Miracle-dz/UniFAR-FTUs huggingface dataset:
The capacity of Australian ED to absorb the projected increase in intern numbers

As a reaction to the medical workforce shortage in Australia, a large expansion of undergraduate medical education has occurred through the provision of funding of additional medical student places. As a consequence, the number of medical graduates is anticipated to increase by as much as 90% with a peak in numbers anticipated in 2012. With ED already under pressure, this increase has serious implications for ED, particularly the delivery of intern and student teaching. This integrated review describes potential challenges that might arise from the predicted increase in intern numbers working in ED. A structured literature search was conducted from which 44 directly relevant articles were identified. We discuss the possible impact of an increased number of medical graduates on emergency medical staff, education, supervision and feedback to interns, and given the potential impacts on the education of junior doctors; we review the purpose and implementation of the Australian Curriculum framework for Junior Doctors in relation to their learning requirements. Although there is consensus by most postgraduate bodies that the core emergency term in emergency medicine should be retained, the impact of increased intern numbers might dramatically affect the clinical experiences, supervision and educational resources in the ED. This might necessitate cultural changes in medical education and ED function.
MicroRNA‐140‐5p suppresses tumor growth and metastasis by targeting transforming growth factor β receptor 1 and fibroblast growth factor 9 in hepatocellular carcinoma

By comparing the expression profiles of microRNAs (miRNAs) in different hepatocellular carcinoma (HCC) subtypes, we identified miR‐140‐5p as an HCC‐related miRNA. We found that miR‐140‐5p was significantly decreased in HCC tissues and all of six liver cancer cell lines examined and its expression levels were correlated with multiple nodules, vein invasion, capsular formation, and differentiation, as well as overall and disease‐free survival of HCC. We also found that miR‐140‐5p suppressed HCC cell proliferation and HCC metastasis. Multipathway reporter arrays suggested that miR‐140‐5p inhibited transforming growth factor β (TGF‐β) and mitogen‐activated protein kinase / extracellular signal‐regulated kinase (MAPK/ERK) signaling. TGFB receptor 1 (TGFBR1) and fibroblast growth factor 9 (FGF9) were then characterized as the direct targets for miR‐140‐5p after it was found that ectopic miR‐140‐5p expression suppressed TGFBR1 and FGF9 expression. Silencing TGFBR1 and FGF9 by small interfering RNA (siRNA) resembled the phenotype resulting from ectopic miR‐140‐5p expression, while overexpression of TGFBR1 and FGF9 attenuated the effect of miR‐140‐5p on HCC growth and metastasis. Conclusion: These data elucidated a tumor suppressor role for miR‐140‐5p in HCC development and progression with therapeutic potential. Our correlation studies in clinical HCC samples further suggest that miR‐140‐5p could be a valuable biomarker for HCC prognosis. (Hepatology 2013 )
COPD: Mortality and Readmissions in Relation to Number of Admissions with Noninvasive Ventilation

ABSTRACT In severe COPD, patients having survived acute hypercapnic respiratory failure (AHRF) treated with noninvasive ventilation (NIV) have a high mortality and risk of readmissions. The aim was to analyze the prognosis for patients with COPD having survived AHRF and to assess whether previous admissions with NIV predict new ones.We conducted a retrospective follow-up analysis of 201 patients two years after NIV treatment of AHRF. Comparison of time-to-event in patients previously treated with NIV versus patients with no previous NIV treatment. We found a one-year mortality of 33.8% and high risks of: readmission (53.2%), any event (67.7%), and life-threatening events (49.8%). Patients with previous NIV treatments had an increased hazard ratio for life-threatening events: 1.60, p = 0.023 despite having lower in-hospital mortality than patients with no previous NIV treatment (18.9% vs. 33.1%, p = 0.043). We found that having survived one episode of AHRF considerably worsened the prognosis for the affected patients.The prognosis for patients having survived AHRF with NIV treatment is poor: the prognosis worsens with additional episodes of AHRF. Future research and treatment should focus on patients with repeated episodes of AHRF.
Keeping an open mind: Investigating options for treatment of the pre-psychotic phase

