Miracle-dz/UniFAR-FTUs huggingface dataset:
A snap audit of “did not attend” patients in a gynecologic outpatient clinic

Correspondence: Babatunde A Gbolade Fertility Control Unit, Department of Obstetrics and Gynaecology, st James’s University hospital, Beckett street, Leeds Ls9 7TF, United Kingdom Tel +44 113 206 7135 Fax +44 113 206 5381 email b.a.gbolade@leeds.ac. uk Objectives: To determine why patients failed to attend their gynecology outpatient clinic (GOPC) appointments on a particular day, and ascertain if the health care provider could demonstrate clear communication of their appointments, to justify referral back to their general practitioners. Methods: This was a spontaneous audit of patients who failed to attend their scheduled GOPC appointments on a specific day in December 2008. We attempted to contact these patients by telephone, about 30 minutes after their missed appointments. A reaudit of the same clinic took place exactly one year later. Findings: Of 21 patients booked for the clinic, 13 (62%) failed to attend their appointments without prior notice. For most of these patients, the health care provider could not demonstrate clear communication of their appointments to them, largely due to administrative errors and inaccurate contact details in the appointments system. A snap reaudit of the same clinic exactly one year later showed that only one of 18 booked patients failed to attend without prior notice. This is the first published spontaneous audit of “did not attend” patients in a gynecologic outpatient clinic. Conclusion: When compared with retrospective or prospective audits, spontaneous audits of patients who failed to attend on the day can quickly and cheaply identify factors that can be remedied earlier. We suggest increased use of spontaneous audits as a means of enhancing patient care and reducing health care costs.
Trypan blue as an indicator of urothelial integrity

Defects in the urinary bladder urothelium may be an etiological factor in conditions such as recurrent urinary tract infection and interstitial cystitis. Initial studies have demonstrated that the colloidal dye trypan blue can be used as a marker for defects in the integrity of the mucosal epithelium. Male white New Zealand rabbits were separated into 4 groups: Control, in vivo overdistension (via saline infusion), intravesical acetone (20 ml 50% for 1 minute), and intravesical 50% DMSO (20 ml “RIMSO‐50” for 30 minutes). Both intravesical instillations were followed by 3–20 ml saline washes. Immediately following acetone or DMSO, 20 ml 1% trypan blue in saline was instilled and left in the bladder for up to 1 hour. After overdistension, 1% trypan blue in saline was infused into the bladder at the same rate until the volume reached that previously defined as the overdistension volume. Control bladders were rinsed with 20 ml saline, twice, before being filled with 20 ml of the trypan blue solution.
Self-Report of Drinking Compared to Objective Markers of Alcohol Consumption

Background: The validity of self-report data is an area of continuing concern in the substance abuse treatment field. It is uncertain how well self-report of alcohol relapse corresponds with more objective indices. Methods: We compared the self-report of alcohol relapse to collateral reports and biological indices of relapse. Twelve-month post-treatment follow-up data were collected from 94 male and female alcohol dependent veterans and 93 of their respective collateral contacts. Biological indices included breathalyzer data, and the blood enzymes aspartate aminotransferase, y-glutamyltransferase, and alanine aminotransferase. Results: A collapsed factor of the more objective indices of use was moderately associated with self-report. A logistic regression analysis revealed that only collateral reports of use predicted the self-report of alcohol relapse. The specificity of collateral report was 82.4% and the sensitivity was 71.9%. Conclusions: Collateral informants serve an important function in supporting the validity of self-report of abstinence versus relapse.
Abstract A96: Breast cancer screening resources and early-stage diagnosis in Appalachia: A geospatial perspective

