Miracle-dz/UniFAR-FTUs huggingface dataset:
315 IMPROVEMENT IN DOCUMENTATION AND DRUG DOSING AFTER IMPLEMENTATION OF A STANDARD ORDER SET FOR PEDIATRIC SEDATION.

Background Medical errors are common in hospitals. Pediatric sedation requires many dosage calculations and a plethora of available equipment. Thus, there are many possible medical errors. Purpose The purpose of this study was to determine if preprinted forms and prepared packets for pediatric sedations at our institution would improve documentation compliance, reduce medication ordering errors, and thus reduce the number of adverse events during pediatric sedations. Methods Our pilot study includes 42 sedations before the intervention and 26 after the intervention. Charts were reviewed for correct dosage of medicine and completeness of medical documentation. Results The mean ages of the patients being sedated were 71 months in the “before” group and 45 months in the “after” group. After the implementation of preprinted physician orders, consent forms, and prepared packets, 4% of order forms and 11% of consent forms were still handwritten. One hundred percent documentation compliance on consent forms increased from 32% before to 69% after. Dating and timing of order forms decreased (98 to 73%; 81 to 65%), and ordering of resuscitation equipment, ASA class, listing of allergies, and postsedation orders increased (93 to 100%; 0 to 81%; 64 to 100%; 43 to 100%). Our procedure notes (PNs) and sedation monitoring forms (SMFs) were not changed in the process; documentation compliance increased 90 to 96% (PNs) and 81 to 100% (SMFs). Medications were ordered using mg/kg or mcg/kg in 56% of the handwritten order forms as compared to 100% on the preprinted order forms. Medication dosages for Versed, fentanyl for 12 years and younger, fentanyl for greater than 12 years, and ketamine that fell within the recommended dosage range using the Lexis-Comp9s Pediatric Dosage Handbook , 12th edition (± 10%) before using preprinted orders were 68%, 100%, 71%, and 67% compared with 100%, 95%, 100%, and 100% after implementation. Reversal agents were ordered using mg/kg in 56% before and 100% after. Handwritten orders did not have adequate reversals at all in 8% of patients. There were not enough adverse events in either group to show a difference between the two groups. Conclusions Using preprinted physician orders, consent forms, and prepared packets increased our documentation compliance in pediatric patients being sedated by the inpatient service. Medication dosage errors were decreased and ordering of reversals and resuscitation equipment increased by using the preprinted documentation packets.
간호조직의 지식관리, 간호사의 근거기반실무 신념 및 역량이 근거기반 의사결정에 미치는 영향

Purpose: The purpose of this study was to explore how knowledge management of hospital and nurses’ beliefs and competences on evidence-based practice can affect evidence-based decision making. Methods: In this descriptive study, a total of 184 nurses who were working in the five general hospitals participated. The data were collected through a self-administered questionnaire in September, 2014. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficient, and step-wise multiple regression with SPSS/WIN Statistics 21.0 program. Results: Evidence-based decision making was correlated with EBP beliefs (r=.55, p<.001), EBP competence (r=.57, p<.001), and knowledge management (r=.50, p<.001). Hierarchical regression analysis showed that EBP beliefs (β=.18, p=.005), EBP competence (β=.37, p<.001), organizational knowledge management (β=.27, p<.001) explained 48.6% of evidence based decision making (p<.001). Conclusion: The study results indicated that evidence-based practice competences, organizational knowledge management, and evidence-based practice beliefs were important factors on evidence-based decision making. In order to improve evidence-based practice among nurses through organizational knowledge management, EBP beliefs and competence at individual level need to be considered and incorporated into any systemic training of EBP.
Biases and Error Measures: How to Compare Valuation Methods

