Miracle-dz/UniFAR-FTUs huggingface dataset:
Facilitating students' reflective practice in a medical course: literature review.

INTRODUCTION Reflection and reflective practice is of increasing importance in medical education curricula. The aim of this review is to summarise the literature published around facilitating reflection in a medical course, and to answer the question : W0 hat is the current evidence regarding learning and development moments across the medical curriculum in developing students' reflective practice? METHODS A review of the literature was undertaken using defined databases and the search terms 'medical students', 'medical education', 'reflection', 'reflectFNx01' and 'medicine'. The search was limited to peer-reviewed published material in English and between the years 2001 and 2011, and included research, reviews and opinion pieces. RESULTS Thirty-six relevant articles were found, identifying enhancing factors and barriers to effectively teaching reflective practice within medical curricula, relating to: The breadth of the meaning of reflection; facilitating reflection by medical educators; using written or web-based portfolios to facilitate reflection; and assessing the reflective work of students. DISCUSSION A variety of reflective purposes was found in this literature review. Evidence indicates that, if students are unclear as to the purpose of reflection and do not see educators modelling reflective behaviours, they are likely to undervalue this important skill regardless of the associated learning and development opportunities embedded in the curriculum.
Vasopressin Receptor mRNA Expression in the Human Gastrointestinal Tract

Background/Aim: Vasopressin and oxytocin are closely related peptides, and both exert effects on the gastrointestinal function. In the present study, we wanted to map the expression of vasopressin receptor mRNAs (V1a, V1b/V3, and V2) in nontumorous tissue biopsy specimens of human gastrointestinal tract and surrounding tissues. Methods: Total and polyA+ RNAs were isolated from human tissue biopsy specimens using an automated nucleic acid extractor and, subsequently, converted into single-stranded cDNA. Seminested PCR amplifications were carried out, using gene-specific V1a, V1b/V3, and V2 receptor primers. The PCR amplicons were partially sequenced to confirm their identity. Results: The present study demonstrated the expression of vasopressin receptor mRNAs in human gastrointestinal tract, pancreas, kidney, lung, brain, and ovary. The expression pattern varied between different parts of the gastrointestinal tract. In the colon ascendens, V1a receptor mRNA expression could not be detected in 3 out of 4 analyzed tissue biopsy specimens. On the other hand, all the vasopressin receptor mRNAs were expressed in all colon transversum biopsy samples. Conclusions: V1a, V1b/V3, and V2 receptor mRNAs are widely expressed throughout human gastrointestinal tract and surrounding tissues. The data obtained provide information for further mapping and determination of the physiological role of the vasopressin receptor mRNA expression in normal and tumorous tissues.
Iron-Mediated Degradation of IRP2, an Unexpected Pathway Involving a 2-Oxoglutarate-Dependent Oxygenase Activity

ABSTRACT Iron regulatory protein 2 (IRP2), a central posttranscriptional regulator of cellular and systemic iron metabolism, undergoes proteasomal degradation in iron-replete cells. The prevailing model postulates that the mechanism involves site-specific oxidation of 3 cysteine residues (C168, C174, and C178) within a 73-amino-acid (73-aa) degradation domain. By expressing wild-type and mutated versions of IRP2 in H1299 cells, we find that a C168S C174S C178S triple mutant, or a deletion mutant lacking the entire “73-aa domain,” is sensitive to iron-mediated degradation, like wild-type IRP2. The antioxidants N-acetylcysteine, ascorbate, and α-tocopherol not only fail to stabilize IRP2 but, furthermore, promote its proteasomal degradation. The pathway for IRP2 degradation is saturable, which may explain earlier data supporting the “cysteine oxidation model,” and shows remarkable similarities with the degradation of the hypoxia-inducible factor 1α (HIF-1α): dimethyl-oxalylglycine, a specific inhibitor of 2-oxoglutarate-dependent oxygenases, stabilizes IRP2 following the administration of iron to iron-deficient cells. Our results challenge the current model for IRP2 regulation and provide direct pharmacological evidence for the involvement of 2-oxoglutarate-dependent oxygenases in a pathway for IRP2 degradation.
Chamberlin Meets Ciriacy‐Wantrup: Using Insights from Experimental Economics to Inform Stated Preference Research

