Miracle-dz/UniFAR-FTUs huggingface dataset:
Racial differences in out-of-hospital cardiac arrest survival and treatment

Objectives To determine whether there are prehospital differences between blacks and whites experiencing out-of-hospital cardiac arrest and to ascertain which factors are responsible for any such differences. Methods Cohort study of 3869 adult patients (353 blacks and 3516 whites) in the Illinois Prehospital Database with out-of-hospital cardiac arrest as a primary or secondary indication for emergency medical service (EMS) dispatch between 1 January 1996 and 31 December 2004. Results Return of spontaneous circulation was lower for black patients (19.8%) than for white patients (26.3%) (unadjusted OR 0.69, 95% CI 0.53 to 0.91). After adjusting for age, sex, prior medical history, prehospital event factors, patient zip code characteristics and EMS agency characteristics, the no difference line was suggestive of a trend, with a CI just transposing 1.00 (adjusted OR 0.71, 95% CI 0.50 to 1.01, p=0.053). Conclusions Blacks were less likely to experience a return of spontaneous circulation than whites, less likely to receive defibrillation or cardiopulmonary resuscitation from EMS and more likely to receive medications from EMS. Differences in underlying health, care prior to the arrival of EMS, and delays in the notification of EMS personnel may contribute to racial disparities in prehospital survival after out-of-hospital cardiac arrest.
Does Hextend Impair Coagulation Compared to 6% Hetastarch? An Ex Vivo Thromboelastography Study

The objective of this study was to determine if coagulation is different between 6% hetastarch in normal saline (NS) and 6% hetastarch in lactated Ringer's solution (LR), with use of an ex vivo thromboelastography (TEG) model with healthy donated volunteer blood. We simulated hemodilution that occurs during clinical resuscitation of hemorrhagic or hypovolemic shock, using healthy human donor whole blood (WB) ex vivo. Coagulopathy related to low, medium, high, or very high dilution of WB with NS or a high-molecular-weight hetastarch-based plasma expander, 6% hetastarch in NS (HSNS) or 6% hetastarch in lactated Ringer's [Hextend (HSLR)], was analyzed by thromboelastography (TEG). No changes were noted in the TEG profile of undiluted WB controls during the 6-hour period of use (P > 0.95). Dilution with HSNS and HSLR significantly impaired coagulation compared to both WB control and NS. Progressive dilution with NS impaired coagulation but to a lesser extent than colloids (P < 0.01). Low dilution of blood with NS increased clot strength by 12% (not significant; P = 0.097). We conclude that WB containing citrate obtained from healthy donors for TEG analysis yields reproducible data over a minimum of 6 hours. Either hetastarch, when present at concentrations comparable to the manufacturer's maximum recommended dose of 20 mL/kg (equivalent to the high dilution used in these experiments), decreases clot tensile strength to levels associated with an increased risk of bleeding. Substitution of lactated Ringer's for NS in 6% hetastarch appears to offer no advantage in avoiding hemostatic compromise in an in vitro model.
The Forum Community, the Connectivist Element of an xMOOC

One of the fastest growing approaches to teaching and learning in the new digital paradigm is the use of Massive Open Online Courses (MOOCs). They are categorised either as cMOOCs following a connectivist approach, or as xMOOCs based on behaviourist principles. However, in xMOOC environments, forums may play a real connectivist role if they are functioning as a community. This paper builds on the criteria of Herring (2004) in order to determine the existence and dynamics of a community. Forum participants, in a connectivist approach, create knowledge together by requesting help, answering questions, discussing concepts and techniques, and suggesting applications and additional learning material. This research questions the existence of a clear distinction between cMOOCs and xMOOCs. It was also observed that gender roles in STEM classes are replicated online. Online teaching nowadays is no longer based on one-way processes but includes users in multi-way processes. These dynamics may be effective in ensuring a strong and well-functioning learning community.
hzar: hybrid zone analysis using an R software package

