Miracle-dz/UniFAR-FTUs huggingface dataset:
The influence of empowering leadership, empowerment and engagement on affective commitment and turnover intentions in community health service workers: Test of a model

Purpose – This study seeks to extend research on the relationship between empowering leadership, empowerment and outcome variables by examining the mediating role of employee engagement. More specifically, the study sets out to test whether employee engagement mediates the effects of empowering leadership and empowerment on affective commitment and turnover intention.Design/methodology/approach – The sample on which conclusions are based consisted of 139 employees of a community health service. Confirmatory factor analysis (CFA) and structural equations modelling (SEM) were used to test the measurement and structural models proposed.Findings – CFA showed acceptable fit indices for the measurement model after respecifying a reduced number of items for the explanatory variables. Structural equations modelling of a respecified model also yielded acceptable fit indices and showed that empowerment mediated the influence of empowering leadership on engagement. Engagement was shown to partially mediate the influ.
Basics of Anesthesia

SECTION I INTRODUCTION: History and scope of anaesthesia. SECTION II PHARMACOLOGY: Basic pharmacologic principles / Autonomic nervous system Effects of inhaled anaesthetics on ventilation and circulation / Intravenous anaesthetics / Local anaesthetics / Muscle relaxants. SECTION III PREOPERATIVE PREPERATION AND INTRAOPERATIVE MANAGEMENT: Preoperative evaluation and choice of anaesthetic technique / Preoperative medication / Anaesthesia systems / Tracheal intubation / Spinal and epidural anaesthesia / Peripheral nerve blocks / Positioning and associated risks / Monitoring / Acid-base balance and blood gas analysis / Fluid and blood therapy. SECTION IV SPECIAL ANAESTHETIC CONSIDERATIONS: Cardiovascular disease / Chronic pulmonary disease / Liver and biliary tract disease / Renal disease / Endocrine and nutritional disease / Central nervous system disease / Ophthalmology and otolaryngology / Obstetrics / Paediatrics / Elderly patients / Organ transplantation / Outpatient surgery / Procedures performed in areas outside the operating room. SECTION V RECOVERY PERIOD: Postanaesthesia care unit / Acute postoperative pain management. SECTION VI CONSULTANT ANAESTHETIC PRACTICE: Critical care medicine and management of the trauma patient / Chronic pain management / Cardiopulmonary resuscitation SECTION VII APPENDICES: Standards for basic intraoperative monitoring / Guidelines for regional anaesthesia in obstetrics / Standards for postanaesthesia care.
ACR Appropriateness Criteria® Ductal Carcinoma in Situ

Abstract: Ductal carcinoma in situ (DCIS) describes a wide spectrum of non‐invasive tumors which carry a significant risk of invasive relapse, thus prevention of local recurrence is vital. For appropriate patients with limited disease, management with breast conserving surgery (BCS) followed by whole‐breast radiation (RT) is supported by multiple Phase III studies, but mastectomy may be appropriate in selected patients. Omission of RT may also be reasonable in some patients, though which criteria are to be utilized remain unclear, and the existing data are contradictory with limited follow‐up. Various RT techniques such as boost to the tumor bed, partial breast radiation or hypofractionated, whole‐breast RT are increasingly utilized but the data to support their use specifically in DCIS is limited. Tamoxifen also increases local control for ER + DCIS, adding to the complexity of the local treatment management. This article reviews the existing scientific evidence, the controversies surrounding local management, and clinical guidelines for DCIS based on the group consensus by the ACR Breast Expert Panel. The American College of Radiology Appropriateness Criteria are evidence‐based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer‐reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Preoperative Staging with Magnetic Resonance Imaging, with Confirmatory Biopsy, Improves Surgical Outcomes in Women with Breast Cancer without Increasing Rates of Mastectomy