type="main" xml:lang="pt"> De nombreuses etudes dans lesquelles des enquetes de preferences declarees sont utilisees pour estimer la demande de biens publics ou prives peuvent etre qualifiees d'experimentales, bien que ce ne soit pas automatiquement le cas. Le present article examine la vaste litterature sur l’economie experimentale afin d'offrir aux concepteurs d'enquetes de preferences declarees et aux chercheurs des connaissances supplementaires sur divers sujets tels que l’elaboration d'une enquete, la conception des mecanismes, la validite externe, l'analyse des donnees et la diffusion des resultats.
Deep prosthetic joint infection: a qualitative study of the impact on patients and their experiences of revision surgery

Objectives Around 1% of patients who have a hip replacement have deep prosthetic joint infection (PJI) afterwards. PJI is often treated with antibiotics plus a single revision operation (1-stage revision), or antibiotics plus a 2-stage revision process involving more than 1 operation. This study aimed to characterise the impact and experience of PJI and treatment on patients, including comparison of 1-stage with 2-stage revision treatment. Design Qualitative semistructured interviews with patients who had undergone surgical revision treatment for PJI. Patients were interviewed between 2 weeks and 12 months postdischarge. Data were audio-recorded, transcribed, anonymised and analysed using a thematic approach, with 20% of transcripts double-coded. Setting Patients from 5 National Health Service (NHS) orthopaedic departments treating PJI in England and Wales were interviewed in their homes (n=18) or at hospital (n=1). Participants 19 patients participated (12 men, 7 women, age range 56–88 years, mean age 73.2 years). Results Participants reported receiving between 1 and 15 revision operations after their primary joint replacement. Analysis indicated that participants made sense of their experience through reference to 3 key phases: the period of symptom onset, the treatment period and protracted recovery after treatment. By conceptualising their experience in this way, and through themes that emerged in these periods, they conveyed the ordeal that PJI represented. Finally, in light of the challenges of PJI, they described the need for support in all of these phases. 2-stage revision had greater impact on participants’ mobility, and further burdens associated with additional complications. Conclusions Deep PJI impacted on all aspects of patients’ lives. 2-stage revision had greater impact than 1-stage revision on participants’ well-being because the time in between revision procedures meant long periods of immobility and related psychological distress. Participants expressed a need for more psychological and rehabilitative support during treatment and long-term recovery.
Firearm homicide among black teenage males in metropolitan counties. Comparison of death rates in two periods, 1983 through 1985 and 1987 through 1989.

OBJECTIVE To identify US counties (1) that had either significantly high or significantly low firearm homicide rates among black males 15 through 19 years of age in 1983 through 1985 and in 1987 through 1989, and/or (2) that experienced a significant increase in the firearm homicide rate between 1983 through 1985 and 1987 through 1989. DESIGN Using the Compressed Mortality File, a county-level mortality and population database maintained by the National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md, county-level firearm homicide rates are analyzed. SETTING Eighty counties with a population of at least 10,000 black males 15 through 19 years of age in 1987 through 1989. SUBJECTS Black males 15 through 19 years of age whose underlying cause of death was classified as firearm homicide (E965.0 through E965.4, or E970) in the ICD-9 (International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision). MAIN OUTCOME MEASURE County-specific firearm homicide rate. RESULTS In 1983 through 1985 and in 1987 through 1989, seven and 13 counties, respectively, were identified that had significantly high firearm homicide rates. Firearm homicide rates were significantly high in both time periods in the following counties: Los Angeles, California; Wayne, Michigan; Kings, New York; St Louis City, Missouri; and Baltimore City, Maryland. Firearm homicide rates increased significantly between 1983 through 1985 and 1987 through 1989 in 34 of the 80 counties. Twenty counties had significantly low rates in both time periods. Several counties with low rates in 1983 through 1985 experienced significant increases and by 1987 through 1989 were among those with high rates. CONCLUSIONS Surveillance of firearm homicide rates at the county levels in counties with high and with low rates is a necessary first step in the development of successful violence prevention programs. Those counties where rates are high and increasing are the counties that are in greatest need for intervention strategies. Knowledge of the incidence of nonfatal firearm injuries is also needed.
Thrombospondin‐1 as an endogenous inhibitor of angiogenesis and tumor growth

