Miracle-dz/UniFAR-FTUs huggingface dataset:
The use of high frequency chest wall oscillation during an acute infective pulmonary exacerbation of cystic fibrosis

BACKGROUND Cystic fibrosis (CF) patients hospitalised for an acute infective pulmonary exacerbation require increased airway clearance. Specialist physiotherapists may be a limited resource. We investigated the use of high frequency chest wall oscillation (HFCWO), in addition to 'usual' airway clearance techniques (ACTs). OBJECTIVE The aim was to assess the utility of HFCWO (The Vest® Airway Clearance System, Hill-Rom) as a self administered therapy compared to European ACTs in facilitating recovery from an acute infective pulmonary exacerbation in people with CF when used in addition to supervised physiotherapy. METHOD A non-blinded randomised, controlled design was used. Patients who met inclusion criteria were randomised to control or HFCWO groups. All patients received four daily sessions, two supervised by a specialist CF physiotherapist and two carried out independently. The control group carried out their usual ACTs, the study group used HFCWO with pauses to huff and cough. The primary outcome measurement was change in FEV1. RESULTS n = 36 (64% male). Data was analysed using the Wilcoxon Rank Sum test. View this table: CONCLUSION Change in FEV1 was not significantly different between groups, however a significant improvement in FVC was demonstrated. HFCWO should be further explored as an adjunct in treatment of infective pulmonary exacerbations of CF.
Bacterial meningitis in the United States, 1998-2007.

BACKGROUND The rate of bacterial meningitis declined by 55% in the United States in the early 1990s, when the Haemophilus influenzae type b (Hib) conjugate vaccine for infants was introduced. More recent prevention measures such as the pneumococcal conjugate vaccine and universal screening of pregnant women for group B streptococcus (GBS) have further changed the epidemiology of bacterial meningitis. METHODS We analyzed data on cases of bacterial meningitis reported among residents in eight surveillance areas of the Emerging Infections Programs Network, consisting of approximately 17.4 million persons, during 1998-2007. We defined bacterial meningitis as the presence of H. influenzae, Streptococcus pneumoniae, GBS, Listeria monocytogenes, or Neisseria meningitidis in cerebrospinal fluid or other normally sterile site in association with a clinical diagnosis of meningitis. RESULTS We identified 3188 patients with bacterial meningitis; of 3155 patients for whom outcome data were available, 466 (14.8%) died. The incidence of meningitis changed by -31% (95% confidence interval [CI], -33 to -29) during the surveillance period, from 2.00 cases per 100,000 population (95% CI, 1.85 to 2.15) in 1998-1999 to 1.38 cases per 100,000 population (95% CI 1.27 to 1.50) in 2006-2007. The median age of patients increased from 30.3 years in 1998-1999 to 41.9 years in 2006-2007 (P<0.001 by the Wilcoxon rank-sum test). The case fatality rate did not change significantly: it was 15.7% in 1998-1999 and 14.3% in 2006-2007 (P=0.50). Of the 1670 cases reported during 2003-2007, S. pneumoniae was the predominant infective species (58.0%), followed by GBS (18.1%), N. meningitidis (13.9%), H. influenzae (6.7%), and L. monocytogenes (3.4%). An estimated 4100 cases and 500 deaths from bacterial meningitis occurred annually in the United States during 2003-2007. CONCLUSIONS The rates of bacterial meningitis have decreased since 1998, but the disease still often results in death. With the success of pneumococcal and Hib conjugate vaccines in reducing the risk of meningitis among young children, the burden of bacterial meningitis is now borne more by older adults. (Funded by the Emerging Infections Programs, Centers for Disease Control and Prevention.).
A field trial to assess a blood-stage malaria vaccine.

