Miracle-dz/UniFAR-FTUs huggingface dataset:
Liability impact of the hospitalist model of care.

BACKGROUND An increasingly large proportion of inpatient care is provided by hospitalists. The care discontinuities inherent to hospital medicine raise concerns about malpractice risk. However, little published data exist on the medical liability risks associated with care by hospitalists. OBJECTIVE We sought to determine the risks and outcomes of malpractice claims against hospitalists in internal medicine. DESIGN Retrospective observational analysis. MEASUREMENTS Using claims data from a liability insurer-maintained database of over 52,000 malpractice claims, we measured the rates of malpractice claims against hospitalists compared to other physician specialties, types of allegations against hospitalists, contributing factors, and the severity of injury in and outcomes of these claims. RESULTS Hospitalists had a malpractice claims rate of 0.52 claims per 100 physician coverage years (PCYs), which was significantly lower than that of nonhospitalist internal medicine physicians (1.91 claims per 100 PCYs), emergency medicine physicians (3.50 claims per 100 PCYs), general surgeons (4.70 claims per 100 PCYs), and obstetricians-gynecologists (5.56 claims per 100 PCYs) (P < 0.001 for all comparisons). The most common allegation types made against hospitalists were for errors in medical treatment (41.5%) and diagnosis (36.0%). The most common contributing factors underlying claims were deficiencies in clinical judgment (54.4%) and communication (36.4%). Of the claims made against hospitalists, 50.4% involved the death of the patient. CONCLUSIONS Despite fears of increased liability from the hospitalist model of care, hospitalists in internal medicine are subject to medical malpractice claims less frequently when compared to other internal medicine physicians and specialties.
Women with Cognitive Impairment and Unplanned or Unwanted Pregnancy: A 2-Year Audit of Women Contacting the Pregnancy Advisory Service

Abstract Little is known about the experience of women with cognitive impairments (intellectual disability and acquired brain injury) in relation to unplanned or unwanted pregnancies. Records of the Pregnancy Advisory Service (PAS) at the Royal Women's Hospital across a 2-year period were examined. Details of 20 women with cognitive impairments, who had contacted PAS for support with an unplanned or unwanted pregnancy, were found. Many of these women had faced significant barriers to reproductive choices. The majority of the women had needed someone to facilitate their first contact with PAS; one quarter had contacted PAS too late for the option of the abortion they were seeking; one quarter were in significant conflict with their support people over the pregnancy; almost half of the women contacted PAS significantly late in their pregnancy; and one quarter (more than half of those who already had children) were currently involved with child protection services. The audit suggests that women with cognitive impairments need more accessible information on sexual and reproductive health, and assistance to access pregnancy information and services. It is important that social workers and other professionals who work with women with cognitive impairments be aware of their greater vulnerability and often complex social situations, and adopt a proactive as well as supportive approach when working with these women.
Childhood obesity and in-hospital asthma resource utilization.

OBJECTIVE To examine the relationship between pediatric obesity and inpatient length of stay (LOS), resource utilization, readmission rates, and total billed charges for in-hospital status asthmaticus. DESIGN/METHODS We conducted a cross-sectional study of patients 5 to 17 years old hospitalized with status asthmaticus to 1 free-standing children's hospital system over 12 months. Only hospitalized patients initially treated in the hospital's emergency department were included to ensure all therapies/charges were examined. Patients with complex chronic conditions, pneumonia, or lacking recorded body mass index (BMI) were excluded. The primary exposure was BMI percentile for age. The primary outcome was LOS (in hours). Secondary outcomes were 90-day readmission rate, billed charges, and resource utilization: number of albuterol treatments, chest radiographs, intravenous fluids, intravenous or intramuscular steroids, and intensive care unit admission. Bivariate, adjusted Poisson and logistic regression model analyses were performed. RESULTS Five hundred eighteen patients met inclusion criteria. Most had a normal BMI (59.7%); 36.7% were overweight or obese. LOS, readmissions, and resource utilization outcomes were not associated with BMI category on bivariate analyses. After adjustment for demographic/clinical characteristics, LOS decreased by 2% for each decile increase in BMI percentile for age. BMI percentile for age was not associated with billed charges, readmissions, or other measures of resource utilization. CONCLUSIONS Although BMI decile for age is inversely associated with LOS for in-hospital pediatric status asthmaticus, the effect likely is not clinically meaningful.
The Possible Origins of Tuberculosis in South America