Abstract: Needle biopsy to evaluate findings on MRI that could alter surgical planning has been recommended. This study is a retrospective review to evaluate MRI preoperative staging with biopsy confirmation of suspicious findings. A total of 184 women were diagnosed with breast cancer between January 2004 and June 2008. Of these, 79 underwent bilateral MRI before definitive surgery and 105 did not. Suspicious findings on MRI, mammography, or clinical exam underwent additional needle biopsy at the discretion of the surgeon. A retrospective chart review was performed to compare the two groups with respect to rates of reoperative surgery, successful breast conservation, and confirmatory biopsies. Sensitivity and specificity of MRI for preoperative staging is 0.81 and 0.84, respectively. There were no significant differences in demographics or cancer characteristics between the MRI and non‐MRI groups. Fewer women who underwent preoperative MRI staging required repeat breast surgery (11% versus 26%, p = .04) or repeat axillary surgery (10% versus 20%, p = .05). There is no difference in the proportion of women who successfully completed conservative therapy and those treated radically (52% versus 53%), but there is a significant increase in women who undergo additional needle biopsy to confirm suspicious findings after initial diagnosis in the MRI group (25% versus 11% p = .04). In this study, mastectomy rates are not increased; suggesting that women who undergo mastectomy following staging would undergo mastectomy following failed conservative therapy if they were not staged. The downside of this improvement is a 14% increase in women who require confirmatory biopsy.
Pseudoangiomatous Stromal Hyperplasia (PASH) of the Breast: A Series of 24 Patients

Abstract: Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal proliferative lesion of the breast. In 2005, only 109 cases had been reported since its initial description in 1986 by Vuitch et al. Our 24 cases represent one of the largest series to be reported from a single institution. We retrospectively reviewed data from 2004 to 2010 of patients diagnosed with PASH by surgical excision or image‐guided biopsy. All pathological specimens were reviewed by a single pathologist. The samples were stained for estrogen and progesterone receptors (ER and PR), CD34, and the lymphatic marker D2‐40. All but one of 24 (96%) patients presented with breast masses either on imaging or clinically. Fourteen of the 24 patients (58%) were diagnosed on surgical excision, 10 (42%) diagnosed with core needle biopsy, and five (20%) were diagnosed using both techniques. The tumors ranged in size from 0.3 cm to 7.0 cm. All women except two were premenopausal or perimenopausal at diagnosis. Nineteen samples were available for hormonal receptor staining and of these 18 of 19 (95%) were ER or PR positive. PASH was diagnosed in two men, a transgender male on hormones and the other with gynecomastia. The patients’ ages ranged from 18 to 86 years old. In addition to PASH other benign histopathological findings include stromal fibrosis and atypical ductal or lobular hyperplasia. Imaging revealed no distinguishing feature for PASH with benign histology. One patient had synchronous ductal carcinoma in‐situ (DCIS). Patients were treated with local excision or observation. This study suggests that PASH is primarily a diagnosis of premenopausal and perimenopausal women. Our series supports a hormonal basis for its development due to the positive staining for hormonal receptors. Management is conservative surgery for larger masses with careful observation being an option in patients not at high risk for breast cancer.
Evaluation of Recombinant Factor VIIa Off-Label Use at an Acute Care Hospital with Established Guidelines for Use

Purpose At present, there are a scarcity of data available evaluating off-label prescribing patterns of recombinant factor VIIa (rFVIIa), pharmacoeconomic impact, and patient outcomes in clinical practice in an acute care setting with guidelines in place to influence prescribing practices. The primary objective of this study was to retrospectively evaluate the off-label usage and prescribing patterns of rFVIIa at a large acute care hospital with established rFVIIa guidelines. Results During the study period, a total of 199 patients were ordered rFVIIa, of which 181 (91%) received at least one dose of rFVIIa for an off-label use (n=181). Refractory bleeding and intracerebral hemorrhage were the 2 leading uses for rFVIIa, accounting for 30% (n = 54) and 29% (n = 51) of all uses, respectively. Overall, the mean number of doses per patient for all uses was 1.79. The mean number of doses per patient by non–FDA-approved use was highest in patients with cardiac surgery and refractory bleeding. The total yearly acquisition of rFVIIa for the study institution has decreased from 5.25 mcg/patient-day in 2005 to 2.52 mcg/patient-day in 2009. Conclusion The findings are encouraging and support the impact that education of pharmacy, nursing, and physician staff along with guideline development may have on off-label rFVIIa usage. Further research evaluating the impact of rFVIIa guidelines and/or order sets is warranted.
Indications and limitations of third-generation aromatase inhibitors

