title stringlengths 0 901 | abstract stringlengths 3 9.89k | PMID int64 22 25.3M | embedding listlengths 768 768 |
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A review of the effect of traffic and weather characteristics on road safety. | Taking into consideration the increasing availability of real-time traffic data and stimulated by the importance of proactive safety management, this paper attempts to provide a review of the effect of traffic and weather characteristics on road safety, identify the gaps and discuss the needs for further research. Despite the existence of generally mixed evidence on the effect of traffic parameters, a few patterns can be observed. For instance, traffic flow seems to have a non-linear relationship with accident rates, even though some studies suggest linear relationship with accidents. On the other hand, increased speed limits have found to have a straightforward positive relationship with accident occurrence. Regarding weather effects, the effect of precipitation is quite consistent and leads generally to increased accident frequency but does not seem to have a consistent effect on severity. The impact of other weather parameters on safety, such as visibility, wind speed and temperature is not found straightforward so far. The increasing use of real-time data not only makes easier to identify the safety impact of traffic and weather characteristics, but most importantly makes possible the identification of their combined effect. The more systematic use of these real-time data may address several of the research gaps identified in this research. | 25,086,442 | [
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Using QALYs in telehealth evaluations: a systematic review of methodology and transparency. | The quality-adjusted life-year (QALY) is a recognised outcome measure in health economic evaluations. QALY incorporates individual preferences and identifies health gains by combining mortality and morbidity into one single index number. A literature review was conducted to examine and discuss the use of QALYs to measure outcomes in telehealth evaluations. Evaluations were identified via a literature search in all relevant databases. Only economic evaluations measuring both costs and QALYs using primary patient level data of two or more alternatives were included. A total of 17 economic evaluations estimating QALYs were identified. All evaluations used validated generic health related-quality of life (HRQoL) instruments to describe health states. They used accepted methods for transforming the quality scores into utility values. The methodology used varied between the evaluations. The evaluations used four different preference measures (EQ-5D, SF-6D, QWB and HUI3), and utility scores were elicited from the general population. Most studies reported the methodology used in calculating QALYs. The evaluations were less transparent in reporting utility weights at different time points and variability around utilities and QALYs. Few made adjustments for differences in baseline utilities. The QALYs gained in the reviewed evaluations varied from 0.001 to 0.118 in implying a small but positive effect of telehealth intervention on patient's health. The evaluations reported mixed cost-effectiveness results. The use of QALYs in telehealth evaluations has increased over the last few years. Different methodologies and utility measures have been used to calculate QALYs. A more harmonised methodology and utility measure is needed to ensure comparability across telehealth evaluations. | 25,086,443 | [
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Induction and suppression of innate antiviral responses by picornaviruses. | The family Picornaviridae comprises of small, non-enveloped, positive-strand RNA viruses and contains many human and animal pathogens including enteroviruses (e.g. poliovirus, coxsackievirus, enterovirus 71 and rhinovirus), cardioviruses (e.g. encephalomyocarditis virus), hepatitis A virus and foot-and-mouth disease virus. Picornavirus infections activate a cytosolic RNA sensor, MDA5, which in turn, induces a type I interferon response, a crucial component of antiviral immunity. Moreover, picornaviruses activate the formation of stress granules (SGs), large aggregates of preassembled mRNPs (messenger ribonucleoprotein particles) to temporarily store these molecules upon cellular stress. Meanwhile, picornaviruses actively suppress these antiviral responses to ensure efficient replication. In this review we provide an overview of the induction and suppression of the MDA5-mediated IFN-α/β response and the cellular stress pathway by picornaviruses. | 25,086,453 | [
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The risks for adolescents of negatively biased self-evaluations of social competence: the mediating role of social support. | This study conducted among 544 adolescents (M = 15.1 years, SD = .82) examined whether perceived social support from parents and peers mediated the relationship between biased self-evaluations of social competence and internalizing problems. The results showed negative links between bias in self-evaluation and depressive symptoms, social anxiety and social avoidance. Bias in self-evaluation of social competence was more strongly related to perceived peer support than perceived parental support. Gender differences were observed in the mediating role of social support. Among boys, parental support was a partial mediator only of the link between bias in self-evaluation and depressive symptoms. While perceived peer support was a partial mediator of the links between bias in self-evaluation and depressive symptoms, social anxiety and social avoidance in girls, this was the case only for social avoidance in boys. These findings suggest that girls may show vulnerability to peer emotional support at an earlier age than boys. | 25,086,456 | [
