Miracle-dz/UniFAR-FTUs huggingface dataset:
Study design, precision, and validity in observational studies.

The use of observational research methods in the field of palliative care is vital to building the evidence base, identifying best practices, and understanding disparities in access to and delivery of palliative care services. As discussed in the introduction to this series, research in palliative care encompasses numerous areas in which the gold standard research design, the randomized controlled trial (RCT), is not appropriate, adequate, or even possible.1,2 The difficulties in conducting RCTs in palliative care include patient and family recruitment, gate-keeping by physicians, crossover contamination, high attrition rates, small sample sizes, and limited survival times. Furthermore, a number of important issues including variation in access to palliative care and disparities in the use and provision of palliative care simply cannot be answered without observational research methods. As research in palliative care broadens to encompass study designs other than the RCT, the collective understanding of the use, strengths, and limitations of observational research methods is critical. The goals of this first paper are to introduce the major types of observational study designs, discuss the issues of precision and validity, and provide practical insights into how to critically evaluate this literature in our field.
Serial in‐office laser treatment of vocal fold leukoplakia: Disease control and voice outcomes

Although vocal fold (VF) leukoplakia is commonly treated with in‐office laser, there is no data on its long‐term effectiveness. This study hypothesizes that VF leukoplakia treated by serial in‐office laser results in long‐term disease control with maintenance of voice and minimal morbidity.
ACIDENTES COM MAT ERIAL BIOLÓGICO ENTRE PROFISSIONAIS DE HOSPITAL UNIVERSITÁRIO EM GOIÂNIA

Health care professionals are under constant risk of biological material hazards, and one of the most concerning consequences is the transmission of infectious diseases. The key to avoid occupational accidents is to take standard precautions when in contact with the patient. This study describes accidents with biological material that occurred with health workers at Hospital das Clinicas of Federal University of Goias (HC/UFG), in the city of Goiânia, central Brazil, between January 2006 and May 2007. The characteristics of the accident were described, and the serological status of the professional was established for hepatitis B, hepatitis C, syphilis, and HIV. A total of 46 workers from different professional categories were attended at a specialized outpatient infectology clinic during this period. The accidents occurred especially among nursing personnel (50%). Percutaneous exposure occurred in the majority of cases (87%), especially through handling of needles and processing materials. There was no seroconversion during the monitored period. Almost 30% of the exposed health care workers had not received Hepatitis B vaccine previously. We conclude that there is a need for emphasizing the continued education for the adoption of preventive measures that reduce the frequency of occupational accidents.
Impact of process improvements on measures of emergency department efficiency.

OBJECTIVE To study the operational impact of process improvements on emergency department (ED) patient flow. The changes did not require any increase in resources or expenditures. METHODS This was a 36-month pre- and post-intervention study to evaluate the effect of implementing process improvements at a community ED from January 2010 to December 2012. The intervention comprised streamlining triage by having patients accepted into internal waiting areas immediately after triage. Within the ED, parallel processes unfolded, and there was no restriction on when registration occurred or which health care provider a patient saw first. Flexible nursing ratios allowed nursing staff to redeploy and move to areas of highest demand. Last, demand-based physician scheduling was implemented. The main outcome was length of stay (LOS). Secondary outcomes included time to physician initial assessment (PIA), left-without-being-seen (LWBS) rates, and left-against-medical-advice (LAMA) rates. Segmented regression of interrupted time series analysis was performed to quantify the impact of the intervention, and whether it was sustained. RESULTS Patients totalling 251,899 attended the ED during the study period. Daily patient volumes increased 17.3% during the post-intervention period. Post-intervention, mean LOS decreased by 0.64 hours (p<0.005). LOS for non-admitted Canadian Triage and Acuity Scale 2 (-0.58 hours, p<0.005), 3 (-0.75 hours, p<0.005), and 4 (-0.32 hours, p<0.005) patients also decreased. There were reductions in PIA (43.81 minutes, p<0.005), LWBS (35.2%, p<0.005), and LAMA (61.9%, p<0.005). CONCLUSION A combination of process improvements in the ED was associated with clinically significant reductions in LOS, PIA, LWBS, and LAMA for non-resuscitative patients.
A dermatoglyphic study in oral submucous fibrosis patients

