Miracle-dz/UniFAR-FTUs huggingface dataset:
Pharmacogenomics and therapeutic strategies for dementia

Recent advances in genomic medicine have contributed to the acceleration of our understanding regarding the pathogenesis of dementia, improving diagnostic accuracy with the introduction of novel biomarkers and personalizing therapeutics with the incorporation of pharmacogenetic and pharmacogenomic procedures to drug development and clinical practice. Most neurodegenerative disorders, including Alzheimer’s disease (AD), share some common features, such as a genomic background in which hundreds of genes might be involved, genome–environment interactions, complex pathogenic pathways, poor therapeutic outcomes and chronic disability. The main aim of a cost-effective treatment is to halt disease progression via modification of the functional cascade involving AD genomics, transcriptomics, proteomics and metabolomics. Unfortunately, the drugs available for the treatment of dementia are not cost effective. The pharmacological treatment of dementia accounts for 10–20% of direct costs, and fewer than 20% of the patients are moderate responders to conventional drugs, some of which may cause important adverse drug reactions. Future antidementia drugs must address the complex pathogenic niche of the disease from a multifactorial perspective. Pharmacogenetic and pharmacogenomic factors may account for 60–90% of drug variability in drug disposition and pharmacodynamics. In addition to antidementia drugs, patients with AD or with other forms of dementia need concomitant medications for the treatment of diverse disorders of the CNS associated with progressive brain dysfunction. Approximately 60–80% of drugs acting on the CNS are metabolized via enzymes of the CYP gene superfamily, and 10–20% of Caucasians are carriers of defective CYP2D6 polymorphic variants that alter the metabolism of many psychotropic agents. Only 26% of the patients are pure extensive metabolizers for the trigenic cluster integrated by allelic variants of the CYP2D6, CYP2C19 and CYP2C9 in combination. Although many genes have been suggested to be associated with AD, with the exception of APOE, most polymorphic variants of potential risk exhibit a very weak association with AD. APOE-4/4 carriers exhibit a dramatic biological disadvantage in comparison with other genotypes, and AD patients harboring this homozygous condition are the worst responders to conventional drugs. The incorporation of pharmacogenetic/pharmacogenomic protocols into AD research and clinical practice can foster the optimization of therapeutics by helping to develop cost-effective biopharmaceuticals and improving drug efficacy and safety.
Adolescents Who Use the Emergency Department as Their Usual Source of Care

Objective To examine the factors associated with use of the emergency department (ED) as the only source of health care among adolescents. Design Analyses of the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, a nationally representative sample of 6748 in-school male and female adolescents in 5th through 12th grade. The χ 2 statistics and logistic regression analyses were computed with the use of SUDAAN. Results Overall, 4.6% of the adolescents in the survey, or 1.5 million adolescents in the United States, reported that the ED was their usual source of health care. In multivariate models, factors associated with the use of the ED included male sex, African American ethnicity, fewer financial resources, and living in a rural area. Adolescents with higher levels of risky behaviors, a history of physical or sexual abuse, and higher depression scores were all more likely to use the ED as their usual source of care. Adolescents who reported using the ED as their usual care source were also less likely to have had regular well visits and were more likely to report having missed needed care than those with other sources of primary care. Conclusions Adolescents who use the ED as their usual source of care are often from vulnerable populations. Many have special mental or physical needs that are unlikely to be met with ED visits only, and they are likely to have missed care they needed. Creating linkages between EDs and other services could help at-risk adolescents identify and use more appropriate sources of primary care.
A qualitative study exploring practice nurses’ experience of participating in a primary care–based randomised controlled trial

Abstract The aim of this study is to explore the views of practice nurses’ recruiting into a primary care–based randomised controlled trial, and to investigate factors that influence the success of trial recruitment. It is known that time pressures, forgetfulness and lack of interest in the research topic negatively influence recruitment into research trials by General Practitioners (GPs), but no studies appear to have explored practice nurses’ experience of recruiting into trials. Semi-structured telephone interviews were conducted with a non-random purposive sample of 10 practice nurses who had participated in recruiting patients for the trial, and data were analysed using a thematic framework approach. Nurses who had been asked to take part in the study found it a positive experience, and had decided to take part because the area of research was of interest and could potentially benefit patients. Nurses who had been delegated the role of recruitment by the GP felt put upon and recruited less well. None of the nurses reported difficulties remembering to recruit patients and developed useful strategies to aid memory. Nurses often acted as gatekeepers, selecting which patients they offered the intervention to. Nurses with dedicated time for research recruited more successfully. For nurses who recruited during routine consultation, it was often the patient’s lack of interest in taking part in the trial, rather than time limitations that hindered recruitment. Overall, nurses were positive about recruiting into the trial, particularly if the research area could benefit patients and if directly asked to take part.
Perceived Competency, Frequency, Training Needs in Physical Assessment among Registered Nurses

