Miracle-dz/UniFAR-FTUs huggingface dataset:
Healthcare professionals' documentation in nursing homes when caring for patients with dementia in end of life - a retrospective records review.

AIMS AND OBJECTIVES To investigate how end-of-life care was described by healthcare professionals in records of deceased persons affected by dementia who had lived in Swedish nursing homes. BACKGROUND In the final stage of dementia disease, the persons are often cared for at nursing homes and they often die there. The research concurs that a palliative approach to end-of-life care is essential but there are still some limitations regarding research about what constitutes the end-of-life care provided to persons affected by dementia in Sweden. DESIGN Descriptive qualitative method with a retrospective approach. METHOD Nursing records (n = 50) and medical records (n = 50) were retrospectively reviewed in two nursing homes. The analysis was conducted using deductive and inductive content analysis. Three phases of The Liverpool Care Pathway; Initial assessment, Continuous assessment and Follow-up, were used deductively to first sort the text in the records, then the text in each phase was further analysed with inductive content analysis. Four categories and 11 subcategories described the content in the records. RESULTS The end-of-life care was described in the healthcare records based on such categories as decision-making, participation and communication, assessment and prevention of symptom and following up after the residents had died. CONCLUSION Paticularly, physical symptoms were documented and, to a lesser degree, psychological or existential/spiritual needs. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals must have a holistic view of the person affected by dementia during the end-of-life care and, according to this study, more focus must be placed on their psychosocial and existential needs in the documentation of end-of-life care.
Evaluation and management of small-bowel obstruction: An Eastern Association for the Surgery of Trauma practice management guideline

BACKGROUND Small-bowel obstruction (SBO) represents as many as 16% of surgical admissions and more than 300,000 operations annually in the United States. The optimal strategies for the diagnosis and management of SBO continue to evolve secondary to advances in imaging techniques, critical care, and surgical techniques. This updated systematic literature review was developed by the Eastern Association for the Surgery of Trauma to provide up-to-date evidence-based recommendations for SBO. METHODS A search of the National Library of Medicine MEDLINE database was performed using PubMed interface for articles published from 2007 to 2011. RESULTS The search identified 53 new articles that were then combined with the 131 studies previously reviewed by the 2007 guidelines. The updated guidelines were then presented at the 2012 annual EAST meeting. CONCLUSION Level I evidence now exists to recommend the use of computed tomographic scan, especially multidetector computed tomography with multiplanar reconstructions, in the evaluation of patients with SBO because it can provide incremental clinically relevant information over plains films that may lead to changes in management. Patients with evidence of generalized peritonitis, other evidence of clinical deterioration, such as fever, leukocytosis, tachycardia, metabolic acidosis, and continuous pain, or patients with evidence of ischemia on imaging should undergo timely exploration. The remainder of patients can safely undergo initial nonoperative management for both partial and complete SBO. Water-soluble contrast studies should be considered in patients who do not clinically resolve after 48 to 72 hours for both diagnostic and potential therapeutic purposes. Laparoscopic treatment of SBO has been demonstrated to be a viable alternative to laparotomy in selected cases.
Tissue-engineered bone formation using human bone marrow stromal cells and novel β-tricalcium phosphate

