Miracle-dz/UniFAR-FTUs huggingface dataset:
Rotura isolada do ligamento cruzado posterior História Natural, Tratamento e Reabilitação

Introduction: The natural history of isolated posterior cruciate ligament (PCL) injuries is not determined. Indications for conservative or surgical treatment remain unclear and several options and techniques are available. Objetives: To better understand the natural history of isolated PCL injuries and assess the current recommendations with regard to treatment and rehabilitation. Sources: Search (in September 2011) in PubMed/Medline, using "posterior cruciate ligament" – resulting in 3,149 articles – and available literature consult. The title, abstract or all article relevance were considered in the selection. Data Synthesis: The fi nal paper comprises 88 references, including 3 textbooks, a controlled study, 30 publications of the last 10 years (about 77%), 3 studies with evidence levels between 1b and 3. Conclusions: The prognosis of isolated PCL injuries varies. There is a tendency to degenerative joint disease and functional deterioration. However, for their regenerative potential, a second evaluation is recommended at six months after injury. Conservative treatment is indicated in grade 1 or 2 instabilities, remaining uncertain in athletes. Surgery is reserved to multiple ligament injuries or isolated grade 3 instabilities. Good results were achieved with hamstring tendon grafts or quadriceps tendon, as well as tibial inlay technique. Advantages in the use of double-bundle grafts remain unclear, contrasting to single-bundle. Synthetic and transplanted PCL are currently under study and the preservation of remaining fi bers, tibial osteotomy or administration of inhibitors of nitric oxide were also suggested.
Early trophic feeding for very low birth weight infants.

BACKGROUND The introduction of enteral feeds for very low birth weight (VLBW) infants is often delayed due to concern that early introduction may not be tolerated and may increase the risk of necrotising enterocolitis. However, enteral fasting may diminish the functional adaptation of the immature gastrointestinal tract and prolong the need for parenteral nutrition with its attendant infectious and metabolic risks. Early trophic feeding, giving infants very small volumes of milk during the first week after birth, may promote intestinal maturation, enhance feeding tolerance and decrease time to reach full enteral feeding independently of parenteral nutrition. OBJECTIVES To determine the effect of early trophic feeding versus enteral fasting on feed tolerance, growth, and the incidence of necrotising enterocolitis, mortality and other morbidities in VLBW infants. SEARCH STRATEGY The standard search strategy of the Cochrane Neonatal Group was used. Searches were made of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2009), MEDLINE (1966 - February 2009), EMBASE (1980 - February 2009), CINAHL (1982 - February 2009), conference proceedings, and previous reviews. SELECTION CRITERIA Randomised or quasi-randomised controlled trials that assessed the effects of early trophic feeding (milk volumes up to 24 ml/kg/day introduced before 96 hours postnatal age and continued until at least one week after birth) versus a comparable period of enteral fasting in VLBW infants. DATA COLLECTION AND ANALYSIS The standard methods of the Cochrane Neonatal Group were used, with separate evaluation of trial quality and data extraction by two review authors. Data were synthesised using a fixed effects model and reported using typical relative risk, typical risk difference and weighted mean difference. MAIN RESULTS Nine trials, in which a total of 754 VLBW infants participated, were eligible for inclusion. These trials did not provide any evidence that early trophic feeding affected feed tolerance or growth rates in VLBW infants. Meta-analysis did not detect a statistically significant effect on the incidence of necrotising enterocolitis: typical relative risk 1.07 (95% confidence interval 0.67, 1.70); typical risk difference 0.01 (95% confidence interval -0.04, 0.05). AUTHORS' CONCLUSIONS The available data cannot exclude important beneficial or harmful effects and are insufficient to inform clinical practice. Further large pragmatic randomised controlled trials are needed to determine how early trophic feeding compared with enteral fasting affects important clinical outcomes in VLBW infants.
Percutaneous transluminal angioplasty and stenting for carotid artery stenosis.

BACKGROUND Carotid percutaneous transluminal angioplasty may be a useful non-surgical procedure for carotid stenosis, particularly for lesions not suitable for surgery. OBJECTIVES The objective of this review was to assess the effect of carotid percutaneous transluminal angioplasty compared with carotid endarterectomy (in patients suitable for surgery) or medical therapy (in patients not suitable for surgery). SEARCH STRATEGY We searched the Cochrane Stroke Groups trials register (to August 1997). We contacted researchers in the field and balloon catheter manufacturers. SELECTION CRITERIA Randomised trials of carotid percutaneous transluminal angioplasty (with or without stenting) compared with carotid endarterectomy, or percutaneous transluminal angioplasty plus best medical therapy compared with best medical therapy alone, in people with carotid artery stenosis (symptomatic or asymptomatic). DATA COLLECTION AND ANALYSIS Two reviewers independently applied the inclusion criteria. MAIN RESULTS No completed trials were found. Two trials are underway. REVIEWER'S CONCLUSIONS There is no evidence as yet to assess the relative effects of carotid percutaneous transluminal angioplasty in people with carotid stenosis.
On-site mental health workers delivering psychological therapy and psychosocial interventions to patients in primary care: effects on the professional practice of primary care providers.