We present a new software package (hzar) that provides functions for fitting molecular genetic and morphological data from hybrid zones to classic equilibrium cline models using the Metropolis–Hastings Markov chain Monte Carlo (MCMC) algorithm. The software applies likelihood functions appropriate for different types of data, including diploid and haploid genetic markers and quantitative morphological traits. The modular design allows flexibility in fitting cline models of varying complexity. To facilitate hypothesis testing, an autofit function is included that allows automated model selection from a set of nested cline models. Cline parameter values, such as cline centre and cline width, are estimated and may be compared statistically across clines. The package is written in the R language and is available through the Comprehensive R Archive Network (CRAN; http://cran.r-project.org/). Here, we describe hzar and demonstrate its use with a sample data set from a well‐studied hybrid zone in western Panama between white‐collared (Manacus candei) and golden‐collared manakins (M. vitellinus). Comparisons of our results with previously published results for this hybrid zone validate the hzar software. We extend analysis of this hybrid zone by fitting additional models to molecular data where appropriate.
The absence of ABCD2 sensitizes mice to disruptions in lipid metabolism by dietary erucic acid[S]

ABCD2 (D2) is a peroxisomal transporter that is highly abundant in adipose tissue and promotes the oxidation of long-chain MUFA. Erucic acid (EA, 22:1ω9) reduces very long chain saturated fatty acids in patients with X-linked adrenoleukodystrophy but promotes dyslipidemia and dilated cardiomyopathy in rats. To determine the role of D2 in the metabolism of EA, we challenged wild-type and D2 deficient mice (D2 KO) with an enriched EA diet. In D2 KO mice, dietary EA resulted in the rapid expansion of adipose tissue, adipocyte hypertrophy, hepatic steatosis, and the loss of glycemic control. However, D2 had no impact on the development of obesity phenotypes in two models of diet-induced obesity. Although there was a significant increase in EA in liver of D2 KO mice, it constituted less than 2% of all fatty acids. Metabolites of EA (20:1, 18:1, and 16:1) were elevated, particularly 18:1, which accounted for 50% of all fatty acids. These data indicate that the failure to metabolize EA in adipose results in hepatic metabolism of EA, disruption of the fatty acid profile, and the development of obesity and reveal an essential role for D2 in the protection from dietary EA.
Long‐range horizontal connections between supragranular pyramidal cells in the extrastriate visual cortex of the rat

In this study, we examined the morphological structure and synaptic physiology of long‐range axon projections among supragranular pyramidal cells in the extrastriate visual cortex of the rat. Intra‐and extracellular recordings form layer II/III pyramidal cells were performed in brain slices of area 18a following extracellular stimulation of either the underlying white matter or within layer II/III. Neurons were injected with biocytin for two‐dimensional reconstruction of their axon arborizations.
Sub-Clinical Anxiety and the Onset of Alcohol Use Disorders: Longitudinal Associations from the Baltimore ECA Follow-Up, 1981–2004

ABSTRACT The current study examines the longitudinal relationship between anxiety disorders in general, specific phobia in particular, and subsequent-onset alcohol use disorders in an adult population-based sample. In addition, the authors explore whether the hypothesized associations vary by gender. Approximately 23 years of data from the Baltimore Epidemiological Catchment Area Follow-up (N = 587) allow for the estimation of the development of incident alcohol use disorders in later life among those with anxiety disorders at the time of the baseline interview in 1981. Although baseline specific phobias were common, neither the number of fears nor any specific fear was statistically associated with the onset of alcohol use disorders. Rather, the findings suggested a modest association between adult sub-clinical specific phobia (without substantial distress or interference) and later-onset alcohol use disorders (odds ratio = 3.2). Moreover, the authors found that this association might be stronger for women than for men.
Factors Promoting and Hindering Performance of Unit Nurse Managers at Kamuzu and Queen Elizabeth Central Hospitals in Malawi

