Miracle-dz/UniFAR-FTUs huggingface dataset:
Looking Beyond Nursing for Clues to Effective Leadership

Effective leadership is one of the most elusive keys to organizational success yet it is a key ingredient to making any organization work. Leadership is also changing in nature. Our current faster, more flexible, flatter organizations face intense competition and require dynamic leadership. This article synthesizes research conducted during the past 5 years that quantifies what separates superior leaders from average leaders. Although this research originated from a study of top global nonhealthcare organizations, it relates to the nursing profession. The author discusses key elements of the research, including emotional intelligence and its link to performance.
Depression in patients with systemic sclerosis: a systematic review of the evidence.

OBJECTIVE To assess the prevalence, course, and predictors of depression in patients with systemic sclerosis (SSc). METHODS We conducted a comprehensive search in November 2006 of MEDLINE, PsycINFO, and CINAHL databases to identify original research studies published in any language that used a structured interview or validated questionnaire to assess major depressive disorder or clinically significant symptoms of depression in patients with SSc. The search was augmented by hand searching 26 selected journals through December 2006 and references from identified articles and reviews. Studies were excluded if only an abstract was provided or if depression was not measured by a validated method. RESULTS No studies used a structured clinical interview to assess the prevalence of major depressive disorder. The prevalence of clinically significant depressive symptoms was 51-65% based on 2 studies that used a Beck Depression Inventory (BDI) score >or=10 and 46-56% based on 2 studies that used a BDI score >or=11. These rates and those reported in 4 other studies that used different assessment tools (36-43%) were consistently high compared with other medical patient groups assessed with the same instruments and cutoffs. Methodologic issues limited the ability to draw strong conclusions from studies of predictors. CONCLUSION Symptoms of depression are common among patients with SSc. The high rates reported across studies suggest that routine screening is recommended. There is a need for studies that examine depression at different time points from the diagnosis of SSc and that systematically investigate factors associated with high levels of depressive symptoms.
From heart-rate data to training quantification: a comparison of 3 methods of training-intensity analysis.

PURPOSE The authors directly compared 3 frequently used methods of heart-rate-based training-intensity-distribution (TID) quantification in a large sample of training sessions performed by elite endurance athletes. METHODS Twenty-nine elite cross-country skiers (16 male, 13 female; 25 ± 4 y; 70 ± 11 kg; 76 ± 7 mL · min-1 · kg-1 VO2max) conducted 570 training sessions during a ~14-d altitude-training camp. Three analysis methods were used: time in zone (TIZ), session goal (SG), and a hybrid session-goal/time-in-zone (SG/TIZ) approach. The proportion of training in zone 1, zone 2, and zone 3 was quantified using total training time or frequency of sessions, and simple conversion factors across different methods were calculated. RESULTS Comparing the TIZ and SG/TIZ methods, 96.1% and 95.5%, respectively, of total training time was spent in zone 1 (P < .001), with 2.9%/3.6% and 1.1%/0.8% in zones 2/3 (P < .001). Using SG, this corresponded to 86.6% zone 1 and 11.1%/2.4% zone 2/3 sessions. Estimated conversion factors from TIZ or SG/TIZ to SG and vice versa were 0.9/1.1, respectively, in the low-intensity training range (zone 1) and 3.0/0.33 in the high-intensity training range (zones 2 and 3). CONCLUSIONS This study provides a direct comparison and practical conversion factors across studies employing different methods of TID quantification associated with the most common heart-rate-based analysis methods.
Structurational Divergence Theory as Explanation for Troublesome Outcomes in Nursing Communication

Structurational divergence (SD) theory captures negative communication cycles resulting from interpenetration of incompatible meaning structures. It is estimated that 12–15% of practicing nurses suffer from a problematic level of SD. With a sample of 713 nurses (57 departments) in a large hospital, this study tests a model positing SD as a root explanation of nursing job satisfaction and turnover. A number of variables long presumed to be explanations for job satisfaction and turnover were hypothesized as mediators between SD and those outcomes. Path analysis showed support for burnout, role conflict, bullying, and organizational identification as useful mediators, explaining 68% of the variance in job satisfaction, and 45% in intentions to leave. The study also explores relationships between SD and hospital quality indicators. SD is a concern because it powerfully explains a number of poor outcomes and provides an underlying explanation for a number of factors that predict job satisfaction and turnover.
Both relative insulin resistance and defective islet beta-cell processing of proinsulin are responsible for transient hyperglycemia in extremely preterm infants.

