Miracle-dz/UniFAR-FTUs huggingface dataset:
Age of Transfused Blood Impacts Perioperative Outcomes Among Patients Who Undergo Major Gastrointestinal Surgery.

OBJECTIVE To evaluate the impact of transfused packed red blood cell (PRBC) age on perioperative morbidity among patients undergoing major gastrointestinal surgery. BACKGROUND Patients undergoing major surgery often receive PRBC transfusions. The effect of PRBC age (ie, storage duration before transfusion) on perioperative surgical outcomes remains poorly defined. METHODS In this study, 1365 patients were identified who underwent a hepato-pancreatic or colorectal resection and received ≥1 unit of PRBCs between 2009 and 2014 at the Johns Hopkins Hospital. Data regarding the storage duration of PRBCs, clinicopathologic characteristics, and perioperative outcomes were obtained and analyzed. Multivariable modified Poisson regression analyses were performed to assess the effect of PRBC age on perioperative morbidity. RESULTS A total of 5901 PRBC units were transfused for a median of 2 (interquartile range 2-4) units transfused per patient. In all, 936 (68.6%) patients received only units of blood that had been stored for less than 35 days ("fresh" blood), whereas 429 (31.4%) patients received at least 1 unit of PRBC that had been stored for ≥35 days ("older" blood). Overall postoperative morbidity was 32.8%. The incidence of postoperative complications (42.7% vs 28.3%) was higher among patients who received "older" vs "fresh" blood (P < 0.001). After adjusting for confounders on multivariable analysis, transfusion of "older" blood remained independently associated with an increased risk of perioperative morbidity (Relative Risk 1.20, P = 0.03). CONCLUSIONS The use of "older" blood was an independent predictor of postoperative morbidity among patients undergoing hepato-pancreatic or colorectal procedures. Transfusion of "older" blood products may contribute to a higher risk of postoperative complications.
Tender Preauricular Swelling with Feeding‐Related Growth in an Older Man

The content of this paper has been submitted as part of a symposium to the 2015 Gerontological Society of America Annual Scientific Meeting. This work was supported by the Veterans Health Affairs (VHA) Office of Rural Health and by the VHA Office of Geriatrics and Extended Care National Institute on Aging (NIA) Long-Term Care program. Dr. Morey is supported by the National Institutes of Health, NIA Claude D. Pepper Older Americans Independence Center AG028716 program. Dr. Hall is supported by a Career Development Award from the Rehabilitation Research and Development Service of the Department of Veterans Affairs (11K2RX001316). None of the coauthors on this project had a commercial relationship with any devices tested. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Tocci, Morey, Caves: study concept and design, data acquisition and interpretation, drafting and revising of the article; final approval of data analysis and of version to be published. Deberry, Leahy: data; manuscript review and revision, approval of version published. Hall: data acquisition and interpretation; manuscript review and revision, approval of version published. Sponsor’s Role: The sponsors had no role in the project beyond funding.
Influence of Barefoot, Minimalist, and Standard Footwear Conditions on Gait and Balance in Healthy Older Adults

Three thousand two hundred twenty-three (73%) of the 4,416 survived the index hospitalization, 895 (28%) of whom were transferred to another inpatient setting, 703 (22%) directly admitted to a nursing home, and 1,625 (50%) discharged back to their homes in the community. The individuals discharged from the index stay (n = 3223) had an average of 3.9 4.3 transitions; 77% had at least one additional transition in the follow-up year, 32% had at least five, and 265 patients (8%) had more than 10. Figure 1 shows the amount of time in each setting and survival time. For most individuals, there were several transitions after hospital discharge, some for brief periods of time. Of those who died during the 12 months after discharge from the index admission, the median number of days they were alive was 78 (95% confidence interval = 72– 90 days).
The Effect of Cuff Occlusion Protocols on Radial Strain and Arterial Haemodynamics

The purpose of this study is to compare arterial vasodilation in response to two occlusive cuff positions and various protocols under reactive hyperaemic stimulus. For determining the optimal reactive hyperaemia protocol we studied 10 healthy young adults and calculated the relative strain and haemodynamic changes of the left brachial artery with motion estimation from sequential ultrasonic images and Doppler sonograms. The results from two occlusion cuff positions (left proximal upper arm and distal forearm) showed that brachial artery vasodilation was significantly greater under upper arm occlusion than under forearm occlusion. Results from optimizing reactive hyperaemia protocols showed that the optimum occlusion pressure was 150 mmHg, with an occlusion time of 5 min. The optimum time interval for recording ultrasonic images and estimating relative strain after releasing the cuff was 45-60 s. Use of these conditions resulted in higher vasodilation and larger blood flow changes. We conclude that the magnitudes of relative strain and blood velocity are related not only to the choice of the location of cuff inflation and the magnitude of occlusion pressure and time, but also to the time interval after the release of the occlusive cuff.
Undamped ultrafast pulsation of plasmonic fields via coherent exciton-plasmon coupling

