Miracle-dz/UniFAR-FTUs huggingface dataset:
Educating physicians for the future: Carnegie's calls for reform

In both 1910 and 2010, The Carnegie Foundation for the Advancement of Teaching used existing educational innovations and learning theory to point the way to the future of medical education. Flexner's transformative report of 1910 was strongly influenced by the innovative curriculum at Johns Hopkins University School of Medicine and by educational principles of the Progressive Era. In 1912, Flexner wrote a similar critique of medical education in Europe. These two reports have powerfully shaped medical education for the past century. Yet much has changed since then, which prompted The Carnegie Foundation for the Advancement of Teaching to commission another report that was published in 2010. Drawing on contemporary educational innovations and research from the learning sciences, the authors make four recommendations for reform: (1) standardize on learning outcomes while individualizing the learning process, (2) integrate formal knowledge with clinical experience, (3) imbue habits of inquiry and improvement to achieve lifelong learning and excellence, and (4) explicitly cultivate the formation of professional identity. In this article, the author describes educational innovations and educational principles relevant to each of these four recommendations.
Dehydration reverses vasopressin antagonist-induced diuresis and aquaporin-2 downregulation in rats

DAVID MARPLES,1 BIRGITTE MØNSTER CHRISTENSEN,2 JØRGEN FRØKIAER,3 MARK A. KNEPPER,4 AND SØREN NIELSEN2 1Physiology Department, University of Leeds, Leeds LS2 9NQ, United Kingdom; 2Department of Cell Biology, Institute of Anatomy, and 3Department of Clinical Physiology, University of Aarhus, DK-8000 Aarhus C, Denmark; and 4National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1603
Imaging the Vulnerable Carotid Artery Plaque

Abstract Imaging plays a key role in the selection of patients for carotid artery surgery. Indication for carotid endarterectomy or stenting is based on symptomatology and degree of stenosis as determined by angiography, duplex ultrasonography or computed tomographic angiography. Degree of stenosis has long time been assumed the most reliable predictor of stroke-risk in patients with carotid artery stenosis and accordingly, traditional imaging methods were focused on luminal stenosis. There is, however, growing evidence that other factors than degree of stenosis determine whether a carotid plaque will result in acute neurologic events or not. Various morphological characteristics and molecular processes have proven to be highly related to carotid plaque instability and symptomatology. As a result, the focus of imaging techniques in carotid artery disease is more and more shifting towards identification of the vulnerable plaque rather than the high-grade stenosis. In traditional imaging modalities, new insights of imaging beyond degree of stenosis have been explored and may be able to detect morphological characteristics of plaque vulnerability. In addition, advanced molecular imaging methods have been developed and are able to identify molecular and cellular processes in the vulnerable carotid artery plaque. It is clear that recent developments in carotid imaging are of great potential in the identification of the vulnerable carotid plaque.
Monte Carlo Simulation of Proton Upsets in Xilinx Virtex-II FPGA Using a Position Dependent  ${\rm Q}_{\rm crit}$ With PROPSET

Proton upsets, predicted by the software code, PROPSET, for the Xilinx Virtex-II FPGA and other devices are presented. PROPSET uses heavy-ion upset data to determine the upset energy threshold at each position within the device's sensitive volume. Sensitivity to the shape and thickness of the sensitive volume, to the choice of Weibull parameters and to model physics are explored
Hearing rehabilitation in congenital aural atresia using the bone-anchored hearing aid: audiological and satisfaction results