OBJECTIVE Many extremely preterm infants develop hyperglycemia in the first week of life during continuous glucose infusion. The objective of this study was to determine whether defective insulin secretion or resistance to insulin was the primary factor involved in transient hyperglycemia of extremely preterm infants. METHODS A prospective comparative study was conducted in appropriate-for-gestational-age preterm infants <30 weeks of gestational age with the aim specifically to evaluate the serum levels of proinsulin, insulin, and C-peptide secreted during transient hyperglycemia by specific immunoassays. Three groups of infants were investigated hyperglycemic (n = 15) and normoglycemic preterm neonates (n = 12) and normal, term neonates (n = 21). In addition, the changes in beta-cell peptide levels were analyzed during and after intravenous insulin infusion in the hyperglycemic group. Data were analyzed using analysis of variance and analysis of variance for repeated measures. RESULTS At inclusion, insulin and C-peptide levels did not differ in hyperglycemic subjects and in preterm controls. Proinsulin concentration was significantly higher in the hyperglycemic group (36.5 +/- 3.9 vs 23.2 +/- 0.9 pmol/L). Compared with term neonates, proinsulin and C-peptide levels were higher in normoglycemic preterm infants (23.2 +/- 0.9 vs 18.9 +/- 2.71 pmol/L and 1.67 +/- 0.3 vs 0.62 +/- 0.12 nmol/L, respectively). During and after insulin infusion in hyperglycemic neonates, plasma glucose concentration fell and proinsulin and C-peptide levels were lowered (18.4 +/- 7.6 and 20.7 +/- 4.5 pmol/L, respectively). CONCLUSION These data suggest that 1) preterm neonates are sensitive to changes in plasma glucose concentration, but proinsulin processing to insulin is partially defective in hyperglycemic preterm neonates; 2) hyperglycemic neonates are relatively resistant to insulin because higher insulin levels are needed to achieve euglycemia in this group compared with normoglycemic neonates. These results also show that insulin infusion is beneficial in extremely preterm infants with transient hyperglycemia.
Neonatal Desflurane Exposure Induces More Robust Neuroapoptosis than Do Isoflurane and Sevoflurane and Impairs Working Memory

Background: In animal models, neonatal exposure to volatile anesthetics induces neuroapoptosis, leading to memory deficits in adulthood. However, effects of neonatal exposure to desflurane are largely unknown. Methods: Six-day-old C57BL/6 mice were exposed to equivalent doses of desflurane, sevoflurane, or isoflurane for 3 or 6 h. Minimum alveolar concentration was determined by the tail-clamp method as a function of anesthesia duration. Apoptosis was evaluated by immunohistochemical staining for activated caspase-3, and by TUNEL. Western blot analysis for cleaved poly-(adenosine diphosphate-ribose) polymerase was performed to examine apoptosis comparatively. The open-field, elevated plus-maze, Y-maze, and fear conditioning tests were performed to evaluate general activity, anxiety-related behavior, working memory, and long-term memory, respectively. Results: Minimum alveolar concentrations at 1 h were determined to be 11.5% for desflurane, 3.8% for sevoflurane, and 2.7% for isoflurane in 6-day-old mice. Neonatal exposure to desflurane (8%) induced neuroapoptosis with an anatomic pattern similar to that of sevoflurane or isoflurane; however, desflurane induced significantly greater levels of neuroapoptosis than almost equivalent doses of sevoflurane (3%) or isoflurane (2%). In adulthood, mice treated with these anesthetics had impaired long-term memory, whereas no significant anomalies were detected in the open-field and the elevated plus-maze tests. Although performance in a working memory task was normal in mice exposed neonatally to sevoflurane or isoflurane, mice exposed to desflurane had significantly impaired working memory. Conclusions: In an animal model, neonatal desflurane exposure induced more neuroapoptosis than did sevoflurane or isoflurane and impaired working memory, suggesting that desflurane is more neurotoxic than sevoflurane or isoflurane.
THE PERSONAL FUTURE AND SUICIDAL IDEATION