In this study we investigated not only the cellular proliferation and osteogenic differentiation of human bone marrow stromal cells (hBMSCs) on the novel β-tricalcium phosphate (β-TCP) scaffolds in vitro but also bone formation by ectopic implantation in athymic mice in vivo. The interconnected porous β-TCP scaffolds with pores of 300–500 µm in size were prepared by the polymeric sponge method. β-TCP scaffolds with the dimension of 3 mm × 3 mm × 3 mm were combined with hBMSCs, and incubated with (+) or without (−) osteogenic medium in vitro. Cell proliferation and osteogenic differentiation on the scaffolds were evaluated by scanning electron microscopy (SEM) observation, MTT assay, alkaline phosphatase (ALP) activity and osteocalcin (OCN) content measurement. SEM observation showed that hBMSCs attached well on the scaffolds and proliferated rapidly. No significant difference in the MTT assay could be detected between the two groups, but the ALP activity and OCN content of scaffolds (+) were much higher than those of the scaffolds (−) (p < 0.05). These results indicated that the novel porous β-TCP scaffolds can support the proliferation and subsequent osteogenic differentiation of hBMSCs in vitro. After being cultured in vitro for 14 days, the scaffolds (+) and (−) were implanted into subcutaneous sites of athymic mice. In β-TCP scaffolds (+), woven bone formed after 4 weeks of implantation and osteogenesis progressed with time. Furthermore, tissue-engineered bone could be found at 8 weeks, and remodeled lamellar bone was also observed at 12 weeks. However, no bone formation could be found in β-TCP scaffolds (−) at each time point checked. The above findings illustrate that the novel porous β-TCP scaffolds developed in this work have prominent osteoconductive activity and the potential for applications in bone tissue engineering.
Functionally graded electrospun scaffolds with tunable mechanical properties for vascular tissue regeneration

Electrospun tubular scaffolds (4 mm inner diameter) based on bio-artificial blends of polyglyconate (Maxon®) and proteins such as gelatin and elastin having a spatially designed multilayer structure were prepared for use as vascular tissue scaffolds. Scanning electron microscopy analysis of scaffolds showed a random nanofibrous morphology with fiber diameter in the range of 200–400 nm for protein-blended Maxon, which mimics the nanoscale dimensions of collagen (50–500 nm). The scaffolds have a well interconnected pore structure and porosity up to 82%, with protein blending and multi-layering in contrast to electrospun Maxon® scaffolds (67%). Fourier-transform infrared spectroscopy, x-ray diffraction and differential scanning calorimetry results confirmed the blended composition and crystallinity of fibers. Uniaxial tensile testing revealed a strength of 14.46 ± 0.42 MPa and a modulus of 15.44 ± 2.53 MPa with a failure strain of 322.5 ± 10% for a pure Maxon® scaffold. The blending of polyglyconate with biopolymers decreased the tensile properties in general, with an exception of the tensile modulus (48.38 ± 2 MPa) of gelatin/Maxon mesh, which was higher than that of the pure Maxon® scaffold. Trilayered tubular scaffolds of gelatin/elastin, gelatin/elastin/Maxon and gelatin/Maxon (GE-GEM-GM) that mimic the complex trilayer matrix structure of natural artery have been prepared by sequential electrospinning. Tensile testing under dry conditions revealed a tensile strength of 2.71 ± 0.2 MPa and a modulus of 20.4 ± 3 MPa with a failure strain of 140 ± 10%. However, GE-GEM-GM scaffolds tested under wet conditions after soaking in a phosphate buffered saline medium at 37 °C for 24 h exhibited mechanical properties (2.5 MPa tensile strength and 9 MPa tensile modulus) comparable to those of native femoral artery.
Working Paper Series Document de travail de la s é rie HOW TO SELL A CONDOM ? THE IMPACT OF DEMAND CREATION TOOLS ON MALE AND FEMALE CONDOM SALES IN RESOURCE LIMITED SETTINGS

Despite condoms being cheap and effective in preventing HIV, there remains an 8 billion shortfall in condom use in risky sex-acts. Social marketing organisations apply private sector marketing approaches to sell public health product. This paper investigates the impact of marketing tools, including promotion and pricing, on demand for male and female condoms in 52 countries between 1997 and 2009. A static model differentiates drivers of demand for male and female condoms, while a dynamic panel data estimator estimates their shortand long-run impacts. Products are not equally affected: female condoms are not affected by advertising, but highly affected by interpersonal communication and HIV prevalence. Promotion has significant shortand long-run effects on both condoms. Price changes have a large impact on the shortand long-run female condom demand, but only affect long-run male condom demand. Programming for HIV prevention technologies needs to consider both product and target population characteristics.
Improvements in pulmonary and general critical care reduces mortality following ventilator-associated pneumonia

