Miracle-dz/UniFAR-FTUs huggingface dataset:
Teaching musculoskeletal ultrasound in the undergraduate medical curriculum

Context and setting Objective structured clinical examinations (OSCEs) are used for summative assessment at final year level in the undergraduate medical programme of a medical school in Malaysia. Training of examiners was instituted 3 years after the OSCE was introduced. Why the idea was necessary Previous observations of examiners in OSCEs raised 2 concerns: faculty were inconsistent in marking checklists and some demonstrated inappropriate behaviour, such as prompting and teaching. What was done Examiner training was instituted in February 2006 to improve skills in OSCE examination. To date, 36 OSCE examiners have been trained through 4 training workshops. In the workshops, volunteer students and 4 standardised stations were used to train examiners using a 2-way mirror system. Examiner behaviour was scored using a checklist and examiners, both inside and outside the consultation room, scored student performance. Station checklist scores were compared before and after discussion. Evaluation of results and impact During the training workshops, examiners showed wide variation in scoring. Examiners were observed during subsequent OSCEs to determine whether their scoring skills and behaviour had improved. Observers in the OSCEs reported wide variations in scoring practices between trained and untrained examiners who examined the same OSCE station in parallel tracks. In addition, examiners who underwent training prior to the OSCE were generally consistent in their behaviour and provided none or minimal prompting. By contrast, untrained examiners were inconsistent and prompted students. These preliminary results confirm that examiner training workshops improved examiner scoring skills, which resulted in better consistency during administration of OSCEs.
Topical corticosteroids in association with miconazole and chlorhexidine in the long-term management of atrophic-erosive oral lichen planus: a placebo-controlled and comparative study between clobetasol and fluocinonide.

OBJECTIVE To evaluate the efficacy of a combination of topical corticosteroids with topical antimycotic drugs in the therapy of atrophic-erosive forms of oral lichen planus (OLP). PATIENTS AND METHODS The study population consisted of 60 patients with OLP subdivided into three groups matched for sex and age. The first group (25 patients) and the second group (24 patients) received respectively 0.05% clobetasol propionate ointment or 0.05% fluocinonide ointment in an adhesive medium (4% hydroxyethyl cellulose gel) plus in each case antimycotic treatment consisting of miconazole gel and 0.12% chlorhexidine mouthwashes. The third group (11 patients), placebo group, received only hydroxyethyl cellulose gel and antimycotic treatment as above. All the treatment regimens were carried out for 6 months. Each patient was examined every 2 months during the 6-month period of active treatment and for a further 6 months of follow-up. Objective and subjective clinical progress was scored and compared between the three groups. Plasma cortisol levels were monitored in half the patients using the topical corticosteroids. RESULTS All patients treated with clobetasol and 90% of the patients treated with fluocinonide witnessed some improvement, whereas in the placebo group only 20% of patients improved (P < 0.0001 and P = 0.00029, respectively. However, when considering complete responses, only clobetasol gave significantly better results than placebo. Clobetasol resolved 75% of the lesions whereas fluocinonide was effective in 25% of cases and placebo in none. Clobetasol achieved better results statistically than did fluocinonide (P = 0.00442) and placebo (P = 0.00049) whereas there was no statistical difference among fluocinonide and placebo (P = 0.140). Similar results were obtained for symptoms. Both drugs were shown to be effective in the treatment of erosive lesions, but clobetasol was considerably more efficacious than fluocinonide in the atrophic areas (75% vs 25% of total response, respectively) (P = 0.00442). None of the treated patients contracted oropharyngeal candidiasis. After 6 months of follow-up, 65% of the clobetasol-treated group and 55% of the fluocinonide group were stable. Estimation of plasma cortisol levels showed no significant systemic adverse effects of clobetasol or fluocinonide. CONCLUSIONS Our results suggest that a very potent topical corticosteroid such as clobetasol may control OLP in most cases, with no significant adrenal suppression or adverse effects. Moreover, a concomitant antimycotic treatment with miconazole gel and chlorhexidine mouthwashes is a useful and safe prophylaxis against oropharyngeal candidiasis.
Comparison of Psychophysiological Stress in Physiotherapy Students Undertaking Simulation and Hospital-Based Clinical Education

