Miracle-dz/UniFAR-FTUs huggingface dataset:
Practice variation, bias, and experiential learning in cesarean delivery: a data-based system dynamics approach.

OBJECTIVES To simulate physician-driven dynamics of delivery mode decisions (scheduled cesarean delivery [CD] vs. vaginal delivery [VD] vs. unplanned CD after labor), and to evaluate a behavioral theory of how experiential learning leads to emerging bias toward more CD and practice variation across obstetricians. DATA SOURCES/STUDY SETTING Hospital discharge data on deliveries performed by 300 randomly selected obstetricians in Florida who finished obstetrics residency and started practice after 1991. STUDY DESIGN We develop a system dynamics simulation model of obstetricians' delivery mode decision based on the literature of experiential learning. We calibrate the model and investigate the extent to which the model replicates the data. PRINCIPAL FINDINGS Our learning-based simulation model replicates the empirical data, showing that physicians are more likely to schedule CD as they practice longer. Variation in CD rates is related to the way that physicians learn from outcomes of past decisions and accumulate experience. CONCLUSIONS The repetitive nature of medical decision making, learning from past practice, and accumulating experience can account for increases in CD decisions and practice variation across physicians. Policies aimed at improving medical decision making should account for providers' feedback-based learning mechanisms.
The Role of Unneutralized Surface Ions in Negative Potential Arcing

The observed arcing on negatively biased solar arrays exposed to plasma environments is shown to be due to an effective charge layer on the interconnect formed by ion collection from the plasma. Time scales to form this layer are shown to be in agreement with experimental observations. A quantitative theory is presented which predicts arcing threshold dependence on plasma density and external potentials. After breakdown, the discharge process is modeled as space charge limited transport to nearby coverslips. Peak currents and decay times predicted by this model are compared with experimental observations.
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP): A Review of Clinical Syndromes and Treatment Approaches in Clinical Practice

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a chronic, acquired immune and inflammatory disorder of the peripheral nervous system. The classic form of the disorder is manifested by progressive or relapsing proximal or generalized limb weakness and areflexia, and usually easily recognized; it is the large number of regional and functional variants and variety of associated illnesses that pose a challenge to the clinician in practice. Similarly, laboratory and electromyography criteria have been developed to confirm the diagnosis; however, these various schemes are contrived because only 50% to 60% of patients with typical clinical features of CIDP fulfill these strict electrodiagnostic research criteria. Several studies have established the efficacy of immune therapies such as corticosteroids, plasma exchange, and intravenous immune globulin as the mainstay of treatment of CIDP, but these treatments might provide only short-term benefit. This review offers an approach to the evaluation and management of patients with CIDP and highlights the difficult clinical problems in those who do not respond or frequently relapse after treatment with standard therapies such as patients with CIDP and concomitant axonal loss, and the assessment of those with CIDP and concurrent diseases such as diabetes mellitus.
Polymorphism 1936A>G in the AKAP10 gene (encoding A-kinase-anchoring protein 10) is associated with higher cholesterol cord blood concentration in Polish full-term newborns

Abstract Aims: A-Kinase anchoring proteins (AKAPs) coordinate the specificity of protein kinase A signaling by localizing the kinase to subcellular sites. The 1936G (V646) AKAP10 allele has been associated with adults with low cholinergic/vagus nerve sensitivity and with newborns with increased blood pressure. Decreased activity of the parasympathetic system is associated with risk of metabolic syndrome. The aim of this study was to answer the question of whether 1936A>G AKAP10 polymorphism is associated with metabolic changes in full-term newborns that are predictive factors for the metabolic phenotype in adulthood. Methods: The study included 114 consecutive healthy Polish newborns born after the end of the 37th week of gestation to healthy women with uncomplicated pregnancies. At birth, cord blood of neonates was obtained for isolation of genomic DNA and cholesterol as well as triglyceride concentration. Results: The cholesterol level in homozygotes GG was significantly higher than that in 1936A variant carriers (AG+AA, recessive mode of inheritance). Conclusions: Our results demonstrate a possible association between the 1936G AKAP10 variant and the total cholesterol level in the cord blood of the Polish newborn population.
Influence of Human Skin Specimens Consisting of Different Skin Layers on the Result of in vitro Permeation Experiments

