Miracle-dz/UniFAR-FTUs huggingface dataset:
Dissociation Between Dialysis Adequacy and Kt/V

Since the initiation of dialysis, nephrologists have sought an index (or indices) for the adequacy of toxic solute removal. This quest has been characterized by a gradual shift in thinking, ending with a preference for dynamic parameters such as clearances normalized for body size (Kt/V). The threshold Kt/V, however, has changed over the years. While present guidelines suggest 1.2 with single‐pool kinetics, higher levels might be proposed in the future. In spite of the known relation between Kt/V and survival, the accuracy of this parameter as a representative of the removal of the whole spectrum of compounds that are responsible for uremia is problematic. Kt/V only assesses the removal of a water‐soluble compound from the body water through mostly hydrophilic membranes to the dialysate water. Furthermore, the small size of urea means that convective and/or diffusive transfer through a given semipermeable membrane is unlikely to be representative of larger molecules, especially if dialyzers with a small pore size are applied. Urea kinetics are also poorly representative of the removal of small protein‐bound molecules and intracellular solutes with cell membrane‐limited clearance. Finally, it should be realized that the Kt/V concept has been developed in a specific population, that is, a group of renal failure patients with few comorbidities, submitted to short intermittent hemodialysis with small‐pore bioincompatible membranes very likely using dialysate of lower quality than that used today. Kt/V might well become less accurate and useful in predicting outcomes as different dialysis conditions are pursued, such as dialysis with biocompatible and/or large‐pore membranes, (ultra) pure dialysate, alternative time frames, high levels of convection, and/or in populations with a different distribution of body mass.
Patient perceptions, physician communication, and the implantable cardioverter-defibrillator.

IMPORTANCE Implantable cardioverter-defibrillators (ICDs) have changed the way in which patients with chronic ventricular dysfunction are evaluated and treated. OBJECTIVE To examine patient-physician communication at the time the decision is made to implant an ICD. DESIGN, SETTING, AND PARTICIPANTS Forty-one patients with ICDs and 11 cardiologists were recruited by a national marketing research company for a study comprising patient focus groups and standardized patient interviews in 3 different metropolitan areas. INTERVENTIONS Eight patient focus groups and (separately) 22 standardized patient interviews with cardiologists. MAIN OUTCOME MEASURES Patient focus group findings and the results of standardized patient interviews (each cardiologist interviewed 2 patients). RESULTS The mean (SD) patient age was 61.4 (14.7) years; 21 were female. Thirty-three patients could not recall a discussion about periprocedural or long-term complications. On a scale of 1 to 10, the mean (SD) rating of the degree to which patients felt informed before the implant procedure was 5.7 (3.2) (1 indicates "not at all informed," and 10 indicates "I had all the information I needed or wanted"). The mean (SD) estimated number of patients out of 100 who would be saved by the ICD was 87.9 (20.1). A negative perception on body image and lifestyle was prevalent. Across 22 standardized patient interviews, cardiologists frequently (in >17 of 22 of interviews) did not address or minimized or denied quality-of-life issues and long-term consequences of ICD placement, including the risk for depression, anxiety, and inappropriate delivery of shock or device advisory. In 15 of 22 of the standardized patient interviews, cardiologists used unexplained medical terms or jargon. CONCLUSIONS AND RELEVANCE Patient-physician communication about ICDs is characterized by unclear representation and omission of information to patients, with notable lack of attention to psychological and long-term risks. Training of cardiologists on information exchange with patients may promote informed decision making and preempt threats to patient quality of life.
Undergraduate medical students’ perceptions on the quality of feedback received during clinical rotations

Abstract Objective: This study aims to report undergraduate medical students’ evaluation of the frequency and the quality of feedback received on their clinical performance during their clerkships. Methods: This is a prospective observational study with a cross-sectional design including students from two cohorts (fifth and sixth years). In a structured interview, a questionnaire was used to report students’ perception on feedback. Results: In all, 53.3% and 66% of the students (fifth, sixth years, respectively) had rarely received feedback from clinical teachers, and only around 18% of them had corrective feedback during patient encounter. Students rated feedback on domains of communication skills with patients, and investigations requested as poorly acknowledged. Students appreciate the impact of feedback, however, 85% and 94% of them (fifth, sixth years, respectively) had poor feedback seeking attitude. The overall process of feedback was rated by the two cohorts collectively as 43.6% poor and 24.5% fair. Conclusion: Results demonstrate that feedback on students’ clinical performance is often not forthcoming and when offered it is deficient and fails to concentrate on the development of different clinical skills. This highlights the critical challenges that need to be addressed by teachers, medical education unit and all hospital departments in order to enhance giving effective and structured feedback to medical students during clerkships. Results also raise the extreme need for the establishment and enhancement of a culture that supports feedback among all levels of clinical supervisors.
Clinical and biochemical study of 28 patients with mucopolysaccharidosis type VI