We investigate biases of valuation methods and document that these depend largely on the choice of error measure (percentage vs. logarithmic errors) used to compare valuation procedures. We analyze four multiple valuation methods (averaging with the arithmetic mean, harmonic mean, median, and the geometric mean) and three present value approaches (dividend discount model, discounted cash flow model, residual income model). Percentage errors generate a positive bias for most multiples, and they imply that setting company values equal to their book values dominates many established valuation methods. Logarithmic errors imply that the median and the geometric mean are unbiased while the arithmetic mean is biased upward as much as the harmonic mean is biased downward. The dividend discount model dominates the discounted cash flow model only for percentage errors, while the opposite is true for logarithmic errors. The residual income model is optimal for both error measures.
restraint and never events: an opportunity for change

summary In light of the decision by the Department of Health (DH) to exclude serious injury or death by physical restraint from the list of 'never events', it is clear that national standards for violence reduction are needed. This article argues that the DH, the National Patient Safety Agency and professional organisations such as the royal colleges should take responsibility for the establishment of national standards for training in physical restraint, and that service providers should be obliged and empowered to comply with them.
IgG3 anti‐Kell allotypic variation results in differential antigen binding and phagocytosis

Human immunoglobulin G (hIgG) includes four different subtypes (IgG1, IgG2, IgG3, and IgG4). Due to genetic variations, each IgG subtype contains different isoallotypes. It was previously shown that a Food and Drug Administration–approved monoclonal anti‐IgG failed to recognize 2 of 15 recombinant, human IgG3 anti‐Kell (K1) isoallotypes (rIgG3‐03 and rIgG3‐13) by indirect antiglobulin test (IAT).
MYC and Twist1 cooperate to drive metastasis by eliciting crosstalk between cancer and innate immunity

Metastasis is a major cause of cancer mortality. We generated an autochthonous transgenic mouse model whereby conditional expression of MYC and Twist1 enables hepatocellular carcinoma (HCC) to metastasize in >90% of mice. MYC and Twist1 cooperate and their sustained expression is required to elicit a transcriptional program associated with the activation of innate immunity, through secretion of a cytokinome that elicits recruitment and polarization of tumor associated macrophages (TAMs). Systemic treatment with Ccl2 and Il13 induced MYC-HCCs to metastasize; whereas, blockade of Ccl2 and Il13 abrogated MYC/Twist1-HCC metastasis. Further, in 33 human cancers (n = 9502) MYC and TWIST1 predict poor survival (p=4.3×10−10), CCL2/IL13 expression (p<10−109) and TAM infiltration (p<10−96). Finally, in the plasma of patients with HCC (n = 25) but not cirrhosis (n = 10), CCL2 and IL13 were increased and IL13 predicted invasive tumors. Therefore, MYC and TWIST1 generally appear to cooperate in human cancer to elicit a cytokinome that enables metastasis through crosstalk between cancer and immune microenvironment.
Estrogen and Progesterone Receptor Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Guideline Update.

PURPOSE. — To update key recommendations of the American Society of Clinical Oncology/College of American Pathologists estrogen receptor (ER) and progesterone receptor (PgR) testing in breast cancer guideline. METHODS. — A multidisciplinary international Expert Panel was convened to update the clinical practice guideline recommendations informed by a systematic review of the medical literature. RECOMMENDATIONS. — The Expert Panel continues to recommend ER testing of invasive breast cancers by validated immunohistochemistry as the standard for predicting which patients may benefit from endocrine therapy, and no other assays are recommended for this purpose. Breast cancer samples with 1% to 100% of tumor nuclei positive should be interpreted as ER positive. However, the Expert Panel acknowledges that there are limited data on endocrine therapy benefit for cancers with 1% to 10% of cells staining ER positive. Samples with these results should be reported using a new reporting category, ER Low Positive, with a recommended comment. A sample is considered ER negative if < 1% or 0% of tumor cell nuclei are immunoreactive. Additional strategies recommended to promote optimal performance, interpretation, and reporting of cases with an initial low to no ER staining result include establishing a laboratory-specific standard operating procedure describing additional steps used by the laboratory to confirm/adjudicate results. The status of controls should be reported for cases with 0% to 10% staining. Similar principles apply to PgR testing, which is used primarily for prognostic purposes in the setting of an ER-positive cancer. Testing of ductal carcinoma in situ (DCIS) for ER is recommended to determine potential benefit of endocrine therapies to reduce risk of future breast cancer, while testing DCIS for PgR is considered optional. Additional information can be found at www.asco. org/breast-cancer-guidelines .
Childhood Maltreatment: Experiences and Perceptions Among Chinese Young People

