Miracle-dz/UniFAR-FTUs huggingface dataset:
Circadian variability and nocturnal dipping pattern in blood pressure in young normotensive subjects

Blood pressure variability (BPV) is one of the recognized risk factors for different types of cardiovascular diseases (CVDs). Several physiological, behavioral and ethnic factors are known to modulate blood pressure (BP). Such studies on the population of southeast India are altogether absent. It is worthwhile, therefore, to examine the circadian variability in systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) and nocturnal dipping pattern in BP in apparently healthy human subjects as a function of gender. Sixty females and 40 males voluntarily participated in the study. All subjects wore an Ambulatory Blood Pressure Monitor (ABPM, TM 2430) for two to four consecutive days. SBP, DBP and HR was measured every 15 and 30 minutes between 07:00–22:00 and 22:00–07:00 hrs, respectively. In addition, double product (DP) and mean arterial pressure (MAP) were also computed. Data were analyzed using A&D, Cosinor and Spectre software. Prevalence of extreme dipper, dipper and non-dipper was 13%, 63% and 24%, respectively. A statistically significant circadian rhythm was validated in all studied variables, irrespective of gender and dipping pattern in BP. However, the rhythm detection ratio was low among non-dippers. Chi-square test revealed a statistically significant association of the frequency of prominent periods of SBP and MAP with nocturnal dipping categories. Further, significant differences for the circadian Mesors of SBP, DBP, HR, DP and MAP and acrophase of DBP and MAP were noticed between males and females. Dipping pattern produced a significant effect on the rhythm characteristics of all the studied variables. On the basis of our findings we can conclude that variability in BP may be associated with factor gender to some extent, whereas nocturnal dipping in BP is independent of gender. Interestingly in the present study about 24% subjects are non-dippers, which may be an indication of higher risk of CVDs among individuals belonging to younger generation of this region. However, further extensive study is desirable to strengthen the above conjecture.
Resolvin(g) innate immunodeficiencies?

In this issue of Blood , Hsieh et al provided the molecular mechanism showing how X-linked inhibitor of apoptosis protein (XIAP) deficiency may lead to selective innate immunodeficiency recalling X-linked lymphoproliferative syndrome type 2 (XLP-2). [1][1] ! [Figure][2] In physiological
Violence in the emergency department: a multicentre survey of nurses’ perceptions in Nigeria

Background Emergency department (ED) violence is common and widespread. ED staff receive both verbal and physical abuse, with ED nurses bearing the brunt of this violence. The violence is becoming increasingly common and lethal and many institutions are still improperly prepared to deal with it. Methods A questionnaire based survey of the perception of violence among nurses working in six tertiary hospitals’ EDs across five states in Nigeria was conducted. Results 81 nurses were interviewed with a male to female ratio of 1:4. Most were right about the definition of violence. About 88.6% of respondents have witnessed ED violence while 65.0% had been direct victims before. Nurses followed by doctors were the usual victims. The acts were carried out mostly by visitors to the ED. Men were usually responsible for the violence, which usually occurred in the evenings. Weapons were not commonly utilised: only 15.8% of the nurses had been threatened with a weapon over a 1-year period. The main perceived reasons for violence were overcrowded emergency rooms, long waiting time and inadequate system of security. All the institutions were lacking in basic strategies for prevention. While most of the nurses were not satisfied with the EDs that were considered not safe, few would wish for redeployment to other departments/units. Conclusions There is a need to make the EDs safer for all users. This can be achieved by a deliberate management policy of ‘zero’ tolerance to workplace violence, effective reporting systems, adequate security and staff training on prevention of violence.
Prehospital delay in acute stroke and TIA

Background Early management improves outcome in acute stroke. This study was designed to assess the prehospital path from symptom onset to arrival in hospital and to identify factors associated with prehospital delay. Methods A prospective study was conducted including patients with acute ischaemic stroke, intracerebral haemorrhage and transient ischaemic attack admitted to hospital. Time intervals for prehospital delay, background data, severity, type of first medical contact and mode of transport were recorded. Univariate and multivariate analyses were performed to identify factors influencing prehospital delay. Results A total of 440 patients were included, with a mean age of 71.4±13.0 years (44.3% female subjects), consisting of 65.9% patients with ischaemic stroke, 11.4% with intracerebral haemorrhage and 22.7% with transient ischaemic attack. The median time from symptom onset to admission was 3.0 h (179 min; IQR 77–542). The median decision delay was 1.5 h (92 min, IQR 25–405) and accounted for 55.1% (median value) of the prehospital delay. 310 (70.5%) patients arrived by ambulance. In the multivariate linear regression analysis, high National Institute of Health Stroke Scale score (p<0.001), transport by ambulance (p<0.001) and lower age (p=0.048) were significantly associated with early admission. Conclusions Severe strokes, use of ambulance and lower age are associated with reduced prehospital delay. The present study shows that more than half of the delay is caused by the hesitation to contact medical services. Public information campaigns should focus on fast symptom recognition and the importance of immediately contacting the Emergency Medical Services upon symptom onset.
The role of rituximab in the management of patients with acquired thrombotic thrombocytopenic purpura.

