Miracle-dz/UniFAR-FTUs huggingface dataset:
Impact of professionalism in nursing on in-hospital bedside monitoring practice.

AIM This article reports a study exploring nursing practice of monitoring in-hospital patients including intra- and interprofessional communication and collaboration. BACKGROUND Sub-optimal care in general in-hospital wards may lead to admission for intensive care, cardiac arrest, or sudden death. Reasons may include infrequent measurements of vital parameters, insufficient knowledge of their predictive values, and/or sub-optimal use of Medical Emergency Teams. This study was designed to improve understanding of nursing practice and to identify changes required to support nursing staff in improving standards of clinical monitoring practice and patient safety in general in-hospital wards. DESIGN The study was designed as a qualitative descriptive clinical study, based on method triangulation including structured individual observations and semi-structured individual interviews. METHODS In the spring of 2009, structured observations and semi-structured interviews of 13 nurses were carried out at a university hospital in Copenhagen, Denmark. The observational notes and interview transcriptions were analysed using content analysis. RESULTS One theme (Professionalism influences nursing monitoring practice) and two sub-themes (Knowledge and skills and Involvement in clinical practice through reflections) were identified. Three categories (Decision-making, Sharing of knowledge, and Intra- and interprofessional interaction) were found to be associated with the theme, the sub-themes, and with each other. CONCLUSION Clinical monitoring practice varies considerably between nurses with different individual levels of professionalism. Future initiatives to improve patient safety by further developing professionalism among nurses need to embrace individual and organizational attributes to strengthen their practice of in-hospital patient monitoring and management.
Selective plasma exchange can reduce auto‐antibodies in patients with bullous pemphigoid without affecting factor XIII and fibrinogen

Bullous pemphigoid (BP) is an autoimmune blistering skin disorder characterized by circulating serum IgG antibodies against two hemidesmosomal proteins: BP180 and BP230. Fundamentally, immunosuppressive therapies are administered to treat this disease, but plasmapheresis can be added for refractory patients. We experienced the case of a 63‐year‐old patient with refractory BP for which we administered double filtration plasmapheresis (DFPP). His skin lesions improved along with decreased IgG BP180 antibodies, but factor XIII (FXIII) and fibrinogen were also reduced by DFPP repetition. Reportedly, deficiency of those factors can cause lethal bleeding. Especially, decreased FXIII cannot be detected by prolongation of bleeding or coagulation time. To prevent further reduction of those factors and bleeding complications, DFPP was switched to selective plasma exchange (SePE), a new modality of plasmapheresis that uses a membrane plasma separator with smaller than ordinary pores. SePE further reduced pathogenic IgG BP180 antibodies, but FXIII and fibrinogen recovered. For this case, we measured the mean of reduction ratios in serum IgG and FXIII both before and after plasmapheresis sessions and detected the decreased levels of FXIII and fibrinogen during DFPP. We were able to switch to SePE from DFPP appropriately before any bleeding event occurred. The utility of SePE was demonstrated, especially for the reduction of pathogenic antibodies with retention of FXIII and fibrinogen, which have the longest half‐lives among coagulation factors and which take a long time to recover.
Photodynamic therapy in dermatology

Editorial commentTherapies that selectively target diseased cells while sparing normal tissue remain the goal of modern medicine. Photodynamic therapy (PDT) achieves double selectivity both by the degree that preferential accumulation of the photosensitizer occurs in the targeted cells and the extent to which the illumination is spatially localized to the target. Dr. GI Stables has reviewed the burgeoning literature on this oxygen-requiring technique by discussing its essential components (photosensitizers, light sources) and its many applications including benign, premalignant, and malignant disease. Most studied has been the use of 5 -aminolaevulinic acid PDT for psoriasis, actinic keratoses and non-melanoma skin cancer. While residents and trainees have reason to be excited about these developments, all readers should be cautioned that PDT's role in routine dermatological practice awaits comparison to carefully controlled trials involving comparison to more standardized techniques.
Hazardous alcohol-drinking problems among a Chinese hospital patient population.