BACKGROUND Mental health problems are common in primary care and mental health workers (MHWs) are increasingly working in this setting delivering psychological therapy and psychosocial interventions to patients. In addition to treating patients directly, the introduction of on-site MHWs represents an organisational change that may lead to changes in the clinical behaviour of primary care providers (PCPs). OBJECTIVES To assess the effects of on-site MHWs delivering psychological therapy and psychosocial interventions in primary care on the clinical behaviour of primary care providers (PCPs). SEARCH STRATEGY The following sources were searched in 1998: the Cochrane Effective Practice and Organisation of Care Group Specialised Register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE, PsycINFO, CounselLit, NPCRDC skill-mix in primary care bibliography, and reference lists of articles. Additional searches were conducted in February 2007 using the following sources: MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Central Register of Clinical Trials (CENTRAL) (The Cochrane Library). SELECTION CRITERIA Randomised trials, controlled before and after studies, and interrupted time series analyses of MHWs working alongside PCPs in primary care settings. The outcomes included objective measures of PCP behaviours such as consultation rates, prescribing, and referral. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed study quality. MAIN RESULTS Forty-two studies were included in the review. There was evidence that MHWs caused significant reductions in PCP consultations (standardised mean difference -0.17, 95% CI -0.30 to -0.05), psychotropic prescribing (relative risk 0.67, 95% CI 0.56 to 0.79), prescribing costs (standardised mean difference -0.22, 95% CI -0.38 to -0.07), and rates of mental health referral (relative risk 0.13, 95% CI 0.09 to 0.20) for the patients they were seeing. In controlled before and after studies, the addition of MHWs to a practice did not affect prescribing behaviour towards the wider practice population and there was no consistent pattern to the impact on referrals in the wider patient population. AUTHORS' CONCLUSIONS This review provides some evidence that MHWs working in primary care to deliver psychological therapy and psychosocial interventions cause a significant reduction in PCP behaviours such as consultations, prescribing, and referrals to specialist care. However, the changes are modest in magnitude, inconsistent, do not generalise to the wider patient population, and their clinical or economic significance is unclear.
Assessment and learning : the impact of professional body requirements

This paper is the result of personal reflection that I undertook during the course of a professional development programme at London Metropolitan University. It was also written days after the University’s Legal Practice Course (LPC) had received its triennial, three-day monitoring visit by the Law Society. During that visit I had to represent the course and present our teaching, curriculum and assessment rationales. However, it is perhaps a misnomer to refer to our ‘assessment rationale’ because while we may develop our own learning outcomes and tweak the curriculum, the Law Society prescribes assessment instruments and criteria. I assumed I would be able to engage in a stimulating debate with the Law Society by plotting our course’s progress with reference to current developments in teaching and learning. However, I emerged from the meetings with the feeling that the assessors did not appreciate what I was talking about. They appear to rely on assessment checklists based upon decades-old narratives and the now prevalent concept of ‘deep-learning’ did not seem to resonate with them.
The effects of on-screen, point of care computer reminders on processes and outcomes of care.

