Miracle-dz/UniFAR-FTUs huggingface dataset:
CPD Groups: A Vehicle for Staying on the HPC Registration Road

This evaluation describes one work-based Continuing Professional Development group of six occupational therapy staff. The evaluation aimed to identify activities completed by the group and evaluate the group’s effectiveness in meeting the Health Professional Council standards for CPD using a postal survey questionnaire. The group enabled participants to maintain a record of their CPD, to engage in a mixture of learning activities, and improve participants’ practice, service delivery and outcomes for service users and carers. The CPD group enabled participants to meet four of the five HPC standards for CPD, indicating that work based CPD groups offer the potential to overcome many of the previously identified barriers to CPD in an effective way.
The Impact of Permanent Job Loss on Health Insurance Benefits

This paper investigates the impact of plant closings and permanent layoffs on the group health insurance coverage for a random sample of workers displaced from 1979-1988. Using data from the 198A, 1986 and 1988 CPS Displaced Worker Surveys and the March 1989 CPS, I find displaced workers that were re-employed at the time of the surveys were significantly less likely to have health insurance on their new job. For all married displaced workers I estimate the overall probability of HI coverage declined 19 percentage points from . 88 to . 69. The probability a married white male lost health insurance after displacement was . 20. For single displaced workers the probability of health insurance coverage declined 25 percent from . 64 to . 48. Single white male workers that had HI benefits on their displaced job had a . 38 probability of losing these benefits after displacement. Comparable effects were found for females. Less educated workers and minorities were more likely to lose coverage than white and college educated workers. I find no evidence that workers who lost health insurance benefits received higher wages on their new jobs to compensate for the loss. In fact, a displaced worker that lost health benefits suffered a greater wage loss than a comparable worker who gained health benefits.
Family matters: kin, demography and child health in a rural Gambian population

In this study, we focus on a traditional society, and assume inclusive fitness arguments largely provide an explanation for allocare. Hamilton's rule states that help will be provided to recipients by their relatives, provided that the costs of helping are less than the benefits to the recipient, discounted by the degree of relatedness between recipient and donor: rb>c where r represents the coefficient of relatedness (the probability that any gene will be shared by recipient and donor), b the benefits of helping and c the costs. For allocare to become common between a given set of relatives, the benefits of allocare (b) must be relatively high, the costs (c) relatively low, or both.
Respiratory muscle weakness and inefficient ventilation in heart failure due to light-chain amyloidosis

Background. Cardiac involvement in light-chain amyloidosis (AL) frequently results in heart failure with dyspnoea. In heart failure due to ischemic or idiopathic etiology, respiratory muscle dysfunction and ventilatory inefficiency contribute to symptoms and are independent prognostic predictors. However, in patients with AL, respiratory muscle function has not been elucidated. Methods. In 46 consecutive male patients with AL, lung function, maximal inspiratory (Pimax) and expiratory (Pemax) mouth occlusion pressures, cardiopulmonary exercise testing, echocardiography, and cardiac biomarkers were prospectively studied. Results. Pimax and Pemax were reduced, P0.1 did not differ between controls and AL. Pimax and Pemax were reduced in AL with congestive heart failure compared with asymptomatic patients (median (range) 5.4 (2.3–12.4) kPa vs 10.4 (6.5–14.0) kPa; p < 0.05). Respiratory muscle weakness occurred in systolic and diastolic LV dysfunction. Pimax was associated with peak exercise oxygen uptake, respiratory inefficiency, wall thickness, and N-terminal pro-brain natriuretic peptide. Conclusions. Respiratory muscle dysfunction and ventilatory inefficiency correlates well with intraventricular septum thickness and peak oxygen uptake and are present even in patients with diastolic dysfunction. Respiratory muscle dysfunction might contribute to dyspnea and exercise limitation and appears to represent a marker of cardiac impairment even in diastolic heart failure. Further studies of Pimax as a potential non-invasive prognostic marker are needed.
Developing an evaluation of family group conferencing across Wales

