Miracle-dz/UniFAR-FTUs huggingface dataset:
A principal component analysis of coagulation after trauma

BACKGROUND: Clotting factor abnormalities underlying acute traumatic coagulopathy are poorly understood, with application of traditional regression techniques confounded by colinearity. We hypothesized that principal components analysis (PCA), a pattern‐finding and data reduction technique, would identify clinically predictive patterns in the complex clotting factor milieu after trauma. METHODS: Plasma was prospectively collected from 163 critically injured trauma patients. Prothrombin; factors V, VII, VIII, IX, X; D‐dimer; activated and native protein C; and antithrombin III levels were assayed and subjected to nonlinear PCA to identify principal components (PCs). RESULTS: Of 163 patients, 19.0% were coagulopathic on admission. PCA identified 3 significant PCs, accounting for 67.5% of overall variance. PC1 identified global clotting factor depletion; PC2 the activation of protein C and fibrinolysis; and PC3 factor VII elevation and VIII depletion. PC1 score correlated with penetrating injury and injury severity, predicting coagulopathy (odds ratio [OR], 4.67; p < 0.001) and mortality (OR, 1.47; p = 0.032). PC2 score correlated with injury severity, acidosis, and shock, and significantly predicted ventilator‐associated pneumonia (OR, 1.59; p = 0.008), acute lung injury (OR, 2.24; p < 0.001), multiorgan failure (OR, 1.83; p = 0.002), and mortality (OR, 1.62; p = 0.006) but was not associated with international normalized ratio (INR)–based or partial thromboplastin time (PTT)–based coagulopathy (p > 0.200). PC3 did not significantly predict outcomes. CONCLUSION: PCA identifies distinct patterns of coagulopathy: depletion coagulopathy predicts mortality and INR/PTT elevation, while fibrinolytic coagulopathy predicts infection, end‐organ failure, and mortality, without detectable differences in INR or PTT. While depletion coagulopathy is intuitive, fibrinolytic coagulopathy may be a distinct but often overlapping entity with differential effects on outcomes. LEVEL OF EVIDENCE: Prognostic study, level III.
Physical, psychosocial, and social health of men who identify as bears: a systematic review.

AIMS AND OBJECTIVES This article examines the existing qualitative and quantitative research on physical, psychosocial and social health of men who identify as Bears, a subcultural group in the gay community. BACKGROUND During the 1980s, one of the first Bear communities emerged in San Francisco. Using the United States as an example, other Bear communities were created throughout the world. Today, Bear-related organizations and events are found globally. METHODS A systematic review was conducted exploring the health of men who identify as Bears. DESIGN To identify articles addressing the health outcomes of men who identify as Bears, the researcher systematically reviewed articles indexed through CINAHL, PsycINFO, Humanities International Index, Cochrane Library, Medline, and LGBT Life. RESULTS The major findings across the 11 articles were systematically grouped into physical, psychosocial, and social health categories. Men identifying as Bears were more likely to have a higher body mass index, engage in risky sexual behaviours and have a lower self-esteem. CONCLUSIONS Future implications for research and practice regarding the health of men who identify as Bears are addressed. RELEVANCE TO CLINICAL PRACTICE Men who identify as Bears have unique health care needs and respond to health care providers who are sensitive towards their needs. Health care providers should understand and acknowledge the unique health needs of men who identify as Bears to better care for these men.
In vitro comparison of sputtered iridium oxide and platinum-coated neural implantable microelectrode arrays

