Miracle-dz/UniFAR-FTUs huggingface dataset:
Introduction of a quality improvement curriculum in the Department of Internal Medicine, Lincoln Medical Center

ABSTRACT Community hospitals with limited resources struggle to engage physicians in Quality improvement initiatives. We introduced Quality Improvement (QI) curriculum for residents in response to ACGME requirements and surveyed the residents understanding of QI and their involvement in QI projects before and after the introduction of the curriculum. The current article describes our experiences with the process, the challenges and possible solutions to have a successful resident led QI initiative in a community hospital. Methods: A formal QI curriculum was introduced in the Department of Internal Medicine from September to October 2015 using the Model for Improvement from Institute for Health care Improvement (IHI). Learners were expected to read the online modules, discuss in small group sessions and later encouraged to draft their QI projects using the Charter form and PDSA form available on the HI website. Online surveys were conducted a week prior and 3 months after completion of the curriculum Results: 80% (100/117) of residents completed the pre-curriculum survey and 52% (61/117) completed the survey post curriculum. 96.7% of residents report that physicians should lead QI projects and training rather than the hospital administrators. Residents had 20% increase in understanding and confidence in leading quality improvement projects post curriculum once initiated. Most Residents (72%) feel QI should be taught during residency. Active involvement of residents with interest was seen after the initiation of Open School Institute of health improvement (IHI) curriculum as compared to Institutional led QI’s. The resident interventions, pitfalls with change processes with an example of PDSA cycle are discussed. Conclusion: A Dedicated QI curriculum is necessary to prepare the physicians deliver quality care in an increasing complex health care delivery system. The strength of the curriculum is the ease of understanding the material, easily available to all, and can be easily replicated in a Community Hospital program with limited resources. Participation in QI by residents may promote constructive competitiveness among related hospitals in public system to improve delivery of safe care. Abbreviations: ACGME: Accreditation Council for Graduate Medical Education; IHI: Institute of Healthcare Improvement; PDSA: Plan-Do-Study-Act; PGY: QI: Quality improvement
Institutions, Behaviour, and the Propensity to Hold Income Protection Insurance by Country of Residence

In this paper, we report the results of a survey on the individual propensity to hold income protection insurance across 11 countries and focus on whether it is meaningful to assume that observed preferences for such products are driven by factors such as respondents’ socio-demographic and economic circumstances or country of residence. We also ask whether it is meaningful to associate observed preferences for income protection insurance to blocs of countries such as the Americas and continental Europe. While country-specific effects dominate the empirical analysis, there is evidence of common preferences across higher-paid individuals within and between blocs of countries. Implications are drawn from our results for understanding the relationship between national institutions, labour market practices and individual behaviour.
Cooling performance of ceiling-plenum-ducted containment systems in data centers

In an effort to improve the reliability and efficiency of data centers, racks and sometimes entire hot aisles are ducted to a dropped ceiling. The cooling performance of such systems strongly depends on IT and cooler airflow, the number and configuration of ducted objects and perforated ceiling tiles, the leakiness of the ceiling system, ceiling plenum depth, and other factors. Recently, a compact model has been proposed in which a Flow Network Model (FNM) representing the ducted equipment is embedded into a parent CFD model. By eliminating the need to explicitly model difficult-to-characterize leakage paths in CFD, this approach allows for realistic solutions while greatly improving the solutions speed and robustness of the CFD simulation. This paper employs the FNM (without CFD) to characterize and compare the cooling effectiveness of individually-ducted racks and ducted hot aisles subject to a given ceiling plenum pressure. Example resistance values needed in the FNM are provided. Additionally, an example data center layout is studied with the coupled FNM-CFD model to explore cooling performance as a function of ceiling leakiness, plenum depth, ratio of cooling to IT airflow, and rack density (IT airflow). Best-practice type recommendations for ducted equipment are provided.
Loss of Histochemical Identity in Mast Cells Lacking Carboxypeptidase A

