Miracle-dz/UniFAR-FTUs huggingface dataset:
A BEME (Best Evidence in Medical Education) review of the use of workplace-based assessment in identifying and remediating underperformance among postgraduate medical trainees: BEME Guide No. 43

Abstract Introduction: The extent to which workplace-based assessment (WBA) can be used as a facilitator of change among trainee doctors has not been established; this is particularly important in the case of underperforming trainees. The aim of this review is to examine the use of WBA in identifying and remediating performance among this cohort. Methods: Following publication of a review protocol a comprehensive search of eight databases took place to identify relevant articles published prior to November 2015. All screening, data extraction and analysis procedures were performed in duplicate or with quality checks and necessary consensus methods throughout. Given the study-level heterogeneity, a descriptive synthesis approach informed the study analysis. Results: Twenty studies met the inclusion criteria. The use of WBA within the context of remediation is not supported within the existing literature. The identification of underperformance is not supported by the use of stand-alone, single-assessor WBA events although specific areas of underperformance may be identified. Multisource feedback (MSF) tools may facilitate identification of underperformance. Conclusion: The extent to which WBA can be used to detect and manage underperformance in postgraduate trainees is unclear although evidence to date suggests that multirater assessments (i.e. MSF) may be of more use than single-rater judgments (e.g. mini-clinical evaluation exercise).
THE ACUTE EFFECTS OF STATIC AND BALLISTIC STRETCHING ON VERTICAL JUMP PERFORMANCE IN TRAINED WOMEN

Traditionally stretching has been included as part of a warm-up that precedes athletic participation. However, there is mixed evidence as to whether stretching actually enhances or hinders athletic performance. Therefore, the purpose of this study was to examine the acute effects of static (SS) and ballistic stretching (BS) on vertical jump (VJ) performance and to investigate whether power was altered at 15 and 30 minutes after stretching. Sixteen actively trained women performed a series of vertical jumps (countermovement and drop jumps) after an initial nonstretching (NS) session and after participating in BS and SS sessions that were conducted in a balanced and randomized order. The results indicated that there was no significant difference (p < 0.05) in VJ scores as a result of static or ballistic stretching, elapsed time, or initial flexibility scores. This suggests that stretching prior to competition may not negatively affect the performance of trained women.
Clinical and Pathologic Predictors of Locoregional Recurrence, Distant Metastasis, and Overall Survival in Patients Treated With Chemoradiation and Mesorectal Excision for Rectal Cancer

Objectives:To identify predictive factors for locoregional recurrence (LR), distant metastasis (DM), and overall survival (OS) in patients treated with chemoradiation and surgery for rectal cancer. Methods:Between 1989 and 2001, 470 patients with rectal cancer were treated with preoperative (89%) or postoperative (11%) chemoradiation and mesorectal excision. Median radiation dose was 45 Gy; 97% received concurrent infusional 5-fluorouracil, and 65% received adjuvant chemotherapy. Median follow-up interval was 5.7 years. Results:The 5-year rates of freedom from LR, freedom from DM, and OS were 90%, 79%, and 80%, respectively. On univariate analysis, significant predictors of LR were female sex, clinical T stage, pathologic T and N stages, and positive radial margin. Significant univariate predictors of DM were circumferential extent of tumor, tumor immobility, lymphovascular invasion, perineural involvement, and pathologic T and N stages. Significant univariate predictors of lower OS were age, circumferential extent of tumor, shorter distance from anal verge, tumor size, tumor immobility, anal canal involvement, lymphovascular invasion, perineural involvement, positive radial margin, and pathologic T and N stages. On Cox multivariate analysis, female sex and pathologic T and N stages independently predicted for LR; pathologic T and N stages independently predicted for DM; and age, circumferential extent of tumor, positive radial margin, and pathologic T and N stages independently predicted for lower OS. Conclusions:Pathologic T and N stages significantly predicted for all 3 end points (LR, DM and OS) on multivariate analysis. Investigations of more aggressive adjuvant chemotherapy appear warranted for pathologic stage T3/T4 or N1/2 rectal cancer.
Atrial overdrive pacing for the obstructive sleep apnea-hypopnea syndrome.