Aims and Objectives: (1) To determine the fingerprint patterns in gutkha chewers with oral submucous fibrosis (OSMF) and in healthy controls without gutkha chewing habit and OSMF. (2) To observe and compare the variations of fingerprints in both these groups. Materials and Methods: A prospective study was conducted in the Department of Oral Medicine and Radiology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, with 50 subjects divided into two groups: group A consisted of 25 clinically and histologically proven OSMF cases and group B consisted of 25 controls without gutkha chewing habit and OSMF. Fingerprints were taken using the ink method described by Cummins and Midlo. Statistical analysis was done using Chi-square and Fisher's exact tests. Results: There was a marked decrease of tented arches, ulnar and radial loops, and an increase of simple whorls in OSMF subjects in comparison with normal individuals. Conclusion: Fingerprint pattern is genetically determined. Similarly, the tendency of development of OSMF in gutkha chewers is also genetically determined. An effort was made to compare the fingerprint patterns among gutkha chewers with OSMF in a small sample, which showed that there was a significant decrease of tented arches, ulnar and radial loops, and an increase of simple whorls in OSMF patients in comparison with normal individuals.
Classic Benzodiazepines Modulate the Open–Close Equilibrium in &agr;1&bgr;2&ggr;2L &ggr;-Aminobutyric Acid Type A Receptors

Background: Classic benzodiazepine agonists induce their clinical effects by binding to a site on &ggr;-aminobutyric acid type A (GABAA) receptors and enhancing receptor activity. There are conflicting data regarding whether the benzodiazepine site is allosterically coupled to &ggr;-aminobutyric acid binding versus the channel open–close (gating) equilibrium. The authors tested the hypothesis that benzodiazepine site ligands modulate &agr;1&bgr;2&ggr;2L GABAA receptor gating both in the absence of orthosteric agonists and when the orthosteric sites are occupied. Methods: GABAA receptors were recombinantly expressed in Xenopus oocytes and studied using two-microelectrode voltage clamp electrophysiology. To test gating effects in the absence of orthosteric agonist, the authors used spontaneously active GABAA receptors containing a leucine-to-threonine mutation at residue 264 on the &agr;1 subunit. To examine effects on gating when orthosteric sites were fully occupied, they activated wild-type receptors with high concentrations of a partial agonist, piperidine-4-sulfonic acid. Results: In the absence of orthosteric agonists, the channel activity of &agr;1L264T&bgr;2&ggr;2L receptors was increased by diazepam and midazolam and reduced by the inverse benzodiazepine agonist FG7142. Flumazenil displayed very weak agonism and blocked midazolam from further activating mutant channels. In wild-type receptors activated with saturating concentrations of piperidine-4-sulfonic acid, midazolam increased maximal efficacy. Conclusions: Independent of orthosteric site occupancy, classic benzodiazepines modulate the gating equilibrium in &agr;1&bgr;2&ggr;2L GABAA receptors and are therefore allosteric coagonists. A Monod-Wyman-Changeux coagonist gating model quantitatively predicts these effects, suggesting that benzodiazepines minimally alter orthosteric ligand binding.
Acute kidney injury as the presenting manifestation of sarcoidosis: A case series and review of literature

Acute kidney injury is rarely the presenting feature of sarcoidosis. We present a case series of patients whose diagnosis of sarcoidosis was only brought to light by the development of renal impairment. Concurrent hypercalcaemia was noted, prompting further investigation. The patients discussed experienced a significant and rapid improvement in both renal function and hypercalcaemia in response to therapy with prednisolone. This is out of keeping with previous reports of sarcoidosis‐induced renal impairment. Our case series highlights the importance of testing for hypercalcaemia in the context of acute kidney injury. Sarcoidosis is primarily a disease of the lungs and reticuloendothelial system; however, the prevalence of renal involvement with sarcoidosis may be under‐recognized. The renal manifestations of sarcoidosis are discussed in the context of the current literature. Furthermore, from our experience, we postulate that in the context of sarcoidosis‐induced renal injury, concurrent hypercalcaemia may present prior to the development of chronic renal injury and therefore these patients may be more likely to recover renal function.
Perspectives on acute kidney injury strategy: Hong Kong

Acute kidney injury is a common condition in hospitalized patients and a strong predictor of short‐term morbidity and mortality. In this article, local epidemiological data on the prevalence and outcome of acute kidney injury amongst hospitalized patient in a tertiary referral center were discussed. The latest practice guidelines endorsed by the Hong Kong College of Physicians will be discussed, with emphasis on local practical issues and problems of guideline implementation.
Serial testing of health care workers for tuberculosis using interferon-gamma assay.