Abstract Conclusion: The BAHA (bone-anchored hearing aid) remains the most reliable method of auditory rehabilitation for patients with congenital aural atresia and improves hearing outcome and quality of life in these patients who are otherwise unable to benefit from traditional hearing aids. New techniques are being developed, such as fully implantable hearing devices, and will have to prove their efficacy and safety in this indication. Objective: To evaluate the audiological results and patient satisfaction after rehabilitation of congenital aural atresia using the BAHA. Methods: Sixteen patients suffering from bilateral congenital aural atresia were implanted with unilateral BAHA. Preoperative air- and bone-conduction thresholds and air–bone gap (ABG), preoperative sound reception threshold (SRT), postoperative aided thresholds, implantation complications, patient satisfaction, and the APHAB questionnaire were collected. Results: After a mean follow-up period of 6.5 years, 15 patients were still using their device. Each patient had an average improvement of 33 ± 7 dB. Closure of the ABG within 15 dB of the preoperative bone-conduction thresholds occurred in 10 patients. Adverse skin reactions appeared in 50% of patients over 6.5 years of follow-up. Eleven of the 12 patients used their BAHA for more than 8 h per day.
Peer-facilitated discussions to enhance OER-based e-learning

Purpose The Open University of Sri Lanka implemented a fully online professional development course on open educational resources-based e-learning (OEReL), which adopted a scenario-based learning (SBL) design within the constructivist pedagogy. It was designed to facilitate knowledge construction in a collaborative manner with the support of open educational resource (OER), mainly through peer-facilitated discussion forum activities. The purpose of this paper is to present a case study on how peer-facilitated discussions affected the OEReL process, what factors supported and hindered peer-facilitated discussions, and what challenges were faced during the process. Design/methodology/approach The OEReL course consisted of five modules with 14 discussion forum activities. Content analysis of the threaded forum discussions was the key data collection and analysis strategy based on the community of inquiry (CoI) framework (Garrison and Arbaugh, 2007). It was supplemented with participants’ reflections and focus group discussions. Findings The three elements of CoI – cognitive presence, social presence and teaching presence played a major role in knowledge construction in the OEReL process. A complementary relationship between cognitive presence, social presence and teaching presence was observed, where the three elements have interacted in supporting knowledge construction. Overall, the findings reaffirm the significant of role of instructors in cultivating the three presences within a peer-facilitated environment, by enabling learners to engage with the content in a meaningful manner through appropriate course design, structure and leadership. Practical implications Forum discussions created an opportunity for participants to engage in meaning making through social negotiation, where facilitation became a shared responsibility among instructors and learners. Peer-facilitation was the key strength that promoted critical, analytical and reflective thinking, as well as self-regulated learning. The SBL design, learning tasks with OER integration, and instructor guidance were the most supportive factors, while time constraints due to the participants’ workload was challenging. Originality/value Through carefully orchestrated, well-structured and pedagogically sound OEReL environments, peer-facilitated forum discussions can be designed creatively and implemented in a meaningful manner to enhance knowledge construction.
Anti-phospholipid antibodies as a cause of recurrent pregnancy loss: a study in Calcutta, India

Summary This prospective, observational study was carried out in a teaching hospital in Calcutta, India. The aim of the study was to evaluate the prevalence of anti-phospholipid syndrome (APS) among women with recurrent miscarriages/late pregnancy loss when no other apparent causes were identified, in the study population. The women were put through a variety of investigations to determine the cause of miscarriage/pregnancy loss. Only those women who had a normal result for all the investigation went for the anti-phospholipid antibodies (APLA) test. The expelled products of conception/placenta were also sent for histopathological confirmation. A total of 445 women were studied over a 4-year period. A total of 155 women were offered a screening for APLA antibodies. Out of them, 43 women (27.7%) tested positive for APLA. Histopathological evidence was present in all the specimens. Interestingly, one woman had histopathological evidence of thrombosis, but her blood tests for the antibody were negative.
Does the age difference between partners influence the career achievements of women

