Miracle-dz/UniFAR-FTUs huggingface dataset:
New Insights on the Pathophysiology of Fatigue in MS: A fMRI Study of the Motor Network (P6.141)

OBJECTIVE: We investigated the functional correlates of cognitive and motor fatigue in multiple sclerosis (MS) and the influence of disease duration on these findings. Adaptation of motor network recruitment during prolonged effort were also assessed. BACKGROUND: An abnormal recruitment of the network connecting the basal ganglia to the frontal lobes occurs in fatigued MS patients. DESIGN/METHODS: Motor fMRI was obtained from 79 MS patients (50 with fatigue [F] and 29 without fatigue [nF]) and 26 matched healthy controls (HC). The severity of cognitive and physical fatigue was rated using the Modified Fatigue Impact Scale (MFIS). Full factorial and multiple regression analyses were performed (SPM8). RESULTS: Compared with HC, nF and F-MS patients had increased activations of the right precentral gyrus, right inferior temporal gyrus (ITG) and bilateral cerebellum. Compared to HC and nF patients, F-MS patients had reduced activations of the left middle temporal gyrus, left supplementary motor area (SMA), bilateral superior frontal gyrus, left postcentral gyrus, left putamen and bilateral caudate nucleus. They also showed selective increased activation of the right middle frontal gyrus, which was mainly driven from F MS patients with disease duration longer than 5 years. HC showed a reduced activity of the SMA and right precentral gyrus and increased activity of the basal ganglia over time. Such a behaviour was significantly impaired in F MS patients. In MS patients, higher MFG activity was related to cognitive and physical MFIS score. Physical MFIS score was related to reduced activity within the right thalamus and SMA. CONCLUSIONS: Distributed abnormalities of activation and impaired timing of communication between different areas of the motor network occur in fatigued MS patients. The involvement of specific GM regions may contribute to explain differences between cognitive and motor fatigue. Study Supported by: The Italian Ministry of Health (GR-2008-1138784 and GR-2009-1529671). Disclosure: Dr. Riccitelli has nothing to disclose. Dr. Rocca has received personal compensation for activities with Novartis, Biogen Idec, and Serono, Inc. as a speaker. Dr. Meani has nothing to disclose. Dr. Rodegher has nothing to disclose. Dr. Colombo has nothing to disclose. Dr. Falini has nothing to disclose. Dr. Comi has received personal compensation for activities with Teva, Novartis, Genzyme, Merck Serono, Biogen Idec, Bayer, Actelion Pharmaceuticals, Almirall, and Serono. Cure PSP, Alzheimer9s Drug Discovery Foundation, and the Jacques and Gloria Gossweiler
Pain Management at the End of Life and the Principle of Double Effect: A Jewish Perspective

Controlling the pain of patients at the end of life can be challenging both clinically and ethically. One ethical obstacle arises when analgesia has the potential to hasten the death of the patient, thus, invoking the principle of “double effect” to resolve such dilemmas. This article will develop, analyze, and apply that principle from a Jewish perspective. It is this writer's opinion, that pain management can be administered effectively from a Jewish perspective in most clinical scenarios.
Residential Care Institutions for People with Disabilities in Russia: Questioning Totality

This paper applies the concept of total institutions, introduced by Erving Goffman, to the case of special care institutions for people with intellectual disabilities in present-day Russia. These institutions represent a classic type of organization that could be studied through the lenses of the total institutions theory and demonstrate the typical features of such institutions, among them the crowded conditions in which the inmates live, a lack of privacy, universal scheduling of daily routines, strict hierarchy, a system of punishments and privileges as an instrument of control, and exploitation of inmate labour for the benefit of the institution. Drawing upon data generated by participant observation and implementing the analytical frame of symbolic interactionism at the level of routine interactions, this paper questions the 'totality' of the control mechanisms, power relations, and standardization processes found within the special care institutions for people with disabilities. One conclusion is that, although inner life in a total institution is to a certain extent subject to strict official rules, it is not limited to them. This 'total' character is manifested at the level of the structural organization of the institutions, institutional logic, and the staff’s discourses, but not at the level of routine interactions. One factor challenging the totality of these institutions is the emergence of new attitudes to people with disabilities manifested by NGO volunteers, who confront the dominant patriarchal approach. In their practice they implement principles of 'normalization' ideology that helps to enhance the agency of the inmates. This enhanced agency plays an important role in managing the 'totality' in everyday interactions with the staff.
Role of Therapeutic Apheresis in the Treatment of Idiopathic Nephrotic Syndrome