Background: National Cancer Institute has designated Appalachia as a priority area characterized by significant disparities in cancer outcomes. However, little research focuses on the availability of cancer care resources in this region and how resource availability may relate to cancer outcomes. This paper will describe the distribution of breast cancer screening resources in Appalachia and examine the relationship between screening resources and breast cancer stage at diagnosis at the population level. Method: Early stage breast cancer as a percent of all breast cancer cases are computed based on the county-level registry data from the four Appalachian states during 2000–2008. Availability of breast cancer screening providers and facilities are estimated for these Appalachian states. Descriptive analysis, exploratory spatial data analysis, and spatial regression are conducted. Results: Appalachian counties have significantly fewer primary physicians, OB/GYN specialists, and diagnostic radiologists per capita than non-Appalachian counties. Spatial analysis demonstrates moderate clustering of scarce breast cancer screening resources and low percentages of early stage breast cancer in West Virginia and Appalachian Kentucky. Those diagnosed at early stages were 67.92% of all Appalachian cases vs. 68.34% of non-Appalachian breast cancer patients. The number of diagnostic radiologists per capita is significantly associated with the percentage of early stage breast cancer incidence when controlling for covariates such as county level poverty rates, uninsurance rate, percentage of adults with college degree, and primary care resources. Conclusions: Fewer diagnostic radiologists per capita in West Virginia and Appalachia Kentucky is associated with lower percentage of early stage breast cancer incidence in the Central Appalachia region. Public health interventions should include policies and regulations to improve breast cancer screening resources in this region. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A96.
Doença renal crônica, inflamação e aterosclerose: novos conceitos de um velho problema

Chronic kidney disease (CKD) has reached epidemic proportions in the last few years, generating an emergent public health problem. Common risk factors for CKD and cardiovascular disease (CVD) are now well known resulting in a high prevalence rate of cardiovascular events which are the main cause of death in CKD patients. Development of accelerated atherosclerosis is related to traditional risk factors such as diabetes mellitus, arterial hypertension, dislipidemia and smoking, but recently other non traditional factors were found to be significantly associated with cardiovascular mortality, including inflammation, oxidative stress, endothelial dysfunction and uremia, even at early stages of CKD. Inflammatory markers such as C-reactive protein, interleukin 6 and fibrinogen are all correlated with cardiovascular death. The MIA syndrome is characterized by the association between inflammation, malnutrition and accelerated atherosclerosis, a condition commonly found in uremic patients, which is related to the genesis of CVD. Other important factors are the high level of oxidative stress, expressed by oxidized lipids, proteins and carbohydrates (AGES) (Advanced Glycation End Products), which cause tissue damage and endothelial dysfunction, that is aggraveted by the uremic environment and other factors. These alterations are the basis for the pathogenic process of atherosclerosis and CVD in CKD patients, contributing to their high morbidity/ mortality. This article is an updated review of the mechanisms of inflammation and oxidative stress and their relation to atherosclerosis in CKD.
Hyperglycaemia, inflammation, RAS activation: Three culprits to blame for acute kidney injury emerging in healthy rats during general anaesthesia

Aim: Major surgery under general anaesthesia might evoke acute kidney injury (AKI), sometimes culminating in end stage renal disease. We investigated the roles of hyperglycaemia, inflammation and renin‐angiotensin system (RAS) activation in induction of AKI following anaesthesia by different anaesthetic drugs and/or regimens.
Prevalence and Predictors of Exclusive Breastfeeding at Hospital Discharge

OBJECTIVE: To estimate the population-based prevalence and predictors of exclusive breastfeeding at hospital discharge in singleton and twin term newborns. METHODS: We studied all hospital births in the province of Ontario, Canada, between April 1, 2009, and March 31, 2010, to perform a retrospective cohort study. We included live singleton and twin births, at term (37 0/7 weeks of gestation to 41 6/7 weeks of gestation), with information about feeding at maternal–newborn discharge. Descriptive statistics were performed and logistic regression was used to identify factors related to exclusive breastfeeding. RESULTS: Our study population consisted of 92,364 newborns, of whom 56,865 (61.6%) were exclusively breastfed at discharge. Older, nonsmoking, higher-income mothers with no pregnancy complications or reproductive assistance were more likely to breastfeed. Mothers of twins were less likely to exclusively breastfeed (adjusted odds ratio [OR] 0.30, 95% confidence interval [CI] 0.25–0.36) as were women who did not attend prenatal classes (adjusted OR 0.80, 95% CI 0.76–0.83). Compared with patients of obstetricians (57%), women cared for by midwives (87%, adjusted OR 4.49, 95% CI 4.16–4.85) and family physicians (67%, adjusted OR 1.54, 95% CI 1.47–1.61) were more likely to exclusively breastfeed. Breastfeeding after a planned (50%, adjusted OR 0.56, 95% CI 0.52–0.60) or unplanned (48%, adjusted OR 0.48, 95% CI 0.44–0.51) cesarean delivery was less common than after a spontaneous vaginal birth (68%). Neonates born at 39, 38, and 37 weeks of gestation (compared with 41 weeks of gestation) were increasingly less likely to breastfeed (adjusted ORs 0.93, 95% CI 0.89–0.98; 0.84, 95% CI 0.80–0.88; and 0.71, 95% CI 0.67–0.76). CONCLUSION: This large population-based study found that fewer than two thirds of term newborns are exclusively breastfed at hospital discharge, substantially lower than previously reported. LEVEL OF EVIDENCE: II
Effect of health visitors working with elderly patients in general practice