Comments on R. P. Bentall and A. P. Morrison's article (see record 2002-04080-001) which presented a moral framework and discussed the dreadfulness of psychosis, accuracy of prediction, the adverse effects of neuroleptics, and the case for non-pharmacological interventions. The current authors reply to Bentall and Morrison's concerns that prescribing antipsychotic medication to those at Ultra High Risk of psychosis is unethical on 4 grounds. (PsycINFO Database Record (c) 2003 APA, all rights reserved).
Adolescent brain development and behavior

The symposium on ‘The Adolescent Brain Development and Behaviour’ was organized in honor of the 40th anniversary of Youthdale Treatment Clinics in Toronto. The idea for a symposium dedicated to the adolescent brain was conceived over a year ago and was stimulated by recent rapid progress in neurobiological research focused on this developmental period. Puberty is a time of dramatic physiological, cognitive and emotional changes associated with increased risk for psychiatric disorders as well as increased risk-taking behavior. The increase in risk for psychiatric disorders may be a function of biological changes in gonadal hormones, or may result from increased emotional stress, or an interaction of these factors. Brain structures show dramatic changes in myelination, synaptogenesis and synaptic pruning from late childhood to early adolescence. Learning and experience probably interact with the biologically programmed developmental influences modifying synaptic connections and region-specific structure and.
Compliance in Psychiatry: Development of a Patient Questionnaire

The reliability of patients in following the physician's advice, generally referred to as 'compliance', has been increasingly recognized as an important variable in medical practice (Haynes et al., 1979). However, particularly in the field of psychiatry, there is a lack of empirical investigations on this topic. As to the theoretical background, no comprehensive model has yet been developed which takes into account the complex factors involved in compliant behaviour.
Desmosterol in human nonalcoholic steatohepatitis

Dysregulation of the cholesterol synthesis pathway and accumulation of cholesterol in the liver are linked to the pathogenesis of nonalcoholic steatohepatitis (NASH). Therefore, we investigated the association of serum and liver levels of cholesterol precursors with NASH. Liver histology was assessed in 110 obese patients (Kuopio Obesity Surgery Study [KOBS] study, age 43.7 ± 8.1 years [mean ± standard deviation, SD], body mass index [BMI] 45.0 ± 6.1 kg/m2). Serum and liver levels of cholesterol precursors were measured with gas‐liquid chromatography. The association between cholesterol precursors and serum alanine aminotransferase (ALT), as a marker of liver disease, was also investigated in a population cohort of 717 men (Metabolic Syndrome in Men Study [METSIM] study, age 57.6 ± 5.8 years, BMI 27.1 ± 4.0 kg/m2). Serum desmosterol levels and the desmosterol‐to‐cholesterol ratio were higher in individuals with NASH, but not in individuals with simple steatosis, compared to obese subjects with normal liver histology (P = 0.002 and P = 0.003, respectively). Levels of serum and liver desmosterol correlated strongly (r = 0.667, P = 1 × 10−9), suggesting a shared regulation. Both serum and liver desmosterol levels correlated positively with steatosis and inflammation in the liver (P < 0.05). Serum desmosterol had a higher correlation with the accumulation of cholesterol in the liver than serum cholesterol. Serum desmosterol levels (P = 2 × 10−6) and the serum desmosterol‐to‐cholesterol ratio (P = 5 × 10−5) were associated with serum ALT in the population study. Conclusion: Levels of desmosterol in serum and the liver were associated with NASH. These results suggest that serum desmosterol is a marker of disturbed cholesterol metabolism in the liver. Whether desmosterol has a more specific role in the pathophysiology of NASH compared to other cholesterol precursors needs to be investigated. (Hepatology 2013;53:976–982)
Education and Training Needs of School Staff Relevant to Preventing Risk Behaviors and Promoting Health Behaviors Among Gay, Lesbian, Bisexual, and Questioning Youth