BACKGROUND The opportunity to improve care by delivering decision support to clinicians at the point of care represents one of the main incentives for implementing sophisticated clinical information systems. Previous reviews of computer reminder and decision support systems have reported mixed effects, possibly because they did not distinguish point of care computer reminders from e-mail alerts, computer-generated paper reminders, and other modes of delivering 'computer reminders'. OBJECTIVES To evaluate the effects on processes and outcomes of care attributable to on-screen computer reminders delivered to clinicians at the point of care. SEARCH STRATEGY We searched the Cochrane EPOC Group Trials register, MEDLINE, EMBASE and CINAHL and CENTRAL to July 2008, and scanned bibliographies from key articles. SELECTION CRITERIA Studies of a reminder delivered via a computer system routinely used by clinicians, with a randomised or quasi-randomised design and reporting at least one outcome involving a clinical endpoint or adherence to a recommended process of care. DATA COLLECTION AND ANALYSIS Two authors independently screened studies for eligibility and abstracted data. For each study, we calculated the median improvement in adherence to target processes of care and also identified the outcome with the largest such improvement. We then calculated the median absolute improvement in process adherence across all studies using both the median outcome from each study and the best outcome. MAIN RESULTS Twenty-eight studies (reporting a total of thirty-two comparisons) were included. Computer reminders achieved a median improvement in process adherence of 4.2% (interquartile range (IQR): 0.8% to 18.8%) across all reported process outcomes, 3.3% (IQR: 0.5% to 10.6%) for medication ordering, 3.8% (IQR: 0.5% to 6.6%) for vaccinations, and 3.8% (IQR: 0.4% to 16.3%) for test ordering. In a sensitivity analysis using the best outcome from each study, the median improvement was 5.6% (IQR: 2.0% to 19.2%) across all process measures and 6.2% (IQR: 3.0% to 28.0%) across measures of medication ordering. In the eight comparisons that reported dichotomous clinical endpoints, intervention patients experienced a median absolute improvement of 2.5% (IQR: 1.3% to 4.2%). Blood pressure was the most commonly reported clinical endpoint, with intervention patients experiencing a median reduction in their systolic blood pressure of 1.0 mmHg (IQR: 2.3 mmHg reduction to 2.0 mmHg increase). AUTHORS' CONCLUSIONS Point of care computer reminders generally achieve small to modest improvements in provider behaviour. A minority of interventions showed larger effects, but no specific reminder or contextual features were significantly associated with effect magnitude. Further research must identify design features and contextual factors consistently associated with larger improvements in provider behaviour if computer reminders are to succeed on more than a trial and error basis.
Physical training for asthma.

BACKGROUND People with asthma may show less tolerance to exercise due to worsening asthma symptoms during exercise or other reasons such as deconditioning, as a consequence of inactivity. Some may also restrict activities as per medical advice or family influence and this might result in reduced physical fitness. Physical training programs aim to improve physical fitness, neuromuscular coordination and self confidence. Subjectively, many people with asthma report that they are symptomatically better when fit, but results from trials have varied and have been difficult to compare because of different designs and training protocols. Also, as exercise can induce asthma, the safety of exercise programmes need to be considered. OBJECTIVES To gain a better understanding of the effect of physical training on the respiratory and general health of people with asthma, from randomised trials. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register of trials up to April 2011. SELECTION CRITERIA We included randomised trials of people over eight years of age with asthma who were randomised to undertake physical training. Physical training had to be undertaken for at least twenty minutes, two times a week, over a minimum period of four weeks. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility for inclusion and the quality of trials. MAIN RESULTS Nineteen studies (695 participants) were included in this review. Physical training was well tolerated with no adverse effects reported. None of the studies mentioned worsening of asthma symptoms following physical training. Physical training improved cardiopulmonary fitness as measured by a statistically and clinically significant increase in maximum oxygen uptake (MD 5.57 mL/kg/min; 95% confidence interval (CI) 4.36 to 6.78; six studies on 149 participants) and maximum expiratory ventilation (6.0 L/min, 95% CI 1.57 to 10.43; four studies on 111 participants) with no significant effect on resting lung function (performed in four studies). Although there were insufficient data to pool due to diverse reporting tools, there is some evidence available to suggest that physical training may have positive effects on health-related quality of life, with four of five studies producing a statistically and clinically significant benefit. AUTHORS' CONCLUSIONS This review demonstrated that physical training can improve cardiopulmonary fitness and was well tolerated among people with asthma in the included studies. As such, people with stable asthma should be encouraged to partake in regular exercise training, without fear of symptom exacerbation.
Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women.