BACKGROUND The role of atrial overdrive pacing (AOP) in sleep apnea remains uncertain. We prospectively evaluated the effect of AOP after 24 hours and after one month in patients with the obstructive sleep apnea-hypopnea syndrome and compared it with the use of nasal continuous positive airway pressure (n-CPAP). METHODS We studied 16 patients with a moderate or severe case of the obstructive sleep apnea-hypopnea syndrome (baseline mean apnea-hypopnea index, 49) and normal left ventricular systolic function in whom a dual-chamber pacemaker had been implanted. After 48 hours, the patients were randomly assigned to AOP (pacing at 15 bpm above the spontaneous mean nocturnal heart rate) or backup atrial pacing (pacing at a heart rate below 40 bpm); the latter group began n-CPAP therapy one day later. After one month, the two groups switched therapies and were followed for an additional month. Polysomnographic studies were performed at baseline, on the first night after randomization, at crossover, and at the end of the study. RESULTS During AOP, no significant changes were observed in any of the respiratory variables measured. The change in the apnea-hypopnea index at one month with AOP was +0.2 (95 percent confidence interval, -2.7 to +2.3; P=0.87). In contrast, all variables improved significantly after one month of n-CPAP (change in the apnea-hypopnea index, -46.3; 95 percent confidence interval, -56.2 to -36.5; P<0.001). CONCLUSIONS Nasal continuous positive airway pressure therapy is highly effective for the treatment of the obstructive sleep apnea-hypopnea syndrome, whereas AOP has no significant effect.
Antimicrobial susceptibility of organisms isolated from sputum culture of Karachi, Pakistan.

Our study aims to contribute to developing antibiotics prescription guidelines at a national and a regional level directed by the antibiotics susceptibility patterns and rapidly emerging resistant organisms. This study is designed to observe the antimicrobial susceptibility in sputum culture isolates and drug resistance patterns against various antimicrobials. This was a retrospective cohort study; data was collected from two laboratories from 1st Jan to 15 July 2007. All laboratory reports were analyzed using SPSS version 19.0. The sputum culture was found positive for microbial growth in 217 reports out of 864 total (25.11%). The leading organisms were 25.8% Klebsiella pneumoniae, 23.5% Streptococcus pneumoniae, 18% Pseudomonas aeruginosa and 12.9% Staphylococcus aureus. S.pneumoniae and S.aureus were sensitive to the combination of beta lactam antibiotics and anti-beta lactamase while K.pneumoniae and P. aureginosa were susceptible to fluoroquinolones, macrolides and aminoglycosides. The total yield of sputum culture was 25.11%. The gram positive cocci which were isolated were mostly resistant to beta lactam antibiotics alone i.e. only 45% of S. pneumoniae and 33% of S. aureus were sensitive to Amoxicillin alone. Sensitivity to Co-amoxiclav was still high. 90% and 85% of S. pneumonia and S. aureus respectively were sensitive to Co-amoxiclav. The P. aeruginosa resistance to Amikacin in our study is 10%.
ENVIRONMENTAL FACTORS AFFECTING MILK YIELD AND LACTATION LENGTH IN SAHIWAL CATTLE

Weekly milk yield records on 661 Sahiwal cows calving during 1990-2000 at the Livestock Experiment Station Bahadurnagar, Okara were used to study how milk yield and lactation length were affected by different environmental factors. Lactation milk yield averaged 1475 ± 651 kg for an average lactation length of 248 ± 67 days (n=2039). Year of calving and season of calving both significantly (P<0.01) affected milk yield and lactation length. Age within parity also significantly affected the two traits. Winter calvers produced more milk (1546 kg) as compared to summer calvers (1362 kg). Milk yield gradually increased towards 4 th and 5 th parity and declined thereafter, while highest lactation length (263 days) was observed for first parity cows. The repeatability estimates for lactation length and milk yield were 0.326 ± 0.025 and 0.46 ± 0.041, respectively. When milk yield was adjusted for lactation length by different procedures, all the variation in milk yield due to lactation length could not be removed (weeks in milk effect remained significant). The environmental factors such as year, season of calving (and their interaction) and age at calving still affected milk yield significantly (P<0.01). The extent of season of calving effect however, reduced. Phenotypic trend for milk yield over the last 10 years was negative while lactation length had a positive trend which needs further exploration. The environmental factors under study were suggested to be incorporated in the models when variation in milk yield needed partitioning into genetic and non-genetic components.
Emerging treatments for soft tissue sarcoma of adults