Unit nurse managers in Malawi experience many challenges in the course of performing their roles. This affects their performance and service delivery including the quality of nursing care to patients. This study was conducted to determine the factors that hindered performance of unit managers in relation to expected quality of nursing services at two referral facilities (Kamuzu and Queen Elizabeth Central hospitals) in Malawi. These two central hospitals have the same structural settings and both offer specialized tertiary health services. A quantitative descriptive design was used to guide the planning and implementation of the study. Purposive sampling was used to select the two major hospitals in Malawi and all available 37 unit nurse managers during the time of the study at the two hospitals participated in the study. Data were collected using semi-structured questionnaires after seeking consent from the participants and were analyzed using SPSS version 16.0. The major roles identified by the unit managers were supervision (75.6%, n = 28) and coordination (70.3%, n = 26). Other roles such as team leader, liaison officer, research allocator, monitor and facilitator were rated by very few participants. Findings of the study showed that performance of unit nurse managers was affected by inadequate material (86.4%, n = 32) and human resources (94.5%, n = 35) and lack of managerial skills (5.4%, n = 2). In addition, the unit managers perceived their role to be stressful (38.9%, n = 14) and challenging (47.2%, n = 17). Therefore, there is a need to provide adequate material and human resources to the wards of the two central hospitals to enable the unit managers perform their duties efficiently.
Histologic, Histochemical, and Ultrastructural Analysis of Soft Tissues from Cleft and Normal Lips

The cause of cleft lip remains speculative. The nature and extent of pathophysiologic changes in cleft lip muscle are controversial. This study was undertaken to better understand the developmental processes at work. There were two groups of patients. In group 1, 40 fresh tissue specimens were taken from 22 patients who were 2 to 5 months old—their age at the time of their primary cleft lip repair. In group 2, eight control specimens were collected from six children who were seen in the emergency department with lip lacerations. Fresh specimens fixed in neutral buffered formalin were evaluated by the use of hematoxylin and eosin with Luxol fast blue, Bielschowsky, and Masson trichrome stains. Fresh frozen tissue was histochemically assessed by the use of hematoxylin and eosin, modified Gomori trichrome, and adenosine triphosphatase. Ultrastructural analysis was performed on fine sections of glutaraldehyde‐fixed tissue. Histologic examination revealed increased endomysial and perimysial collagen in cleft specimens with evidence of muscle‐bundle size variation and nonneurogenic atrophy. Insignificant differences were observed between cleft‐side and noncleftside specimens when the means of 200 counts of neuraltissue bundles in the subdermis were compared (p = 0.093). Histochemical examination revealed no typical checkerboard pattern, but a preponderance of type 2 fiber was seen. By means of electron microscopy, increased numbers of subsarcolemmal mitochondria were found in cleft, noncleft, and control specimens. Increased absolute numbers of mitochondria and variations in size, shape, and crystal arrangement were identified. In conclusion, there is no evidence of deficient neural supply in the cleft lip. There is also no evidence of neurogenic muscle atrophy or a metabolic abnormality. There are characteristic myopathic changes. These, in concert with the observed interstitial fibrosis, may have far‐reaching implications for growth and function. (Plast. Reconstr. Surg. 108: 605, 2001.)
Effect of long-term treatment with propionyl-L-carnitine on smooth muscle cell polyploidy in spontaneously hypertensive rats.

Experimental studies suggest that DNA content is increased in the smooth muscle cells of the arteries of hypertensive animals. It is unclear whether an increase in DNA content occurring in the smooth muscle cells of hypertensive rats represents a pressure-dependent effect. To evaluate the antihypertensive effect of long-term treatment with propionyl-L-carnitine and the possible morphological changes in thoracic smooth muscle cells correlated with this effect, we studied 4-month-old spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY) randomly divided into five groups. One group of SHR was treated with propionyl-L-carnitine for 12 months; the other four groups of SHR and WKY received no treatment and were controls. We used static and flow cytometry to evaluate the polyploid cell content in thoracic aorta smooth muscle cells. Systolic pressure in untreated SHR progressively increased during the experiment. Treatment did not significantly influence pressure values in SHR. In WKY, blood pressure was significantly lower than that in treated and untreated age-matched SHR (2P < .02). The number of polyploid smooth muscle cells was significantly lower in the propionyl-L-carnitine-treated SHR than in the untreated rats (2P < .04) and similar to values for WKY. The reduction of polyploid cells in treated SHR was paralleled by a significant decrease of the aortic total DNA content, whereas no modifications occurred in smooth muscle cell mass. Long-term treatment with propionyl-L-carnitine may interfere with cellular mechanisms regulating the secondary responses involved in DNA synthesis.
Characteristics and molecular basis of celecoxib modulation on Kv7 potassium channels