RATIONALE Although interferon-gamma (IFN-gamma) assays are promising alternatives to the tuberculin skin test (TST), their serial testing performance is unknown. OBJECTIVE To compare TST and IFN-gamma conversions and reversions in healthcare workers. METHODS We prospectively followed-up 216 medical and nursing students in India who underwent baseline and repeat testing (after 18 mo) with TST and QuantiFERON-TB Gold In-Tube (QFT). TST conversions were defined as reactions greater than or equal to 10 mm, with increments of 6 or 10 mm over baseline. QFT conversions were defined as baseline IFN-gamma less than 0.35 and follow-up IFN-gamma greater than or equal to 0.35 or 0.70 IU/ml. QFT reversions were defined as baseline IFN-gamma greater than or equal to 0.35 and follow-up IFN-gamma less than 0.35 IU/ml. RESULTS Of the 216 participants, 48 (22%) were TST-positive, and 38 (18%) were QFT-positive at baseline. Among 147 participants with concordant baseline negative results, TST conversions occurred in 14 (9.5%; 95% confidence interval [CI] = 5.3-15.5) using the 6 mm increment definition, and 6 (4.1%; 95% CI = 1.5-8.7) using the 10 mm increment definition. QFT conversions occurred in 17/147 participants (11.6%; 95% CI = 6.9-17.9) using the definition of IFN-gamma greater than or equal to 0.35 IU/ml, and 11/147 participants (7.5%; 95% CI = 3.8-13.0) using IFN-gamma greater than or equal to 0.70 IU/ml. Agreement between TST (10 mm increment) and QFT conversions (>or= 0.70 IU/ml) was 96% (kappa = 0.70). QFT reversions occurred in 2/28 participants (7%) with baseline concordant positive results, as compared with 7/10 participants (70%) with baseline discordant results (p < 0.001). CONCLUSIONS IFN-gamma assay shows promise for serial testing, but repeat results need to be interpreted carefully. To meaningfully interpret serial results, the optimal thresholds to distinguish new infections from nonspecific variations must be determined.
LSU Digital Commons LSU Digital Commons Multiple deletions reveal the essentiality of the DedA membrane Multiple deletions reveal the essentiality of the DedA membrane protein family in Escherichia coli protein family in Escherichia coli

The DedA family is a highly conserved, ancient family of membrane proteins with representatives in most sequenced genomes. A characteristic of prokaryotic DedA family genes is extensive gene duplication, with most bacterial genomes carrying two or more homologues. The Escherichia coli genome carries eight DedA genes, each individually nonessential. We previously described an E. coli mutant (BC202; D yghB :: kan R , D yqjA :: tet R ) with in-frame deletions of two DedA genes encoding proteins with 61 % amino acid identity. BC202 fails to complete cell division or grow at elevated temperatures. Here, we report that restoration of normal growth and cell division of BC202 is possible by overexpression of a subset of the eight E. coli DedA genes ( yabI , yohD , yqjA and yghB ) but not others ( dedA , ydjX , ydjZ and yqaA ), suggesting the existence of two functional groups within the family. We have constructed individual E. coli strains in which all eight DedA genes are deleted in a nonpolar manner, and growth is supported by a single DedA family gene under control of an inducible promoter. Strain BAL801 (with growth supported by cloned dedA ) and BAL802 (with growth supported by cloned yqjA ) exhibit slow growth that is absolutely dependent upon the presence of the arabinose inducer. Growth in the presence of glucose results in cell death. These results indicate that while not individually essential, the E. coli DedA family proteins are collectively essential. These observations suggest important functions for the E. coli DedA protein family.
On-Farm Evaluation of Beans Varieties for Adaptation and Adoption in Kigoma Region in Tanzania

