Miracle-dz/UniFAR-FTUs huggingface dataset:
Newly qualified doctors’ views on the significance and accessibility of career advice during medical training in Saudi Arabia

Background: Career advice is an important instrument to help students with the proper specialty selection. The study aims (1) to explore the views of newly graduated doctors in Saudi Arabia about their experience with the current status of career support system during medical training and (2) to identify cross-cultural similarities and differences. Methods: A cross-sectional design study was conducted using a questionnaire to elicit the responses of participants from newly qualified doctors concerning the availability and significance of career advice. SPSS (version 11.0; Chicago, IL) was used to analyze the data and statistical tests, such as chi-square and unpaired t tests, were used to analyze the observations. Results: A response rate of 94.7% was obtained. Among this group, 102 were males and 78 were females. Only 53% did receive career advice. The majority of men felt that career advice during medical studies was inadequate, while women were less negative (69% versus 32%; p = 0.0001). Furthermore, men were more disappointed about the possibilities for career advice after graduating than women (34% versus 13%, p = 0.0001). Conclusions: The results show that only half of newly graduated doctors had received any career advice during medical training. As the health care system cannot afford the potential waste of time and resources for doctors, career guidance should begin in undergraduate training so that the process of thinking about their future career starts longtime before they make their career choice.
Writing a manuscript for publication : informing advanced practice nurses about routine screening for intimate partner violence in rural health care settings

Millions of women in the United States experience intimate partner violence (IPV) which can lead to devastating physical and psychological problems. Intimate partner violence is the leading cause of injury to women of childbearing years. Approximately 1200 women are murdered every year by their husband or boyfriend. Children who witness IPV are 3 times more likely to be abused than children who do not witness IPV. The economic burden to the individual and society as a whole are enormous. Despite endorsements by several health care and professional organizations, only 10% of healthcare providers screen for IPV routinely. The Centers for Disease Control and Prevention (CDC) estimates the costs of IPV to society are over 8 billion dollars each year. Advanced Practice Nurses (APNs) working in rural primary care settings face unique challenges to routine screening for IPV including geographical and social isolation, limited IPV resources, and a culture that values self-reliance and may normalize IPV. The purpose of this project is to write a manuscript that is suitable for publication which will identify strategies for the successful implementation of routine IPV screening in rural primary care settings.
High blood pressure and its association with obesity among preuniversity college students of Udupi taluk

Background: There is an evidence of tracking of high blood pressure (BP) from childhood to adulthood. Hence detection, assessment, and management of high BP are important. Objectives: To estimate the proportion of adolescents of Udupi taluk having high BP and to assess the association of high BP with overweight/obesity and other correlates. Materials and Methods: A cross-sectional study was carried out among 838 adolescents studying in preuniversity colleges (PUCs) of Udupi taluk. Of the 49 PUCs of Udupi taluk, 15 PUCs were randomly chosen and one class from each was taken as a cluster. A pretested and structured questionnaire, based on World Health Organization Stepwise approach was used. Weight, height, and BP were measured using standardized tools. Data were analyzed using Statistical Package for the Social Sciences, version 15.00. Pearson’s correlation and univariate and multiple logistic regressions were used to analyze the data. Results: The prevalence of high BP and overweight/obesity was found to be 23.05% and 9.18%, respectively. High BP was positively correlated with overweight/obesity. Being a male, currently consuming alcohol, and being overweight/obese were the risk factors associated with high systolic BP and factor associated with high diastolic BP was overweight/obesity. Conclusion: The proportion of respondents having high BP as well as overweight/obesity was found to be high. As high BP was found to be strongly associated with overweight/obesity in this study, we recommend screening of BP to be carried out both in children and adolescents and the inclusion of sports hours in their curriculum.
Genetic Variation in SP-A2 Leads to Differential Binding to Mycoplasma pneumoniae Membranes and Regulation of Host Responses