The study aimed to investigate young Chinese people’s childhood and adolescence exposure to maltreatment from all types of perpetrators, and to explore their perceptions of such experiences. A cross-sectional study was carried out among 1,255 young people at three universities located in Zhejiang Province, Eastern China. A questionnaire drawing on validated tools was developed to measure childhood and adolescence exposure to physical and emotional maltreatment. Physical and emotional maltreatment by any perpetrator before the age of 18 years was reported by 83.3% and 85.9% of the students, respectively; extreme forms were not rare. Overall, 68.8% of the students reported physical maltreatment by parents, 56.1% by teachers, 29.8% by peers, 11.7% by siblings, and 9.1% by grandparents; 58.5% reported emotional maltreatment by parents, 43.3% by teachers, 53.3% by peers, 12.0% by siblings, and 10.0% by grandparents. Physical or emotional maltreatment by any perpetrator was common in all sociodemographic groups, irrespective of urban/rural residence and economic status. Risk factors for maltreatment differ with type of maltreatment and perpetrator. Personal experience of emotional maltreatment was generally perceived as more harmful and less acceptable than physical, especially in females. In conclusion, high levels of maltreatment of children and adolescents in China indicate the need for (a) parent education about appropriate discipline measures when raising children, (b) teacher education and enforcement of existing laws banning institutional corporal punishment, (c) the adoption of a comprehensive anti-bullying strategy, and (d) the development of a formal child protection system to protect and support the most vulnerable families.
Synthesis, characterization and bio-functionalization of magnetic nanoparticles to improve the diagnosis of tuberculosis

Mycobacterium tuberculosis is the cause of one of the diseases with the highest mortality and morbidity rate in the Americas and in the world. In developing countries, the diagnosis of tuberculosis (TB) is based on baciloscopy and bacteriological cultures. The first method has a low sensitivity, and the second can take several weeks to reach a confirmatory diagnosis. The lack of a rapid diagnosis compromises the efforts to control this disease and favors the transmission of tuberculosis to the susceptible population. In this work, we present the synthesis, amine-silanization, characterization and bio-functionalization of magnetic nanoparticles (MNPs) to develop a sandwich ELISA to detect and concentrate antigens from M. tuberculosis. For this purpose, a recombinant mycobacterial heat shock protein Hsp16.3, which contributes to the persistence of TB, was cloned and expressed in the E. coli system. Polyclonal antibodies anti-Hsp16.3 were produced in a rabbit and in mice. Magnetic nanoparticles were synthesized by co-precipitation, amine-functionalized and characterized by several physical-chemical methods. The XRD, Mossbauer spectroscopy, zeta potential, TEM, and FTIR all proved the successful preparation of the MNPs showing a diffraction crystal diameter of 10.48 ± 2.56 nm, superficial net charge of ᶎ : +23.57 ± 2.87 mV, characteristic patterns of magnetite and a structure similar to a sphere. Additionally, it showed a magnetization saturation of 37.06 emu.g−1. For the functionalization of nanoparticle surfaces with anti-Hsp16.3, the active ester method was used for bond formation, and parameters such as time of incubation, coupling agents ratio (EDC/NHS) and concentration as well as surface saturation level of amine-silanized MNPs (MNP@Si@NH2) were standardized. Finally, bio-functionalized MNPs were used to detect, fix and concentrate the recombinant antigen Hsp16.3 from M. tuberculosis in a sandwich ELISA-MNP assay.
Spine Computed Tomography to Magnetic Resonance Image Synthesis Using Generative Adversarial Networks : A Preliminary Study