Neural interfaces connect signal processing electronics to the nervous system via implanted microelectrode arrays such as the Utah electrode array (UEA). The active sites of the UEA are coated with thin films of either platinum (Pt) or iridium oxide (IrOx). Pt and IrOx have attracted attention as a stimulating or recording material due to their ability to transfer between ionic and electronic current and to resist corrosion. The physical, mechanical, chemical, electrical and optical properties of thin films depend on the method and deposition parameters used to deposit the films. In this work, surface morphology, impedance and charge capacity of Pt and sputtered iridium oxide film (SIROF) were investigated and compared with each other. UEAs with similar electrode area and shape were employed in this study. DC sputtering was used to deposit Pt films and pulsed-dc reactive sputtering was used to deposit SIROF. The electrodes coated with SIROF and Pt were characterized by scanning electron microcopy, cyclic voltammetry, electrochemical impedance spectroscopy and potential transient measurements to measure charge injection capacity (CIC). SIROF and Pt selectively deposited on the electrode tip had dendrite and granular microstructure, respectively. The CIC of unbiased SIROF and Pt was 2 and 0.3 mC cm−2, respectively. The average impedance at 1 kHz, of SIROF and Pt electrodes, was 6 kΩ and 125 kΩ, respectively. Low impedance and high CIC make SIROF promising stimulation/recording material for neural prosthetic applications.
Principles of T2*‐weighted dynamic susceptibility contrast MRI technique in brain tumor imaging

Dynamic susceptibility contrast magnetic resonance imaging (DSC‐MRI) is used to track the first pass of an exogenous, paramagnetic, nondiffusible contrast agent through brain tissue, and has emerged as a powerful tool in the characterization of brain tumor hemodynamics. DSC‐MRI parameters can be helpful in many aspects, including tumor grading, prediction of treatment response, likelihood of malignant transformation, discrimination between tumor recurrence and radiation necrosis, and differentiation between true early progression and pseudoprogression. This review aims to provide a conceptual overview of the underlying principles of DSC‐MRI of the brain for clinical neuroradiologists, scientists, or students wishing to improve their understanding of the technical aspects, pitfalls, and controversies of DSC perfusion MRI of the brain. Future consensus on image acquisition parameters and postprocessing of DSC‐MRI will most likely allow this technique to be evaluated and used in high‐quality multicenter studies and ultimately help guide clinical care. J. Magn. Reson. Imaging 2015;41:296–313. © 2013 Wiley Periodicals, Inc.
Quality of life improves in patients with chronic heart failure and Cheyne‐Stokes respiration treated with adaptive servo‐ventilation in a nurse‐led heart failure clinic

AIMS AND OBJECTIVES The aim of this study was to investigate if quality of life improved in chronic heart failure patients with Cheyne-Stokes respiration treated with adaptive servo-ventilation in nurse-led heart failure clinic. BACKGROUND Cheyne-Stokes respiration is associated with decreased quality of life in patients with chronic heart failure. Adaptive servo-ventilation is introduced to treat this sleep-disordered breathing. DESIGN Randomised, controlled design. METHODS Fifty-one patients (ranging from 53-84 years), New York Heart Association III-IV and/or left ventricular ejection fraction ≤40% and Cheyne-Stokes respiration were randomised to an intervention group who received adaptive servo-ventilation or a control group. Minnesota Living with Heart Failure Questionnaire was used to assess quality of life at randomisation and after three months. Both groups were followed in the nurse-led heart failure clinic. RESULT Adaptive servo ventilation improved quality of life-scores both in a per protocol analysis and in an intention to treat analysis. Twenty-one patients dropped out of the study, nine in the control and 12 in the intervention group. CONCLUSION Use of adaptive servo-ventilation improved quality of life in chronic heart failure patients with Cheyne-Stokes respiration. However, the drop-out rate was high. RELEVANCE TO CLINICAL PRACTICE Chronic heart failure patients come regularly to the nurse-led heart failure clinic. The heart failure nurses' competency has to include knowledge of equipment to provide support and continuity of care to the patients.
Transfusion of red blood cells in patients with a prehospital Glasgow Coma Scale score of 8 or less and no evidence of shock is associated with worse outcomes

