Miracle-dz/UniFAR-FTUs huggingface dataset:
Interventions to Educate Family Physicians to Change Test Ordering

The purpose is to systematically review randomised controlled trials (RCTs) to change family physicians’ laboratory test-ordering. We searched 15 electronic databases (no language/date limitations). We identified 29 RCTs (4,111 physicians, 175,563 patients). Six studies specifically focused on reducing unnecessary tests, 23 on increasing screening tests. Using Cochrane methodology 48.5% of studies were low risk-of-bias for randomisation, 7% concealment of randomisation, 17% blinding of participants/personnel, 21% blinding outcome assessors, 27.5% attrition, 93% selective reporting. Only six studies were low risk for both randomisation and attrition. Twelve studies performed a power computation, three an intention-to-treat analysis and 13 statistically controlled clustering. Unweighted averages were computed to compare intervention/control groups for tests assessed by >5 studies. The results were that fourteen studies assessed lipids (average 10% more tests than control), 14 diabetes (average 8% > control), 5 cervical smears, 2 INR, one each thyroid, fecal occult-blood, cotinine, throat-swabs, testing after prescribing, and urine-cultures. Six studies aimed to decrease test groups (average decrease 18%), and two to increase test groups. Intervention strategies: one study used education (no change): two feedback (one 5% increase, one 27% desired decrease); eight education + feedback (average increase in desired direction >control 4.9%), ten system change (average increase 14.9%), one system change + feedback (increases 5-44%), three education + system change (average increase 6%), three education + system change + feedback (average 7.7% increase), one delayed testing. The conclusions are that only six RCTs were assessed at low risk of bias from both randomisation and attrition. Nevertheless, despite methodological shortcomings studies that found large changes (e.g. >20%) probably obtained real change.
The Nuchal Ligament Restrains Cervical Spine Flexion

Study Design. A biomechanical study using a cadaver model was conducted to define the function of the nuchal ligament in the restraint of flexion of the cervical spine. Objective. To test the hypothesis that surgical resection of the nuchal ligament significantly reduces the structural restraints to cervical flexion. Summary of Background Data. Although previous studies have examined the role of the posterior ligaments and capsules on cervical stability, no prior study has quantified the biomechanical significance of the nuchal ligament. The clinical significance may include progressive loss of lordosis or even kyphosis after trauma or posterior surgical procedures such as laminectomy, laminoplasty, or tumor resection. Methods. Cervical spines from the occiput to the first thoracic vertebra were harvested from 12 human cadavers. Specimens were tested under 3 conditions: all ligaments intact, after resection of the nuchal ligament, and then after additional resection of the supraspinous, interspinous, and yellow ligaments. Flexion moments were applied; load and displacement were measured. Changes in flexion range of motion and tangent stiffness between treatment conditions were statistically compared. Results. The flexion range increased 28% after removing the nuchal ligament. After subsequent resections, the flexion range increased 52% compared with intact (P <0.005). Tangent stiffness decreased 27% after nuchal ligament resection; after all resections, stiffness was 35% lower than intact (P <0.05). Conclusion. Resection of the nuchal ligament increased the flexion range of motion and decreased stiffness in flexion. Injury to the nuchal ligament may increase the risk of cervical spine instability and malalignment.
A FACTOR ANALYSIS STUDY ON TEAM COOPERATION QUALITY OF UNIVERSITY FACULTIES IN TAIWAN - DARK SIDE EFFECTS OF RELATIONSHIPS ON TEAM COHESION -

This study was conducted to identify the factors inspiring team cooperation among universities in pursuit of teaching quality improvement. Data were collected from 146 faculty members belonging to 18 universities in Taiwan, who participated in inter-instituted cooperative projects for teaching quality improvement. The research findings revealed that both trust and commitment among the faculties created significant effects on the team cohesion in faculty collaboration communities. The trust factor was also a very significant moderating factor to faculty team cohesion; whereas, the commitment factor was approved not to act the role as moderating factor. Critically, this study concluded that the dark side of relationships created different effect on the team cohesion of faculty members’ collaboration from other sample communities because that university faculty members, as social elites, usually possess well-educated backgrounds and socio-economic status. This study suggested future studies to further address the inner structural mechanism of cooperation factor mechanism through qualitative research methodologies and various research scenarios.
Clinical Implications for Children Born With Congenital Cytomegalovirus Infection Following a Negative Amniocentesis.