This paper presents data collected by a Brazilian center in a multinational multicenter observational study of patients with mucopolysaccharidosis type VI (MPS VI), aiming at determining the epidemiological, clinical, and biochemical profile of these patients. Twenty‐eight south‐American patients with MPS VI were evaluated through medical interview, physical exam, echocardiogram, electrocardiogram, ophthalmologic evaluation, quantification of glycosaminoglycans (GAGs) in urine, and measurement of the activity of N‐acetylgalactosamine‐4‐sulfatase (ARSB) in leukocytes. 92.9% of patients were Brazilian. Mean age at diagnosis and at evaluation was 48.4 months and 97.1 months, respectively. 88% of patients had onset of symptomatology before the age of 36 months. Consanguinity was reported by 27% of the families. Mean weight and height at birth were 3.481 kg and 51.3 cm, respectively. The most frequently reported clinical manifestations were short stature, corneal clouding, coarse facial features, joint contractures, and claw hands. All patients presented with echocardiogram changes as well as corneal clouding. Mean ARSB activity in leukocytes was 5.4 nmoles/h/mg protein (reference values: 72–174), and urinary excretion of GAGs was on average 7.9 times higher than normal. The number of clinical manifestations did not show a significant correlation with the levels of urinary GAGs nor with the ARSB activity. Also, no significant correlation was found between the levels of urinary GAGs and the ARSB activity. It was concluded that MPS VI has high morbidity and that, when compared with data published in the literature, patients in our study were diagnosed later and presented with a higher frequency of cardiological findings.
In-situ measurement of various thin bond-line-thickness thermal interface materials with correlation to structural features

Thermal characterisation of thermal interfaces becomes even tougher a challenge at low bond line thicknesses and higher thermal conductivities of the interface materials as more accurate measurement techniques are required. As in parallel the quest for high conductivity adhesives and greases is ongoing, a correlation between thermal bulk or interface properties and structure is in high demand. We have developed test-stands for various classes of thermal interface materials. These permit characterisation for materials with thin bond line thickness and high thermal conductivity still using steady state techniques. The methods are benchmarked for greases, adhesives and sintered silver. For the latter, the technology development is described. Then, structural features such as particle density and porosity are examined. It will be the aim to compare and correlate them to thermal resistance. Part of the work has been accomplished within the running EU Project ldquoNanopackrdquo.
Investigating social media potential for teacher learning in Aceh, Indonesia

This study was designed to provide an initial descriptive analysis to investigate the potential of social media to support teacher professional learning for local content studies in Aceh, Indonesia. This paper explores the data that was collected from 381 primary school teachers from both urban and rural teaching locations. This data provides a means to explore the teachers' experiences, preferences and views on support for their learning and use of social media technology. Davis' technology acceptance model was consulted in initial development of constructs along with consequent research discussions on technology acceptance which emphasised the need to gather data relating to the community being studied. Thus the survey and focus group discussion questions were developed to provide knowledge about teachers' experiences and perceptions. In this mixed method research, teacher responses were analysed through the constructs of current practice, social media readiness, and support preferences. The results show that social media has the potential to support teachers in undertaking professional learning for local content studies. These results promote that harnessing social media to the traditional culture value of `goyong royong' (loosely translated as cooperation and mentoring values), will facilitate teachers' abilities to professionally interact, collaborate and learn with one another and other stakeholders. However this potential must be activated. Doing so could assist in people-centred support for teachers' learning and the teaching of local content.
Circadian Clock Gene Expression in Brain Regions of Alzheimer ’s Disease Patients and Control Subjects

Circadian oscillators have been observed throughout the rodent brain. In the human brain, rhythmic expression of clock genes has been reported only in the pineal gland, and little is known about their expression in other regions. The investigators sought to determine whether clock gene expression could be detected and whether it varies as a function of time of day in the bed nucleus of the stria terminalis (BNST) and cingulate cortex, areas known to be involved in decision making and motivated behaviors, as well as in the pineal gland, in the brains of Alzheimer’s disease (AD) patients and aged controls. Relative expression levels of PERIOD1 (PER1 ), PERIOD2 (PER2), and Brain and muscle Arnt-like protein-1 (BMAL1) were detected by quantitative PCR in all 3 brain regions. A harmonic regression model revealed significant 24-h rhythms of PER1 in the BNST of AD subjects. A significant rhythm of PER2 was found in the cingulate cortex and BNST of control subjects and in all 3 regions of AD patients. In controls, BMAL1 did not show a diurnal rhythm in the cingulate cortex but significantly varied with time of death in the pineal and BNST and in all 3 regions for AD patients. Notable differences in the phase of clock gene rhythms and phase relationships between genes and regions were observed in the brains of AD compared to those of controls. These results indicate the presence of multiple circadian oscillators in the human brain and suggest altered synchronization among these oscillators in the brain of AD patients.
Resonance frequency of microbubbles in small blood vessels: a numerical study