We show that under certain conditions the plasmonic field of a hybrid system consisting of a metallic nanoparticle and a semiconductor quantum dot can be converted into ultrashort stationary pulses with temporal widths as short as 300 ps. This happens as this system interacts with an infrared and visible laser fields, both with time-independent amplitudes. These fields generate quantum coherence via simultaneous interband and intersubband transitions of the quantum dot, forcing the polarization dephasing rate of the quantum dot to become negative during the plasmon pulses. This makes the amplitudes of such pulses time-independent (undamped), indicating total suppression of quantum decoherence of the quantum dot. These results suggest that hybrid quantum dot-metallic nanoparticle systems can act as undamped coherent-plasmonic oscillators.
Understanding the causes of trauma: the Indigenous African perspective

We investigated the African Belief System on explanation of the causes of trauma. The study was conducted in the rural communities of the Vhembe District in South Africa. Seventy-five participants (female = 55; male = 20; age range = 25–60 years; mean age = 35.6 years; ethnicity: Black African) were conveniently selected for the study. Focus group discussions were conducted with the participants. Data were analysed using thematic content analysis. The African Belief System gives various causal reasons of trauma. The causes range from natural to witchcraft and ‘mazhuluzhulu’. Other causes include rape, road accidents, house or business breaking, murder, domestic violence and ancestral spirits. Future study with a larger sample is recommended to increase the transferability of the findings to people in similar situations.
Cause-specific Mortality in a Population-based Cohort of 9799 Women Treated for Ductal Carcinoma In Situ

Objective: To assess cause-specific mortality in women treated for ductal carcinoma in situ (DCIS). Background: From screening and treatment perspective, it is relevant to weigh the low breast cancer mortality after DCIS against mortality from other causes and expected mortality in the general population. Methods: We conducted a population-based cohort study comprising 9799 Dutch women treated for primary DCIS between 1989 and 2004 and estimated standardized mortality ratios (SMRs). Results: After a median follow up of 9.8 years, 1429 patients had died of whom 284 caused by breast cancer (2.9% of total cohort). DCIS patients <50 years experienced higher mortality compared with women in the general population (SMR 1.7; 95% confidence interval, CI: 1.4–2.0), whereas patients >50 had significantly lower mortality (SMR 0.9; 95% CI: 0.8–0.9). Overall, the risk of dying from general diseases and cancer other than breast cancer was lower than in the general population, whereas breast cancer mortality was increased. The SMR for breast cancer decreased from 7.5 (95% CI: 5.9–9.3) to 2.8 (95% CI: 2.4–3.2) for women aged <50 and >50 years, respectively. The cumulative breast cancer mortality 10 years after DCIS was 2.3% for women <50 years and 1.4% for women >50 years treated for DCIS between 1999 and 2004. Conclusions: DCIS patients >50 years had lower risk of dying from all causes combined compared with the general female population, which may reflect differences in health behavior. Women with DCIS had higher risk of dying from breast cancer than the general population, but absolute 10-year risks were low.
Pulmonary Disease Associated With Inflammatory Bowel Disease

Extraintestinal manifestations of inflammatory bowel disease, Crohn disease, and ulcerative colitis are frequently reported. While autoimmune disorders of the skin, eye, joints, and mouth remain the most common complications, a variety of pulmonary manifestations have been described. Numerous studies have investigated the frequency of subclinical disease associated with inflammatory bowel disease found on bronchoalveolar lavage and pulmonary function testing. Case reports on airways involvement, parenchymal lung disease, pleural disease, and complications of drug therapy all related to inflammatory bowel disease are numerous. In many reports, the severity of lung disease may be unrelated to inflammatory bowel disease activity. In this article, a comprehensive review of these manifestations is provided to raise the clinical suspicion for the presence of inflammatory bowel disease–related pulmonary complications.
Acetaminophen in Perspective

complications were comparable and uncommon (2.0% in After Eighty vs 1.6% in the Italian Elderly ACS subgroup). Considering that screening failure was high in the After Eighty study (89%), whereas the current trial had randomized approximately 50% of potentially eligible individuals, the consistency of the current study data with those of the After Eighty trial suggests the benefit of an invasive strategy over a conservative one even in very elderly adults with NSTE myocardial infarction. Figure 1 shows the pooled analysis, with a highly significant estimated effect favoring the invasive approach (risk ratio (RR) = 0.64, 95% confidence interval 0.53–0.76; p for heterogeneity = . 22, I = 32%, tau-squared = 0.023). However, in the individual patient, decisions should also take into consideration estimated life expectancy, comorbidities, frailty, and personal preferences. These aspects had not been quantified in the above-reported trials. A recently published scientific statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society strongly recommends assessing functional and cognitive outcomes in older adults with ACS and incorporating this information in risk-stratification tools relevant to identify individuals who are most likely to derive benefit from invasive management.
A systematic review of the rehabilitation of LISS plate fixation of proximal tibial fractures

