Miracle-dz/UniFAR-FTUs huggingface dataset:
Promoting patient-centred care through trainee feedback: Assessing Residents' C-I-CARE (ARC) Program

Aims In recent years, patient satisfaction has been integrated into residency training practices through core competency requirements as set forth by the Accreditation Council of Graduate Medical Education (ACGME). In 2006, the UCLA Health Systems established a program designed to obtain patient feedback and assess the communication abilities of resident physicians with a standard tool through the Assessing Residents' C-I-CARE (ARC) Program. Methods This Program utilized a 17-item questionnaire, completed via a facilitator-administered interview, which employed polar, Likert and comment scale questions to assess physician trainees' interpersonal and communication skills. Results From 2006 to 2010, the ARC Program provided patient feedback data to more than six clinical departments while collecting 5,634 surveys for 323 trainees. Scores for resident recognition and performance increased from the first to second year of activity by an average of 22.5%, while attending recognition scores decreased 19% over the four years. Additionally, residents and attendings in surgical specialties received higher recognition rates than those in non-surgical specialties. Conclusions The ARC Program provided a standard tool for attaining patient feedback through a facilitator-administered survey that assisted in the accreditation process of training programs. Furthermore, hospitals, health organizations and medical schools may find the ARC Program valuable in collecting information for quality control as well as providing an opportunity for students to become involved in the healthcare field.
Characterization of Pythium oligandrum populations that colonize the rhizosphere of vines from the Bordeaux region.

This study focused on one oomycete, Pythium oligandrum, well-known for its plant protection abilities, which thrives in microbial environment where bacteria and fungal communities are also present. The genetic structures and dynamics of fungal and bacterial communities were studied in three Bordeaux subregions with various types of soil, using single-strand conformation polymorphism. The structure of the fungal communities colonizing the rhizosphere of vines planted in sandy-stony soils was markedly different from that those planted in silty and sandy soils; such differences were not observed for bacteria. In our 2-year experiment, the roots of all the vine samples were also colonized by echinulated oospore Pythium species, with P. oligandrum predominating. Cytochrome oxidase I and tubulin gene sequencings showed that P. oligandrum strains clustered into three groups. Based on elicitin-like genes coding for proteins able to induce plant resistance, six populations were identified. However, none of these groups was assigned to a particular subregion of Bordeaux vineyards, suggesting that these factors do not shape the genetic structure of P. oligandrum populations. Results showed that different types of rootstock and weeding management both influence root colonization by P. oligandrum. These results should prove particularly useful in improving the management of potentially plant-protective microorganisms.
Harnessing the cloud of patient experience: using social media to detect poor quality healthcare

Recent years have seen increasing interest in patient-centred care and calls to focus on improving the patient experience. At the same time, a growing number of patients are using the internet to describe their experiences of healthcare. We believe the increasing availability of patients’ accounts of their care on blogs, social networks, Twitter and hospital review sites presents an intriguing opportunity to advance the patient-centred care agenda and provide novel quality of care data. We describe this concept as a ‘cloud of patient experience’. In this commentary, we outline the ways in which the collection and aggregation of patients’ descriptions of their experiences on the internet could be used to detect poor clinical care. Over time, such an approach could also identify excellence and allow it to be built on. We suggest using the techniques of natural language processing and sentiment analysis to transform unstructured descriptions of patient experience on the internet into usable measures of healthcare performance. We consider the various sources of information that could be used, the limitations of the approach and discuss whether these new techniques could detect poor performance before conventional measures of healthcare quality.
A Multisite Study of Community Treatment Programs for Mentally Ill Offenders With Major Mental Disorders