Objective To generate synthetic spine magnetic resonance (MR) images from spine computed tomography (CT) using generative adversarial networks (GANs), as well as to determine the similarities between synthesized and real MR images. Methods GANs were trained to transform spine CT image slices into spine magnetic resonance T2 weighted (MRT2) axial image slices by combining adversarial loss and voxel-wise loss. Experiments were performed using 280 pairs of lumbar spine CT scans and MRT2 images. The MRT2 images were then synthesized from 15 other spine CT scans. To evaluate whether the synthetic MR images were realistic, two radiologists, two spine surgeons, and two residents blindly classified the real and synthetic MRT2 images. Two experienced radiologists then evaluated the similarities between subdivisions of the real and synthetic MRT2 images. Quantitative analysis of the synthetic MRT2 images was performed using the mean absolute error (MAE) and peak signal-to-noise ratio (PSNR). Results The mean overall similarity of the synthetic MRT2 images evaluated by radiologists was 80.2%. In the blind classification of the real MRT2 images, the failure rate ranged from 0% to 40%. The MAE value of each image ranged from 13.75 to 34.24 pixels (mean, 21.19 pixels), and the PSNR of each image ranged from 61.96 to 68.16 dB (mean, 64.92 dB). Conclusion This was the first study to apply GANs to synthesize spine MR images from CT images. Despite the small dataset of 280 pairs, the synthetic MR images were relatively well implemented. Synthesis of medical images using GANs is a new paradigm of artificial intelligence application in medical imaging. We expect that synthesis of MR images from spine CT images using GANs will improve the diagnostic usefulness of CT. To better inform the clinical applications of this technique, further studies are needed involving a large dataset, a variety of pathologies, and other MR sequence of the lumbar spine.
FAM134B oligomerization drives endoplasmic reticulum membrane scission for ER‐phagy

Degradation of endoplasmic reticulum (ER) by selective autophagy (ER‐phagy) is crucial for ER homeostasis. However, it remains unclear how ER scission is regulated for subsequent autophagosomal sequestration and lysosomal degradation. Here, we show that oligomerization of ER‐phagy receptor FAM134B (also referred to as reticulophagy regulator 1 or RETREG1) through its reticulon‐homology domain is required for membrane fragmentation in vitro and ER‐phagy in vivo. Under ER‐stress conditions, activated CAMK2B phosphorylates the reticulon‐homology domain of FAM134B, which enhances FAM134B oligomerization and activity in membrane fragmentation to accommodate high demand for ER‐phagy. Unexpectedly, FAM134B G216R, a variant derived from a type II hereditary sensory and autonomic neuropathy (HSAN) patient, exhibits gain‐of‐function defects, such as hyperactive self‐association and membrane scission, which results in excessive ER‐phagy and sensory neuron death. Therefore, this study reveals a mechanism of ER membrane fragmentation in ER‐phagy, along with a signaling pathway in regulating ER turnover, and suggests a potential implication of excessive selective autophagy in human diseases.
Telemedicine Evaluations for Low-Acuity Patients Presenting to the Emergency Department: Implications for Safety and Patient Satisfaction.

Background: Telemedicine is being rapidly adopted by traditional health care systems. We have used telemedicine in a program we call Express Care to allow a single physician to remotely perform evaluations of low-acuity patients. Materials and Methods: We conducted a retrospective cohort study of quality assurance data comparing low-acuity patients treated by an emergency department (ED) physician through telemedicine (Express Care) with those treated by an ED physician in person between July 16, 2016 and September 30, 2017. We compared patient demographics, length of stay (LOS), visit severity as measured by emergency severity index (ESI), visit diagnosis type, return visits, and patient satisfaction scores. Results: There were 3,266 low-acuity patients seen through telemedicine and 21,129 seen in person during the observation period. Patients receiving evaluation by telemedicine were younger (mean age ± standard deviation [in years]: 42 ± 18 vs. 45 ± 17; p < 0.001) and more likely to be male (51% vs. 46%; p < 0.001). Median ESI was slightly lower for patients treated by telemedicine [4 (4-5) vs. 4 (4-4); p < 0.001], and there were modest differences in diagnosis type between the two groups. Median ED LOS was 63.6 (interquartile range [IQR] 42.6-93.6) min for telemedicine patients and 133.8 (IQR 90.6-196.8) min for patients seen in person (p < 0.001). Seventy-two hour returns (3.4% vs. 3.0%; p = 0.302) and 72-h returns requiring admission (0.2% vs. 0.3%; p = 0.252) were similar between groups. Patient satisfaction scores were also similar between the groups. Conclusion: Telemedicine evaluation for ED patients can be effective and safe when treating low-acuity conditions without compromising patient satisfaction.
Diagnostic accuracy of specific IgG antibodies for bird fancier's lung: a systematic review and meta-analysis.