Purpose: The purpose of this study was to identify registered nurses learning needs about physical assessment. Specifically, what are the perceived competency, frequency of skill use and the unmet training needs. Methods: The study was an exploratory survey study. The sample was 104 registered nurses. Data were collected through three instruments: The Perceived Competency in Physical Assessment Scale, the Frequency of Physical Assessment Scale, and the Training Needs of Physical Assessment Scale which incorporated 30 core physical assessment skills. Descriptive statistics, t-test, and Pearson’s correlation coefficient were used to analyze the data. Results: Auscultation of heart and lung sounds and inspection of the spine were rated by the subjects as physical assessment skills they feel least competent and also were less frequently performed. The most competent area for physical assessment was neurological system. The respiratory and abdominal system was identified as two systems that more education would be needed. Nurses with less than one year of working experience reported needing more training. Nurses with more than five years of clinical work experience performed physical assessment more frequently than nurses with less than five year of work experience. The perceived competency was positively related to the frequency of physical assessment. Conclusion: Continuing education is necessary to further train registered nurses regarding physical assessment skills and the program needs to be focused on the area which nurses are less competent for and have high training need.
Hospitality spaces, hospitable moments: consumer encounters and affective experiences in commercial settings

This paper examines the production of hospitable experiences within consumer encounters in commercial hospitality spaces. It considers the different dimensions or forms of hospitality and distinguishes between the offer of food, drink, shelter and entertainment within commercial transactions, the offer of hospitality as a means of achieving social or political goals, and meta-hospitality – temporary states of being that are different from the rational manifestations of hospitality. It is argued that meta-hospitality is tied to communitesque moments – short-lived emotional bonds that may be built or experienced through hospitality transactions. A case study is used to identify three factors that shape the development of communitesque experiences – the ecology in which it occurs, the participants' roles and their capabilities.
Facet denervation in the management of back and sciatic pain.

: Back pain, with or without sciatic radiation, may come from a number of anatomical sites. Radiofrequency facet denervation suggests that a majority of patients seem to have pain referred from distress of the facet joints or the sacro-iliac joints. In those patients who are properly selected and have not had previous surgical treatment, radiofrequency denervation of the appropriate facet joints yields partial to total relief of pain in 82% of cases. The technique for doing this procedure and for selection of patients must be followed very closely but in over 800 patients surveyeyed for this report no neurologic complications have been reported. Facet denervation, when indicated, is proposed as a safe alternative to either chemonucleolysis or surgery.
Assessments of maternal psychosocial adaptation for pre-labor hospitalized pregnant women in Japan

Maternal psychosocial adaptation to pregnancy is significant task for women during pregnancy. Antepartum hospitalization is often characterized by maternal anxiety, boredom, feelings of imprisonment, and loneliness. The purpose of this study was to explore maternal psychosocial adaptation during pregnancy for hospitalized pregnant women compared with such adaptation in low-risk pregnant women from a reference population. This was a cross-sectional study with convenience samples of high-risk hospitalized and low-risk mothers. This study was carried out in five hospitals and two clinics between March and December 2009 in several areas of Japan. Subjects were 189 hospitalized women diagnosed with premature labor who had received continuous 24-h treatment with intravenous ritodrine hydrochloride for more than 1 week. The Japanese version of Prenatal Self-Evaluation Questionnaire was administered to measure maternal psychosocial adaptation during pregnancy. Women in hospitalized group had significantly lower adaptation in acceptance of pregnancy and preparation for labor (P<.05-.001) and showed significantly higher adaptation in identification of a motherhood role and relationship with her husband. Moreover, in hospitalized group, relationship with her husband showed significantly higher adaptation (P<.05) in primipara, acceptance of pregnancy and preparation for labor were significantly lower adaptation score (P<.01-.001) in multipara. Hospitalized pre-term pregnant women should be assessed maternal psychosocial adaptation especially the domains of acceptance of pregnancy, preparation for labor, relationship with her husband, and identification of a motherhood role. Health care provider should know the character and background of those women as well as the character of primipara and multipara.
Identifying Effectiveness in ‘‘The Old Old’’