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National trends in school victimization among Asian American adolescents. | The "model minority" perception of Asian American students often ignores the academic and social challenges that many face in schools. One area that has received less attention is the school victimization experiences of Asian American adolescents. While some qualitative researchers have explored factors contributing to school victimization in recent years, missing in the literature is the scope of these incidents among Asian Americans. This paper contributes to this literature by (1) examining national trends in the victimization of Asian American adolescents in schools over the last decade and (2) investigating how victimization varies according to their gender, socioeconomic status, and achievement levels. The results show that although Asian American adolescents are consistently less likely to be bullied relative to other students, they are more likely to report experiences of racial discrimination. Victimization incidents for Asian Americans also differ by gender and academic achievement levels. | 25,086,460 | [
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Self-reported rates of interpersonal conflict vary as a function of questionnaire format: why age-related trends in disagreement (and other events) may not be what they seem. | Two studies examine whether self-reports of interpersonal conflict differ as a function of how the question is asked. In Study 1, 56 U.S. college students (M = 20.7 years) completed different versions of a questionnaire, four times, at one week intervals. Participants reported more conflicts with the aid of memory prompts than without, an effect that was especially strong when questions focused on events from the previous day. In Study 2, 123 middle-school students (M = 11.08 years) and 128 primary school students (M = 8.2 years) from the same region completed one of two questionnaires describing conflict during the previous day. Children reported more conflicts with memory prompts than without. The effect was twice as strong for younger children than older children. The findings suggest that increases in reports of conflict across the transition into adolescence may be due to improvements in the ability to recall and recount events in the absence of memory cues. | 25,086,497 | [
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High-field MR imaging in pediatric congenital heart disease: initial results. | Comprehensive assessment of pediatric congenital heart disease (CHD) at any field strength mandates evaluation of both vascular and dynamic cardiac anatomy for which diagnostic quality contrast-enhanced magnetic resonance angiography (CEMRA) and cardiac cine are crucial. To determine whether high-resolution (HR) CEMRA and steady-state free precession (SSFP) cine can be performed reliably at 3.0 T in children with CHD and to compare the image quality to similar techniques performed at 1.5 T. Twenty-eight patients with a median age of 5 months and average weight 9.0 ± 7.8 kg with suspected or known CHD were evaluated at 3.0 T. SSFP cine (n = 86 series) and HR-CEMRA (n = 414 named vascular segments) were performed and images were scored for image quality and artifacts. The findings were compared to those of 28 patients with CHD of similar weight who were evaluated at 1.5 T. Overall image quality on HR-CEMRA was rated as excellent or good in 96% (397/414) of vascular segments at 3.0 T (k = 0.49) and in 94% (349/371) of vascular segments at 1.5 T (k = 0.36). Overall image quality of SSFP was rated excellent or good in 91% (78/86) of cine series at 3.0 T (k = 0.55) and in 81% (87/108) at 1.5 T (k = 0.47). Off-resonance artifact was common at both field strengths, varied over the cardiac cycle and was more prevalent at 3.0 T. At 3.0 T, off-resonance dark band artifact on SSFP cine was absent in 3% (3/86), mild in 69% (59/86), moderate in 27% (23/86) and severe in 1% (1/86) of images; at 1.5 T, dark band artifact was absent in 16% (17/108), mild in 69% (75/108), moderate in 12% (13/108) and severe in 3% (3/108) of cine images. The signal-to-noise ratio and contrast-to-noise ratio of both SSFP cine and HR-CEMRA images were significantly higher at 3.0 T than at 1.5 T (P < 0.001). Signal-to-noise ratio and contrast-to-noise ratio of high-resolution contrast-enhanced magnetic resonance angiography and SSFP cine were higher at 3.0 T than at 1.5 T. Artifacts on SSFP cine were cardiac phase specific and more prevalent at 3.0 T such that frequency-tuning was required in one-third of exams. In neonates, high spatial resolution CEMRA was highly reliable in defining extracardiac vascular anatomy. | 25,086,500 | [
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Phen-Gen: combining phenotype and genotype to analyze rare disorders. | We introduce Phen-Gen, a method that combines patients' disease symptoms and sequencing data with prior domain knowledge to identify the causative genes for rare disorders. Simulations revealed that the causal variant was ranked first in 88% of cases when it was a coding variant-a 52% advantage over a genotype-only approach-and Phen-Gen outperformed other existing prediction methods by 13-58%. If disease etiology was unknown, the causal variant was assigned the top rank in 71% of simulations. Phen-Gen is available at http://phen-gen.org/. | 25,086,502 | [
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Forecasting longitudinal changes in oropharyngeal tumor morphology throughout the course of head and neck radiation therapy. | To create models that forecast longitudinal trends in changing tumor morphology and to evaluate and compare their predictive potential throughout the course of radiation therapy. Two morphology feature vectors were used to describe 35 gross tumor volumes (GTVs) throughout the course of intensity-modulated radiation therapy for oropharyngeal tumors. The feature vectors comprised the coordinates of the GTV centroids and a description of GTV shape using either interlandmark distances or a spherical harmonic decomposition of these distances. The change in the morphology feature vector observed at 33 time points throughout the course of treatment was described using static, linear, and mean models. Models were adjusted at 0, 1, 2, 3, or 5 different time points (adjustment points) to improve prediction accuracy. The potential of these models to forecast GTV morphology was evaluated using leave-one-out cross-validation, and the accuracy of the models was compared using Wilcoxon signed-rank tests. Adding a single adjustment point to the static model without any adjustment points decreased the median error in forecasting the position of GTV surface landmarks by the largest amount (1.2 mm). Additional adjustment points further decreased the forecast error by about 0.4 mm each. Selection of the linear model decreased the forecast error for both the distance-based and spherical harmonic morphology descriptors (0.2 mm), while the mean model decreased the forecast error for the distance-based descriptor only (0.2 mm). The magnitude and statistical significance of these improvements decreased with each additional adjustment point, and the effect from model selection was not as large as that from adding the initial points. The authors present models that anticipate longitudinal changes in tumor morphology using various models and model adjustment schemes. The accuracy of these models depended on their form, and the utility of these models includes the characterization of patient-specific response with implications for treatment management and research study design. | 25,086,518 | [