BACKGROUND Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit, with substantial subsequent mortality. The mortality following VAP declined in the 1980s and 1990s. Experts suggest that little progress has been made in the outcomes from VAP since several novel interventions have failed. We nonetheless hypothesized that mortality following VAP has continued to decrease owing to advances in pulmonary critical care. METHODS We identified all adult patients with Centers for Disease Control and Prevention–defined, intensive care unit–acquired VAP between January 1, 1997, and December 31, 2008, from a prospectively collected database. RESULTS A total of 793 cases of VAP occurred in the study period. Cases were divided into four periods (1997–1999, 2000–2002, 2003–2005, or 2006–2008) to compare outcomes over time. Acute Physiology and Chronic Health Evaluation II scores were stable, while mortality was significantly lower in Period 4 when compared with Periods 1 and 2 (p = 0.004 and 0.009, respectively). A logistic regression model predicting death (c statistic = 0.871) revealed age (odds ratio, 1.03; 95% confidence interval, 1.02–1.05), Acute Physiology and Chronic Health Evaluation II score (1.09, 1.05–1.14), white blood cell count (1.03, 1.00–1.06), transplant recipient (3.45, 1.40–8.53), transfusions (3.25, 1.37–7.68), and pulmonary disease (3.01, 1.67–5.45) were independent predictors of death, as was the presence of trauma (0.10, 0.06–0.18), chronic steroid therapy (0.39, 0.17–0.91), and patient length of stay (0.99, 0.98–0.99), with odds ratios less than 1.0. In addition, those patients treated in Period 1 (2.23, 1.16–4.29) or Period 2 (2.13, 1.12–4.06) had twice the risk of death following an episode of VAP when compared with those treated in the most recent period. CONCLUSION We have shown that mortality following an episode of VAP continues to decrease over time and attribute this to advancements in pulmonary and general critical care rather than any specific interventions. LEVEL OF EVIDENCE Prognostic study, level II.
Development and validation of a novel method to derive central aortic systolic pressure from the MR aortic distension curve

Central aortic systolic pressure (CASP) is a more accurate measure of load and cardiovascular risk than brachial pressure. Unfortunately, CASP is difficult to measure using current methods. In this study we report three methods of determining CASP by combining MR‐derived aortic area curves with different models of the pressure–area relationship.
The effect of extracellular calcium and inorganic phosphate on the growth and osteogenic differentiation of mesenchymal stem cells in vitro: implication for bone tissue engineering

The aim of this study is to demonstrate the effect of extracellular calcium ion (Ca2+) and inorganic phosphate (Pi) concentrations on the growth and differentiation of bone-marrow-derived mesenchymal stem cells (MSCs), which is essential to understand the interaction between calcium phosphate ceramic (CPC) scaffolds and seeded cells during the construction of tissue-engineered bones. MSCs were separated from rabbits and cultured in media with different concentrations of Ca2+ and Pi supplements. Their proliferation, apoptosis, mineralization and osteogenic differentiation were determined by the MTT assay, TUNEL assay, Vonkossa stain and RT-PCR examination. A two-way ANOVA calculation with comparisons of estimated marginal means by LSD was used for statistical analysis. Results showed that the optimal extracellular Ca2+ and Pi concentrations for the cells to proliferate and differentiate were 1.8 mM and 0.09 mM, respectively, which are the concentrations supplied in many commonly used culture media such as DMEM and α-MEM. Cell proliferation and differentiation decreased significantly with greater or lower concentrations of the Pi supplement. Greater Pi concentrations also led to significant cell apoptosis. Greater Ca2+ concentrations did not change cell proliferation but significantly inhibited cell differentiation. In addition, greater Ca2+ concentrations could significantly enhance cell mineralization. In conclusion, extracellular Ca2+ and Pi significantly influence the growth and osteogenic differentiation of MSCs. It is important to take the cellular effect of Ca2+ and Pi into consideration when designing or constructing scaffolds for bone tissue engineering with CPC.
Providing informal home care for pressure ulcer patients: how it affects carers' quality of life and burden.