Celecoxib is a selective cyclooxygenase‐2 (COX‐2) inhibitor used for the treatment of pain and inflammation. Emerging and accumulating evidence suggests that celecoxib can affect cellular targets other than COX, such as ion channels. In this study, we characterized the effects of celecoxib on Kv7 K+ channels and compared its effects with the well‐established Kv7 channel opener retigabine.
The Effect of an Electronic Checklist on Critical Care Provider Workload, Errors, and Performance

Purpose: The strategy used to improve effective checklist use in intensive care unit (ICU) setting is essential for checklist success. This study aimed to test the hypothesis that an electronic checklist could reduce ICU provider workload, errors, and time to checklist completion, as compared to a paper checklist. Methods: This was a simulation-based study conducted at an academic tertiary hospital. All participants completed checklists for 6 ICU patients: 3 using an electronic checklist and 3 using an identical paper checklist. In both scenarios, participants had full access to the existing electronic medical record system. The outcomes measured were workload (defined using the National Aeronautics and Space Association task load index [NASA-TLX]), the number of checklist errors, and time to checklist completion. Two independent clinician reviewers, blinded to participant results, served as the reference standard for checklist error calculation. Results: Twenty-one ICU providers participated in this study. This resulted in the generation of 63 simulated electronic checklists and 63 simulated paper checklists. The median NASA-TLX score was 39 for the electronic checklist and 50 for the paper checklist (P = .005). The median number of checklist errors for the electronic checklist was 5, while the median number of checklist errors for the paper checklist was 8 (P = .003). The time to checklist completion was not significantly different between the 2 checklist formats (P = .76). Conclusion: The electronic checklist significantly reduced provider workload and errors without any measurable difference in the amount of time required for checklist completion. This demonstrates that electronic checklists are feasible and desirable in the ICU setting.
Blood–brain barrier opening with alkylglycerols: Biodistribution of 1-O-pentylglycerol after intravenous and intracarotid administration in rats

Short-chain alkylglycerols have been described to increase the penetration of drugs and macromolecules across the blood–brain barrier (BBB) into the central nervous system (CNS) and were considered to be of potential value in the pharmaceutical treatment of CNS disorders. Due to the lack of information on the pharmacological behavior of these compounds in vivo, pharmacokinetics and biodistribution of [14C]- and [3H]-labeled 1-O-pentylglycerol (49 mg/kg, 100 mM) was investigated in normal male Wistar rats after intravenous as well as intracarotid administration. There was a rapid and predominant renal elimination of 1-O-pentylglycerol and more than 70% of administered dose was found in the urine within 270 min. Analysis of the pharmacokinetic parameters after a single i.v. bolus injection of 1-O-pentylglycerol resulted in a peak blood concentration of 0.58±0.06 μmol/ml, an initial half life of 23±7 min and a terminal half life of 18.8±4.1 h. No accumulation of 1-O-pentylglycerol was observed in the brain or other organs while highest concentrations were found in liver and thymus. This was confirmed by autoradiographic studies. Five minutes after intracarotid administration, high radioactivity was found in the ipsilateral brain, whereas after 30 min radioactivity in the brain has dramatically decreased. Autoradiographic images gave evidence of biliary excretion in addition to the renal elimination. There were no signs of cleavage of the O-alkyl bond in vivo as demonstrated by HPLC analysis. In conclusion, 1-O-pentylglycerol is characterized by pharmacological properties appearing very favorable for in vivo use as a permeabilizing drug for increased drug delivery to the brain.
The link among nitric oxide synthase activity, endothelial function, and aortic and ventricular hypertrophy in hypertension.