Tuberculosis is one of the most widespread bacterial diseases on the planet. It is an infection that has plagued humans for over millennia. One line of bioarchaeological research is concerned with the origins and spread of the disease (phylogeography). A new research study within this field indicates that the origin of the disease in the South American continent is attributable to transmission from seals and sea lions, rather than from people [1]. This finding re-opens a longstanding debate as to whether tuberculosis originated from a bovine source and proceeded to infect humans, which infers a specific historical trajectory relating to the domestication of animals, or whether the pathogen is considerably older and developed in tandem with the first humans.
C Virus and Lymphomagenesis: with villous lymphocytes after treatment of hepatitis virus

Some epidemiologic studies suggest a link between hepatitis C virus (HCV) infection and some B-cell non-Hodgkin’s lymphomas. We undertook this study after a patient with splenic lym-phomawith villous lymphocytes had a hematologic response after antiviral treatment of HCV infection. Nine patients who had splenic lymphoma with villous lymphocytes and HCV infection were treated with interferon alfa-2b (3 million IU three times per week) alone or in combination with ribavirin (1000 to 1200 mg per day). The outcomes were compared with those of six similarly treated patients with splenic lymphoma with villous lymphocytes who tested negative for HCV infection. Of the nine patients with HCV infection who received interferon alfa, seven had a complete remission after the loss of detectable HCV RNA. The other two patients had a partial and a complete remission after the addition of ribavirin and the loss of detectable HCV RNA One patient had a relapse when the HCV RNA load again became detectable in blood. In contrast, none of the six HCV-negative patients had a response to interferon therapy. In patients with splenic lymphoma with villous lymphocytes who are infected with HCV, treatment with interferon can lead to regression of the lymphoma.
First Results of the Implementation of Telemedical Service in The Odessa Region

First Results of the Implementation of Telemedical Service in The Odessa Region Results on the implementation of technical system purposed for telemedical consultations in Odessa Region of Ukraine are presented. Such a system permitted to perform telemedical consultations in the form of videoconferences with parallel transmission of medical images, and ECG records. First (half year) experience of performing consultative activity was in favour of identification of urgent indications for surgery in some patients, and proved to be preventive with regard to some complications in patients with acute heart and vessel diseases as well as in patients with traumas. The main conclusion on high effectiveness of proposed telemedical technical configuration, and especially in terms of heightening standards of regional medical care was made.
Functionalised hexagonal-domain graphene for position-sensitive photodetectors

Graphene’s unique photoresponse has been largely used in a multitude of optoelectronics applications ranging from broadband photodetectors to wave-guide modulators. In this work we extend the range of applications to position-sensitive photodetectors (PSDs) using FeCl3-intercalated hexagonal domains of graphene grown by atmospheric pressure chemical vapour deposition (APCVD). The FeCl3-based chemical functionalisation of APCVD graphene crystals is affected by the presence of wrinkles and results in a non-uniform doping of the graphene layers. This doping profile creates multiple p–p+ photoactive junctions which show a linear and bipolar photoresponse with respect to the position of a focused light spot, which is ideal for the realization of a PSD. Our study paves the way towards the fabrication of flexible and transparent PSDs that could be embedded in smart textile and wearable electronics.
A novel field emission microscopy method to study field emission characteristics of freestanding carbon nanotube arrays

Field emission (FE) uniformity and the mechanism of emitter failure of freestanding carbon nanotube (CNT) arrays have not been well studied due to the difficulty of observing and quantifying FE performance of each emitter in CNT arrays. Herein a field emission microscopy (FEM) method based on poly(methyl methacrylate) (PMMA) thin film is proposed to study the FE uniformity and CNT emitter failure of freestanding CNT arrays. FE uniformity of freestanding CNT arrays and different levels of FE current contributions from each emitter in the arrays are recorded and visualized. FEM patterns on the PMMA thin film contain the details of the CNT emitter tip shape and whether multiple CNT emitters occur at an emission site. Observation of real-time FE performance and the CNT emitter failure process in freestanding CNT arrays are successfully achieved using a microscopic camera. High emission currents through CNT emitters causes Joule heating and light emission followed by an explosion of the CNTs. The proposed approach is capable of resolving the major challenge of building the relationship between FE performance and CNT morphologies, which can significantly facilitate the study of FE non-uniformity, the emitter failure mechanism and the development of stable and reliable FE devices in practical applications.
Imaging haematopoietic cells recruitment to an acute wound in vivo identifies a role for c‐Met signalling