Thrombospondin‐1 (TSP‐1) is a matricellular glycoprotein that influences cellular phenotype and the structure of the extracellular matrix. These effects are important components of the tissue remodeling that is associated with angiogenesis and neoplasia. The genetic mutations in oncogenes and tumor suppressor genes that occur within tumor cells are frequently associated with decreased expression of TSP‐1. However, the TSP‐1 that is produced by stromal fibroblasts, endothelial cells and immune cells suppresses tumor progression. TSP‐1 inhibits angiogenesis through direct effects on endothelial cell migration and survival and through indirect effects on growth factor mobilization. TSP‐1 that is present in the tumor microenvironment also acts to suppress tumor cell growth through activation of transforming growth factor β in those tumor cells that are responsive to TGFβ. In this review, the molecular basis for the role of TSP‐1 in the inhibition of tumor growth and angiogenesis is summarized.
Materiality in natural resource management: a systems theory view

ABSTRACT This short paper is a commentary on Duineveld et al.’s article [(2017). Power/knowledge and natural resource management: Foucaultian foundations in the analysis of adaptive governance. Journal of Environmental Policy and Planning, this issue]. A Luhmannian systems-theoretic perspective proposed in this commentary reaffirms the Foucaultian conceptualization of natural resource management as a site for the interaction of discourses constituting social reality through radical entwinements with materiality, with livelihoods being a key example of such entwinements. Several extensions of Duineveld et al.’s argument are proposed. First, the Luhmannian perspective stresses the problematic nature of such entwinements in view of the inherent system–environment adaptation problems. Second, the idea of livelihoods advocated by the authors is interpreted as the reflection of the sensitivity to the environment beyond the limits imposed by the systemic operational closure and complexity reduction. Third, it is argued that even though specific discursive constructions of materiality may underpin adaptive governance with respect to specific environmental segments, they cannot guarantee system–environment adaptation in any general sense, primarily in view of the unknowability of the environment and the incommensurability of discourses.
Physical Illness as an Outcome of Chronic Anxiety Disorders

Background: The literature indicates increased rates of some medical conditions in patients with anxiety disorders. We used the Saskatchewan Health databases to examine the development of nonpsychiatric medical diseases in patients with anxiety disorders. This study has a large population base, and the Saskatchewan health plan does not limit the provision of services to this populaiton. Method: We observed the annual incidence of specified medical conditions in patients with anxiety disorders and in control subjects over a 10-year period. Subjects in both groups had not been treated for the specified medical conditions before the start of the observation period. Results: The anxiety cohort had a significantly higher relative risk of developing medical diseases compared with the control group. The highest relative risk, indicated by the hazard ratio, was for cerebrovascular disease (hazard ratio 2, 95% CI 1.09–3.65). Hazard ratios were significant for cerebrovascular disease and atherosclerosis as well as for ischemic heart, gastrointestinal, hypertensive, and respiratory diseases. Conclusions: This study provides additional evidence for an association between anxiety disorder and the later development of medical morbidity.
Differential regulation of toll-like receptor pathways in acute and chronic HIV-1 infection

