Miracle-dz/UniFAR-FTUs huggingface dataset:
Occupational stress, job satisfaction and well‐being in anaesthetists

An understanding of the extent and aetiology of occupational stress within medical specialities is lacking, despite the extensive research into stress in health care organizations. This study examines the nature of stress experienced by anaesthetists and its effect on job satisfaction and individual well-being. The Occupational Stress Indicator (OSI) and additional anaesthetist-specific stress questions were distributed to 1000 members of the Association of Anaesthetists of Great Britain and Ireland, yielding 564 useable responses. Compared to other workers, anaesthetists reported high levels of stress comparable to other health care professionals. Four themes emerged: daily demands, communication within the hospital, maintaining standards of patient care, accountability. Multiple regression analyses found that organizational issues, especially communication within the hospital and perceived lack of control, were most important in determining job satisfaction and individual well-being. The implications and limitations of the study are discussed. Copyright © 1999 John Wiley & Sons, Ltd.
Experimental evolution can unravel the complex causes of natural selection in clinical infections.

It is increasingly clear that rapid evolutionary dynamics are an important process in microbial ecology. Experimental evolution, wherein microbial evolution is observed in real-time, has revealed many instances of appreciable evolutionary change occurring on very short timescales of a few days or weeks in response to a variety of biotic and abiotic selection pressures. From clinical infections, including the chronic bacterial lung infections associated with cystic fibrosis that form a focus of my research, there is now abundant evidence suggesting that rapid evolution by infecting microbes contributes to host adaptation, treatment failure and worsening patient prognosis. However, disentangling the drivers of natural selection in complex infection environments is extremely challenging and limits our understanding of the selective pressures acting upon microbes in infections. Controlled evolution experiments can make a vital contribution to this by determining the causal links between predicted drivers of natural selection and the evolutionary responses of microbes. Integration of experimental evolution into studies of clinical infections is a key next step towards a better understanding of the causes and consequences of rapid microbial evolution in infections, and discovering how these evolutionary processes might be influenced to improve patient health.A video of this Prize Lecture, presented at the Society for General Microbiology Annual Conference 2015, can be viewed via this link: Michael A. Brockhurst https://www.youtube. com/watch? v=N1bodVSl27E.
The Health Status of Asian Americans and Pacific Islanders and Their Access to Health Services

ABSTRACT In the year 2000, the Asian American and Pacific Islander population comprised more than four percent or approximately eleven million of the total United States population. They are often referred to as Asian Americans. This number is expected to double by 2009. Though Asian Americans are considered a “model minority,” subgroups of them, especially the elderly, experience lower health status than do their Caucasian counterparts. Some Asian Americans use fewer health services and engage in unhealthy behaviors. Lower utilization of health services is mainly due to numerous cultural barriers, language barriers, and inadequate health insurance coverage. Previous researchers have offered policy recommendations and actions have been taken at the local and national level to address health problems among Asian Americans. These have included increased data collection on Asian Americans and provision of culturally sensitive programs and services. However, health disparities between Asian Americans and the majority population have not been eliminated and continued efforts to address the health care needs of Asian Americans are needed.
Effects of mammal host diversity and density on the infection level of Trypanosoma cruzi in sylvatic kissing bugs

Several reports have described host species diversity and identity as the most important factors influencing disease risk, producing either dilution or amplification of the pathogen in a host community. Triatomine vectors, mammals and the protozoan Trypanosoma cruzi (Trypanosomatida: Trypanosomatidae) Chagas are involved in the wild cycle of Chagas disease, in which infection of mammals occurs by contamination of mucous membranes or skin abrasions with insect‐infected faeces. We examined the extent to which host diversity and identity determine the infection level observed in vector populations (i.e. disease risk in humans). We recorded infection in triatomine colonies and on the coexisting host mammalian species in semi‐arid Chile. Host diversity, and total and infected host species densities are used as predictor variables for disease risk. Disease risk did not correlate with host diversity changes. However, the densities of each infected rodent species were positively associated with disease risk. We suggest that the infected host density surrounding the vector colonies is a relevant variable for disease risk and should be considered to understand disease dynamics. It is crucial to pay attention on the spatial scale of analysis, considering the pattern of vector dispersal, when the relationship between host diversity and disease risk is studied.
Analysis of ectoparasites (chigger mites, gamasid mites, fleas and sucking lice) of the Yunnan red‐backed vole (Eothenomys miletus) sampled throughout its range in southwest China