We have used a direct in vivo imaging strategy to investigate the role of c‐Met signalling and kinase activity during the immune response to wounding. Our assay utilizes the optical translucent properties of the zebrafish embryo and demonstrates the versatility of microscopy‐based approach to the screening of compounds for inhibition of the wounding response. We have focussed on the c‐Met pathway as little is known about the influence of c‐Met signalling in immune responses, although it has been suggested that the c‐Met tyrosine kinase receptor signalling pathway may be involved in cytokine secretion and directional migration in immune cells. Using both imaging of fixed zebrafish embryos in combination with digital time lapse microscopy of neutrophils recruited to a wound site, we find that pharmacological inhibition of c‐Met, using a specific inhibitor, modulates the immune response in zebrafish embryos. We have found that inhibition of c‐Met does not prevent the inflammatory response but does appear to limit recruitment and retention of immune cells at the wound site. This work demonstrates the versatility of using direct imaging assays for inhibitor studies and suggests that the HGF/c‐Met signalling cascade plays an important role in the migration of haematopoietic cells in vivo.
Quantitative temperature‐depending mapping of mechanical properties of bitumen at the nanoscale using the AFM operated with PeakForce TappingTM mode

The mechanical properties of bitumen, such as elasticity/Young's modulus, stickiness/adhesion, hardness and energy loss, and sample deformation were acquired quantitatively and simultaneously with the topology at the microscale, discriminating clearly two separate phases within the bitumen. Temperature‐dependent measurements revealed detailed and specific data about the changes of these properties with temperature, enabling the development of predictive models for the performance and durability of asphalt.
C - reactive protein levels in women with pregnancy induced hypertension

Objective: The main objective of this study is to determine the level of C- reactive protein in pregnancy induced hypertension (PIH) along its relation with normal pregnant mothers and also to compare it with different grades of pregnancy. C-reactive protein and inflammation are interrelated. Another objective of this study is to find out the relationship of C- reactive protein, biochemical and hematological parameter in PIH as well as its clinical correlation. Materials and Methods: The study was conducted in the department of Gynaecology and department of Pathology in Burdwan Medical College West Bengal India after taking permission from ethical committee. 50 cases of PIH mothers and age and gestational matched 50 cases of normal control pregnant mothers and 50 normal healthy non pregnant adult women were included in this present study. CRP was estimated by turbidometric method. Serum Uric acid, SGPT, Serum Creatinine were estimated by semi auto analyzer, Serum s HCG was estimated by ELISA technique. The total leukocytes count, absolute Neutrophils count, Platelet counts were done in hematological cell counter with correlation from peripheral direct smear and manual counting. Urine protein was detected by dipstick method. Results: Serum C- reactive protein was positively correlated with severity of in PIH. Results shows a significantly increased C-reactive protein in PIH (Mean SD 42.02 mg/L±18 .01 mg/L, P<0.001) in comparison to normal control mother (Mean SD 4.2 ±0.93 mg/L). Conclusion: Serum C-reactive protein levels can be used as marker for early diagnosis and intervention of PIH and can be reduced maternal as well as fetal morbidity and mortality. Key words: C - reactive protein, pregnancy induced hypertension. DOI: http://dx.doi. org/ 10.3329/bjms.v10i3. 8358 BJMS 2011; 10(3): 159-162
Ureaplasma urealyticum In Young Children With Acute Respiratory Symptoms