A 40-year-old obese black woman developed abdominal pain with progressive generalized weakness over several days. Physical examination was normal except for several small bruises on her extremities. Laboratory data revealed the following: hemoglobin, 5.0 g/dL; platelet count, 4000/µL; creatinine, 0
Notes from practice: Methadone prescribing in north central London—doses, compliance, goals and treatment setting

Aims: To examine methadone prescribing in public drug treatment services in inner London; compare levels of methadone prescribing with national guidelines and surveys; investigate whether methadone reduces illicit opiate use; and compare clients treated in specialist clinics with those in shared-care in general practice. Methods: A cross-sectional survey of four drug treatment services in north central London. Findings: Data were collected on 715 clients. Mean methadone dose was 57.2 mg but for clients on methadone maintenance, the mean dose was 63.4 mg. Reported heroin use fell from 24.8 days in the last 30 at initial assessment to 11 days (p < 0.001). Clients on methadone doses greater than 60 mg were more likely than those on lower doses to test negative for morphine on urinalysis (49% vs. 39.4%, p < 0.01). Clients in GP shared-care were more likely to have been in treatment for less time, be on lower doses of methadone and have stabilization or detoxification as their treatment goal. Conclusions: Methadone treatment is associated with a reduction in illicit opiate use but not abstinence. Inadequate doses and lack of supervised consumption may in part explain the relatively poor response to treatment. Clients in GP shared-care received substantially different treatment from those in the specialist clinics.
Ibrutinib increases the risk of atrial fibrillation, potentially through inhibition of cardiac PI3K-Akt signaling.

To the editor: The Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib sets a new standard of care for the treatment of patients with relapsed or refractory chronic lymphocytic leukemia (CLL)[1][1],[2][2] and mantle cell lymphoma (MCL). [3][3] Ibrutinib is generally well tolerated and largely
Management of Anterior Glenohumeral Instability Associated With Large Hill–Sachs Defects

Anatomic pathology following shoulder instability includes capsulolabral injury as well as bone defects on both the glenoid and humeral head. The common surgical repairs address the soft tissue labral tears (Bankart lesions) as well as the capsular redundancy that occurs with these injuries. These soft tissue repairs are usually sufficient to deal with most instability cases. Unfortunately, in certain circumstances, bone deficiency of the glenoid or of the humeral head (Hill–Sachs) may give rise to ongoing instability of the glenohumeral joint that is not controlled by soft tissue repairs alone. Although rare, Hill–Sachs lesions have been reported to play a role in the failures of anterior glenohumeral instability surgical repairs. Various methods have been reported to treat these Hill–Sachs lesions, including tight soft tissue reconstructions and derotational osteotomies. We describe a technique that accomplishes an anatomic reconstruction of the humeral head using a side- and size-matched humeral head osteoarticular allograft. This technique involves an anatomic reconstruction, which eliminates the structural bone pathology while maintaining the range of motion of the glenohumeral joint. We have reported a series of patients where Hill–Sachs defects were reconstructed for recurrent traumatic anterior instability following failed repairs. This technique has been shown to be effective for a difficult problem with few available treatment options. While associated with some residual disability, it has led to a high subjective approval, allowing return to near normal function with no further instability.
Allelic ratio: a marker of clonal dominance.

In this issue of Blood , Schlenk et al provide compelling data on the prognostic implications of FMS-like tyrosine kinase 3 ( FLT3 )/internal tandem duplication allelic ratio (ITD-AR), as well as its impact on response to allogeneic stem cell transplantation. [1][1] They provide detailed analysis of
Paramedic perceptions of the feasibility and practicalities of prehospital clinical trials: a questionnaire survey

