Miracle-dz/UniFAR-FTUs huggingface dataset:
Inflammation and Progression of CKD: The CRIC Study.

BACKGROUND AND OBJECTIVES CKD is a global public health problem with significant mortality and morbidity. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We examined the multivariable association of plasma levels of IL-1, IL-1 receptor antagonist, IL-6, TNF-α, TGF-β, high-sensitivity C-reactive protein, fibrinogen, and serum albumin with progression of CKD in 3430 Chronic Renal Insufficiency Cohort study participants. RESULTS Over a median follow-up time of 6.3 years, 899 participants reached the composite end point of ≥50% decline in eGFR from baseline or onset of ESRD. Elevated plasma levels of fibrinogen, IL-6, and TNF-α and lower serum albumin were associated with a greater decline in eGFR over time. After adjusting for demographics, BP, laboratory variables, medication use, and baseline eGFR, hazard ratios for the composite outcome were greater for the patients in the highest quartile of fibrinogen (hazard ratio, 2.05; 95% confidence interval, 1.64 to 2.55; P<0.001), IL-6 (hazard ratio, 1.44; 95% confidence interval, 1.17 to 1.77; P<0.01), and TNF-α (hazard ratio, 1.94; 95% confidence interval, 1.52 to 2.47; P<0.001) compared with those in the respective lowest quartiles. The hazard ratio was 3.48 (95% confidence interval, 2.88 to 4.21; P<0.001) for patients in the lowest serum albumin quartile relative to those in the highest quartile. When also adjusted for albuminuria, the associations of fibrinogen (hazard ratio, 1.49; 95% confidence interval, 1.20 to 1.86; P<0.001), serum albumin (hazard ratio, 1.52; 95% confidence interval, 1.24 to 1.87; P<0.001), and TNF-α (hazard ratio, 1.42; 95% confidence interval, 1.11 to 1.81; P<0.001) with outcome were attenuated but remained significant. CONCLUSIONS Elevated plasma levels of fibrinogen and TNF-α and decreased serum albumin are associated with rapid loss of kidney function in patients with CKD.
Interaction between PPARA genotype and beta-blocker treatment influences clinical outcomes following acute coronary syndromes.

AIMS beta-blockers (BB) are strongly recommended after an acute coronary syndrome (ACS), although all patients may not benefit. Causes for variable patient responses to BB are unknown. Given that myocardial ischemia and BB influence metabolic processes regulated by peroxisome proliferator-activated receptor alpha (PPARalpha), we hypothesized that interactions between polymorphisms of the PPARalpha gene (PPARA) and BB treatment would influence clinical outcome following ACS. PATIENTS & METHODS Patients were prospectively enrolled into an ACS registry. A total of 735 ACS patients were genotyped. Mortality and cardiac rehospitalization through 1 year were analyzed in relation to PPARA genotype and BB prescription (597 BB; 138 no BB) at discharge. RESULTS Significantly different outcomes associated with BB therapy were observed according to PPARA IVS7 2498 genotype (p = 0.002 for interaction). PPARA IVS7 2498 GG homozygous patients discharged on BB had decreased cardiac rehospitalization (hazard ratio [HR]: 0.52; 95% CI: 0.32-0.86; p = 0.011), while C allele carriers discharged on BB had nearly threefold increased cardiac rehospitalization (HR: 2.92; 95% CI: 1.32-6.92; p = 0.015; genotype interaction p = 0.0005) compared with patients not on BB. PPARA genotype was also associated with differences in PPARalpha expression, with significantly increased mRNA levels in myocardial samples from normal hearts among GC heterozygotes compared with GG homozygotes (p = 0.04). Transgenic mice with cardiac-specific overexpression of PPARalpha showed significantly reduced myocardial contractile and chronotropic responses to the beta-sympathomimetic dobutamine (p < 0.05) compared with wild-type littermates, supporting the hypothesis that increased PPARalpha levels result in a blunted beta-adrenergic response. CONCLUSIONS PPARA IVS7 2498 genotype is associated with heterogeneity in 1-year outcome in response to BB among patients following ACS, and may predict which patients benefit from BB therapy, putatively related to the effect of myocardial PPARalpha expression on beta-adrenergic responsiveness.
α-[11C] methyl-L-tryptophan and glucose metabolism in patients with temporal lobe epilepsy