AIMS AND OBJECTIVES To evaluate the quality of life of informal caregivers of patients with pressure ulcer; to assess their levels of burden; to analyse the variables influencing both their quality of life and burden. BACKGROUND Informal caregivers of pressure ulcer patients, besides coping with the natural dependency of these patients, deal with the specificity of caring these types of wounds. This situation has an impact on not only the quality of life and burden felt by informal caregivers but also on individual and familiar dynamics. DESIGN Descriptive and correlational study. METHODS This study focused on 145 informal caregivers providing home care. Measurement instruments were: SF-36v2 and the Burden Interview Scale. Descriptive analysis of the quantitative variables was carried out according to measures of central tendency, and the qualitative variables were described using absolute and relative frequencies. The relationships or associations between variables were explored through correlational analysis and, whenever the data allowed, multivariate techniques were used. RESULTS AND DISCUSSION Informal caregivers showed low levels of quality of life and, most of them, significant burden. Quality of life decreased with overload, with the increasing number of pressure ulcer and with less experience of informal caregivers, with lack of financial remuneration, with unemployment, with patient positioning and with the direct care of the wound. The burden increased with the number of pressure ulcer in each patient and with the lack of financial remuneration. CONCLUSION These informal caregivers have low quality of life and are overburdened. Both situations are positively and negatively influenced by factors related to the pressure ulcer and to the patients' sociodemographic data. RELEVANCE TO CLINICAL PRACTICE The results of this study allow more effective monitoring by health professionals of levels of burden and quality of life encountered in pressure ulcer informal caregivers, as well as direct interventions to inhibit the factors inducing burden and enhance those that improve quality of life.
In Vivo 31P magnetic resonance spectroscopic imaging (MRSI) for metabolic profiling of human breast cancer xenografts

To study cancer associated with abnormal metabolism of phospholipids, of which several have been proposed as biomarkers for malignancy or to monitor response to anticancer therapy. We explored 3D 31P magnetic resonance spectroscopic imaging (MRSI) at high magnetic field for in vivo assessment of individual phospholipids in two patient‐derived breast cancer xenografts representing good and poor prognosis (luminal‐ and basal‐like tumors).
The apatite formation ability of CaF2 doping tricalcium silicates in simulated body fluid

The purpose of this study was to investigate the effects of CaF2 on the apatite formation ability of tricalcium silicates (Ca3SiO5, C3S) and the mechanism of apatite formation on C3S pastes. Different amounts of CaF2 (0, 1, 2 and 3 wt%) were mixed in the raw materials during the synthesis process of C3S. The apatite formation ability of the CaF2 doping C3S was examined by soaking the one-day setting pastes in simulated body fluid (SBF). The fluoride concentrations, pH values, structural and morphological variations of the pastes were examined during soaking in SBF. With the addition of CaF2, the initial crystalline apatite formation time of the pastes was decreased from three days to one day. After soaking for seven days, the thicknesses of apatite layers depositing on the surface of C3S doped with 0, 1, 2 and 3 wt% CaF2 were about 88, 102, 168 and 136 µm, respectively. C3S doped with 2 wt% CaF2 showed the better ability to induce the formation of apatite. Furthermore, the mechanism of the apatite formation of the CaF2 doping C3S pastes may be attributed to the formation and stability of F-substituted apatite determined by x-ray photoelectron spectroscopy (XPS) at the early age. The results indicated that CaF2 doping C3S has better in vitro bioactivity, and may be used to prepare novel bone cement.
Blood volume fraction imaging of the human lung using intravoxel incoherent motion