Background Clinical trials are required to strengthen the evidence base for prehospital care. This questionnaire study aimed to explore paramedics’ perceptions of prehospital research and barriers to conducting prehospital clinical trials. Methods A self-completed questionnaire was developed to explore paramedic perceptions and barriers to undertaking prehospital trials based upon a review of existing research and semistructured qualitative interviews with five paramedics. The questionnaire was distributed by ‘research champions’ to 300 paramedics at randomly selected ambulance stations in Yorkshire. Results Responses were received from 96/300 participants (32%). Interest in clinical trials was reported, but barriers were recognised, including perceptions of poor knowledge and limited use of evidence, that conducting research is not a paramedics’ responsibility, limited support for involvement in trials, concerns about the practicalities of randomisation and consent, and time pressures. No association was found between training route and perceived understanding of trials (p=0.263) or feeling that involvement in trials was a professional responsibility (p=0.838). Previous involvement in prehospital research was not associated with opinions on importance of an evidence base (p=0.934) or gaining consent (p=0.329). The number of years respondents had been practicing was not associated with opinions on personal experience versus scientific evidence (p=0.582) or willingness to receive training for clinical trials (p=0.111). However, the low response rate limited the power of the study to detect potential associations. Conclusions Paramedics reported interest and understanding of research, but a number of practical and ethical barriers were recognised that need to be addressed if prehospital clinical trials are to increase.
Blinding assessment in clinical trials: A review of statistical methods and a proposal of blinding assessment protocol

There is strong consensus in the clinical trial community that blinding is an important issue in randomized controlled trials. At present grossly incomplete reporting of procedures and the use of any assessment for blinding still prevails. The term ‘double-blind’ has almost become a convention without any checks or balances. Also there is a lack of consensus on quantitative procedures for evaluating the success of blinding in the literature. This article reviews statistical methods of blinding assessment along with software options, and discusses some of the most pressing issues surrounding the acquisition, interpretation, and reporting of blinding data. Finally, it proposes a sample blinding assessment protocol to address some of these issues.
The Lucite Calvarium—A Method for Direct Observation of the Brain: II. Cranial Trauma and Brain Movement

I N A :PREVIOUS report 23 an experimental surgical technic in which the convex portion of the monkey skull is replaced by a transparent lucite calvarium was described. Because a large area of both cerebral hemispheres is exposed through the lucite window, the method is ideally suited for the study of intracranial phenomena under "closed box" conditions. I t may be of interest to mention that the technic was developed primarily to study the effects of cranial trauma on the underlying brain. The patterns of brain motion resulting from blows to both the freely movable and the immobile head were recorded by high-speed cinematography. I t is stressed that these experiments were conducted to study the motion patterns of the cerebral mass and any other visible physical change. I t is not a study of cerebral concussion. Although brain movement and concussion are probably closely interrelated the mechanism of concussion is not explainable in the light of our findings. I t is hoped, however, that this study may furnish additional data toward the eventual solution of the problem of cerebral concussion. HISTORICAL BACKGROUND
Occupational Therapists' Roles and Attitudes toward Sexual Habilitation of Chronically Ill and Disabled Children

Normal progression through psychosexual stages in infancy and childhood has been recognized as a critical component in the shaping of one's personality and self concept. Long term hospitalization, institutionalization, and disability could deprive infants and children of the essential environmental and experiential elements for the development of sexuality. A sample of 37 occupational therapists who were involved in the care of chronically ill and disabled children in British Columbia were given a questionnaire related to specific tasks that promote the development of sexuality in infants and children. The results indicated that the majority of the therapists did not perform one or more of the tasks but believed that the tasks were important in occupational therapy. They indicated that their preparation for performing the tasks was inadequate. When asked who should primarily perform the tasks, their responses showed uncertainty. The therapists held positive attitudes toward sexual habilitation and considered it an important aspect of health care for which an appropriate content should be integrated into the basic curriculum in occupational therapy.
Impact of introducing a major trauma network on a regional helicopter emergency medicine service in the UK

Introduction In the West Midlands region of the UK, the delivery of prehospital trauma care has recently been remodelled through the introduction of a regionalised major trauma network (MTN). Helicopter emergency medical services (HEMS) are integral to the network, providing means of delivering highly skilled specialist teams to scenes of trauma and rapid transfer of patients to major trauma centres. This study reviews the impact of introducing the West Midlands MTN on the operation of one its regional HEMS units. Methods Retrospective review of the Midlands Air Ambulance clinical database for the 6 months after the launch of the West Midlands MTN. The corresponding period for the previous year was reviewed for comparison. The contribution of trauma cases to overall workload, mission outcome data and the number of interventions performed at the scene were compared. Results The proportion of HEMS activations for trauma cases was similar in both cohorts (70.84% before MTN vs 71.57% after MTN). The proportion of mission cancellations was significantly lower after the launch of the network (23.71% vs 19.03%). Significantly more scene attendances resulted in interventions by HEMS crews after the MTN launch (44.66% vs 56.92%). Conclusions Since the introduction of the West Midlands MTN, tasking of HEMS assets appears to be better targeted to cases involving significant injury, and a reduction in mission cancellations has been observed. There is a need for more detailed evaluation of patient outcomes to identify strategies for optimising the utilisation of HEMS assets within the regional network.
Role of naive-derived T memory stem cells in T-cell reconstitution following allogeneic transplantation.