By using a soliloquy technique to re-evoke subjective experiences that occurred immediately prior to the suicide attempts of 15 patients, we found that suicidal ideation was associated with a hopeless and helpless outlook on a foreshortened personal future. The soliloquy technique may become useful for studying the interactions of subjective experiences associated with a crisis that is difficult to investigate at the time it occurs.
Evaluation of cytogenotoxic and antimutagenic potency of water extract of Centella asiatica Linn . using the Allium cepa assay

In this study, toxicological safety (mutagenicity) and therapeutic potential (antimutagenicity) of water extract of Centella asiatica Linn. , were evaluated using the Allium cepa assay. The mitotic index (MI) at 6.25% concentration of the extract decreased significantly from 3.13% to 2.05% after 24 h and 48 h, respectively, however, the MI increased significantly by 60% and 400% at 12.5% and 50.0% concentrations, respectively. There was total arrest of cell division at 100% concentration after 24 h and 48 h of onion’s roots exposure to the water extract. The chromosomal aberrations (CA) induced by the extract were not significantly different from the negative control (p ≥ 0.05) at the tested concentrations. The mutagenic activity of cyclophosphamide was significantly suppressed above 50% at the tested concentrations. These results suggest non-genotoxic effect, and antimutagenic potency of water extract of C. asiatica in A. cepa cells, being desirable characteristics of anticancer therapeutics.
Asymptomatic Same-Site Recurrent Disc Herniation After Lumbar Discectomy: Results of a Prospective Longitudinal Study With 2-Year Serial Imaging

Study Design. This is a prospective cohort study with serial imaging. Objective. We set out to determine the incidence of symptomatic and asymptomatic same-level recurrent disc herniation and assess their effect on 2-year outcome. Summary of Background Data. The reported incidence of symptomatic same-level recurrent disc herniation after lumbar discectomy varies widely in retrospective studies. To date, the incidence of radiographic same-level recurrent disc herniation has not been studied prospectively with sequential imaging. Furthermore, the clinical relevance of recurrent disc herniation on magnetic resonance imaging (MRI) after discectomy remains unknown, particularly in patients with poorly specific pain after surgery. Methods. One hundred eight patients undergoing lumbar discectomy for a single-level herniated disc at five institutions were prospectively observed for 2 years. Computed tomography (CT) and MRI of the lumbar spine were obtained every 3 months to assess reherniation and disc height loss. Leg and back pain visual analog scale (VAS), Oswestry Disability Index (ODI), and quality of life (SF-36 physical component) were assessed 3, 6, 12, and 24 months after surgery. Results. No patients demonstrated residual disc on postoperative MRI. By 2 years after discectomy, 25 (23.1%) patients had demonstrated radiographic evidence of recurrent disc herniation at the level of prior discectomy on serial imaging (mean ± SD, 11.8 ± 8.3 months after surgery). Radiographic disc herniation was asymptomatic in 14 (13%) patients and symptomatic in 11 (10.2%) patients. The occurrence of symptomatic recurrent disc herniation was associated with worse 2-year leg pain (VAS-LP, P=0.002) and disability (ODI, P=0.036) but not quality of life (SF-36) or disc height loss. The occurrence of asymptomatic reherniation was not associated with disc height loss or any outcome measure (VAS, ODI, and SF-36) by 2 years. Conclusion. Nearly one-fourth of patients undergoing lumbar discectomy demonstrated radiographic evidence of recurrent disc herniation at the level of prior surgery, the majority of which were asymptomatic. Asymptomatic disc herniation was not associated with clinical consequences by 2 years. Clinically silent recurrent disc herniation is common after lumbar discectomy. When obtaining MRI evaluation within the first 2 years of discectomy, providers should expect that radiographic evidence of reherniation may be encountered and that treatment should be considered only when correlating radicular symptoms exist.
Gene frequencies and microdifferentiation among the Makiritare Indians. I. Eleven blood group systems and the ABH-Le secretor traits: a note on Rh gene frequency determinations.