Mycoplasma pneumoniae is an extracellular pathogen that colonizes mucosal surfaces of the respiratory tract and is associated with asthma exacerbations. Previous reports demonstrate that surfactant protein-A (SP-A) binds live M. pneumoniae and mycoplasma membrane fractions (MMF) with high affinity. Humans express a repertoire of single–amino acid genetic variants of SP-A that may be associated with lung disease, and our findings demonstrate that allelic differences in SP-A2 (Gln223Lys) affect the binding to MMF. We show that SP-A−/− mice are more susceptible to MMF exposure and have significant increases in mucin production and neutrophil recruitment. Novel humanized SP-A2–transgenic mice harboring the hSP-A2 223K allele exhibit reduced neutrophil influx and mucin production in the lungs when challenged with MMF compared with SP-A−/− mice. Conversely, mice expressing hSP-A2 223Q have increased neutrophil influx and mucin production that are similar to SP-A−/− mice. Using tracheal epithelial cell cultures, we show that enhanced mucin production to MMF occurs in the absence of SP-A and is not dependent upon neutrophil recruitment. Increased phosphorylation of the epidermal growth factor receptor (EGFR) was evident in the lungs of MMF-challenged mice when SP-A was absent. Pharmacologic inhibition of EGFR prior to MMF challenge dramatically reduced mucin production in SP-A−/− mice. These findings suggest a protective role for SP-A in limiting MMF-stimulated mucin production that occurs through interference with EGFR-mediated signaling. SP-A interaction with the EGFR signaling pathway appears to occur in an allele-specific manner that may have important implications for SP-A polymorphisms in human diseases.
Decision-making bias in assessment: The effect of aggregating objective information and anecdote

Introduction: Assessment decisions increasingly rely on synthesis of information from a variety of sources. It is known that aggregation of information to make decisions is open to a number of biases. The aim of this research was to investigate bias, accuracy and confidence of assessment decision making. Methods: The participants were consultation skills assessors. A model for incremental information was developed with participants being shown results from purposefully selected, but authentic, data from the University's final summative 10-station Objective Structured Clinical Examination (OSCE). After each piece of information, participants gave a pass-fail decision and their confidence in that choice. Following the information from 10 OSCE stations the participants were given a discordant fictional anecdote and again participants gave a pass-fail decision and their confidence. Results: When there is overwhelming evidence to support a pass or fail, participants were not as confident as the data would support. Participants were less confident to make a fail decision than a pass. Despite considerable evidence from multiple results some participants altered decisions based on isolated contradictory information from an anecdote. Discussion: These findings are significant in understanding decision-making. Given equivalent levels of evidence, decision makers are less confident to fail than pass and less robust information can undermine more robust information.
Amino Acid Metabolism Inhibits Antibody-Driven Kidney Injury by Inducing Autophagy

Inflammatory kidney disease is a major clinical problem that can result in end-stage renal failure. In this article, we show that Ab-mediated inflammatory kidney injury and renal disease in a mouse nephrotoxic serum nephritis model was inhibited by amino acid metabolism and a protective autophagic response. The metabolic signal was driven by IFN-γ–mediated induction of indoleamine 2,3-dioxygenase 1 (IDO1) enzyme activity with subsequent activation of a stress response dependent on the eIF2α kinase general control nonderepressible 2 (GCN2). Activation of GCN2 suppressed proinflammatory cytokine production in glomeruli and reduced macrophage recruitment to the kidney during the incipient stage of Ab-induced glomerular inflammation. Further, inhibition of autophagy or genetic ablation of Ido1 or Gcn2 converted Ab-induced, self-limiting nephritis to fatal end-stage renal disease. Conversely, increasing kidney IDO1 activity or treating mice with a GCN2 agonist induced autophagy and protected mice from nephritic kidney damage. Finally, kidney tissue from patients with Ab-driven nephropathy showed increased IDO1 abundance and stress gene expression. Thus, these findings support the hypothesis that the IDO–GCN2 pathway in glomerular stromal cells is a critical negative feedback mechanism that limits inflammatory renal pathologic changes by inducing autophagy.
Periodontal Disease as a Risk Factor for Preeclampsia