Soft tissue sarcomas are a heterogeneous group of malignancies arising from mesenchymal tissues. Patients can present with a localised tumour (primary or local recurrence) at different sites (e.g., extremity, abdomen) or metastatic disease, which may require different treatment strategies. Is the surgical resection of a localised sarcoma enough or is it better to give an additional treatment like adjuvant and/or preoperative radiotherapy and/or chemotherapy? Which chemotherapy should be selected in the first or second line situation? Do new treatment options exist, such as targeted therapies? This review provides answers to some of these questions. To decide on consecutive treatment steps, it is important to know as many relevant factors as possible at first presentation. Therefore, the first part of this review discusses the specific characteristics and prognostic factors of importance for treatment planning. A short summary of current therapy strategies and existing standards is then given. The main body of the review summarises information on new and emerging clinical compounds for patients with soft tissue sarcoma of adults, including recent developments of targeted therapy.
Penetration Study of Formulated Nanosized Titanium Dioxide in Models of Damaged and Sun‐Irradiated Skins

Inorganic ultraviolet filters such as titanium dioxide (TiO2), safe to use on healthy skin, are often applied on compromised and irradiated skin. The aim of this study was to evaluate in vitro the cutaneous penetration of TiO2 nanoparticles (≥ 20 nm primary size), included in a sunscreen, in intact, damaged, irradiated, and damaged/irradiated pigskin. Cutaneous penetration and localization of TiO2 after a 24‐h sunscreen application were investigated quantitatively using inductively coupled plasma‐mass spectrometry, and qualitatively using transmission electron microscopy (TEM). Elemental identity of the nanoparticles was evaluated by TEM‐coupled Energy Dispersive X‐ray analysis (TEM‐EDX). In intact and damaged/irradiated skins, 102.35 ± 4.20% and 102.84 ± 5.67% of the titanium deposited, respectively, were found at the surface and stratum corneum (SC), whereas only 0.19 ± 0.15% and 0.39 ± 0.39% were found in the viable epidermis and dermis and no titanium was detected in the receptor fluid. TEM‐EDX analysis confirmed the presence of titanium in the aggregates formed by TiO2 at the SC surface, as already characterized in the sunscreen formulation. TiO2 nanoparticles included in a sunscreen thus remain in the uppermost layers of the SC, whether in intact skin or in compromised and/or skin exposed to simulated solar radiation.
The role of the real exchange rate in credit growth in central and eastern European countries : a bank-level analysis

This study analyzes the effects of macroeconomic and bank-level variables on the loan growth of banks in Central and Eastern European countries (CEECs) for the period between 1999 and 2010. Differences between private, state, domestic and foreign banks are analyzed by using the ownership structures of banks. We show that, unlike macroeconomic factors and other bank-level variables, leverage growth and equity growth have consistently significant effects on the loans of both domestic and foreign banks. The real exchange rate turns out to be a significant factor only for foreign banks. The latter result is important in understanding the transmission of global shocks to domestic credit. The results are robust to different specifications.
Stock Return Predictability in South Africa: An Alternative Approach

There is considerable debate internationally as to whether share returns are predictable. The limited evidence in South Africa (Gupta and Modise, 2012a, b and 2013) reveals that valuation ratios have no forecasting power but the Treasury bill rate, term spread and money supply have been found to be able to predict share returns at a relatively short horizon. In this study, the consumption aggregate wealth ratio of Lettau and Ludvigson (2001) is applied to South African share returns to assess its forecasting power using in-sample tests over both short and long horizons. The forecasting power of this composite variable is compared to a number of traditional variables. Similarly to the developed market evidence, the results indicate that the consumption aggregate wealth ratio is a significant predictor of returns and combined with the term spread, can explain a substantial component of the variation in future share returns. The implications of these findings for practitioners and policy makers are discussed.
EFNS‐ENS guidelines for the use of PCR technology for the diagnosis of infections of the nervous system