Introduction Simulation-based clinical education often aims to replicate varying aspects of real clinical practice. It is unknown whether learners’ stress levels in simulation are comparable with those in clinical practice. The current study compared acute stress markers during simulation-based clinical education with that experienced in situ in a hospital-based environment. Methods Undergraduate physiotherapy students’ (n = 33) acute stress responses [visual analog scales of stress and anxiety, continuous heart rate (HR), and saliva cortisol] were assessed during matched patient encounters in simulation-based laboratories using standardized patients and during hospital clinical placements with real patients. Group differences in stress variables were compared using repeated measures analysis of variance for 3 time points (before, during the patient encounter, and after) at 2 settings (simulation and hospital). Results Visual analog scale stress and anxiety as well as HR increased significantly from baseline levels before the encounter in both settings (all P < 0.05). Stress and anxiety were significantly higher in simulation [mean (SD), 45 (22) and 44 (25) mm; P = 0.003] compared with hospital [mean (SD), 31 (21) and 26 (20) mm; P = 0.002]. The mean (SD) HR during the simulation patient encounter was 90 (16) beats per minute and was not different compared with hospital [mean (SD), 87 (15) beats per minute; P = 0.89]. Changes in salivary cortisol before and after patient encounters were not statistically different between settings [mean (SD) simulation, 1.5 (2.4) nmol/L; hospital, 2.5 (2.9) nmol/L; P = 0.70]. Conclusions Participants’ experienced stress on clinical placements, irrespective of the clinical education setting (simulation vs. hospital). This study revealed that psychological stress and anxiety were greater during simulation compared with hospital settings; however, physiological stress responses (HR and cortisol) were comparable. These results indicate that psychological stress may be heightened in simulation, and health professional educators need to consider the impact of this on learners in simulation-based clinical education. New learners in their clinical education program may benefit from a less stressful simulation environment, before a gradual increase in stress demands as they approach clinical practice.
THE ATACAMA COSMOLOGY TELESCOPE: THE LABOCA/ACT SURVEY OF CLUSTERS AT ALL REDSHIFTS

We present a multi-wavelength analysis of 11 Sunyaev–Zel’dovich effect (SZE)-selected galaxy clusters (10 with new data) from the Atacama Cosmology Telescope (ACT) southern survey. We have obtained new imaging from the Large APEX Bolometer Camera (345 GHz; LABOCA) on the Atacama Pathfinder EXperiment (APEX) telescope, the Australia Telescope Compact Array (2.1 GHz; ATCA), and the Spectral and Photometric Imaging Receiver (250, 350, and 500 μm; SPIRE) on the Herschel Space Observatory. Spatially resolved 345 GHz SZE increments with integrated signal-to-noise ratio ( S / N ) > 5 ? > are found in six clusters. We compute 2.1 GHz number counts as a function of cluster-centric radius and find significant enhancements in the counts of bright sources at projected radii θ < θ 2500 c ? > . By extrapolating in frequency, we predict that the combined signals from 2.1 GHz-selected radio sources and 345 GHz-selected submillimeter galaxies (SMGs) contaminate the 148 GHz SZE decrement signal by ∼5% and the 345 GHz SZE increment by ∼18%. After removing radio source and SMG emission from the SZE signals, we use ACT, LABOCA, and (in some cases) new Herschel SPIRE imaging to place constraints on the clusters’ peculiar velocities. The sample’s average peculiar velocity relative to the cosmic microwave background is ⟨ v p ⟩ = 153 ± 383 km s − 1 ? > .
The Efficacy of Polymerized Pyridoxylated Hemoglobin Solution as an O2 Carrier

A polymerized pyridoxylated hemoglobin solution (Poly SFH-P) has been prepared with a normal [Hb] of 14 g/dL, a normal COP of 20 to 25 torr, a P50 of 16 to 20 torr, and a plasma T1/2 of 40 to 46 hours. Animals underwent a total exchange transfusion with Poly SFH-P to assess its ability to support hemodynamics and oxygen transport in the absence of red cells. All animals survived the exchange transfusion. Mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), and oxygen consumption (VO2) remained at baseline values at zero hematocrit after the exchange. The final plasma [Hb] at Hct less than 1% was 9.7 +/- 0.4 g/dL. These results are significantly better than previous data with unmodified tetrameric hemoglobin solution (SFH). Poly SFH-P supports life in the absence of red cells. In contrast to SFH, Poly SFH-P achieves a nearly normal [Hb], a longer T1/2, and maintains baseline hemodynamics and oxygen consumption at zero hematocrit. These results document that Poly SFH-P is an effective oxygen carrier that offers greater potential than previous products as a clinically useful red cell substitute.
Small hepatocellular carcinomas: improved sensitivity by combining gadoxetic acid-enhanced and diffusion-weighted MR imaging patterns.