BACKGROUND Recently, congenital cytomegalovirus (cCMV) infection was reported irrespective of a negative amniotic fluid prenatal analysis for cytomegalovirus (CMV). The question of whether this phenomenon represents low sensitivity of the test or late development of fetal infection (after amniocentesis) was discussed, but not answered. However, if late transmission is the rule, then infants born with cCMV after negative amniocentesis would be expected to carry better prognosis than those who tested positive. METHODS Data of all infants with cCMV infection, followed in 2 pediatric centers from 2006 to 2015, were reviewed. Infant outcome after birth of symptomatic vs asymptomatic disease was compared with infants born after a negative amniocentesis (study group) and those with a positive amniocentesis (control group). RESULTS Amniocentesis was performed in 301 pregnancies of our cohort of infants with cCMV and was negative for CMV in 47 (15.6%). There were fewer symptomatic cCMV neonates in the study group than in the control group (4.3% vs 25%; P < .001). Hearing impairment at birth was also less frequent in the study group (2.2% vs 17.4%; P = .012). None of the children in the study group had neurologic sequelae at long-term follow up, compared with 13 (14.1%) in the control group (P < .001). CONCLUSIONS Although negative amniocentesis does not exclude cCMV, infants with cCMV born after a negative amniocentesis seldom present with mild clinical symptoms or cerebral ultrasound features at birth. These children also have a very good long-term outcome. Our findings support the theory of a late development of fetal infection, after the time of the amniocentesis.
Double induction containing either two courses or one course of high-dose cytarabine plus mitoxantrone and postremission therapy by either autologous stem-cell transplantation or by prolonged maintenance for acute myeloid leukemia.

PURPOSE Intensification by high-dose cytarabine in postremission or induction therapy and prolonged maintenance are established strategies to improve the outcome in patients with acute myeloid leukemia (AML). Whether additional intensification can add to this effect has not yet been determined. PATIENTS AND METHODS A total of 1,770 patients (age 16 to 85 years) with de novo or secondary AML or high-risk myelodysplastic syndrome (MDS) were randomly assigned upfront for induction therapy containing one course with standard dose and one course with high-dose cytarabine, or two courses with high-dose cytarabine, and in the same step received postremission prolonged maintenance or busulfan/cyclophosphamide chemotherapy with autologous stem-cell transplantation. RESULTS The complete remission rate in patients younger than 60 and > or = 60 years of age was 70% and 53%, respectively. The overall survival at 3 years in the two age groups was 42% and 19%, the relapse-free survival was 40% and 19%, and the ongoing remission duration was 48% and 22%, respectively. There were no significant differences in these results between the two randomized induction arms or between the two postremission therapy arms. There was no significant difference in any prognostic subgroup according to secondary AML/MDS, cytogenetics, WBC, lactate dehydrogenase, and early blast clearance. CONCLUSION The regimen of one course with standard-dose cytarabine and one course with high-dose cytarabine for induction, and prolonged maintenance for postremission chemotherapy in patients with AML is not improved by additional escalation in cytotoxic treatment.
Is the ECB too decentralized

This paper analyzes whether the decision-making process of the European Central Bank (ECB) may be too decentralized in case of business cycle asymmetries and differences in preferences among the member countries. Looking into the example of the federal German Bundesbank, we find evidence that although business cycles in the German states have become more similar over time, differences in the economic situation in the various states have affected the voting behavior in the governing Council. For the Eurozone countries we find some evidence of increased business cycle synchronization and convergence of preferences. Still, important differences remain. As all national central banks have one vote within the governing council of the ECB, there is a risk that national considerations may prevail over Eurozone-wide considerations.
Effect of nutrient deprivation on lipid, carbohydrate, DNA, RNA, and protein levels in Vibrio cholerae