The literature exhibits high variation in results from drug permeation experiments across human skin. Our purpose was to investigate the influence of human skin specimens, consisting of different skin layers and resulting from different skin preparation techniques, on the in vitro permeation of a model drug, i.e. flufenamic acid (FFA). FFA permeation across human (1) trypsin-isolated stratum corneum, (2) heat-separated epidermis and (3) dermis, (4) dermatomized skin and (5) full-thickness skin (FTS) from either a hydrophilic or lipophilic donor was investigated in Franz-type diffusion cells. Cumulative permeated drug amounts were plotted versus time, and a fit to Fick’s 2nd law of diffusion was performed. Since performing skin diffusion experiments in the laboratory is time consuming and expensive, especially when using FTS, we also investigated the possibility of calculating the resistances of composite skin layers from the diffusion resistances of the individual skin layers. Due to short lag time, practical handling and economic preparation, heat-separated epidermis appears to be superior in human skin in vitro permeation experiments compared to separated stratumcorneum sheets, dermatomized skin and FTS. Furthermore, we found a good correlation between calculated and experimental resistances which underlines that calculation of the total diffusion resistance of composed skin preparations from resistances of individual skin layers is legitimate and useful. Considering our findings, improved interpretation of literature data and more consistent results for future permeation experiments are possible.
Cannabis use frequency and use-related impairment among African-American and White users: the impact of cannabis use motives

ABSTRACT Objectives. Cannabis use motives are differentially related to cannabis-related impairment and coping motives appear to have the strongest relation to use-related impairment. However, it is currently unknown whether African-American individuals differ from White persons in reasons for using cannabis. It is also unknown whether motives’ relations to cannabis use and related impairment vary as a function of race. The present study examined the role of race on cannabis use motives and tested whether motives’ relations with cannabis use and related impairment differed by race. Design. The sample consisted of 111 (67.6% non-Hispanic White, 32.4% African-American) current cannabis-using adults. Results. African-American participants did not significantly differ from White participants on cannabis use frequency or use-related impairment. African-American participants endorsed more social motives than White participants. Race interacted with social, coping, and conformity motives to predict cannabis-related impairment such that these motives were positively related to cannabis impairment among African-American, but not White, participants. Conclusion. Although African-American and White participants do not differ in their cannabis use frequency or cannabis-related impairment, they appear to use cannabis for different reasons. Further, conformity, coping, and social motives were differentially associated with cannabis-related impairment as a function of race. Findings suggest motives for cannabis use should be contexualised in the context of race.
Cultural Sensitivity Among Clinical Nurses: A Descriptive Study

PURPOSE The purpose of this study was to investigate the cultural sensitivity of nurses working in rural and urban hospitals in Turkey. DESIGN AND METHODS The sampling of this descriptive and correlational study was composed of only 516 clinical nurses working in inpatient clinics. The data collection tools were the Socio-Demographic Questionnaire and the Intercultural Sensitivity Scale. FINDINGS A majority of the participating nurses experienced culture-related problems. Intercultural Sensitivity Scale results were partially high. The nurses had more problems in areas related to language barriers, patients' education level, and health perception about disease and religious beliefs when providing health care. Participants who were female, had an undergraduate or graduate education, had received in-service education on cultural care, or had taken transcultural nursing coursework obtained higher scores on the Intercultural Sensitivity Scale and its Interaction Engagement subscale. The cultural sensitivity level was 84.01 ± 9.1 (range = 43-107). The proportion of nurses who had received no in-service education was very high. They wanted to participate in an education program to gain better understanding of the culture of the society in which they lived. CONCLUSIONS The results of the present study demonstrated that nurses should be prepared in cultural sensitivity and cultural competence. CLINICAL RELEVANCE Continuing education and formal courses on cultural sensitivity for nursing professionals are essential for optimal health outcomes. Thus, inequalities in health could be prevented and the quality of health care could be improved.
Intra-articular Hyaluronic Acid: Potential Treatment of Younger Patients with Knee Injury and/or Post-Traumatic Arthritis