PURPOSE To determine if the combination of gadoxetic acid-enhanced magnetic resonance (MR) imaging and diffusion-weighted (DW) imaging helps to increase accuracy and sensitivity in the diagnosis of small hepatocellular carcinomas (HCCs) compared with those achieved by using each MR imaging technique alone. MATERIALS AND METHODS The institutional review board approved this retrospective study and waived the requirement for informed consent. The study included 130 patients (95 men, 35 women) with 179 surgically confirmed small HCCs (≤2.0 cm) and 130 patients with cirrhosis (90 men, 40 women) without HCC who underwent gadoxetic acid-enhanced MR imaging and DW imaging at 3.0 T between May 2009 and July 2010. Three sets of images were analyzed independently by three observers to detect HCC: a gadoxetic acid set (unenhanced, early dynamic, and hepatobiliary phases), a DW imaging set, and a combined set. Data were analyzed by using alternative-free response receiver operating characteristic analysis. Diagnostic accuracy (area under the receiver operating characteristic curve [A(z)]), sensitivity, specificity, and positive predictive value were calculated. RESULTS The mean A(z) values for the combined set (0.952) were significantly higher than those for the gadoxetic acid set (A(z) = 0.902) or the DW imaging set alone (A(z) = 0.871) (P ≤ .008). On a per-lesion basis, observers showed higher sensitivity in their analyses of the combined set (range, 91.1%-93.3% [163-167 of 179]) than in those of the gadoxetic acid set (range, 80.5%-82.1% [144-147 of 179]) or the DW imaging set alone (range, 77.7%-79.9% [139-143 of 179]) (P ≤ .003). Positive predictive values and specificity for all observers were equivalent for the three imaging sets. CONCLUSION The combination of gadoxetic acid-enhanced MR imaging and DW imaging yielded better diagnostic accuracy and sensitivity in the detection of small HCCs than each MR imaging technique alone.
Metodologia do ensino na preceptoria da residência médica

Quase toda a atividade da Residencia Medica se desenvolve em torno de tres atores principais: o paciente, o residente e o preceptor. O primeiro, como objeto de estudo e razao de todo o treinamento proposto; o segundo, como aquele que busca aprender e desenvolver capacidades tecnicas e intelectuais que o capacitem a exercer a atividade profissional; e o terceiro como o responsavel pelo preparo profissional, etico e humanista do residente mas, tambem, pela supervisao no atendimento prestado ao paciente.
The size of plume heterogeneities constrained by Marquesas isotopic stripes

The scale and geometry of chemical and isotopic heterogeneities in the source of plumes have important scientific implications on the nature, composition and origin of plumes and on the dynamics of mantle mixing over time. Here, we address these issues through the study of Marquesas Islands, one of the Archipelagoes in Polynesia. We present new Sr, Nd, Pb, Hf isotopes as well as trace element data on lavas from several Marquesas Islands and demonstrate that this archipelago consists of two adjacent and distinct rows of islands with significantly different isotopic compositions. For the entire 5.5 Ma construction period, the northern islands, hereafter called the Ua Huka group, has had systematically higher 87Sr/86Sr and lower 206Pb/204Pb ratios than the southern Fatu Hiva group at any given 143Nd/144Nd value. The shape and curvature of mixing arrays preclude the ambient depleted MORB mantle as one of the mixing end‐members. We believe therefore that the entire isotopic heterogeneity originates in the plume itself. We suggest that the two Marquesas isotopic stripes originate from partial melting of two adjacent filaments contained in small plumes or “plumelets” that came from a large dome structure located deep in the mantle under Polynesia. Low‐degree partial melting under Marquesas and other “weak” Polynesian hot spot chains (Pitcairn‐Gambier, Austral‐Cook, Society) sample small areas of the dome and preserve source heterogeneities. In contrast, more productive hot spots build up large islands such as Big Island in Hawaii or Réunion Island, and the higher degrees of melting blur the isotopic variability of the plume source.
The Notch signaling pathway in head and neck squamous cell carcinoma: A meta-analysis.