one female infant the dilatation was due to vesicoureteric reflux rather than obstruction; other abnormalities were also present and at 12 months cot death occurred. Two other baby boys, one who had urethral valves and the other anterior urethral hypoplasia, are alive at 1 year and have normal plasma biochemistry, but both have severe additional defects-Down's syndrome and Noonan's syndrome. Another boy with moderate outflow obstruction (urethral valves) is otherwise normal and has plasma concentrations of urea and creatinine within normal limits after resection of the urethral valves. In the final case termination of pregnancy was undertaken before 20 weeks' gestation. Histological examination showed gross renal dysplasia. As a result of our experience we have decided against intrauterine drainage. The outcome in these cases would not have been much influenced had we intervened in utero. Apart from difficulties in selecting for treatment fetuses who do not have other severe abnormalities, it is probable that in the cases with a fatal outcome the renal damage was already irreversible when the abnormality was evident on ultrasound scanning. Further research is certainly needed, but this should be limited to the few centres where clinical work is part of a wider programme of fetal surgery. At the moment the main contribution of antenatal detection of urinary tract abnormalities seems to be to enable investigation and treatment to begin before infection supervenes in the obstructed urinary tract.
Safety of the Pandemic H1N1 Influenza Vaccine Among Pregnant U.S. Military Women and Their Newborns

OBJECTIVES: To assess adverse pregnancy outcomes among active-duty U.S. military women who received pandemic H1N1 vaccine during pregnancy as well as adverse health outcomes among the newborns resulting from these pregnancies. METHODS: The primary study population was a retrospective cohort of active-duty U.S. military women vaccinated during pregnancy with either the pandemic H1N1 vaccine between October 2009 and June 2010 or with seasonal influenza vaccine between October 2008 and June 2009. Rates of pregnancy loss, preeclampsia or eclampsia, and preterm labor were compared between pandemic H1N1 vaccine-exposed (n=10,376) and seasonal influenza vaccine-exposed pregnancies (n=7,560). A secondary study population consisted of newborns resulting from these pregnancies. Rates of preterm birth, birth defects, fetal growth problems, and the male-to-female sex ratio were compared between newborns exposed to pandemic H1N1 vaccine and newborns exposed to seasonal influenza vaccine in utero. RESULTS: No significant differences were observed in rates of pregnancy loss (6.4% compared with 6.5%), preeclampsia or eclampsia (5.8% compared with 5.2%), or preterm labor (6.5% compared with 6.2%) between pandemic H1N1 vaccine-exposed and seasonal influenza vaccine-exposed pregnancies. Furthermore, no significant differences were observed in rates of preterm birth (6.2% compared with 6.3%), birth defects (2.1% compared with 2.0%), fetal growth problems (2.6% compared with 2.4%), or the male-to-female sex ratio (1.05 compared with 1.07) between newborns exposed in utero to pandemic H1N1 vaccine compared with seasonal influenza vaccine. Rates of all outcomes were lower or similar to overall general population rates. This study had at least 80% power to detect hazard ratios of 1.18–1.21 or odds ratios of 1.10–1.36, depending on outcome prevalence. CONCLUSION: No adverse pregnancy or newborn health outcomes associated with pandemic H1N1 vaccination during pregnancy were noted among our cohort. These findings should be used to encourage increased vaccine coverage among pregnant women. LEVEL OF EVIDENCE: II
Replenishing our defensive microbes