Detailed knowledge of the genetic structure of human populations at any and all cultural levels remains notably sparse. Most of the current concepts (and mathemati-cal treatments) of this structure are based on limited knowledge of civilized populations in a state of cultural, economic, and social transition. Plainly, painstaking and meticulous studies of the genetic details of a variety of populations are necessary to an understanding of such questions as the scope for natural selection and the sig-nificance of the enormous amount of genetic variability in human populations. We are currently in midstream of an effort to characterize in all ways possible the important genetic parameters of a relatively large and undisturbed Indian tribe located in southern Venezuela and northern Brazil, the Yanomama. A recent pre-liminary communication has reported marked genetic microdifferentiation between the villages of these Indians (Arends et al. 1967). Although there are other reports of tribal microdifferentiation (reviewed in Neel and Salzano 1967), this case was espe-cially striking, perhaps because of the size and lack of acculturation of the tribe. On their northern and western tribal boundaries, the Yanomama are in contact with Makiritare, also still a relatively undisturbed tribe. When it became apparent that there was genetic exchange occurring between these two tribes, quite possibly along the pattern of much of the genetic exchange between the tribal populations of the past, our studies were expanded to the Makiritare. It will be the purpose of this series of four papers to (1) extend earlier reports (Arends and Gallango 1962, 1964, 1965; Layrisse et al. 1963; Layrisse and Wilbert 1966) on Makiritare gene frequencies, (2) record microdifferentiation among the Makiritare villages comparable to that observed among the Yanomama, gene frequencies were the common-ly employed method of Mourant (1954), in the absence of the appropriate indicator phenotype, a gene is assumed not to exist in the population. For four of the seven villages the results of the computer program and the Mourant procedures are in close agreement. These villages (A, BD, C, and E) are the presence RO r phenotypes,
Linkage analysis of the fragile X gene FMR‐1 and schizophrenia: no evidence for linkage but report of a family with schizophrenia and an unstable triplet repeat

We have examined 23 families multiply affected with schizophrenia for linkage to the FMR-1 gene on the X chromosome. Alleles at the FMR-1 CGG triplet repeat were analysed by the polymerase chain reaction, and methylation status at the FMR-1 locus in individuals with evidence of expanded or unstable repeats was analysed by Southern hybridization. Two-point LOD score analyses with a range of X-linked single gene models and a non-parametric affected sib-pair method revealed no evidence for linkage. In one family, however, a fragile X premutation was found, and one individual with schizophrenia and developmental delay was a mosaic for the full and premutation. We conclude that although mutations within the FMR-1 gene do not have a major aetiological role in schizophrenia in our collection of pedigrees, it is possible that FMR-1 mutations can modify the clinical phenotype of schizophrenia.
A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis.

BACKGROUND In two of three phase 3 trials, pirfenidone, an oral antifibrotic therapy, reduced disease progression, as measured by the decline in forced vital capacity (FVC) or vital capacity, in patients with idiopathic pulmonary fibrosis; in the third trial, this end point was not achieved. We sought to confirm the beneficial effect of pirfenidone on disease progression in such patients. METHODS In this phase 3 study, we randomly assigned 555 patients with idiopathic pulmonary fibrosis to receive either oral pirfenidone (2403 mg per day) or placebo for 52 weeks. The primary end point was the change in FVC or death at week 52. Secondary end points were the 6-minute walk distance, progression-free survival, dyspnea, and death from any cause or from idiopathic pulmonary fibrosis. RESULTS In the pirfenidone group, as compared with the placebo group, there was a relative reduction of 47.9% in the proportion of patients who had an absolute decline of 10 percentage points or more in the percentage of the predicted FVC or who died; there was also a relative increase of 132.5% in the proportion of patients with no decline in FVC (P<0.001). Pirfenidone reduced the decline in the 6-minute walk distance (P=0.04) and improved progression-free survival (P<0.001). There was no significant between-group difference in dyspnea scores (P=0.16) or in rates of death from any cause (P=0.10) or from idiopathic pulmonary fibrosis (P=0.23). However, in a prespecified pooled analysis incorporating results from two previous phase 3 trials, the between-group difference favoring pirfenidone was significant for death from any cause (P=0.01) and from idiopathic pulmonary fibrosis (P=0.006). Gastrointestinal and skin-related adverse events were more common in the pirfenidone group than in the placebo group but rarely led to treatment discontinuation. CONCLUSIONS Pirfenidone, as compared with placebo, reduced disease progression, as reflected by lung function, exercise tolerance, and progression-free survival, in patients with idiopathic pulmonary fibrosis. Treatment was associated with an acceptable side-effect profile and fewer deaths. (Funded by InterMune; ASCEND ClinicalTrials.gov number, NCT01366209.).
Involvement of WalK (VicK) phosphatase activity in setting WalR (VicR) response regulator phosphorylation level and limiting cross‐talk in Streptococcus pneumoniae D39 cells