This article presents reasons for undertaking “The Comparative Study of the Prevention of Crime and Violence by Mentally Ill Persons” and reasons for decisions regarding the study design and choice of measures. A brief portrait of the forensic patients that have been recruited is also presented. Community treatment programs could offer long-term cost-effective care for offenders with major mental disorders (MMDs). The study aims to identify the necessary ingredients of an effective program. Sites are selected in four countries where identification of most, if not all, persons with MMD who commit crimes within the catchment area was possible. Within each site, two samples of patients with MMD are recruited, one from a forensic hospital and one from a general psychiatric hospital. Assessments are completed prior to discharge. Participants are followed during a 5-year period. Comparisons of the forensic patients recruited in the four sites indicate many more similarities than differences.
6. THE CORRELATION OF THE RHYIHMIC WAVES OF THE HIPPOCAMPUS WITH THE BEHAVIORS OF DOGS

Two types of the so-called hippocampal arousal waves were reported in relation to the dog's behaviors. The one, hippocampal rhythmic wave-S, occurred only after sleep pattern spontaneously or by stimuli, during the appearance of which the animal kept continuously a sleeping posture but showed a few localized twichings of eyelids, conchae, vibrissae, facial muscles etc. and frequently rapid movement potentials of eyeballs. The other, hippocampal rhythmic wave-A, was seen in a short train during wakefulness, accompanying some actions, i.e. head-turning, sniffing, searching on the floor etc. The characteristics and interrelationships of these waves were discussed.
A transposon-based strategy to identify the regulatory gene network responsible for landomycin E biosynthesis.

We report here a transposon-based strategy to generate Streptomyces globisporus 1912 mutants with improved landomycin E production. The modified minitransposon with strong, outward-oriented promoters for the overexpression of downstream-situated genes has been applied for mutant library generation. Approximately 2500 mutants of S. globisporus 1912 were analyzed for landomycin E production, leading to the identification of several overproducers. Subcloning and sequencing of the sites of integration showed that some of the inactivated genes encode proteins with a similarity to known bacterial regulators such as TetR and LuxR families. One of the regulators (GntR type) has shown the strongest influence on the landomycin E production. Its ortholog (encoded by sco3269) in Streptomyces coelicolor was characterized in greater detail and showed similar effects on actinorhodin production and morphological differentiation.
Spiritual care: how to do it

Objective This study explores the provision of spiritual care by healthcare professionals working at the end of life. Design Qualitative–ethnographic inquiry. Setting Phase 1: five Canadian sites; phase 2: a residential hospice in Alberta, Canada. Participants Phase 1: six palliative care leaders; phase 2: 24 frontline palliative care clinicians. Results Data were collected over a 12-month period with analysis of findings occurring concurrently. Using semistructured interviews and participant observation, 11 themes, organised under five overarching categories, emerged from the data. Five bedside skills were identified as essential to spiritual care: hearing, sight, speech, touch and presence. The integration of these bedside skills with the intrinsic qualities of healthcare professionals, including their values and spiritual beliefs, appeared to be essential to their application in spiritual care. Spiritual care primarily involved the tacit qualities of healthcare professionals and their effect on patient's spiritual well-being, rather than their explicit technical skill set or expert knowledge base. Conclusion Participants identified spiritual care as both a specialised care domain and as a philosophy of care that informs and is embedded within physical and psychosocial care. Hearing, sight, speech, touch and presence were identified as the means by which healthcare professionals impacted patients' spiritual well-being regardless of clinician's awareness or intent. An empirical framework is presented providing clinicians with a pragmatic way of incorporating spiritual care into clinical practice.
A scheme for smoothing delay-sensitive traffic offered to ATM networks

The authors present a scheme for smoothing delay-sensitive traffic offered to an asynchronous transfer mode (ATM) network. They outline such a smoothing scheme, which, when applied to variable bit rate (VBR) coded video traffic, is both optimal and avoids violation of delay constraints. The scheme is based on the assumption that recent behavior of the traffic stream can be used to predict the behavior of the input stream in the near future. The effectiveness of the scheme was evaluated by simulation. The conclusion is that even with a rudimentary forecasting rule, smoothing can lower cell losses and increase the effectiveness of VBR schemes for video transmission. <<ETX>>
End-of-life conversations and care: an asset-based model for community engagement