ABSTRACT Mast cell carboxypeptidase A (Mc-cpa) is a highly conserved secretory granule protease. The onset of expression in mast cell progenitors and lineage specificity suggest an important role for Mc-cpa in mast cells. To address the function of Mc-cpa, we generated Mc-cpa-null mice. Mc-cpa− / − mast cells lacked carboxypeptidase activity, revealing that Mc-cpa is a nonredundant enzyme. While Mc-cpa − / − peritoneal mast cells were ultrastructurally normal and synthesized normal amounts of heparin, they displayed striking histochemical and biochemical hallmarks of immature mast cells. Wild-type peritoneal mast cells had a mature phenotype characterized by differential histochemical staining with proteoglycan-reactive dyes (cells do not stain with alcian blue but stain with safranin and with berberine) and a high side scatter to forward scatter ratio by flow cytometry and were detergent resistant. In contrast, Mc-cpa − / − peritoneal mast cells, like immature bone marrow-derived cultured mast cells, stained with alcian blue normally or weakly and either did not stain with safranin and berberine or stained weakly, had a low side scatter to forward scatter ratio, and were detergent sensitive. This phenotype was partially ameliorated with age. Thus, histochemistry and flow cytometry, commonly used to measure mast cell maturation, deviated from morphology in Mc-cpa − / − mice. The Mc-cpa − / − mast cell phenotype was not associated with defects in degranulation in vitro or passive cutaneous anaphylaxis in vivo. Collectively, Mc-cpa plays a crucial role for the generation of phenotypically mature mast cells.
Double-blind Placebo-controlled Study With Interleukin-18 and Interleukin-12-encoding Plasmid DNA Shows Antitumor Effect in Metastatic Melanoma in Gray Horses

Melanoma is a disease with high incidence in gray horses and has limited therapeutic options in metastatic disease. Gene therapy has shown some success in animal models and human patients. A randomized double-blind, placebo-controlled study was conducted to investigate 2 treatment options using cytokine-encoding plasmid DNA in horses with metastatic melanoma to induce immunologic antitumor effects. Adult gray horses with spontaneously occurring metastatic melanoma (n=26) were included in the study. Treatment of 26 gray horses with metastatic melanoma consisted of interleukin-18-encoding plasmid DNA, interleukin-12-encoding plasmid DNA, or empty plasmid DNA (control group), injected intratumorally, respectively. Tumor response was assessed using ultrasound and caliper measurements and histologic assessment of tumor biopsies. Significant tumor regression could be shown in both the treatment groups receiving IL-18 and IL-12-encoding plasmid DNA whereas placebo-treated control patients showed tumor growth over the course of the treatment. In addition, 7 of 10 tumors from horses treated with IL-18 or IL-12 showed peritumoral and/or intratumoral inflammatory infiltrates after treatment compared with 1 of the 6 in the control group. The treatment as assessed by serial blood draws and clinical investigation, was safe and well tolerated. These data suggest that the intratumoral treatment with IL-18 and IL-12-encoding plasmid DNA has antitumor effects, which is well tolerated and thus holds promise for the treatment of patients with metastatic melanoma.
Euroscepticism as a transnational and pan-European phenomenon: the emergence of a new sphere of opposition

As the EU enters an increasingly uncertain phase after the 2016 Brexit referendum, Euroscepticism continues to become an increasingly embedded phenomenon within party systems, non-party groups and within the media. Yet, academic literature has paid little attention to the emergence of, and increased development of, transnational and pan-European networks of EU opposition. As the ‘gap’ between Europe’s mainstream political elites and an increasingly sceptical public has widened, pan-European spheres of opposition towards the EU have developed and evolved.
Inhibition of Tumor Progression and Paraneoplastic Syndrome Development in a Murine Lung Adenocarcinoma by Medroxyprogesterone Acetate and Indomethacin

