Miracle-dz/UniFAR-FTUs huggingface dataset:
Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock*

Principle:Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis; however, it is plausible that elevated serum lactate is simply a manifestation of clinically apparent organ dysfunction and/or shock (i.e., refractory hypotension). Objective:To test whether the association between initial serum lactate level and mortality in patients presenting to the emergency department (ED) with severe sepsis is independent of organ dysfunction and shock. Design:Single-center cohort study. The primary outcome was 28-day mortality and the risk factor variable was initial venous lactate (mmol/L), categorized as low (<2), intermediate (2–3.9), or high (≥4). Potential covariates included age, sex, race, acute and chronic organ dysfunction, severity of illness, and initiation of early goal-directed therapy. Multivariable logistic regression analyses were stratified on the presence or absence of shock. Setting:The ED of an academic tertiary care center from 2005 to 2007. Patients:Eight hundred thirty adults admitted with severe sepsis in the ED. Interventions:None. Measurements and Main Results:Mortality at 28 days was 22.9% and median serum lactate was 2.9 mmol/L. Intermediate (odds ratio {lsqb;OR{rsqb; = 2.05, p = 0.024) and high serum lactate levels (OR = 4.87, p < 0.001) were associated with mortality in the nonshock subgroup. In the shock subgroup, intermediate (OR = 3.27, p = 0.022) and high serum lactate levels (OR = 4.87, p = 0.001) were also associated with mortality. After adjusting for potential confounders, intermediate and high serum lactate levels remained significantly associated with mortality within shock and nonshock strata. Conclusions:Initial serum lactate was associated with mortality independent of clinically apparent organ dysfunction and shock in patients admitted to the ED with severe sepsis. Both intermediate and high serum lactate levels were independently associated with mortality.
Medial Femoral Condyle Cartilage Defect Biomechanics

Background: Medial femoral condyle (MFC) chondral defects cause knee pain. Clinical studies have shown worse functional outcomes and cartilage defect fill rates after microfracture in obese patients (BMI ≥30) and for defects with size ≥2 cm2. Purpose: To determine the effect of obesity, defect size, and cartilage thickness on the force sustained at the base of full-thickness MFC cartilage defects during weightbearing. Study Design: Controlled laboratory study. Methods: Eight human cadaveric knees were loaded in 15° of flexion. A sensor measured force across the medial compartment. The area at the base of the defect protected from load, termed the “area of containment,” was quantified, and loads simulating weightbearing for BMIs of 20, 30, and 40 were applied. A full-thickness cartilage defect was created on the MFC. Cycles of loads were applied for defect sizes with diameters of 6, 8, 10, 12, 14, 16, 18, and 20 mm. A second sensor recorded force at the base of the defect for defects with diameters of 14, 16, 18, and 20 mm. Results: Loads simulating BMI ≥30 led to a decrease in the area of containment for all defects ≥14 mm in diameter (P ≤ .038). Base of defect force increased for defects ≥16 mm in diameter (area, ≥2 cm2) between loaded and unloaded states (P ≤ .042) and for loads simulating BMI ≥30 (P ≤ .045). Cartilage rim thickness <2 mm showed higher base of defect force than did thickness ≥2 mm, for all BMI groups (P ≤ .025). Conclusion: Increased force at the base of MFC cartilage defects was observed for weightbearing loads simulating BMI ≥30, for defect size ≥2 cm2, and for rim thickness <2 mm. This may lead to a biomechanically unfavorable environment after microfracture in these patient subsets. Clinical Relevance: These biomechanical findings corroborate clinical studies that have noted worse outcomes after microfracture in patients with BMI ≥30 and cartilage defects of size ≥2 cm2. Further clinical studies are needed to compare microfracture with other cartilage restoration procedures in these patient subsets.
In the Dark: Young Men’s Stories of Sexual Initiation in the Absence of Relevant Sexual Health Information