The response of Vibrio cholerae to low nutrient levels was determined by measuring the concentrations of lipids, carbohydrates, DNA, RNA, and proteins over a 30-day starvation period. Ultrastructural integrity was observed by transmission electron microscopy. Total lipids and carbohydrates declined rapidly within the first 7 days, while DNA and protein exhibited a more constant decline over the 30 days of starvation. In contrast, RNA showed little decrease upon starvation. Although neutral lipids were lost, the percentage of neutral lipids did not decline as rapidly as the phospholipids. Detectable levels of poly-beta-hydroxybutyrate disappeared completely by 7 days. Carbohydrate profiles revealed the relative loss of the five-carbon sugar ribose and N-acetylglucosamine and a relative increase in the total six-carbon sugars, especially glucose. Morphologically, ribosomes appeared to exhibit no structural change, while inclusion bodies and mesosomelike structures disappeared completely, and cell wall and membrane integrity was lost. The data suggest that V. cholerae differs somewhat from other marine vibrios in its response to low nutrients but shares some characteristics in common with them. The data also suggest that certain lipids and carbohydrates may provide the endogenous energy sources needed for dormancy preparation and cell maintenance under nutrient starvation.
The Occurrence and Awareness of a Misstatement Effect in Auditors' Internal Control Severity Judgments

We define a misstatement effect as a tendency for auditors to take the non-detection of a misstatement as evidence of the absence of a material weakness and test the hypothesis that it occurs unconsciously in their internal control severity judgments. In a between-participants design, which is analogous to the practice setting, we find that auditors evaluate an internal control deficiency less severely when it has not led to a misstatement. However, in a within-participants design, where the misstatement manipulation (detected or not detected) is more salient, we find that auditors evaluate the deficiencies as equally severe, suggesting that the misstatement effect in the between-participants design is not intended. The findings suggest the need to consider the use of decision aids that align auditors' heuristics and knowledge. For instance, auditors may be required to document possible misstatements that could occur when evaluating control deficiencies that have not led to misstatements.
Total Factor Productivity and Efficiency in OECD Countries: Possibility of Convergence in 2000-2012 Period

This study discusses efficiency, productivity, and the existence of convergence in 34 OECD countries between 2000 and 2012. Physical capital per worker and human capital per worker are used as inputs to determine total factor productivity and efficiency scores in data envelopment analysis while GDP per worker is used as the output. Efficiency scores observed in CCR and BCC models indicate that Latin American and Eastern European countries are more efficient. Analysis of productivity by using the Malmquist Index indicates that productivity was positive but increased less than 1 percent at the end of the period. Panel regression estimation is used for standard deviations of convergence and to determine beta convergence. If GDP per worker is (yi), there is convergence between log(yi/yi,t-T,) and starting values log(yi,t-T); however, the convergence effect of TFP values could not be determined. Similar results are reported for Sigma convergence.
Transcriptional regulatory cascades controlling plasma cell differentiation

Summary: Plasma cells are the terminally differentiated effector cells of the B lymphocyte lineage. Recently, studies using genetically altered mice and analyses of global gene expression programs have significantly expanded our understanding of the molecular mechanisms regulating plasmacytic differentiation. Specific molecular components of a multistep cascade of transcriptional regulators have been identified. Furthermore, two transcriptional regulators, X box binding protein‐1 (XBP‐1) and B lymphocyte induced maturation protein‐1 (Blimp‐1), have been shown to be necessary for plasmacytic differentiation. In addition to providing a mechanistic basis for the induction of genes necessary for immunoglobulin secretion, cessation of cell cycle and other phenotypic changes characteristic of terminally differentiated plasma cells, these studies have led to the important concept that plasmacytic differentiation involves repression of regulators, such as Bcl‐6 and Pax5, that are necessary to maintain the earlier developmental phenotype of activated, germinal center B cells. This review describes our current understanding of the transcriptional cascades regulating terminal differentiation of B cells.
Cortical bone graft and endoprosthesis in the distal radius of dogs: a biomechanical comparison of two different limb-sparing techniques.

