Miracle-dz/UniFAR-FTUs huggingface dataset:
The search for understanding: the role of paradigms.

BACKGROUND Kuhn's ( 1962 ) acknowledgement of a paradigm as a way that scientists make sense of their world and its reality gave recognition to the idea of 'paradigm shift'. This shift exposes the transience of paradigm development shaped by societal and scientific evolution. This ongoing evolutionary development provides the researcher with many paradigms to consider regarding how research is undertaken and the search for understanding achieved. AIM An understanding of paradigm development is necessary when planning a study and can shape the search for understanding. It is hoped that the discussion presented here will assist novice and experienced researchers in articulating the rationales for their paradigm choices. DISCUSSION An overview of the dominant paradigms is presented, reflecting ongoing paradigm development shaped by ontological, epistemological and methodological perspectives. Potential paradigm choices that shape research aims, objectives and focus in the search for understanding are considered. CONCLUSION The inherent debates about paradigm shift, division, war and synthesis leave the researcher many perspectives to consider. Articulating the world views underpinning constructivism, interpretivism and pragmatism is particularly challenging because of the blurring of boundaries between them. IMPLICATIONS FOR PRACTICE The evolutionary nature of paradigmatic development has provided nurse researchers with the opportunity for methodological openness to the myriad research approaches, methods and designs that they may choose to answer their research question. However, it is imperative that researchers consider their ontological stances and the nature of their research questions. This is challenging in constructivism, interpretivism and pragmatism, where there is often an overlap of paradigm world views.
An integrated approach for individualised support: carers' views

Purpose – The purpose of this paper was to capture carers’ views of a service in Bristol funded jointly by the Local Authority and the NHS Clinical Commissioning Group, which offers support to carers in the form of a one-off payment which they can use for anything they choose. Design/methodology/approach – A multi-method evaluation of this integrated service was conducted between August 2012 and October 2013 to explore its impact on carers’ health and well-being. This paper presents findings from 40 interviews conducted with carers as part of the evaluation. Findings – Many carers have little respite from very stressful situations; the break enabled them to focus on their own needs. Carers’ needs included actual short breaks away with or without those being cared for, as well as items like household equipment or exercise classes. Research limitations/implications – The study was centred on an innovation and integrated approach to support carers in one city and provides a snap-shot of the short-term effect.
The Relationship between Staff Development and Health Instruction in Schools in the United States

Abstract This analysis examined differences in health instruction among teachers of required health education classes or courses who had received or wanted staff development on health topics, teachers who had a degree in health education, and teachers who were Certified Health Education Specialists. Classroom-level data were collected from teachers of a nationally representative sample of randomly selected classes in public and private elementary schools and randomly selected required health education courses in public and private middle/junior and senior high schools. Health topics analyzed included tobacco, alcohol, and other drug use prevention; accident or injury prevention; violence prevention; HIV, sexually transmitted disease, and pregnancy prevention; nutrition and dietary behaviors; and physical activity and fitness. Participation in and desire for staff development on health topics were low. Staff development on health topics during the 2 years preceding the study was associated with teaching more health topics; for most topics at the upper grade levels, this association was independent of whether health education topics were within health infused classes or separate health education courses. At the upper grade levels, courses taught by teachers with degrees in health education were associated with teaching all health topics examined; however, for most topics, this finding was not significant when health infused versus separate health education courses were controlled.
HPV detection in patients with atypical squamous cells diagnosis in a Mexican population. Comparison of HC2 and PCR tests

1Departamento de Citopatología, Instituto Nacional de Cancerología, México. 2Unidad de Investigación Biomédica en Cáncer. Instituto Nacional de Cancerología, México and Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México. Correspondence: Dra. Rita Sotelo Regil Hallmann. Av. San Fernando N° 22. Col. Sección XVI, Tlalpan 14080 Mexico, D.F. Mexico. Telephone/fax: 5628 0468. E-mail: rsotelo24@hotmail.com T RESUMEN
Triceps Rupture: A Case Series, Anatomical Study of the Triceps Footprint and Description of Surgical Technique