A growing body of research has investigated the effectiveness of abstinence-only sexual education. There remains a dearth of research on the relevant sexual health information available to young men who have sex with men (YMSM). Drawing on a mixed-methods study with 526 YMSM, this study explores how and where YMSM receive relevant information on sexual health/behavior. Findings indicate that information related to gay men’s sexuality is not readily available from family, friends, or schools. At initiation of anal intercourse, respondents generally had limited information about HIV and sexually transmitted infections (STIs). In some cases, this resulted in the perception that activities such as unprotected sex were “low risk. ” Many mentioned they first learned about anal sex during their sexual debut, describing painful and/or unpleasant experiences. Some relied on older/more experienced partners, the Internet, and pornography for information. Findings are discussed in relation to how providers can help YMSM build solid foundations of sexual education to protect them from STI and HIV infection.
Design and performance of a microelectromagnetic vibration powered generator

In this paper we, report on the design, simulation and initial results of a microgenerator, which converts external vibrations into electrical energy. Power is generated by means of electromagnetic transduction with static magnets positioned either side of a moving coil located on a silicon structure designed to resonate laterally in the plane of the chip. The development and fabrication of a micromachined microgenerator that uses standard silicon based fabrication techniques and a low cost, batch process is presented. Finite element simulations have been carried out using ANSYS to determine an optimum geometry for the microgenerator. Electromagnetic FEA simulations using Ansoft's Maxwell 2D software have shown voltage levels of 4 to 9 V can be generated from the single beam generator designs. Initial results at atmospheric pressure yield 0.5 /spl mu/W at 9.81 ms/sup -2/ and 9.5 kHz and emphasise the importance of reducing unwanted loss mechanisms such as air damping.
Effect of low flow and high flow oxygen delivery on exercise tolerance and sensation of dyspnea. A study comparing the transtracheal catheter and nasal prongs.

HYPOTHESIS We hypothesized that high flow transtracheal oxygen (HFTTO) will improve exercise tolerance as compared with low flow transtracheal oxygen (LFTTO) and that transtracheal oxygen (TTO) will increase exercise tolerance with less dyspnea as compared with nasal prongs (NP) at equivalent oxygen saturation (SaO2). PATIENT SELECTION Ten subjects, six male and four female, who were already receiving TTO were recruited for the study. STUDY DESIGN Each subject underwent a total of four modified progressive treadmill tests in a single-blind randomized fashion on two separate days. Two tests were performed with the patients receiving LFTTO and HFTTO while the other two were performed with low- and high-flow oxygen by NP. The flows were adjusted to provide equivalent oxygen saturations at rest for respective groups. RESULTS The mean +/- SD exercise distance with HFTTO (1,134 +/- 631 ft) was 2.5 times greater than with LFTTO (446 +/- 328 ft; p < 0.006); and high-flow NP (HFNP [1207 +/- 763 ft]) was 2.38 times greater than with low-flow NP (LFNP[492 +/- 487 ft; p < 0.005]). There was no significant difference in exercise distance and dyspnea scores with HFTTO as compared with HFNP and LFTTO versus LFNP. CONCLUSION We conclude that the use of high-flow oxygen via both transtracheal catheter and NP significantly increased exercise tolerance in our COPD patients when compared to low-flow oxygen. Transtracheal oxygen did not increase maximum exercise tolerance with less dyspnea as compared with oxygen via NP at equivalent SaO2.
Empowerment in nurse leader groups in middle management: a quantitative comparative investigation

AIMS AND OBJECTIVES The aim was to investigate structural empowerment in nurse leaders in middle management positions. Objectives were to determine levels of empowerment of nurse leaders and to compare levels of empowerment between nurse leader groups. BACKGROUND Access to formal and informal power, opportunity, resources, information and support are determinants of structural empowerment. Empowerment of nurse leaders in middle management positions is vital given their roles in enabling nursing teams to deliver high-quality care, benefitting both patient and workforce outcomes. DESIGN Quantitative component of a mixed methods study using survey principles. METHODS The Conditions of Work Effectiveness Questionnaire II was distributed to the total population (n = 517) of nurse leaders in an NHS Foundation Trust in England. Nurse leader groups comprised unit leaders (sisters, matrons) and senior staff nurses. Quantitative data entered on spss v 17/18, were analysed using descriptive and inferential statistics. RESULTS Overall, the unit response rate was 44·1% (n = 228). Levels of total and global empowerment were moderate and moderate to high respectively. Groups did not differ significantly on these parameters or on five elements of total empowerment, but significantly higher scores were found for unit leaders' access to information. Significantly higher scores were found for senior staff nurses on selected aspects of informal power and access to resources, but scores were significantly lower than unit leaders for components of support. CONCLUSIONS A moderately empowered population of nurse leaders differed in relation to access to information, aspects of support, resources and informal power, reflecting differences in roles, spheres of responsibility, hierarchical position and the constraints on empowerment imposed on unit leaders by financial and resource pressures. RELEVANCE TO CLINICAL PRACTICE Empowerment of nurse leaders in middle management is vital in enabling nursing teams to deliver high-quality care. Roles, spheres of responsibility, hierarchical position and constraints imposed by financial and resource pressures influence nurse leader empowerment. Administrative support is needed to sustain practice engagement.
Risks and benefits of phase 1 oncology trials, 1991 through 2002.