Objective: To determine whether metabolism in the brain serotonergic system, including the kynurenine pathway, is involved in temporal lobe epilepsy (TLE). Methods: The authors studied 14 patients with intractable TLE by PET using α-[11C] methyl-l-tryptophan (α-MTrp) and 2-[18F]-fluoro-deoxy-glucose (FDG) and compared results with 21 healthy control subjects who had α-MTrp PET studies. Seven patients had unilateral hippocampal atrophy (HA), and seven had normal hippocampal volumes (NV). The regional uptake constant (K*) for α-MTrp and regional FDG uptake were calculated in regions with high serotonergic innervation, including the hippocampus, amygdala, lateral temporal lobe, frontal lobe, thalamus, lenticular nucleus, and cingulate cortex. Results: A significant increase of α-MTrp uptake was observed in the hippocampus ipsilateral to the seizure focus in seven TLE patients with NV compared to seven patients with HA as well as to healthy controls. In patients with TLE, glucose utilization in the lateral temporal lobe ipsilateral to the seizure focus was correlated negatively with K* for α-MTrp in the ipsilateral hippocampus and positively with K* in the ipsilateral lenticular nucleus and cingulate cortex. Glucose utilization in the frontal lobe ipsilateral to the seizure shows a reduction in the glucose utilization which relates to the increase in the α-MTrp uptake in the ipsilateral lateral temporal lobe. Conclusion: This study demonstrates dysfunction of the serotonergic system, which could include metabolism through the kynurenine pathway in TLE patients with normal hippocampal volumes. α-MTrp PET studies might be useful for lateralizing the epileptic focus in TLE patients with normal hippocampal volumes.
Chronic Noise Exposure and Physiological Response: A Prospective Study of Children Living Under Environmental Stress

Chronic exposure to aircraft noise elevated psychophysiological stress (resting blood pressure and overnight epinephrine and norepinephrine) and depressed quality-of-life indicators over a 2-year period among 9- to 11-year-old children. Data collected before and after the inauguration of a major new international airport in noise-impacted and comparison communities show that noise significantly elevates stress among children at ambient levels far below those necessary to produce hearing damage.
Are therapeutic radiographers able to achieve clinically acceptable verification for stereotactic lung radiotherapy treatment (SBRT)?

Abstract Purpose The aim of this study was to assess the feasibility of radiographer led verification of cone-beam computed tomography (CBCT) images for patients with solitary lung tumours treated with stereotactic body radiotherapy treatment (SBRT). Material and methods CBCT setup images of 20 patients from the first fraction of each patient were retrospectively registered by therapeutic radiographers. The displacements recorded were compared with the clinical oncologist’s original online match. The time taken by radiographers to verify the CBCT images was also recorded. Results Overall agreement for all radiographers when compared with the clinical oncologist match was 91%. Interobserver variations between radiographers were X plane 0·87 (0·76–0·94); Y plane 0·74 (0·51–0·88); and Z plane 0·88 (0·78–0·95) intraclass correlation coefficient and 95% confidence interval. The average time taken for verification was 128 seconds. Conclusion Therapeutic radiographers are able to verify CBCT images for thorax SBRT with results comparable to the ‘gold standard’ clinical oncologists’ match, however additional training will be provided for online verification. The time taken was within acceptable limits.
Valuation of quality of life in rheumatoid arthritis

