no Estado do Parana (97,8%), residia em area urbana (64,3%) dos quais 51,3% adquiriu a infeccao durante atividades de lazer. O diagnostico da maioria dos pacientes foi estabelecido nos dois primeiros meses de evolucao das lesoes (54,0%) e apresentando a forma cutânea da doenca (88,9%). Uma parcela (34,4%) significativa dos pacientes que residiam em area rural adquiriu a infeccao no domicilio ou peridomicilio. O estudo mostra a predominância da forma cutânea da leishmaniose tegumentar americana e sugere a atividade de lazer e o ambiente do domicilio como fatores preditivos importantes para a infeccao. Palavras-Chave: Leishmaniose cutânea. Epidemiologia. Leishmania. Leishmania (Viannia) braziliensis.
Prevalence of ocular morbidities among basic school children in the Kwabre East District of Ghana

Background: Many ocular conditions when detected at an early age such as basic school age through vision screening are amenable to interventional measures. Despite this, there are no eye screening programs for school children in Ghana. Objective: The study set out to determine the prevalence of ocular morbidity among basic school children in the Kwabre East District of Ghana. Methods: A descriptive, cross-sectional survey was carried out in March 2014. A multi-stage random sampling technique was used to select school children aged 6-16 years from five randomly selected schools in the district. Ocular history and basic ocular examinations were carried out on the children that were sampled. Results: A total of 456 children were examined; they comprised 170 (27.3%) males and 286 (62.7%) females with a mean age of 12.6 ± 2.25. 215 (47.1%) of the school children had various ocular morbidities. Refractive error was found to be the most predominant ocular morbidity among 120 (26.3%) school children, followed by allergic conjunctivitis 79 (17.3%). A total of 445 (97.6%) of the participants had a visual acuity (VA) of 6/5-6/12, 8 (1.8%) had a VA of < 6/12-6/36 and 3 (0.7%) had a VA of 6/60 - NPL in their right eye. Only 12.8% of the school children had knowledge about refractive errors. Conclusion: Uncorrected refractive error and allergic conjunctivitis were the leading ocular morbidities found among school children in this sample. A routine ocular health assessment among basic school children is recommended to prevent any visual impairment.
Thirty-day readmission rates for Medicare beneficiaries by race and site of care.

CONTEXT Understanding whether and why there are racial disparities in readmissions has implications for efforts to reduce readmissions. OBJECTIVE To determine whether black patients have higher odds of readmission than white patients and whether these disparities are related to where black patients receive care. DESIGN Using national Medicare data, we examined 30-day readmissions after hospitalization for acute myocardial infarction (MI), congestive heart failure (CHF), and pneumonia. We categorized hospitals in the top decile of proportion of black patients as minority-serving. We determined the odds of readmission for black patients compared with white patients at minority-serving vs non-minority-serving hospitals. SETTING AND PARTICIPANTS Medicare Provider Analysis Review files of more than 3.1 million Medicare fee-for-service recipients who were discharged from US hospitals in 2006-2008. MAIN OUTCOME MEASURE Risk-adjusted odds of 30-day readmission. RESULTS Overall, black patients had higher readmission rates than white patients (24.8% vs 22.6%, odds ratio [OR], 1.13; 95% confidence interval [CI], 1.11-1.14; P < .001); patients from minority-serving hospitals had higher readmission rates than those from non-minority-serving hospitals (25.5% vs 22.0%, OR, 1.23; 95% CI, 1.20-1.27; P < .001). Among patients with acute MI and using white patients from non-minority-serving hospitals as the reference group (readmission rate 20.9%), black patients from minority-serving hospitals had the highest readmission rate (26.4%; OR, 1.35; 95% CI, 1.28-1.42), while white patients from minority-serving hospitals had a 24.6% readmission rate (OR, 1.23; 95% CI, 1.18-1.29) and black patients from non-minority-serving hospitals had a 23.3% readmission rate (OR, 1.20; 95% CI, 1.16-1.23; P < .001 for each); patterns were similar for CHF and pneumonia. The results were unchanged after adjusting for hospital characteristics including markers of caring for poor patients. CONCLUSION Among elderly Medicare recipients, black patients were more likely to be readmitted after hospitalization for 3 common conditions, a gap that was related to both race and to the site where care was received.
Technology-enhanced simulation for health professions education: a systematic review and meta-analysis.

CONTEXT Although technology-enhanced simulation has widespread appeal, its effectiveness remains uncertain. A comprehensive synthesis of evidence may inform the use of simulation in health professions education. OBJECTIVE To summarize the outcomes of technology-enhanced simulation training for health professions learners in comparison with no intervention. DATA SOURCE Systematic search of MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, Scopus, key journals, and previous review bibliographies through May 2011. STUDY SELECTION Original research in any language evaluating simulation compared with no intervention for training practicing and student physicians, nurses, dentists, and other health care professionals. DATA EXTRACTION Reviewers working in duplicate evaluated quality and abstracted information on learners, instructional design (curricular integration, distributing training over multiple days, feedback, mastery learning, and repetitive practice), and outcomes. We coded skills (performance in a test setting) separately for time, process, and product measures, and similarly classified patient care behaviors. DATA SYNTHESIS From a pool of 10,903 articles, we identified 609 eligible studies enrolling 35,226 trainees. Of these, 137 were randomized studies, 67 were nonrandomized studies with 2 or more groups, and 405 used a single-group pretest-posttest design. We pooled effect sizes using random effects. Heterogeneity was large (I(2)>50%) in all main analyses. In comparison with no intervention, pooled effect sizes were 1.20 (95% CI, 1.04-1.35) for knowledge outcomes (n = 118 studies), 1.14 (95% CI, 1.03-1.25) for time skills (n = 210), 1.09 (95% CI, 1.03-1.16) for process skills (n = 426), 1.18 (95% CI, 0.98-1.37) for product skills (n = 54), 0.79 (95% CI, 0.47-1.10) for time behaviors (n = 20), 0.81 (95% CI, 0.66-0.96) for other behaviors (n = 50), and 0.50 (95% CI, 0.34-0.66) for direct effects on patients (n = 32). Subgroup analyses revealed no consistent statistically significant interactions between simulation training and instructional design features or study quality. CONCLUSION In comparison with no intervention, technology-enhanced simulation training in health professions education is consistently associated with large effects for outcomes of knowledge, skills, and behaviors and moderate effects for patient-related outcomes.
Effects of renal denervation with a standard irrigated cardiac ablation catheter on blood pressure and renal function in patients with chronic kidney disease and resistant hypertension.