The Yunnan red‐backed vole Eothenomys miletus (Rodentia: Cricetidae) is an endemic rodent species and reservoir host of zoonoses in southwest China. Based on a large host sample (2463 voles collected from 39 localities between 2001 and 2013), a general analysis of four categories of ectoparasite (fleas, sucking lice, chigger mites and gamasid mites) on E. miletus across its entire range of distribution was made. This analysis identified a total of 71 895 ectoparasites belonging to 320 species (30 species of flea, 9 of sucking louse, 106 of gamasid mite and 175 of chigger mite) with a high prevalence (87%), mean abundance (29.19) and mean intensity (33.69). Of the 18 vector species of zoonoses found on E. miletus, the flea Ctenophthalmus quadratus (Siphonaptera: Hystrichopsyllidae) and chigger mite Leptotrombidium scutellare (Trombidiformes: Trombiculidae) were the dominant species; these are the main vectors of zoonoses in China. All of the dominant parasite species showed an aggregated distribution pattern. Male voles harboured more species of parasite than females. Chigger mites represented the most abundant species group on voles and their prevalence was positively correlated with mean abundance (r = 0.73; P < 0.05). As a single rodent species, E. miletus has a high potential to harbour abundant ectoparasites with high species diversity and high rates of infestation. The sex of the vole affects ectoparasite infestation.
Knee Cartilage Tibio-Femoral Injuries

Articular cartilage lesions of the femoral condyles are common and have limited healing capacity. The goal of surgical management is to relieve pain and mechanical symptoms, and hopefully slow the progression of osteoarthritis. Numerous surgical procedures have been described to include chondroplasty, microfracture, autologous chondrocyte implantation, autologous osteochondral transfer, allograft osteochondral transplantation, and fragment fixation. Each technique is distinguished by number of procedures required, expense, donor-site morbidity, risks of allograft tissues, and rehabilitation requirements. To maximize the surgical outcomes, it is imperative to treat any concomitant pathology to include mechanical malalignment, ligamentous instability, and/or meniscal deficiency. Several treatment algorithms have been proposed to guide management of symptomatic, focal chondral injuries of the femoral condyles. Algorithm decisions are based on lesion location, size, patient activity level, and earlier treatment. This article reviews the treatment considerations of the various techniques and the published results and illustrative case examples.
Molecular detection of Wolbachia pipientis in natural populations of mosquito vectors of Dirofilaria immitis from continental Portugal: first detection in Culex theileri

Wolbachia pipientis (Rickettsiales: Rickettsiaceae) protects mosquitoes from infections with arboviruses and parasites. However, the effect of its co‐infection on vector competence for Dirofilaria immitis (Spirurida: Onchocercidae) in the wild has not been investigated. This study aimed to screen vectors of D. immitis for wPip, to characterize these, and to investigate a possible association between the occurrence of W. pipientis and that of the nematode. The presence of W. pipientis was assessed in the five mosquito potential vectors of D. immitis in Portugal. Polymerase chain reaction (PCR) products were sequenced, and wPip haplotypes were determined by PCR–restricted fragment length polymorphism (RFLP). Results showed that wPip was detected in 61.5% of Culex pipiens (Diptera: Culicidae) pools and 6.3% of Culex theileri pools. wPip 16s rRNA sequences found in Cx. theileri exactly match those from Cx. pipiens, confirming a mosquito origin, rather than a nematode origin, as some specimens were infected with D. immitis. Only wPip haplotype I was found. No association was found between the presence of wPip and D. immitis in mosquitoes and hence a role for this endosymbiont in influencing vectorial competence is yet to be identified. This study contributes to understanding of wPip distribution in mosquito populations and, to the best of the authors' knowledge, is the first report of natural infections by wPip in Cx. theileri.
Conversion of vascular access type among incident hemodialysis patients: description and association with mortality.