Background: Preeclampsia is a unique idiopathic syndrome in human pregnancy that can involve almost all organ systems. Objectives: The aim of the present study was to compare the periodontal diseases between the preeclamptic and normal pregnant women in order to find a possible risk factor relationship. Materials and Methods: This case-control study was performed on 200 pregnant women, with maternal age ≤ 35 years and gestational age ˃ 20 weeks with singleton pregnancies. Of these, 100 women were preeclamptic with proteinuria and blood pressure ≥ 140/90 and 100 women with normal blood pressure in the control group. Oral examination was performed on all women by a dentist for detection of periodontal diseases. Gingivitis and periodontitis were diagnosed based on the American Academy of Periodontology (AAP)/American Dental Association (ADA) classification, using the measurement method of Ramfjord. The preeclamptic women were then sub-classified into mild and moderate and comparisons were made between all groups. Results: The mean maternal age, BMI, neonatal birth weights and gestational age at delivery were not significantly different between the preeclamptic and normal groups. There was a significant association between preeclampsia and periodontal diseases (P ˂ 0.01). The mean number of involved teeth (P ˂ 0.001) and the mean pocket depth (P = 0.04) were higher among the preeclamptic group. Gingivitis was more frequent among the cases with mild (56.8%) compared to (31.6%) in the severe preeclamptic group (P = 0.04). Periodontitis was more prevalent among the cases with severe preeclampsia which was not statistically significant. The mean neonatal birth weight was significantly lower in the group with severe preeclampsia (P < 0.01). Conclusions: There was a significant association between preeclampsia and periodontal diseases. The number of involved teeth and pocket depth were higher among the preeclamptic mothers compared to normal pregnant women.
Antagonizing Peroxisome Proliferator–Activated Receptor α Activity Selectively Enhances Th1 Immunity in Male Mice

Females exhibit more robust Th1 responses than males. Our previous work suggested that this sex disparity is a consequence of higher activity of the androgen-induced gene peroxisome proliferator–activated receptor α (PPARα) in male CD4+ T cells. The objective of this study was to elucidate the cellular and molecular mechanism of how PPARα inhibits Th1 responses in male mice. In this study, we found that PPARα functions within CD4+ and CD8+ T lymphocytes and NKT cells to negatively regulate IFN-γ responses in male mice and identified Ifng as the gene target of PPARα repression. Treatment of male CD4+ T cells with the PPARα agonist fenofibrate induced the recruitment of PPARα and the nuclear receptor-interacting protein, nuclear receptor corepressor 1, to specific cis-regulatory elements in the Ifng locus. This recruitment associated with reduced histone acetylation at these sites. Knockdown of nuclear receptor corepressor 1 in primary male T cells abolished the effect of fenofibrate in reducing IFN-γ production. In contrast, treatment of male T cells with IS001, a novel antagonist of PPARα, increased Ifng gene expression and histone acetylation across the Ifng locus. Finally, we investigated the effects of IS001 on IFN-γ responses in mice during infection with the Th1-associated pathogen Listeria monocytogenes and observed that IS001 enhanced IFN-γ production by NKT, CD4+, and CD8+ T cells and improved the survival of male, but not female, mice. Our findings provide a novel mechanism of why IFN-γ responses are more robust in females and introduce a small-molecule IS001 that can be used to enhance Th1 immunity in males.
Selective Targeting of a Disease-Related Conformational Isoform of Macrophage Migration Inhibitory Factor Ameliorates Inflammatory Conditions

Macrophage migration inhibitory factor (MIF), a proinflammatory cytokine and counterregulator of glucocorticoids, is a potential therapeutic target. MIF is markedly different from other cytokines because it is constitutively expressed, stored in the cytoplasm, and present in the circulation of healthy subjects. Thus, the concept of targeting MIF for therapeutic intervention is challenging because of the need to neutralize a ubiquitous protein. In this article, we report that MIF occurs in two redox-dependent conformational isoforms. We show that one of the two isoforms of MIF, that is, oxidized MIF (oxMIF), is specifically recognized by three mAbs directed against MIF. Surprisingly, oxMIF is selectively expressed in the plasma and on the cell surface of immune cells of patients with different inflammatory diseases. In patients with acute infections or chronic inflammation, oxMIF expression correlated with inflammatory flare-ups. In addition, anti-oxMIF mAbs alleviated disease severity in mouse models of acute and chronic enterocolitis and improved, in synergy with glucocorticoids, renal function in a rat model of crescentic glomerulonephritis. We conclude that oxMIF represents the disease-related isoform of MIF; oxMIF is therefore a new diagnostic marker for inflammation and a relevant target for anti-inflammatory therapy.
Granzyme B–Mediated Activation-Induced Death of CD4+ T Cells Inhibits Murine Acute Graft-versus-Host Disease