Abstract A national-level needs assessment of high school psychologists, social workers, counselors, and nurses was conducted to identify training and educational resource material needs of these staff relevant to providing health and mental health services to gay, lesbian, bisexual, and questioning (GLBQ) youth. Systematic sampling procedures were employed with professional membership lists of five national organizations. A self-administered survey, extensively pilot tested, was completed by 941 school staff. Results revealed that most staff acknowledged the presence of GLBQ youth in their schools; reported “accepting” attitudes toward these students; perceived GLBQ students to be at much higher risk, than their heterosexual counterparts, for several health and mental health problems; indicated that they should be providing more services to these students; and identified a number of barriers related to school climate, lack of staff training, and community/parental opposition that hamper service provision to GLBQ youth. Based on these findings, the authors recommend that school professionals discuss effective strategies for risk prevention and health promotion for GLBQ youth within their specific school-based setting, and the delivery of professional development activities to school health professionals on topics of GLBQ youth and health.
Cellular‐specific role of toll‐like receptor 4 in hepatic ischemia‐reperfusion injury in mice

Ischemia‐reperfusion (I/R) injury is a process whereby an initial hypoxic insult and subsequent return of blood flow leads to the propagation of innate immune responses and organ injury. The necessity of the pattern recognition receptor, Toll‐like receptor (TLR)4, for this innate immune response has been previously shown. However, TLR4 is present on various cell types of the liver, both immune and nonimmune cells. Therefore, we sought to determine the role of TLR4 in individual cell populations, specifically, parenchymal hepatocytes (HCs), myeloid cells, including Kupffer cells, and dendritic cells (DCs) subsequent to hepatic I/R. When HC‐specific (Alb‐TLR4−/−) and myeloid‐cell–specific (Lyz‐TLR4−/−) TLR4 knockout (KO) mice were subjected to warm hepatic ischemia, there was significant protection in these mice, compared to wild type (WT). However, the protection afforded in these two strains was significantly less than global TLR4 KO (TLR4−/−) mice. DC‐specific TLR4−/− (CD11c‐TLR4−/−) mice had significantly increased hepatocellular damage, compared to WT mice. Circulating levels of high‐mobility group box 1 (HMGB1) were significantly reduced in Alb‐TLR4−/− mice, compared to WT, Lyz‐TLR4−/−, CD11c‐TLR4−/− mice and equivalent to global TLR4−/− mice, suggesting that TLR4‐mediated HMGB1 release from HCs may be a source of HMGB1 after I/R. HCs exposed to hypoxia responded by rapidly phosphorylating the mitogen‐activated protein kinases, c‐Jun‐N‐terminal kinase (JNK) and p38, in a TLR4‐dependent manner; inhibition of JNK decreased release of HMGB1 after both hypoxia in vitro and I/R in vivo. Conclusion: These results provide insight into the individual cellular response of TLR4. The parenchymal HC is an active participant in sterile inflammatory response after I/R through TLR4‐mediated activation of proinflammatory signaling and release of danger signals, such as HMGB1. (HEPATOLOGY 2013)
Outcomes of an International Cooperative Education Experience for Undergraduate Nursing Students

A qualitative study was conducted to identify the outcomes of international cooperative education in nursing. Seventeen alumni who completed 19 cooperative work experiences were interviewed. International cooperative experiences support learning about culture and contribute to personal and professional development. Outcomes included increased maturation, confidence, and flexibility; elevated political and global awareness; and ability to create effective relationships with culturally diverse patients and coworkers.
Rifaximin is an efficacious treatment for the parkinsonian phenotype of hepatic encephalopathy

Marcellin et al. suggest that the rate of sustained virologic response 12 weeks posttreatment (SVR12), rather than SVR24, could be a reliable primary endpoint in trials of interferon (IFN)based therapy for chronic hepatitis C virus (HCV) infection. To determine whether this is true for IFN-free regimens, we analyzed data from the SOUND-C2 trial, which investigated the IFN-free combination of the protease inhibitor faldaprevir (BI 201335) and the nonnucleoside polymerase inhibitor deleobuvir (BI 207127) in treatment-naı̈ve patients with genotype-1 HCV. HCV RNA was measured 4, 12, 24, and 48 weeks posttreatment and concordance between SVR rates at different timepoints was calculated. SVR12 rates were up to 69% in the overall population and 85% in genotype-1b patients without any relapses occurring between SVR12 and SVR24. The positive predictive value (PPV) of SVR12 for SVR24 was 100% in all study arms. In preliminary analyses, only one patient of all 250 patients who achieved SVR12 relapsed between the SVR12 and SVR48 timepoints. The PPV of SVR12 for SVR48 was 98%-100%. The relapsing patient was a 66-year-old white male without cirrhosis (IL28B non-CC), with HCV genotype-1b. HCV RNA was 6.4 log10 IU/mL at baseline and dropped below the limit of detection by Day 14. It remained undetectable until relapse was detected 48 weeks posttreatment (HCV RNA 5.4 log10 IU/mL). No adherence issues were reported and no mutations known to confer resistance to faldaprevir or deleobuvir were detected at baseline or time of relapse. The nucleotide sequences of the NS3 and NS5B regions in the baseline and relapse virus were >99% homologous, indicating relapse rather than reinfection. Low rates of late relapse have previously been observed following IFN-based treatment and IFN-free treatment. The explanation for late relapse requires further investigation. Our results support SVR12 as a primary endpoint in IFN-free HCV trials. They also emphasize the importance of monitoring all patients for at least 1 year following the end of IFN-based or IFNfree treatment.
Student-Faculty Lunch Program to Increase Mentoring and Facilitate Cross-Program Relationships in School of Nursing