Polymerase chain reaction (PCR) as a means to amplify nucleic acids has become an essential element in diagnosis of infections. It has evolved into a simple and rapid, easy‐ to‐ use approach. At present there are no published guidelines for the usage of PCR technology for the diagnosis of infections of the nervous system.
Synaptic connections between the hindwing stretch receptor and flight motor neurones in the locust revealed by double cobalt labelling for electron microscopy

Synaptic interactions between sensory and motor neurones in the locust flight system have been investigated by using intracellular labelling with cobalt and nickel for electron microscopy. Simultaneous axonal filling of two neurones with different concentrations of metal ions produces differential labelling, so that contacts between them in the central nervous system can be recognized. We have investigated the connectivity of the hindwing stretch receptor neurone (SR) with a direct hindwing depressor motor neurone (MN 127) known from physiological experiments to receive monosynaptic input from the SR, and an indirect hindwing depressor motor neurone (MN 112/1), for which no monosynaptic connection with the SR has been reported.
Climate Change: US Public Opinion

A review of research findings and polling data about Americans’ attitudes on climate change reveals a lack of meaningful long-term change in mass opinion. Instead, the structure of Americans’ attitudes toward belief in climate change's existence, concern about its consequences, and demand for policy response is similar to that regarding many other issues in contemporary US politics: stability in aggregate opinion that masks partisan and ideological polarization enhanced by communications from elites. But features of the climate change problem elicit some distinctive determinants of opinion, including individuals’ trust in science, risk processing, and personal experience. Although our review of the literature and data leaves us skeptical that majority opinion will spur elected officials anytime soon to undertake the costly solutions necessary to tackle this problem comprehensively at the national level, we identify several avenues by which attitudes might promote less substantial but nevertheless conseque.
A contemporary civil rights issue: the thoughts of African American Christian religious leaders and university professors on seeking public office (a life history method)

This research examines the historical evidence abounds with examples of how African Americans sought control and agency in the struggle for freedom throughout American history. More specifically, it is a study of their fight for economic, political, and educational rights from the 1960s to the present day. It critiques how ideas and terms such as “leadership” and “activism” have evolved in the African American experience, and how African Americans themselves have sought to participate in these forms of engagement. It argues that the people who brought attention to political, economic, and educational inequalities of African Americans during the 1960s, have been displaced or reduced because this ideal for leadership or activism has been lost on those serving African American communities. This dissertation is accordingly, a community research study on political (in)-activism in Urbana-Champaign, Illinois. It seeks to answer the following question: How, and in what ways, do levels of political activism on the part of African American community members (particularly Christian religious leaders and university professors) works to promote the academic success of African American students in local schools?
Evaluation of Bank Products Appeal across Demographic Consideration: A Comparative Study of Nigeria and South Africa

Influence of demographic variables on banking has continued to attract the interest of researchers over the years with a good number focussing on impact of demographic variables on choice of banks by customers. This study however differs from previous studies in that its focus is on the evaluation of bank products appeal across demographic variables in South Africa and Nigeria. This descriptive study made use of primary data collected by administering validated and pre-tested questionnaires to 3,684 bank customers within selected strategic locations across Nigeria and South Africa using the snowball sampling technique. Both descriptive and inferential statistics were used to analyse the data generated. High Chi-Square statistics (corroborated with cross – tabulation and correlation analyses) coupled with very low probability values indicate highly significant associations between demographic variables and the dependent variables. The study recommends customer-centric approach on the part of banks to be able to provide customers with effective and unique value offers for various customer segments. Also, policy intervention is required to promote infrastructural upgrade for better product and service delivery. A more inclusive regulatory framework is required to draw more of the unbanked self – employed populace in the interest of boosting the economic performance of both countries.
Increased and decreased relative risk for noninsulin‐dependent diabetes mellitus conferred by HLA class II and by CD4 alleles