BACKGROUND Limited data exist describing vascular access conversions during the first year on dialysis therapy or the effect of converting to and from a catheter on subsequent mortality risk. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS We studied a random sample of incident US hemodialysis patients (initiated long-term dialysis < 30 days before study entry) in the Dialysis Outcomes and Practice Patterns Study (DOPPS; 1996-2004). PREDICTORS At dialysis therapy initiation, we assessed vascular access type in use (arteriovenous fistula [AVF], arteriovenous graft [AVG], or catheter) and other patient characteristics. We characterized changes in vascular access type (conversions) by using regularly collected functional status information. OUTCOME & MEASUREMENTS We assessed time to all-cause mortality. We first described conversions, then used time-dependent Cox regression to estimate mortality hazard ratios (HRs) for conversions from a catheter to a permanent vascular access (versus no conversion) and conversions from a permanent vascular access to a catheter (versus no conversion). RESULTS The study included 4,532 patients; 69.2% were dialyzing with a catheter; 17.6%, with an AVG; and 13.1%, with an AVF. In patients initiating therapy with an AVF or AVG, 22% experienced a conversion (failure), and median times to first failure were 62 and 84 days, respectively. In catheter patients, 59% converted to an AVF/AVG (predominantly AVG [57%]); median times to first conversion were 92 and 66 days, respectively. Conversion to a permanent access was associated with an adjusted mortality HR of 0.69 (95% confidence interval, 0.55 to 0.85). The effect was similar for conversion to an AVF or AVG, and these persisted across demographic groups and facilities with different conversion practices. Conversion from a permanent vascular access to a catheter was associated with an adjusted mortality HR of 1.81 (95% confidence interval, 1.22 to 2.68). LIMITATIONS Potential for residual confounding because of unmeasured factors influencing decision to convert. CONCLUSION Vascular access conversions are common in incident patients. Continued efforts to increase early nephrologist referral and permanent vascular access placement may help decrease mortality risk in incident dialysis patients.
Association of soluble endotoxin receptor CD14 and mortality among patients undergoing hemodialysis.

BACKGROUND CD14 is a key molecule in innate immunity that mediates cell activation and signaling in response to endotoxin and other bacterial wall-derived components. CD14 protein exists in soluble (sCD14) and membrane-bound forms. The correlates of sCD14 in persons undergoing long-term hemodialysis (HD) therapy are not known. We hypothesized that increased sCD14 levels in HD patients are associated with proinflammatory cytokine activation and increased mortality. STUDY DESIGN Cohort study. SETTING & PARTICIPANTS 310 long-term HD patients who participated in the Nutritional and Inflammatory Evaluation in Dialysis (NIED) Study, a cohort derived from a pool of more than 3,000 HD outpatients during 5 years in 8 DaVita maintenance dialysis facilities in the South Bay Los Angeles, CA, area. PREDICTORS sCD14 levels in serum. OUTCOMES 33-month mortality. RESULTS Mean sCD14 level was 7.24 +/- 2.45 microg/mL. Tumor necrosis factor alpha level was the strongest correlate of sCD14 level (r = +0.24; P < 0.001), followed by interleukin 6 level (r = +0.18; P = 0.002), serum ferritin level (r = +0.21; P < 0.001), total iron-binding capacity (r = -0.19; P < 0.001), body mass index (r = -0.15; P = 0.008), vintage (r = +0.14; P = 0.01), low-density lipoprotein cholesterol level (r = +0.13; P = 0.03), and body fat (r = -0.11; P = 0.06). During the 33-month follow-up, 71 (23%) patients died. Multivariable Cox proportional analysis adjusted for case-mix and other nutritional and inflammatory confounders, including serum tumor necrosis factor alpha, C-reactive protein, and interleukin 6 levels, showed that compared with the lowest sCD14 tertile, sCD14 levels in the third tertile (>7.8 microg/mL) were associated with greater death risk (hazard ratio, 1.94; 95% confidence interval, 1.01 to 3.75; P = 0.04). LIMITATIONS Survivor bias in combined incident/prevalent studies. CONCLUSIONS Increased sCD14 level is related positively to markers of inflammation and negatively to nutritional status and is an independent predictor of mortality in long-term HD patients. Additional studies are needed to examine the usefulness of sCD14 level in risk stratification and the clinical decision-making process in HD patients.
Endoscopic trans(naso)orbital management of supraorbital mucoceles with biliary T‐tube stenting