Abstract Anterior cruciate ligament (ACL) and meniscal injuries are common in both athletes and the general population. Such injuries may lead to early-onset post-traumatic osteoarthritis (OA) in 50% to 60% of patients, regardless of whether patients had reconstruction performed. In younger patients, intra-articular (IA) injection of hyaluronic acid (HA) may be useful for improving short-term outcomes and possibly slowing or arresting the progression of OA. Hyaluronic acid has anti-inflammatory, anabolic, and chondroprotective effects, which have been demonstrated in in vitro and animal models of meniscal and ACL injury. Results from several clinical trials and patient series have demonstrated the benefit of IA HA injection in younger patients with acute knee damage, including symptomatic meniscal tears and isolated ACL injury with chondral injury, although evidence for this is less extensive than the large database supporting the use of IA HA injection in older patients with knee OA. Administration of HA has been shown to improve outcomes in patients undergoing knee arthroscopy, and IA HA also has direct antinociceptive effects that may contribute to its benefit in patients with patellofemoral pain. However, the use of IA HA in patients with ACL injury or early OA has been evaluated in only a few studies. Thus, there is a need for larger-scale randomized controlled trials with longer durations of follow-up to provide more definitive evaluation of the efficacy and safety of IA HA in these patients. Such studies provide an opportunity to further elucidate the benefits of IA HA in younger patients with knee damage and may result in appropriate expansion of use in this large population, which has a substantial need for new treatment alternatives.
Fellowship training, workload, fatigue and physical stress: a prospective observational study

Background: Fatigue in physician trainees may compromise patient safety and the well-being of the trainees and limit the educational opportunities provided by training programs. Anecdotal evidence suggests that the on-call workload and physical demands experienced by trainees are significant despite duty-hour regulation and support from nursing staff, other trainees and staff physicians. Methods: We measured the workload and the level of fatigue and physical stress of 11 senior fellows during 35 shifts in the critical care unit at the Hospital for Sick Children in Toronto. We determined number of rostered hours, number of admissions and discharges, number and type of procedures, nurse:patient ratios and related measures of workload. Fellows self-reported the number of pages they received and the amount of time they slept. We estimated physical stress by using a commercially available pedometer to measure the distance walked, by using ambulatory electrocardiographic monitoring to determine arrhythmias and by determining urine specific gravity and ketone levels to estimate hydration. Results: The number of rostered hours were within current Ontario guidelines. The mean shift duration was 25.5 hours (range 24–27 hours). The fellows worked on average 69 hours (range 55–106) per week. On average during a shift, the fellows received 41 pages, were on non-sleeping breaks for 1.2 hours, slept 1.9 hours and walked 6.3 km. Ketonuria was found in participants in 7 (21%) of the 33 shifts during which it was measured. Arrhythmia (1 atrial, 1 ventricular) or heart rate abnormalities occurred in all 6 participants. These fellows were the most senior in-house physician for a mean of 9.4 hours per shift and were responsible for performing invasive procedures in two-thirds of their shifts. Interpretation: Established Canadian and proposed American guidelines expose trainees to significant on-call workload, physical stress and sleep deprivation.
Upper limb and trunk muscle activity patterns during seated and standing cycling

ABSTRACT The objective of this study is to clarify the functional roles of upper limb muscles during standing and seated cycling when power output increases. We investigated the activity of seven upper limb and trunk muscles using surface electromyography (EMG). Power outputs ranged from ~100–700 W with a pedalling frequency of 90 revolution per minute. Three-dimensional handle and pedal forces were simultaneously recorded. Using non-negative matrix factorisation, we extracted muscle synergies and we analysed the integrated EMG and EMG temporal patterns. Most of the muscles showed tonic activity that became more phasic as power output increased. Three muscle synergies were identified, associated with (i) torso stabilisation, (ii) compensation/generation of trunk accelerations and (iii) upper body weight support. Synergies were similar for seated and standing positions (Pearson’s r > 0.7), but synergy #2 (biceps brachii, deltoidus and brachioradialis) was shifted forward during the cycle (~7% of cycle). The activity levels of synergy #1 (latissimus dorsi and erector spinae) and synergy #2 increased markedly above ~500 W (i.e., ~+40–70% and +130–190%) and during periods corresponding to ipsi- and contralateral downstrokes, respectively. Our study results suggest that the upper limb and trunk muscles may play important roles in cycling when high power outputs are required.
Does a fall down a centile chart matter? The growth and developmental sequelae of mild failure to thrive