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Independent calculation of dose distributions for helical tomotherapy using a conventional treatment planning system. | The dosimetric verification of treatment plans in helical tomotherapy usually is carried out via verification measurements. In this study, a method for independent dose calculation of tomotherapy treatment plans is presented, that uses a conventional treatment planning system with a pencil kernel dose calculation algorithm for generation of verification dose distributions based on patient CT data. A pencil beam algorithm that directly uses measured beam data was configured for dose calculation for a tomotherapy machine. Tomotherapy treatment plans were converted into a format readable by an in-house treatment planning system by assigning each projection to one static treatment field and shifting the calculation isocenter for each field in order to account for the couch movement. The modulation of the fluence for each projection is read out of the delivery sinogram, and with the kernel-based dose calculation, this information can directly be used for dose calculation without the need for decomposition of the sinogram. The sinogram values are only corrected for leaf output and leaf latency. Using the converted treatment plans, dose was recalculated with the independent treatment planning system. Multiple treatment plans ranging from simple static fields to real patient treatment plans were calculated using the new approach and either compared to actual measurements or the 3D dose distribution calculated by the tomotherapy treatment planning system. In addition, dose-volume histograms were calculated for the patient plans. Except for minor deviations at the maximum field size, the pencil beam dose calculation for static beams agreed with measurements in a water tank within 2%/2 mm. A mean deviation to point dose measurements in the cheese phantom of 0.89% ± 0.81% was found for unmodulated helical plans. A mean voxel-based deviation of -0.67% ± 1.11% for all voxels in the respective high dose region (dose values >80%), and a mean local voxel-based deviation of -2.41% ± 0.75% for all voxels with dose values >20% were found for 11 modulated plans in the cheese phantom. Averaged over nine patient plans, the deviations amounted to -0.14% ± 1.97% (voxels >80%) and -0.95% ± 2.27% (>20%, local deviations). For a lung case, mean voxel-based deviations of more than 4% were found, while for all other patient plans, all mean voxel-based deviations were within ± 2.4%. The presented method is suitable for independent dose calculation for helical tomotherapy within the known limitations of the pencil beam algorithm. It can serve as verification of the primary dose calculation and thereby reduce the need for time-consuming measurements. By using the patient anatomy and generating full 3D dose data, and combined with measurements of additional machine parameters, it can substantially contribute to overall patient safety. | 25,086,519 | [
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Dose-to-water conversion for the backscatter-shielded EPID: a frame-based method to correct for EPID energy response to MLC transmitted radiation. | To develop a frame-by-frame correction for the energy response of amorphous silicon electronic portal imaging devices (a-Si EPIDs) to radiation that has transmitted through the multileaf collimator (MLC) and to integrate this correction into the backscatter shielded EPID (BSS-EPID) dose-to-water conversion model. Individual EPID frames were acquired using a Varian frame grabber and iTools acquisition software then processed using in-house software developed inMATLAB. For each EPID image frame, the region below the MLC leaves was identified and all pixels in this region were multiplied by a factor of 1.3 to correct for the under-response of the imager to MLC transmitted radiation. The corrected frames were then summed to form a corrected integrated EPID image. This correction was implemented as an initial step in the BSS-EPID dose-to-water conversion model which was then used to compute dose planes in a water phantom for 35 IMRT fields. The calculated dose planes, with and without the proposed MLC transmission correction, were compared to measurements in solid water using a two-dimensional diode array. It was observed that the integration of the MLC transmission correction into the BSS-EPID dose model improved agreement between modeled and measured dose planes. In particular, the MLC correction produced higher pass rates for almost all Head and Neck fields tested, yielding an average pass rate of 99.8% for 2%/2 mm criteria. A two-sample independent t-test and fisher F-test were used to show that the MLC transmission correction resulted in a statistically significant reduction in the mean and the standard deviation of the gamma values, respectively, to give a more accurate and consistent dose-to-water conversion. The frame-by-frame MLC transmission response correction was shown to improve the accuracy and reduce the variability of the BSS-EPID dose-to-water conversion model. The correction may be applied as a preprocessing step in any pretreatment portal dosimetry calculation and has been shown to be beneficial for highly modulated IMRT fields. | 25,086,526 | [
