Miracle-dz/UniFAR-FTUs huggingface dataset:
Effects of residency training in family medicine v. internship training on professional attitudes and practice patterns.

OBJECTIVES To determine whether the professional attitudes and practice patterns of physicians with residency training in family medicine differ from those of generalists with internship training. DESIGN Mail survey conducted in 1985-86. SETTING Province of Quebec. PARTICIPANTS A stratified random sample of French-speaking family and general practitioners who graduated after 1972 (325 physicians with residency training and 304 with internship training) (response rate 82%). MAIN RESULTS Physicians with residency training were 3 years younger on average than those with internship training, were more likely to be female (38% v. 18%, p less than 0.001) and were more likely to work on a salaried basis in CLSCs (public community health centres) (36% v. 14%, p less than 0.001). Even after these confounding factors were controlled for, physicians with residency training seemed to be more sensitive to the psychosocial aspects of patient care and tended to attach more importance to informing patients about useful materials and resources concerning their health problems. They were not, however, more likely to value health counselling or integrate it in medical practice. CONCLUSION Our findings provide some evidence that the new requirement that physicians complete a residency in family medicine to obtain medical licensure in general practice in Quebec may foster a more patient-centred approach to health care.
Species abundance distributions and numerical dominance in gastrointestinal helminth communities of fish hosts

Abstract The abundances of different species in a parasite community are never similar: there is typically one or a few numerically dominant species and many species with low abundance. Here, we determine whether basic features of parasite communities are associated with strong dominance by one or a few species, among 39 component communities of gastrointestinal helminths in marine fishes from Brazil. First, we tested whether the shape of the species abundance distribution in these communities fits that predicted by several theoretical models, using a goodness-of-fit procedure. Only the canonical lognormal model could be rejected for 5 out of 39 communities; all other comparisons of observed and predicted abundance distributions showed no significant differences, although this may be due to limited statistical power. Second, we used the ratio between the abundance of the most abundant species and either the second or third most abundant species, as indices of dominance; these show, for instance, that the dominant species in a community is typically twice, but sometimes over ten times, as abundant as the next most abundant species. We found that these ratios were not influenced by either the community's species richness, the mean number of individual parasites per host, or the taxonomic identity of the dominant species. However, the abundance ratio between the first and third most abundant species in a community was significantly correlated with an independent index of species interactivity, based on the likelihood that the different parasite species in a component community co-occur in the same host individuals: the difference in abundance between the dominant and third most abundant species was greater in communities characterized by weak interactions. These findings suggest that strong interactions may lead to greater evenness in the abundance of species, and that numerical dominance is more likely to result from interspecific differences in recruitment rates.
Protein structural dynamics in solution unveiled via 100-ps time-resolved x-ray scattering

We have developed a time-resolved x-ray scattering diffractometer capable of probing structural dynamics of proteins in solution with 100-ps time resolution. This diffractometer, developed on the ID14B BioCARS (Consortium for Advanced Radiation Sources) beamline at the Advanced Photon Source, records x-ray scattering snapshots over a broad range of q spanning 0.02–2.5 Å-1, thereby providing simultaneous coverage of the small-angle x-ray scattering (SAXS) and wide-angle x-ray scattering (WAXS) regions. To demonstrate its capabilities, we have tracked structural changes in myoglobin as it undergoes a photolysis-induced transition from its carbon monoxy form (MbCO) to its deoxy form (Mb). Though the differences between the MbCO and Mb crystal structures are small (rmsd < 0.2 Å), time-resolved x-ray scattering differences recorded over 8 decades of time from 100 ps to 10 ms are rich in structure, illustrating the sensitivity of this technique. A strong, negative-going feature in the SAXS region appears promptly and corresponds to a sudden > 22 Å3 volume expansion of the protein. The ensuing conformational relaxation causes the protein to contract to a volume ∼2 Å3 larger than MbCO within ∼10 ns. On the timescale for CO escape from the primary docking site, another change in the SAXS/WAXS fingerprint appears, demonstrating sensitivity to the location of the dissociated CO. Global analysis of the SAXS/WAXS patterns recovered time-independent scattering fingerprints for four intermediate states of Mb. These SAXS/WAXS fingerprints provide stringent constraints for putative models of conformational states and structural transitions between them.
Acoustics : Paper 299 Spatial modulation : Hearing the environment