This article explores some implications of the increasing reliance on clinical trials in contemporary health care, particularly health care payers’ efforts to use them in the so-called fourth hurdle decisions. How do these agencies manage medical uncertainty given the desire to produce clear guidelines for clinicians? Their solutions take account of trials in at least two ways, reflecting broader debates about the meaning of these medical experiments. Trials can be read as either ‘‘proofs of protocol’’—straightforward guides to action with individual drugs in specific populations—or ‘‘proofs of principle’’— where extrapolation is made possible through an appeal to underlying biological mechanisms. These contrasting readings of trials are illustrated with reference to guidelines on heart disease prevention/cholesterol reduction using statins among the elderly in North America and the United Kingdom. Uncertainty in these cases does not lead to inertia but solutions use different fixed points to aid navigation, including both physiological principles and moral values.
Bacteriology in Secretory Otitis Media

Nasopharyngeal cultures from children with longstanding Secretory Otitis Media (SOM), obtained under general anaesthesia, disclosed colonization of respiratory pathogens in 79% of the cases, though there was no evidence for recent infection in the ENT region. In a partly overlapping series of cultures from the middle ear effusions the same strains of respiratory pathogens were isolated in 18% of the cases. The pathogens, Haemophilus influenzae, Streptococcus pneumoniae and Branhamella catarrhalis, appeared as single species or in various combinations. The occurrence of beta-lactamase producing strains may inactivate betalactam antibiotics. There is cause to believe that an antibiotic with special characteristics should be looked for, to be used on strictly chosen indications in an attempt to increase the resolution of SOM.
Change in reflections of physiotherapy students over time in clinical placements

Physiotherapy programmes are expected to develop reflective practitioners. Research has indicated that the reflections of senior students and clinicians are different from students beginning their clinical experience. However, most of these studies are cross-sectional in nature. The purpose of this qualitative study was to describe the changes in the reflections of a group of physiotherapy students from their first to their third clinical placements. Subjects were 15 female students (mean age: 20.1 years) in an undergraduate physiotherapy programme in the United Arab Emirates. They wrote weekly entries in a journal during their first and third clinical placements. They described an event, their reaction to it and how it might affect their future behaviour. Two evaluators independently read and coded the content of all journals, and then worked together to categorize the data, rate the level of reflection of each weekly entry and develop themes. The levels of reflection and the themes from the two time periods were compared. Quotes from individual students from both time periods illustrated the changes in reflections. Students’ highest level of reflection for each entry ranged from level 1 (only described the event) to level 4 (gained a new understanding), with a slightly higher mean level of reflection during the third clinical placement. Themes derived from the journals were Professional behaviour, Learning, Self-development, and Ethical issues, in the first placement, and Communication, Ethics, Learning, and Scope of practice, in the third placement. In the latter placement, students were more confident and more focused on the client compared with their first placement. Although the overall themes were somewhat similar in the first and third clinical placements, students broadened their perception of the roles and responsibilities of physiotherapists and of the ultimate impact of their actions on the patient.
Neuropsychological Outcomes of Children Treated for Posterior Fossa Tumours:A Review

Abstract The posterior fossa region of the brain is a frequent site for tumour development in children, with over half of all childhood tumours occurring at this site. The principal brain structure implicated at this site is the cerebellum. Children treated for posterior fossa tumours can have a wide range of neurological and psychosocial problems. This paper describes the literature to date that addresses the neuropsychological impact of tumour and treatment in children with posterior fossa tumours. This paper reviews the literature on the causes of morbidity in this group. It discusses the recent research on the role of the cerebellum in outcomes and the studies that identify variables that interact with radiation effects.
The mononuclear phagocyte system and its cytokine inflammatory networks in schizophrenia and bipolar disorder