BACKGROUND Osteoporosis is an abnormal reduction in bone mass and bone deterioration leading to increased fracture risk. Alendronate belongs to the bisphosphonate class of drugs, which act to inhibit bone resorption by interfering with the activity of osteoclasts. OBJECTIVES To assess the efficacy of alendronate in the primary and secondary prevention of osteoporotic fractures in postmenopausal women. SEARCH STRATEGY We searched CENTRAL, MEDLINE and EMBASE for relevant randomized controlled trials published between 1966 to 2007. SELECTION CRITERIA Women receiving at least one year of alendronate, for postmenopausal osteoporosis, were compared to those receiving placebo and/or concurrent calcium/vitamin D. The outcome was fracture incidence. DATA COLLECTION AND ANALYSIS We undertook study selection and data abstraction in duplicate. We performed meta-analysis of fracture outcomes using relative risks and a > 15% relative change was considered clinically important. We assessed study quality through reporting of allocation concealment, blinding and withdrawals. MAIN RESULTS Eleven trials representing 12,068 women were included in the review. Relative (RRR) and absolute (ARR) risk reductions for the 10 mg dose were as follows. For vertebral fractures, a significant 45% RRR was found (RR 0.55, 95% CI 0.45 to 0.67). This was significant for both primary prevention, with 45% RRR (RR 0.55, 95% CI 0.38 to 0.80) and 2% ARR, and secondary prevention with 45% RRR (RR 0.55, 95% CI 0.43 to 0.69) and 6% ARR. For non-vertebral fractures, a significant 16% RRR was found (RR 0.84, 95% CI 0.74 to 0.94). This was significant for secondary prevention, with 23% RRR (RR 0.77, 95% CI 0.64 to 0.92) and 2% ARR, but not for primary prevention (RR 0.89, 95% CI 0.76 to 1.04). There was a significant 40% RRR in hip fractures (RR 0.60, 95% CI 0.40 to 0.92), but only secondary prevention was significant with 53% RRR (RR 0.47, 95% CI 0.26 to 0.85) and 1% ARR. The only significance found for wrist was in secondary prevention, with a 50% RRR (RR 0.50 95% CI 0.34 to 0.73) and 2% ARR. For adverse events, we found no statistically significant differences in any included study. However, observational data raise concerns regarding potential risk for upper gastrointestinal injury and, less commonly, osteonecrosis of the jaw. AUTHORS' CONCLUSIONS At 10 mg per day, both clinically important and statistically significant reductions in vertebral, non-vertebral, hip and wrist fractures were observed for secondary prevention ('gold' level evidence, www.cochranemsk.org). We found no statistically significant results for primary prevention, with the exception of vertebral fractures, for which the reduction was clinically important ('gold' level evidence).
Modeling and Surveillance of Pandemic Influenza Outbreaks

Pandemic outbreaks are unpredictable as to their virus strain, transmissibility, and impact on our quality of life. Hence, the decision support models for mitigation of pandemic outbreaks must be user-friendly and operational, and also incorporate valid estimates of disease transmissibility and severity. This dissertation research is aimed at 1) reviewing the existing pandemic simulation models to identify their implementation gaps with regard to usability and operability, and suggesting research remedies, 2) increasing operability of simulation models by calibrating them via an epidemiological model that estimates infection probabilities using viral shedding profiles of concurrent pandemic and seasonal influenza, and 3) developing a testing strategy for the state laboratories, with their limited capacities, to improve their ability to estimate evolving transmissibility parameters. Our review of literature (Aim 1) indicates the need to continue model enhancements in critical areas including updating of epidemiological data during a pandemic, smooth handling of large demographical databases, incorporation of a broader spectrum of social-behavioral aspects, and improvement of computational efficiency and accessibility. As regards the ease of calibration (Aim 2), we demonstrate that the simulation models, when driven by the infection probabilities obtained from our epidemiological model, accurately reproduce the disease transmissibility parameters. Assuming the availability of sufficient disease reporting infrastructure and strong compliance by both infected population and healthcare providers, our testing strategy (Aim 3) adequately supports characterization of real-time epidemiological parameters. Future research on this topic will be aimed at integrating the laboratory testing strategy with our modeling and simulation approach to develop dynamic mitigation strategies for pandemic outbreaks.
System and Autophagy Lysosomal degradation of intracellular nucleic acids—multiple autophagic pathways

Cell metabolism can be considered as a process of serial construction and destruction of cellular components, both of which must be regulated accurately. In eukaryotic cells, a variety of cellular components are actively delivered into lysosomes/vacuoles, specialized compartments for hydrolysis of macromolecules. Such processes of ‘self-eating’ are called autophagy. Despite a wide variety of lysosomal/vacuolar hydrolases, much of the interest has been focused on the proteolytic functions of autophagy and less attention has been devoted to the degradation of other macromolecules such as nucleic acids. In this review, we focus on delivery and degradation of endogenous nucleic acids by autophagic systems, and discuss their molecular mechanisms and physiological/pathophysiological roles.
Programmable formation of catalytic RNA triangles and squares by assembling modular RNA enzymes

RNA is a biopolymer that is attractive for constructing nano-scale objects with complex structures. Three-dimensional (3D) structures of naturally occurring RNAs often have modular architectures. The 3D structure of a group I (GI) ribozyme from Tetrahymena has a typical modular architecture, which can be separated into two structural modules (ΔP5 and P5abc). The fully active ribozyme can be reconstructed by assembling the two separately prepared modules through highly specific and strong assembly between ΔP5 ribozyme and P5abc RNA. Such non-covalent assembly of the two modules allows the design of polygonal RNA nano-structures. Through rational redesign of the parent GI ribozyme, we constructed variant GI ribozymes as unit RNAs for polygonal-shaped (closed) oligomers with catalytic activity. Programmed trimerization and tetramerization of the unit RNAs afforded catalytically active nano-sized RNA triangles and squares, the structures of which were directly observed by atomic force microscopy (AFM).