The objective of this article is to describe our surgical technique for accessing orbital and supraorbital ethmoid sinus mucoceles and the novel application of a biliary T‐tube to stent and redirect mucociliary flow into the frontal recess. We describe in technical terms our surgical approach and the use of an 8‐Fr pediatric biliary T‐tube as a paranasal sinus stent with demonstrative case reports. Four patients have been successfully managed employing the endoscopic trans(naso)orbital approach to access and marsupialize supraorbital and superiorly located orbital mucoceles without egress to the frontal recess. Patency of drainage was maintained by utilizing a flexible, pediatric, biliary T‐tube that is inserted via an above (trephination) and below (endoscopic) approach in three patients, and without the need for stenting in one patient (median follow‐up, 14.5 months). The presented surgical strategy is safe and effective in accessing and maintaining long‐term patency of problematic supraorbital and superiorly located intraorbital mucoceles without communication to the frontal recess. Laryngoscope, 2012
An innovative radio-guided surgery technique for complete resection of tumors

Finding new ways to fight cancer is essential to increase the patients life expectancy. This paper reports the latest results of the project CHIRONE finalized to increase the potential of the Radio Guided Surgery through the use of β− emitting radio-tracers and β− probes. This innovation could overcome the present main limiting factor represented by a diffuse background due to the high penetration power of the gamma radiation used. We created a prototype of β− probe and in this paper we report measures of photon efficiency, acquired with commercial photons sources. Then we estimated the signal and background rates in realistic cases of meningioma through a simulation. The device is able to detect residuals of 0.1 ml in 1 s with an administered activity less than 3 MBq/kg.
Does a Structured Gardening Programme Improve Well-Being in Young-Onset Dementia? A Preliminary Study

Introduction: Young-onset dementia affects about 1 in 1500 people aged under 65 years in the United Kingdom (UK). It is associated with loss of employment, independence and an increase in psychological distress. This project set out to identify the benefits of a 2 hours per week structured activity programme of gardening for people with young-onset dementia. Method: A mixed methods (qualitative and quantitative) study of therapeutic gardening for people with young-onset dementia, measuring outcomes for both participants with young-onset dementia and their carers, was used. Twelve participants were recruited from a county-wide mental health service for older adults, based on onset of dementia being before the age of 65 years (range 43–65 years). Of these, two participants dropped out and one died during the project. Measures included the Mini Mental State Examination (MMSE), Bradford Well-Being Profile, Large Allen Cognitive Level Screen (LACLS) and Pool Activity Level (PAL). Findings: Over a 1-year period the carers of the people with young-onset dementia found that the project had given participants a renewed sense of purpose and increased well-being, despite cognitive functioning continuing to decline during this period. Conclusion: This study suggests that a meaningful guided activity programme can maintain or improve well-being in the presence of cognitive deterioration.
Quantitative Gated Single-Photon Emission Computed Tomography With 99mTc Sestamibi Predicts Major Cardiac Events in Elderly Patients With Known or Suspected Coronary Artery Disease

Background Although electrocardiogram-gated single-photon emission computed tomography (SPECT) may be useful in risk stratification of elderly patients with coronary artery disease (CAD), few studies have prospectively evaluated its prognostic value in this patient population. Methods and Results A total of 175 patients aged 75 years or more with known or suspected CAD were prospectively evaluated by stress gated SPECT using a 20-segment model and an automatic functional analysis. Patients with acute coronary syndrome within the previous 3 months, and those who underwent coronary revascularization within 3 months after the SPECT study were excluded. Outcome assessment included prespecified cardiac events and noncardiac deaths. During a mean follow-up of 3.4 years, there were 18 cardiac events: 2 cardiac deaths, 1 nonfatal myocardial infarction, 3 coronary artery bypass grafting, 5 percutaneous coronary interventions, 1 unstable angina, 4 heart failures, and 2 malignant arrhythmias. Kaplan-Meier survival estimation indicated an event-free survival rate of 98.1% at 3 years in patients without myocardial ischemia, but 79.9% in those with ischemia as documented by gated SPECT (p=0.0001). Multivariate analysis using the Cox proportional hazard model demonstrated that stress-induced myocardial ischemia was the only independent predictor for subsequent cardiac events (p<0.01). Conclusions Stress gated SPECT predicts cardiac events in patients aged 75 years or more with known or suspected CAD and may have a role in risk stratification of this patient population. (Circ J 2007; 71: 1029 - 1034)
Racial and ethnic differences in the association of body mass index and survival in maintenance hemodialysis patients.