Idiopathic NS (INS) is characterized by diffuse foot process effacement on electron microscopy and minimal changes (minimal change nephropathy [MCN]), or focal segmental glomerular sclerosis (FSGS) on optical microscopy. MCN is the most common form of INS in children and is sensitive to corticosteroid therapy in almost cases. FSGS is more common in adult patients and has a less favourable course. Most of drug resistant patients develop terminal renal failure in 6–8 years. Moreover, FSGS reappears in many cases after renal transplantation. Genetic or secondary forms of INS have been identified and their response to therapy is unpredictable, whereas the recurrent forms in transplanted kidney are considered a more omogeneous group. Sera from patients with FSGS may contain some proteinuric or permeability factors (PFs), which have been partially identified. Corticosteroids and immunosuppressive drugs are the mainstay of the standard therapy. In steroid resistant cases, new therapeutic strategies directed against the action of PFs are under evaluation. The removal of PFs by means of Plasmapheresis or selective aphesis has been associated with proteinuria reduction. In this review we will analyze the preliminary results of the new therapies and the main studies on apheretic treatment in steroid resistant patients affected by INS.
The role of clinical leadership in the implementation of large-scale Electronic Health Records in hospitals

Background: Many Information and Communication Technology (ICT) implementations fail to deliver described effects and organizational goals. Empirical evidence suggests that organizational and socio-technical challenges are frequently overlooked. Objective: The proposed PhD research project aims to develop theoretically informed guidelines and strategies for how clinical managers should be positioned and engaged in ICT implementation, change management and work practice adaptation. Methods: This qualitative study will employ an interpretive approach with data capturing at three different organizational levels: Top management, mid-level clinical management, clinicians. Empiracally we will use the implementation of a structured Electronic Health Record in Norwegian hospitals as case. Conclusion: A better understanding of how ICT portfolios can be governed, and how and too what degree clinical managers should be involved in an accusation and implementation process can improve outcomes and organizational effects of clinical ICT implementations. The proposed research project will study the implementation of large-scale clinical ICT, with the aim of identifying and describing strategies for what role and involvement clinical managers should have in both development, implementation and governance in order to facilitate the needed change management within own organization.
Vitiligo pathogenesis and immunotherapy of melanoma

Thymic T cell selection mechanisms generate a cross-reactive, self-MHC restricted peripheral T cell pool. Affinity and avidity are of profound influence on this selection and the generation of immunity. Auto-reactive T cells can escape thymic deletion by lowering their avidity, and retain this ‘tuned’ state in the periphery. Upon activation, tuned T cells can cause autoimmunity, while immunotherapeutic strategies may be hampered by existing T cell tolerance. The regulation of T cell avidity and tuning therefore determines the balance between tolerance and autoimmunity and should be taken into account in the design of therapeutic strategies aimed at T cell reactivity.
Foundations for Health Promotion with Youth: A Review of Observations from the Bogalusa Heart Study

Abstract Cardiovascular risk factors associated with underlying coronary artery and hypertensive disease develop during childhood. Although the major adult heart diseases do not become symptomatic until adulthood, cardiovascular risk factors predictive of these diseases can be identified early in life. Race- and gender-specific observations from childhood to young adulthood provide clues to the early onset of cardiovascular disease risk. Observations on the distributions of levels, tracking, and determinants of blood pressure and serum lipids and lipoproteins and the impact of obesity on cardiovascular risk are of particular importance in understanding the clinical presentation of cardiovascular diseases later in life. Genetic and environmental factors obviously determine the development of the major cardiovascular diseases; however, there is a growing awareness that certain factors, for example, improper diet, physical inactivity, alcohol consumption and cigarette smoking, that lead to heart disease are .
ADHD Often Undiagnosed in Adults

SAN FRANCISCO—Although attentiondeficit/hyperactivity disorder (ADHD) was long perceived as a disorder of children, it is now recognized as a chronic condition persisting into adulthood. But it is often undiagnosed in adults—an unfortunate oversight, because appropriate treatment often can help those who’ve struggled with the effects of their condition for years. ADHD specialists explored advances in diagnosis and treatment of the disorder at the annual meeting of the American Psychiatric Association (APA), and in subsequent interviews.
Assessing the influence of exposure to violent living condition, knowledge, and personal motivation on human immunodeficiency virus infection prevention behavior among historically black college students.