Non‐insulin‐dependent diabetes mellitus has been recognized to be heterogeneous in etiology, with multiple subgroups. Several genes or chromosomal regions have been implicated in the development of the disease. In this study the association of HLA class II alleles and genotypes and the association of CD4 and CD3 polymorphisms were assessed in a large number of Belgian non‐insulin‐dependent diabetes mellitus patients. Furthermore, the importance of the DQα***Arg52/DQαlArg52 and the DQβlAsp57/DQβlAsp57 genotypes and the combination of both genotypes were examined. Our results show that in the HLA class II genes only the DQαlArg52+/DQαlArg52+ genotype was significantly associated with non‐insulin‐dependent diabetes mellitus compared with controls (p=0.011, RR=2.02). We also observed that the frequency of the CD4*A4/*A8 genotype and the CD4*A7 allele was significantly increased and decreased respectively in non‐insulin‐dependent diabetes mellitus patients as compared with the controls (p=0.018, RR=2.16 and p=0.0003, RR=0.49 respectively). These results therefore suggest that HLA class II and CD4 genes might independently contribute to the susceptibility for non‐insulin‐dependent diabetes mellitus and that these alleles and genotypes might identify subgroups of patients with different susceptibilities.
Alcohol and marijuana use in the context of tobacco dependence treatment: impact on outcome and mediation of effect.

INTRODUCTION Alcohol and marijuana are among the most commonly used substances together with tobacco worldwide, but their relationship to smoking cessation is unclear. Although alcohol use decreases the likelihood of abstinence from tobacco, mechanisms of this effect have not been identified. Moreover, a small literature has yielded inconsistent findings regarding the effect of marijuana use on tobacco dependence treatment outcome. The aims of this study were to test increased positive-reinforcement smoking urge as a mediator of the relationship between alcohol and cigarette use and evaluate the impact of marijuana use on abstinence from tobacco. METHODS Participants were adult cigarette smokers (N = 739) from 3 randomized clinical trials of smoking cessation treatment. Alcohol consumption and marijuana use were assessed at pretreatment and postcessation. Biochemically verified, 7-day point prevalence smoking abstinence was determined at Weeks 12, 24, 36, and 52, as were urges to smoke as measured by the Questionnaire of Smoking Urges. RESULTS Increased positive-reinforcement urge mediated the effect of postcessation alcohol use on smoking abstinence. Although pretreatment alcohol use was associated with a decreased likelihood of abstinence from tobacco, increased positive-reinforcement urge did not account for this relationship. Marijuana use was not associated with abstinence from tobacco. CONCLUSIONS Smoking cessation treatments should provide those who drink during a quit attempt techniques designed to mitigate positive-reinforcement urge to smoke. Additional research is needed to determine how pretreatment alcohol consumption exerts its effect on cigarette use. Modifying the use of marijuana might not be critical to the success of tobacco interventions.
Segregating the functions of human hippocampus.

It is now accepted that hippocampal lesions impair episodic memory. However, the precise functional role of the hippocampus in episodic memory remains elusive. Recent functional imaging data implicate the hippocampus in processing novelty, a finding supported by human in vivo recordings and event-related potential studies. Here we measure hippocampal responses to novelty, using functional MRI (fMRI), during an item-learning paradigm generated from an artificial grammar system. During learning, two distinct types of novelty were periodically introduced: perceptual novelty, pertaining to the physical characteristics of stimuli (in this case visual characteristics), and exemplar novelty, reflecting semantic characteristics of stimuli (in this case grammatical status within a rule system). We demonstrate a left anterior hippocampal response to both types of novelty and adaptation of these responses with stimulus familiarity. By contrast to these novelty effects, we also show bilateral posterior hippocampal responses with increasing exemplar familiarity. These results suggest a functional dissociation within the hippocampus with respect to the relative familiarity of study items. Neural responses in anterior hippocampus index generic novelty, whereas posterior hippocampal responses index familiarity to stimuli that have behavioral relevance (i.e., only exemplar familiarity). These findings add to recent evidence for functional segregation within the human hippocampus during learning.