Fifty‐two children aged 18 months who had fallen across two weight centile lines were compared to 52 controls. Five years after the initial study, 89% of these children were traced. At follow‐up, four of the cases but none of the controls had been placed in care and cases were significantly shorter and lighter than controls. Reanalysis of the early weight data revealed that the screening criterion had been over‐inclusive, identifying a majority with only borderline failure to thrive (FTT). Although the mean IQ was lower in the cases than in controls, the difference was not statistically significant. However, a significant association was found within the cases between severity of FTT and IQ. There was no difference in the number of behaviour problems reported. The use of a simple centile shift‐based definition of FTT, while proving to be over‐sensitive, has identified a subgroup of children who suffered adverse long‐term cognitive outcomes.
Fractal and Image Analysis of the Microvasculature in Normal Intestinal Submucosa and Intestinal Polyps in ApcMin/+ Mice

Abstract Tumors are supported by the development of a unique vascular bed. We used fractal dimension (Db) and image analysis to quantify differences in the complexity of the vasculature in normal intestinal submucosa and intestinal polyps. ApcMin/+ mice and wild-type mice were perfused with a curable latex compound, intestines sectioned, and images collected via confocal microscopy. The images were analyzed and area (A), perimeter (P), and integrated optical density (IOD) of the normal and tumor vascular beds were measured. The Db, a quantitative descriptor of morphological complexity, was significantly greater for the polyp vasculature from ApcMin/+ mice than controls. This indicates that the polyp microvasculature is more chaotic than that of the controls, while the IOD and average vascular density values displayed no differences. This suggests the mass of blood volume is equivalent in normal and polyp microvasculature. The lower vascular area-perimeter ratios expressed by the polyp microvasculature suggest it is composed of smaller, more tortuous vessels. These data demonstrate that fractal analysis is applicable for providing a quantitative description of vascular complexity associated with angiogenesis occurring in normal or diseased tissue. Application of Db, IOD, and average density provides a clearer quantification of the complex morphology associated with tissue microvasculature.
Investigation of Optical Modulators in Optimized Nonlinear Compensated LTE RoF System

In this paper, we investigate a nonlinear compensation technique with two different architectures using direct modulation (DM) and external modulation (EM) techniques, termed as DM based frequency dithering (DMFD) and EM based frequency dithering (EMFD). We show that DMFD and EMFD methods operate substantially different in radio-over-fiber (RoF) system by optimizing the dithering technique relative to the LTE technology. The proposed techniques is only applicable if the condition of {fL <; fd <; fRF} is met, where fL represents the dithering boundary limit of 14 MHz, fd is DMFD signal frequency and fRF is the RoF carrier frequency. Analysis of the optical launch power for DMFD and EMFD methods reveal that the stimulated Brillouin scattering threshold is above ~6 dBm for the LTE-RoF system. In addition, we also unveil that DMFD and EMFD methods do not introduce additional distortion for the linear and optimum optical launch power regions, which are frequency chirp driven regions. If the given condition is met, the proposed method improves the LTE-RoF system without any shortcoming. Finally, at 10 dBm launch power, DMFD and EMFD methods exhibits an average signal-to-noise ratio gain of ~5.95 and ~7.71 dB, respectively.
Central apnoeas have significant effects on blood pressure and heart rate in children