OBJECTIVE To compare the biomechanical properties of cortical bone and surgical steel endoprosthesis for limb-sparing surgery of the distal radius in dogs and evaluate the role of the ulna in providing stability to the reconstructed limb. STUDY DESIGN Cadaveric biomechanical study. ANIMALS Twelve pairs of normal canine thoracic limbs. METHODS Paired limbs were divided into 4 groups: endoprosthesis and cortical bone graft, with and without preservation of the ulna. In each limb pair, the distal segment of the radius resected from the limb to be reconstructed with an endoprosthesis was used as the cortical bone graft in the contralateral limb. The ulna was resected en bloc with the radius and at the same level as the radial osteotomy in limbs where the ulna was not preserved. Limbs were tested in axial loading until failure. The load-deformation curve was used to acquire the biomechanical properties of each construct, which were compared using 2-way ANOVA. Failure modes were compared descriptively. RESULTS Limbs reconstructed with the endoprosthesis had significantly greater yield load, energy at yield, and ultimate load compared with limbs reconstructed with a cortical bone graft. There were no significant differences in either energy to failure or stiffness between the 2 constructs. Preservation of the ulna did not significantly improve any of the biomechanical properties tested with either endoprosthesis or cortical bone graft constructs. The modes of failure in all 4 groups were variable and inconsistent. CONCLUSIONS Limbs reconstructed with an endoprosthesis were biomechanically superior to limbs reconstructed with a cortical bone graft in axial loading to failure. Preservation of the ulna is not required to improve the stability in axial compression after limb-sparing surgery of the distal radius. CLINICAL RELEVANCE The endoprosthesis may provide another option for limb-sparing surgery of the distal radius in dogs. It has potential advantages when compared with cortical bone grafts, including better biomechanical performance and resistance to implant failure in axial compression, immediate availability, and no requirement for bone banking facilities. The ulna can be resected en bloc with the radius without having a negative impact on construct stability. En bloc resection of the ulna and radius may decrease the risk of local tumor recurrence after limb-sparing surgery.
Association of whole blood viscosity with non-alcoholic fatty liver disease.

BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is an independent risk factor for increased cardiovascular disease. Altered hemorheological parameters have also been shown to play a crucial role in atherogenesis. Moreover, increased viscosity is observed in insulin resistance, metabolic syndrome, hypertension, diabetes, ischemic heart disease, and stroke. A recent study confirmed that whole blood viscosity (WBV) is a predictor of cardiovascular events. AIMS This study aimed to investigate the association of WBV with NAFLD. METHODS In this cross-sectional study, we investigated the relationship between WBV and NAFLD in 1329 subjects (962 men and 367 women) in a general health examination. RESULTS WBV at low shear stress was elevated in patients with NAFLD. In addition, the prevalence of metabolic syndrome and NAFLD increased as WBV quartiles increased both in men and in women. Multiple regression analysis further identified WBV as an independent and significant determinant for NAFLD. CONCLUSIONS The findings showed that WBV at low shear stress is increased in NAFLD. Moreover, WBV at low shear stress is independently associated with NAFLD even after adjusting other cardiovascular risk factors.
Delusion of inanimate doubles: Description of a case of focal retrograde amnesia