Objective and design:The objective of this study was to determine changes in toll-like receptor (TLR) responses of monocytes, myeloid dendritic cells and plasmacytoid dendritic cells during primary and chronic HIV-1 infection. TLRs serve as important innate receptors to sense pathogens, and have been implicated in mediating immune activation in HIV-1 infection. Studies assessing the consequences of HIV-1 infection on the ability of innate immune cells to respond to TLR stimulation have come to varying conclusions. Methods:Using intracellular flow cytometry, cytokine production by cryopreserved peripheral blood mononuclear cells from healthy controls and HIV-1-infected individuals were examined after TLR stimulation. Results:We observed that the effect of HIV-1 infection on TLR responses not only depended on the stage of HIV-1 infection, but was also dependent on the individual receptor and cell type examined. Monocyte and myeloid dendritic cell responses to TLR8 stimulation were associated with HIV-1 viral load and CD4+ T-cell count, whereas plasmacytoid dendritic cell responses to TLR7 stimulation were not. Responses to TLR2 stimulation were not affected by HIV-1 infection, whereas responses to TLR9 stimulation were universally decreased in all HIV-1-infected individuals examined regardless of treatment or clinical parameters. Conclusion:Responsiveness to TLR7/8 stimulation, which have been shown to recognize HIV-1 ssRNA, did not decrease in chronic infection, and may represent a contributing factor to ongoing T-cell immune activation in the setting of chronic viremic HIV-1 infection.
Impact of psoas muscle index on short-term outcome after living donor liver transplantation.

BACKGROUND/AIMS Living donor liver transplantation is an operation with high morbidity and mortality rates. The purpose of this study was to examine factors affecting the short-term outcome after living donor liver transplantation. MATERIALS AND METHODS Forty-seven adult patients who underwent living donor liver transplantation from September 2001 to December 2014 were included. Short-term post-transplant outcomes were evaluated in terms of the onset of postoperative complications of grade 3a and above (Clavien-Dindo classification) and postoperative 120-day mortality. Univariate and multivariate analyses were used to determine possible predictive factors among perioperative variables such as preoperative psoas muscle index (PMI), blood laboratory test results, perioperative nutritional therapy, and operative factors. RESULTS Lower PMI (lower than the first quartile of PMI of donors), higher blood urea nitrogen level (≥14 mg/dL), and blood type incompatibility were independent risk factors for the development of postoperative complications. The 120-day survival rates were significantly lower for the lower PMI group (n=30, 66.7%) than for the higher PMI group (n=17, 94.1%, p=0.034). CONCLUSION A significant correlation was observed between preoperative PMI and short-term postoperative outcomes. Sarcopenia estimated by PMI may serve as a measure of patient frailty and a target for risk stratification.
Mechanism of an unusual, but clinically significant, digoxin–bupropion drug interaction

An unusual, but clinically significant, digoxin (DIG)–bupropion (BUP) drug interaction (DDI), in which BUP increased DIG renal clearance by 80% is reported. To investigate the mechanism(s) of this unusual DDI, first the effect of BUP, its circulating metabolites or their combination on [3H]‐DIG transport by cells expressing human P‐gp or human OATP4C1 was determined. Second, the study asked whether this DDI could be replicated in the rat so that it could be used to conduct mechanistic studies. Then, the effect of BUP and its rat metabolites on [3H]‐DIG transport were tested by cells expressing rat Oatp4c1. Bupropion and its metabolites had no effect on human P‐gp mediated transepithelial transport of [3H]‐DIG. Bupropion and hydroxybupropion (HBUP) significantly stimulated H‐OATP4C1 mediated transport of [3H]‐DIG. In addition, BUP cocktail (BUP plus its metabolites) significantly increased the H‐OATP4C1 mediated transport of [3H]‐DIG, and partially reversed the inhibition by 100 µm DIG. However, erythro‐hydrobupropion (EBUP) and threo‐hydrobupropion (TBUP) did not affect the [3H]‐DIG uptake by H‐OATP4C1 cells. Bupropion administration significantly increased digoxin renal clearance in rats. Surprisingly, bupropion significantly inhibited r‐Oatp4c1 mediated transport of [3H]‐DIG at clinically relevant unbound plasma concentrations of BUP or those observed in the rat study, while HBUP or TBUP did not. These data support our hypothesis that at clinically relevant plasma concentrations, bupropion and its metabolites activate H‐OATP4C1 mediated DIG tubular secretion, and could possibly explain the increase in digoxin renal clearance produced by bupropion. While bupropion increased digoxin renal clearance in the rat, it appeared to do so by inhibiting r‐Oatp4c1‐mediated digoxin renal reabsorption. Copyright © 2014 John Wiley & Sons, Ltd.
Design of Wideband LNA Employing Cascaded Complimentary Common Gate and Common Source Stages