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Microdosimetry of proton and carbon ions. | To investigate microdosimetry properties of 160 MeV/u protons and 290 MeV/u(12)C ion beams in small volumes of diameters 10-100 nm. Energy distributions of primary particles and nuclear fragments in the beams were calculated from simulations with the general purpose code SHIELD-HIT, while energy depositions by monoenergetic ions in nanometer volumes were obtained from the event-by-event Monte Carlo track structure ion code PITS99 coupled with the electron track structure code KURBUC. The results are presented for frequencies of energy depositions in cylindrical targets of diameters 10-100 nm, dose distributions yd(y) in lineal energy y, and dose-mean lineal energies yD. For monoenergetic ions, the yD was found to increase with an increasing target size for high-linear energy transfer (LET) ions, but decrease with an increasing target size for low-LET ions. Compared to the depth dose profile of the ion beams, the maximum of the yD depth profile for the 160 MeV proton beam was located at ∼ 0.5 cm behind the Bragg peak maximum, while the yD peak of the 290 MeV/u (12)C beam coincided well with the peak of the absorbed dose profile. Differences between the yD and dose-averaged linear energy transfer (LETD) were large in the proton beam for both target volumes studied, and in the (12)C beam for the 10 nm diameter cylindrical volumes. The yD determined for 100 nm diameter cylindrical volumes in the (12)C beam was approximately equal to the LETD. The contributions from secondary particles to the yD of the beams are presented, including the contributions from secondary protons in the proton beam and from fragments with atomic number Z = 1-6 in the (12)C beam. The present investigation provides an insight into differences in energy depositions in subcellular-size volumes when irradiated by proton and carbon ion beams. The results are useful for characterizing ion beams of practical importance for biophysical modeling of radiation-induced DNA damage response and repair in the depth profiles of protons and carbon ions used in radiotherapy. | 25,086,531 | [
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Interactive lung segmentation in abnormal human and animal chest CT scans. | Many medical image analysis systems require segmentation of the structures of interest as a first step. For scans with gross pathology, automatic segmentation methods may fail. The authors' aim is to develop a versatile, fast, and reliable interactive system to segment anatomical structures. In this study, this system was used for segmenting lungs in challenging thoracic computed tomography (CT) scans. In volumetric thoracic CT scans, the chest is segmented and divided into 3D volumes of interest (VOIs), containing voxels with similar densities. These VOIs are automatically labeled as either lung tissue or nonlung tissue. The automatic labeling results can be corrected using an interactive or a supervised interactive approach. When using the supervised interactive system, the user is shown the classification results per slice, whereupon he/she can adjust incorrect labels. The system is retrained continuously, taking the corrections and approvals of the user into account. In this way, the system learns to make a better distinction between lung tissue and nonlung tissue. When using the interactive framework without supervised learning, the user corrects all incorrectly labeled VOIs manually. Both interactive segmentation tools were tested on 32 volumetric CT scans of pigs, mice and humans, containing pulmonary abnormalities. On average, supervised interactive lung segmentation took under 9 min of user interaction. Algorithm computing time was 2 min on average, but can easily be reduced. On average, 2.0% of all VOIs in a scan had to be relabeled. Lung segmentation using the interactive segmentation method took on average 13 min and involved relabeling 3.0% of all VOIs on average. The resulting segmentations correspond well to manual delineations of eight axial slices per scan, with an average Dice similarity coefficient of 0.933. The authors have developed two fast and reliable methods for interactive lung segmentation in challenging chest CT images. Both systems do not require prior knowledge of the scans under consideration and work on a variety of scans. | 25,086,546 | [
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VolHOG: a volumetric object recognition approach based on bivariate histograms of oriented gradients for vertebra detection in cervical spine MRI. | The automatic recognition of vertebrae in volumetric images is an important step toward automatic spinal diagnosis and therapy support systems. There are many applications such as the detection of pathologies and segmentation which would benefit from automatic initialization by the detection of vertebrae. One possible application is the initialization of local vertebral segmentation methods, eliminating the need for manual initialization by a human operator. Automating the initialization process would optimize the clinical workflow. However, automatic vertebra recognition in magnetic resonance (MR) images is a challenging task due to noise in images, pathological deformations of the spine, and image contrast variations. This work presents a fully automatic algorithm for 3D cervical vertebra detection in MR images. We propose a machine learning method for cervical vertebra detection based on new features combined with a linear support vector machine for classification. An algorithm for bivariate gradient orientation histogram generation from three-dimensional raster image data is introduced which allows us to describe three-dimensional objects using the authors' proposed bivariate histograms. A detailed performance evaluation on 21 T2-weighted MR images of the cervical vertebral region is given. A single model for cervical vertebrae C3-C7 is generated and evaluated. The results show that the generic model performs equally well for each of the cervical vertebrae C3-C7. The algorithm's performance is also evaluated on images containing various levels of artificial noise. The results indicate that the proposed algorithm achieves good results despite the presence of severe image noise. The proposed detection method delivers accurate locations of cervical vertebrae in MR images which can be used in diagnosis and therapy. In order to achieve absolute comparability with the results of future work, the authors are following an open data approach by making the image dataset used in their performance evaluation available to the public. | 25,086,554 | [