Background: Use of aromatase inhibitors in postmenopausal breast cancer, initially in advanced disease but recently also for adjuvant therapy, represents a major advance. Objective: To summarize research leading to this success and to review clinical data from large Phase III trials revealing efficacy of novel third-generation aromatase inhibitors in metastatic and early breast cancer. Methods: Literature on PubMed and on ISI Web of Science for the last 10 years was searched using the word ‘aromatase’. Recent key presentations and abstracts are also included. Results/conclusion: Third-generation aromatase inhibitors improve relapse-free survival compared to tamoxifen, and some trials reveal a survival advantage in early breast cancer. Although substantial data now confirm the safety of these potent compounds with respect to bone metabolism and cardiovascular risk, there is a need for continuous long-term follow-up, in particular into potential vascular effects. The mechanisms and optimal treatment of musculoskeletal and joint pain remain to be addressed. Ongoing studies evaluate sequential treatment versus monotherapy, potential differences between individual compounds and optimal duration of treatment, as well as combining aromatase inhibitors with novel targeting agents.
Microscopic and physiologic evidence for biofilm‐associated wound colonization in vivo

A biofilm is a collection of microbial cells that are attached to a surface and embedded in a self‐produced extrapolymeric substance. The understanding of the biofilm phenotype is important in the understanding of bacteria in vitro but it has been difficult to translate biofilm science to the clinical setting. More recently, preliminary criteria for defining biofilm associated diseases have been proposed and the purpose of this study was to create a biofilm‐associated wound model based on these criteria. Using a porcine model, partial thickness wounds were inoculated with a wound isolate Staphylococcus aureus strain. Wounds were then treated with either one of two topical antimicrobial agents (mupriocin cream or triple antibiotic ointment) within 15 minutes to represent planktonic bacteria or 48 hours after initial inoculation to represent biofilm‐associated wound infection. Using light microscopy, scanning electron microscopy and epifluorescence microscopy, we were able to observe biofilm‐like structures in wounds after 48 hours of inoculation and occlusion. The in vivo antimicrobial assay was used to demonstrate that both mupirocin cream and the triple antibiotic ointment were effective in reducing planktonic S. aureus but had reduced efficacy against biofilm‐embedded S. aureus. Our results demonstrated that S. aureus form firmly attached microcolonies and colonies of bacteria encased in an extracellular matrix on the surface of the wounds. These biofilm‐like communities also demonstrated increased antimicrobial resistance when compared with their planktonic phenotype in vivo. The structural and physiological results support the hypothesis that bacterial biofilms play a role in wound colonization and infection.
Diagnosing glaucoma progression with optical coherence tomography.

PURPOSE OF REVIEW Optical coherence tomography (OCT) imaging of the retinal nerve fiber layer (RNFL), optic nerve head (ONH) and macula has gained popularity in recent years to detect and monitor glaucoma. With significant improvement in scan speed and scan resolution, spectral-domain OCT has become an efficient platform to evaluate progressive RNFL thinning and ONH remodeling. This review summarizes the recent progress of OCT RNFL, ONH and macular measurements for the detection of glaucoma progression. RECENT FINDINGS The RNFL thickness map facilitates visualization of RNFL defects and their progression patterns, and attains a higher sensitivity to detect glaucoma progression compared with the conventional circumpapillary RNFL thickness profile. The measurement of lamina cribrosa displacement is informative to discern the relationship between intraocular pressure and ONH modeling. Ganglion cell and inner plexiform layer analysis has offered a useful alternative to track glaucoma progression. In the interpretation of progression analysis, the impact of age-related change, disease severity and image signal-to-noise ratio should always be considered. SUMMARY The analyses of the RNFL thickness map, lamina cribrosa displacement and inner macular thickness have provided a new paradigm to evaluate glaucomatous damage and its progression.
Phase 1 and pharmacokinetic study of everolimus in combination with cetuximab and carboplatin for recurrent/metastatic squamous cell carcinoma of the head and neck