BACKGROUND Previous reviews of phase 1 oncology trials reported a rate of response to treatment of 4 to 6 percent and a toxicity-related death rate of 0.5 percent. These results may not reflect the rates in current phase 1 oncology trials. METHODS We reviewed all nonpediatric phase 1 oncology trials sponsored by the Cancer Therapy Evaluation Program at the National Cancer Institute between 1991 and 2002. We report the rates of response to treatment, of stable disease, of grade 4 toxic events, and of treatment-related deaths. RESULTS We analyzed 460 trials involving 11,935 participants, all of whom were assessed for toxicity and 10,402 of whom were assessed for a response to therapy. The overall response rate (i.e., for both complete and partial responses) was 10.6 percent, with considerable variation among trials. "Classic" phase 1 trials of single investigational chemotherapeutic agents represented only 20 percent of the trials and had a response rate of 4.4 percent. Studies that included at least one anticancer agent approved by the Food and Drug Administration constituted 46.3 percent of the trials and had a response rate of 17.8. An additional 34.1 percent of participants had stable disease or a less-than-partial response. The overall rate of death due to toxic events was 0.49 percent. Of 3465 participants for whom data on patient-specific grade 4 toxic events were available, 14.3 percent had had at least one episode of grade 4 toxic events. CONCLUSIONS Overall response rates among phase 1 oncology trials are higher than previously reported, although they have not changed for classic phase 1 trials, and toxicity-related death rates have remained stable. Rates of response and toxicity vary, however, among the various types of phase 1 oncology trials.
Ep‐CAM in malignant liver tumours

We read with great interest the article by De Boer et al. [1] concerning the expression of Ep-CAM in normal, regenerating, metaplastic, and neoplastic liver. In recent investigations into the expression of Ep-CAM in liver tumours using the antibody KS1/4 (kindly provided by Dr R. A. Reisfeld, The Scripps Research Institute, La Jolla, CA, USA) we found immunoreactivity for Ep-CAM in 7 out of 20 hepatocellular carcinomas (35%), a higher percentage of positive cases than that observed by De Boer et al. [1] (20%). We would like to draw attention to the fact that immunoreactivity for Ep-CAM not only may be found in cholangiocarcinoma and hepatocellular carcinoma (malignant tumours that occur mainly in adulthood), but also occurs in hepatoblastoma, the most common malignant liver tumour in childhood. Using immunohistochemistry and immunoelectron microscopy, we detected the expression of Ep-CAM in 9 of 11 hepatoblastomas (82%), the percentage of immunoreactive cells ranging from less than 5% to 100% in the epithelial tumour areas (Figure 1). Immunoreactive cells were found in the mesenchymal areas of mixed hepatoblastoma (in the osteoid) in only one case. As suggested by De Boer et al. [1] in the case of cholangiocarcinoma, the large percentage of positive cases of hepatoblastoma might be related to the derivation of this tumour from a pluripotent progenitor cell. This hypothesis is supported by the principles of tumour biology, which suggest that a tumour such as hepatoblastoma, which may exhibit multiple epithelial and mesenchymal lines of differentiation, must be derived from a pluripotent stem cell. The existence in this tumour of small epithelial cells with the ultrastructural and immunophenotypic features of oval cells, i.e. putative hepatic progenitor cells [2,3], would also support this view. In addition to its diagnostic and histogenetic signi®cance, the expression of Ep-CAM by malignant liver tumours may also be of therapeutic importance. Immunotherapy with a humanized antibody±interleukin 2 fusion protein against Ep-CAM (huKS1/4±IL-2) has been shown to eradicate disseminated carcinoma in animal models [4], and its use in the treatment of metastatic disease in humans is being investigated in
Effects of dimethoate on snail B-esterase and growth as a function of dose, time and exposure route in a laboratory bioassay