Family group conferences (FGCs) were developed in New Zealand in the 1980s and from there began to be used across the world. The model puts decision making in the hands of families with professionals as resources in cases where the welfare of children was concerned. As a relatively new intervention, the model has undergone a range of scrutiny and discussion. This research project was set up to develop an evaluation tool that was then used in number of projects across Wales. In line with FGC philosophy, the views of users of FGC services (families, referrers and FGC workers) were sought in developing the tool. An audit of evaluation carried out by FGC services in Wales and England was undertaken to inform semi-structured interviews with a range of participants involved in FGCs. The All Wales Family Group Meeting Network (AWFGMN) was consulted throughout the development of the tool, which was then used by projects across the country for two 18 month periods of data gathering. Data are presented from 486 FGCs, showing the amount of work FGC projects carried out, who was prepared, who attended and their demographic details. The views of participants in FGCs on whether they felt their FGCs met the aims identified for it are reported. On the whole, referrers, young people and their carers felt that their FGCs met their aims, but there are gaps in the data. The usefulness or otherwise of the tool developed with stakeholders is explored in light of the data gathered and the findings presented. Consideration is given to the strengths and weaknesses of using this model of development of evaluation in comparison to that which might be developed by a researcher looking at FGC.
Effects of the 2011 duty hour reforms on interns and their patients: a prospective longitudinal cohort study.

IMPORTANCE In 2003, the first phase of duty hour requirements for US residency programs recommended by the Accreditation Council for Graduate Medical Education (ACGME) was implemented. Evidence suggests that this first phase of duty hour requirements resulted in a modest improvement in resident well-being and patient safety. To build on these initial changes, the ACGME recommended a new set of duty hour requirements that took effect in July 2011. OBJECTIVE To determine the effects of the 2011 duty hour reforms on first-year residents (interns) and their patients. DESIGN As part of the Intern Health Study, we conducted a longitudinal cohort study comparing interns serving before (2009 and 2010) and interns serving after (2011) the implementation of the new duty hour requirements. SETTING Fifty-one residency programs at 14 university and community-based GME institutions. PARTICIPANTS A total of 2323 medical interns. MAIN OUTCOME MEASURES Self-reported duty hours, hours of sleep, depressive symptoms, well-being, and medical errors at 3, 6, 9, and 12 months of the internship year. RESULTS Fifty-eight percent of invited interns chose to participate in the study. Reported duty hours decreased from an average of 67.0 hours per week before the new rules to 64.3 hours per week after the new rules were instituted (P < .001). Despite the decrease in duty hours, there were no significant changes in hours slept (6.8 → 7.0; P = .17), depressive symptoms (5.8 → 5.7; P = .55) or well-being score (48.5 → 48.4; P = .86) reported by interns. With the new duty hour rules, the percentage of interns who reported concern about making a serious medical error increased from 19.9% to 23.3% (P = .007). CONCLUSIONS AND RELEVANCE Although interns report working fewer hours under the new duty hour restrictions, this decrease has not been accompanied by an increase in hours of sleep or an improvement in depressive symptoms or well-being but has been accompanied by an unanticipated increase in self-reported medical errors.
Cerebral toxoplasmosis after rituximab therapy.

lines, especially after normal co-testing results. A novel benefit of co-testing is the ability to extend screening intervals immediately among women who have no prior screening or whose screening history is unavailable if both test results are normal, yet the lowest adherence to guidelines was for the vignette of a woman with unknown Papanicolaou test history and negative co-test results (3.1%, all years combined). The finding of exceedingly low adherence in this scenario is troubling because reports from a large US cohort demonstrate that more than 90% of women will have normal co-testing results. The highest adherence to guidelines occurred when the recommended interval was less than 3 years, suggesting that clinicians are willing to adhere to guidelines if more vigilant testing is recommended. The ability to obtain prior screening results and the use of electronic medical records or systems changes, such as office reminders or reimbursement packages, may help achieve adherence to recommended intervals. The low response rate in 2007 (NAMCS) was a limitation of our study. However, estimates were weighted to physician population and accounted for survey nonresponse. Uncertain concordance of practitioner response to hypothetical vignette with actual practice might also be of concern. Vignettes, however, have been shown to be inexpensive and useful tools for measuring quality of care by physicians. Important strengths are the inclusion of the latest NAMCS and NHAMCS data available and the consistent methodology, which make the survey a useful tool to gauge changes in clinicians’ recommendations over time. Future analyses will monitor adherence to newer guidelines that recommend extending screening intervals to 5 years among women with normal co-testing results, a strategy designed to achieve a reasonable balance between benefits and harms.
Relationship between the prognostic expectations of seriously ill patients undergoing hemodialysis and their nephrologists.