The increased use of patient-reported outcome measures in health care, including measures of health-related quality of life (HRQoL), warrant the evaluation of the psychometric properties of these instruments. HRQoL instruments are frequently carried out within an economic analysis of health technologies. For this purpose, HRQoL instruments that measure valuations of health states (‘utilities’) from a societal perspective are preferred, such as the EuroQol-5D (EQ-5D) and the Short Form-6D (SF-6D). Although research has addressed the psychometric performance of these instruments, further research is required into the responsiveness of these instruments to improvements in patients’ health. In this thesis, both the responsiveness of the EQ-5D and that of the SF-6D in RA patients with active disease treated with effective TNF-blockers were only moderate over a one-year period. Less research has been carried out into the psychometric properties of instruments, such as Time Trade-Off (TTO) and Standard Gamble (SG), which measure utilities from a patient perspective. Existing research in RA shows poor psychometric properties. Because patients have a unique and full knowledge of, and experience with, their own health condition and are directly affected by interventions, we believe that it is important to obtain patients’ valuations. In this thesis, both the interview and computer TTO were poorly correlated with, and were poorly discriminative for, self-reported health outcome measures. The TTO asks patients about the number of life years they are willing to trade off, i.e. to die earlier, in return for perfect health. It is assumed that the more life years they are willing to trade off, the worse their health state is. An important explanation for the poor construct validity could be the fact that RA patients are less willing to trade any of their life years because they do not perceive their disease as life-threatening. Possibly, there are more realistic health-related anchors for RA patients. A qualitative and quantitative study of RA patients in this thesis showed that the scenario ‘being dependent on others’ was the most appropriate worst-case alternative. This thesis has given suggestions to improve the measurement of HRQoL representing the patient perspective and the societal perspective.
Medical and Everyday Assistive Device Use among Older Adults with Arthritis*

ABSTRACT This research compared older adults' use of medical assistive devices (ADs) with their use of everyday ADs as a means of managing chronic physical disability. The study also examined whether predisposing, need, and enabling factors were associated with device use in three domains of activity: personal care / in-home mobility, household activities, and community mobility. Participants were 248 adults, aged 55 years and older, with a wide range of disability levels as a result of osteoarthritis. All participants were administered an in-depth, structured questionnaire, as part of a larger study examining older adults' independence and adaptation to chronic physical illness. The results revealed that respondents actively adapted to their disabilities and used a wide range of medical and everyday devices, with everyday devices being reported more than twice as often as medical ADs and the fewest devices overall being reported for community mobility. In general, medical devices were used when subjective and objective need for ADs was considerable. Everyday devices were reported earlier in the trajectory of the disease, at mild and moderate disability levels, and were associated with a broader pattern of adaptation that included planning to avoid problems, exercise, and pacing activities. RÉSUMÉ Cette recherche offre une comparaison entre l'emploi des aides technologiques fonctionnelles médicales et l'emploi des aides fonctionnelles quotidiennes par les personnes âgées en matière de gérance d'incapacité physique chronique. De plus, l'étude examine si les facteurs de prédisposition, de besoin et d'habilitation sont associés à l'usage des aides propres à trois domaines d'activités : les soins personnels et la mobilité à domicile, les activités ménagères et la mobilité communautaire. Ont participé, quelques 248 individus âgés de 55 ans et plus et souffrant d'une vaste gamme de niveaux d'incapacités causées par l'arthrite par usure. Chacun a reçu un questionnaire exhaustif et structuré faisant partie d'une étude élargie traitant le sujet de l'autonomie et l'adaptation à la maladie physique chronique des personnes âgées. Les résultats suggèrent qu'effectivement, il y a une adaptation de la part des répondants face à leur incapacité. De plus, ceux-ci utilisent une gamme d'aides médicales et quotidiennes. Dans l'ensemble, la mobilité communautaire avait le moins de cas de recours aux aides médicales et quotidiennes. En général, il y a recours aux aides fonctionnelles médicales lorsque le besoin subjectif et objectif de ces aides est considérable. Le recours aux aides quotidiennes est signalé surtout au début de la trajectoire de la maladie, lorsque les niveaux d'incapacité sont bénins ou moyens et associés à un profil plus étendu. Ce profil comprend la planification de contournement de problèmes, l'exercice et les activités d'entraînement.
Low-Dose Estradiol Spray: a Novel Treatment for Vasomotor Instability in Postmenopausal Women