BACKGROUND Blood-stage malaria vaccines are intended to prevent clinical disease. The malaria vaccine FMP2.1/AS02(A), a recombinant protein based on apical membrane antigen 1 (AMA1) from the 3D7 strain of Plasmodium falciparum, has previously been shown to have immunogenicity and acceptable safety in Malian adults and children. METHODS In a double-blind, randomized trial, we immunized 400 Malian children with either the malaria vaccine or a control (rabies) vaccine and followed them for 6 months. The primary end point was clinical malaria, defined as fever and at least 2500 parasites per cubic millimeter of blood. A secondary end point was clinical malaria caused by parasites with the AMA1 DNA sequence found in the vaccine strain. RESULTS The cumulative incidence of the primary end point was 48.4% in the malaria-vaccine group and 54.4% in the control group; efficacy against the primary end point was 17.4% (hazard ratio for the primary end point, 0.83; 95% confidence interval [CI], 0.63 to 1.09; P=0.18). Efficacy against the first and subsequent episodes of clinical malaria, as defined on the basis of various parasite-density thresholds, was approximately 20%. Efficacy against clinical malaria caused by parasites with AMA1 corresponding to that of the vaccine strain was 64.3% (hazard ratio, 0.36; 95% CI, 0.08 to 0.86; P=0.03). Local reactions and fever after vaccination were more frequent with the malaria vaccine. CONCLUSIONS On the basis of the primary end point, the malaria vaccine did not provide significant protection against clinical malaria, but on the basis of secondary results, it may have strain-specific efficacy. If this finding is confirmed, AMA1 might be useful in a multicomponent malaria vaccine. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT00460525.).
Management of Depression in Older Adults: A Review

Importance Depression in older adults is a common psychiatric disorder affecting their health-related quality of life. Major depression occurs in 2% of adults aged 55 years or older, and its prevalence rises with increasing age. In addition, 10% to 15% of older adults have clinically significant depressive symptoms, even in the absence of major depression. Observations Depression presents with the same symptoms in older adults as it does in younger populations. In contrast to younger patients, older adults with depression more commonly have several concurrent medical disorders and cognitive impairment. Depression occurring in older patients is often undetected or inadequately treated. Antidepressants are the best-studied treatment option, but psychotherapy, exercise therapy, and electroconvulsive therapy may also be effective. Psychotherapy is recommended for patients with mild to moderate severity depression. Many older patients need the same doses of antidepressant medication that are used for younger adult patients. Although antidepressants may effectively treat depression in older adults, they tend to pose greater risk for adverse events because of multiple medical comorbidities and drug-drug interactions in case of polypharmacy. High-quality evidence does not support the use of pharmacologic treatment of depression in patients with dementia. Polypharmacy in older patients can be minimized by using the Screening Tool of Older Persons Prescriptions and Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria, a valid and reliable screening tool that enables physicians to avoid potentially inappropriate medications, undertreatment, or errors of omissions in older people. Antidepressants can be gradually tapered over a period of several weeks, but discontinuation of antidepressants may be associated with relapse or recurrence of depression, so the patient should be closely observed. Conclusions and Relevance Major depression in older adults is common and can be effectively treated with antidepressants and electroconvulsive therapy. Psychological therapies and exercise may also be effective for mild-moderate depression, for patients who prefer nonpharmacological treatment, or for patients who are too frail for drug treatments.
Mechanisms of Psychogenic Fever

Psychogenic fever is a psychosomatic disease especially seen in young adults. However, the mechanisms explaining how psychological stress increases core body temperature (Tc) in these patients are not yet fully understood. Therefore, this article reviews the current understanding of the mechanisms of stress-induced hyperthermia and the distinctive effects of acute, repeated, or chronic stress on Tc in laboratory animals. Acute exposure to anxiety-provoking stress induces a transient, monophasic increase in Tc. In contrast, repeated stress either induces anticipatory hyperthermia, reduces diurnal changes in Tc, or slightly increases Tc throughout the day. Chronically stressed animals also show depressive-like behaviors and display an enhanced hyperthermic response to a novel stress. A fearful experience in the past induces conditioned hyperthermia to the fear context. The high Tc that psychogenic fever patients develop may be a complex of many kinds of hyperthermic responses previously modeled in animals. Animal studies also show that psychological stress increases Tc via mechanisms distinct from infectious fever, which requires proinflammatory mediators. However, psychological stress and immune insults may increase Tc via a common efferent pathway, i.e., the rostral medullary raphe region-sympathetic nervous system circuit.
Hepatitis A, B y C en un centro ocupacional para disminuidos psíquicos

