Miracle-dz/UniFAR-FTUs huggingface dataset:
Assessing clinical reasoning: a method to monitor its development in a PBL curriculum

The aim of this study was to develop and trial a method to monitor the evolution of clinical reasoning in a PBL curriculum that is suitable for use in a large medical school. Termed Clinical Reasoning Problems (CRPs), it is based on the notion that clinical reasoning is dependent on the identification and correct interpretation of certain critical clinical features. Each problem consists of a clinical scenario comprising presentation, history and physical examination. Based on this information, subjects are asked to nominate the two most likely diagnoses and to list the clinical features that they considered in formulating their diagnoses, indicating whether these features supported or opposed the nominated diagnoses. Students at different levels of medical training completed a set of 10 CRPs as well as the Diagnostic Thinking Inventory, a self-reporting questionnaire designed to assess reasoning style. Responses were scored against those of a reference group of general practitioners. Results indicate that the CRPs are an easily administered, reliable and valid assessment of clinical reasoning, able to successfully monitor its development throughout medical training. Consequently, they can be employed to assess clinical reasoning skill in individual students and to evaluate the success of undergraduate medical schools in providing effective tuition in clinical reasoning.
Assessment of biological remains from excavations in Wellington Row , York ( sitecode 1988-9 . 24 )

The concentration and quality of preservation of plant and invertebrate remains was very variable through the samples examined, but several groups of deposits gave interpretatively useful assemblages. In particular, some samples from an early ‘turf bank’ and others from mid/late 2nd Century Roman occupation deposits evidently containing highly organic material similar to stable manure, are likely to be valuable in understanding aspects of the local environment and human activity at this site. Another group of samples (of 3rd/4th Century date) contained few biological remains other than peat. For samples from these three groups of deposits, further analysis is worthwhile, in some cases by means of larger subsamples. Samples from a few other deposits showed some bioarchaeological potential but the concentrations of remains were low. For these and some other groups of samples (especially those from the phases of late Roman abandonment and re-use in Trench 7), a low-cost review is recommended.
Riboflavin-Mediated Reduction of Oxidant Injury, Rejection, and Vasculopathy after Cardiac Allotransplantation

Background. Riboflavin is a well-known nutritional supplement that has been shown to exhibit antioxidant properties and protect tissue from oxidative damage. We hypothesized that riboflavin given during cardiac ischemia-reperfusion (I/R) might reduce subsequent acute rejection, after allotransplantation, and coronary allograft vasculopathy (CAV). Methods. A murine heterotopic cardiac transplantation model was used to test whether riboflavin improves I/R injury and acute/chronic rejection. Results. Riboflavin significantly reduced oxidant production and inflammatory mediator production induced by I/R injury, as evidenced by decreased levels of malondialdehyde, myeloperoxidase activity, and tumor necrosis factor alpha. Administration of riboflavin also improved graft survival and suppressed T-cell infiltration and donor-reactive alloantibody formation during the early period after allotransplantation. A murine long-term cardiac allograft model using immunosuppression (preoperative anti-murine CD4 and anti-CD8) was employed to investigate the effect of riboflavin against CAV at 60 days. Riboflavin-treated grafts exhibited a significant decrease in the severity of coronary artery luminal occlusion as compared with saline-treated grafts (17.4±1.8% vs. 43.5±5.6%, P=0.0012). However, there was no significant effect of riboflavin to reduce donor-reactive alloantibodies in this chronic model. Conclusions. These data indicate that riboflavin improves early I/R injury and reduces the development of CAV, most likely due to alloantigen-independent effects such as reduced early graft oxidant stress. Riboflavin administered in the setting of cardiac allograft transplantation appears to be a powerful means to reduce early graft lipid peroxidation, leukocytic infiltration, and cytokine production as well as to suppress the late development of cardiac allograft vasculopathy.
Cancer of the Laryngopharynx