This article describes a novel transdermal estradiol spray developed for the treatment of menopausal vasomotor instability. The spray delivers estradiol directly into the subcutaneous microcirculation achieving the advantages of estradiol patches, creams and gels but with minimal skin reaction, patient inconvenience or cosmetic shortcomings associated with transdermal methods. In the one published Phase III clinical trial, postmenopausal women (n = 454) with eight or more moderate-to-severe hot flashes per day applied each morning, one, two or three estradiol 90 μl sprays (each containing estradiol 1.53 mg) versus matching placebo sprays. There was a significant decrease in hot flash frequency and intensity at weeks 4 and 12 compared with corresponding placebo groups (p < 0.010). The systemic estradiol delivery rates at week 12 were approximately 0.021, 0.029 and 0.040 mg/day for the 1-, 2- and 3-spray doses, respectively. There were common adverse events similar to those previously reported with transdermal estradiol, except for skin irritation, which was very low. The spray is a well-tolerated, cosmetically attractive and convenient method of delivering low-dose, transdermal estradiol.
Role of Trastuzumab in the Adjuvant Treatment of HER2-Positive Early Breast Cancer

Amplification of the human epidermal growth factor receptor 2 (HER2) gene occurs in 18–23% of invasive breast carcinomas and is associated with a worse prognosis. This novel transforming gene was identified in 1985, and in 1987 HER2 amplification was demonstrated to be central to the aggressive, malignant phenotype of these cancers and a significant predictor of both time to relapse and overall survival. These observations led to the development of the first monoclonal antibody targeting the extracellular domain of HER2, trastuzumab (Herceptin®, Genentech and Hoffman LaRoche, Switzerland), which was approved by the US FDA for metastatic breast cancer in 1998. In 2005, results from four major trastuzumab adjuvant trials demonstrated a marked reduction in risk of recurrence, and trastuzumab is now an essential component of the adjuvant treatment of H ER2-positive early breast cancer. Concerns regarding cardiac safety and mechanisms of resistance to trastuzumab remain important issues and are being addressed in ongoing research efforts.
Effect of Manual Hyperinflation on Hemodynamics, Gas Exchange, and Respiratory Mechanics in Ventilated Patients

The authors investigated the effect of manual hyperinflation (MHI) with set parameters applied to patients on mechanical ventilation on hemodynamics, respiratory mechanics, and gas exchange. Sixteen critically ill patients post-septic shock, with acute lung injury, were studied. Heart rate, arterial pressure, and mean pulmonary artery pressure were recorded every minute. Pulmonary artery occlusion pressure, cardiac output, arterial blood gases, and dynamic compliance (Cdyn) were recorded pre- and post-MHI. From this, systemic vascular resistance index (SVRI), cardiac index, oxygen delivery, and partial pressure of oxygen: fraction of inspired oxygen (PaO2:FiO2) ratio were calculated. There were significant increases in SVRI ( P < 0.05) post-MHI and diastolic arterial pressure ( P < 0.01) during MHI. Cdyn increased post-MHI ( P < 0.01) and was sustained at 20 minutes post-MHI ( P < 0.01). Subjects with an intrapulmonary cause of lung disease had a significant decrease ( P = 0.02) in PaO2:FiO2, and those with extrapulmonary causes of lung disease had a significant increase ( P < 0.001) in PaO2:FiO2 post-MHI. In critically ill patients, MHI resulted in an improvement in lung mechanics and an improvement in gas exchange in patients with lung disease due to extrapulmonary events and did not result in impairment of the cardiovascular system.
Perceptions of Risk and Testing for Sexually Transmitted Infections Among Military Personnel and Health Care Providers in the Canadian Armed Forces: A Qualitative Study

This study explored perceptions of sexually transmitted infection (STI) risks and barriers to STI secondary prevention among Canadian Armed Forces (CAF) personnel and their health care providers using semistructured interviews. Results underlined a number of factors that facilitated STI testing practices in this setting, including the accessibility, staff, and protocols of the clinic. They also pointed to both positive and negative influences of military culture on STI screening practices. Despite the small scale of the study, findings provide valuable insight into possible directions for future research on the secondary prevention of STIs in the military context.
How People with Parkinson's Disease Get Out of Bed

