Miracle-dz/UniFAR-FTUs huggingface dataset:
SAT0037 Serum 14-3-3Eta Predicts the Risk of RA Development and Its Higher Titres Are Associated with Higher Risk

Background 14-3-3eta (η) is a mechanistic biomarker that is useful in RA diagnosis. We have previously reported that its plasma expression precedes and independently predicts RA development in arthralgia subjects. 14-3-3η titres further improve the predictive value of variables such as ACPA, number of painful joints and alcohol non-use, which are independently associated with RA development. Objectives To determine whether higher 14-3-3η serum cut-off informs a higher likelihood of RA development in arthralgia patients. Methods 14-3-3η plasma levels were measured in 148 consecutive arthralgia patients of whom 44 (30%) developed RA [median time to RA, 14.5 months, range (1-68)] and 104 did not. Entry into the cohort was based on the absence of clinical arthritis at baseline but a positive ACPA and/or IgM-RF status and a history of arthralgia. 14-3-3η positivity was defined by the diagnostic cut-off of ≥0.19 ng/ml and a second cut-off of ≥0.80 ng/ml was set at the 75th percentile serum level of the group that did not develop RA. Fisher exact test and stepwise multivariate analyses were performed to determine 14-3-3η's association with other clinical/serological markers for RA development risk. Variables included in the model were ACPA positivity, alcohol non-use, VAS pain, morning stiffness and number of total painful joints. Results 14-3-3η median plasma levels were significantly higher in the group that developed RA [0.9 (0.2-6.9) vs 0.3 (0.2-0.8) ng/ml, p<0.004]. ACPA levels were also differentially expressed (407 vs 54 IU/ml, p<0.001). Age, gender and RF titres did not differ between the groups. The Fisher exact test revealed that 14-3-3η levels at ≥0.19 ng/ml were associated with RA development with a likelihood ratio (LR) of 5.7 (p=0.02), a relative risk (RR) of 2.2 (95%CI: 1.0-4.5) and more significantly so at ≥0.80 ng/ml with an LR of 9.3 (p=0.002) and a RR of 2.2 (95%CI, 1.3-3.5). Alcohol non-use 1.7 (95%CI: 1.1-2.8), p=0.02 and ACPA positivity 7.9 (95%CI: 2.6-24.1), p<0.0001 but not RF, were also associated with RA development. In a multivariate analysis including these variables, 14-3-3η expression independently predicted RA development with a LR of 4.0 (p=0.05) at the ≥0.19ng/ml cut-off and more strongly so at the higher ≥0.80 ng/ml cut-off with a LR=5.9 (p=0.02). Conclusions Plasma 14-3-3η titres are independently associated with RA development and levels ≥0.80 ng/ml are associated with a higher likelihood of developing RA. These findings are consistent with the mechanistic understanding of 14-3-3η's deleterious role in the pathophysiology of RA. Disclosure of Interest D. van Schaardenburg: None declared, W. Maksymowych Consultant for: Augurex Life Sciences Corp, M. Boers: None declared, M. van Beers-Tas: None declared, A. Marotta Employee of: Augurex Life Sciences Corp DOI 10.1136/annrheumdis-2014-eular.3326
The backbone of history: Health and nutrition in the western hemisphere

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Israeli National Policy for Carbapenem-Resistant Enterobacteriaceae Screening, Carrier Isolation and Discontinuation of Isolation

Abstract Since 2006, Israel has been confronting an outbreak of carbapenem-resistant Enterobacteriaceae (CRE), and in 2007 Israel implemented a national strategy to contain spread. The intervention was initially directed toward acute-care hospitals and later expanded to include an established reservoir of carriage in long-term-care hospitals. It included regular reporting of CRE cases to a central registry and daily oversight of management of the outbreak at the institutional level. Microbiological methodologies were standardized in clinical laboratories nationwide. Uniform requirements for carrier screening and isolation were established, and a protocol for discontinuation of carrier status was formulated. In response to the evolving epidemiology of CRE in Israel and the continued need for uniform guidelines for carrier detection and isolation, the Ministry of Health in 2016 issued a regulatory circular updating the requirements for CRE screening, laboratory diagnosis, molecular characterization, and carrier isolation, as well as reporting and discontinuation of isolation in healthcare institutions nationwide. The principal elements of the circular are contained herein. Infect Control Hosp Epidemiol 2018;39:85–89
Care‐givers’ reflections on an ethics education immersive simulation care experience: A series of epiphanous events