Mice bearing LP07 lung adenocarcinoma present some characteristics similar to those shown in patients with several malignant diseases. LP07 tumor bearers develop paraneoplastic syndromes such as cachexia, leukocytosis, and hypercalcemia, partly due to a systemic inflammatory response. We analyzed some of the mechanisms involved in the effectiveness of the association of the appetite-stimulant medroxiprogesterone acetate (MPA) and the nonselective cyclooxigenase (COX) inhibitor indomethacin (INDO) in LP07 tumor bearing mice. INDO and INDO plus MPA treatments significantly inhibited tumor growth, which was not inhibited by MPA. The number of lung metastatic nodules was decreased with all treatments, being most effective INDO alone and INDO plus MPA. A significant decrease of plasmatic levels of the matrix metalloproteinases MMP-9 and MMP-2 correlated with these results. Paraneoplastic syndromes, leukocytosis, and cachexia were abolished by all treatments. We determined effects of the treatments on circulating cytokines shown to regulate cachexia and inflammation. Both treatments alone, and INDO plus MPA, reduced circulating IL-6 throughout tumor evolution. A pronounced increase in serum IL-1β levels was detected in untreated tumor bearers. These levels decreased and were closer to normal serum values when LP07 mice were treated with INDO plus MPA. The combination of a nonsteroidal antiinflammatory drug as INDO and MPA showed to be effective in inhibiting tumor and metastatic growth and diminishing paraneoplastic symptoms and SIR. A variety of specific molecules are implicated as playing a role in cancer-induced cachexia and hematological alterations.
Efficacy of enteral and parenteral nutrition in cancer patients.

Before attempting to analyze the potential efficacy of the two different routes of administering nutrients to cancer patients, enteral nutrition (EN) versus total parenteral nutrition (TPN), it should be appreciated that patients who are usually fed via a vein are not the same as those who receive EN. If fact, nowadays, the option for TPN only emerges if a patient is not suitable for EN because his/her gut is not working. Consequently the different effects of EN and TPN cannot be attributed only to the administration route of nutrients, but also to the different basic conditions of these 2 groups of patients. There are, however, some exceptions: at the beginning of the era of artificial nutrition, TPN was more developed than EN probably because the impetus of this new approach relied on an urgent need to solve the problems of patients with intestinal failure. In fact, initially TPN was developed in surgical departments to meet the nutritional requirements of patients with short-bowel syndrome or abdominal catastrophes. This translated into the use of TPN also in patients with a working gut, and finally rendered a comparison between TPN and EN not only possible, but even scientifically rational and ethically acceptable. At this point we were roughly in the 1980s. Another field where TPN and EN are frequently compared is the perioperative setting. Nutritional support in the perioperative period is not nutrition in the traditional meaning of the word: it is the attempt to control the metabolic reaction to surgical trauma and to potentiate the defenses of the patient through the administration of nutrients. The indication for nutritional support in this patient population was questioned for a long time and the simple provision of a saline solution for a few days was usually accepted in many institutions. Consequently in the literature there are studies comparing not only different nutritional regimens and Lochs H, Thomas DR (eds): Home Care Enteral Feeding. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 10, pp 127–142, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2005.
Perceived Family Difficulties and Prediction of 23-Year Stroke Mortality among Middle-Aged Men

Background/Objective: To examine the association of indicators of family problems, support and coping style and prediction of stroke mortality among a large cohort of middle-aged men. Methods: A cohort of 10,059 men aged ≧40 years at study inclusion that were tenured civil servants or municipal employees were followed for mortality over 23 years, for a total of about 200,000 person-years of follow-up. Mortality attributed to stroke and to CHD as underlying causes was determined. Subjects underwent a structured psychosocial questionnaire at baseline by trained interviewers, and associations between each indicator of perceived family difficulties, support and coping (9 indicators in total) and mortality from stroke and from CHD were estimated using the proportional hazard model by Cox. Results: During the 23-year follow-up period, 364 men died of stroke, and 1,098 men died of CHD.Among the indicators, perceived serious family difficulties at baseline, adjusted for traditional risk factors, were associated with higher risk of dying from stroke (HR 1.34, 95% CI 1.04–1.72), as were wife and children not tending to listen (HR 1.29, 95% CI 1.00–1.65), and person tending to keep feelings to oneself when conflict with wife (HR 1.27, 95% CI 1.03–1.37), while other indicators had associated HRs nearer unity. None of the variables assessed predicted mortality from CHD over a long-term follow-up. Conclusion: Several indicators of perceived family problems, family support and coping style are related to risk of dying from stroke over a long-term follow-up among middle-aged men.
MEASUREMENTS OF FOETAL GROWTH VIA TRANSABDOMINAL ULTRASONOGRAPHY DURING FIRST HALF OF PREGNANCY AT EWES FROM SYNTHETIC POPULATION BULGARIAN MILK