Auditory processing of complex sources, after an initial peripheral spectro-temporal stage, is thought to have a more central stage identify in the output time segments and frequency regions of higher activity by way of a temporal and spectral modulation analysis. Such analysis broadens the view on perception, both that of complex signals and of auditory scene analysis (ASA). When resolution of temporal and spectral modulations is adequate, the auditory system can decode complex signals and separate simultaneous sources in a scene. Although research in the modulation domain has uncovered important properties of the central (cortical) mechanism active in such analysis, so far it has bypassed the spatial dimension. The present study proposes to include spatial modulation in the horizontal plane into this mechanism. The signal emanating from multiple and diverse sources at different azimuths will first undergo peripheral binaural processing using known methods, consisting of frequency analysis, phasecompensated rectification, left-right cross-correlation, straightening, and weighted frequency integration. The output will represent azimuthal activity between -π and +π radians as a function of time. This analysis stage will be followed by the modulation analysis stage: convolution of the magnitudes, across the azimuth activity axis, with a kernel function that signifies resolution of nearby simultaneous sources. Results of the spatial modulation analysis will be shown as a function of the same input frequency analyzed and put through a stage of temporal modulation processing. Spatial and temporal modulation analysis results viewed side-by side will predict the temporal fluctuation rate and spatial source density at which perception of multiple sources should be optimal.
Fever During Pediatric Intensive Care Unit Admission Is Independently Associated With Increased Morbidity

Aims: To investigate the occurrence and etiology of fever at anytime during pediatric intensive care unit (PICU) admission, and to study its possible effects on clinical outcome in a heterogeneous population of critically ill children. Methods: Retrospective, observational single-center study, comprising 202 patients aged 0 to 18 years, admitted during a 6-month period between January and June 2004. Demographic and clinical data were collected. Fever was defined by a core temperature ≥38.3°C. Outcomes of interest were duration of mechanical ventilation (MV) and PICU stay. Statistical analyses were done using nonparametric univariate analysis and multivariate Cox’s regression analysis. Results: Fever during PICU stay occurred in 82 of 202 children (40.6%). Demographic, clinical, and laboratory data of febrile patients were compared to data of nonfebrile patients. In 76 of the febrile patients (92.7%), fever occurred in the first 48 hours of admission and was associated with primary diagnosis in all cases. Six patients developed fever after 48 hours of admission and 8 patients developed a new febrile period after 48 nonfebrile hours. At least 50% of the late-onset fever was caused by cultured proven nosocomial infections, in the other cases a nosocomial infection was suspected. Fever after 48 hours of PICU admission or a secondary episode of fever was independently associated with prolonged length of ventilatory support and prolonged length of PICU stay. Conclusions: Fever in critically ill children occurs frequently during PICU stay. Fever after 48 hours of admission or new episodes of fever after 48 nonfebrile hours were mainly caused by nosocomial infections and was independently associated with prolonged length of ventilatory support and PICU stay.
Neuroendocrine stress responses predict catecholamine-dependent working memory-related dorsolateral prefrontal cortex activity

Abstract It is generally thought that the effect of acute stress on higher-order functions such as working memory is, for an important part, mediated by central catecholamine activity. However, little is known about the association between neuroendocrine stress responses and catecholamine-dependent working memory-related brain function in the absence of stress. Here, we investigate for the first time in healthy humans (n = 18) how neuroendocrine responses to stress (cortisol and alpha-amylase) relate to fronto-parietal working memory activity changes in response to atomoxetine, a noradrenaline transporter inhibitor that selectively increases extracellular cortical dopamine and noradrenaline. We observed positive correlations between stress-induced cortisol (Pearson‘s r = 0.75, P < 0.001) and alpha amylase (r = 0.69, P = 0.02) increases and catecholamine-dependent working memory-related activity in dorsolateral prefrontal cortex. Stress-induced cortisol increases furthermore correlated with supramarginal gyrus working memory-related activity (r = 0.79, P < 0.001). Comparing high vs low stress responders revealed that these correlations were driven by decreased working memory activity on placebo and greater working memory activity increases following atomoxetine in high stress responders. These results further corroborate the notion that neuroendocrine responses to stress are an informative proxy of catecholamine function relevant to higher order functions and provide novel hints on the complex relationship between acute stress, catecholamine function and working memory.
Tissue-specific lability and expression of avian leukosis virus long terminal repeat enhancer-binding proteins