Granzyme B (GzmB) has previously been shown to be critical for CD8+ T cell–mediated graft-versus-host disease (GVHD) but dispensable for GVHD mediated by CD4+ T cells. However, previous studies used high doses of CD4+ T cells in MHC-mismatched models that caused rapid and lethal GVHD. Because of the hyperacute lethality, it is possible that the role of GzmB was concealed by the system. Therefore, in this study, we have titrated down the T cell dose to precisely determine the contribution of GzmB in GVHD mediated by CD4+CD25– T cells. Surprisingly, we have found that GzmB−/−CD4+CD25– T cells cause more severe GVHD compared with wild-type CD4+CD25– T cells in both MHC-matched and mismatched models. Mechanistic analyses reveal that although GzmB does not affect donor T cell engraftment, proliferation or tissue-specific migration, GzmB−/− CD4+CD25– T cells exhibit significantly enhanced expansion because of GzmB-mediated activation-induced cell death of wild-type CD4+CD25– T cells. As a result of enhanced expansion, GzmB−/− T cells produced higher amounts of proinflammatory cytokines (e.g., TNF-α and IFN-γ) that may contribute to the exacerbated GVHD. These results reveal that GzmB diminishes the ability of CD4+ T cells to cause acute GVHD, which contradicts its established role in CD8+ T cells. The differential roles suggest that targeting GzmB in selected T cell subsets may provide a strategy to control GVHD.
A Clinicopathological Study of Urinary Bladder Neoplasms in Patients at Three Centers in Khartoum, Sudan

OBJECTIVES: To present the histopathological pattern of urinary bladder neoplasms using the WHO/ISUP classification system and relate it to the outcome.METHODS: This study was conducted in the period from January 2004 through December 2005 at three centres in Khartoum, Sudan. One hundred and six patients with urinary bladder neoplasms were included in the study.RESULTS: The commonest affected age group was 60-80 years with male to female ratio 4.6:1. Urothelial neoplasms were found in 72 (67.9%), Squamous cell carcinoma (SCC) in 26 (24.5%), urothelial neoplasms with Squamous differentiation in 3 (2.8%), and other types in 5 (4.7%) of thepatients. There were 43.4% of the urothelial neoplasms graded as papillary carcinoma of high grade, 52.6% papillary carcinoma of low grade, 1.3% papillary neoplasm of low malignant potential, 1.3% papilloma, and 1.3% was graded as flat neoplasm. Of the SCCs, twelve (42.9%)were poorly differentiated SCCs, nine (32.1%) moderately differentiated, and seven (25%) cases were well differentiated SCCs. Follow-up information was available in 32 patients. At last followup, fifteen (46.9%) patients were dead of the disease, twelve (35.5%) were alive with no evidence of disease, four (12.5%) were alive with disease, and one (3.1%) was alive and terminally ill. CONCLUSION: Histological grade (P: 0.006), and muscle invasion (P: 0.002) were significantly associated with survival. A subset of the cases could not be assessed for muscle invasion due toinadequate sampling; we thus recommend proper trans-urethral bladder biopsy (TUBP) sampling.Key words: Urinary bladder neoplasm; Papillary carcinoma; Squamous cell carcinoma; WHO/ISUP classification system
Students’ and junior doctors’ preparedness for the reality of practice in sub-Saharan Africa

Abstract Background: Evidence tailored to sub-Saharan Africa on outcomes of innovations in medical education is needed to encourage and advance their implementation in this region. Aim: To investigate preparedness for practice of students and graduates from an innovative and a conventional medical curriculum in a sub-Saharan African context. Methods: Using mixed methods we compared junior doctors and fifth-year students from two Mozambican medical schools: one with an innovative problem- and community-based curriculum and one with a conventional lecture- and discipline-based curriculum. A questionnaire on professional competencies was administered, semi-structured interviews were conducted, and work diaries were collected. The findings were integrated in a conceptual model. Results: Six areas of tension between global health care ideals and local health care practice emerged from the data that challenged doctors’ motivation and preparedness for practice. Four elements of the innovative curriculum equipped students and graduates with skills, attitudes and competencies to better cope with these tensions. Students and graduates from the innovative curriculum rated significantly higher levels on various competencies and expressed more satisfaction with the curriculum and its usefulness for their work. Conclusion: An innovative problem- and community-based curriculum can improve sub-Saharan African doctors’ motivation and preparedness to tackle the challenges of health care practice in this region.
Observations on diseases of the central nervous system of sheep in New Zealand.