AIM The aims of this study were to explore: (1) the prevalence and predictors for hazardous alcohol-drinking problems; and (2) previous assessments and interventions for alcohol-drinking problems in hospitalized Chinese patients. BACKGROUND Alcohol is legally accessible and widely used in Taiwan, but few studies have addressed alcohol-drinking problems in hospital settings. DESIGN A cross-sectional design was used. METHOD Self-report data were collected in 2009 from 484 patients at five randomly selected general teaching hospitals. FINDINGS The prevalence of hazardous alcohol-drinking problems was 19·2%. Logistic regression analysis revealed that predictors for hazardous drinking problems were being male, smoking, and chewing betel quid. Only 29·1% of participants had been assessed for drinking problems in the past year. Only 38·7% of participants with drinking problems had received a drinking intervention in the past year. CONCLUSION These findings suggest that alcohol problems in Taiwanese general teaching hospitals are insufficiently assessed and targeted with interventions. Targeting high-risk groups in general teaching hospitals is important to prevent patients' drinking problems.
Assessment and Monitoring Tumor Vascularity With Contrast-Enhanced Ultrasound Maximum Intensity Persistence Imaging

Objectives:Contrast-enhanced ultrasound imaging is increasingly being used in the clinic for assessment of tissue vascularity. The purpose of our study was to evaluate the effect of different contrast administration parameters on the in vivo ultrasound imaging signal in tumor-bearing mice using a maximum intensity persistence (MIP) algorithm and to evaluate the reliability of in vivo MIP imaging in assessing tumor vascularity. The potential of in vivo MIP imaging for monitoring tumor vascularity during antiangiogenic cancer treatment was further evaluated. Materials and Methods:In intraindividual experiments, varying contrast microbubble concentrations (5 × 105, 5 × 106, 5 × 107, 5 × 108 microbubbles in 100 μL saline) and contrast injection rates (0.6, 1.2, and 2.4 mL/min) in subcutaneous tumor-bearing mice were applied and their effects on in vivo contrast-enhanced ultrasound MIP imaging plateau values were obtained using a dedicated small animal ultrasound imaging system (40 MHz). Reliability of MIP ultrasound imaging was tested following 2 injections of the same microbubble concentration (5 × 107 microbubbles at 1.2 mL/min) in the same tumors. In mice with subcutaneous human colon cancer xenografts, longitudinal contrast-enhanced ultrasound MIP imaging plateau values (baseline and at 48 hours) were compared between mice with and without antiangiogenic treatment (antivascular endothelial growth factor antibody). Ex vivo CD31 immunostaining of tumor tissue was used to correlate in vivo MIP imaging plateau values with microvessel density analysis. Results:In vivo MIP imaging plateau values correlated significantly (P = 0.001) with contrast microbubble doses. At 3 different injection rates of 0.6, 1.2, and 2.4 mL/min, MIP imaging plateau values did not change significantly (P = 0.61). Following 2 injections with the same microbubble dose and injection rate, MIP imaging plateau values were obtained with high reliability with an intraclass correlation coefficient of 0.82 (95% confidence interval: 0.64, 0.94). In addition, in vivo MIP imaging plateau values significantly correlated (P = 0.01; R2 = 0.77) with ex vivo microvessel density analysis. Tumor volumes in treated and nontreated mice did not change significantly (P = 0.22) within 48 hours. In contrast, the change of in vivo MIP imaging plateau values from baseline to 48 hours was significantly different (P = 0.01) in treated versus nontreated mice. Conclusions:Contrast-enhanced ultrasound MIP imaging allows reliable assessment of tumor vascularity and monitoring of antiangiogenic cancer therapy in vivo, provided that a constant microbubble dose is administered.
Sharing good practice: knowledge in action