Brief central apnoeas (CAs) during sleep are common in children and are not usually considered clinically significant unless associated with oxygen desaturation. CAs can occur spontaneously or following a movement or sigh. The aim of this study was to investigate acute cardiovascular changes associated with CAs in children. Beat‐by‐beat mean arterial pressure (MAP) and heart rate (HR) were analysed across CAs, and spontaneous and movement‐induced events were compared using two‐way analysis of variance with post hoc analyses. Fifty‐three children (28 male/25 female) aged 7–12 years referred for investigation of sleep‐disordered breathing (SDB) and 21 age‐matched healthy controls (8 male/13 female) were studied. Children underwent routine clinical polysomnography with continuous blood pressure (BP) recordings. Movement‐induced, but not spontaneous, CAs were more frequent in children with mild or moderate/severe obstructive sleep apnoea (OSA) compared with healthy controls (P < 0.05 for both). Movement‐induced CAs were associated with significantly larger MAP and HR changes across the event compared with spontaneous CAs. The percentage changes in MAP and HR between late‐event and post‐event were significantly greater for movement‐induced compared with spontaneous CAs (MAP 20.6 ± 2.3 versus 12.2 ± 1.8%, P < 0.01; HR 28.2 ± 2.6 versus 14.7 ± 2.5%, P < 0.001). This study demonstrates that movement‐induced CAs are more common in children with OSA, and are associated with significantly greater changes in HR and BP compared with spontaneous CAs. These data suggest that movement‐induced CAs should be considered when assessing the cardiovascular impact of SDB.
Molecular analysis of caffeoyl residues related to pigmentation in green cotton fibers

The pigment components in green cotton fibers were isolated and identified as 22-O-caffeoyl-22-hydroxymonodocosanoin and 22-O-caffeoyl-22-hydroxydocosanoic acid. The concentration of 22-O-caffeoyl-22-hydroxymonodocosanoin correlated positively with the degree of colour in the green fibers, indicating a role for caffeoyl derivatives in the pigmentation of green cotton fibers. Upland cotton (Gossypium hirsutum L.) contains four genes, Gh4CL1-Gh4CL4, encoding 4-coumarate:CoA ligases (4CLs), key enzymes in the phenylpropanoid biosynthesis pathway. In 15-24-day post-anthesis fibers, the expression level of Gh4CL1 was very low, Gh4CL3 had a similar expression level in both white and green cottons, Gh4CL2 had a significantly higher expression level in green fibers than in white fibers, while Gh4CL4 had a higher expression level in white fibers than in green fibers. According to enzyme kinetics analysis, Gh4CL1 displayed a preference for 4-coumarate, Gh4CL3 and Gh4CL4 exhibited a somewhat low but still prominent activity towards ferulate, while Gh4CL2 had a strong preference for caffeate and ferulate. These results suggest that Gh4CL2 might be involved in the metabolism of caffeoyl residues and related to pigment biosynthesis in green cotton fibers. Our findings provide insights for understanding the biochemical and molecular mechanisms of pigmentation in green cotton fibers.
Activation of calmodulin by various metal cations as a function of ionic radius.

The active form of calmodulin is a Ca2+ . calmodulin complex. The purpose of this investigation was to determine whether other metal cations substitute for Ca2+ to activate calmodulin. Binding of Ca2+ resulted in an altered conformation of calmodulin with an increased quantum yield in its tyrosine fluorescence. Qualitatively similar results were obtained with Zn2+, Mn2+, Cd2+, Hg2+, Sr2+, Pb2+, Tb3+, Sm3+, and La3+. The relative extents of fluorescence enhancement by these cations were related to their ionic radii: all cations with ionic radii close to Ca2+ (0.99 A) increased tyrosine fluorescence, whereas those with different ionic radii were not effective, or much less so. The change in calmodulin conformation by the cations was confirmed by its altered electrophoretic mobility on polyacrylamide gels. Cations that change the conformation of calmodulin allow it to stimulate phosphodiesterase. The relative extents of stimulation of phosphodiesterase by cations were also related to their ionic radii. Finally, the ability of metal cations to inhibit Ca2+ binding was similarly related to their ionic radii. In general, the closer the radius of a metal cation was to that of Ca2+, the more effective was the cation to substitute for Ca2+. The range of effective ionic radii was approximately 1 +/- 0.2 A. Calmodulin-stimulated phosphodiesterase activity by the cations was reversed by trifluoperazine, an antagonist of calmodulin.