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Evaluating the utility of intraprocedural 3D TRUS image information in guiding registration for displacement compensation during prostate biopsy. | In targeted 3D transrectal ultrasound (TRUS)-guided biopsy, patient and prostate movement during the procedure can cause target misalignments that hinder accurate sampling of preplanned suspicious tissue locations. Multiple solutions have been proposed for displacement compensation via registration of intraprocedural TRUS images to a baseline 3D TRUS image acquired at the beginning of the biopsy procedure. While 2D TRUS images are widely used for intraprocedural guidance, some solutions utilize richer intraprocedural images such as bi- or multiplanar TRUS or 3D TRUS, acquired by specialized probes. In this work, the impact of such richer intraprocedural imaging on displacement compensation accuracy was measured to evaluate the tradeoff between cost and complexity of intraprocedural imaging versus improved displacement compensation. Baseline and intraprocedural 3D TRUS images were acquired from 29 patients at standard sextant-template biopsy locations. Planes extracted from 3D TRUS images acquired at sextant positions were used to simulate 2D and 3D intraprocedural information available in different potential clinically relevant scenarios for co-registration with the baseline 3D TRUS image. In practice, intraprocedural 3D information can be acquired either via the use of specialized ultrasound probes (e.g., multiplanar or 3D probes) or via axial rotation of a tracked 2D TRUS probe. Registration accuracy was evaluated by calculating the target registration error (TRE) using manually identified homologous intrinsic fiducial markers (microcalcifications). The TRE was analyzed separately at the base, mid-gland and apex regions of the prostate. The results indicate that TRE improved gradually as the number of intraprocedural imaging planes used in registration was increased, implying that 3D TRUS information assisted the registration algorithm to robustly converge to more accurate solutions. The acquisition of a partial volume up to the angle of rotation supported more accurate displacement compensation than acquiring biplane configurations. Additional intraprocedural 3D TRUS image information was more beneficial to registration accuracy in the base and apex regions as compared with the mid-gland region. While the majority of the registrations using 2D TRUS images provided a clinically desired level of accuracy, intraprocedural 3D imaging helped improve the overall registration accuracy and robustness, especially in the base and apex regions of the prostate. These results are helpful for devising image-based registration methods for displacement compensation when designing 3D TRUS-guided biopsy systems. | 25,086,558 | [
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Motion tracking in the liver: validation of a method based on 4D ultrasound using a nonrigid registration technique. | Treatments like radiotherapy and focused ultrasound in the abdomen require accurate motion tracking, in order to optimize dosage delivery to the target and minimize damage to critical structures and healthy tissues around the target. 4D ultrasound is a promising modality for motion tracking during such treatments. In this study, the authors evaluate the accuracy of motion tracking in the liver based on deformable registration of 4D ultrasound images. The offline analysis was performed using a nonrigid registration algorithm that was specifically designed for motion estimation from dynamic imaging data. The method registers the entire 4D image data sequence in a groupwise optimization fashion, thus avoiding a bias toward a specifically chosen reference time point. Three healthy volunteers were scanned over several breathing cycles (12 s) from three different positions and angles on the abdomen; a total of nine 4D scans for the three volunteers. Well-defined anatomic landmarks were manually annotated in all 96 time frames for assessment of the automatic algorithm. The error of the automatic motion estimation method was compared with interobserver variability. The authors also performed experiments to investigate the influence of parameters defining the deformation field flexibility and evaluated how well the method performed with a lower temporal resolution in order to establish the minimum frame rate required for accurate motion estimation. The registration method estimated liver motion with an error of 1 mm (75% percentile over all datasets), which was lower than the interobserver variability of 1.4 mm. The results were only slightly dependent on the degrees of freedom of the deformation model. The registration error increased to 2.8 mm with an eight times lower temporal resolution. The authors conclude that the methodology was able to accurately track the motion of the liver in the 4D ultrasound data. The authors believe that the method has potential in interventions on moving abdominal organs such as MR or ultrasound guided focused ultrasound therapy and radiotherapy, pending the method is enabled to run in real-time. The data and the annotations used for this study are made publicly available for those who would like to test other methods on 4D liver ultrasound data. | 25,086,560 | [
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Could the heat sink effect of blood flow inside large vessels protect the vessel wall from thermal damage during RF-assisted surgical resection? | To assess by means of computer simulations whether the heat sink effect inside a large vessel (portal vein) could protect the vessel wall from thermal damage close to an internally cooled electrode during radiofrequency (RF)-assisted resection. First,in vivo experiments were conducted to validate the computational model by comparing the experimental and computational thermal lesion shapes created around the vessels. Computer simulations were then carried out to study the effect of different factors such as device-tissue contact, vessel position, and vessel-device distance on temperature distributions and thermal lesion shapes near a large vessel, specifically the portal vein. The geometries of thermal lesions around the vessels in the in vivo experiments were in agreement with the computer results. The thermal lesion shape created around the portal vein was significantly modified by the heat sink effect in all the cases considered. Thermal damage to the portal vein wall was inversely related to the vessel-device distance. It was also more pronounced when the device-tissue contact surface was reduced or when the vessel was parallel to the device or perpendicular to its distal end (blade zone), the vessel wall being damaged at distances less than 4.25 mm. The computational findings suggest that the heat sink effect could protect the portal vein wall for distances equal to or greater than 5 mm, regardless of its position and distance with respect to the RF-based device. | 25,086,561 | [