Let’s DU Lunch is a pilot program launched to explore the impact of a low-cost, student-faculty lunch program to increase mentoring and facilitate cross-program relationships. This program gave students the opportunity to go to lunch with a faculty member of their choice. A total of 71 students and 25 faculty participated. This program provided the opportunity for positive student-faculty interaction and mentoring and facilitated cross-program relationships.
Resistance analysis of hepatitis C virus genotype 1 prior treatment null responders receiving daclatasvir and asunaprevir

In a sentinel cohort, hepatitis C virus (HCV) patients (primarily genotype [GT] 1a) were treated with daclatasvir (NS5A inhibitor) and asunaprevir (NS3 protease inhibitor). Preexistence, emergence, and persistence of resistance variants in patients who failed this treatment are described. HCV‐infected null responders received daclatasvir (60 mg once daily) and asunaprevir (600 mg twice daily) alone (Group A, 11 patients) or with peginterferon alfa‐2a and ribavirin (Group B, 10 patients) for 24 weeks. Resistance testing was performed on baseline samples and samples with HCV RNA ≥1,000 IU/mL at Week 1 through posttreatment Week 48. Resistance substitution susceptibility to inhibition by asunaprevir and daclatasvir was assessed using HCV replicon assays. In Group A, six GT1a patients experiencing viral breakthrough and one GT1a patient who relapsed had detectable NS5A (Q30E/R, L31V/M, Y93C/N) and NS3 (R155K, D168A/E/V/Y) resistance‐associated variants at failure. Two of six viral breakthrough patients achieved SVR48 after treatment intensification with peginterferon alfa‐2a and ribavirin. For 2/4 viral breakthrough patients not responding to treatment intensification, NS3 resistance variants changed (D168Y to D168T; R155K to V36M‐R155K). At posttreatment Week 48, daclatasvir‐resistant variants persisted while asunaprevir‐resistant variants were generally replaced by wild‐type sequences. The NS3 sequence remained unchanged in the one patient with NS3‐R155K at baseline, relapse, and posttreatment Week 48. In Group B, no viral breakthrough was observed. Conclusion: The treatment failure of daclatasvir and asunaprevir in HCV GT1a patients was associated with both NS5A and NS3 resistance variants in prior null responders. NS5A resistance variants persisted while NS3 resistance variants generally decayed, suggesting a higher relative fitness of NS5A variants. (Hepatology 2013;53:902–911)
Review article: Management of cyanide poisoning

Cyanide poisoning is uncommon, but generates interest because of the presumed utility of an antidote immediately available in those areas with a high risk of cyanide exposure. As part of its regular review of guidelines, the Australian Resuscitation Council conducted a systematic review of the human evidence for the use of various proposed cyanide antidotes, and a narrative review of the relevant pharmacological and animal studies. There have been no relevant comparative or placebo‐controlled human trials. Nine case series were identified. Treatment with hydroxocobalamin was reported in a total of 361 cases. No serious adverse effects of hydroxocobalamin were reported, and many patients with otherwise presumably fatal poisoning survived. Sodium thiosulphate use was reported in two case series, similarly with no adverse effects. Treatment with a combination of sodium nitrite, amyl nitrite and sodium thiosulphate was reported in 74 patients, with results indistinguishable from those of hydroxocobalamin and sodium thiosulphate. No case series using dicobalt edetate or 4‐dimethylaminophenol were identified, but successful use in single cases has been reported. Hydroxocobalamin and sodium thiosulphate differ from alternatives in having negligible adverse effects, and on the basis of current evidence are the antidotes of choice. The indications for the use of an antidote, the requirements for supportive care and a recommended approach for workplaces where there is a risk of cyanide poisoning are presented.
Adenosine kinase is a key determinant for the anti‐HCV activity of ribavirin

