Miracle-dz/UniFAR-FTUs huggingface dataset:
Monitor Zorggerelateerde Schade 2015/2016: dossieronderzoek bij overleden patiënten in Nederlandse ziekenhuizen

In dit rapport worden de resultaten en aanbevelingen gepresenteerd van de vierde meting van de Monitor Zorggerelateerde Schade. Centraal stond de vraag of de potentieel vermijdbare schade en potentieel vermijdbare sterfte in ziekenhuizen is gedaald ten opzichte van de vorige meting. Een tweede vraag betrof de rol van medische technologie bij het ontstaan van zorggerelateerde schade. Sinds 2004 wordt om de vier jaar een landelijk onderzoek uitgevoerd naar de potentieel vermijdbare schade en sterfte in Nederlandse ziekenhuizen. Nederland is hierin uniek en houdt op deze wijze periodiek inzicht in de stand van zaken van patientveiligheid en mogelijke verbeterpunten voor de toekomst. Methode De onderhavige meting heeft uitsluitend betrekking op in het ziekenhuis overleden patienten in 2015/2016. Aan het onderzoek hebben 19 willekeurig geselecteerde ziekenhuizen deelgenomen. De ziekenhuizen zijn een goede afspiegeling van alle Nederlandse ziekenhuizen wat betreft type ziekenhuis (academisch, topklinisch, algemeen) en regionale spreiding. Categorale ziekenhuizen en zelfstandige behandelcentra waren uitgesloten van het onderzoek. In elk ziekenhuis is een willekeurige steekproef getrokken van 150 overleden patienten. In totaal zijn ruim 2800 opnames van overleden patienten beoordeeld. Conclusies De omvang van de zorggerelateerde schade, waaronder complicaties en bijwerkingen, is tussen 2011/2012 en 2015/2016 significant gedaald, maar de potentieel vermijdbare schade en potentieel vermijdbare sterfte is tussen 2011/2012 en 2015/2016 niet verder gedaald, maar gelijk gebleven. Bij patientveiligheid gaat het om het zo ver mogelijk reduceren van potentieel vermijdbare schade en sterfte. ‘Potentieel vermijdbaar’ betekent immers dat de schade mogelijk voorkomen had kunnen worden omdat er sprake was van suboptimale zorgverlening en tekortkomingen in de organisatie van zorg. Een duidelijke reductie vond wel plaats tussen 2008 en 2011/2012, de looptijd van het VMS veiligheidsprogramma. Ook na afloop van het veiligheidsprogramma hadden ziekenhuizen en zorgprofessionals de ambitie om door te gaan met het verder verbeteren van de patientveiligheid en het reduceren van de potentieel vermijdbare schade en sterfte. Dat er nog mogelijkheden voor verbetering zijn, laten studies uit de VS/UK/Canada zien. Ziekenhuizen zijn continue bezig met het verbeteren van de patientveiligheid, maar aangezien er geen verdere daling van de potentieel vermijdbare schade en sterfte heeft plaatsgevonden, moet er gezocht worden naar effectievere verbetermogelijkheden. Daarnaast dienen zich regelmatig nieuwe risico’s aan waar ziekenhuizen op proberen te anticiperen.
Pili annulati with fragility: Electron microscopic findings of a case

Pili annulati (PA) is typically characterized by shinny beads seen along the hair shaft. PA is accepted to belong to the classification of hair shaft abnormalities without fragility. Herein, we described a 14-year-old, fair skin with dark-haired girl diagnosed as PA with fragility which was demonstrated by weathering features in electron microscopic examinations. The patient had shinny beaded, easily breakable hairs since the age of four. A few broken hairs were observed by a light pull test. Transmitted light microscopy revealed periodic dark bands in the hair shaft. These dark bands disappeared after application of 10% aqueous potassium hydroxide. Multiple cavities within hair shaft and severe cuticular damages representing the weathering pattern were observed in electron microscopic examinations. All these findings were found to be consistent with presence of fragility in PA. This case provides evidences of fragile hair structure of PA which may be due to pathological cavities within hair shafts.
Lower retinol levels as an independent predictor of mortality in long-term hemodialysis patients: a prospective observational cohort study.