Abstract This study aimed systematically to review the evidence-base to determine the optimal rehabilitation for patients following Less Invasive Stabilization System (LISS) plate fixation for proximal tibial fractures. The electronic databases AMED, Cinhal, Medline and EMBASE were reviewed from their inception to October 2008, sources of grey literature and a pertinent hand search of specialist orthopaedic and physiotherapy journals was undertaken. Study methodology was assessed using the Critical Appraisal Skills Programme (CASP) tool. A total of nine publications including 391 patients with 398 proximal tibial fractures after LISS management were reviewed. The results suggested that range of motion exercises have been commenced immediately post-operatively; braces and casts are sometimes used, particularly for patients with concomitant ligamentus injury; and weight-bearing status has been initially restricted as either non- or toe-touch. There did not appear to be a substantial difference in clinical, radiological outcomes or complication rates between differing exercise or weight-bearing protocols. The literature, however, exhibited numerous methodological weaknesses such as reviewing small, underpowered samples, and poorly detailing the physiotherapy strategies used. It is therefore recommended that randomized controlled trials are now undertaken to compare different post-operative rehabilitation programmes for patients following LISS fixation of proximal tibial fractures.
Perception of Patient Safety Culture and Safety Care Activity among Nurses in Small-Medium Sized General Hospitals

Purpose: This study was done to identify the factors affecting the perception of patient-safety-culture and the level of safety-care-activity among nurses in small-medium sized general hospitals. Method: Data were collected during April and May 2011, from 241 nurses of five hospitals. A hospital survey questionnaire on patient-safety-culture and safety-care-activity was used. Collected data were analyzed using descriptive statistics, Pearson correlation, t-test, ANOVA, Scheffe test and multiple-regression. Results: There were significant differences in the level of perception of patient-safety-culture according to the nurses' age, type of hospital, position, work department, and knowing whether there was a Patient-Safety committee in their hospitals. Nurses with higher perceived level of the patient-safety-culture performed more safety-care-activities. Factors influencing on the safety-care-activities were general patient safety, having had safety-education, patient-to-nurse ratio, employment status, and the level of reporting medical errors. These factors explained 22.9% of the safety-care-activity. Conclusions: The study findings suggest that in order to improve the nurses' perceived level of patient-safety-culture and safety-care-activity, the hospitals need to establish patient-safety committees and communication systems, and openness to reporting medical errors are needed. Better work conditions to ensure appropriate work time, regulate patient-to-nurse ratio, and nursing education standards and criteria, are also required.
Targeted lipid–polyaniline hybrid nanoparticles for photoacoustic imaging guided photothermal therapy of cancer

Designing a targeted and versatile photothermal agent for the integration of precise diagnosis and effective photothermal treatment of tumors is desirable but remains a great challenge. In this study, folic acid ligand conjugated lipid-coated polyaniline hybrid nanoparticles (FA–Lipid–PANI NPs) were successfully fabricated by a distinctive technology. The obtained hybrid FA–Lipid–PANI NPs with small size exhibited not only significant photoacoustic (PA) imaging signals, but also a remarkable photothermal effect for tumor treatment. With PA imaging and photothermal therapy (PTT), the tumor could be accurately positioned and thoroughly eradicated in vivo after intravenous injection of FA–Lipid–PANI NPs. These multifunctional nanoparticles could play an important role in simultaneously facilitating imaging and PTT to achieve better therapeutic efficacy.
A Cost-effectiveness Analysis of Total Hip Arthroplasty for Osteoarthritis of the Hip