On-farm beans research was carried out in Kigoma region, Tanzania. Objectives were to evaluate beans varieties for yield under farmers’ management conditions and to assess farmers’ preferences on beans varieties. Nine farmers from three villages with three farmers per village participated in beans trials. A randomized complete block design with five plots per replications was used to evaluate five bean varieties: Lyamungo 90, Jesca, Uyole 94, Kablanketi, and Kigoma yellow (control). Beans were planted on a 10 m × 2.5 m plot at a spacing of 50 cm × 20 cm. Data was subjected to analysis using ANOVA table in GenStat statistical computer software. Three villages × three seasons resulted in nine environments which were used for stability analysis. Farmers developed their criterion to assess the performance and acceptability of beans varieties. Lyamungo 90 and Jesca ranked high and outyielded other varieties with an average yield of 1430.00 and 1325.67 kg ha−1, respectively. Genotypes sum of squares accounted for the most of the variability (89.12%). Introduction of high yielding bean varieties with the desired farmers’ traits is expected to revamp beans production and contribute to the improved food security in Tanzania.
The impact of neonatologists' religiosity and spirituality on health care delivery for high-risk neonates.

BACKGROUND Ethical decision-making regarding life-sustaining therapies (LST) for high-risk neonates can be challenging for both neonatologists and parents. Parents depend on neonatologists to interpret complex information, identify critical opportunities for decision-making, and present options for care. How neonatologists' belief systems affect care delivery for critically ill newborns is unexplored. OBJECTIVE To characterize the relationship between neonatologists' religiosity or spirituality and the provision of intensive care services for high-risk newborns. METHODS Neonatologists practicing at an American Academy of Pediatrics Neonatal-Perinatal Training Program were surveyed about their religious/spiritual beliefs, provision of LST for critically ill neonates, and communication with families. RESULTS Two hundred ninety-eight neonatologists responded to the survey; 66.4% consider themselves very or moderately spiritual, 40.8% very or moderately religious. In response to a hypothetical prenatal consultation for a fetus at 23 1/7 weeks gestation, 96.3% agreed that the physician has a moral obligation to present all options to parents, including the provision of comfort care. More than 95% had no objection to withholding or withdrawing LST, with religion playing almost no part in these decisions. 38% of participants reported no objection to resuscitating an infant with trisomy 13 or 18; 40% of these neonatologists considered themselves very/moderately religious, 60% slightly/not at all religious. Eighty-nine neonatologists reported that their religious beliefs influence their medical practice. These physicians had similar responses as those not influenced by religion. CONCLUSION For the majority of neonatologists participating in this study, differences in critical care practice cannot be attributed to personal religious or spiritual views.
Analysis of factors associated with electing endoscopic sinus surgery

Medically refractory chronic rhinosinusitis (CRS) can be managed with appropriate continued medical therapy (CMT) or surgery followed by CMT. Patients who initially elect CMT and do not experience adequate symptom resolution may “cross over” to endoscopic sinus surgery (ESS). Our objective was to identify patient covariates associated with this subset of patients who elect this change in treatment modality.
Cerebral Vasospasm: A Review