IMPORTANCE Patients undergoing hemodialysis have an annual mortality rate exceeding 20%, comparable to many types of cancer. Past research has shown that patients with cancer overestimate their likelihood of survival relative to their physicians, but this relationship has not been examined in patients with noncancer diagnoses. Perceptions of prognosis and transplant candidacy may influence goals of care. OBJECTIVES To compare the perceptions of hemodialysis patients and their nephrologists concerning prognosis and the likelihood of transplant; to follow actual survival; and to explore the relationship between patients' expectations and their goals of care. DESIGN We completed a medical record abstraction to estimate 1-year mortality risk among patients who underwent dialysis at any time from November 1, 2010, through September 1, 2011. We then conducted in-person interviews with eligible patients whose predicted 1-year mortality, based on validated prognostic tools, was at least 20%. We also interviewed their nephrologists. We compared patients' and physicians' expectations about 1- and 5-year survival and transplant candidacy and measured the association between patients' expectations and goals of care. We then followed actual survival using Kaplan-Meier methods. SETTING AND PARTICIPANTS Two dialysis units in Boston. Two hundred seven patients undergoing hemodialysis included in the medical record review, with 62 eligible patients interviewed. MAIN OUTCOMES AND MEASURES Predicted 1-year mortality risk using validated prognostic tools; actual survival; patients' and physicians' expectations about 1-year survival and likelihood of transplant; and patients' goals of care. RESULTS Of the 207 hemodialysis patients, 72.5% had a predicted 1-year mortality of at least 20%. Of the 80 patients eligible for interview, 62 participated (response rate, 78%). Patients were significantly more optimistic than their nephrologists about 1- and 5-year survival (P < .001 for both) and were more likely to think they were transplant candidates (37 [66%] vs 22 [39%] [P = .008]). Of the 81% of patients reporting a 90% chance or greater of being alive at 1 year, 18 (44%) preferred care focused on extending life, even if it meant more discomfort, compared with 1 (9%) among patients reporting a lower chance of survival (P = .045). Actual survival was 93% at 1 year but decreased to 79% by 17 months and 56% by 23 months. CONCLUSIONS AND RELEVANCE Hemodialysis patients are more optimistic about prognosis and transplant candidacy than their nephrologists. In our sample, patients' expectations about 1-year survival were more accurate than those of their nephrologists, but their longer-term survival expectations dramatically overestimated even their 2-year survival rates. Patients' prognostic expectations are associated with their treatment preferences. Our findings suggest the need for interventions to help providers communicate effectively with patients about prognosis.
Field Endocrinology and Conservation Biology1

Abstract Field endocrinology techniques allow the collection of samples (i.e., blood, urine, feces, tissues) from free-living animals for analysis of hormones, receptors, enzymes, etc. These data reveal mechanisms by which individuals respond to environmental challenges, breed, migrate and regulate all aspects of their life cycles. Field endocrinology techniques can also be used to address many issues in conservation biology. We briefly review past and current ways in which endocrine methods are used to monitor threatened species, identify potential stressors and record responses to environmental disturbance. We then focus on one important aspect of conservation: how free-living populations respond to human disturbance, particularly in relation to ecotourism. Breeding adult Magellanic penguins, Spheniscus magellanicus, appear to habituate well to tourists, and breed in an area where about 70,000 people visit during the season. Baseline levels of corticosterone return to normal after exposure of naïve birds to humans. However, penguin chicks appear to show a heightened adrenocortical response to handling stress in nests exposed to tourists, compared to chicks living in areas isolated from human intrusions. Given that developmental exposure to stress can have profound influences on how individuals cope with stress as adults, this potential effect of tourists on chicks could have long-term consequences. This field endocrine approach identified a stressor not observed through monitoring behavior alone.
Automated morphometric magnetic resonance imaging analysis for the detection of periventricular nodular heterotopia