Microbubbles are currently used as ultrasound contrast agents. Their potential therapeutic applications are also under investigation. This work is designed to provide some insight into the mechanisms of energy absorption and deposition by a preformed gas bubble in the microvasculature to optimize its efficacy. In the linear regime, the most favourable condition for the transfer of energy from an ultrasonic field to a gas bubble occurs when the centre frequency of the ultrasonic field equals the resonance frequency of the bubble. The resonance frequency of gas microbubbles has been investigated up to now mainly in unbounded liquids; however when bubbles are confined in small regions, their resonance frequency is strongly affected by the surrounding boundaries. A parametric study on how the resonance frequency of microbubbles in blood vessels is affected by the bubble radius, vessel radius and the bubble position in the vessel is presented. The resonance frequency decreases below its free value with decreasing vessel radius for vessels smaller than 200–300 µm depending on the bubble size. This model suggests the possibility of using ultrasound in a range of frequencies that are, in general, lower than the ones used now for therapeutic and diagnostic applications of ultrasound (a few MHz). When microbubbles oscillate at their resonance frequency they absorb and therefore emit more energy. This energy may allow specific blood vessels to be targeted for both diagnostic and therapeutic applications of ultrasound.
Metabolic alkalosis with hypoelectrolytemia in infants with cystic fibrosis

Background : Infants with cystic fibrosis (CF) can develop episodes of hyponatremic hypochloremic dehydration with metabolic alkalosis when they sweat excessively, which is not caused by sweating in normal infants. We investigated the incidence of the metabolic alkalosis with hypoelectrolytemia in CF infants, the possible risk factors for its occurrence and the importance of the manifestation in the diagnosis of CF.
Demografía y crecimiento de la población española durante el siglo XX

En el umbral del siglo XXI, Espana, demograficamente hablando, parece haberse convertido en un pais especializado en batir records mundiales: asi lo atestiguan los niveles en la fecundidad con 1,2 hijos por mujer y en la esperanza de vida, que se situaba en 75,3 anos para los hombres y 82,5 para las mujeres en 1999, segun los ultimos datos ofrecidos por la Comision Europea (Eurostat, 2000). En cuanto a los movimientos migratorios, podemos estimar que los flujos, aunque crecientes, se encuentran aun muy por debajo de los registrados en otros paises de la Union Europea, siendo el cambio de signo del saldo migratorio la caracteristica mas relevante de su evolucion reciente. Espana que secularmente estuvo marcada por la emigracion, a partir de mediados de los setenta pasara a ser un pais de inmigracion: el retorno de los antiguos migrantes espanoles primero, y la llegada creciente de migrantes de nacionalidad extranjera despues, explican esa inversion.
[Effectiveness of nursing instruction in reducing uncertainty, anxiety and self-care in breast cancer women undergoing initial chemotherapy].

BACKGROUND Level of uncertainty and anxiety may increase when breast cancer women experience unexpected side effects during chemotherapy. PURPOSE This longitudinal study explored the effectiveness of nursing instruction in reducing uncertainty, anxiety and self-care in breast cancer women undergoing initial chemotherapy. METHODS This study used a quasi-experimental design. Convenience sampling was used to recruit 75 women with breast cancer at a medical centre in northern Taiwan between January 2008 and September 2008. Participants were divided into either the control (n=37) or experimental (n=38) group. Control group patients received usual care. Experimental group patients were provided with nursing instructions that followed the evidence-based guidelines prescribed in the "Chemotherapy Self-Care for Breast Cancer" handbook and individualized education. Both groups received repeated questionnaires in the first, third and sixth chemotherapy cycles. Demographic data, Mishel's Uncertainty Illness Scale, Hospital Anxiety and Depression Scale and the Self-Care Scale were used for data collection and analysis. RESULTS There were no significant differences in demographic data between the two groups. There were moderate to high levels of uncertainty and low levels of anxiety in both groups prior to the first chemotherapy cycle. There was a significant decrease in uncertainty and an elevation in self-care level (p<.05*) in both groups at the sixth chemotherapy cycle. However, the experimental group showed less uncertainty and higher levels of self-care in comparison with the control group. There was a significant decrease in complexity uncertainty in the experimental group (p=.02*) and no significant decrease in the control group. CONCLUSIONS Study results indicate that nursing instruction can decrease uncertainty and elevate self-care levels. We suggest that nurses provide structured nursing instructions based on evidence-based guidelines to breast cancer women undergoing initial chemotherapy in order to promote self-care level and patient degree of control over their disease and treatment. This intervention may ameliorate patient and family uncertainties with regard to disease and chemotherapy complexity.
Parental history of hypertension and parental history of diabetes and microvascular complications in insulin‐dependent diabetes mellitus: the EURODIAB IDDM complications study