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A comparison of a centralized versus de-centralized recruitment schema in two community-based participatory research studies for cancer prevention. | Use of community-based participatory research (CBPR) approaches is increasing with the goal of making more meaningful and impactful advances in eliminating cancer-related health disparities. While many reports have espoused its advantages, few investigations have focused on comparing CBPR-oriented recruitment and retention. Consequently, the purpose of this analysis was to report and compare two different CBPR approaches in two cancer prevention studies. We utilized frequencies and Chi-squared tests to compare and contrast subject recruitment and retention for two studies that incorporated a randomized, controlled intervention design of a dietary and physical activity intervention among African Americans (AA). One study utilized a de-centralized approach to recruitment in which primary responsibility for recruitment was assigned to the general AA community of various church partners whereas the other incorporated a centralized approach to recruitment in which a single lay community individual was hired as research personnel to lead recruitment and intervention delivery. Both studies performed equally well for both recruitment and retention (75 and 88 % recruitment rates and 71 and 66 % retention rates) far exceeding those rates traditionally cited for cancer clinical trials (~5 %). The de-centralized approach to retention appeared to result in statistically greater retention for the control participants compared to the centralized approach (77 vs. 51 %, p < 0.01). Consequently, both CBPR approaches appeared to greatly enhance recruitment and retention rates of AA populations. We further note lessons learned and challenges to consider for future research opportunities. | 25,086,566 | [
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Mechanisms controlling mast cell and basophil lineage decisions. | Basophils and mast cells have long been known to play critical roles in allergic disease and host defense against parasitic infections. Recent recognition of these effector cells in immune regulations, host defense against bacteria and virus, and autoimmune diseases entices increased interest in studying these cells. However, origin and molecular regulation of basophil and mast cell differentiation remain incompletely understood. In this review, we focus on recent advances of the understanding the origin and molecular regulation of mouse basophil and mast cell development. We also summarize progress in the understanding of the origin and molecular regulation of human basophil and mast cell development. A more complete understanding of molecular regulation of basophils and mast cells will lead to the development of interventions that are more effective in achieving long-term success. | 25,086,577 | [
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A comprehensive thalamocortical projection map at the mesoscopic level. | The thalamus relays sensori-motor information to the cortex and is an integral part of cortical executive functions. The precise distribution of thalamic projections to the cortex is poorly characterized, particularly in mouse. We employed a systematic, high-throughput viral approach to visualize thalamocortical axons with high sensitivity. We then developed algorithms to directly compare injection and projection information across animals. By tiling the mouse thalamus with 254 overlapping injections, we constructed a comprehensive map of thalamocortical projections. We determined the projection origins of specific cortical subregions and verified that the characterized projections formed functional synapses using optogenetic approaches. As an important application, we determined the optimal stereotaxic coordinates for targeting specific cortical subregions and expanded these analyses to localize cortical layer-preferential projections. This data set will serve as a foundation for functional investigations of thalamocortical circuits. Our approach and algorithms also provide an example for analyzing the projection patterns of other brain regions. | 25,086,607 | [
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RAD51C germline mutations found in Spanish site-specific breast cancer and breast-ovarian cancer families. | BRCA1 and BRCA2 are the most well-known breast and ovarian cancer susceptibility genes. Additional genes involved in DNA repair have been identified as predisposing to breast cancer. Recently, RAD51C, a new Fanconi Anemia gene, essential for homologous recombination repair, has been reported to be a rare hereditary breast and ovarian cancer susceptibility gene. Indeed, several pathogenic mutations have been identified in BRCA1/BRCA2-negative hereditary breast and ovarian cancer families. Here, we present the results of the screening of RAD51C mutations in a large series of 516 BRCA1/BRCA2-negative Spanish patients from breast and/or ovarian cancer families, and the evaluation of these results in the context of all RAD51C carriers. RAD51C mutation screening was performed by DNA analysis for all index cases. All the genetic variants identified were analyzed in silico for splicing and protein predictions. cDNA analysis was performed for three selected variants. All previous RAD51C mutation studies on breast and/or ovarian cancer were reviewed. We identified three inactivating RAD51C mutations. Two mutations were found in breast and ovarian cancer families and one mutation in a site-specific breast cancer family. Based on the mean age of ovarian cancer diagnosis in RAD51C carriers, we would recommend prophylactic bilateral salpingo-ophorectomy in premenopausal RAD51C mutation carriers. Our results support that RAD51C is a rare breast and ovarian cancer susceptibility gene and may contribute to a small fraction of families including breast and ovarian cancer cases and families with only breast cancer. Thus, RAD51C testing should be offered to hereditary breast and/or ovarian cancer families without selecting for specific cancer origin. | 25,086,635 | [