BACKGROUND Malnutrition, inflammation, and oxidative stress are inter-related mechanisms linked to the progression of cardiovascular disease and prognosis of long-term hemodialysis (HD) patients. In this study, we focus on antioxidant vitamins and trace elements and the relationship of their serum levels to the prognosis of long-term HD patients. STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS 261 long-term HD patients prospectively followed up for 5 years (2003-2008). The control group consisted of 66 healthy participants. PREDICTORS Retinol, alpha-tocopherol, retinol-binding protein 4 (RBP-4), and the trace elements zinc and selenium. OUTCOMES Mortality and cardiovascular mortality. During follow-up, 146 patients (56%) died, and for 71 of these, death was due to cardiovascular causes. MEASUREMENTS Retinol, alpha-tocopherol, RBP-4, zinc, selenium, and basic nutritional and inflammatory parameters measured at the beginning of the study. RESULTS Retinol and RBP-4 levels were significantly increased, whereas retinol:RBP-4 ratio and alpha-tocopherol, selenium, and zinc levels were decreased in HD patients compared with controls (retinol, 168.1 +/ 64.4 microg/dL in HD patients vs 99.1 +/-23.3 [corrected] microg/dL in controls; P<0.001). Lower retinol level was found to be a significant independent predictor of overall and cardiovascular mortality in multivariate Cox analysis (HR, 0.733 [95% CI, 0.599-0.896], P=0.002, and 0.694 [95% CI, 0.511-0.942], P=0.02, per 1 SD, respectively). The worst prognoses for patients with lower retinol levels were observed when these were combined with low albumin levels. LIMITATIONS Sample size, investigation of prevalent, not incident, dialysis patients. CONCLUSIONS This is the first study showing a lower retinol level as an independent predictor of overall and cardiovascular mortality in HD patients. It has to be elucidated whether the beneficial effects of higher serum retinol levels should be attributed to only better nutritional support or also to retinol's role in immune response and differentiation.
Parent–child attachment and internalizing symptoms in childhood and adolescence: A review of empirical findings and future directions

Abstract The purpose of this paper is to evaluate the theory and evidence for the links of parent–child attachment with internalizing problems in childhood and adolescence. We address three key questions: (a) how consistent is the evidence that attachment security or insecurity is linked to internalizing symptoms, anxiety, and depression? (b) How consistent is the evidence that specific forms of insecurity are more strongly related to internalizing symptoms, anxiety, and depression than are other forms of insecurity? (c) Are associations with internalizing symptoms, anxiety, and depression consistent for mother–child and father–child attachment? The current findings are consistent with the hypothesis that insecure attachment is associated with the development of internalizing problems. The links between specific insecure attachment patterns and internalizing problems are difficult to evaluate. Father–child and mother–child attachments have a comparable impact, although there are relatively few studies of father–child attachment. No moderators consistently affect these relations. We also propose two models of how attachment insecurity may combine with other factors to lead to anxiety or depression.
Transmission Rate Control for Molecular Communication among Biological Nanomachines

In this paper, we discuss issues concerned with transmission rate control in molecular communication, an emerging communication paradigm for bio-nanomachines in an aqueous environment. In molecular communication, a group of bio-nanomachines acting as senders transmit molecules, the molecules propagate in the environment, and another group of bio-nanomachines acting as receivers chemically react to the molecules propagating in the environment. In the model of molecular communication considered in this paper, senders may transmit molecules at a high rate to accelerate the receiver reactions or to increase the throughput. However, if the senders transmit molecules faster than the receivers react, the excess molecules remain in the environment and eventually degrade or diffuse away, which results in loss of molecules or degradation in efficiency. Such a potential issue associated with throughput and efficiency is in this paper discussed as an optimization problem. A mathematical expression for an upper-bound on the throughput and efficiency is first derived to provide an insight into the impact of model parameters. The optimal transmission rates that maximize the throughput and efficiency are then numerically calculated and presented, and throughput and efficiency are shown to be in trade-off relationships in a wide range of transmission rates. Further, two classes of feedback-based transmission rate control schemes are designed for autonomous bio-nanomachines to dynamically control their transmission rates, respectively based on negative and positive feedback from the receivers. The numerical evaluation of the two transmission rate control schemes is then shown to provide useful guidelines for application developers to satisfy their design goals.
Outcomes of an HIV Prevention Peer Group Intervention for Rural Adults in Malawi