I HAVE nothing dramatic to contribute to our knowledge of the unhappy disease of cancer of the laryngopharynx. Nevertheless the occasional reappraisal of familiar aspects of a problem may promote better understanding, as apparently minor details sometimes assume a greater importance when viewed in a later and different context: given, as it were, a new slant. I have been closely in touch with this disease since 1928 when I first jworked for Wilfred Trotter as a dresser. Later as house surgeon I saw him at close quarters handling many of these cases, listened to his comments on them and to his general philosophy of cancer, developed by long and personal contact with so many of these unhappy patients. This early introduction was followed by further experience when I was _Lionel Colledge's Assistant Surgeon at Golden Square. It is saddening to record how little vital progress has been made in all these years.
Impact of Pollution from Kosova’S Power Plant in Obiliq on Some Biochemical Parameters of the Local Population of Garden Snail ( Helix Pomatia L. )

Ga rden snail specimens (Helix pomat ia L.) were collected fro m the area surrounding the Obiliq Power Plant in the central area of Kosova to determine the potential impact of pollution. The concentrations of hemocyanin (Hc) and the activity of transaminases (ASTand ALT) in the hemoly mph plus catalase in hemoly mph, hepatopancreas and albumen gland were determined. Results showed a significant increase of transaminases activity in hemo ly mph and catalse in albu men g land, a significant decrease of hemocyanin concentration in hemo ly mph as well as non-significant decrease of catalase activity in hemoly mph and hepatopancreas, compared to respective values for these parameters in control group of snails. A significant increase of transaminases and catalase activity were reported also to the group of snails treated with Pb-acetate in their hemocoel, co mpared to control who received physiological solution instead. Statistical data analyses were calculated using different statistical software as ANOVA and MINITA B 16.
Electrothermal analysis of modified OPGW cables using Multiphysics Model

In this paper we investigate electrical and thermal characteristics of modifications of existing optical ground wire cables - OPGW. The modifications consist of changing geometrical and physical parameters of armor wires. The simulations are carried out by a Multiphysics Model with coupled equations, i.e., the electrical and thermal effects are considered simultaneously in order to increase accuracy of the results. We calculate current density distribution and temperature variation in some points of the cables during short-circuit regime and analyze the influence of the modifications on these characteristics by the software COMSOL.
Perturbation Factors in the Clinical Handling of a Fiber-Coupled Raman Probe for Cutaneous in Vivo Diagnostic Raman Spectroscopy

The application of fiber-coupled Raman probes for the discrimination of cancerous and normal skin has the advantage of a noninvasive in vivo application, easy clinical handling, and access to the majority of body sites, which would otherwise be limited by stationary Raman microscopes. Nevertheless, including optical fibers and miniaturizing optical components, as well as measuring in vivo, involves the sensibility to external perturbation factors that could introduce artifacts to the acquired Raman spectra and thereby potentially reduce classification performance. In this study, typical perturbation factors of Raman measurements with a Raman fiber probe, optimized for clinical in vivo discrimination of skin cancer, were investigated experimentally. Measurements were performed under standardized conditions in clinical settings in vivo on human skin, as well as ex vivo on porcine ears. Raman spectra were analyzed in the fingerprint region between 1150 and 1730 cm−1 using principal component analysis. The largest artifacts in the Raman spectra were found in measurements performed under the influence of strong ambient light conditions as well as after miscellaneous pre-treatments to the skin, such as use of a permanent marker or a sunscreen. Minor influences were also found in measurements using H2O immersion and when varying the probe contact force. The effect of reasonable variation of the fiber-bending radius was found to be of negligible impact. The influence of measurements on hairy or sun-exposed body sites, as well as inter-subject variation, was also investigated. The presented results may serve as a guide to avoid negative effects during the process of data acquisition and so avoid misclassifcation in tumor discrimination.
Individual Escherichia coli cells studied from light scattering with the scanning flow cytometer.