The aim was to study the effects of dimethoate on enzymatic targets and on the growth of Helix aspersa for different times and modes of exposure under laboratory conditions. Young snails were exposed to increasing dimethoate concentrations in the food (D.exp) or in an artificial substrate (S.exp) for 1, 2, 7 and 14 days. Both acetylcholinesterase (AChE) and carboxylesterase (CaE) activities were measured in the foot of the snails for each concentration and exposure time tested. Growth was evaluated after 7 days of exposure. AChE inhibition, dose-dependent for all lengths of exposure, was stronger in S.exp. AChE was more sensitive than CaE for both modes of exposure. IC50-7 days was 38. 3μg g-1 in D.exp and 11. 7μg g-1 in S.exp for AChE and was higher than 150 μg g-1 in two exposure modes for CaE. AChE activity decreased from the first day to reach maximum inhibition after 7 days of exposure. As noted for B-esterase activities, growth inhibition was stronger in S.exp and was only significant for AChE inhibition of >90%. The present results show that AChE activity could be used to give early warning of toxic effects of dimethoate in terrestrial gastropods.
Brain mast cells link the immune system to anxiety-like behavior

Mast cells are resident in the brain and contain numerous mediators, including neurotransmitters, cytokines, and chemokines, that are released in response to a variety of natural and pharmacological triggers. The number of mast cells in the brain fluctuates with stress and various behavioral and endocrine states. These properties suggest that mast cells are poised to influence neural systems underlying behavior. Using genetic and pharmacological loss-of-function models we performed a behavioral screen for arousal responses including emotionality, locomotor, and sensory components. We found that mast cell deficient KitW−sh/W−sh (sash−/−) mice had a greater anxiety-like phenotype than WT and heterozygote littermate control animals in the open field arena and elevated plus maze. Second, we show that blockade of brain, but not peripheral, mast cell activation increased anxiety-like behavior. Taken together, the data implicate brain mast cells in the modulation of anxiety-like behavior and provide evidence for the behavioral importance of neuroimmune links.
Examining Social And Cognitive Aspects Determining Physician's Adoption Of Electronic Medical Records

The primary health care IT-system (HIT) physicians in hospitals are exposed to is the electronic medical record (EMR) - the “information backbone” of all patient related activity and data. Despite the commonly acknowledged beneficial improvements through HIT, the level of EMR adoption in Germany is relatively low. Less than 20% of all hospitals have implemented a fully functional EMR. Apparently, the users have certain antipathies against the EMR. In order to identify the salient factors of these aversions and to provide a plausible explanation for the scarce penetration of EMR systems, a case study research in German hospitals has been conducted. The research subjects were physicians as the most influential EMR users. Social Cognitive Theory (SCT) was applied to analyze their perceptions towards using the EMR. Findings indicate that performance-related outcome expectations and anxieties are the most relevant factors. However, as the majority of the subject group generally has high confidence in EMR systems, expected benefits seem to outweigh perceived risks of EMR usage.
RNA decay systems enhance reciprocal switching of sense and antisense transcripts in response to glucose starvation