Background Distal triceps tendon ruptures are rare accounting for less than 1% of all tendinous injuries in the upper extremity. Such injuries should be suspected in patients who have pain about the elbow following an eccentric contraction to the upper extremity. Complete ruptures should be treated with early surgical repair with reattachment of the tendon to the olecranon. Most reports to date have used suture fixation through olecranon drill holes. This study was performed to asses the anatomy of the triceps insertion and it's implications on the adequate fixation of the triceps tendon using a novel technique. Methods Ten cadaveric adult upper extremities with no signs of prior trauma or surgery were used in this study. The specimens were stripped of all skin and subcutaneous tissue through a direct posterior approach, to identify the triceps insertion. The insertion of the triceps tendon was then mapped and the area of the medial, long and lateral heads measured. Three cases of distal triceps rupture using this new open repair technique are also described using two distal drill holes and sutures augmented with a proximal anchor. Two of the three patients also needed LARS ligament augmentation at the time of surgery due to tissue loss. Results In all cadaveric sections separate insertions were found consisting of the medial head and the conjoint tendons of the long and lateral heads. The mean surface areas for the medial and long/lateral insertions were 100.4 mm2 and 307.9 mm2 respectively. The mean total area for the triceps insertion was found to be 408.3 mm2. At follow up all cases were assessed using the Oxford Elbow Score, Mayo Elbow Performance Scores and Disabilities of the Arm, Shoulder and Hand Scores. Conclusions We have shown that the insertion of the triceps tendon is a “footprint” made from the tendon of the medial head and a conjoint tendon of the long and lateral heads. For cases of distal triceps rupture we have described an open procedure using a “double row footprint reconstruction” technique which we believe anatomically reconstructs the triceps insertion.
Harmful Impact of ZnS Nanoparticles on Daphnia sp. in the Western Part (Districts of Bankura and Purulia) of West Bengal, India

ZnS nanoparticles of different sizes are synthesized employing a simple wet chemical method. These nanoparticles are used to study their impact on the Daphnia sp. through traditional toxicity tests. The percentage of mortality is found to increase initially with increasing nanoparticle concentration or exposure time and is finally found to saturate for higher concentrations or exposure times. Mortality is found to be higher for smaller particles. Hopping frequency and heart rate are also found to increase with increasing nanoparticle exposure time for a fixed nanoparticle concentration. These observations can be attributed to the enhanced surface photooxidation property of the ZnS nanoparticles. Thus the present study will help people to understand the hitherto unknown harmful impact of ZnS nanoparticles on aquatic organisms in the western part of West Bengal (Bankura and Purulia districts), India.
The Characteristics of Capgras Syndrome in Patients Diagnosed as Probable Alzheimer Disease

Objective: We assessed the characteristics of Capgras syndrome in patients diagnosed as probable Alzheimer disease, and com-pared the clinical and imaging findings with other previous reports.Methods: We obtained medical records of patients with Capgras syndrome diagnosed as probable Alzheimer disease in three hos-pitals from March 2009 to March 2010. The basic characteristics, neuropsychologic tests, brain imaging data were investigated.Results: The mean age of the patients was 74.7 years old and all of the patients experienced this syndrome in relation to a spouse. Brain magnetic resonance imaging showed mild-to-moderate global atrophy, variable hippocampal atrophy in this study. The Mini-Mental State Examination mean scores were 18.78 and clinical dementia rating scores were from 1 to 2. All of the patients took medi-cine of acetycholine esterase inhibitors and two patients recovered with antipsychotic medication. Five patients had showed con-tinuous Capgras syndrome, at the last follow-up day, for a year.Conclusion: Capgras syndrome patients in this study who were diagnosed as probable Alzheimer disease showed similar results to the individuals from other reports. More study is needed to estimate the numbers and characteristics of patients with this syndrome. Keywords: Capgras syndrome; Dementia; Alzheimer disease
Up-to-date Definition of the Polycystic Ovary and Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is common in the general population. In this paper the author presents the up to date definition of PCOS and PCO. At a joint ASRM/ESHRE consensus meeting, a refined definition of the PCOS was agreed, in which two out of the following are required: (1) oligomenorrhoea or amenorrhoea; (2) clinical and/or biochemical signs of hyperandrogenism; (3) polycystic ovaries, once appropriate tests have been performed to exclude other causes of androgen excess and menstrual disturbance. The definition of a polycystic ovary (PCO) should have at least one of the following: either 12 or more follicles measuring 2–9 mm in diameter or increased ovarian volume (>10 cm3). If there is a follicle >10 mm in diameter, the scan should be repeated at a time of ovarian quiescence in order to calculate volume and area. The presence of a single PCO is sufficient to provide the diagnosis. The distribution of follicles and a description of the stroma are not required in the diagnosis.
Interrelationship of PTSD, perceived health, and treatment satisfaction

Purpose – The residential therapeutic community (TC) treatment modality has been shown to effectively reduce drug use and improve psychiatric/medical health among clients who are often disproportionately impacted by medical conditions and have a co-occurring psychiatric disorder such as Posttraumatic Stress Disorder (PTSD). Yet not much is known regarding how clients’ health may impact their treatment satisfaction. Using path analysis, the interrelationship between PTSD, perceived health, and treatment satisfaction was examined. The paper aims to discuss these issues. Design/methodology/approach – A survey including the Posttraumatic Stress Disorder Checklist-Specific (PCL-S), a perceived health rating, and a Treatment Satisfaction Scale was collected from 303 clients at three comparable long-term residential TC treatment programs in New York City. Findings – Findings indicated that clients with PTSD rated their health significantly worse than those without PTSD. Although no direct relationship between PT.
Healthcare Services Based on Knowledge Structure