Purpose – The purpose of this article is to describe the development of the NHS Clinical Governance Support Team's (CGST) information products, with a focus on good practice “eurekas” and an integrated management system for storing knowledge and learning; an intranet‐based “action points” system.Design/methodology/approach – The process behind development of a set of products and a system to capture and share good practice in health care.Findings – To ensure that good practice in clinical governance was being disseminated effectively, and to celebrate success, the CGST developed “eurekas” as short, structured accounts of local improvements to health care. To enhance the number of “raw” eurekas turned into finished, online products, the process of production was streamlined through an online “action points” system. This is an effective knowledge management tool for storing, retrieving and monitoring the development of information into a range of products for sharing across the NHS (e.g. stories, case studi.
Overcoming muscle atrophy in a hibernating mammal despite prolonged disuse in dormancy: Proteomic and molecular assessment

Prolonged disuse of skeletal muscle causes significant loss of myofibrillar contents, muscle tension, and locomotory capacity. However, hibernating mammals like bats appear to deviate from this trend. Although low functional demands during winter dormancy has been implicated as a factor contributing to reduced muscle loss, the precise mechanism that actively prevents muscle atrophy remains unclear. We explored proteomic and molecular assessments of bat muscle to test a hypothesis that expression levels of major myofibrillar proteins are retained during hibernation, with periodic arousals utilized as a potential mechanism to prevent disuse atrophy. We examined changes in myofibrillar contents and contractile properties of the pectoral or biceps brachii muscles of the bat Murina leucogaster in summer active (SA), hibernation (HB) and early phase of arousal (AR) states. We found the bat muscles did not show any sign of atrophy or tension reduction over the 3‐month winter dormancy. Levels of most sarcomeric and metabolic proteins examined were maintained through hibernation, with some proteins (e.g., actin and voltage dependent anion channel 1) 1.6‐ to 1.8‐fold upregulated in HB and AR compared to SA. Moreover, expression levels of six heat shock proteins (HSPs) including glucose‐regulated protein 75 precursor were similar among groups, while the level of HSP70 was even 1.7‐fold higher in HB and AR than in SA. Thus, considering the nature of arousal with strenuous muscle shivering and heat stress, upregulation or at least balanced regulation of the chaperones (HSPs) would contribute to retaining muscle properties during prolonged disuse of the bat. J. Cell. Biochem. 104: 642–656, 2008. © 2008 Wiley‐Liss, Inc.
Dysregulation of apoptotic signaling in cancer: Molecular mechanisms and therapeutic opportunities

Apoptosis is a tightly regulated cell suicide program that plays an essential role in the maintenance of tissue homeostasis by eliminating unnecessary or harmful cells. Defects in this native defense mechanism promote malignant transformation and frequently confer chemoresistance to transformed cells. Indeed, the evasion of apoptosis has been recognized as a hallmark of cancer. Given that multiple mechanisms function at many levels to orchestrate the regulation of apoptosis, a multitude of opportunities for apoptotic dysregulation are present within the intricate signaling network of cell. Several of the molecular mechanisms by which cancer cells are protected from apoptosis have been elucidated. These advances have facilitated the development of novel apoptosis‐inducing agents that have demonstrated single‐agent activity against various types of cancers cells and/or sensitized resistant cancer cells to conventional cytotoxic therapies. Herein, we will highlight several of the central modes of apoptotic dysregulation found in cancer. We will also discuss several therapeutic strategies that aim to reestablish the apoptotic response, and thereby eradicate cancer cells, including those that demonstrate resistance to traditional therapies. J. Cell. Biochem. 104: 1124–1149, 2008. © 2008 Wiley‐Liss, Inc.
A Low Power Voltage Controlled Oscillator Design

The performance of voltage controlled oscillator (VCO) is of great importance for any telecommunication or data transmission network. Here, voltage controlled oscillators (VCOs) using three-transistor NAND gates have been designed. New delay cell with three-transistor NAND gate has been used for designing the ring based VCO circuits. Three-, five-, and seven-stage VCOs have been proposed. Output frequency has been controlled with supply voltage variation from 1.8 V to 2.4 V. Three stage VCO shows output frequency variation in the range of 3.2909 GHz to 4.2280 GHz whereas power consumption varies in the range of 335.4071 μW to 486.1816 μW. Five-stage VCO depicts frequency in the range of 1.9406 GHz to 2.5769 GHz with power consumption variation from 559.0118 μW to 810.3027 μW. Moreover a seven-stage VCO shows frequency variation from 1.3984 GHz to 1.8077 GHz. Power consumption of seven-stage VCO varies from 782.6165 μW to 1134.400 μW. Phase noise results for these VCOs have also been obtained. Power consumption, output frequency, and phase noise results of proposed circuits have been compared with earlier reported circuits, and the proposed circuits show significant improvements.
Effects of Pulmonary Edema on Airway Reactivity