Eighty-eight children ranging in age from 2 to 64 months were seen in a pediatric practice for acute pulmonary symptoms, such as wheezing, cough, bronchiolitis, and respiratory distress. Throat cultures were performed for Ureaplasma urealyticum and Mycoplasma hominis. U. urealyticum was isolated from 29 (33%). Of the 54 infants 12 months or younger, 19 (35%) were positive for U. urealyticum. Of 21 children between 1 and 2 years of age, 9 (43%) had U. urealyticum in the throat. One (14%) of seven was positive at 2 to 3 years. Six children older than 3 years were negative. Only one child had M. hominis as well as U. urealyticum. Cultures of 22 age-matched asymptomatic children resulted in one isolation of U. urealyticum (P < .01). This article documents the presence of U. urealyticum in the respiratory tract of children with severe respiratory symptoms up to the age of 3 years. Eradication of U. urealyticum led to clinical improvement.
Plasmon–emitter interaction using integrated ring grating–nanoantenna structures

Overcoming the diffraction limit to achieve high optical resolution is one of the main challenges in the fields of plasmonics, nanooptics and nanophotonics. In this work, we introduce novel plasmonic structures consisting of nanoantennas (nanoprisms, single bowtie nanoantennas and double bowtie nanoantennas) integrated in the center of ring diffraction gratings. Propagating surface plasmon polaritons (SPPs) are generated by the ring grating and coupled with localized surface plasmons (LSPs) at the nanoantennas exciting emitters placed in their gap. SPPs are widely used for optical waveguiding but provide low resolution due to their weak spatial confinement. In contrast, LSPs provide excellent sub-wavelength confinement but induce large losses. The phenomenon of SPP–LSP coupling witnessed in our structures allows for achieving more precise focusing at the nanoscale, causing an increase in the fluorescence emission of the emitters. Finite-difference time-domain simulations as well as experimental fabrication and optical characterization results are presented to study plasmon–emitter coupling between an ensemble of dye molecules and our integrated plasmonic structures. A comparison is given to highlight the importance of each structure on the photoluminescence and radiative decay enhancement of the molecules.
Sleepiness in critical care nurses: results of a pilot study.

BACKGROUND Sleep deprivation, compounded by circadian disruptions, is a common problem in health care workers. Sleepiness in nurses has important implications for patients as well as nurses' own safety. OBJECTIVE The objective of the study was to assess comprehensively sleepiness levels in post-night-shift nurses. METHODS Post-night-shift nurses in the ICU and on general floors (medicine and surgery) were assessed using subjective (Epworth Sleepiness Scale [ESS]) and objective (Mean Sleep Latency Test [MSLT]) measures. RESULTS ESS was abnormal (>8) in 7 of 10 ICU nurses compared with 2 of 10 floor nurses (P < .005), and mean ESS score was also higher (8.7 +/- 3.9 vs. 5.6 +/- 2.1, respectively; P = 0.042). MSLT values for the first nap period were in the pathologic range in the ICU nurses compared with the floor nurses (4.65 +/- 5.5 vs. 10.85 +/- 7.4 minutes, respectively; P < .05). CONCLUSIONS Post-night-shift RNs working in the ICU have a pathologic degree of sleepiness.
Guidance for Providers of Speech and Language Therapy Services: Dysarthria

Abstract Commissioners of speech and language therapy services are requiring more explicit information to inform purchasing decisions. The Royal College of Speech and Language Therapists in the United Kingdom commissioned work to identify the needs of commissioners and supply core information to support managers of speech and language therapy services in the tendering process. This paper details issues of importance to commissioners including the nature of dysarthria, its impact and epidemiology, the nature of speech and language therapy, and consideration of different modes of service provision and evidence. The literature review undertaken was unique in that it searched not only for evidence-based practice but also for papers that would have an influence on purchasing decisions. The synthesis for the provision of dysarthria services is provided.
Perceptions of resident physicians about management of inpatient hyperglycemia in an urban hospital.