Ribavirin (RBV) is often used in conjunction with interferon‐based therapy for patients with chronic hepatitis C. There is a drastic difference in the anti–hepatitis C virus (HCV) activity of RBV between the HuH‐7‐derived assay system, OR6, possessing the RBV‐resistant phenotype (50% effective concentration [EC50]: >100 µM) and the recently discovered Li23‐derived assay system, ORL8, possessing the RBV‐sensitive phenotype (EC50: 8 µM; clinically achievable concentration). This is because the anti‐HCV activity of RBV was mediated by the inhibition of inosine monophosphate dehydrogenase in RBV‐sensitive ORL8 cells harboring HCV RNA. By means of comparative analyses using RBV‐resistant OR6 cells and RBV‐sensitive ORL8 cells, we tried to identify host factor(s) determining the anti‐HCV activity of RBV. We found that the expression of adenosine kinase (ADK) in ORL8 cells was significantly higher than that in RBV‐resistant OR6 cells harboring HCV RNA. Ectopic ADK expression in OR6 cells converted them from an RBV‐resistant to an RBV‐sensitive phenotype, and inhibition of ADK abolished the activity of RBV. We showed that the differential ADK expression between ORL8 and OR6 cells was not the result of genetic polymorphisms in the ADK gene promoter region and was not mediated by a microRNA control mechanism. We found that the 5' untranslated region (UTR) of ADK messenger RNA in ORL8 cells was longer than that in OR6 cells, and that only a long 5' UTR possessed internal ribosome entry site (IRES) activity. Finally, we demonstrated that the long 5' UTR functioned as an IRES in primary human hepatocytes. Conclusion: These results indicate that ADK acts as a determinant for the activity of RBV and provide new insight into the molecular mechanism underlying differential drug sensitivity. (Hepatology 2013;58:1236–1244)
Çalışmanın çocuk bedeni üzerine etkisi: İzmit’te yapılan iki araştırma sonuçlarının karşılaştırılması

Amac: Bu calisma calismanin cocuklarin bedensel gelisimine etkisini ortaya koymak amaciyla yapilmistir Gerec ve Yontem: Calismada Izmit rsquo;te ortaogrenime devam eden ogrenciler ile Mesleki Egitim Merkezi rsquo;nde egitim goren calisan cocuklari temsil eden bir orneklemde yurutulmus ayni doneme ait iki kesitsel arastirmanin verileri kullanilmistir Her iki arastirmanin veri setinden benzer yas gruplarindaki cocuklar alinmis boylece 15 17 9 yas arasinda 401 ogrenci ve 243 calisan cocuk karsilastirilmistir Iki grubun karsilastirilmasinda yasa gore boy yasa gore agirlik ve beden kitle indeksi Z skorlari gibi cesitli antropometrik olcutler kullanilmistir Antropometrik olcutlerin hesaplanmasinda CDC Center for Disease Control tarafindan gelistirilmis Dunya Saglik Orgutu rsquo;nun de onerdigi toplumu temel alan Epi Info 2000 programi kullanilmistir
Craniocerebral Trauma Caused By Traffic Accidents In Young People Of Southeast Europe. How Society Should Deal With It

Our experience shows that 44% of severe brain trauma is annually caused in traffic accidents . This is similar to the findings of other authors , noting that in economically developed countries this percentage decreases slightly from year to year. According to the WHO report for 2008 in Europe there were 120,000 deaths and 2.4 million injured in traffic accidents. In most of the examined 49 countries, a significant number of victims were young population aging roughly from 15 to 30 . There are several kinds of measures in dealing with trauma caused by traffic.