Background Public awareness work regarding palliative and end-of-life care is increasingly promoted within national strategies for palliative care. Different approaches to undertaking this work are being used, often based upon broader educational principles, but little is known about how to undertake such initiatives in a way that equally engages both the health and social care sector and the local communities. An asset-based community engagement approach has been developed that facilitates community-led awareness initiatives concerning end-of-life conversations and care by identifying and connecting existing skills and expertise. Aims (1) To describe the processes and features of an asset-based community engagement approach that facilitates community-led awareness initiatives with a focus on end-of-life conversations and care; and (2) to identify key community-identified priorities for sustainable community engagement processes. Methods An asset-based model of community engagement specific to end-of-life issues using a four-step process is described (getting started, coming together, action planning and implementation). The use of this approach, in two regional community engagement programmes, based across rural and urban communities in the northwest of England, is described. Findings The assets identified in the facilitated community engagement process encompassed people's talents and skills, community groups and networks, government and non-government agencies, physical and economic assets and community values and stories. Five priority areas were addressed to ensure active community engagement work: information, outreach, education, leadership and sustainability. Conclusions A facilitated, asset-based approach of community engagement for end-of-life conversations and care can catalyse community-led awareness initiatives. This occurs through the involvement of community and local health and social care organisations as co-creators of this change across multiple sectors in a sustainable way. This approach provides a framework for other communities seeking to engage with public awareness in end-of-life issues.
A phase 1 study evaluating the safety and tolerability of otlertuzumab, an anti-CD37 mono-specific ADAPTIR therapeutic protein in chronic lymphocytic leukemia.

Otlertuzumab is a novel humanized anti-CD37 protein therapeutic. This study evaluated the safety of otlertuzumab administered intravenously to patients with chronic lymphocytic leukemia (CLL). Otlertuzumab was administered weekly for up to 8 weeks followed by 1 dose per month for 4 months ranging from 0.03 to 20 mg/kg in the dose-escalation phase and 10 to 30 mg/kg in the dose-expansion phase. Responses were determined by using the 1996 National Cancer Institute (NCI-96) and 2008 International Workshop on Chronic Lymphocytic Leukaemia (IWCLL) criteria. Fifty-seven patients were treated in the dose-escalation phase and 26 in the dose-expansion phase. A maximum-tolerated dose was not identified. Response occurred in 19 (23%) of 83 treated patients by NCI-96 criteria. All responses were partial and occurred more commonly in patients with symptomatic untreated CLL (6/7) or 1 to 2 prior therapies (12/28) vs 3 or more therapies (1/48). Twenty percent (12/61) with serial computed tomography scan assessment had a response per IWCLL criteria. The most frequent adverse events were infusion reactions, fatigue, nausea, and diarrhea and were not dose related. Otlertuzumab was well tolerated, and modest clinical activity was observed. Otlertuzumab warrants further evaluation in combination with other agents for the treatment of CLL. This trial was registered at www.clinicaltrials. gov as #NCT00614042.
Achieving the goal of optimised renin system suppression: preclinical experience with a direct renin inhibitor

Aliskiren is the first orally available direct renin inhibitor and is a highly potent and specific inhibitor of human renin.The high specificity for human renin has resulted in considerable challenges in utilising animal models in preclinical studies. Both marmoset and spontaneously hypertensive rat models demonstrate the safety and efficacy of aliskiren in reducing blood pressure, although both models have drawbacks.The former are difficult to study, while the latter feature a renin that is less amenable to inhibition by a human-renin-specific drug. However, a double transgenic rat (dTGR) model has been shown to be extremely valuable in preclinical studies of aliskiren.These rats are designed to express genes for human renin and angiotensinogen. Preclinical studies in dTGR demonstrate the efficacy and safety of aliskiren, both as monotherapy and in combination with ACE inhibitors and ARBs in the treatment of hypertension. Direct renin inhibition with aliskiren improves kidney function and reduces left ventricular hypertrophy, and may have the potential to provide end-organ protection.
High α‐fetoprotein level correlates with high stage, early recurrence and poor prognosis of hepatocellular carcinoma: Significance of hepatitis virus infection, age, p53 and β‐catenin mutations