Aim: This study assesses the effects of prevention education, prevention personal motivation, prevention knowledge, and past exposure to violent living conditions on human immunodeficiency virus (HIV) infection prevention behavioral skills among historically black college and University (HBCU) students. Study Design: Quasi-experimental One-shot Case Study Design. Place and duration of study: Fayetteville State University; November 2012 to May 2013. Methodology: Survey data of indicators of the four Information-Motivation-Behavioral skills (IMB) model’s latent constructs prevention information or knowledge, prevention Research Article British Journal of Medicine & Medical Research, 4(1): 572-589, 2014 573 motivation, and prevention behavioral skills, and past exposure to violent living conditions (PEVLC)prevention was collected from students attending an HBCU. Exploratory principal component factor analysis and Cronbach’s alpha test were performed to identify the factorial structure of the PEVLC questionnaire and reliability of the violent exposure subscales, respectively. Structural equation modeling analysis was performed to estimate the overall model fit indices and the magnitude of effects of prevention motivation, PEVLC prevention and prevention information or knowledge on the prevention behavior of the students. Results: The analysis found that personal motivation to prevent HIV infection and knowledge of HIV prevention had a positive moderate and significant effect on HIV prevention behavior. Witnessing violence with weapons prevention had a large, but insignificant effect on HIV prevention behavior. Exposure to physical violence prevention and weapon victim prevention had no effect on HIV prevention behavior. HIV prevention knowledge, witnessing violence prevention, and violence victimization prevention had no meaningful effect on prevention behavior of HBCU students. Conclusion: Collectively, these findings suggest that to be effective, the focus of HIV prevention programs in HBCUs may be on promoting personal motivation and HIV education, and identifying and treating students who have been exposed to past weapon and sexual violent living conditions for post-traumatic stress disorder.
Demographic and socioeconomic characteristics of tuberculosis mortality in San Cristóbal de Las Casas, Chiapas, Mexico 1997-2009

Objective: To analyze the demographic and socio-economic characteristics of deceased tuberculosis patients. Subjects: Individuals who died between 1997 and 2009 in San Cristobal de Las Casas (San Cristobal), Chiapas, Mexico and had previously been registered as tuberculosis patients. Methods: All reports and death certificates from the San Cristobal civil registry were reviewed. We identified and analyzed cases in which the cause of death was listed as tuberculosis (n=79). Socio-economic data was taken from the death certificate. To analyze the degree of social marginalization, addresses of decedents were geo-coded by Basic Geostatistical Area (BGA). Results: Most patients dying of tuberculosis had one or more of the following characteristics: 1) they lived in an BGA with high or very high levels of social marginalization, 2) they had low educational attainment; 3) they were peasants, migrants, or housewives, and/or 4) they were not covered by so-cial security. Conclusion: Most patients dying of tuberculosis are socially vulnerable. In order to prevent further mor-tality from tuberculosis in the suburbs of San Cristobal, TB detection and treatment programs must be significantly strengthened amongst marginalized groups.
Secondary students' views regarding the use of computers in mathematics learning:exploring the engagement-gender-achievement nexus

Abstact: The aim of this study was to investigate the complex relationship between the students’ mathematics confidence, confidence with technology, attitude to learning mathematics with technology, affective engagement and behavioural engagement, achievement, gender and year level. The participants were Middle High school students from co-educational schools in Greece. A factor analytic data reduction method was used, followed by a Cluster Analysis. Gender differences as well as differences between the seven resulting clusters were investigated by using a MANOVA (Only the Cluster Analysis and partial MANOVA results are reported in this paper). It was found that boys expressed more positive views towards mathematics and more positive views towards the use of technology in mathematics, compared to girls. It was also found that high achievement in mathematics was associated with high levels of mathematics confidence, strongly positive levels of affective engagement and behavioural engagement, high confidence in using technology and a strongly positive attitude to learning mathematics with technology.
On Butterflies and Silences: Exploring Teachers' and Students' Experiences in High School Biology Classrooms

This paper is a hermeneutic inquiry into how students and teachers experience the biology classroom and how they navigate between expectations from external factors leading to classrooms that are focused on memorizing facts and the desire to engage students deeply in the discipline of biology. From data collected from semi-structured interviews with teachers and students, and an open-ended questionnaire, the paper explores the experiences and assumptions about teaching biology that is prevalent in the classroom. The inability of teachers or students to be able to point to memorable experiences within the classroom leads to a discussion of students’ experience of biology as a passive transmission of facts that are often considered irrelevant and boring. The paper explores the teachers’ sense of conflict between wanting to instill a love for biology in their students and their perceived role in preparing students to memorize information for tests and prepare students for post-secondary school.
Longitudinal Clinical Changes of Non-Fluent/Agrammatic Primary Progressive Aphasia as Tau Spectrum Disorder: A Case Report

Frontotemporal dementia (FTD) is the second most common early onset neurodegenerative disorder with an average age of onset of 50–60 years. It is clinically characterized by progressive behavioral changes and frontal executive deficits and/or selective language difficulties.1 As a neuropathologically heterogeneous disorder, it encompasses a range of different clinical syndromes, including the behavioral variant of FTD, the language variants, the semantic variant primary progressive aphasia, and nonfluent/agrammatic primary progressive aphasia (nfvPPA). 1,2 The nfvPPA is clinically characterized by profoundly slowed and effortful non-fluent speech resulting from several different pathologies.3 Previous studies have reported that nfvPPA associated with taupathy has overlapping clinical features such as corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP) that may represent different points of a single disease spectrum.4-7 To the best of our knowledge, there are only a few case reports on tau spectrum disorder including nfvPPA, CBD, and PSP that have described detailed changes of the clinical and laboratory changes based on longitudinal follow-ups. Herein, we report a patient with clinical course of nfvPPA, CBD, and PSP with initial clinical presentation of a progressive speech disorder.
RISK REDUCTION OF LIFESTYLE‐RELATED DISEASES IN YOUNG ADULTS ON SOY‐ OR FISH‐RICH TRADITIONAL JAPANESE MEALS