There has been little previous scholarship regarding the aims, options and impact of ethics education on residential care-givers. This manuscript details findings from a pragmatic cluster trial evaluating the impact of three different approaches to ethics education. The focus of the article is on one of the interventions, an immersive simulation experience. The simulation experience required residential care-givers to assume the profile of elderly care-recipients for a 24-hr period. The care-givers were student nurses. The project was reviewed favourably by a university ethics committee, and participants provided informed consent. Data from six postsimulation experience focus groups were analysed thematically and three themes were identified: the experience of vulnerability, dignity in care and the organisation of care. Findings suggest that the immersive simulation experience had a powerful immediate impact as participants described epiphanous insights relating to their care experiences. It is suggested that reflecting on and recording epiphanous events has the potential to sustain ethical care practices. Further research is required to evaluate the impact of different ethics education interventions in different cultural contexts. Exploration is also required regarding the meaning and significance of care epiphanies, those "most delicate and evanescent of moments," for the sustainability of ethical care.
Cardiovascular disease and prediabetes as complex illness: People's perspectives

Cardiovascular disease (CVD) and sustained high blood glucose as prediabetes are an established comorbidity. People's experience in reconciling these long-term conditions requires deeper appreciation if nurses are to more effectively support person-centred care for people who have them. Our analysis explores the initial experience of people admitted to hospital with CVD who then find they also have sustained high blood glucose. Our methodology is informed by the philosophy of Gadamer and applies interpretive description to develop an interpretation of participant experiences. The major theme emerging from participant interviews was the 'invisible disequilibrium' characterised by three subthemes: 'losing equilibrium', 'becoming embattled' and 'evolving illness'. This study examines CVD and prediabetes in conjunction with the Gadamerian notion of the 'whole', as being in a social and emotional world in which illness is also a component part. We explore how participants lived within an 'invisible disequilibrium', with prediabetes frequently remaining unnoticed, while CVD was manifest. To identify multiple conditions and support effective intervention to manage them as part of person-centric care, nursing practice should explore the 'whole' of the person's experience, value people's knowledge as potential indicators of complex illness, thereby reducing the risk of accelerating complex illness.
Osteossarcoma parosteal: aspectos na radiologia convencional

OBJECTIVE: To evaluate the most significant features of parosteal osteosarcoma and to describe the most frequent findings on conventional radiology. MATERIALS AND METHODS: A retrospective study was performed including 26 cases of patients with parosteal osteosarcoma from the archives of "Clube do Osso", Rio de Janeiro, RJ, Brazil, with analysis of main clinical and radiological findings. RESULTS: The disease was prevalent in female patients in the third decade of life. Main clinical findings were the increase in volume on the site of the tumor (77% of cases) and local pain (68% of cases). The most frequent site of tumor was the popliteal fossa (40%), and metaphyseal involvement has occurred in 92% of cases. The most frequent radiological findings were densely mineralized lesions on juxtacortical locations, and irregularly thickened adjacent host cortex (92.3%), with adherence areas being observed in 88.5% of cases, besides lobular (50%) or irregular (38.5%) tumor margins. Also, a radiolucent line between the tumor and the adjacent bone (48%), a denser mineralization on the basis than in the periphery of the tumor (42.3%), and a small rate of periosteal reaction (15.4%) were found. CONCLUSION: Although computed tomography and magnetic resonance imaging are important modalities for identifying some aspects of parosteal osteosarcoma, conventional x-ray is essential in the initial evaluation of this type of lesion, most frequently allowing differential diagnosis with other surface bone lesions.
Bariatric surgery: risks and recommendations for the prevention of perioperative thromboembolism

Globally the numbers of overweight, obese and severely obese people are increasing rapidly. High incidences of obesity and overweight have been documented for the South African population (Table Ia and Ib). Although polygenetic factors play an important role in obesity, environmental factors should also be considered. A sedentary occupation and lifestyle with easy access to energy dense foods is a major contributor to the obesity epidemic. For patients with a BMI > 40 kg/m2, who have failed to successfully lose weight, bariatric surgery is a treatment option. This surgical intervention can achieve long-term sustained weight loss and often induces resolution of comorbidities such as diabetes, sleep apnoea, hyperlipidaemia and hypertension (Table II). 1 Venous thromboembolism (VTE) may occur after bariatric surgery which can cause significant morbidity and mortality. Evidence-based regimens for VTE prophylaxis in bariatric and metabolic surgery have resulted in some controversy. Recently the American College of Chest Physicians (8th edition) published new guidelines on perioperative management of antithrombotic therapy.2 Both the obese patient and the procedure itself have risks. When looking at VTE rates post major abdominal surgery, bariatric surgery has the lowest rate and splenectomy the highest.3 46% of the world’s 400 million obese people are from the developing world.4
Effectiveness of a national ‘Minnesota Model’ based residential treatment programme for alcohol dependence in Ireland: outcomes and predictors of outcome