Purpose: To describe a novel magnetic resonance imaging (MRI) postprocessing technique for the detection of periventricular nodular heterotopia (PNH) and to evaluate its diagnostic value. The method is a further development of voxel‐based morphometric analysis with focus on a region of interest around the lateral ventricles to increase the sensitivity and specificity for automated detection of abnormally located gray matter in this area.
A retrospective analysis of potential prognostic factors in children with rhabdomyosarcoma : peer reviewed original article

A retrospective study was done to identify significant prognostic factors in thirty-nine children with parameningeal or orbital rhabdomyosarcoma who were treated with a combination of chemotherapy and radiation. Statistical analysis was done using the Cox proportional hazard regression model and the study end-point was overall survival. The influence of the analyzed potential prognostic factors was found not to be statistically significant. The estimated 2-year and 5-year overall survivals were 88% and 55% respectively. Patients aged below 6 years, with embryonal rhabdomyosarcoma, who were treated using two-dimensional radiotherapy treatment plans, and girls with orbital rhabdomyosarcoma, had a better overall survival rate.
Treatment of anxiety disorders in epilepsy: An evidence‐based approach

During recent years growing attention has been paid to psychiatric comorbidities in epilepsy. However, anxiety disorders still remain underrecognized and undertreated. This is largely related to the lack of specific screening instruments and the frequent co‐occurrence with mood disorders. Data on treatment are insufficient and clinical practice still relies heavily on individual experience. In this article we review evidence‐based treatment strategies for primary major anxiety disorders and adapt them to the specific needs of patients with epilepsy. In panic disorder, a combined approach, namely serotonin‐reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) is always indicated during the acute phase. Long‐term maintenance treatment may include combined therapy or CBT alone depending on individual cases. For generalized anxiety disorders pregabalin has to be considered first choice for short‐term and long‐term treatment. In social anxiety disorder and posttraumatic stress disorder SSRIs, in particular sertraline and paroxetine, can be safely used. Obsessive‐compulsive disorder represents a serious condition that needs to be approached in a psychiatric setting. CBT should be considered as the first choice in patients with epilepsy. If drug treatment is needed, epileptologists have to be aware that high‐dose antidepressants are appropriate and that SSRIs, in particular sertraline, should be considered first choice. In these patients, careful clinical monitoring is indicated, in selected cases, for potential seizure precipitation and side effects due to pharmacodynamics interactions.
Diagnostic performance of random urine samples using albumin concentration vs ratio of albumin to creatinine for microalbuminuria screening in patients with diabetes mellitus: a systematic review and meta-analysis.