A wideband low noise amplifier (LNA) is presented, which composes of cascaded complimentary common gate (CCG) stage and common source (CS) stages. Based on the current reusing technique, the CCG stage saves dc power and reduces chip area by replacing two inductors with one transformer. The source-degenerated CS stage helps form a frequency-dependent load for the CCG stage. With a load reusing technique, this load can be transformed to the input and helps achieve simultaneous wideband gain, wideband input matching, and flat noise figure (NF) over the desired band. The proposed LNA shows the measured 3-dB bandwidth from 7.6 to 29 GHz, the maximum power gain of 10.7 dB, and the NF from 4.5 to 5.6 dB. The power consumption is 12.1 mW with 1-V supply voltage and the chip occupies an area of 0.3 mm2 in Taiwan Semiconductor Manufacturing Company (TSMC) 65-nm CMOS process.
Kinetics of endocytosis and recycling of the GPI-anchored variant surface glycoprotein in Trypanosoma brucei

The dense coat of glycosylphosphatidylinositol (GPI)-anchored variant surface glycoprotein (VSG) covering parasitic African trypanosomes is essential for survival in mammalian hosts. VSG is internalised and recycled exclusively via a specialised part of the plasma membrane, the flagellar pocket. Direct measurement of the kinetics of VSG endocytosis and recycling shows that the VSG cell-surface pool is turned over within 12 minutes. Correspondingly, the turnover of the intracellular pool (9±4% of total VSG) requires only 1 minute, and this is an exceptionally high rate considering that endocytosis and exocytosis are limited to only 5% of the cell surface area. Kinetic 3D co-localisation analysis using biotinylated VSG and a panel of compartmental markers provides consistent evidence for the itinerary of VSG through the cell: VSG is endocytosed in large clathrin-coated vesicles, which bud from the flagellar pocket membrane at a rate of 6-7 vesicles per second, and is then delivered to RAB5-positive early endosomes. From there, VSG is recycled to RAB11-positive recycling endosomes at two stages, either directly or via RAB7-positive, late endosomes. Small clathrin-coated vesicles carrying fluid-phase cargo and being depleted of VSG bud from early and recycling endosomes. These vesicles are postulated to deliver their content to late endosomes and/or the lysosome. The recycling endosomes give rise to RAB11-positive exocytic carriers that fuse with the flagellar pocket and thereby return VSG to the cell surface. VSG recycling provides an interesting model for studies on the cellular trafficking and sorting of GPI-anchored proteins.
Supplementary immunization activities to achieve measles elimination: experience of the European Region.

BACKGROUND Supplementary immunization activities (SIAs) using measles-containing vaccine (MCV) have had a substantial impact on reducing mortality associated with measles worldwide. METHODS To assess impact of SIAs on measles incidence in the World Health Organization European Region and their role at the final stages of measles elimination efforts in Europe, we reviewed information on SIAs, measles surveillance, and routine vaccination coverage during 2000-2009. RESULTS During 2000-2009, >57 million persons received MCV through SIAs in 16 countries. The Region primarily focused on catch-up campaigns with wider target age groups than in other regions and subsequently relied on routine vaccination rather than periodic follow-up SIAs for the second MCV dose. In addition, the concept of SIAs has been expanded from short-term (<30 days) mass campaigns implemented in other regions to incorporate vaccination efforts over longer periods and outbreak response vaccination. In 2009, 14 of 16 countries that conducted SIAs reported no measles cases or <1 case per 1,000,000 population, reflecting the post-SIA decrease in incidence. CONCLUSIONS SIAs have made a substantial contribution to the success of measles elimination efforts and will likely remain an important strategy for interrupting measles virus transmission in the European Region, although specific approaches will vary by country.