BACKGROUND Red blood cell transfusion practices vary, and the optimal hemoglobin for patients with traumatic brain injury has not been established. METHODS A retrospective review of data collected prospectively as part of a randomized, controlled trial involving emergency medical service agencies within the Resuscitation Outcomes Consortium was conducted. In patients with a Glasgow Coma Scale (GCS) score of 8 or less without evidence of shock (defined by a systolic blood pressure [SBP] < 70 or SBP of 70 to 90 with a heart rate ≥108), the association of red blood cell transfusion with 28-day survival, adult respiratory distress syndrome–free survival, Multiple Organ Dysfunction Score (MODs), and 6-month Extended Glasgow Outcome Scale (GOSE) score was modeled using multivariable logistic regression with robust SEs adjusting for age, sex, injury severity (Injury Severity Score [ISS]), initial GCS score, initial SBP, highest field heart rate, penetrating injury, fluid use, study site, and hemoglobin (Hgb) level. RESULTS A total of 1,158 patients had a mean age of 40, 76% were male, and 98% experienced blunt trauma. The initial mean GCS score was 5, and the initial mean SBP was 134. The mean head Abbreviated Injury Scale (AIS) score was 3.5. A categorical interaction of red blood cell transfusion stratified by initial Hgb showed that when the first Hgb was greater than 10 g/dL, volume of packed red blood cell was associated with a decreased 28-day survival (odds ratio, 0.83; 95% confidence interval [CI], 0.74–0.93; p < 0.01) and decreased adult respiratory distress syndrome–free survival (odds ratio, 0.82; 95% CI, 0.74–0.92; p < 0.01). When the initial Hgb was greater than 10, each unit of blood transfused increased the MODs by 0.45 (coefficient 95% CI, 0.19–0.70; p < 0.01). CONCLUSION In patients with a suspected traumatic brain injury and no evidence of shock, transfusion of red blood cells was associated with worse outcomes when the initial Hgb was greater than 10. LEVEL OF EVIDENCE Therapeutic study, level III.
Bone induction through controlled release of novel BMP-2-related peptide from PTMC11-F127-PTMC11 hydrogels

Bone morphogenetic protein 2 (BMP-2) is the most powerful osteogenic factor; its effectiveness in enhancing osteoblastic activation has been confirmed both in vitro and in vivo. We developed a novel peptide (designated P24) derived from the ‘knuckle’ epitope of BMP-2 and found it also had osteogenic bioactivity to some extent. The main objective of this study was to develop a controlled release system based on poly(trimethylene carbonate)–F127–poly(trimethylene carbonate) (PTMC11-F127-PTMC11) hydrogels for the P24 peptide, to promote bone formation. By varying the copolymer concentrations, we demonstrated that P24/PTMC11-F127-PTMC11 hydrogels were an efficient system for the sustained release of P24 over 21–35 days. The P24-loaded hydrogels elevated alkaline phosphatase activity and promoted the expression of osteocalcin mRNA in bone marrow stromal cells (BMSCs) in vitro. Radiographic and histological examination showed that P24-loaded hydrogels could induce more effective ectopic bone formation in vivo than P24-free hydrogels. These results indicate that the PTMC11-F127-PTMC11 hydrogel is a suitable carrier for the controlled release of P24, and is a promising injectable biomaterial for the induction of bone regeneration.
Synthesis, characterization and cytocompatibility of spherical bioactive glass nanoparticles for potential hard tissue engineering applications