WalRK (YycFG) two‐component systems (TCSs) of low‐GC Gram‐positive bacteria play critical roles in regulating peptidogylcan hydrolase genes involved in cell division and wall stress responses. The WalRK (VicRK) TCSs of Streptococcus pneumoniae (pneumococcus) and other Streptococcus species show numerous differences with those of other low‐GC species. Notably, the pneumococcal WalK sensor kinase is not essential for normal growth in culture, unlike its homologues in Bacillus and Staphylococcus species. The WalK sensor kinase possesses histidine autokinase activity and mediates dephosphorylation of phosphorylated WalR∼P response regulator. To understand the contributions of these two WalK activities to pneumococcal growth, we constructed and characterized a set of walK kinase and phosphatase mutants in biochemical reactions and in cells. We identified an amino acid substitution in WalK that significantly reduces phosphatase activity, but not other activities. Comparisons were made between WalRK regulon expression levels and WalR∼P amounts in cells determined by Phos‐tag SDS‐PAGE. Reduction of WalK phosphatase activity resulted in nearly 90% phosphorylation to WalR∼P, consistent with the conclusion that WalK phosphatase is strongly active in exponentially growing cells. WalK phosphatase activity was also shown to depend on the WalK PAS domain and to limit cross‐talk and the recovery of WalR∼P from walK+ cells.
Winter Atmospheric Forcing of the Ross Sea Polynya

Polynyas, or areas of combined open water and thin ice surrounded by sea and/or land ice, are thought to play important roles in heat transfer from ocean to atmosphere, ice production, the formation of dense shelf water, spring disinte­ gration of sea ice, and the sustenance of primary and secondary productivity in polar regions. This study examines the interannual variation of the Ross Sea Polynya and winter atmospheric forcing from 1988 1991. The results show that significant interannual variability is observed in winter. The largest open water fraction occurs in 1988 in conjunction with the warmest winter temperatures and the strongest winds, with the other three winters being similar in open water fraction and atmospheric forcing. The polynya event survey shows the maximum number of events takes place in 1988 and the minimum in 1990. However, consideration of the polynya duration combined with the anomalous open water fraction during polynya events identifies the 1988 and 1990 winter polynyas as having the same large cumulative impact on the oceanic surface energy balance, and the 1989 and 1991 polynyas as having a 20% smaller impact. The result for the 1988 winter is contaminated by two long polynya events which are not clearly distinguished from the average conditions by open water fraction anomalies from the 25-day running mean. Comparison between polynya open water fractions and wind and temperature variations at automatic weather station 07 explains about 25% of the polynya fluctuation variance, similar to previous findings for the Terra Nova Bay polynya. A case study elaborates the role played by atmospheric forcing. It is found that a synoptic cyclone near Roosevelt Island induces a sea level pressure distribution over the Ross Ice Shelf with isobars oriented almost parallel to the Transantarctic Mountains. This setup, which is also seen in other years, results in an intensification and northwestward propagation of the katabatic winds across the ice shelf with an associated low-level warming. An immediate impact of this katabatic surge event is development of the polynya. The study reveals the high spatial variability of the atmospheric forcing fields, and indicates that fluctuations of this large polynya can only be approximately related to wind and temperature observations from one site. The interannual variability of the katabatic surge events is determined. On average for the winters of 1988-1991, about 60% of the polynya events are linked to katabatic surge events.