BACKGROUND Flow cytometry is a powerful tool for the analysis of individual particles in a flow. Differential light scattering (an indicatrix) was used for many years to obtain morphologic information about microorganisms. The indicatrices play the same role for individual particle recognition as a spectrum for substance characterization. We combined two techniques to analyze the indicatrix of the cells for the purpose of developing a database of light-scattering functions of cells. METHODS The scanning flow cytometer (SFC) allows the measurement of the entire indicatrix of individual particles at polar angles ranging from 5 degrees to 100 degrees. In this work, light-scattering properties of Escherichia coli have been studied both experimentally and theoretically with the SFC and the T-matrix method, respectively. The T-matrix method was used because of the nonspherical shape of E. coli cells, which were modeled by a prolate spheroid. RESULTS The indicatrices of E. coli cells were stimulated with T-matrix method at polar angles ranging from 10 degrees to 60 degrees. The absolute cross-section of light scattering of E. coli has been determined comparing the cross section of polystyrene particles modeled by a homogeneous sphere. The E. coli indicatrices were compared for logarithmic and stationary phases of cell growth. CONCLUSIONS The indicatrices of E. coli were reproducible and could be used for identification of these cells in biologic suspensions. The angular location of the indicatrix minimum can be used in separation of cells in logarithmic and stationary phases. To use effectively the indicatrices for that purpose, the light-scattering properties of other microorganisms have to be studied.
Statistical Characteristics of the Weighted Inter-Rater Reliability Index for Clinically Validating Nursing Diagnoses.

PURPOSE To analyze the statistical characteristics of the weighted inter-rater reliability index for validating nursing diagnoses. METHODS From a computational algorithm, the index values were compared with the sample size, frequency of the clinical indicator, number of agreements between raters, and three other agreement estimators. FINDINGS The index moderately correlated with the frequency of the clinical indicator and strongly correlated with the number of agreements and disagreements between the raters. This index showed a poor correlation with sample size. CONCLUSION This index selects those clinical indicators with high frequency and/or absolute agreement and therefore has a high sensitivity. IMPLICATIONS FOR NURSING PRACTICE The high sensitivity may result in incorporating false positive clinical indicators.
Organizational Oscillation Between Learning and Forgetting: The Dual Role of Serious Errors

We know that organizations change over time as a result of their ability to learn and their tendency to forget. What we know less about, however, is why they might change back, despite evidence suggesting that this occurs. In this paper, we develop and test a model of organizational oscillation that explains why firms cycle through periods of learning and periods of forgetting. In particular, we identify a dual role for serious errors, which push firms toward a focus on safety while also pulling them away from other foci, such as efficiency or innovation. Although existing learning research recognizes errors as disruptive, this dual effect has not been theorized. We also demonstrate that, over time, the effect of a serious error on safety weakens, allowing alternative activities to emerge that lead to subsequent errors. We draw on qualitative data from the National Aeronautics and Space Administration’s Challenger and Columbia accidents to build theory about why organizations oscillate between safety and .
Switching to anastrozole versus continued tamoxifen treatment of early breast cancer: preliminary results of the Italian Tamoxifen Anastrozole Trial.

PURPOSE Tamoxifen, which is actually the gold standard adjuvant treatment in estrogen receptor-positive early breast cancer, is associated with an increased risk of endometrial cancer and other life-threatening events. Moreover, many women relapse during or after tamoxifen therapy because of the development of resistance. Therefore new approaches are required. PATIENTS AND METHODS We conducted a prospective randomized trial to test the efficacy of switching postmenopausal patients who were already receiving tamoxifen to the aromatase inhibitor anastrozole. After 2 to 3 years of tamoxifen treatment, patients were randomly assigned either to receive anastrozole 1 mg/d or to continue receiving tamoxifen 20 mg/d, for a total duration of treatment of 5 years. Disease-free survival was the primary end point. Event-free survival, overall survival, and safety were secondary end points. RESULTS Four hundred forty-eight patients were enrolled. All women had node-positive, estrogen receptor-positive tumors. At a median follow-up time of 36 months, 45 events had been reported in the tamoxifen group compared with 17 events in the anastrozole group (P = .0002). Disease-free and local recurrence-free survival were also significantly longer in the anastrozole group (hazard ratio [HR] = 0.35; 95% CI, 0.18 to 0.68; P = .001 and HR = 0.15; 95% CI, 0.03 to 0.65; P = .003, respectively). Overall, more adverse events were recorded in the anastrozole group compared with the tamoxifen group (203 v 150, respectively; P = .04). However, more events were life threatening or required hospitalization in the tamoxifen group than in the anastrozole group (33 of 150 events v 28 of 203 events, P = .04). CONCLUSION Switching to anastrozole after the first 2 to 3 years of treatment is well tolerated and significantly improves event-free and recurrence-free survival in postmenopausal patients with early breast cancer.
DO ANGLES OF OBLIQUITY APPLY TO 30° SCATTERED RADIATION FROM MEGAVOLTAGE BEAMS?