Large‐scale characterization of the human microbiota has largely focused on Western adults, yet these populations may be uncharacteristic because of their diets and lifestyles. In particular, the rise of “Western diseases” may in part stem from reduced exposure to, or even loss of, microbes with which humans have coevolved. Here, we review beneficial microbes associated with pathogen resistance, highlighting the emerging role of complex microbial communities in protecting against disease. We discuss ways in which modern lifestyles and practices may deplete physiologically important microbiota, and explore prospects for reintroducing or encouraging the growth of beneficial microbes to promote the restoration of healthy microbial ecosystems.
Simulated anaesthetists in high fidelity simulations for surgical training: feasibility of a training programme for actors

Background: High fidelity simulations within the operating theatre (OT) require physical infrastructure and a full OT team. Such teams place heavy demands on clinical service. Research and training programmes in our surgical department were often compromised by the late cancellation of anaesthetists. Aims: This paper describes and evaluates a training programme in which actors were trained as simulated anaesthetists. Methods: The training programme was developed, piloted and implemented in a surgical education programme. Evaluation consisted of interviews with actors after the series of simulations. Surgical participants were not informed that the anaesthetist was an actor until after the simulation when they completed an interview and a 10-point authenticity scale (1 = not at all to 10 = highly authentic). Results: Three actors played the role of anaesthetists in 34 scenarios with 17 surgeons in simulations of carotid endarterectomy. Although initially anxious about their role, actors found the training programme valuable and came to feel confident. Mean ratings of anaesthetist authenticity was 8.1 (Range 2–10). Surgeons? comments showed that in most scenarios they found the anaesthetist? s performance highly authentic. Conclusions: Although this study demonstrates the feasibility of using actors as anaesthetists in high fidelity surgical simulations, there are also limitations. Factors contributing to success included: selective actor recruitment; written training materials; formal OT orientation, audio link between the control room and the actor; the opportunity to rehearse; and, structured observations.
Stem cells and aging from a quasi‐immortal point of view

Understanding aging and how it affects an organism's lifespan is a fundamental problem in biology. A hallmark of aging is stem cell senescence, the decline of functionality, and number of somatic stem cells, resulting in an impaired regenerative capacity and reduced tissue function. In addition, aging is characterized by profound remodeling of the immune system and a quantitative decline of adequate immune responses, a phenomenon referred to as immune‐senescence. Yet, what is causing stem cell and immune‐senescence? This review discusses experimental studies of potentially immortal Hydra which have made contributions to answering this question. Hydra transcription factor FoxO has been shown to modulate both stem cell proliferation and innate immunity, lending strong support to a role of FoxO as critical rate‐of‐aging regulator from Hydra to human. Constructing a model of how FoxO responds to diverse environmental factors provides a framework for how stem cell factors might contribute to aging.
Rural learning is more than marks: Sensitised to knowledge

Introduction: Twenty-five percent of Western Australian medical students must undertake a full year of their clinical training in rural areas. This training must be up to standard and substantial evaluation is undertaken to ensure equity with metropolitan trained students. Aim of the study: To determine whether students considered themselves sufficiently and satisfactorily prepared for their sixth year of medical studies after studying in rural areas in their fifth year. Method: Selected students were interviewed 12 months after completion of their rural study. Open ended questions were asked, interviews taped, transcribed, themes selected and compared back to the data for confirmation and expansion of the concepts. Results: The rural experience was experienced as offering a lot more than the straight city training. Students moved from theoretical knowledge (knowing what they were taught) to a new way of experiential knowing that had consequences for their subsequent learning, clinical behaviour and attitudes. Discussion: The current model of tertiary hospital teaching aims to give students as wide a range of clinical experiences as possible with consequences that clinical variety and volume of experiences necessarily comes at the expense of longitudinal exposure to both patient care and collegial relationships. Students sensitized to such knowledge felt a strong emotional connection to rural life.
Replication protein A prevents promiscuous annealing between short sequence homologies: Implications for genome integrity