α‐Fetoprotein (AFP) is often elevated in hepatocellular carcinoma (HCC). This study was to elucidate the significance and related factors of AFP elevation in HCC in 781 unifocal HCCs receiving curative hepatectomy. We showed that high AFP (> 200 ng/ml), which was associated with AFP mRNA expression in HCC (p = 0.00001), correlated with major clinicopathologic factors. Younger age (≤ 55 years; p = 0.00001), hepatitis B surface antigen (HBsAg) in serum (p = 0.00001), p53 mutation (p = 0.008), large tumor (p = 0.00001), vascular invasion (p = 0.00001) and early tumor recurrence (p = 0.00001) were significant associates of high AFP, while anti‐HCV in serum and β‐catenin mutation in HCC had less frequent high AFP (p = 0.013 and < 0.0001, respectively). We also showed that HCC with high AFP had a lower 10‐year survival (p < 0.0001), particularly in large HCC (p < 0.0001). At univariate analysis, high AFP (p < 0.0001), HBsAg positivity (p = 0.05), p53 mutation (p = 0.0004), liver cirrhosis (p = 0.0094), large tumor (p = 0.0003), vascular invasion (p < 0.0001) and early recurrence (p < 0.0001) were significant unfavorable prognostic factors. In Cox proportional hazards regression analysis, high AFP remained a borderline significance (OR = 1.2; CI = 1.0–1.4) after adjustment for the effect of tumor size and tumor stage (p = 0.0821). Furthermore, the detection of AFP mRNA in the liver of AFP mRNA‐positive HCC was associated with more frequent early recurrence (p = 0.0026) and might be a useful marker of intrahepatic spread. We therefore conclude that AFP elevation, more than a coincidental epiphenomenon, appears to contribute to vascular invasion and HCC progression and help to identify subsets of HCC patients with increased risk for early recurrence and poor prognosis after hepatectomy. © 2004 Wiley‐Liss, Inc.
Social media and palliative medicine: a retrospective 2-year analysis of global Twitter data to evaluate the use of technology to communicate about issues at the end of life

Background Social media describes technological applications which are used to exchange information in a virtual environment. The use of social media is increasing, in professional and social contexts, on a variety of platforms such as Twitter; however, the scope and breadth of its use to discuss end-of-life care has not previously been reported. Aims To determine the frequency, sentiment and trend of Twitter ‘tweets’ containing palliative care-related identifiers (hashtags) and/or phrases sent by users over a 2-year period. Methods A 2-year retrospective analysis of Twitter posts (tweets), between the 1 August 2011 to 31 July 2013, using a social media analytics tool: TopsyPro. Thirteen search terms were identified and analysed for tweet volume, frequency, sentiment and acceleration. Results A total of 683.5K tweets containing a combination of 13 palliative care terms were analysed. The tweet volume for all terms increased by 62.3% between 2011–2012 (262.5K) and 2012–2013 (421K). The most popular terms include ‘end-of-life’ (210K), #hpm (114K) and ‘palliative care’ (93.8K). Sentiment was high with 89% of tweets rated more positive than all other tweets sent on Twitter during this period. The term ‘Liverpool Care Pathway’ experienced the highest percentage increase in tweets (55% increase) reaching a peak in July 2013. Conclusions A lot of discussion about palliative care is taking place on Twitter, and the majority of this is positive. Social media presents a novel opportunity for engagement and ongoing dialogue with public and professional groups.
Mutations in the cohesin complex in acute myeloid leukemia: clinical and prognostic implications.