BACKGROUND The Notch signaling pathway has been associated with the regulation of self-renewal capacity, cell cycle exit, and survival. However, the relationship between the Notch signaling pathway and HNSCC remains controversial. OBJECTIVES A meta-analysis was conducted to evaluate the role of Notch signaling pathway in HNSCC. MATERIAL AND METHODS Relevant studies published until March 31, 2015 were identified by searching the PubMed, EMBASE and Ovid database. RESULTS A total of 9 articles were eligible for this meta-analysis. The meta-analysis results showed that the expression of Notch1, Notch3 and NICD was significantly higher in HNSCC as compared with control tissue. There was no significant difference in Jagged1 and HES1 expression between HNSCC and control tissue. Stratified analysis results showed that the expression of Notch1 was significantly higher in poor differentiation, III and IV stage and positive lymph node metastasis patients. Additionally, over-expression of Notch1, NICD, HES1 and DLL4 significantly predicted poor OS in HNSCC patients. CONCLUSION The Notch signaling pathway plays an important role in tumor development of HNSCC. Inhibition of the Notch signaling pathway is a potential therapeutic method of HNSCC.
Sources of Private Information in FX Trading

This paper examines the information content of trades by different participants via different trading channels in the spot foreign exchange market. Using spot FX transactions of a major Australian bank, we find that central banks have the greatest price impact, followed by nonbank financial institutions such as hedge funds and mutual funds. Trades by non-financial corporations have the least impact on dealer pricing. In the interbank market, dealers with greater private information appear to choose direct trading which has lower post-trade transparency, while indirect trading via brokers has little price impact. Furthermore, the price impact from each group largely comes from dealers or customers in the top quartile of trading volume. Overall the study presents an information hierarchy across different types of players and the choices of trading mechanisms in the FX market.
Noumenalism and Response-Dependence

En reponse a l'article precedent de M. Smith et D. Stoljar intitule «Global response-dependance and noumenal realism» (in «The monist», 81, 1, 1998, pp. 85-111), l'A. admet l'implication de la verite du realisme noumenal par la these de la dependance de la reponse globale, mais montre que son caractere non-universel lui enleve de son serieux. Examinant la notion a priori de dependance de la reponse, l'A. montre que la these globale ne se distingue pas du noumenalisme et rejete toute position epistemique disjonctiviste
Laboratory evaluation of Toxorhynchites splendens (Diptera: Culicidae) for predation of Aedes albopictus mosquito larvae

Abstract. Biology of the mosquito Toxorhynchites splendens (Wiedemann) was studied in the laboratory to provide baseline data for using the predatory larvae of this species against those of Aedes albopictus (Skuse) in a biological control programme. The mean incubation time of Tx.splendens eggs was 43.8 h and the time required for newly‐hatched larvae to initiate predation was 2.5 h. Mean numbers of prey larvae consumed and killed by each Tx. splendens larva totalled 389 and 345 respectively. The larval period of Tx.splendens was not significantly different for rearing individually or in groups of nine, with equal prey density, and duration of larval development was proportional to prey density. In mass rearing, larval cannibalism was usually observed during days 1–3 post‐eclosion. The incidence of cannibalism decreased sharply on the fourth day after hatching when some larvae became fourth‐instar. Adult female Tx.splendens usually commenced oviposition on day 4 after emergence. The number of eggs laid daily increased on day 7 and the peak oviposition of 6.3 eggs/female/day occurred on day 11. When oviposition containers were provided only intermittently, gravid females of Tx.splendens scattered most of their eggs on the dry floor of the cage. Viability of eggs laid by females aged 4–14 days was high (60–90%) but decreased to less than 40% as the females aged.
Imaging of cardiac amyloidosis by (99m)Tc-PYP scintigraphy.