IMPORTANCE A random urine sample measuring the albumin concentration (UAC) without simultaneously measuring the urinary creatinine is less expensive than measuring the ratio of albumin to creatinine (ACR), but comparisons of their diagnostic performance for microalbuminuria screening among patients with diabetes mellitus (DM) have not been undertaken in previous meta-analyses. OBJECTIVE To compare the diagnostic performance of the UAC vs the ACR in random urine samples for microalbuminuria screening among patients with DM. DATA SOURCES Electronic literature searches of PubMed, MEDLINE, and Scopus for English-language publications from the earliest available date of indexing through July 31, 2012. STUDY SELECTION Clinical studies assessing the UAC or the ACR of random urine samples in detecting the presence of microalbuminuria among patients with DM using a urinary albumin excretion rate of 30 to 300 mg/d in 24-hour timed urine collections as the criterion standard. DATA EXTRACTION AND SYNTHESIS Bivariate random-effects models for analysis and pooling of the diagnostic performance measures across studies, as well as comparisons between different screening tests. MAIN OUTCOMES AND MEASURES The primary end point was the diagnostic performance measures of the UAC or the ACR in random urine samples, as well as comparisons between them. RESULTS We identified 14 studies, with a total of 2078 patients; 9 studies reported on the UAC, and 12 studies reported on the ACR. Meta-analysis showed pooled sensitivities of 0.85 and 0.87 for the UAC and the ACR, respectively, and pooled specificities of 0.88 and 0.88, respectively. No differences in sensitivity (P = .70), specificity (P = .63), or diagnostic odds ratios (P = .59) between the UAC and the ACR were found. The time point of urine collection did not affect the diagnostic performance of either test. CONCLUSIONS AND RELEVANCE The UAC and the ACR yielded high sensitivity and specificity for the detection of microalbuminuria. Because the diagnostic performance of the UAC is comparable to that of the ACR, our findings indicate that the UAC of random urine samples may become the screening tool of choice for the population with DM, considering the rising incidence of DM and the constrained health care resources in many countries.
Pronostic de la mortalité des patients transplantés rénaux : application à la cohorte DIVAT

Le developpement d'outils pronostiques de la mortalite des patients transplantes renaux est essentiel pour l'amelioration de la prise en charge personnalisee. Neanmoins, cet objectif souleve de nombreuses questions methodologiques et cliniques. Dans ce manuscrit, nous proposons un score de mortalite calcule a 1 an post-transplantation comportant de bonnes capacites pronostiques. Nous pensons que ce score pourrait etre utile en pratique pour l'adaptation de la prise en charge des receveurs en complementarite de l'evaluation du risque de retour en dialyse. Nous presentons egalement une nouvelle methodologie, appelee courbes ROC nettes dependantes du temps. Elle reprend le concept de survie nette et vise a evaluer les capacites d'un marqueur a predire la mortalite en exces due a une pathologie, en prenant la population generale comme reference. Dans le contexte particulier de la transplantation renale, la population de reference appropriee est celle des patients dialyses en attente de transplantation. Nous nous interessons donc finalement a etudier la mortalite relative des patients transplantes par rapport a ceux restes en dialyse. Nous presentons ainsi les resultats originaux obtenus a partir d'un modele de survie relative a risques multiplicatifs.
Proposal for a “phase II” multicenter trial model for preclinical new antiepilepsy therapy development

There is a pressing need to address the current major gaps in epilepsy treatment, in particular drug‐resistant epilepsy, antiepileptogenic therapies, and comorbidities. A major concern in the development of new therapies is that current preclinical testing is not sufficiently predictive for clinical efficacy. Methodologic limitations of current preclinical paradigms may partly account for this discrepancy. Here we propose and discuss a strategy for implementing a “phase II” multicenter preclinical drug trial model based on clinical phase II/III studies designed to generate more rigorous preclinical data for efficacy. The goal is to improve the evidence resulting from preclinical studies for investigational new drugs that have shown strong promise in initial preclinical “phase I” studies. This should reduce the risk for expensive clinical studies in epilepsy and therefore increase the appeal for funders (industry and government) to invest in their clinical development.
Williams-Beuren syndrome.

Williams–Beuren syndrome, a multisystem disorder caused by the deletion of a chromosome region of 1.5 million to 1.8 million base pairs containing 26 to 28 genes, is a disorder of microdeletion or contiguous gene deletion. This review covers current understanding of the biology of this disorder.
Subclinical early posttraumatic seizures detected by continuous EEG monitoring in a consecutive pediatric cohort

Traumatic brain injury (TBI) is an important cause of morbidity and mortality in children, and early posttraumatic seizures (EPTS) are a contributing factor to ongoing acute damage. Continuous video‐EEG monitoring (cEEG) was utilized to assess the burden of clinical and electrographic EPTS.