BACKGROUND Estimation of prevalence of serologic markers of viral hepatitis A, B and C in students and staff of an occupational centre in Castellon (Spain). METHODS Serologic markers of hepatitis A (IgG anti-HAV) and B (HBsAg, anti-HBe, anti-HBc, anti-HBs) were detected by radioimmunoassay (RIA) and serologic markers of hepatitis C (anti-HCV) by immunoradiometric assay (IRMA). Ninety per cent of students (54/60) and 80% of staff (8/10) participated. RESULTS The prevalence of IgG anti-HVA was 55.6% in students and 75% in staff, increasing with age. Considering persons not vaccinated against hepatitis B, the prevalence of serologic markers hepatitis B was 18.5% in students, two HBsAg and anti-HBe positive, and nobody in staff. Serologic markers hepatitis B was associated with duration of stay institutions for mentally handicapped. None of the center was positive for anti-HCV. CONCLUSIONS Viral hepatitis prevalences present notable differences. To maintain a serological surveillance of these diseases is important to control and prevention.
Genetic basis for in vivo daptomycin resistance in enterococci.

BACKGROUND Daptomycin is a lipopeptide with bactericidal activity that acts on the cell membrane of enterococci and is often used off-label to treat patients infected with vancomycin-resistant enterococci. However, the emergence of resistance to daptomycin during therapy threatens its usefulness. METHODS We performed whole-genome sequencing and characterization of the cell envelope of a clinical pair of vancomycin-resistant Enterococcus faecalis isolates from the blood of a patient with fatal bacteremia; one isolate (S613) was from blood drawn before treatment and the other isolate (R712) was from blood drawn after treatment with daptomycin. The minimal inhibitory concentrations (MICs) of these two isolates were 1 and 12 μg per milliliter, respectively. Gene replacements were made to exchange the alleles found in isolate S613 with those in isolate R712. RESULTS Isolate R712 had in-frame deletions in three genes. Two genes encoded putative enzymes involved in phospholipid metabolism, GdpD (which denotes glycerophosphoryl diester phosphodiesterase) and Cls (which denotes cardiolipin synthetase), and one gene encoded a putative membrane protein, LiaF (which denotes lipid II cycle-interfering antibiotics protein but whose exact function is not known). LiaF is predicted to be a member of a three-component regulatory system (LiaFSR) involved in the stress-sensing response of the cell envelope to antibiotics. Replacement of the liaF allele of isolate S613 with the liaF allele from isolate R712 quadrupled the MIC of daptomycin, whereas replacement of the gdpD allele had no effect on MIC. Replacement of both the liaF and gdpD alleles of isolate S613 with the liaF and gdpD alleles of isolate R712 raised the daptomycin MIC for isolate S613 to 12 μg per milliliter. As compared with isolate S613, isolate R712--the daptomycin-resistant isolate--had changes in the structure of the cell envelope and alterations in membrane permeability and membrane potential. CONCLUSIONS Mutations in genes encoding LiaF and a GdpD-family protein were necessary and sufficient for the development of resistance to daptomycin during the treatment of vancomycin-resistant enterococci. (Funded by the National Institute of Allergy and Infectious Diseases and the National Institutes of Health.).
Improving homeless persons' utilisation of primary care: lessons to be learned from an outreach programme in The Netherlands

Elissen AMJ, Van Raak AJA, Derckx EWCC, Vrijhoef HJM. Improving homeless persons' utilisation of primary care: lessons to be learned from an outreach programme in The Netherlands Faced with rising homelessness, countries around the world are in need of innovative approaches to caring for those without shelter, who, more often than not, suffer from severe health problems. We conducted a case study of an innovative Dutch Primary Care for the Homeless (PCH) programme to gain insight into clients' demographic characteristics, health problems and service use, and to develop an explanation for its success in increasing the latter. Our analyses are based on a combination of quantitative and qualitative data. The results of the study suggest that the success of the PCH programme can be explained by the providers' pragmatism and will to adapt their mode of care provision to the behavioural patterns and needs of their homeless clients.
Dynamic stability in unilateral transtibial prosthesis users