1 One hundred and sixty‐four female junior college students aged 18–24 were randomized into three groups, with each group consuming a specified lunch for 5 weeks: group C (ordinary school lunch; K), group S (K + soy‐rich lunch containing more than 40 mg soy isoflavones) and group F (K + fish containing more than 700 mg DHA). 2 Of the 157 subjects who completed the study (46 from group C, 54 from group S and 57 from group F), triglycerides (TG) in subjects of S and F groups were significantly decreased from the baseline (P < 0.01 and P < 0.05, respectively), and a significant intergroup difference was observed between C and F groups (P < 0.05). Body fat percentage (BFP) was significantly increased from the baseline in group C (P < 0.01), and a significant intergroup difference was observed in the amount of change between groups C and S. 3 The TG of subjects with BFP greater than or equal to 28% were significantly decreased from the baseline in S and F groups (P < 0.01 and P < 0.05, respectively). The TG of subjects with BFP less than 28% did not decrease significantly. 4 Diets enriched with soy or fish could effectively reduce the risk of lifestyle‐related diseases in adolescent Japanese women.
Modelling connections in aged care: Clinical placements for undergraduate students in aged care-A systematic review

Background: This systematic review was conducted as the first part of the Modelling Connections in Aged Care project in order to identify available evidence related to the operation of undergraduate clinical placements in aged care. Method: Databases containing journal articles and reports published during the years 2000 – 2005 in the fields of nursing, general health sciences and service delivery, education, aged care, psychology, other social sciences, quality assurance, treatment guidelines, and systematic reviews were searched, followed by hand searching of selected journals and the reference lists of numerous reports and investigations. Four reviewers then collaborated to read and rate all retained items against set criteria Results: The total number of items selected for a full review was 173. We found that few items: · focus on the specific circumstances and needs of aged care nursing · reported studies/gathered data from across national/cultural boundaries · reported studies conducted in Australia · were multi-site studies. · involved careful comparative elements, even pre- and post – testing of the same group being rather rare · displayed sufficient ‘scientific rigour’ as that is conventionally understood in the systematic review literature, with only one item rated Level II and a total of only 13% of all the evidence being rated in the level II – Level IV band. Conclusions: The systematic review revealed that, taken overall, the literature on this sphere of education is abundant but often disappointing, and reliable evidence on the many difficult issues clinical education confronts is scarce. This highlights the importance of obtaining Level II evidence in the implementation of an evidence based/best practice model of clinical placements in aged care.
Immunology of HCV and HBV in Renal Failure and Transplantation

B hepatitis C virus (HCV) and hepatitis B virus (HBV) infections are common in patients with end-stage renal disease (ESRD) and in renal transplant recipients (1-4). Although both viral replication and liver disease progression are accelerated after renal transplantation, the subsequent long-term impact of chronic HBV and chronic HCV is unclear. Chronic renal failure patients are at particular risk of HBV infection. Early studies have demonstrated that renal failure patients benefit from vaccination; however, not all studies have consistently shown benefit. HCV infection is common among patients with ESRD (5, 6). However, the effect of HCV infection on survival among ESRD patients, and the impact of renal transplantation on the course of HCV infection have not been adequately defined. The primary goal of treatment of both chronic hepatitis B and C should be eradication of the viral infection. Secondary aims are prevention of decompensated cirrhosis or hepatocellular carcinoma through sustained viral suppression. When determining the optimal treatment regimen, several questions must be addressed which antiviral agents, whom to treat, and when to start antiviral therapy. Interferon has direct antiviral and potent immunomodulatory actions (7). Development of screening serological tests for detection of HBV and HCV infections has significantly reduced the incidence rates of these infections after renal transplantation (8). However, chronic liver disease resulting from HBV and HCV infections is still a major concern in kidney recipients (9). It is certain that immunosuppressive agents facilitate higher replication rates of both
Comparing the Impact of Open Access (OA) vs. Non-OA Articles in the Same Journals

The way to test the impact advantage of Open Access (OA) is not to compare the citation impact factors of OA and non-OA journals but to compare the citation counts of individual OA and non-OA articles appearing in the same (non-OA) journals. Such ongoing comparisons are revealing dramatic citation advantages for OA.