Objectives The aims of this study were (a) to examine the effectiveness of an inpatient treatment programme for alcohol dependence based on the ‘Minnesota Model’ and (b) to examine potential predictors of outcomes from such treatment. Methods Demographics and data relating to psychosocial functioning of a group of individuals who commenced treatment for alcohol dependence were gathered at the point of treatment entry. These individuals were then followed up 6 months after they were to complete their inpatient treatment to establish their alcohol-related outcomes. Outcomes from treatment were identified as an index of treatment effectiveness and the outcome data were analysed to determine whether any of the baseline variables could be used to predict outcomes from treatment. Results Of those who were contacted at 6-month follow-up, 81.5% had a ‘good outcome’. This represented 66.7% of the total group who participated in the study. The only variable that was found to predict outcomes at 6-month follow-up was severity of alcohol dependence at treatment entry, with more severe alcohol problems associated with poorer outcomes. Conclusions This study provides evidence of the potential for a Minnesota-based treatment programme to be effective in helping people with alcohol dependence to reduce the amount of alcohol they consume and sustain this reduction beyond the treatment period.
Young people, the internet and mental health

The original research by Mullen et al. in this issue is a welcome contribution to the increasingly important research area concerned with mental health and internet use. There is a persistent and growing tension between harmful online content and the potential to support vulnerable people online. Although current research has established both negative and positive influences of the internet on mental health, a policy framework to guide the development of online mental health resources is lacking. Based on 20 years of online service provision (in Australia originally and now in Ireland), ReachOut.com has gained important insights into young people’s online behaviour and help-seeking preferences. Given that young people have expressed concerns about the impact of the internet and social media on their mental health, yet they will go online for support, there is a clear need for leadership and the resourcing of quality assured, engaging online mental health supports. Such an approach will be the most effective way of mitigating the threat posed by harmful online content.
Pre Participation Examination: Tool for Cardiovascular Screening of Competitive Athletes

he heart of an has instilled inquisitiveness in many researchers, clinicians since a century. It is now well established that tedious physical training results in significant changes in cardiac structure and function. The recent increases in the number of people participating in recreational exercises and sports competitions have led to growing number of people exhibiting such changes. So the pre-participation screening becomes an important tool for non invasive examination and for diagnostic purposes. The main purpose of this consensus document is to reinforce the principle of the need for pre-participation medical clearance of all competitive athletes involved in organized sports programs, on the basis of (i) systematic screening by 12-lead ECG (in addition to history and physical examination) to identify hypertrophic cardiomyopathy - the leading cause of sports-related sudden death - and to prevent athletic field fatalities; (ii) transthoracic echocardiography with the potential ability of screening ability in detecting other lethal cardiovascular diseases.
Predictors of screening mammography among Asian Indian American women: a cross-sectional study in the Baltimore-Washington metropolitan area.

OBJECTIVE To assess adherence to screening mammography guidelines and examine predictors of having a mammogram in the past 2 years among immigrant Asian Indian women (AIW) aged > or = 40 years. METHODS Face-to-face surveys of 418 AIW in the Baltimore-Washington metropolitan area were conducted. Subjects were recruited through Asian Indian (AI) religious and other community-based organizations. RESULTS Of the 418 AIW surveyed, 83% had ever had a mammogram, and 70% had obtained a mammogram within the past 2 years. AIW who had lived in the United States for > 10 years had a higher rate of obtaining a mammogram (75.4%) within the past 2 years than did those who had lived in the United States for < or = 10 years (24.6%). In multiple logistic regression analysis, length of stay in the United States, marital status, knowledge of mammogram guidelines, age, having health insurance, physician recommendations, and number of relatives who had a mammogram were positively associated with having a mammogram within the past 2 years. Physician ethnicity and not having a healthcare provider were negatively associated with having a mammogram within the past 2 years. CONCLUSIONS This study lays a foundation for designing guidelines for interventions to improve mammography screening behaviors among AIW women. Increasing the use of mammogram to the levels recommended by guidelines will require a two-pronged approach directed at both AIW and AI physicians.
SET FORCING AND STRONG CONDENSATION FOR H(ω2)

Abstract The Axiom of Strong Condensation, first introduced by Woodin in [14], is an abstract version of the Condensation Lemma of L. In this paper, we construct a set-sized forcing to obtain Strong Condensation for H(ω2). As an application, we show that “ZFC + Axiom of Strong Condensation + ”is consistent, which answers a question in [14]. As another application, we give a partial answer to a question of Jech by proving that “ZFC + there is a supercompact cardinal + any ideal on ω1 which is definable over H(ω2) is not precipitous” is consistent under sufficient large cardinal assumptions.
Inter‐ and intra‐rater reproducibility of automated and integrated pressure‐flow analysis of esophageal pressure‐impedance recordings

Automated impedance manometry pressure‐flow analysis (AIM analysis) determines pressure measurements relative to bolus flow and has to date shown subtle variations in esophageal motility in relation to dysphagia. In this study, we assessed intra‐ and inter‐rater reproducibility of AIM metrics derived using purpose designed software.
Combined effects of smoking and systolic blood pressure on risk of coronary heart disease: a cohort study in Chinese women.