Nanotechnology offers a new strategy to develop novel bioactive materials, given that nano-scaled biomaterials exhibit an enhanced biocompatibility and bioactivity. In this work, we developed a method for the synthesis of spherical bioactive glass nanoparticles (BGNP) aimed at producing biomaterials for potential use in the repair of hard tissues. The BGNP were prepared using the sol–gel process based on the reaction of alkoxides and other precursors in aqueous media for obtaining the oxide-ternary system with the stoichiometric proportion of 60% SiO2, 36% CaO and 4% P2O5. The system was extensively characterized by Fourier transform infrared, x-ray diffraction and scanning electron microscope/energy-dispersive x-ray spectroscopy with regard to chemical composition, crystallinity and morphology. Moreover, the results suggested the BGNP to be highly bioactive, which was confirmed by the formation of a hydroxyapatite biomimetic layer on the material surfaces upon immersion in simulated body fluid solution. In addition, the bioactivity response toward the developed BGNPs was assessed by direct contact of osteoblast cells using resazurin and alkaline phosphatase assays. The new BGNP have presented a significant increase in the osteoblast in vitro cytocompatibility behavior as compared to similar micro-sized bioactive glass particles. Such improvement in the overall bioactive behavior of BGNP was attributed to the much higher surface area causing enhanced interactions at the cell–nanomaterial interfaces. Hence, based on the results, the BGNP produced are the biomaterials to be potentially utilized in hard tissue engineering applications.
Guidance in Managing Patients Following Radiation Events

The threat of a radiological or nuclear disaster is ever-present. If such an event were to occur, hospitals would experience a surge of patients and advanced practice nurses (APNs) in the emergency department would be expected to immediately respond. To mitigate the effects of the disaster, treat patients, and prevent self-contamination, APNs must be well informed of nuclear disaster management and clinical treatment of radiation exposure. Understanding the effects of exposure, pathophysiology of radiation syndromes, and the basic tenants of radiation safety is essential for APNs. APNs will be required to utilize personal protective equipment during treatment and perform unique tasks including disaster triage, decontamination, environmental management, and radiological survey while tending to the psychological needs of affected individuals. An integrative review of peer-reviewed literature was conducted regarding the nursing clinical guidelines for radioactive/nuclear disaster management, revealing limited information pertaining to the role of nursing in radiological emergency management and decontamination.
Military to civilian nurse: Personal and professional reconstruction

AIMS AND OBJECTIVES To examine and describe the transition process of military nurses from military nursing practice to civilian nursing practice. A second aim was to identify challenges and facilitators to this transition. BACKGROUND Serving in the military, and embodying its values, can have a major impact on a person's worldview. These individuals serve not only as nurses but also as part of a larger military culture with a mission to protect. The decision to separate from the military and transition into the civilian workforce carries many challenges capable of influencing nurses' personal and professional identities. DESIGN Qualitative descriptive. METHODS Semi-structured interviews of 10 nurse veterans were conducted in 2015-2016. Data were collected until saturation was reached. RESULTS The transition includes four major phases from military to civilian nurse: Separating from Military Life, Conflict and Chaos, Shifting Sands and Personal and Professional Reconstruction. Duration and progress through each phase varied slightly for individual nurses. CONCLUSIONS Both work-role and personal identity transition occur when a nurse leaves the military and enters civilian practice. Military and civilian organisations, in both the USA and other countries, can implement supports to aid these nurses during this personal and professional change. Recommendations from the study group are provided. RELEVANCE TO CLINICAL PRACTICE The global nursing profession, as well as healthcare organisations that employ nurse veterans, has a commitment and obligation to understand the transition process of nurses who practise within the scope of military nursing and later in civilian nursing environments so that they may be supported and used to the extent of their prior experience. Lessons learned and advice from this group of nurses may positively aid others in their transition experience.
Building nurses’ capacity to address health inequities: incorporating lesbian, gay, bisexual and transgender health content in a family nurse practitioner programme