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Rapid diagnostic test supply chain and consumption study in Cabo Delgado, Mozambique: estimating stock shortages and identifying drivers of stock-outs. | Malaria rapid diagnostic tests (RDTs) are particularly useful in low-resource settings where follow-through on traditional laboratory diagnosis is challenging or lacking. The availability of these tests depends on supply chain processes within the distribution system. In Mozambique, stock-outs of malaria RDTs are fairly common at health facilities. A longitudinal cross-sectional study was conducted to evaluate drivers of stock shortages in the Cabo Delgado province. Data were collected from purposively sampled health facilities, using monthly cross-sectional surveys between October 2011 and May 2012. Estimates of lost consumption (consumption not met due to stock-outs) served as the primary quantitative indicator of stock shortages. This is a better measure of the magnitude of stock-outs than binary indicators that only measure frequency of stock-outs at a given facility. Using a case study based methodology, distribution system characteristics were qualitatively analysed to examine causes of stock-outs at the provincial, district and health centre levels. 15 health facilities were surveyed over 120 time points. Stock-out patterns varied by data source; average monthly proportions of 59%, 17% and 17% of health centres reported a stock-out on stock cards, laboratory and pharmacy forms, respectively. Estimates of lost consumption percentage were significantly high; ranging from 0% to 149%; with a weighted average of 78%. Each ten-unit increase in monthly-observed consumption was associated with a nine-unit increase in lost consumption percentage indicating that higher rates of stock-outs occurred at higher levels of observed consumption. Causes of stock-outs included inaccurate tracking of lost consumption, insufficient sophistication in inventory management and replenishment, and poor process compliance by facility workers, all arguably stemming from inadequate attention to the design and implementation of the distribution system. Substantially high levels of RDT stock-outs were found in Cabo Delgado. Study findings point to a supply chain with a commendable degree of sophistication. However, insufficient attention paid to system design and implementation resulted in deteriorating performance in areas of increased need. In such settings fast moving commodities like malaria RDTs can call attention to supply chain vulnerabilities, the findings from which can be used to address other slower moving health commodities. | 25,086,645 | [
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Determinants for acceptance of preventive treatment against heart disease - a web-based population survey. | Patients' perception of risk and their lifestyle choices are of major importance in the treatment of common chronic diseases. This study reveals determinants for and knowledge about why people accept or reject preventive medical interventions against heart disease. A representative sample of 40-60-year-old Danish inhabitants was invited to participate in a web-based survey. The respondents were presented with a hypothetical scenario and asked to imagine that they were at an increased risk of heart disease, and subsequently presented with an offer of a preventive medical intervention. The aim was to elicit preference structures when potential patients are presented with different treatment conditions. About one third of the respondents were willing to accept preventive medical treatment. Respondents with personal experience with heart disease were more likely to accept treatment than respondents with family members with heart disease or no prior experience with heart disease. The willingness to accept treatment was similar for both genders, and when adjusting for experience with heart disease, age was not associated with willingness to accept treatment. Socioeconomic status in terms of lower education was positively associated with acceptance. The price of treatment reduced willingness to accept for the lower income groups, whereas it had no effect in the highest income group. Some 57% of respondents who were willing to accept treatment changed their decision following information on potential side effects. In accordance with our pre-study hypothesis, individuals with low income were more sensitive to price than individuals with high income. Thus, if the price of preventive medication increases above certain limits, a substantial proportion of the population may refrain from treatment. More than half of the respondents who were initially willing to accept treatment changed their decision when informed about the presence of potential side effects. This is an important observation in relation to risk communication, since most side effects occur very seldom, and a skewed assessment of treatment efficacy compared to risk of side effects may refrain some patients from treatment. Thus, more research is needed to better allow patients to compare treatment efficacy with risk of side effects in quantitative terms. | 25,086,654 | [
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The changing face of the molecular evolutionary clock. | The molecular clock has played an important role in biological research, both as a description of the evolutionary process and as a tool for inferring evolutionary timescales. Genomic data have provided valuable insights into the molecular clock, allowing the patterns and causes of evolutionary rate variation to be characterized in increasing detail. I explain how genome sequences offer exciting opportunities for estimating the timescale of the Tree of Life. I describe the different approaches that have been used to deal with the computational and statistical challenges encountered in molecular clock analyses of genomic data. Finally, I offer a perspective on the future of molecular clocks, highlighting some of the key limitations and the most promising research directions. | 25,086,668 | [