OBJECTIVES To quantify the combined effects of systolic blood pressure (SBP) and cigarette smoking on incident coronary heart disease (CHD) in women. METHODS Overall, 86,338 women aged >or=40 years were enrolled in 1991. The follow-up evaluation was conducted in 1999-2000, with a response rate of 92.9%. RESULTS A total of 829 CHD events (fatal and nonfatal) were observed among the participants who were free of cardiovascular diseases (CVD) at baseline. Higher SBP was significantly associated with more risk of CHD in both nonsmokers and current smokers (all p < 0.0001 for linear trends). Comparing with never smoking, both low and high levels of cigarettes smoked per day (1-7, and >or=8 cigarettes per day) and pack-years (<10, and >or=10 pack-years) were associated with increased risk of CHD in those with normal and high SBP. The multivariate adjusted relative risks (RRs) of CHD were 2.54 (95% confidence interval [CI] 2.00-3.23), 1.28 (1.01-1.63), and 1.57 (1.33-1.86) for current smokers with high SBP, current smokers with normal SBP, and nonsmokers with high SBP, respectively, compared with nonsmokers with normal SBP. The present study identified a statistically significant additive interaction between these two factors on CHD. CONCLUSIONS Our study indicated that the combined effects of cigarette smoking and high SBP could be expected to have extra adverse effects on CHD in women, which highlights the importance of multifactorial interventions to decrease the risk of CHD, for example, quitting smoking and treatment of high blood pressure in Chinese women.
Negative symptoms in schizophrenia show association with amygdala volumes and neural activation during affective processing

Objectives Negative symptoms in schizophrenia have been associated with structural and functional alterations of the amygdala. We hypothesised that there would be between-group differences in amygdala volume and neural activation patterns during processing of affective stimuli among patients with schizophrenia and healthy controls. We further hypothesised correlations between neuroimaging metrics and clinical ratings of negative symptoms in patients with schizophrenia. Methods We used structural and functional magnetic resonance imaging to assess volume and neural activation of the amygdala in 28 patients with schizophrenia and 28 healthy controls. Results We found no between-group differences in amygdala volume or neural activation. However, we found a significant negative correlation between emotional blunting and neural activation in the left amygdala during processing of positive affect. We also found a significant negative correlation between stereotyped thinking and the volume of right amygdala. Conclusion Our findings implicate the amygdala in a subgroup of negative symptoms in schizophrenia that are characterised by reduced expression with blunted affect and stereotyped thinking.
Alcohol problems and responses: challenges for Africa

Despite important variations, commonalties exist between most African countries. Prominent among these are colonial experiences and current economic difficulties. While the use and type of alcohol differ from country to country, evidence exists for an increasing level of consumption across most of the continent. However, information about consumption trends and the extent of patterns of alcohol-related harm is still sparse. Official statistics are largely unreliable and research is poorly supported. Response to alcohol problems is consequently weak and not informed by strong data. The challenge to the continent is to strengthen information gathering, including alcohol research, devise culturally sensitive policies that would reduce overall consumption of alcohol, and emphasize the need for early detection, at the primary care level, of problem drinking.
The role of MMP genes in recurrent depressive disorders and cognitive functions

Objective Among the 28 metalloproteinases described so far, 23 can be found in the human organism, but only few are expressed in the human brain. The main objective of this study was to analyse the relationship between MMP-2, MMP-9 and TIMP-2 gene expression and cognitive performance. Methods The study comprised 234 subjects: patients suffering from recurrent depressive disorder (rDD, n=139) and healthy subjects (HS, n=95). The cognitive function assessment was carried out with the help of the following tests: Trail Making Test, The Stroop Test, Verbal Fluency Test and Auditory Verbal Learning Test. Gene expression on the mRNA and protein level was evaluated for MMP-2, MMP-9 and TIMP-2 in both groups using RNA extraction, reverse transcription and enzyme-linked immunosorbent assay. Results Both mRNA and protein expression levels of all the genes were significantly lower in rDD subjects as compared with HS. Having analysed the entire experimental group (N=234), significant interrelations were found between the expression of the analysed genes and the results of the tests used to measure cognitive functions. Increased expression on both the mRNA and the protein level was associated in each case with better performance of all the tests conducted. After carrying out a separate analysis on the people from the rDD group and the HS group, similar dependencies were still observed. Conclusions The results of our study show decreased expression of MMP-2, MMP-9 and TIMP-2 genes on both mRNA and protein levels in depression. Elevated expression of MMP-2, MMP-9, TIMP-2 positively affects cognitive efficiency: working memory, executive functions, attention functions, direct and delayed auditory–verbal memory, the effectiveness of learning processes and verbal fluency. The study highlights the important role of peripheral matrix metalloproteinases genes in depression and cognitive functions.