This article presents a conceptual structure for enabling knowledge creation and knowledge transference in the knowledge-intensive health services. Identifying the proposed critical elements in health management, it analyses the required organisational characteristics for the change from a traditional context to a complex context. The conceptual framework applied to the hospital management highlights the differences between ’structure based on information’ and ’structure based on knowledge’. Hospitals which are focused on solving complex problems demand new service strategies for the creation and transference of knowledge. A qualitative research was applied in a in-depth case study and conducted as an exploratory investigation in the Vascular Medical Center, that includes neurology and cardiology services, and is a Brazilian hospital specialised in complex problems. By looking into the patient’s adherence, two critical contexts were identified: one was the interaction between patients and healthcare professionals, and the second was the organisational behaviour regarding the patients’ experiences. Knowledge structure demands the reconfiguration of the internal value chain of hospitals considering the results of the assistance process. The organisational context to promote knowledge for solving adherence problems was characterised as a facilitator environment that would be required to develop an educational process for both patients and healthcare professionals.
Rehabilitation in a primary care setting for persons with chronic illness – a randomized controlled trial

Aim The primary objective of this study was to determine whether adults with a chronic illness within a primary care setting who received a rehabilitation intervention in this setting showed greater improvement in health status and had fewer hospital admissions and emergency room visits compared with adults who do not receive the intervention. Background More than half of Canadians (16 million people) live with chronic illness. Persons with chronic illness in primary care, especially older persons who are most at risk for functional decline, are currently not receiving effective management. Methods A randomized controlled trial was used. A rehabilitation multi-component intervention was delivered by a physiotherapist (PT) and occupational therapist in a primary care setting and included collaborative goal setting for rehabilitation needs, a six-week chronic disease self-management (SM) workshop, referral to community programs and a web-based education programme. Findings Three hundred and three patients participated, n = 152 intervention group and n = 151 in the control group. There was a significant difference between the groups for planned hospital days (F = 6.3, P = 0.00) with an adjusted difference 0.60 day per person, and increased satisfaction with rehabilitation services however no difference on health status or emergency room visits. This rehabilitation intervention which had a strong SM component prevented planned hospitalizations that resulted in a conservative estimated cost saving from reduced hospitalizations of $65 000. Future research needs to examine which patient groups with chronic illness show positive responses to rehabilitation and self-management.
A case report of anti-parathyroid hormone immunotherapy for parathyroid carcinoma

Parathyroid carcinoma is a unique malignant tumor, the primary clinical manifestations of which are hyperfunction of the parathyroid gland, various metabolic disorders secondary to hypercalcemia and corresponding impairment of tissues and organs. A complete laboratory examination, accurate imaging, and reliable histopathologic findings are critical to the diagnosis of parathyroid carcinoma. Parathyroid carcinoma is insensitive to chemotherapy and radiotherapy. Immunotherapy is a technology developed in recent years that provides a novel pathway to treat hypercalcemia that is resistant to traditional therapeutic methods. In this study, an anti-parathyroid hormone (PTH) autoantibody produced by the immunization of artificially synthesized human and bovine PTH peptide was used. We aimed to report the efficacy of this therapy in the treatment of parathyroid carcinoma. Key words: Parathyroid carcinoma, immunotherapy, anti-parathyroid hormone.
Satisfaction and prosthesis related complaints in women with immediate breast reconstruction following prophylactic and oncological mastectomy

This study evaluated patient's satisfaction with immediate breast reconstruction (IBR) with silicone prosthesis. Special attention is paid to the differences in satisfaction, and specific prosthesis related complaints of IBR after prophylactic and oncological mastectomy. All women who were operated on between April 1995 and May 1999 at the Erasmus Medical Centre, Daniel den Hoed Cancer Centre received 1 year following operation a self-report questionnaire, concerning their perceived advantages of and satisfaction with IBR, their prosthesis-related complaints and various psycho-social variables. The most important perceived advantage of IBR was not to have to wear an external prosthesis (95%). Despite the fact that one third of the patients had specific prosthesis related complaints, 80% was satisfied with IBR and 88% would do it again. There was no significant difference in satisfaction between the prophylactic and the cancer group. Overall satisfaction is mostly influenced by cosmetics (r = − 0.58), information (r = − 0.45) and specific prosthesis related complaints (r = − 0.39). Especially specific prosthesis related complaints are important for both the prophylactic and the cancer group. The majority of patients were satisfied with IBR after oncological or prophylactic mastectomy. However the findings of the importance of specific prosthesis related complaints should be taken serious for the information and care of patients.
Using Goal Attainment Scaling in physiotherapeutic home-based stroke rehabilitation