AIMS Evaluation of the safety and efficacy of renal denervation with a standard irrigated cardiac ablation catheter (SICAC) in chronic kidney disease (CKD) patients with refractory hypertension. METHODS AND RESULTS Twenty-four patients were included and treated with a SICAC. Denervation was performed by a single operator following the standard technique. Patients included with CKD were on stages 2 (n = 16), 3 (n = 4), and 4 (n = 4). Data were obtained at baseline and monthly until 180th day of follow-up. Baseline values of blood pressure (mean ± SD) were 186 ± 19 mmHg/108 ± 13 mmHg in the office, and 151 ± 18 mmHg/92 ± 11 mmHg by 24 h ambulatory blood pressure monitoring (ABPM). Office blood pressure values at 180th day after the procedure were 135 ± 13 mmHg/88 ± 7 mmHg (P < 0.0001, for both comparisons). The mean ABPM decreased to 132 ± 15 mmHg/85 ± 11 mmHg at the 180th day after the procedure (P < 0.0001 for systolic and P = 0.0015 for diastolic). Estimated glomerular filtration (mean ± SD) increased from baseline (64.4 ± 23.9 mL/min/1.73 m(2)) to the 180th day (85.4 ± 34.9 mL/min/1.73 m(2), P < 0.0001) of follow-up. The median urine albumin:creatinine ratio decreased from baseline (48.5, IQR: 35.8-157.2 mg/g) to the 180th day after ablation (ACR = 15.7, IQR: 10.3-34.2 mg/g, P = 0.0017). No major complications were seen. CONCLUSION The procedure using SICAC seemed to be feasible, effective, and safe resulting in a better control of BP, a short-term increase in estimated glomerular filtration rate, and reduced albuminuria. Although encouraging, our data are preliminary and need to be validated in the long term.
Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review.

CONTEXT Several studies have suggested that depression is associated with an increased risk of stroke; however, the results are inconsistent. OBJECTIVE To conduct a systematic review and meta-analysis of prospective studies assessing the association between depression and risk of developing stroke in adults. DATA SOURCES A search of MEDLINE, EMBASE, and PsycINFO databases (to May 2011) was supplemented by manual searches of bibliographies of key retrieved articles and relevant reviews. STUDY SELECTION We included prospective cohort studies that reported risk estimates of stroke morbidity or mortality by baseline or updated depression status assessed by self-reported scales or clinician diagnosis. DATA EXTRACTION Two independent reviewers extracted data on depression status at baseline, risk estimates of stroke, study quality, and methods used to assess depression and stroke. Hazard ratios (HRs) were pooled using fixed-effect or random-effects models when appropriate. Associations were tested in subgroups representing different participant and study characteristics. Publication bias was evaluated with funnel plots and Begg test. RESULTS The search yielded 28 prospective cohort studies (comprising 317,540 participants) that reported 8478 stroke cases (morbidity and mortality) during a follow-up period ranging from 2 to 29 years. The pooled adjusted HRs were 1.45 (95% CI, 1.29-1.63; P for heterogeneity <.001; random-effects model) for total stroke, 1.55 (95% CI, 1.25-1.93; P for heterogeneity = .31; fixed-effects model) for fatal stroke (8 studies), and 1.25 (95% CI, 1.11-1.40; P for heterogeneity = .34; fixed-effects model) for ischemic stroke (6 studies). The estimated absolute risk differences associated with depression were 106 cases for total stroke, 53 cases for ischemic stroke, and 22 cases for fatal stroke per 100,000 individuals per year. The increased risk of total stroke associated with depression was consistent across most subgroups. CONCLUSION Depression is associated with a significantly increased risk of stroke morbidity and mortality.
The adjustment experience of new graduate nurses to acute care on Prince Edward Island: an interpretive descriptive study

Many studies have been completed on the new graduate nurse transition experience but not specific to new graduates in acute care facilities on Prince Edward Island (PEI). The purpose of this study was to use an interpretive descriptive approach to examine this experience for ten new graduates in two acute care facilities on Prince Edward Island. Research interest was in trying to understand the underlying adjustments within the required transition and what could help or hinder these adjustments. All participants were interviewed within two years of graduation and the findings indicate that the adjustment experience for these new graduates is comparable to the experiences of registered nurses (RN’s) elsewhere in Canada and abroad. New graduates on PEI experience four areas of adjustment which include social: taking on a new status; developmental: developing clinical expertise for area of practice; organizational: changing contractual relationships; and occupational: changing nature of work. Facilitators and barriers to adjustment are present with each particular area. Findings may provide a greater understanding of the main transitions that new graduates make as they move from the role of a student to an RN on PEI, as well as implications for nursing educators, administrators and researchers.