Abstract Extract The purpose of this paper is to describe the salient features of the neurological conditions seen in sheep in New Zealand which are associated with changes in the central nervous system. Several of the conditions associated with perinatal mortality will be mentioned only briefly in this paper as the details will be included in a subsequent paper on ovine perinatal mortality. Some of the entities to be described have been reported before and are reviewed. Others are described here for the first time.
UNC-45A Is a Nonmuscle Myosin IIA Chaperone Required for NK Cell Cytotoxicity via Control of Lytic Granule Secretion

NK cell’s killing is a tightly regulated process under the control of specific cytoskeletal proteins. This includes Wiskott–Aldrich syndrome protein, Wiskott–Aldrich syndrome protein–interacting protein, cofilin, Munc13-4, and nonmuscle myosin IIA (NMIIA). These proteins play a key role in controlling NK-mediated cytotoxicity either via regulating the attachment of lytic granules to the actin-based cytoskeleton or via promoting the cytoskeletal reorganization that is requisite for lytic granule release. UNC-45A is a highly conserved member of the UNC-45/CRO1/She4p family of proteins that act as chaperones for both conventional and nonconventional myosin. Although we and others have shown that in lower organisms and in mammalian cells NMIIA-associated functions, such as cytokinesis, cell motility, and organelle trafficking, are dependent upon the presence of UNC-45A, its role in NK-mediated functions is largely unknown. In this article, we describe UNC-45A as a key regulator of NK-mediated cell toxicity. Specifically we show that, in human NK cells, UNC-45A localize at the NK cell immunological synapse of activated NK cells and is part of the multiprotein complex formed during NK cell activation. Furthermore, we show that UNC-45A is disposable for NK cell immunological synapse formation and lytic granules reorientation but crucial for lytic granule exocytosis. Lastly, loss of UNC-45A leads to reduced NMIIA binding to actin, suggesting that UNC-45A is a crucial component in regulating human NK cell cytoskeletal dynamics via promoting the formation of actomyosin complexes.
Thirty years of illness scripts: Theoretical origins and practical applications

Abstract Aim: This study describes the introduction and spread of the concept of “illness script” in the medical education literature. Method: First, I will concisely discuss the development of the “script” concept in the general psychological literature and the results of the studies performed to provide it with the necessary empirical basis. Next, I will sketch how “scripts” entered the medical domain via efforts to develop diagnostic systems in the field of artificial intelligence. Subsequently, I will describe how the illness script concept was elaborated and specified by medical educators and educational researchers. Results and discussion: The illness script concept has solid underpinnings and can be used to elucidate aspects of medical expertise development. It can also be used to formulate recommendations for clinical teaching and has yielded a specific test, the Script Concordance Test.
Hospital separations due to traumatic brain injury, Australia 2004-05

This report describes hospitalisations for Traumatic Brain Injury (TBI) in Australia for the period 2004-2005. TBI, as distinct from head injury, is characterised by an external impact to the head that results in damage to the brain. TBI is defined in this report by the presence in hospital separation records of at least one ICD-10-AM code in the S06 intracranial injury range occurring in at least one of fifty available diagnosis fields. The 22,710 records meeting this criterion were analysed in three groups, according to the prominence of TBI in the record. Analysis and description of combinations of injury types resulting in TBI admissions to a hospital are reported, including discussion of severity of injury, and cost and burden on the systems for acute care and rehabilitation. About 980 (4.3% of cases) deaths in hospital were reported. Direct costs for hospital care for TBI separations were estimated to be more than $184 million. http://www.nisu. flinders.edu. au/pubs/reports/2008/injcat116.php Language: en