This study evaluated a multi-factorial, portable method of assessing dynamic-stability for unilateral transtibial prosthesis users. Twenty unilateral transtibial prosthesis users completed walking trials over various conditions (level and uneven ground, stairs, and a ramp). Plantar pressure data were collected using the F-Scan Mobile system. Six dynamic-stability parameters (relating to center of pressure motion, foot perturbations, and gait timing) were extracted from this data and dynamic-stability index values were calculated. Results showed that the parameters and index values differed between the intact and prosthetic limbs, between walking conditions, and between prosthesis users able-bodied subjects. Parameter and index values correlated poorly with stability criteria measures (Community Balance and Mobility Scale, Berg Balance Scale, Prosthetics Evaluation Questionnaire). Parameter and index calculations should be optimized for unilateral transtibial prosthesis users. Improved validation of the parameters and index is recommended, using an established, quantitative, dynamic-stability assessment method.
Isokinetic strength values, conventional ratio and dynamic control ratio of shoulder rotator muscles in elite badminton players

Nine male and seven female asymptomatic elite badminton players were tested bilaterally to determine concentric and eccentric strength values, conventional ratio and dynamic control ratio of shoulder rotator muscles. All tests were performed at 60 and 120 ◦ /sec. The study shows significant differences that were similar for men and women: the dominant arm was stronger than the non-dominant arm, normalised peak torque values at 60 ◦ /sec were higher than at 120 ◦ /sec, the concentric internal rotator strength (IRS) was larger than the concentric external rotator strength (ERS) and the eccentric ERS was larger than the concentric ERS. For females the eccentric ERS was larger than the concentric IRS as opposed to men in whom the concentric IRS was larger than the eccentric ERS. For both sexes the CVR for the dominant arm was significantly higher than for the non-dominant arm. The DCR at 60 ◦ /sec was significantly lower than at 120 ◦ /sec and the DCR for females was significantly higher than for men. Data presented are important for interpreting isokinetic shoulder rotator strength tests in elite badminton players and could be relevant in rehabilitation and prevention of shoulder injuries.
A meta-analytic investigation of occupational stress and related organisational factors: is nursing really a uniquely stressful profession?

These studies investigated relationships between occupational stressors and strain through the application of meta-analysis. In Study I, the meta-analytic procedure specified by Hunter and Schmidt (1990) was applied to 53 studies that utilised 54 independent samples of nurses (N = 14, 524) and presented 143 correlations between occupational stressors and strain. This study showed that patient care demands, workload, conflict with co-workers, lack of co-worker and supervisor support, poor leadership, role uncertainty, lack of role confidence and competence, responsibility, lack of job control, job complexity, poor physical environment, shift work, home/work conflict, lack of career prospects, and lack of professional esteem were all significantly correlated with strain. Some of the strongest effect sizes were found for workload, home/work conflict, leadership, co-worker conflict. Nursing specialisation moderated the effect sizes of professional esteem and patient care demands, such that professional esteem was more strongly related to strain in paediatric nurses than in other nurses, and the relationship between patient care demands and strain was stronger in mental health nurses than in general nurses. In Study II, archival data from various administrations of the Queensland Public Agency Staff Survey (QPASS) among nurses and public servants employed by the Queensland Government (N = 4,509) was meta-analysed. This study showed that all organisational climate variables, positive and negative work events measured by the QPASS were significantly related to individual distress at work. Organisational issues such as staff relationships, leadership, role clarity, goal congruence, and workplace morale and workplace distress were amongst those most strongly associated with distress. Employment status did not moderate any of the relationships, but the relationship between personality clashes and distress was moderated by occupation, whereby the effect size was stronger in nurses than in public servants. It was suggested that generic interventions used to improve organisational climate and decrease stress will also be of value in the nursing profession. Several avenues for further meta-analytic research in the organisational health domain were identified.
Effect of bronchoconstriction on airway remodeling in asthma.