Metodiev, N. , d. diMov, i. Ralchev and e. Raicheva, 2012. Measurements of foetal growth via transabdominal ultrasonography during first half of pregnancy at ewes from synthetic population Bulgarian milk. Bulg. J. Agric. Sci., 18: 493-500 The aim of present work was to determine values of some measurements of foetal growth via transabdominal ultrasonography during first half of pregnancy at ewes from Synthetic Population Bulgarian Milk. Two parallel experiments were carried out with ewes, which were in different gestational phases. The first experiment was carried out with 19 ewes, conceived in three consecutive days. Three consecutive ultrasound observations in 10 days intervals were done, on days 40-42, 51-53 и 6163 after conceiving. The following measurements were taken: head diameters: biparieatal (BPD) and occipito-nasal (ONL), Placentome size: width and length. The second experiment was carried out with 17 ewes, conceived in the same day. The examination days were 25, 36 and 46 after artificial insemination. It was measured: Day 25: diameter of embryonic vesicle; length of embryo Day 36: crown-rump length; Day 46: crown-rump length; head diameters: biparieatal (BPD) and occipito-nasal (ONL); placentome size: width and length. All measurements were in millimeters (mm). The effect of gestational phase on foetal growth is analysed by one way ANOVA. The coefficients of correlation (r) and determination (R2) between gestational phase and embryofetal measurements were established by standard regression. The gestational phase influence significantly ((P<0.001) all taken measurements. The mean values for BPD were11.16 mm on 40-42 gestational days and reached 21,08 mm on 61-63 days, and for ONL -15.17 mm on 40-42 days and reached 32.94 mm on 61-63 days. The size of palcentomes varied in wide range for all taken measurements. On days 40-42 the mean values were: length13.67 mm and width – 10.06 mm, and reached on 61-63 days mean length – 33.02 mm and mean width – 21.33 mm. It was established high, positive and significant correlation between head diameters and gestational age (r=0.93*** и r=0.93***). It was obtained moderate values of the coefficient of determination for the size of placentomes and gestational age (R2= R2= 0.46 и R2= 0.47). The embroyfetal length was 11.08 mm on day 25, 26.03 mm on day 36 and 51.79 mm on day 46. It was established high, positive and significant correlation between CRL and gestational age (r= 0.84***).
Topographical rearrangements of visna virus envelope glycoprotein during antigenic drift

Visna virus undergoes antigenic drift during persistent infection in sheep and thus eludes neutralizing antibodies directed against its major envelope glycoprotein, gp135. Antigenic variants contain point mutations in the 3' end of the genome, presumably within the envelope glycoprotein gene. To localize the changes in the viral proteins of antigenic mutants, we isolated 35 monoclonal antibodies (MAbs) against the envelope glycoprotein gp135 or the major core protein p27 of visna virus. The MAbs defined five partially overlapping epitopes on gp135. We used the MAbs and polyclonal immune sera directed against visna virus, gp135, or p27 in enzyme-linked immunosorbent assays to compare visna virus (strain 1514) with antigenic mutants (LV1-1 to LV1-6) previously isolated from a single sheep persistently infected with plaque-purified strain 1514. Polyclonal immune sera and anti-core p27 MAbs failed to distinguish antigenic differences among the viruses. By contrast, the anti-gp135 MAbs detected changes in all five epitopes of the envelope glycoprotein. Three gp135 epitopes, prominently exposed on strain 1514, were lost or obscured on the mutants; two covert gp135 epitopes, poorly exposed on strain 1514, were reciprocally revealed on the mutants. Even virus LV1-2, which is indistinguishable from parental strain 1514 by serum neutralization tests and which differs from it by only two unique oligonucleotides on RNase-T1 fingerprinting, displayed global changes in gp135. Our data suggest that visna virus variants may emerge more frequently during persistent infection than can be detected by serological tests involving the use of polyclonal immune sera, and the extent of phenotypic changes in their envelope glycoproteins may be greater than predicted by the small number of genetic changes previously observed. We suggest that topographical rearrangements in the three-dimensional structure of gp135 may magnify the primary amino acid sequence changes caused by point mutations in the env gene. This may complicate strategies to construct lentiviral vaccines by using the envelope glycoprotein.
Seroprevalence of HIV, HSV-2, and Treponema pallidum in the Kosovarian population