To present a technique for non‐contrast‐enhanced in vivo imaging of the blood volume fraction of the human lung. The technique is based on the intravoxel incoherent motion (IVIM) approach. However, a substantial novelty is introduced here: the need for external diffusion sensitizing gradients is eliminated by exploiting the internal magnetic field gradients typical of the lung tissue, due to magnetic susceptibility differences at air/tissue interfaces.
In vitro cartilage tissue engineering using cancellous bone matrix gelatin as a biodegradable scaffold

In this study, we constructed tissue-engineered cartilage using allogeneic cancellous bone matrix gelatin (BMG) as a scaffold. Allogeneic BMG was prepared by sequential defatting, demineralization and denaturation. Isolated rabbit chondrocytes were seeded onto allogeneic cancellous BMG, and cell–BMG constructs were harvested after 1, 3 and 6 weeks for evaluation by hematoxylin and eosin staining for overall morphology, toluidine blue for extracellular matrix (ECM) proteoglycans, immunohistochemical staining for collagen type II and a transmission electron microscope for examining cellular microstructure on BMG. The prepared BMG was highly porous with mechanical strength adjustable by duration of demineralization and was easily trimmed for tissue repair. Cancellous BMG showed favorable porosity for cell habitation and metabolism material exchange with larger pore sizes (100–500 µm) than in cortical BMG (5–15 µm), allowing cell penetration. Cancellous BMG also showed good biocompatibility, which supported chondrocyte proliferation and sustained their differentiated phenotype in culture for up to 6 weeks. Rich and evenly distributed cartilage ECM proteoglycans and collagen type II were observed around chondrocytes on the surface and inside the pores throughout the cancellous BMG. Considering the large supply of banked bone allografts and relatively convenient preparation, our study suggests that allogeneic cancellous BMG is a promising scaffold for cartilage tissue engineering.
Development and validation of the Simulation Learning Effectiveness Scale for nursing students.

AIMS AND OBJECTIVES To develop and validate the Simulation Learning Effectiveness Scale, which is based on Bandura's social cognitive theory. BACKGROUND A simulation programme is a significant teaching strategy for nursing students. Nevertheless, there are few evidence-based instruments that validate the effectiveness of simulation learning in Taiwan. DESIGN This is a quantitative descriptive design. METHODS In Study 1, a nonprobability convenience sample of 151 student nurses completed the Simulation Learning Effectiveness Scale. Exploratory factor analysis was used to examine the factor structure of the instrument. In Study 2, which involved 365 student nurses, confirmatory factor analysis and structural equation modelling were used to analyse the construct validity of the Simulation Learning Effectiveness Scale. RESULTS In Study 1, exploratory factor analysis yielded three components: self-regulation, self-efficacy and self-motivation. The three factors explained 29·09, 27·74 and 19·32% of the variance, respectively. The final 12-item instrument with the three factors explained 76·15% of variance. Cronbach's alpha was 0·94. In Study 2, confirmatory factor analysis identified a second-order factor termed Simulation Learning Effectiveness Scale. Goodness-of-fit indices showed an acceptable fit overall with the full model (χ2 /df (51) = 3·54, comparative fit index = 0·96, Tucker-Lewis index = 0·95 and standardised root-mean-square residual = 0·035). In addition, teacher's competence was found to encourage learning, and self-reflection and insight were significantly and positively associated with Simulation Learning Effectiveness Scale. Teacher's competence in encouraging learning also was significantly and positively associated with self-reflection and insight. Overall, theses variable explained 21·9% of the variance in the student's learning effectiveness. CONCLUSION The Simulation Learning Effectiveness Scale is a reliable and valid means to assess simulation learning effectiveness for nursing students. RELEVANCE TO CLINICAL PRACTICE The Simulation Learning Effectiveness Scale can be used to examine nursing students' learning effectiveness and serve as a basis to improve student's learning efficiency through simulation programmes. Future implementation research that focuses on the relationship between learning effectiveness and nursing competence in nursing students is recommended.