The angle of obliquity is used in radiation shielding calculations to account for the longer path length x rays will see when obliquely incident on the protective barrier. According to the National Council on Radiation Protection and Measurements (NCRP), use of the angle of obliquity is explicitly assumed for primary radiation, so that an angle of obliquity for secondary radiation is never addressed. However, in the example section of the latest report, it specifically recommends against using an angle of obliquity for scattered radiation. To check this assumption, the existence or not of an angle of obliquity for scattered radiation has been investigated for bremsstrahlung x-ray beams of 4, 6, 10, 15, and 18 MV and for barriers consisting of concrete, lead, and steel using a Monte Carlo approach. The MCNP Monte Carlo code, v4.2C, has been used to generate scattered radiation at 30° from a water phantom and incident on a secondary barrier at the same angle relative to the normal to the barrier. The barrier thickness was increased from zero to a thickness sufficient to reduce the fluence (f4 tally) to <10−3. A transmission curve was created for each energy-barrier material combination by normalizing to zero thickness. The results for the first tenth-value layer (TVL) in concrete (5 energies) show an average angle of obliquity of 21.7° ± 5.6°, and for the first two TVLs averaged 29.7° ± 3.9°. The results for the first TVL in lead (3 energies) show an average angle of obliquity of 27.7° ± 4.0°, and for the first two TVLs averaged 20.5° ± 5.8°. There are no data in the NCRP reports for 30° scattered radiation attenuated by steel with which to make a comparison.
Correlates of Polyvictimization Among African American Youth

African American adolescents are exposed to high rates of community violence, and recent evidence indicates that these youth may also be at high risk of polyvictimization. Guided by an ecological approach, this study explored individual, familial, and extra-familial correlates of single and multiple forms of violence exposures (i.e., witnessing verbal parental aggression, witnessing or being a victim of community violence exposures) among a sample of 563 urban African American adolescents. Findings indicated that boys reported higher levels of polyvictimization than girls. In addition, the correlates of violence exposures varied by typology and gender. These findings support the development and use of gender-oriented approaches for identifying youth at risk of various types of violence exposures.
The effects of intravenously administered aminophylline on cerebral circulation and metabolism in man.

There is a widely held belief that aminophylline, in addition to its effect on bronchioles, kidneys and heart, also exerts a stimulating effect on central nervous function and improves the cerebral circulation (1, 2). Experimental evidence for this belief is difficult to find. Practically none has been reported in humans and very little in animals. Dumke and Schmidt (3) demonstrated that the cerebral vessels are dilated by the intra-arterial injection of aminophylline in the anesthetized macacque monkey. Intravenous aminophylline, on the other hand, increased cerebral blood flow in two monkeys and decreased it in another two. Thus, the cerebral actions of aminophylline as it is used clinically are not clearly defined and it seemed of interest, therefore, to study the effects on the cerebral circulation and metabolism in man.
Persistent nuclear actin filaments inhibit transcription by RNA polymerase II