Avian leukosis virus (ALV) induces bursal lymphomas in chickens, after proviral integration next to the cellular myc proto-oncogene, and subsequent c-myc hyperexpression. Our previous work suggested that labile or short-lived cellular proteins interact with the viral long terminal repeat (LTR) enhancer, and binding of these proteins appeared to be essential for high rates of LTR-enhanced transcription (A. Ruddell, M. Linial, W. Schubach, and M. Groudine, J. Virol. 62:2728-2735, 1988). This lability is specific for B-lymphoid cell types, since T cells and fibroblasts show stable high rates of LTR-enhanced transcription and stable LTR-binding activity. Moreover, the lability of these proteins may be important in determining susceptibility to bursal lymphoma. In this study, we separated and characterized the labile and stable LTR-binding proteins and examined their lability and expression in different cell types. Gel shift and DNase I footprinting analyses indicated that at least five proteins interact with the 140-base-pair LTR enhancer region. These proteins were distinct by several criteria, including lability or stability after inhibition of protein synthesis, resistance to heat denaturation, chromatographic behavior, and expression in different cell types. Two binding proteins were present in many cell types and were specifically labile in B cells. A third binding protein showed hematopoietic-cell-type-specific expression and was also labile in B cells. These findings indicate that there is tissue-specific modulation of the lability and expression of ALV LTR-binding proteins, which may be important for regulation of LTR transcription enhancement and ALV bursal lymphomagenesis.
Reliability and Validity of the Dissociative Experiences Scale Among South Korean Patients With Schizophrenia

The Dissociative Experiences Scale (DES) is the most widely used self-report tool for use with the general population and various clinical entities, including those with schizophrenia. This preliminary study tested the reliability of the DES, especially temporal stability and validity, in patients diagnosed with schizophrenia receiving inpatient or outpatient treatment. The DES was administered at a university-affiliated training hospital in South Korea to a total of 68 patients (39 inpatients and 29 outpatients) whose diagnosis of schizophrenia was confirmed using the Structured Clinical Interview for DSM–IV Axis Disorders. Internal consistency, 4-week test–retest reliability, and validity were calculated. Participants also completed the Childhood Trauma Questionnaire, the Beck Depression Inventory, and the Symptom Checklist–Posttraumatic Stress Disorder Scale. Four-week test–retest reliability was moderate (r = .69) and internal consistency was good (Cronbach’s α = .95). Total score on the DES was correlated with childhood trauma (r = .69, p < .001), posttraumatic symptoms (r = .50, p < .001), and depression (r = .52, p < .001), demonstrating the convergent validity of the scale. Our study confirms the psychometric soundness of the DES among patients with schizophrenia after the acute stage of illness (e.g., 3 weeks after admission), supporting use of the scale for screening and evaluating dissociative symptoms within this population.
Impact of Different Methods of Feedback to Clinicians After Postprescription Antimicrobial Review Based on the Centers for Disease Control and Prevention's 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults

Objectives. To evaluate (1) the framework of the 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults that is part of the Centers for Disease Control and Prevention (CDC) Campaign to Prevent Antimicrobial Resistance in Healthcare Settings, with regard to steps addressing antimicrobial use; and (2) methods of feedback to clinicians regarding antimicrobial use after postprescription review. Design. Prospective intervention to identify and modify inappropriate antimicrobial therapy. Setting. A 1,000-bed, tertiary care teaching hospital. Patients. Inpatients in selected medicine and surgery units receiving broad-spectrum antimicrobials for 48-72 hours. Interventions. We created a computer-based clinical-event detection system that automatically identified inpatients taking broad-spectrum and “reserve” antimicrobials for 48-72 hours. Although prior approval was required for initial administration of broad-spectrum and reserve antimicrobials, once approval was obtained, therapy with the antimicrobials could be continued indefinitely at the discretion of the treating clinician. Therapy that was ongoing at 48-72 hours was reviewed by an infectious diseases pharmacist or physician, and when indicated feedback was provided to clinicians to modify or discontinue therapy. Feedback was provided via a direct telephone call, a note on the front of the medical record, or text message sent to the clinician's pager. The acceptance rate of feedback was recorded and recommendations were categorized according to the 12 steps recommended by the CDC. Results. Interventions were recommended for 334 (30%) of 1,104 courses of antimicrobial therapy reviewed. A total of 87% of interventions fit into one of the CDC's 12 steps of prevention: 39% into step 3 (“target the pathogen”), 1% into step 4 (“access experts”), 3% into steps 7 and 8 (“treat infection, not colonization or contamination”), 18% into step 9 (“say ‘no’ to vancomycin”), and 26% into step 10 (“stop treatment when no infection”). The rate of compliance with recommendations to improve antimicrobial use was 72%. No differences in compliance were seen with the different methods of feedback. Conclusions. Nearly one-third of antimicrobial courses did not follow the CDC's recommended 12 steps for prevention of antimicrobial resistance. Clinicians demonstrated high compliance with following suggestions made after postprescription review, suggesting that it is a useful approach to decreasing and improving antimicrobial use among inpatients.
Predicting psychosocial outcomes using a brief measure of quality of life in a sample of people with spinal cord injury.