Objective. —To quantify the trade-off between the expected increased short- and long-term costs and the expected increase in quality-adjusted life expectancy (QALE) associated with total hip arthroplasty (THA) for persons with functionally significant hip osteoarthritis. Design. —A cost-effectiveness study was performed from the societal perspective by constructing stochastic tree, decision analytic models designed to estimate lifetime functional outcomes and costs of THA and nonoperative managements. Main Outcome Measures. —A modified four-state American College of Rheumatology functional status classification was used to measure effectiveness. These functional classes were assigned utility values to allow the relative effectiveness of THA to be expressed in quality-adjusted life years (QALYs). Lifetime costs included costs associated with primary and potential revision surgeries and long-term care costs associated with the functionally dependent class. Data Used in the Cost-effectiveness Model. —Probability and incidence rate data were summarized from the literature. The THA hospital cost data were obtained from local teaching hospitals' cost accounting systems. Estimates of recurring medical costs for functionally significant hip osteoarthritis and for custodial care were derived from the literature. Results. —The THA cost-effectiveness ratio increases with age and is higher for men than for women. In the base-case scenario for 60-year-old white women who have functionally significant but not dependent hip osteoarthritis, the model predicts that THA is cost saving because of the high costs of custodial care associated with dependency due to worsening hip osteoarthritis and that the procedure increases QALE by about 6.9 years. In the base-case scenario for men aged 85 years and older, the average lifetime cost associated with THA is $9100 more than nonoperative management, with an average increase in QALE of about 2 years. Thus, the THA cost-effectiveness ratio for men aged 85 years and older is $4600 per QALY gained, less than that of procedures intended to extend life such as coronary artery bypass surgery or renal dialysis. Worst-case analysis suggests that THA remains minimally cost-effective for this oldest age category ($80 000/QALY) even if probabilities, rates, utilities, costs, and the discount rate are simultaneously varied to extreme values that bias the analysis against surgery. Conclusions. —For persons with hip osteoarthritis associated with significant functional limitation, THA can be cost saving or, at worst, cost-effective in improving QALE when both short- and long-term outcomes are considered. Further research is needed to determine whether this procedure is actually being used in this cost-effective manner, especially in older age categories. ( JAMA . 1996;275:858-865)
Rheologische und kapillarmikroskopische Größen zur Diagnostik des von-Willebrand-Jürgens-Syndroms

In future, the capillary microscopy may add to the spectrum of differential diagnosis finding in haemostaseological and angiogical centres as a screening test. Especially the fast and simple observation of the capillary morphology with changes such as capillary dilatations, capillary bleeding (the easiest case, extravasal cells, but also fresh bleeding at the summit of the capillary) and simultaneous findings of torqua-tion of the capillaries seem to be very sensitive for the diagnosis of the von Willebrand-Jurgens syndrome – according to the data collected until now.
Influence of Adult Knee Height, Age at First Birth, Migration, and Current Age on Adult Physical Function of Bangladeshi Mothers and Daughters in the United Kingdom and Bangladesh

In the United Kingdom, Bangladeshi women have the lowest self-reported levels of physical activity and some of the highest levels of metabolic disease of all ethnic groups. To better understand these risks for poor health we employed life course and intergenerational hypotheses to predict lower body physical function in a sample of 121 Bangladeshi mothers (40–70 years old) and one of their adult daughters (17–36 years old) living in Bangladesh or in the UK. For the mothers, older age and shorter knee height predicted reduced lower body physical function. Knee height is a biomarker of nutrition and health status between birth and puberty. Age at first birth did not have a significant effect. For daughters, older age and migration to the UK predicted reduced lower body physical function. We controlled for total stature and fatness in all analyses. UK-born daughters were taller than BD-born daughters living in the UK, mostly due to differences in knee height. These new findings support previous research indicating that early life health and adequate nutritional status, along with appropriate adult physical activity and diet, may decrease risks for poor physical function, morbidity, and premature mortality.
Topical delivery of interleukin‐13 antisense oligonucleotides with cationic elastic liposome for the treatment of atopic dermatitis

Interleukin (IL)‐13, overproduced in the skin of atopic dermatitis (AD), has been shown to play an essential role in the pathogenesis of the disease. Thus, inhibition of IL‐13 production should provide a key step to alleviate disease conditions of the atopic skin. In the present study, IL‐13 antisense oligonucleotide (ASO) was designed and formulated with cationic elastic liposome (cEL) to improve transdermal delivery.
UK health visiting: challenges faced during lean implementation

Purpose – The purpose of this paper is to present the challenges identified during a lean implementation in a health visiting service within a large primary care trust in NHS UK.Design/methodology/approach – Following a series of lean workshops a triangulated approach to data collection was adopted in order to determine the root cause of the challenges that were faced during this lean implementation. The three methods that were selected for qualitative analysis included semi‐structured interviews, document analysis and researcher participant observation.Findings – Six key challenges were identified from the data analysis. These were: high process variability; a lack of understanding of lean; poor communication and leadership; target focused; problems defining waste; and difficulty in determining who is the customer and what do they value? Practical implications – Although this particular lean implantation had limited success, the research has highlighted a number of challenges which would have to be addres.