Early T-cell reconstitution following allogeneic transplantation depends on the persistence and function of T cells that are adoptively transferred with the graft. Posttransplant cyclophosphamide (pt-Cy) effectively prevents alloreactive responses from unmanipulated grafts, but its effect on subsequent immune reconstitution remains undetermined. Here, we show that T memory stem cells (TSCM), which demonstrated superior reconstitution capacity in preclinical models, are the most abundant circulating T-cell population in the early days following haploidentical transplantation combined with pt-Cy and precede the expansion of effector cells. Transferred naive, but not TSCM or conventional memory cells preferentially survive cyclophosphamide, thus suggesting that posttransplant TSCM originate from naive precursors. Moreover, donor naive T cells specific for exogenous and self/tumor antigens persist in the host and contribute to peripheral reconstitution by differentiating into effectors. Similarly, pathogen-specific memory T cells generate detectable recall responses, but only in the presence of the cognate antigen. We thus define the cellular basis of T-cell reconstitution following pt-Cy at the antigen-specific level and propose to explore naive-derived TSCM in the clinical setting to overcome immunodeficiency. These trials were registered at www.clinicaltrials. gov as #NCT02049424 and #NCT02049580.
Annotation. AUTOANTIBODY FORMATION ASSOCIATED WITH METHYLDOPA (ALDOMET) THERAPY

Methyldopa (~-methyl-3,4-dihydroxy-~-phenylalanine, ‘Aldomet‘, MD) is an anti-hypertensivc drug which has been widely used over the past 7-8 years. It is known to be an effective inhibitor of dopa decarboxylase both in vitro and in vivo and it was at one time thought that in the body this inhibition reduced the synthesis of dopamine and noradrenaline and led to a depletion of tissue catecholamines with subsequent lowering of the blood pressure. However, all the steps in this sequence have been challenged and very little is really known of its catabolism in man. In 1966, we reported that a high proportion of patients treated with MD gave a positive direct antiglobulin test and a few of these developed an overt haemolytic anaemia serologically identical with ‘idiopathic’ autoimmune haemolytic anaemia (Carstairs, Breckenridge, Dollery and Worlledge, 1966; Worlledge, Carstairs and Dacie, 1966). These two observations have now been confirmed from many parts of the world.
Simultaneous map building and localization for an autonomous mobile robot

Discusses a significant open problem in mobile robotics: simultaneous map building and localization, which the authors define as long-term globally referenced position estimation without a priori information. This problem is difficult because of the following paradox: to move precisely, a mobile robot must have an accurate environment map; however, to build an accurate map, the mobile robot's sensing locations must be known precisely. In this way, simultaneous map building and localization can be seen to present a question of 'which came first, the chicken or the egg? ' (The map or the motion? ) When using ultrasonic sensing, to overcome this issue the authors equip the vehicle with multiple servo-mounted sonar sensors, to provide a means in which a subset of environment features can be precisely learned from the robot's initial location and subsequently tracked to provide precise positioning. <<ETX>>
Ultrasonic Sensing For A Mobile Robot To Recognize An Environment - Measuring The Normal Direction Of Walls -

With a conventional ultrasonic sensor system for a mobile robot, the distance to an ob- ject can be obtained with a time-of-flight (TOF) method, in which a reflected point is regarded to be located directly on the transducer line-of- sight. However, in an indoor environment, flat walls have specular characteristics. So, the real reflected point is not located on the transducer's lime-of-sight, because an echo from the normal in- cidence only returns to the transducer, since ul- trasonic directivity is not so sharp in air. So, to accurately recognize the position of an object, it is important to detect the direction of the re- flected point. One method to obtain the direction is to calculate it from the time difference between two parallel receivers. In this paper, an ultrasonic sensing method with a wide angle and high res- olution in specular environment is proposed, and accurate environment recognition can be realized.
Does Immunonutrition Make an Impact? It Depends on the Analysis

Heyland and Drover are kind to congratulate us on our "large, well-designed randomized controlled trial of immunonutrition in the critically ill" (1) but such sentiments often precede a sting in the tail! We made great efforts not to overinterpret our results in attempting to provide the Critical Care Medicine readership and its editorialists with the facts. As we stated, reductions in length of stay are difficult to interpret in the face of differences in mortality rates but that is precisely the reason why we performed a second analysis censoring the lengths of stay of the patients who died. Contrary to Heyland and Drover's assertion, the difference in length of stay did not disappear. It remained but did not achieve statistical significance at the conventional 5% level (p = .08, log rank test). This is not surprising given the dwindling numbers of patients included (29 Impact, 31 controls) but the trend remains. Moreover, the multiple linear regression model identified the formulation of the feed as having an independent statistically significant effect on postrandomization length of stay. Circumstantial evidence maybe, but evidence all the same!