BACKGROUND Information regarding practitioner beliefs about inpatient diabetes care is limited. OBJECTIVE To assess resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal glycemic control in an urban hospital setting. DESIGN A previously developed questionnaire was modified and administered. Residents were asked about the importance of inpatient glucose control, desirable glucose ranges, and problems encountered when managing hyperglycemia. SETTING Urban teaching hospital. RESULTS Of 85 resident physicians, 66 completed the survey (mean age, 31 years; 47% men; 33% in first residency year). Most respondents categorized glucose control as "very important" in critically-ill and perioperative patients but only "somewhat important" in non-critically-ill patients. Most residents said they would target a therapeutic glucose range within the recommended levels. Most residents (88%) also said they felt "very comfortable" or "somewhat comfortable" using subcutaneous insulin therapy, whereas some were "not at all comfortable" with either subcutaneous (11%) or intravenous (18%) administration. In general, respondents were not very familiar with existing institutional policies and preprinted order sets. The most commonly reported barrier to management of inpatient hyperglycemia was lack of knowledge about appropriate insulin regimens and their use. Anxiety about hypoglycemia was only the third most frequent concern. CONCLUSION Most residents acknowledged the importance of good glucose control in hospitalized patients and chose target glucose ranges consistent with existing guidelines. Lack of knowledge about insulin treatment options was the most commonly cited barrier to ideal management. Educational programs should emphasize inpatient treatment strategies for glycemic control.
Evaluation of hospital glycemic control at US academic medical centers.

OBJECTIVE To evaluate contemporary hospital glycemic management in US academic medical centers. DESIGN This retrospective cohort study was conducted on patients discharged from 37 academic medical centers between July 1 and September 30, 2004; 1,718 eligible adult patients met at least 1 of the inclusion criteria: 2 consecutive blood glucose readings >180 mg/dL within 24 hours, or insulin treatment at any time during hospitalization. We assessed 3 consecutive measurement days of glucose values, glycemic therapy, and additional clinical and laboratory characteristics. RESULTS In this diverse cohort, 79% of patients had a prior diagnosis of diabetes, and 84.6% received insulin on the second measurement day. There was wide variation in hospital performance of recommended hospital diabetes care measures such as glycosylated hemoglobin (A1C) assessment (range, 3%-63%) and timely admission laboratory glucose measurement (range, 39%-97%). Median glucose was significantly lower for patients in the intensive care unit (ICU) compared to ward/intermediate care. ICU patients treated with intravenous insulin had significantly lower median glucose when compared to subcutaneous insulin. Only 25% of ICU patients on day 3 had estimated 6 AM glucose <or=110 mg/dL. Hyperglycemia was common, 50% of all patients had >or=1 glucose measurement >or=180 mg/dL on measurement days 2 and 3. Severe hypoglycemia (<50 mg/dL) occurred in 2.8% of all patient days. CONCLUSIONS Despite frequent insulin use, glucose control was suboptimal. Academic medical centers have opportunities to improve care to meet current American Diabetes Association hospital diabetes care standards.
Devolution: a process, not an event

Early in 2002, I was asked by the then President of the College Professor John Cox to ‘take soundings’ within the College with regard to matters of devolution. [1][1] The topic had arisen partly because of an increase in devolved health powers in the Scottish and Welsh governments; some unease
Galectin-9 inhibits CD44-hyaluronan interaction and suppresses a murine model of allergic asthma.

RATIONALE Galectin-9 (Gal-9) belongs to the galectin family, which exhibits affinity for beta-galactosides. Gal-9 has a variety of biological activities; however, its role in allergic inflammation is unknown. OBJECTIVES We evaluated the effect of a stable form of the human protein on allergic airway inflammation in a mite allergen-induced asthma model. METHODS Human stable Gal-9 was given by intravenous injection to mice during antigen challenge. The effect of Gal-9 on airway inflammation and airway hyperresponsiveness (AHR) was then evaluated. MEASUREMENTS AND MAIN RESULTS Gal-9 reduced AHR as well as Th2-associated airway inflammation. Furthermore, administration of Gal-9 as well as anti-CD44 monoclonal antibody inhibited the infiltration of peripheral blood Th2 cells into the airway. Interestingly, Gal-9 directly bound the CD44 adhesion molecule and inhibited interactions with hyaluronan (HA). Consistent with the concept that CD44-HA interactions mediate the migration of T cells into the lung, Gal-9 blocked CD44-dependent adhesion of BW5147 mouse T cells to HA. CONCLUSIONS We conclude that Gal-9 inhibits allergic inflammation of the airway and AHR by modulating CD44-dependent leukocyte recognition of the extracellular matrix.