This paper reports the case of a patient, M.P., who developed delusion of inanimate doubles, without Capgras syndrome, after traumatic brain injury. His delusional symptoms were studied longitudinally and the cognitive impairments associated with delusion were investigated. Data suggest that M.P. did ‘perceive’ the actual differences between doubles and originals rather than ‘confabulate’ them. The cognitive profile, characterized by retrograde episodic amnesia, but neither object processing impairment nor confabulations, supports this hypothesis. The study examines the nature of object misidentification based on Ellis’ and Staton's account and proposes a new account based on concurrent unbiased retrieval of semantic memory traces and biased recollection of episodic memory traces.
Quality of life and needs assessment on people living with HIV and AIDS in Malawi

Abstract Purpose. Malawi is a sub-Saharan African nation with a severe HIV epidemic. The quality of life (QoL) has never been investigated among people living with HIV and AIDS (PLWHA) in Malawi. This study examines the QoL and associated factors including life needs among PLWHA at different stages of their illness in the northern region of Malawi. Methods. Survey analysis of consecutive outpatient participants receiving highly active antiretroviral therapy at the Rainbow Clinic and non-HIV patients receiving care at the affiliated Mzuzu Central Hospital during a one-month period was performed. Laboratory testing and clinical diagnosis were used to determine HIV status, determine CD4 count, and classify WHO clinical stage. A total of 267 HIV-infected patients and 598 non-HIV participants completed a needs assessment and a Short Form-36 (SF-36) questionnaire, which contained a QoL subscale. SF-36 subscales and needs assessment scores were analyzed using t-test, ANOVA test, and Generalized Linear Model-Tukey's test. Results. HIV-positive patients had significantly lower physical functioning (p=0.0365), mental health (p=0.001), social functioning (p<0.0001), and mental component summary (p=0.0069) scores than HIV-negative patients. Further, WHO Stage III HIV patients had significantly lower vitality (p=0.0439) and mental health (p=0.0022) scores than WHO Stages I and II patients; and WHO Stage IV patients had significantly lower vitality (p=0.0015), mental health (p=0.0006), and physical component summary (p=0.0443) scores than WHO Stages I and II patients. Finally, AIDS patients, as determined by CD4 count, had significantly lower bodily pain (p=0.0423) and physical component summary (p=0.0148) scores than non-AIDS, HIV-positive patients. Conclusion. HIV patients undergoing treatment in Malawi have a significantly lower QoL, both mentally and physically, than their non-HIV counterparts. Further, HIV patients at more advanced stages, both by the WHO definition and by CD4 count, have a significantly lower QoL than HIV patients at earlier stages of the disease.
Modification and Reorganization of the Cytoprotective Cellular Chaperone Hsp27 during Herpes Simplex Virus Type 1 Infection

ABSTRACT Chaperone-enriched domains are formed in the nuclei of cells lytically infected with herpes simplex virus type 1 (HSV-1). These domains, called VICE, for virus induced chaperone enriched, contain Hsc70, Hsp70, Hsp40, Hsp90, polyubiquitinated proteins, and components of the proteasome machinery. Accumulating evidence indicates that these sites may be utilized during infection to sequester misfolded, modified, or otherwise unwanted proteins away from viral replication compartments, sites of robust transcription, DNA synthesis, and capsid maturation. To further explore the role of cellular chaperones and VICE domains during HSV-1 infection, we have analyzed the cytoprotective chaperone Hsp27. Here we present evidence that Hsp27, which is known to possess several antioxidant functions, is rapidly reorganized and modified at early stages in response to HSV-1 infection and signaling from the mitogen-activated protein kinase p38. Immunofluorescence analysis and fractionation experiments reveal disparate subcellular localizations of nonphosphorylated and phosphorylated forms of Hsp27 during wild-type HSV-1 infection. Unmodified forms of Hsp27 are localized in nuclear foci that are outside of replication compartments, adjacent to VICE domains, and in the cytoplasm. Conversely, we find that phosphorylated forms of Hsp27 are localized exclusively in the cytoplasm. Last, in cells depleted of all forms of Hsp27, virus replication is significantly reduced.