Diabetic nephropathy clusters in families, suggesting an inherited predisposition. Parental history of hypertension and of Type 2 diabetes mellitus have been associated with nephropathy in offspring with Type 1 diabetes in some studies but not in others. The associations of parental history of hypertension and of diabetes with both albuminuria and proliferative retinopathy were studied in a large cross‐sectional study of 3250 patients with Type 1 diabetes, from 16 European countries. Albuminuria was associated with hypertension in a parent (p < 0.01 in men, p < 0.05 in women), adjusted for age. Patients with a parental history of hypertension had a higher prevalence of hypertension (p < 0.001 in men, p < 0.01 in women) and a higher prevalence of parental diabetes (p < 0.001 in men, p < 0.001 in women). The association of albuminuria with parental hypertension was independent of parental diabetes in men but not women (OR = 1.28 in men p = 0.04, OR = 1.25 in women p = 0.09) and was not independent of hypertension in the patient him/herself in either sex. Albuminuria was associated with parental diabetes in women only (OR = 1.36, p = 0.04). This association was independent of both parental hypertension and hypertension in the patient herself. Proliferative retinopathy was not associated with parental hypertension or diabetes. The implications of these data are that both candidate genes for hypertension and Type 2 diabetes should be considered in the search for the genetic determinants of diabetic nephropathy. © 1998 John Wiley & Sons, Ltd.
Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome.

BACKGROUND Most patients requiring mechanical ventilation for acute lung injury and the acute respiratory distress syndrome (ARDS) receive positive end-expiratory pressure (PEEP) of 5 to 12 cm of water. Higher PEEP levels may improve oxygenation and reduce ventilator-induced lung injury but may also cause circulatory depression and lung injury from overdistention. We conducted this trial to compare the effects of higher and lower PEEP levels on clinical outcomes in these patients. METHODS We randomly assigned 549 patients with acute lung injury and ARDS to receive mechanical ventilation with either lower or higher PEEP levels, which were set according to different tables of predetermined combinations of PEEP and fraction of inspired oxygen. RESULTS Mean (+/-SD) PEEP values on days 1 through 4 were 8.3+/-3.2 cm of water in the lower-PEEP group and 13.2+/-3.5 cm of water in the higher-PEEP group (P<0.001). The rates of death before hospital discharge were 24.9 percent and 27.5 percent, respectively (P=0.48; 95 percent confidence interval for the difference between groups, -10.0 to 4.7 percent). From day 1 to day 28, breathing was unassisted for a mean of 14.5+/-10.4 days in the lower-PEEP group and 13.8+/-10.6 days in the higher-PEEP group (P=0.50). CONCLUSIONS These results suggest that in patients with acute lung injury and ARDS who receive mechanical ventilation with a tidal-volume goal of 6 ml per kilogram of predicted body weight and an end-inspiratory plateau-pressure limit of 30 cm of water, clinical outcomes are similar whether lower or higher PEEP levels are used.
Bionomics of Phlebotomine Sand Flies from Three Villages in Bihar, India

ABSTRACT: This study examined the spatial distribution and seasonal fluctuations of population densities of phlebotomine sand flies and was designed to obtain baseline data on the population trends of Phlebotomus argentipes, P. papatasi, and Sergentomyia spp. in a visceral leishmaniasis endemic area of Bihar, India. Beginning on 28 October 2009 and through 20 October 2010, 63 CDC light traps were evenly distributed in human homes, cattle sheds, combined dwellings, chicken coops, and adjacent vegetation areas in three villages in the Saran District of Bihar State. Sand fly collections were made on a weekly basis, sorted, and identified according to species, sex, and feeding status of the two genera. The daily temperatures and relative humidity ranges were collected in a representative human home, cattle shed, and combined dwelling in each of the three study villages. Village census surveys were conducted in the three study villages in February 2010, acquiring human population data, structural composition data, and livestock census information, and documenting the history of visceral leishmaniasis within each household. A total of 52,653 sand flies was trapped and identified over 3,276 trap-nights. Peaks in abundance were observed in November 2009, March and April, June through August. Of the sand flies trapped, 72.1% were P. argentipes, 27.1% Sergentomyia spp. , and 0.8% P. papatasi. Distribution of the sand fly captures included 30.6%, 26.7%, 18.6%, 12.1%, and 12.0% from vegetation, combined dwellings, cattle sheds, housing, and poultry houses, respectively.