Mutations in the cohesin complex are novel, genetic lesions in acute myeloid leukemia (AML) that are not well characterized. In this study, we analyzed the frequency, clinical, and prognostic implications of mutations in STAG1, STAG2, SMC1A, SMC3, and RAD21, all members of the cohesin complex, in a cohort of 389 uniformly treated AML patients by next generation sequencing. We identified a total of 23 patients (5.9%) with somatic mutations in 1 of the cohesin genes. All gene mutations were mutually exclusive, and STAG1 (1.8%), STAG2 (1.3%), and SMC3 (1.3%) were most frequently mutated. Patients with any cohesin complex mutation had lower BAALC expression levels. We found a strong association between mutations affecting the cohesin complex and NPM1. Mutated allele frequencies were similar between NPM1 and cohesin gene mutations. Overall survival (OS), relapse-free survival (RFS), and complete remission rates (CR) were not influenced by the presence of cohesin mutations (OS: hazard ratio [HR] 0.98; 95% confidence interval [CI], 0.56-1.72 [P = .94]; RFS: HR 0.7; 95% CI, 0.36-1.38 [P = .3]; CR: mutated 83% vs wild-type 76% [P = .45]). The cohesin complex presents a novel pathway affected by recurrent mutations in AML. This study is registered at www.clinicaltrials. gov as #NCT00209833.
Multi-class connection admission control policy for high speed ATM switches

Broadband networks based on ATM have to support multiple classes of services with widely different traffic characteristics and quality of services. We propose and develop a multi-class connection admission control (CAC) policy that supports cell loss and delay requirements. In this model-based CAC, the source traffic is described in terms of the usage parameter control (UPC) parameters. Through careful analysis and approximations, we derive simple closed-form formulas to calculate the bandwidth required to meet guarantees on quality of service (QoS). While being robust, the CAC achieves a high level of resource utilization and can be easily implemented for real-time admission control.
Scalable delivery of Web pages using cyclic best-effort multicast

The World Wide Web (WWW) has gained tremendously in popularity. In this work we explore the use of UDP, best-effort multicast as a delivery option. Reliability is achieved through repetitive, cyclic transmission of a requested page. This solution is expected to be most efficient when used for highly requested pages. We view this cyclic multicast technique as a delivery option that can be integrated with the traditional reliable unicast and reliable multicast options. We first describe the architecture of an integrated Web server employing all three delivery options. We then describe the cyclic multicast technique and consider the various procedures needed for its successful operation. We characterize the gains in performance achieved by our proposal through an extensive performance analysis and simulation of our technique by itself, and when integrated with the other delivery options. We also describe our experience with an implementation of a prototype cyclic multicast server and its performance over the multicast backbone (MBone).
An empirical study of real audio traffic

The delivery of multimedia content is a facet of Internet traffic that is rapidly growing in importance. The new generation of World Wide Web sites rely heavily on extensive multimedia content such as graphics, sound, music and video to attract and retain visitors. While there have been extensive studies on the growth and effects of hyper text transfer protocol (HTTP) traffic used on the Web, little or no work has been performed in analyzing streaming multimedia traffic. We present the results of a brief study to examine the traffic emanating from a popular Internet audio service using the RealAudio program. We found protocol distributions that show a bias towards non-TCP friendly protocols. In addition, we observed consistencies in audio traffic packet sizes and data rate patterns may be useful as a tool for identifying audio data flows. Our results show that audio flows exhibit significant consistency in data rates and are considerably more persistent than HTTP connections.
Four commonly utilized metabolic systems fail to produce similar results during submaximal and maximal exercise

This study evaluated the reproducibility of four commonly utilized metabolic systems. The metabolic carts and associated electronic cycle ergometers were: (1) the Q‐PLEX I/Corival, (2) SensorMedics 2900/Ergometrics, (3) Medical Graphics Corporation (MGC) 2001/Mijnhardt, and (4) CPX/Medifit. Five individuals (mean age, 32 years; weight, 74 kg; height, 179 cm) experienced in graded exercise testing participated. Duplicate submaximal and maximal protocols were completed on separate days with all four systems. The submaximal power outputs averaged 85, 135, and 190 W and were each 4 minutes in duration. A maximal effort was achieved with a continuous ramp protocol (30 W/min) until exhaustion. All four systems demonstrated excellent reproducibility (usually 5% or less variation) for values reported during either submaximal or maximal exercise. These values were system dependent, however, as evident from a significant difference in submaximal and maximal pulmonary ventilation, oxygen consumption (VO2), carbon di.