Antisense RNA has emerged as a crucial regulator of opposite‐strand protein‐coding genes in the long noncoding RNA (lncRNA) category, but little is known about their dynamics and decay process in the context of a stress response. Antisense transcripts from the fission yeast fbp1 locus (fbp1‐as) are expressed in glucose‐rich conditions and anticorrelated with transcription of metabolic stress‐induced lncRNA (mlonRNA) and mRNA on the sense strand during glucose starvation. Here, we investigate the localization and decay of antisense RNAs at fbp1 and other loci, and propose a model to explain the rapid switch between antisense and sense mlonRNA/mRNA transcription triggered by glucose starvation. We show that fbp1‐as shares many features with mRNAs, such as a 5′‐cap and poly(A)‐tail, and that its decay partially depends upon Rrp6, a cofactor of the nuclear exosome complex involved in 3′–5′ degradation of RNA. Fluorescence in situ hybridization and polysome fractionation show that the majority of remaining fbp1‐as localizes to the cytoplasm and binds to polyribosomes in glucose‐rich conditions. Furthermore, fbp1‐as and antisense RNA at other stress‐responsive loci are promptly degraded via the cotranslational nonsense‐mediated decay (NMD) pathway. These results suggest NMD may potentiate the swift disappearance of antisense RNAs in response to cellular stress.
Professionals' views of fetal-monitoring support the development of devices to provide objective longer-term assessment of fetal wellbeing

Abstract Objective: Continuous longer-term fetal monitoring has been proposed to address limitations of current technologies in the detection of fetal compromise. We aimed to assess professionals' views regarding current fetal-monitoring techniques and proposed longer-term continuous fetal monitoring. Methods: A questionnaire was designed and validated to assess obstetricians' and midwives' use of current fetal-monitoring techniques and their views towards continuous monitoring. 125 of 173 received responses (72% obstetricians, 28% midwives) were analysed. Results: Professionals had the strongest views about supporting evidence for the most commonly employed fetal-monitoring techniques (maternal awareness of fetal movements, ultrasound assessment of fetal growth and umbilical artery Doppler). 45.1% of professionals agreed that a continuous monitoring device would be beneficial (versus 28.7% who disagreed); this perceived benefit was not influenced by professionals' views regarding current techniques or professional background. Professionals have limited experience of continuous fetal monitoring, but most respondents believed that it would increase maternal anxiety (64.3%) and would have concerns with its use in clinical practice (81.7%). Conclusion: Continuous fetal monitoring would be acceptable to the majority of professionals. However, development of these technologies must be accompanied by extended examination of professionals' and women's views to determine barriers to its introduction.
Bexsero® chronicle

Abstract Neisseria meningitidis causes globally 1·2 million invasive disease cases and 135 000 deaths per year, mostly in infants and adolescents. A century of traditional vaccinology had failed the fight against the serogroup B meningococcus (MenB), mostly prevalent in developed countries. Eighteen years after the publication of the first complete genome sequence from a living organism, thanks to an innovative genome-based approach named ‘reverse vaccinology’, the first broadly effective MenB vaccine was licensed for use by the European Medical Agency and other authorities, and is being implemented worldwide. Here we review this long and passionate journey, from the disease epidemiology to novel antigen discovery, from vaccine clinical development to public health impact: two decades of scientific and technological innovation to defeat one of the most sudden and devastating invasive diseases.
Effect of replacing dietary vitamin E by sage on performance and meatiness of spent hens, and the oxidative stability of sausages produced from their meat

Abstract 1. A total of 3960 hens (half ISA Warren and half Dekalb White) were housed in 18 compartments with 220 hens each. The effect of replacing dietary vitamin E by sage on productivity, meat yield and oxidative stability of sausages was studied. 2. One third of all animals received either a vitamin E deficient diet (negative control) or diets supplemented with 30 mg/kg α-tocopherylacetate (positive control) or 25 g sage leaves/kg. At slaughter, meat yield was assessed and sausages were produced (n = 12 per treatment). 3. The omission of vitamin E did not impair the oxidative stability of the raw sausage material or the spiced sausages in comparison to the positive control. Sage supplementation improved oxidative stability after 7 m of frozen storage, but not after 1, 4 and 10 m. Spice addition during meat processing had an antioxidant effect regardless of dietary treatment. Diet supplementation of any type did not affect laying performance and sausage meat yield. 4. Feeding antioxidants to spent hens seemed to be not as efficient as in growing chickens, while seasoning with spices during sausage production proved to be a feasible way to delay lipid oxidation.
UvA-DARE ( Digital Academic Repository ) Granulocyte transfusion therapy : randomization after all ?

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