Abstract Cerebral vasospasm is a prolonged but reversible narrowing of cerebral arteries beginning days after subarachnoid hemorrhage. Progression to cerebral ischemia is tied mostly to vasospasm severity, and its pathogenesis lies in artery encasement by blood clot, although the complex interactions between hematoma and surrounding structures are not fully understood. The delayed onset of vasospasm provides a potential opportunity for its prevention. It is disappointing that recent randomized, controlled trials did not demonstrate that the endothelin antagonist clazosentan, the cholesterol-lowering agent simvastatin, and the vasodilator magnesium sulfate improve patient outcome. Minimizing ischemia by avoiding inadequate blood volume and pressure, administering the calcium antagonist nimodipine, and intervention with balloon angioplasty, when necessary, constitutes current best management. Over the past two decades, our ability to manage vasospasm has led to a significant decline in patient morbidity and mortality from vasospasm, yet it still remains an important determinant of outcome after aneurysm rupture. RÉSUMÉ Vasospasme cérébral : revue du sujet. Le vasospasme cérébral consiste en un rétrécissement prolongé mais réversible d’une artère cérébrale débutant dans les jours suivant une hémorragie sous-arachnoïdienne (HSA). La progression vers l’ischémie cérébrale est liée surtout à la sévérité du vasospasme et sa pathogenèse est en lien avec le caillot formant une gaine autour de l’artère. Cependant, les interactions complexes entre l’hématome et les structures environnantes demeurent mal connues. Le délai entre l’HSA et le vasospasme fournit une occasion potentielle de prévention. Des essais contrôlés randomisés récents n’ont pas démontré que le clazosentan, un antagoniste de l’endothéline, la simvastatine, un hypocholestérolémiant, ou le sulfate de magnésium, un vasodilatateur, améliorent le résultat chez le patient. Actuellement, le meilleur traitement consiste à minimiser l’ischémie en s’assurant que le volume sanguin et la tension artérielle sont adéquats, en administrant de la nimodipine, un antagoniste du calcium, et en procédant à une angioplastie par ballonnet si nécessaire. Au cours des vingt dernières années, une diminution significative de la morbidité et de la mortalité due au vasospasme a été observée grâce à ces moyens de traitement. Cependant le vasospasme demeure un important déterminant de l’issue chez le patient après la rupture d’un anévrisme cérébral.
Essential Tremor with Head Tremor: Trait or State?

I read with great interest the paper by Lenka and colleagues, which questions whether essential tremor (ET) with head tremor is a distinct clinical subtype of ET. In their group of 202 ET cases without cervical dystonia, the 74 ET cases with head tremor were older, more likely to be female, had an older age of tremor onset, and were more likely to have voice tremor than the 128 ET cases without head tremor. Based on these clinical differences, the authors consider the possibility that ET cases with head tremor have a distinct clinical phenotype. In essence, the proposition that the authors put forth is that the presence of head tremor is a trait difference (i.e., a difference in kind). An alternative explanation is that the difference is merely one of state (i.e., a difference of degree). That is, patients with ETwho develop head tremor are at a more advanced stage of disease (i.e., a more advanced state), whichwould explain their older age and their co-accumulation of other clinical features (e.g., voice tremor). In our clinical-epidemiological study of ET, we enrolled 364 ET cases between 2000 and 2009. All cases were diagnosed with ET using Washington-Heights Inwood Genetic Study of Essential Tremor diagnostic criteria; none had dystonia. We analyzed these data in order to determine whether we were able to confirm the findings reported by Lenka and colleagues. We compared the 137 ET cases with head tremor to the 227 ET cases without head tremor (Table). The results were similar to those reported. Essential tremor cases with head tremor were older, more likely to be female, had an older age of onset, and were more likely to have voice tremor than the cases without head tremor (Table); furthermore, those with head tremor had more severe limb tremor (i.e., higher total tremor score) and were more likely to have rest tremor on examination (Table). The interpretation of these data is of somewhat challenging. On the one hand, they are consistent with the notion that the presence of head tremor is a trait difference; on the other, they are consistent with the notion that it is a state difference. To further dissect this issue, we frequency-matched a subsample of these ET cases based on tremor duration so that ET cases with head tremor and those without head tremor had a similar duration of tremor. Even here, ET cases with head tremor were older, more likely to be female, had an older age of onset, more likely to have voice tremor and more likely to have rest tremor on examination than the cases without head tremor (Table). Tremor severity did not differ between the two groups (Table). These data suggest that the clinical differences between ET cases with and without head tremor are independent of duration;
Does Intensive Glycemic Control Reduce Cardiovascular Complications in Type 2 Diabetes?

This continuing feature updates readers on recent developments in cardiovascular pharmacotherapy. Cardiovascular disease remains the number 1 killer in the United States, and more clinical outcome trials have been conducted in cardiology than in any other field of medicine. Given this rapidly expanding knowledge base, if pharmacists stay current with developments in drug therapy, they can have a significant impact on prevention and treatment.