Airway hyperreactivity can be defined as an extreme sensitivity of the airways to a wide variety of pharmacologic, chemical, or physical stimuli. It is a characteristic and consistent feature of patients with asthma and is present in some patients with chronic bronchitis. Airway hyperreactivity can be manifested clinically as cough, wheezing, and tachypnea. Airway reactivity to a stimulus is assessed objectively by measurements of pulmonary function that reflect airway constriction, such as the forced expiratory volume in one second (FEV1) or airway resistance (Raw)One method of measuring the degree of airway reactivity present in a patient or experimental animal is to administer increasing doses of a bronchoconstrictor material such as methacholine or histamine by inhalation and to make sequential measurements of pulmonary function. The results of such a study in a patient with hyperreactive airways (solid symbols) and in a patient with normal airways (open symbols) are depicted in Figure 1. The patient with airway hyperreactivity developed a significant degree of bronchoconstriction after inhaling relatively small amounts of histamine; the patient with normal airways reacted only slightly to large doses of histamine. Because airway hyperreactivity can be present in patients with normal spirometry, assessment of airway reactivity has been proposed as a diagnostic test of otherwise inapparent asthma. Despite the term "cardiac asthma," airway hyperreactivity has not been reported to accompany episodes of left ventricular failure, or to follow bouts of cardiogenic pulmonary edema. As discussed earlier in this issue, the wheezing present during cardiogenic pulmonary edema probably results from passive narrowing of the airways, and does not indicate the presence of airway hyperreactivity. However, there is suggestive evidence that noncardiogenic pulmonary edema, the adult 100
An experimental approach to improve the Monte Carlo modelling of offline PET/CT-imaging of positron emitters induced by scanned proton beams

We report on the experimental campaign carried out at the Heidelberg Ion-Beam Therapy Center (HIT) to optimize the Monte Carlo (MC) modelling of proton-induced positron-emitter production. The presented experimental strategy constitutes a pragmatic inverse approach to overcome the known uncertainties in the modelling of positron-emitter production due to the lack of reliable cross-section data for the relevant therapeutic energy range. This work is motivated by the clinical implementation of offline PET/CT-based treatment verification at our facility. Here, the irradiation induced tissue activation in the patient is monitored shortly after the treatment delivery by means of a commercial PET/CT scanner and compared to a MC simulated activity expectation, derived under the assumption of a correct treatment delivery. At HIT, the MC particle transport and interaction code FLUKA is used for the simulation of the expected positron-emitter yield. For this particular application, the code is coupled to externally provided cross-section data of several proton-induced reactions. Studying experimentally the positron-emitting radionuclide yield in homogeneous phantoms provides access to the fundamental production channels. Therefore, five different materials have been irradiated by monoenergetic proton pencil beams at various energies and the induced β+ activity subsequently acquired with a commercial full-ring PET/CT scanner. With the analysis of dynamically reconstructed PET images, we are able to determine separately the spatial distribution of different radionuclide concentrations at the starting time of the PET scan. The laterally integrated radionuclide yields in depth are used to tune the input cross-section data such that the impact of both the physical production and the imaging process on the various positron-emitter yields is reproduced. The resulting cross-section data sets allow to model the absolute level of measured β+ activity induced in the investigated targets within a few per cent. Moreover, the simulated distal activity fall-off positions, representing the central quantity for treatment monitoring in terms of beam range verification, are found to agree within 0.6 mm with the measurements at different initial beam energies in both homogeneous and heterogeneous targets.
Cardiovascular Risk Reduction Strategies in Community Pharmacy Settings Need Real World Angle