Women earn less than men at most career stages, and they also tend to partner with older men. This study investigates whether being the younger partner in a marriage reduces a woman’s incentive to pursue an independent career. We hypothesize that the income gender gap might be partially explained by the age differences between spouses. Using both a within-twin (n = 4716) and pooled-twin (n = 13354) design to more readily account for differences in early household environments, we investigated for Denmark whether the age gap between a female twin and her partner has any influence on her income. The hypothesis could not be confirmed, as the age gap between partners did not appear to be associated with women’s earnings. The finding that women’s wages were generally unaffected by partnering with an older man could be a result of heterogeneous groups of women entering men-older partnerships. Future research should explore this question further by using the number of promotions to assess the career success of women, and should extend this work to countries with different social welfare systems and less egalitarian gender norms.
Doing the Right Thing: A Value Based Economy

This book is for all those who are seeking a human perspective on economic and organizational processes. It lays the foundations for a value based approach to the economy. The key questions are: “What is important to you or your organization? ” “What is this action or that organization good for? ” The book is directed at the prevalence of instrumentalist thinking in the current economy and responds to the calls for another economy. Another economy demands another economics. The value based approach is another economics; it focuses on values and on the most important goods such as families, homes, communities, knowledge, and art. It places economic processes in their cultural context. What does it take to do the right thing, as a person, as an organization, as a society? What is the good to strive for? This book gives directions for the answers. The value based approach restores the ancient idea that quality of life and of society is what the economy is all about. It advocates shifting the focus from quantities (“how much? ”) to qualities (“what is important? ”).
A longitudinal study comparing the effort - reward imbalance and demand - control models using objective measures of physician utilization

Background: The objectives of this study were to compare the predictive validity of the demand - control and effort - reward imbalance models using objective measures of physician utilization. Methods: Self-reports for psychosocial work conditions were obtained in interviews with 1,028 workers using the demand - control and effort - reward imbalance models. Physician utilization outcomes were obtained through linkage to the British Columbia Linked Health Database. Outcomes were any visit to a physician for mental health reasons and 30 or more physician visits for any reason. The predictive validity of both models was compared in a longitudinal study using logistic regression. Results: Neither job strain nor effort - reward imbalance predicted either outcome. However, low esteem reward and low status control increased the risk for 30 or more physician visits by, respectively, approximately 60% and 30%. Conclusions: In a sample of middle-aged blue-collar current and ex-sawmill workers in Western Canada, followed prospectively, after controlling for sociodemographic and workplace confounders, and reducing the potential for adverse health selection into high-stress jobs, low esteem reward and low status control were associated with a significantly greater risk for 30 or more physician visits for any reason.
An Evaluation of Arkansas’ Developmental Coursework Policy at Postsecondary Institutions

This dissertation is an evaluation of the impacts of assignment to and enrollment in postsecondary remedial coursework in the state of Arkansas. In this study, I evaluate the impacts of the policy on students’ academic achievement and attainment as measured by graduation rates and persistence. I include subgroup analyses of these outcomes to determine whether there are heterogeneous effects for students enrolling at two-year or four-year institutions, institutions with the highest remediation rates, and students of different races, genders, and baseline achievement. Like previous evaluations of remediation in other settings, the results here point to negative impacts of remediation on students’ persistence and earning a degree, regardless of institution type. Secondary analyses show that students who were assigned to English Language Arts remediation but tested out of the course earned higher grades in the first college-level course compared to their peers who were unable to test out of remedial courses. There was no detectable difference in course performance for math students. Similarly, there were few substantial differences in noncognitive skills for students enrolling in remedial English courses compared to their nonremedial peers. These studies contribute to the literature on college remediation policies by providing the first rigorous evaluation of the policy in Arkansas, a comparison of noncognitive skills of remedial and nonremedial students, and a descriptive analysis of course performance for students who avoided
Paradoxical muscle movement in human standing