Abstract The aim of the study was to explore with community-based physiotherapists the feasibility and acceptability of using Goal Attainment Scaling (GAS) in home-based stroke rehabilitation (HBSR) and to gain a deeper understanding of physiotherapy practice in this setting. Four physiotherapists and seven patients (three men, four women) participated in this qualitative study. Interpretative description was used to analyse data collected from multiple sources including in-depth interviews, clinical patient notes and treatment observations. Physiotherapy participants were cautiously enthusiastic of the role of GAS in HBSR, finding it useful to focus their treatment interventions on specific patient-centred goals, although it was not easy to set goals with all patients. Participants questioned the reliability of GAS as a method of measuring patient outcome. Physiotherapy in this setting was found to be complex and covered a range of interventions; interventions ensuring a process of care for patients requiring a great deal of care and support to interventions for patients functioning at a high level within their community. GAS maybe a feasible means of measuring outcome in HBSR for some patients, but more research is required to establish how goals and indicators can be set reliably and at the correct level of intensity.
MicroRNAs in Body Fluids as Biomarkers for Non-Small Cell Lung Cancer: A Systematic Review

Non-small cell lung cancer (NSCLC) is one of the most common life-threatening malignant tumors. A test for early diagnosis of NSCLC needs to be not too invasive and not too heavy a burden for weakened patients. A series of studies reported various microRNAs (miRNAs) could be novel serum biomarkers for NSCLC. However, the diagnostic ability of different miRNA biomarkers varies among the reports. The goal of this study was to perform a systematic review to examine the effect of miRNAs on NSCLC-related outcomes. We systematically searched The Cochrane Central Register of Controlled Trials, MEDLINE, Pub Med, EMBASE, the Chinese Biomedical Literature Database, the China Academic Journals Full-text Database, and the Chinese Scientific Journals Database for potential studies. Studies were included if they were related to miRNAs, NSCLC, and reported diagnostic outcomes. Diagnostic values analysis was used to summarize the overall test performance of miRNAs. 13 studies were included in this systematic review. The ranges of sensitivity (SEN) and specificity (SPE) of diagnosis model with miRNAs as identifying NSCLC were 0.69~1.00 and 0.66~1.00, respectively. The overall area under the curve (AUC) value of summary receiver operating characteristic (SROC) curve was 0.9151. The ranges of positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 2.33~24.75 and 0.01~0.40, respectively. The range of diagnostic odds ratio (DOR) was 6.52~983.38. The current evidence indicates that miRNAs in body fluids show high accuracy in identifying NSCLC, and could be a useful screening tool for diagnosing NSCLC patients.
Severe Symptomatic Hypocalcemia after Denosumab Administration in an End-Stage Renal Disease Patient on Peritoneal Dialysis with Controlled Secondary Hyperparathyroidism

We report the 1 case of severe, symptomatic hypocalcemia after denosumab (RANKL inhibitor) treatment in a peritoneal dialysis patient with secondary hyperparathyroidism and osteoporosis. A 58-year-old Caucasian female has been receiving chronic ambulatory peritoneal dialysis for four years secondary to polycystic kidney disease. Laboratory studies revealed: albumin-corrected calcium 9.0 mg/dL, phosphorus 5 mg/dL, alkaline phosphatase (ALP) 58 U/L [normal, 40-105], albumin 3.4 gm/dL [normal, 3.6-5.4] and intact parathyroid hormone (PTH) 315 pg/mL [normal, 40-72]. Marked osteoporosis was noted on the DXA scan, preventing her from renal transplantation considerations. She had failed conventional medical treatment, including per os calcium, monthly ergocalciferol (50,000 units/month), activated vitamin-D analog (doxercalciferol) and Case Study British Journal of Medicine & Medical Research, 3(4): 1398-1406, 2013 1399 renal-failure adjusted alendronate (70 mg twice a month). She was started on subcutaneous denosumab 60 mg every 6 months. After her first dose, she developed a progressive drop of calcium, phosphorus, bicarbonate and magnesium, in spite of massive escalation of doxercalciferol and calcium supplementation. Hypocalcemia nadired at 6.3 mg/dL with symptomatic tetany, requiring a brief hospitalization approximately 7 weeks after denosumab treatment. Her elevated PTH rose further transiently (647 pg/mL), along with ALP (123 U/L). Bone-mineral parameters normalized approximately 3 months after denosumab administration. The observed phenomenon resembled the phenotype of “hungry bone syndrome” observed after surgical parathyroidectomy. Conclusion: Treatment decisions based on bone densitometry results alone are not transposable between patients with or without end-stage renal disease. Denosumab may lead to critical hypocalcemia in dialysis patients and further aggravate existing secondary hyperparathyroidism.