BACKGROUND In maintenance hemodialysis (HD) patients, overweight and obesity are associated with survival advantages. Given the greater survival of maintenance HD patients who are minorities, we hypothesized that increased body mass index (BMI) is associated more strongly with lower mortality in blacks and Hispanics relative to non-Hispanic whites. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS We examined a 6-year (2001-2007) cohort of 109,605 maintenance HD patients including 39,090 blacks, 17,417 Hispanics, and 53,098 non-Hispanic white maintenance HD outpatients from DaVita dialysis clinics. Cox proportional hazards models examined the association between BMI and survival. PREDICTORS Race and BMI. OUTCOMES All-cause mortality. RESULTS Patients had a mean age of 62 ± 15 (standard deviation) years and included 45% women and 45% patients with diabetes. Across 10 a priori-selected BMI categories (<18-≥40 kg/m(2)), higher BMI was associated with greater survival in all 3 racial/ethnic groups. However, Hispanic and black patients experienced higher survival gains compared with non-Hispanic whites across higher BMI categories. Hispanics and blacks in the ≥40-kg/m(2) category had the largest adjusted decrease in death HR with increasing BMI (0.57 [95% CI, 0.49-0.68] and 0.63 [95% CI, 0.58-0.70], respectively) compared with non-Hispanic whites in the 23- to 25-kg/m(2) group (reference category). In linear models, although the inverse BMI-mortality association was observed for all subgroups, overall black maintenance HD patients showed the largest consistent decrease in death HR with increasing BMI. LIMITATIONS Race and ethnicity categories were based on self-identified data. CONCLUSIONS Whereas the survival advantage of high BMI is consistent across all racial/ethnic groups, black maintenance HD patients had the strongest and most consistent association of higher BMI with improved survival.
Decreased levels of guanosine 3′, 5′‐monophosphate (cGMP) in cerebrospinal fluid (CSF) are associated with cognitive decline and amyloid pathology in Alzheimer's disease

Levels of the cyclic nucleotides guanosine 3′, 5′‐monophosphate (cGMP) or adenosine 3′, 5′‐monophosphate (cAMP) that play important roles in memory processes are not characterized in Alzheimer's disease (AD). The aim of this study was to analyse the levels of these nucleotides in cerebrospinal fluid (CSF) samples from patients diagnosed with clinical and prodromal stages of AD and study the expression level of the enzymes that hydrolyzed them [phosphodiesterases (PDEs)] in the brain of AD patients vs. controls.
Quality of life in cochlear implantees: Comparing utility values obtained through the Medical Outcome Study Short‐Form Survey‐6D and the Health Utility Index Mark 3

To evaluate the changes in health‐related quality of life in unilateral adult cochlear implant patients using the Medical Outcome Study Short‐Form Survey‐36 (SF‐36) and the Health Utility Index Mark 3 (HUI‐3). To do so, a health utility index was obtained by converting the SF‐36 to the Medical Outcome Study Short‐Form Survey‐6D (SF‐6D) to permit comparison with HUI‐3 scores in the context of health preference as measured by quality‐adjusted life years.
Distinctive genomic signature of neural and intestinal organoids from familial Parkinson's disease patient‐derived induced pluripotent stem cells

The leucine‐rich repeat kinase 2 (LRRK2) G2019S mutation is the most common genetic cause of Parkinson's disease (PD). There is compelling evidence that PD is not only a brain disease but also a gastrointestinal disorder; nonetheless, its pathogenesis remains unclear. We aimed to develop human neural and intestinal tissue models of PD patients harbouring an LRRK2 mutation to understand the link between LRRK2 and PD pathology by investigating the gene expression signature.