The adaptive changes that occur in the left ventricle (LV) and vessels in response to hypertension, namely, muscle hypertrophy/hyperplasia, endothelial dysfunction, and extracellular matrix increase, do not depend solely on blood pressure elevation. These changes are in fact, maladaptive since they are forerunners of cardiac failure, stroke, and renal failure. Nitric oxide, an endogenous vasodilator and inhibitor of vascular smooth muscle cell growth, is synthesized in the endothelium by constitutive nitric oxide synthase (cNOS). We investigated the relationships among LV and aortic cNOS activity (conversion of [14C] L-arginine to [14C] L-citrulline), with LV hypertrophy (LV weight/body weight), and (2) aortic hypertrophy (aortic weight/ length) in spontaneously hypertensive rats (SHR) and Dahl salt-sensitive (DS) rats matched for blood pressure (219 +/- 12 versus 211 +/- 7 mm Hg, P = NS) and age. Compared with their normotensive counterparts, aortic cNOS activity was increased 106% in SHR but reduced by 73% in DS rats. The correlation between blood pressure and aortic cNOS activity was positive (r = .74, P < .01) in SHR and negative (r = -.82, P < .01) in DS rats, LV cNOS activity was increased 73% in SHR compared with normotensive Wistar-Kyoto rats (P < .01). On the other hand, LV cNOS activity was not increased in hypertensive DS rats compared with normotensive DS rats. In SHR, aortic hypertrophy did not increase significantly and LV hypertrophy increased only 15%, whereas in hypertensive DS rats the aorta and LV hypertrophied 36% and 88%, respectively (both P < .01). Moreover, in DS rats there was a negative correlation between cNOS activity and aortic hypertrophy (r = -.70, P < .01). In DS rats, antihypertensive therapy consisting of an angiotensin-converting enzyme inhibitor, perindopril, and a diuretic, indapamide, normalized blood pressure, aortic cNOS activity, and LV hypertrophy and reduced aortic hypertrophy. Our studies imply that upregulation of vascular cNOS activity has a protective cardiovascular homeostatic role in hypertension. Clinically, the variable end-organ disease observed in individuals with similar severity of hypertension may be explained, at least in part, by genetically conditioned differences in vascular cNOS activity in response to hypertension.
Where are we on the diffusion curve? Trends and drivers of primary care physicians' use of health information technology.

OBJECTIVE To describe trends in primary care physicians' use of health information technology (HIT) between 2009 and 2012, examine practice characteristics associated with greater HIT capacity in 2012, and explore factors such as delivery system and payment reforms that may affect adoption and functionality. DATA We used data from the 2012 and 2009 Commonwealth Fund International Health Policy Surveys of Primary Care Physicians. The data were collected in both years by postal mail between March and July among a nationally representative sample of primary care physicians in the United States. STUDY DESIGN We compared primary care physicians' HIT capacity in 2009 and 2012. We employed multivariable logistic regression to analyze whether participating in an integrated delivery system, sharing resources and support with other practices, and being eligible for financial incentives were associated with greater HIT capacity in 2012. PRINCIPAL FINDINGS Primary care physicians' HIT capacity has significantly expanded since 2009, although solo practices continue to lag. Practices that are part of an integrated delivery system or share resources with other practices have higher rates of electronic medical record (EMR) adoption, multifunctional HIT, electronic information exchange, and electronic access for patients. Receiving or being eligible for financial incentives is associated with greater adoption of EMRs and information exchange. CONCLUSIONS Federal efforts to increase adoption have coincided with a rapid increase in HIT capacity. Delivery system and payment reforms and federally funded extension programs could offer promising pathways for further diffusion.