The objective of this study was to evaluate the seroprevalence of infection with HIV, herpes simplex virus type 2 (HSV-2), and Treponema pallidum (TP) in a Kosovarian population. A cross-sectional study was performed in Peja, Kosovo, from January to March 2005, among 1285 persons recruited at the Peja Hospital. The seroprevalence of HIV, HSV-2, and TP was evaluated, and the viral correlates for each infection were analysed. No HIV-positive cases were found. The seroprevalence of HSV-2 was 20.2%. The factors significantly associated with HSV-2 infection at the multivariate analysis were: female gender (adjusted OR, 1.73; 95% CI 1.24–2.41) and being married (adjusted OR, 1.46; 95% CI 1.06–2.01). Three persons (0.2%) had a positive serology for TP. The only risk factor associated with TP infection was age = 50 y. Our results show a low seroprevalence of HIV infection and TP, and a high seroprevalence of HSV-2 in Kosovo. These findings suggest the need for appropriate surveillance systems, prevention programmes, and information aimed at controlling the spread of HIV and other sexually transmitted infections in this area. Moreover, the circulation of infections acquired through sexual contact may facilitate an increase in the sexually transmitted HIV epidemic in the near future.
Muscle afferent contributions to the cardiovascular response to isometric exercise

The cardiovascular response to isometric exercise is governed by both central and peripheral mechanisms. Both metabolic and mechanical stresses on the exercising skeletal muscle produce cardiovascular change, yet it is often overlooked that the afferent signal arising from the muscle can be modified by factors other than exercise intensity. This review discusses research revealing that muscle fibre type, muscle mass and training status are important factors in modifying this peripheral feedback from the active muscles. Studies in both animals and humans have shown that the pressor response resulting from exercise of muscle with a faster contractile character and isomyosin content is greater than that from a muscle of slower contractile character. Athletic groups participating in training programmes that place a high anaerobic load on skeletal muscle groups show attenuated muscle afferent feedback. Similarly, longitudinal studies have shown that specific local muscle training also blunts the pressor response to isometric exercise. Thus it appears that training may decrease the metabolic stimulation of muscle afferents and in some instances chronic exposure to the products of anaerobic metabolism may blunt the sensitivity of the muscle metaboreflex. There may be surprising parallels between the local muscle conditions induced in athletes training for longer sprint events (e.g. 400 m) and by the low‐flow conditions in, for example, the muscles of chronic heart failure patients. Whether their similar attenuations in muscle afferent feedback during exercise are due to decreased metabolite accumulation or to a desensitization of the muscle afferents is not yet known.
Deficiency in Mouse Oxytocin Prevents Milk Ejection,but not Fertility or Parturition

Oxytocin is a nonapeptide hormone that participates in the regulation of parturition and lactation. It has also been implicated in various behaviors, such as mating and maternal, and memory. To investigate whether or not oxytocin (OT) is essential for any of these functions, we eliminated, by homologous recombination, most of the first intron and the last two exons of the OT gene in mice. Those exons encode the neurophysin portion of the oxytocin preprohormone which is hypothesized to help in the packaging and transport of OT. The homozygous mutant mice have no detectable neurophysin or processed oxytocin in the paraventricular nucleus, supraoptic nucleus or posterior pituitary. Interestingly, homozygous mutant males and females are fertile and the homozygous mutant females are able to deliver their litters. However, the pups do not successfully suckle and die within 24 h without milk in their stomachs. OT injection into the dams restores the milk ejection in response to suckling. These results indicate an absolute requirement for oxytocin for successful milk ejection, but not for mating, parturition and milk production, in mice.