BACKGROUND Spinal cord injury (SCI) significantly impacts an individual's quality of life (QOL). A brief and subjective measure of QOL is necessary to monitor the progress and outcomes of SCI rehabilitation. OBJECTIVE To determine whether this measure of QOL was associated with clinically important physical and psychosocial outcomes in a sample of people with SCI, to determine how people with SCI scored on this measure of QOL, and to determine whether people with SCI scored differently than nondisabled individuals on the QOL scale. METHODS Participants were 134 people with SCI (65% male; 35% female) and 227 nondisabled people (35% male; 65% female). Participants were assessed on a number of psychosocial and physiological variables at a large urban university and rehabilitation center. Variables examined were QOL, life satisfaction, depression, social interaction, pain, fatigue, and level of functioning. RESULTS Participants with SCI reported more low QOL scores and fewer high QOL scores than the nondisabled group. For participants with SCI, QOL was positively related to life satisfaction and social interaction and negatively related to pain, fatigue, and depression. CONCLUSIONS Participants with SCI scored lower on the QOL measure than those without a disability, although the difference was not clinically significant. QOL was unrelated to level of functioning; people may still experience a high QOL despite their physical limitations. Depression and social interaction were significantly related to QOL and should be secondary targets for intervention following SCI rehabilitation.
Current treatment of HIV/hepatitis B virus coinfection

Coinfection with HIV and hepatitis B virus (HBV) has become a significant global health problem. Liver disease is now one of the leading causes of morbidity and mortality in individuals with HIV, particularly those with viral hepatitis. There are a number of agents available with dual activity against HIV and HBV, and effective treatment depends on understanding the potential advantages and pitfalls in using these agents. There are a number of unresolved issues in the management of HIV/HBV coinfection. These include the role of liver biopsy, the significance of normal aminotransferase levels, serum HBV DNA threshold for treatment, treatment end‐points, and the treatment of HBV when HIV does not yet require treatment. Treatment of HBV should be considered in individuals with HIV/HBV coinfection with evidence of significant fibrosis (≥F2), or with elevated serum HBV DNA levels (>2000 IU/mL). Sustained suppression of serum HBV DNA to below the level of detection by the most sensitive available assay should be the goal of therapy, and, at present, treatment of HBV in HIV/HBV coinfection is lifelong. If antiretroviral therapy is required, then two agents with anti‐HBV activity should be incorporated into the regimen. If antiretroviral therapy is not required, then the options are pegylated interferon, adefovir or the early introduction of antiretroviral therapy. Close monitoring is necessary to detect treatment failure or hepatic flares, such as immune reconstitution disease. Further studies of newer anti‐HBV agents in individuals HIV/HBV coinfection may advance treatment of this important condition.
Seasonal Changes in Stress Indicators in High Level Football

This study aimed at describing changes in stress and performance indicators throughout a competitive season in high level football. 15 players (19.5±3.0 years, 181±5 cm, 75.7±9.0 kg) competing under professional circumstances were tested at baseline and 3 times during the season 2008/09 (in-season 1, 2, 3). Testing consisted of the Recovery-Stress Questionnaire for Athletes (Total Stress and Recovery score), vertical jump tests (counter movement and drop jump (DJ)), and a maximal ramp-like running test. Average match exposure was higher during a 3-weeks period prior to in-season 3 compared to in-season 1 and 2 (1.5 vs. 1 h/week, p=0.05). Total Stress score was elevated at in-season 1 and 2 compared to baseline (p<0.01) with a further increase at in-season 3 (p<0.03; generalized eta squared (η(2)(g))=0.37). Total Recovery score was decreased at in-season 1 and 3 compared to baseline (p<0.05; η(2)(g)=0.21). Maximal running velocity (V(max)) and jumping heights were not significantly affected (η(2)(g)≤0.04). Changes in DJ height and V (max) between baseline and in-season 3 were correlated with the corresponding changes in Total Stress score (r=-0.55 and r=-0.61, p<0.03). Usual match exposure during a professional football season does not induce relevant changes in performance indicators. Accumulated stress and a lack of recovery towards the end of a season might be indicated by psychometric deteriorations.