This study used a quasi-experimental design to evaluate a six-session peer group intervention for HIV prevention among rural adults in Malawi. Two rural districts were randomly assigned to intervention and control conditions. Independent random samples of community adults compared the districts at baseline and at 6 and 18 months postintervention. Using multiple regressions controlling for six demographic factors, intervention district adults had significantly more favorable outcomes at 6- and 18-month evaluations for condom attitudes, self-efficacy for community prevention, self-efficacy for practicing safer sex, partner communication, using condoms ever in the past 2 months, and community prevention activities. Knowledge and hope for controlling the epidemic were significantly higher in the intervention district only at the 6-month evaluation; having a recent HIV test was significantly higher only at 18 months. Levels of stigma and the number of risky sex practices did not decrease when demographic factors were controlled. Expanding peer group intervention for HIV prevention would benefit rural adults.
Identification of PVK / CAP 2 b neuropeptides from single neurohemal organs of the stable fly and horn fly via MALDI-TOF / TOF tandem mass spectrometry

MALDI-TOF/TOF tandem mass spectrometry has been applied to determine the complete sequences of the PVK/CAP2b neuropeptides in the stable fly Stomoxys calcitrans and horn fly Haematobia irritans, insect pests of livestock. This peptidomic analysis of single neurohemal organ preparations allows the unambiguous assignment of internal Leu/Ile positions not distinguishable by previous mass spectrometric techniques. The sequences are as follows: Stoca-PVK/CAP2b-1, AGGASGLYAFPRVa; Stoca-PVK/CAP2b-2, NAKLYPVPRVa; and HaeirPVK/CAP2b-1, AGGASGLYAFPRVa; Haeir-PVK/CAP2b-1, NAKLYPMPRVa. Both Stoca-PVK/ CAP2b-1 and -2 stimulate Malpighian tubule fluid secretion in the stable fly, with EC50 values between 3 and 11 nM. The identification of these novel neuropeptides adds to our knowledge of the peptidomes of flies, and can aid in the development of neuropeptide-based control strategies of these insect pests. Published by Elsevier Inc. avai lab le at www.sc iencedi rect . com journal homepage: www.elsev ier . com/ locate /pept ides
89Zr immuno-PET: comprehensive procedures for the production of 89Zr-labeled monoclonal antibodies.

UNLABELLED The use of immuno-PET, the combination of PET with monoclonal antibodies (mAbs), is an attractive option to improve tumor detection and mAb quantification. The long-lived positron emitter (89)Zr has ideal physical characteristics for immuno-PET, such as a half-life of 3.27 d, which is compatible with the time needed for intact mAbs to achieve optimal tumor-to-nontumor ratios. Thus far, a major limitation in the use of (89)Zr has been the lack of suitable methods for its stable coupling to mAbs. In this article, practical protocols for reproducible isolation of highly pure (89)Zr and the production of optimal-quality mAb-(89)Zr conjugates are provided. METHODS (89)Zr was produced by a (p,n) reaction on natural yttrium ((89)Y), isolated with a hydroxamate column, and used for labeling of premodified mAbs. mAbs were premodified with a novel bifunctional derivative of the chelate desferrioxamine B (Df) via a new linker chemistry. To this end, Df was initially succinylated (N-sucDf), temporarily filled with Fe(III), esterified by use of tetrafluorophenol, and then directly coupled to mAbs. Chimeric mAb (cmAb) U36, directed against head and neck cancer, was used for in vitro and in vivo evaluation. The in vitro stability of cmAb U36-N-sucDf-(89)Zr was assessed in human serum, and its in vivo behavior was evaluated by biodistribution and PET imaging studies in tumor-bearing nude mice. A cmAb U36-Df-(89)Zr conjugate containing a previously described succinimide ring-thioether unit in the linker was used as a reference. RESULTS (89)Zr was produced in large batches (6.5-13.5 GBq) and isolated with improved radionuclidic purity (>99.99%) and high yield (>94%). The Df-premodified mAbs gave (89)Zr-labeling efficiencies of 80% within 30 min, resulting in conjugates with preserved integrity and immunoreactivity. With respect to stability, the novel cmAb U36-N-sucDf-(89)Zr conjugate appeared to be superior to the reference conjugate. In vivo, the novel conjugate demonstrated selective tumor targeting, and on PET images obtained at 24, 48, and 72 h after injection of this conjugate, small tumors in the range of 19-154 mg were readily visualized. CONCLUSION Methods were developed for improved purification of the long-lived positron emitter (89)Zr. Moreover, a novel bifunctional Df chelate was synthesized for the reproducible coupling of (89)Zr to mAbs. The suitability of such conjugates to detect millimeter-sized tumors in xenograft-bearing nude mice was demonstrated.
Changes in Corneal Sensation, Epithelial Damage, and Tear Function After Descemet Stripping Automated Endothelial Keratoplasty