Platinum‐based therapy combined with cetuximab is standard first‐line therapy for recurrent or metastatic squamous cell carcinoma of the head and neck (RMSCCHN). Preclinical studies have suggested that mammalian target of rapamycin inhibitors may overcome resistance to epidermal growth factor receptor blockers and may augment cetuximab antitumor activity. We conducted a phase 1b trial of carboplatin, cetuximab, and everolimus for untreated RMSCCHN.
Potential Impact of Rotarix According to Rotavirus Type Distribution

Background: The human attenuated rotavirus vaccine, Rotarix (GlaxoSmithKline Biologicals, Rixensart, Belgium), is now licensed in more than 100 countries, including Europe. Because of the diversity of circulating rotavirus types worldwide, the potential impact of this vaccine should be evaluated by geographic context according to regional rotavirus type distribution. Methods: The potential vaccine efficacy (VE) of Rotarix against severe rotavirus gastroenteritis (RVGE) was calculated using a simple modeling approach considering different published rotavirus type distributions and known type-specific VE. Results: Utilizing global rotavirus type distribution data and type-specific VE data from a large recent European Phase III study, the potential proportion of severe RVGE cases averted by 2 oral doses of Rotarix was found to range from 89.1% (in Africa) to 94.5% (in Europe). Based on a more conservative approach using type-specific VE data from a large Latin American Phase III study, the potential proportion of severe RVGE cases averted by Rotarix was found to range from 83.2% to 88.1%. In Europe, utilizing most recent rotavirus type distribution data from 2 prospective surveillance studies in areas where the G9 type is currently prevalent, 2 oral doses of Rotarix could potentially avert between 85.1% (based on Latin American type-specific VE data) and 95.5% (based on European type-specific VE data) of all cases of severe RVGE among children aged <5 years. Conclusions: Despite geographic and temporal differences in type distribution, the potential impact of Rotarix is expected to be high in all continents, including those with emerging rotavirus types.
Multiple Organ Dysfunction Syndrome: Pathogenesis and Approach to Therapy

Multiple nonpulmonary organ dysfunction (previously referred to as multiple organ failure or multiple systems organ failure) refers to the pattern of altered organ function that occurs in acutely ill patients. Moreover, as detailed elsewhere in this issue of Seminars, the multiple organ dysfunction syndrome (MODS) is frequently associated with the adult respiratory distress syndrome (ARDS) and is the major reason that mortality from ARDS remains in excess of 50%. 1 2 In fact, clinical predispositions for MODS and ARDS are similar, and MODS is now considered to be a systemic disorder characterized by simultaneous dysfunction of the lungs and other nonpulmonary organs. In this context, ARDS can be thought of as the pulmonary manifestation of MODS, which, in turn, is the result of global microcirulatory injury. At the present time, death from ARDS is no longer primarily caused by progressive, irreversible respiratory failure. Rather, death is most often due to the development of MODS. ,9 These observations suggest that MODS will continue to be an important clinical problem in the years, and perhaps decades, to come. Thus, the remainder of this review will focus on our current understanding, and gaps in our understanding, of the definition, epidemiology, pathogenesis, management, and prevention of MODS.
O11.2 Sexual Behaviour of Heterosexual Men and Women Receiving Antiretroviral Pre-Exposure Prophylaxis For HIV Prevention: Post-Unblinding Analysis of the Partners PrEP Study