AIMS AND OBJECTIVES To describe our experience in incorporating lesbian, gay, bisexual and transgender health content into the family nurse practitioner curriculum at a Midwestern college of nursing in the United States. BACKGROUND Globally, lesbian, gay, bisexual and transgender people face disparities in the domains of physical health, behavioural risks, mental health and victimisation. There remains a paucity of nursing research on most aspects of lesbian, gay, bisexual and transgender health and access to care. To date, nursing leadership and curricular bodies have not provided clear guidance on the role of nurse educators in preparing nursing students to provide care to lesbian, gay, bisexual and transgender people. DESIGN Discursive paper describing the development of a lesbian, gay, bisexual and transgender health learning module for inclusion in a family nurse practitioner programme. METHODS We summarise health disparities experienced by lesbian, gay, bisexual and transgender people, describe the process of module development and outline the learning content included in the module. We also discuss challenges faced in incorporating lesbian, gay, bisexual and transgender content into nursing curricula. CONCLUSIONS Despite the lack of formal direction from the nursing sector, nursing faculty should prepare nursing students to provide culturally sensitive and competent care to lesbian, gay, bisexual and transgender people. Our experience incorporating lesbian, gay, bisexual and transgender-specific content into the family nurse practitioner programme has proven to be positive for both students and faculty. RELEVANCE TO CLINICAL PRACTICE Given their large numbers and presence across systems of care, nurses are uniquely positioned to address barriers to care faced by lesbian, gay, bisexual and transgender people. Modules such as the one described here can be used by nurse faculty to guide the inclusion of lesbian, gay, bisexual and transgender-specific content in family nurse practitioner or other nursing courses-as well as to guide the development of nursing competencies in the care of lesbian, gay, bisexual and transgender people.
Implementation evaluation and refinement of an intervention to improve blunt chest injury management—A mixed‐methods study

Aims and objectives To investigate uptake of a Chest Injury Protocol (ChIP), examine factors influencing its implementation and identify interventions for promoting its use. Background Failure to treat blunt chest injuries in a timely manner with sufficient analgesia, physiotherapy and respiratory support, can lead to complications such as pneumonia and respiratory failure and/or death. Design This is a mixed‐methods implementation evaluation study. Methods Two methods were used: (i) identification and review of the characteristics of all patients eligible for the ChIP protocol, and (ii) survey of hospital staff opinions mapped to the Theoretical Domains Framework (TDF) to identify barriers and facilitators to implementation. The characteristics and treatment received between the groups were compared using the chi‐square test or Fischer's exact test for proportions, and the Mann–Whitney U‐test for continuous data. Quantitative survey data were analysed using descriptive statistics. Qualitative data were coded in NVivo 10 using a coding guide based on the TDF and Behaviour Change Wheel (BCW). Identification of interventions to change target behaviours was sourced from the Behaviour Change Technique Taxonomy Version 1 in consultation with stakeholders. Results Only 68.4% of eligible patients received ChIP. Fifteen facilitators and 10 barriers were identified to influence the implementation of ChIP in the clinical setting. These themes were mapped to 10 of the 14 TDF domains and corresponded with all nine intervention functions in the BCW. Seven of these intervention functions were selected to address the target behaviours and a multi‐faceted relaunch of the revised protocol developed. Following re‐launch, uptake increased to 91%. Conclusions This study demonstrated how the BCW may be used to revise and improve a clinical protocol in the ED context. Relevance to clinical practice Newly implemented clinical protocols should incorporate clinician behaviour change assessment, strategy and interventions. Enhancing the self‐efficacy of emergency nurses when performing assessments has the potential to improve patient outcomes and should be included in implementation strategy.
Bioamine-crosslinked gellan gum hydrogel for neural tissue engineering

Neural tissue engineering and three-dimensional in vitro tissue modeling require the development of biomaterials that take into account the specified requirements of human neural cells and tissue. In this study, an alternative method of producing biomimetic hydrogels based on gellan gum (GG) was developed by replacing traditional crosslinking methods with the bioamines spermidine and spermine. These bioamines were proven to function as crosslinkers for GG hydrogel at +37 °C, allowing for the encapsulation of human neurons. We studied the mechanical and rheological properties of the formed hydrogels, which showed biomimicking properties comparable to naïve rabbit brain tissue under physiologically relevant stress and strain. Human pluripotent stem cell-derived neuronal cells demonstrated good cytocompatibility in the GG-based hydrogels. Moreover, functionalization of GG hydrogels with laminin resulted in cell type-specific behavior: neuronal cell maturation and neurite migration.