OBJECTIVE Cardiac amyloidosis (CA) is an underestimated and underdiagnosed cause of cardiac insufficiency. Despite being often considered as a solitary entity attributable to extracellular deposition of fibrillary proteins, there exist at least two different pathophysiologic backgrounds, with different clinical course and treatment. a) In light-chain cardiac amyloidosis (immunoglobulin light-chain amyloidosis-AL) the fibrils consist of light-chain immunoglobulins produced by a clonal plasma cell population in bone marrow. b) In CA related to transthyretin (transthyretin-related amyloidosis - ATTR), whether familial amyloid cardiomyopathy or senile systemic amyloidosis, monomers or dimers of the normally tetrameric protein of transthyretin are deposited in the myocardium. Today, definitive diagnosis of cardiac amyloid disease is based on endomyocardial biopsy in conjunction with immunohistochemical parameters or, in ambiguous cases, with mass spectroscopy. Several radiotracers have been hitherto tried in the detection of CA. SUBJECTS AND METHODS In this pilot study technetium-99m pyrophosphate ((99m)Tc-PYP) was administered to patients suffering from CA, aiming to differentiate scintigraphically between AL and ATTR. Twelve patients (8 males, aged [mean±SD] 70,6±13,2y; 4 females, aged 65,7±9,9y) were enrolled for the discrimination between AL and ATTR. Diagnosis was confirmed by biopsy combined with the clinical and laboratory evaluation of the patients. Myocardial scintigraphy (planar and tomographic imaging) was conducted at 1, 2 and/or 3h after intravenous administration of 555-925MBq (99m)Tc-PYP. Myocardial radiotracer uptake was evaluated optically and also by a semiquantitative method. Two regions of interest (ROI) were drawn: one over the heart and another over the contralateral hemithorax, to calculate the corresponding heart-to-contralateral (H/CL) count ratio. According to established reference standards, a cut-off H/CL value of 1.5 best discriminates between the two conditions. (99m)Tc-PYP scintigraphy revealed diffuse intense myocardial uptake upon visual evaluation that was also verified semi-quantitatively in 6 patients, all of which had ATTR. Faint or no myocardial tracer uptake was found in 4 patients who were diagnosed with AL. Two AL patients had a borderline positive scan on visual evaluation but their H/CL ratios did not exceed the value of 1.5. In three patients, we also attempted scintigraphy with the tracer pentavalent (99m)Tc-dimercaptosuccinic acid. Results and possible mechanisms of uptake are discussed. The sensitivity and specificity of scintigraphy with (99m)Tc-PYP was high, albeit the small number of patients. IN CONCLUSION These preliminary results are compatible with current international literature, and demonstrate that scintigraphy with (99m)Tc-PYP may prove a simple, non-invasive and widely available method in the identification of patients with the ATTR subtype, thus optimizing therapeutic decisions.
TRF2‐Mediated Stabilization of hREST4 Is Critical for the Differentiation and Maintenance of Neural Progenitors

Telomere repeat binding factor 2 (TRF2) is a component of the shelterin complex that is known to bind and protect telomeric DNA, yet the detection of TRF2 in extra‐telomeric regions of chromosomes suggests other roles for TRF2 besides telomere protection. Here, we demonstrate that TRF2 plays a critical role in antagonizing the repressive function of neuron‐restrictive silencer factor, also known as repressor element‐1 silencing transcription factor (REST), during the neural differentiation of human embryonic stem cells (hESCs) by enhancing the expression of a truncated REST splice isoform we term human REST4 (hREST4) due to its similarity to rodent REST4. We show that TRF2 is specifically upregulated during hESC neural differentiation concordantly with an increase in the expression of hREST4 and that both proteins are highly expressed in NPCs. Overexpression of TRF2 in hESCs increases hREST4 levels and induces their neural differentiation, whereas TRF2 knockdown in hESCs and NPCs reduces hREST4 expression, hindering their ability to differentiate to the neural lineage. Concurrently, we show that TRF2 directly interacts with the C‐terminal of hREST4 through its TRF2 core binding motif [F/Y]xL, protecting hREST4 from ubiquitin‐mediated proteasomal degradation and consequently furthering neural induction. Thus, the TRF2‐mediated counterbalance between hREST4 and REST is vital for both the generation and maintenance of NPCs, suggesting an important role for TRF2 in both neurogenesis and function of the central nervous system. Stem Cells 2014;32:2111–2122