Background Limited data are available to assess the potential for increased sexual risk-taking by persons using antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention. In July 2011, the Partners PrEP Study, a randomised trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among HIV-uninfected members of African heterosexual HIV serodiscordant couples, demonstrated efficacy of PrEP for HIV prevention and use of placebo was discontinued in the trial. Follow-up of study participants on active PrEP through December 2012 provided an opportunity to evaluate risk behaviour on PrEP after efficacy was announced. Methods Among participants assigned to active PrEP pre-unblinding who continued follow-up after the placebo arm was stopped, we used zero-inflated negative binomial regression with robust standard errors and adjusted for baseline sexual behaviour, age, gender, and secular changes to compare the frequency of unprotected sex up to 12 months before versus after knowledge of PrEP efficacy. Results We analysed 54,876 person-months (33,254 pre- versus 21,622 post-unblinding) from 3024 HIV-uninfected subjects (64% male). On average, the observed frequency of unprotected sex with the HIV-infected study partner was 58 per 100 person-months pre-unblinding versus 53 per 100 person-months post-unblinding, reflecting no immediate change or change in trend over time following unblinding (p = 0.734 and 0.264, respectively). The annual average total number of unprotected sex post-unblinding was 6 acts versus 5 that would have been expected in the counterfactual situation had unblinding not occurred. There was no significant increase in diagnoses of incident sexually transmitted infections or pregnancy post- versus pre-unblinding (p > 0.05). Conclusion The transition from a blinded, placebo-controlled trial to all participants aware they were receiving active PrEP in the Partners PrEP Study provided a “natural experiment” to evaluate behavioural risk compensation. PrEP, provided as part of a comprehensive prevention package, may not result in substantial changes in risk-taking sexual behaviour in HIV serodiscordant couples.
TREATING ADOLESCENT DRUG ABUSE: A COMPARISON OF FAMILY SYSTEMS THERAPY, GROUP THERAPY, AND FAMILY DRUG EDUCATION

The differential effectiveness of three models of adolescent drug abuse treatment was assessed in a controlled outcome study. Family Systems Therapy (FST) was compared to Adolescent Group Therapy (AGT) and Family drug Educations (FDE). FST appeared to be more effective in stopping adolescent drug abuse than AGT or FDE, registering twice as many apparently drug-free clients than FDE and three times as many as AGT. However, a number of possible confounds make this conclusion tentative. No tretment approach was superior in altering patterns of family functioning although all three conditions improved perceived intergenerational communication.
Re-engineering Travel Agencies with the World Wide Web

ISSN: 1019-6781 (Print) 1422-8890 (Online) Journal homepage: http://www.tandfonline. com/loi/rema20 Re-Engineering Travel Agencies With The World Wide Web C. Standing , T. Vasudavan & S. Borbely To cite this article: C. Standing , T. Vasudavan & S. Borbely (1998) Re-Engineering Travel Agencies With The World Wide Web, Electronic Markets, 8:4, 40-43 To link to this article: http://dx.doi. org/10.1080/10196789800000055
Current trends in the management of thyroid eye disease

Purpose of review The present review summarizes the body of literature concerning the medical and surgical treatment of thyroid eye disease (TED) from 1 January 2014 through 30 March 2015. Recent findings Corticosteroids continue to be the primary medical therapy for TED. Recent research has offered insight into potential differences between oral corticosteroid and intravenous corticosteroid treatment regimens in terms of efficacy and side-effect profiles. Steroid-sparing medications, for example, rituximab and others, are an area of active study. There has been renewed interest in the role of radiation therapy as a nonmedical treatment for TED with some promising data. The use of balanced orbital decompression techniques have become popular, although the data regarding postoperative diplopia are mixed, and ‘fat decompression’ offers an alternative or an augmentation to bony decompression. Stereotactic image guidance is a useful adjunct to orbital decompression surgery. Summary TED continues to be a difficult condition for the patient to cope with and for the clinician to treat, and recent research builds on the present foundation of knowledge and treatments, but unfortunately does not offer paradigm-shifting information at the present time.