ABSTRACT Actin is abundant in the nucleus and it is clear that nuclear actin has important functions. However, mystery surrounds the absence of classical actin filaments in the nucleus. To address this question, we investigated how polymerizing nuclear actin into persistent nuclear actin filaments affected transcription by RNA polymerase II. Nuclear filaments impaired nuclear actin dynamics by polymerizing and sequestering nuclear actin. Polymerizing actin into stable nuclear filaments disrupted the interaction of actin with RNA polymerase II and correlated with impaired RNA polymerase II localization, dynamics, gene recruitment, and reduced global transcription and cell proliferation. Polymerizing and crosslinking nuclear actin in vitro similarly disrupted the actin–RNA-polymerase-II interaction and inhibited transcription. These data rationalize the general absence of stable actin filaments in mammalian somatic nuclei. They also suggest a dynamic pool of nuclear actin is required for the proper localization and activity of RNA polymerase II. Highlighted Article: Depletion of actin in the nucleus by polymerization into stable nuclear actin filaments inhibits the actin–polymerase-II interaction, resulting in impaired RNA polymerase II activity, localization, and gene recruitment.
Apriori-Based Rule Generation in Incomplete Information Databases and Non-Deterministic Information Systems

This paper discusses issues related to incomplete information databases and considers a logical framework for rule generation. In our approach, a rule is an implication satisfying specified constraints. The term incomplete information databases covers many types of inexact data, such as non-deterministic information, data with missing values, incomplete information or interval valued data. In the paper, we start by defining certain and possible rules based on non-deterministic information. We use their mathematical properties to solve computational problems related to rule generation. Then, we reconsider the NIS-Apriori algorithm which generates a given implication if and only if it is either a certain rule or a possible rule satisfying the constraints. In this sense, NIS-Apriori is logically sound and complete. In this paper, we pay a special attention to soundness and completeness of the considered algorithmic framework, which is not necessarily obvious when switching from exact to inexact data sets. Moreover, we analyze different types of non-deterministic information corresponding to different types of the underlying attributes, i.e., value sets for qualitative attributes and intervals for quantitative attributes, and we discuss various approaches to construction of descriptors related to particular attributes within the rules' premises. An improved implementation of NIS-Apriori and some demonstrations of an experimental application of our approach to data sets taken from the UCI machine learning repository are also presented. Last but not least, we show simplified proofs of some of our theoretical results.
Functional Implications of the Binding Mode of a Human Conformation-Dependent V2 Monoclonal Antibody against HIV

ABSTRACT Data from the RV144 HIV vaccine trial indicated that gp120 V2 antibodies were associated with a lower risk of infection; thus, the mapping of V2 epitopes can contribute to the design of an effective HIV vaccine. We solved the crystal structure of human monoclonal antibody (MAb) 2158, which targets a conformational V2 epitope overlapping the α4β7 integrin binding site, and constructed a full-length model of V1V2. Comparison of computational energy stability to experimental enzyme-linked immunosorbent assay (ELISA) results identified a hydrophobic core that stabilizes the V2 region for optimal 2158 binding, as well as residues that directly mediate side chain interactions with MAb 2158. These data define the binding surface recognized by MAb 2158 and offer a structural explanation for why a mismatched mutation at position 181 (I181X) in the V2 loop was associated with a higher vaccine efficiency in the RV144 clinical vaccine trial. IMPORTANCE Correlate analysis of the RV144 HIV-1 vaccine trial suggested that the presence of antibodies to the second variable region (V2) of HIV-1 gp120 was responsible for the modest protection observed in the trial. V2 is a highly variable and immunogenic region, and structural information on its antigenic landscape will be important for rational design of an effective HIV-1 vaccine. Using X-ray crystallography, computational design tools, and mutagenesis assays, we carried out a detailed and systematic investigation of the epitope recognition of human V2 MAb 2158 and demonstrated that its epitope region overlaps the integrin binding site within V2. In addition, we propose a structure-based mechanism for mismatching of the isoleucine at position 181 and the increased vaccine efficacy seen in the RV144 vaccine trial.