Purpose: To study the ocular surface changes in eyes after Descemet stripping automated endothelial keratoplasty (DSAEK) compared with those after penetrating keratoplasty (PKP). Methods: This prospective study compared the changes in 31 eyes of 28 patients who underwent DSAEK (DSAEK group) with those in 15 disease-matched eyes of 15 patients who underwent PKP (PKP group). Corneal epithelial integrity was evaluated using a fluorescein staining score. Corneal sensation was measured with a Cochet–Bonnet esthesiometer. Tear function was evaluated using the Schirmer test, tear clearance test, tear function index, and tear break-up time. Results: The postoperative fluorescein staining score was significantly higher in the PKP group than in the DSAEK group (P = 0.02). Postoperative corneal sensation was significantly better in the DSAEK group than in the PKP group (P < 0.01). Corneal sensation after DSAEK was significantly better than the preoperative value (P = 0.02). There were no statistically significant changes in the Schirmer test, tear clearance test, tear function index, or break-up time before and after the surgery in both the DSAEK and PKP groups. No significant differences were observed between the DSAEK and PKP groups after the surgery. Conclusions: Corneal sensation was preserved, and epithelial damage was less severe after DSAEK compared with PKP. Preservation of corneal sensation may contribute to the early recovery of visual function and long-term maintenance of ocular surface health after DSAEK.
A Phase I-II Study of α-Galactosylceramide-Pulsed IL-2/GM-CSF-Cultured Peripheral Blood Mononuclear Cells in Patients with Advanced and Recurrent Non-Small Cell Lung Cancer1

To evaluate the safety, immune responses, and antitumor responses after the administration of α-galactosylceramide (αGalCer) KRN7000-pulsed PBMC cultured with IL-2 and GM-CSF (IL-2/GM-CSF-cultured PBMCs), a phase I-II study in patients with non-small cell lung cancer was conducted. Patients with advanced non-small cell lung cancer or recurrent lung cancer refractory to the standard therapy were eligible. αGalCer-pulsed IL-2/GM-CSF-cultured PBMCs (1 × 109/m2) were i.v. administered four times. Immune responses were monitored weekly. Twenty-three patients were enrolled in this study and 17 cases (73.9%) completed. No severe adverse event related to the treatment was observed. After the injection of αGalCer-pulsed IL-2/GM-CSF-cultured PBMCs, an increased number of IFN-γ-producing cells in the peripheral blood were detected in 10 patients (58.8%). Five cases remained as stable disease, and the remaining 12 cases were evaluated as progressive disease. The estimated median survival time (MST) of the 17 cases was 18.6 mo (range, 3.8 to 36.3 mo). Ten patients who displayed increased IFN-γ-producing cells (≥2-fold) showed prolonged MST (31.9 mo; range, 14.5 to 36.3 mo) as compared with poor-responder patients (n = 7) MST (9.7 mo; range, 3.8 to 25.0 mo) (log-rank test, p = 0.0015). The administration of αGalCer-pulsed IL-2/GM-CSF-cultured PBMCs was well tolerated and was accompanied by the successful induction of NKT cell-dependent immune responses. The increased IFN-γ-producing cells that result from αGalCer stimulation in PBMCs were significantly associated with prolonged MST. These results are encouraging and warrant further evaluation for survival benefit of this immunotherapy.
Cytokine correlates of clinical response patterns to infliximab treatment of ankylosing spondylitis

Objective: To identify clinical and immunological markers of response to treatment with infliximab in ankylosing spondylitis (AS). Methods: Baseline and sequential cytokine levels (IL1, TNFα, IFNγ, TGFβ and IL10) were examined after 52 weeks of infliximab treatment 5 mg/kg in 22 patients. Results: At week 52, 18 patients were responders and four non-responders according to ASAS group criteria. Clinical measures of disease activity between the two groups at baseline were similar, apart from a trend towards longer disease duration in non-responders (p = 0.08). Baseline CRP and TNFα levels were higher in responders than non-responders (p<0.01 and p<0.006, respectively). The two groups had similar baseline cytokine levels, apart from TNFα. Baseline CRP levels did not correlate significantly with baseline cytokine levels in responders, but a strong correlation was noted between baseline CRP and IL1, IFNγ, and IL10 in non-responders. Apart from an early rise in TGFβ and a decrease in IL10 in responders after the first infusion, sequential cytokine analysis for the first six months of treatment was not related to clinical disease activity measures. Conclusion: Although sequential cytokine analysis does not appear to be informative, baseline CRP and TNFα levels are useful markers of clinical response patterns in patients with AS treated with infliximab.
The Ethics of Paying Drug Users Who Participate in Research: A Review and Practical Recommendations