In human standing, gravity causes forward toppling about the ankle joint which is prevented by activity in the soleus and gastrocnemius muscles. It has long been assumed that when people sway forwards the calf muscles are stretched and conversely that they shorten with backward sway. Consequently, for many years, two explanations for standing stabilization have flourished. First, tonic muscle activity itself may generate adequate intrinsic ankle stiffness. Second, if intrinsic ankle stiffness is inadequate, the resistance to stretch of the calf muscles may be augmented by stretch reflexes or by central control. These explanations require that the passive tissue (Achilles' tendon, foot) transmitting the calf muscle tension is stiff. However, our recent measurements have indicated that this passive tissue is not stiff during standing. Accordingly, we predicted a counterintuitive mode of control where the muscles and body must, on average, move in opposite directions (paradoxical movements). Here we use dynamic ultrasound imaging in vivo with novel automated tracking of muscle length to test our hypothesis. We show that soleus and gastrocnemius do indeed move paradoxically, shortening when the body sways forward and lengthening when the body returns. This confirms that intrinsic ankle stiffness is too low to stabilize human standing. Moreover, it shows that the increase in active tension is associated with muscle shortening. This pattern cannot be produced by muscle stretch reflexes and can only arise from the anticipatory neural control of muscle length that is necessary for balance.
Development of the Russian matrix sentence test

Objective: To develop the Russian matrix sentence test for speech intelligibility measurements in noise. Design: Test development included recordings, optimization of speech material, and evaluation to investigate the equivalency of the test lists and training. For each of the 500 test items, the speech intelligibility function, speech reception threshold (SRT: signal-to-noise ratio, SNR, that provides 50% speech intelligibility), and slope was obtained. The speech material was homogenized by applying level corrections. In evaluation measurements, speech intelligibility was measured at two fixed SNRs to compare list-specific intelligibility functions. To investigate the training effect and establish reference data, speech intelligibility was measured adaptively. Study sample: Overall, 77 normal-hearing native Russian listeners. Results: The optimization procedure decreased the spread in SRTs across words from 2.8 to 0.6 dB. Evaluation measurements confirmed that the 16 test lists were equivalent, with a mean SRT of − 9.5 ± 0.2 dB and a slope of 13.8 ± 1.6%/dB. The reference SRT, − 8.8 ± 0.8 dB for the open-set and − 9.4 ± 0.8 dB for the closed-set format, increased slightly for noise levels above 75 dB SPL. Conclusions: The Russian matrix sentence test is suitable for accurate and reliable speech intelligibility measurements in noise.
Occurrence of CYP1B1 Mutations in Juvenile Open-Angle Glaucoma With Advanced Visual Field Loss.

IMPORTANCE Juvenile open-angle glaucoma (JOAG) is a severe neurodegenerative eye disorder in which most of the genetic contribution remains unexplained. OBJECTIVE To assess the prevalence of pathogenic CYP1B1 sequence variants in an Australian cohort of patients with JOAG and severe visual field loss. DESIGN, SETTING, AND PARTICIPANTS For this cohort study, we recruited 160 patients with JOAG classified as advanced (n = 118) and nonadvanced (n = 42) through the Australian and New Zealand Registry of Advanced Glaucoma from January 1, 2007, through April 1, 2014. Eighty individuals with no evidence of glaucoma served as a control group. We defined JOAG as diagnosis before age 40 years and advanced JOAG as visual field loss in 2 of the 4 central fixation squares on a reliable visual field test result. We performed direct sequencing of the entire coding region of CYP1B1. Data analysis was performed in October 2014. MAIN OUTCOMES AND MEASURES Identification and characterization of CYP1B1 sequence variants. RESULTS We identified 7 different pathogenic variants among 8 of 118 patients with advanced JOAG (6.8%) but none among the patients with nonadvanced JOAG. Three patients were homozygous or compound heterozygous for CYP1B1 pathogenic variants, which provided a likely basis for their disease. Five patients were heterozygous. The allele frequency among the patients with advanced JOAG (11 in 236 [4.7%]) was higher than among our controls (1 in 160 [0.6%]; P = .02; odds ratio, 7.8 [95% CI, 0.02-1.0]) or among the control population from the Exome Aggregation Consortium database (2946 of 122 960 [2.4%]; P = .02; odds ratio, 2.0 [95% CI, 0.3-0.9]). Individuals with CYP1B1 pathogenic variants, whether heterozygous or homozygous, had worse mean (SD) deviation on visual fields (-24.5 [5.1] [95% CI, -31.8 to -17.2] vs -15.6 [10.0] [95% CI, -17.1 to -13.6] dB; F1,126 = 5.90; P = .02; partial ηp2 = 0.05) and were younger at diagnosis (mean [SD] age, 23.1 [8.4] [95% CI, 17.2-29.1] vs 31.5 [8.0] [95% CI, 30.1-33.0] years; F1,122 = 7.18; P = .008; ηp2 = 0.06) than patients without CYP1B1 pathogenic variants. CONCLUSIONS AND RELEVANCE Patients with advanced JOAG based on visual field loss had enrichment of CYP1B1 pathogenic variants and a more severe phenotype compared with unaffected controls and patients with nonadvanced JOAG.
Sample size and power calculations for medical studies by simulation when closed form expressions are not available