Background Serologic assays for specific immunoglobulin G (IgG) antibodies are available for diagnosing the condition of bird fancier's lung, however, their usefulness is controversial. This systematic review was aimed at investigating the diagnostic accuracy of specific IgG antibodies used for avian antigens. Methods Medline, Embase, the Cochrane Library, the International Clinical Trials Registry Platform, and the Web of Science were searched for studies performed to evaluate the diagnostic accuracy of the Ouchterlony method, enzyme-linked immunosorbent assays (ELISAs), electrosyneresis, and ImmunoCAP assays for diagnosing bird fancier's lung. Nine articles were included in the meta-analysis. The pooled sensitivity and specificity were summarized using a bivariate mixed-effects model, and a hierarchical summary receiver operating characteristic curve was rendered to determine the diagnostic accuracy of the antibodies. Results The pooled sensitivities and specificities of each specific IgG antibody were 82.9% (95% confidence interval, 71.1-90.5%) and 93.0% (95% confidence interval, 74.4-98.4%) for the Ouchterlony method, 92.5% (95% confidence interval, 71.3-98.4%) and 90.8% (95% confidence interval, 72.1-97.4%) for ELISAs, 90.0% (95% confidence interval, 55.5-99.7%) and 84.6% (95% confidence interval, 73.5-92.4%) for the electrosyneresis method, and 43.5% (95% confidence interval, 35.3-52.1%) and 100% (95% confidence interval, 0-100%) for ImmunoCAP assays. The overall quality of the collective evidence was low, primarily due to the high risk of bias, indirectness, and imprecision of the included studies. Conclusions The Ouchterlony method demonstrated high specificity, the ELISA method showed high sensitivity, and the diagnostic utilities of electrosyneresis and ImmunoCAP assay testing remain unclear.
The open targets post-GWAS analysis pipeline

Abstract Motivation Genome-wide association studies (GWAS) are a powerful method to detect even weak associations between variants and phenotypes; however, many of the identified associated variants are in non-coding regions, and presumably influence gene expression regulation. Identifying potential drug targets, i.e. causal protein-coding genes, therefore, requires crossing the genetics results with functional data. Results We present a novel data integration pipeline that analyses GWAS results in the light of experimental epigenetic and cis-regulatory datasets, such as ChIP-Seq, Promoter-Capture Hi-C or eQTL, and presents them in a single report, which can be used for inferring likely causal genes. This pipeline was then fed into an interactive data resource. Availability and implementation The analysis code is available at www.github. com/Ensembl/postgap and the interactive data browser at postgwas.opentargets. io.
Trajectory analysis of sleep maintenance problems in midlife women before and after surgical menopause: the Study of Women's Health Across the Nation (SWAN).

OBJECTIVE Investigate temporal patterns of sleep maintenance problems in women who became surgically menopausal (hysterectomy with bilateral oophorectomy) before their final menstrual period and examine whether presurgery trajectories of sleep maintenance problems are related to problems staying asleep postsurgery. METHODS Longitudinal analysis of sleep self-reports collected every 1 to 2 years from 1996 to 2013 from 176 surgically menopausal women in the Study of Women's Health Across the Nation, a seven-site community-based, multiethnic/multiracial, cohort study. Median follow-up was 15.3 years (4.2 years presurgery, 10.2 years postsurgery). Group-based trajectory modeling was used to identify patterns of problems staying asleep, and the presurgery trajectories were used to predict similar postsurgery sleep problems. RESULTS Four trajectory patterns of sleep maintenance problems were identified: low (33.5% of women), moderate (33.0%), increasing during presurgery (19.9%), and high (13.6%). One-fifth of women reported a presurgery increase in these problems. Postsurgically, problems staying asleep remained associated with similar levels of presurgical problems, even after adjusting for postsurgical early morning awakening, frequent vasomotor symptoms, and bodily pain score (βlow = -1.716, βmoderate = -1.144, βincreasing = -0.957, βhigh = -1.021; all P values <0.01). CONCLUSIONS Sleep maintenance problems were relatively stable across time postsurgery. These data are remarkably consistent with our trajectory results across the natural menopause, suggesting that presurgical assessment of sleep concerns could help guide women's expectations postsurgically. Although reassuring that sleep complaints do not worsen postsurgically for most surgically menopausal women, referral to a sleep specialist should be considered if sleep symptoms persist or worsen after surgery.