It is well established that cardiovascular risk reduction strategies are often not successful in primary care settings and several organizations suggest that community pharmacists should play a more active role. As a result, several studies have attempted to examine the benefits of involving community pharmacists in the management of cardiovascular-risk patients. While many have reported positive results, real-world implementation has been minimal at best. In our view, 3 major barriers to widespread implementation of published protocols exist: generalizability, efficiency, and strategic focus.
18F-FDG PET Rarely Provides Additional Information to 11C-Methionine PET Imaging in Hyperparathyroidism

Aim The aim of this study was to assess the utility of combined 11C-methionine and 18F-FDG PET/CT imaging in hyperparathyroidism. Patients and Methods We reviewed all scans performed for hyperparathyroidism with both 11C-methionine and 18F-FDG PET/CT or PET in our institution since 1993. Forty-three patients (47 pairs of scans) were included (13 men and 30 women) with a mean age of 63 years. 11C-methionine and 18F-FDG PET/CT scans were classified as positive or negative for localization of abnormal parathyroid tissue, and the site of uptake was noted in the positive scans. Other concurrent imaging (99mTc-MIBI scintigraphy, ultrasonography, CT, or MRI) findings were also noted when performed. Clinical follow-up information was available in 27 patients (30 episodes). Results Of the 47 PET scan episodes, 23 (49%) were positive. Twenty-two 11C-methionine scans showed abnormal focal localization of which 10 also showed concordant abnormal 18F-FDG uptake. One patient was positive with 18F-FDG and negative with 11C-methionine. Of the 16 patients who underwent subsequent surgery, 6 had concordant 11C-methionine, 18F-FDG, and surgical findings; 6 had concordant 11C-methionine and surgical findings; 1 had concordant 18F-FDG and surgical findings; and 3 had both PET scans negative but had adenomas excised during surgery. Of the 3 with both PET scans negative and discordant surgical findings, 1 had mediastinal parathyroid lipoadenoma excised and 2 had normally sited parathyroid adenoma excised. Conclusions 18F-FDG PET/CT rarely provides additional information and could be saved for patients in whom 11C-methionine PET/CT is negative.
Commentary by Stringer

This quantitative study addresses a health concern focusing on the role of welfare reform and health disparities in women. As the authors point out, in 1996, legislation replaced Aid to Families with Dependent Children with Temporary Assistance for Needy Families (TANF). This shift in fundamental benefits for women and children, our most vulnerable group of citizens, may have implications for the health of our nation. As we institute mandatory federal policy changes, the importance of determining and monitoring the potential effect on the women we serve is of utmost importance. This study provides an important contribution to our beginning knowledge concerning women’s experiences during the postwelfare reform and the health care implications. In particular, these researchers explored the relationship of welfare status, stress, and health in unemployed women receiving TANF benefits. Sixty-five unemployed women receiving TANF benefits were studied using a repeat, one-group study design. Women were compared for psychosocial, physiologic, and health status measures at two time periods. The first measurement time period was at enrollment when receiving TANF through the Welfare Transition Program (WTP) and the second measurement time period was 2 months after leaving the WTP. The two psychosocial stress scales used were the Perceived Stress Scale and the Symptom Checklist–90 Revised. Both of these scales had documented reliability, validity, and appropriateness for target population. The two physiologic measures for stress included salivary cortisol and 24-hour ambulatory blood pressure device. To ensure salivary cortisol sample reliability and validity, rigorous methods were established. For instance, study protocol mandated the performing of all assays in duplicate and providing subjects detailed instructions prior to cortisol salvia sampling. To measure blood pressure, the 24-hour ambulatory blood pressure device, a noninvasive measurement tool, was used in conjunction with a self-report diary. Lastly, health status was assessed using measurements for depression and general health. Depression was measured with the Center for Epidemiologic Studies Depression Scale, and the Short-Form–36 Health Survey was used to measure self-reported health. Both of these tools have demonstrated reliability and validity and Western Journal of Nursing Research Volume 29 Number 7 November 2007 884-886 © 2007 Sage Publications 10.1177/0193945906297379 http://wjn.sagepub. com hosted at http://online.sagepub. com