This paper shows how Monte Carlo simulation can be used for sample size, power or precision calculations when planning medical research studies. Standard study designs can lead to the use of analysis methods for which power formulae do not exist. This may be because complex modelling techniques with optimal statistical properties are used but power formulae have not yet been derived or because analysis models are employed that divert from the population model due to lack of availability of more appropriate analysis tools. Our presentation concentrates on the conceptual steps involved in carrying out power or precision calculations by simulation. We demonstrate these steps in three examples concerned with (i) drop out in longitudinal studies, (ii) measurement error in observational studies and (iii) causal effect estimation in randomised controlled trials with non-compliance. We conclude that the Monte Carlo simulation approach is an important general tool in the methodological arsenal for assessing power and precision.
3D Kinematic Analysis and Clinical Evaluation of Neck Movements in Patients with Whiplash Injury

In recent decades whiplash injuries, being a major reason for compensation claims, have become increasingly important in forensic medicine. In view of this, a reliable diagnostic method of assessing cervical range of motion (ROM) is needed. The aim of the present study was to evaluate neck function with a 3D kinematic method compared with clinical evaluation in whiplash injury. Seventy consecutive patients (M/F = 18/52) with a history of whiplash injury (WH) and 46 healthy volunteers (M/F = 24/22), mean age, respectively 33 ± 9 and 28 ± 6 years (mean ± SD) entered the study. Patients suffered from neck pain and/or unilateral headache. A computerized kinematic analysis of the ROM (Elite system) using passive markers and two infrared TV cameras was used. Clinical evaluation of active ROM was also performed both in patients and in 61 controls (M/F = 23/38; mean age 47 ± 18 years). Thirty out of 70 patients were tested at the time of their first consultation (T0) and 6 months later (T6), and 12 were also followed up after a year (T12). All neck movements, except extension, were significantly reduced in WH subjects compared with controls, in particular lateral bending. Comparing ROM at T0, T6 and T12, no significant differences were found. A global index of motion (GIM), obtained by calculating the sum of ROM in absolute value for all the movements acquired, was significantly reduced in WH compared with control subjects. The interobserver reliability of the clinical evaluation was globally acceptable. On the basis of the clinical evaluation, a significantly reduced ROM was found in all movements in WH subjects compared with an age-matched population. Computing the number of impaired cervical movements (ICMs), a significantly higher number was observed in WH patients than in controls, showing a decreasing trend at T6 and T12, with a significant improvement at T6 vs. T0. The computerized study of neck ROM may constitute a useful tool in the evaluation of WH at baseline and follow-up.
Complications of Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Constructs

Rupture of the anterior cruciate ligament is a common injury. Correct diagnosis and patient selection, along with proper surgical technique, with careful attention to anatomic graft placement, followed by attention to proper rehabilitation, leads to predictably good to excellent results. This article reviews the recognition and avoidance of complications associated with bone–patellar tendon–bone contructs of anterior cruciate ligament reconstruction.