The payment of research participants raises ethical and empirical questions that have special importance in addictions research involving drug-dependent participants. Despite a now large literature on human subjects payment, what is still needed is practical guidance for investigators and ethics committees. This paper reviews the literature on: Current payment practices and guidelines; defining features of undue and due incentives and fair reimbursement; and the significance of risks and harms that may arise from paying drug using participants. We conclude that research payments are ethically acceptable in most circumstances of addictions research, but should be closely scrutinized in situations where these may exacerbate existing harms or create additional risks for participants and investigators. General principles, key questions and procedural options are highlighted for an applied approach to ethical research payments. Future research directions are identified.
Predictive value of red blood cell distribution width for coronary artery lesions in patients with Kawasaki disease

Abstract Recent studies have shown that elevated red blood cell distribution width is associated with poor outcome in cardiovascular diseases. In order to assess the predictive value of red blood cell distribution width, before treatment with intravenous immunoglobulins, for coronary artery lesions in patient with Kawasaki disease, we compared 83 patients with coronary artery lesions and 339 patients without coronary artery lesions before treatment with intravenous immunoglobulin. Clinical, echocardiographic, and biochemical values were evaluated along with red blood cell distribution width. A total of 422 consecutive patients with Kawasaki disease were enrolled into our study. According to receiver operating characteristic curve analysis, the optimal red blood cell distribution width cut-off value for predicting coronary artery lesions was 14.55% (area under the curve was 0.721; p=0.000); eighty-three patients (19.7%) had coronary artery lesions, and 70% of the patients with coronary artery lesions had red blood cell distribution width level >14.55%. Logistic regression analysis revealed that fever duration >14 days (odds ratio was 3.42, 95% confidence interval was 1.27–9.22; p=0.015), intravenous immunoglobulin resistance (odds ratio was 2.33, 95% confidence interval was 1.02–5.29; p=0.04), and red blood cell distribution width >14.55% (odds ratio was 3.49, 95% confidence interval was 2.01–6.05; p=0.000) were independent predictors of coronary artery lesions in patients with Kawasaki disease. In Conclusion, red blood cell distribution width may be helpful for predicting coronary artery lesions in patients with Kawasaki disease.
High-Order Calderón Preconditioned Time Domain Integral Equation Solvers

Two high-order accurate Calderón preconditioned time domain electric field integral equation (TDEFIE) solvers are presented. In contrast to existing Calderón preconditioned time domain solvers, the proposed preconditioner allows for high-order surface representations and current expansions by using a novel set of fully-localized high-order div- and quasi curl-conforming (DQCC) basis functions. Numerical results demonstrate that the linear systems of equations obtained using the proposed basis functions converge rapidly, regardless of the mesh density and of the order of the current expansion.
Atlanta, revised Atlanta, and Determinant-based classification – application in a cohort of Portuguese patients with acute pancreatitis

Background Acute pancreatitis (AP) represents a complex and potentially fatal disease with a highly variable clinical course. Three classification systems for assessing the severity in AP have been validated for clinical use. Aims The aim of the present study was to evaluate the performance of the Atlanta and Determinant-based classifications in predicting severe clinical outcomes in patients with AP. Methods In this retrospective study we reviewed the treatment and follow-up records of 525 patients with AP admitted to our unit between the years of 2003 and 2014. Outcomes included mortality, admission to the ICU, need for interventional procedures or nutritional support, and duration of hospital and ICU stay. Results The prevalence of organ failure and persistent organ failure in our cohort was 23.0 and 10.7%, respectively, and the mortality rate was 5.9%. Higher grades of severity were associated with worse outcomes in all classification systems. The revised Atlanta and Determinant-based classifications performed similarly in predicting outcomes, and both proved to be superior to the former classic Atlanta classification. Conclusion Recent classifications proved to be more accurate in predicting important clinical outcomes in patients with AP.