This review describes patients with schizophrenia and bipolar disorder. In such patients, a high inflammatory set point of circulating monocytes at the transcriptome level is observed, involving various inflammatory transcripts forming distinct fingerprints (the transcriptomic monocyte fingerprint in schizophrenia overlaps with that in bipolar disorder, but also differs with it at points). There are increased levels of compounds of the IL-1, IL-6 and TNF system in the serum (be it modest and inconsistent). There is also evidence that the IL-2 system is activated in patients with schizophrenia (and perhaps those with mania), although independently of the activation of the IL-1, IL-6 and TNF systems, suggesting separate inducing mechanisms for monocyte and T-cell activation. It is not yet known whether such T cell activation involves the Th1/Th2/Th17 or Treg systems.
Factors influencing clinical teaching of midwifery students in a selected clinical setting in Tanzania

A quantitative, descriptive non-experimental design was used to identify the factors that influence clinical teaching of midwifery students in selected postnatal clinical settings in Tanzania. Structured questionnaires were used to collect data from midwifery tutors/preceptors. The major findings of the study showed that both the professional and educational qualification of tutors was low; tutors and preceptors were overworked due to shortage of staff; the school skills laboratory and postnatal wards lacked equipment and necessary supplies; there were no clinical accompaniment guidelines, and overcrowding of postnatal patients. Recommendations included developing the clinical teaching guidelines, employing more tutors, preceptors and clinical staff; improving the tutors’/ preceptors’ educational and professional qualifications and updating the qualifications of ward supervisors and clinical facilitators.
Best practice of BRAF V600E mutation testing for the diagnosis and management of thyroid cancers

BRAF V600E mutation is the single most common genetic alteration identified in papillary thyroid carcinoma. There is significant association between BRAF V600E mutation and aggressive tumor behavior. BRAF V600E mutation has also been found to be an independent predictor of treatment failure and tumor recurrence even in patients with low-stage disease. Pre-operative BRAF mutation testing of thyroid fine needle aspiration specimens has become a routine clinical practice that enhances the predictability of malignancy in indeterminate fine needle aspiration cytology specimens especially those in the follicular lesion of undetermined significance/atypia of undetermined significance category. In addition to histological evaluation of subsequent core needle biopsy and BRAF immunohistochemistry, an expanded panel of mutation testing including BRAF V600E, NRAS, HRAS, RET/papillary thyroid carcinoma and PAX8/PPARγ rearrangements are currently advocated to further improve the diagnostic predictability in the detection of thyroid carcinomas using cytological specimens.
The relationship between media exposure and awareness of health behaviour guidelines among older Australians

This study aimed to determine whether or not there was a relationship between media exposure and awareness of health behaviour guidelines for physical activity, breast cancer screening and alcohol consumption among older Australians. The results of the study suggest that media exposure to certain health issues does in fact impact on people’s health knowledge and in some cases lead people to form incorrect perceptions. This is most evident with breast cancer where the heavy emphasis on the disease in the media has led to the misconception that breast cancer is the leading cause of death among Australian women and that women under the age of 40 should engage in regular mammograms.
Correlation between the burn-in effect and the extrinsic base surface quality in C-doped GaInP/GaAs HBTs

The present work compares two sets of carbon doped GaInP/GaAs HBTs. The only difference between the device sets resides in the technology employed to passivate the extrinsic base surface region. The results demonstrate that the burn-in effect is a surface related phenomenon and that the ledge passivation technology is a very promising method to improve device reliability.
Certified Abstract Interpretation with Pretty-Big-Step Semantics

This paper describes an investigation into developing certified abstract interpreters from big-step semantics using the Coq proof assistant. We base our approach on Schmidt's abstract interpretation principles for natural semantics, and use a pretty-big-step (PBS) semantics, a semantic format proposed by Charguéraud. We propose a systematic representation of the PBS format and implement it in Coq. We then show how the semantic rules can be abstracted in a methodical fashion, independently of the chosen abstract domain, to produce a set of abstract inference rules that specify an abstract interpreter. We prove the correctness of the abstract interpreter in Coq once and for all, under the assumption that abstract operations faithfully respect the concrete ones. We finally show how to define correct-by-construction analyses: their correction amounts to proving they belong to the abstract semantics.