Replication protein A (RPA) is the main eukaryotic single‐stranded DNA (ssDNA) binding protein, having essential roles in all DNA metabolic reactions involving ssDNA. RPA binds ssDNA with high affinity, thereby preventing the formation of secondary structures and protecting ssDNA from the action of nucleases, and directly interacts with other DNA processing proteins. Here, we discuss recent results supporting the idea that one function of RPA is to prevent annealing between short repeats that can lead to chromosome rearrangements by microhomology‐mediated end joining or the formation of hairpin structures that are substrates for structure‐selective nucleases. We suggest that replication fork catastrophe caused by depletion of RPA could result from cleavage of secondary structures by nucleases, and that failure to cleave hairpin structures formed at DNA ends could lead to gene amplification. These studies highlight the important role RPA plays in maintaining genome integrity.
Visual Performance After Contralateral Implantation of Multifocal Intraocular Lenses With +3.0 and +4.0 Diopter Additions

PurposeTo evaluate visual performance after contralateral implantation of AcrySof ReSTOR aspheric intraocular lenses (IOLs) with +3.0 and +4.0 diopter near additions. DesignThis was a retrospective case study conducted at Tokyo Dental College Suidobashi Hospital in Tokyo, Japan. MethodsEleven patients who were implanted with the SN6AD1 IOL and the SN6AD3 IOL contralaterally were included in this study. The distance, intermediate (1 m, 50 cm), and near (40 and 30 cm) uncorrected and corrected binocular visual acuity (VA), contrast sensitivity, depth of focus, and patient satisfaction were assessed more than 1 month postoperatively. ResultsPostoperatively, the mean uncorrected (corrected) binocular logarithm of the minimum angle of resolution VA levels were as follows: distance, −0.120 (−0.163); intermediate, 1 m, 0.226 (0.012) and 50 cm, 0.037 (0.006); and near, 40 cm, 0.067 (−0.040) and 30 cm, 0.091 (−0.053). The depth of focus had a smooth curve with double peaks. The mean contrast sensitivity was normal at all spatial frequencies. All patients were spectacle independent and expressed high satisfaction. ConclusionsContralateral implantation of multifocal IOLs with +3.0 and +4.0 D additions takes advantage of the good uncorrected near VA provided by both IOLs and may be an option for patients who require a broader range of good uncorrected near VA.
Insider trading: Extracellular matrix proteins and their non‐canonical intracellular roles

In metazoans, the extracellular matrix (ECM) provides a dynamic, heterogeneous microenvironment that has important supportive and instructive roles. Although the primary site of action of ECM proteins is extracellular, evidence is emerging for non‐canonical intracellular roles. Examples include osteopontin, thrombospondins, IGF‐binding protein 3 and biglycan, and relate to roles in transcription, cell‐stress responses, autophagy and cancer. These findings pose conceptual problems on how proteins signalled for secretion can be routed to the cytosol or nucleus, or can function in environments with diverse redox, pH and ionic conditions. We review evidence for intracellular locations and functions of ECM proteins, and current knowledge of the mechanisms by which they may enter intracellular compartments. We evaluate the experimental methods that are appropriate to obtain rigorous evidence for intracellular localisation and function. Better insight into this under‐researched topic is needed to decipher the complete spectrum of physiological and pathological roles of ECM proteins.
Abscisic acid and other plant hormones: Methods to visualize distribution and signaling

The exploration of plant behavior on a cellular scale in a minimal invasive manner is key to understanding plant adaptations to their environment. Plant hormones regulate multiple aspects of growth and development and mediate environmental responses to ensure a successful life cycle. To monitor the dynamics of plant hormone actions in intact tissue, we need qualitative and quantitative tools with high temporal and spatial resolution. Here, we describe a set of biological instruments (reporters) for the analysis of the distribution and signaling of various plant hormones. Furthermore, we provide examples of their utility for gaining novel insights into plant hormone action with a deeper focus on the drought hormone abscisic acid.