BACKGROUND Asthma is characterized pathologically by structural changes in the airway, termed airway remodeling. These changes are associated with worse long-term clinical outcomes and have been attributed to eosinophilic inflammation. In vitro studies indicate, however, that the compressive mechanical forces that arise during bronchoconstriction may induce remodeling independently of inflammation. We evaluated the influence of repeated experimentally induced bronchoconstriction on airway structural changes in patients with asthma. METHODS We randomly assigned 48 subjects with asthma to one of four inhalation challenge protocols involving a series of three challenges with one type of inhaled agent presented at 48-hour intervals. The two active challenges were with either a dust-mite allergen (which causes bronchoconstriction and eosinophilic inflammation) or methacholine (which causes bronchoconstriction without eosinophilic inflammation); the two control challenges (neither of which causes bronchoconstriction) were either saline alone or albuterol followed by methacholine (to control for nonbronchoconstrictor effects of methacholine). Bronchial-biopsy specimens were obtained before and 4 days after completion of the challenges. RESULTS Allergen and methacholine immediately induced similar levels of bronchoconstriction. Eosinophilic inflammation of the airways increased only in the allergen group, whereas both the allergen and the methacholine groups had significant airway remodeling not seen in the two control groups. Subepithelial collagen-band thickness increased by a median of 2.17 μm in the allergen group (interquartile range [IQR], 0.70 to 3.67) and 1.94 μm in the methacholine group (IQR, 0.37 to 3.24) (P<0.001 for the comparison of the two challenge groups with the two control groups); periodic acid-Schiff staining of epithelium (mucus glands) also increased, by a median of 2.17 percentage points in the allergen group (IQR, 1.03 to 4.77) and 2.13 percentage points in the methacholine group (IQR, 1.14 to 7.96) (P=0.003 for the comparison with controls). There were no significant differences between the allergen and methacholine groups. CONCLUSIONS Bronchoconstriction without additional inflammation induces airway remodeling in patients with asthma. These findings have potential implications for management.
Association Between Elevated Brain Amyloid and Subsequent Cognitive Decline Among Cognitively Normal Persons

Importance Among cognitively normal individuals, elevated brain amyloid (defined by cerebrospinal fluid assays or positron emission tomography regional summaries) can be related to risk for later Alzheimer-related cognitive decline. Objective To characterize and quantify the risk for Alzheimer-related cognitive decline among cognitively normal individuals with elevated brain amyloid. Design, Setting, and Participants Exploratory analyses were conducted with longitudinal cognitive and biomarker data from 445 cognitively normal individuals in the United States and Canada. Participants were observed from August 23, 2005, to June 7, 2016, for a median of 3.1 years (interquartile range, 2.0-4.2 years; maximum follow-up, 10.3 years) as part of the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Exposures Individuals were classified at baseline as having normal (n = 243) or elevated (n = 202) brain amyloid using positron emission tomography amyloid imaging or a cerebrospinal fluid assay of amyloid &bgr;. Main Outcomes and Measures Outcomes included scores on the Preclinical Alzheimer Cognitive Composite (PACC; a sum of 4 baseline standardized Z scores, which decreases with worse performance), Mini-Mental State Examination (MMSE; 0 [worst] to 30 [best] points), Clinical Dementia Rating Sum of Boxes (CDR–Sum of Boxes; 0 [best] to 18 [worst] points), and Logical Memory Delayed Recall (0 [worst] to 25 [best] story units). Results Among the 445 participants (243 with normal amyloid, 202 with elevated amyloid), mean (SD) age was 74.0 (5.9) years, mean education was 16.4 (2.7) years, and 52% were women. The mean score for PACC at baseline was 0.00 (2.60); for MMSE, 29.0 (1.2); for CDR–Sum of Boxes, 0.04 (0.14); and for Logical Memory Delayed Recall, 13.1 (3.3). Compared with the group with normal amyloid, those with elevated amyloid had worse mean scores at 4 years on the PACC (mean difference, 1.51 points [95% CI, 0.94-2.10]; P < .001), MMSE (mean difference, 0.56 points [95% CI, 0.32-0.80]; P < .001), and CDR–Sum of Boxes (mean difference, 0.23 points [95% CI, 0.08-0.38]; P = .002). For Logical Memory Delayed Recall, between-group score was not statistically significant at 4 years (mean difference, 0.73 story units [95% CI, −0.02 to 1.48]; P = .056). Conclusions and Relevance Exploratory analyses of a cognitively normal cohort followed up for a median of 3.1 years suggest that elevation in baseline brain amyloid level, compared with normal brain amyloid level, was associated with higher likelihood of cognitive decline, although the findings are of uncertain clinical significance. Further research is needed to assess the clinical importance of these differences and measure longer-term associations.