Background and Purpose. Difficulty with bed mobility is reported by 66% of people with Parkinson's disease (PD). Our purpose was to describe movement patterns (MPs) used by individuals with PD for rising from the bed and the influence of physical therapy (PT) on these patterns. Subjects. Thirty-nine subjects, ages between 45 and 89, Hoehn and Yahr levels I-IV, participated. Methods. Subjects were videotaped rising from bed five times. MPs were categorized for each body part. Subjects' reports of previous bed mobility training was documented. Results. The most common MPs were “come to sit” for the axial region, “multipush” for the near arm, “double-push” for the far arm, and “synchronous” for the legs. People with PD are significantly more likely to lift their legs synchronously and significantly less likely to use the “roll off” strategy than older adults without PD. Nine (23%) subjects had been taught the “lateral roll. ” Only three actually used it, and none of those three used it for every trial. Discussion and Conclusion. Further research is needed to investigate the motor control and flexibility demands of different strategies for getting out of bed and to determine why most people with PD do not use the “lateral roll” strategy taught by PT.
Placental thickness: A sonographic indicator of gestational age in normal singleton pregnancies in Nigerian women

The study is aimed to investigate placental thickness as a parameter for estimating gestational age in normal singleton pregnancies in Nigerian women. 730 Nigerian women with normal singleton pregnancies who were attending antenatal clinic at Federal Medical Centre, Makurdi, Nigeria were studied by transabdominal ultrasound between February, 2007 and January, 2008. Sonography was carried out using Sonoscape SSI 600 ultrasound machine with 3.5MHz transducer. Gestational age was stimated by crown-rump length (CRL), biparietal diameter (BPD), femur length (FL) and abdominal circumference (AC) and the composite average recorded while placental thickness was measured at the point of insertion of the umbilical cord. Mean placental thickness with standard deviation was calculated for each gestational age. Correlation analysis was used to determine the relationship between placental thickness and gestational age while regression analysis yielded mathematical relationships between placental thickness and gestation age. The maximum mean placental thickness of 45.1 ± 6.4mm was recorded at 39 weeks gestation. There was a fairly linear increase in mean placental thickness with gestation age. There was significant and strong positive correlation between placental thickness and gestational age. Placental thickness appears promising as an accurate indicator of gestational age in singleton pregnancies in Nigerian women.
An Eyelash-induced Lacrimal Gland Stone

Purpose: To report a case of lacrimal gland stone initiated by an eyelash. Case summary: A 31-year-old woman presented with foreign body sensation, pain, and conjunctival injection in the lateral palpebral conjunctiva of her right eye over 6 months in duration. The physical examination revealed a small, firm nodule at the lateral canthal area. The excisional biopsy was performed, and the mass was a concretion that contained an eyelash in the center. During one-year follow-up, the patient showed no signs of recurrence or complication after excision. Conclusions: Although rare in occurence, eyelashes may be the initial nidus for lacrimal gland stone formation.
E-motion Picture Magic: A Movie Lover's Guide to Healing and Transformation

Film can be a powerful medium. Films can draw us out of ourselves and into another character, and when they are watched with conscious awareness—and self-exploration—healing and transformation can occur. This is the core premise of E-motion Picture Magic: A Movie Lover's Guide to Healing and Transformation, a comprehensive book that can be used as a self-help book or used by therapists as an adjunct to therapy. The author, Birgit Wolz, Ph.D., a psychotherapist with extensive experience with using film as a therapeutic tool, brings her knowledge about and passion for film to the book.
Handoff Communication and Electronic Health Records

When transferring patient care responsibilities across the healthcare continuum, clinicians strive to communicate safely and effectively, but communication failures exist that threaten patient safety. Although researchers are making great strides in understanding and solving intraservice handoff problems, inter-service transition communication remains underexplored. Further, electronic health records (EHRs) figure prominently in healthcare delivery, but less is known about how EHRs contribute to inter-service handoffs. This descriptive, qualitative study uses Sensemaking Theory to explore EHR-facilitated, inter-service handoffs occurring between emergency medicine and internal/hospitalist medicine physicians. The researchers conducted six focus groups with 16 attending physicians and medical residents at a major Midwestern academic hospital. Findings suggest clinicians hold varied expectations for information content and relational communication/style. Their expectations contribute to making sense of uncertain handoff situations and communication best practices. Participants generally perceive EHRs as tools that, when used appropriately, can enhance handoffs and patient care continuity. Ideas for practical applications are offered based on study results.