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Genome-wide association study identifies multiple susceptibility loci for pancreatic cancer. | We performed a multistage genome-wide association study including 7,683 individuals with pancreatic cancer and 14,397 controls of European descent. Four new loci reached genome-wide significance: rs6971499 at 7q32.3 (LINC-PINT, per-allele odds ratio (OR) = 0.79, 95% confidence interval (CI) 0.74-0.84, P = 3.0 × 10(-12)), rs7190458 at 16q23.1 (BCAR1/CTRB1/CTRB2, OR = 1.46, 95% CI 1.30-1.65, P = 1.1 × 10(-10)), rs9581943 at 13q12.2 (PDX1, OR = 1.15, 95% CI 1.10-1.20, P = 2.4 × 10(-9)) and rs16986825 at 22q12.1 (ZNRF3, OR = 1.18, 95% CI 1.12-1.25, P = 1.2 × 10(-8)). We identified an independent signal in exon 2 of TERT at the established region 5p15.33 (rs2736098, OR = 0.80, 95% CI 0.76-0.85, P = 9.8 × 10(-14)). We also identified a locus at 8q24.21 (rs1561927, P = 1.3 × 10(-7)) that approached genome-wide significance located 455 kb telomeric of PVT1. Our study identified multiple new susceptibility alleles for pancreatic cancer that are worthy of follow-up studies. | 25,086,665 | [
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Discovery and in vivo evaluation of alcohol-containing benzothiazoles as potent dual-targeting bacterial DNA supercoiling inhibitors. | A series of dual-targeting, alcohol-containing benzothiazoles has been identified with superior antibacterial activity and drug-like properties. Early lead benzothiazoles containing carboxylic acid moieties showed efficacy in a well-established in vivo model, but inferior drug-like properties demanded modifications of functionality capable of demonstrating superior efficacy. Eliminating the acid group in favor of hydrophilic alcohol moieties at C(5), as well as incorporating solubilizing groups at the C(7) position of the core ring provided potent, broad-spectrum Gram-positive antibacterial activity, lower protein binding, and markedly improved efficacy in vivo. | 25,086,682 | [
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Maxillofacial reconstruction with nasolabial and facial artery musculomucosal flaps. | The nasolabial and facial artery musculomucosal (FAMM) flaps are predictable methods to reconstruct perioral and intraoral defects with vascularized tissue. The nasolabial flap can be harvested as an axial or random patterned flap, whereas the FAMM flap is truly an axial patterned flap, with either a superior or an inferior base. Both flaps have been widely used to provide predictable results, with low morbidity. Future studies are needed to further prove their use in compromised patients, including patients with a history of head and neck radiation and neck dissections. | 25,086,694 | [
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Assessment on proximate composition, dietary fiber, phytic acid and protein hydrolysis of germinated Ecuatorian brown rice. | Germinated brown rice (GBR) is considered healthier than brown rice (BR) but its nutritive value has been hardly studied. Since nutritive quality of GBR depends on genetic diversity and germination conditions, six Ecuadorian BR varieties were germinated at 28 and 34 ºC for 48 and 96 h in darkness and proximate composition, dietary fiber fractions, phytic acid content as well as degree of protein hydrolysis and peptide content were studied. Protein, lipids, ash and available carbohydrate ranged 7.3-10.4%, 2.0-4.0%, 0.8-1.5% and 71.6 to 84.0%, respectively, in GBR seedlings. Total dietary fiber increased during germination (6.1-13.6%), with a large proportion of insoluble fraction, while phytic acid was reduced noticeably. In general, protein hydrolysis occurred during germination was more accused at 28 ºC for 48 h. These results suggest that GBR can be consumed directly as nutritive staple food for a large population worldwide contributing to their nutritional requirements. | 25,086,701 | [
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Structure-property relationship of sol-gel electrospun ZnO nanofibers developed for ammonia gas sensing. | Zinc oxide (ZnO) based nanomaterials have been used in various gas sensors due to the wide band gap (3.37eV), large exciton binding energy and high mobility of charge carriers of ZnO. In this work, nanocrystalline ZnO nanofiber mats were synthesized through combined sol-gel electrospinning techniques followed by calcination, in which poly(styrene-co-acrylonitrile) and zinc acetate were used as the binder and precursor, respectively. Average diameter of the ZnO nanofibers decreased from 400 to 60nm, while their grain size and crystallinity were enhanced by increasing the calcination temperature. Morphology and structure of the ZnO nanofiber mats were characterized by high resolution transmission electron microscopy, scanning electron microscopy, Fourier transform infrared spectroscopy and X-ray diffraction. ZnO nanofiber mats were found to be superhydrophilic (contact angle was close to 0°) by contact angle measurements. The sensitivity of these ZnO nanofibers in detecting gaseous ammonia was tested using an indigenous set up. Due to their high surface area and superhydrophility, these ZnO nanofiber mats were highly sensitive in sensing gaseous ammonia and the sensitivity of these mats increased as a function of their calcination temperatures. | 25,086,723 | [
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Predictors of labor abnormalities in university hospital: unmatched case control study. | Abnormal labor is one of the common emergency obstetric problems contributing for more than two-thirds of the unplanned cesarean section. In Ethiopia, although labor abnormality and its complications like obstetric fistula are highly prevalent, there is no published study that determines the predictors of labor abnormalities. The study design was an unmatched case control which included 844 women (408 cases and 436 controls). Cases were identified when a woman was diagnosed to have one of the labor abnormalities at term (prolonged latent stage, active phase disorder, prolonged second stage, descent disorder and obstructed labor). Subgroup logistic regression analyses were done taking the different type of labor abnormalities as the dependent variable. Nearly half of the cases (48.6%) were found to have the active phase disorder. Obstructed labor alone accounted for about 16.8% of the cases. The mean gestational age of cases and controls was almost comparable. More than a quarter of cases and controls came to the hospital in the second stage of labor. More than two-thirds of the cases (67.4%) gave birth by cesarean section. The logistic regression analysis demonstrated an independent association of overall labor abnormality with pelvic inadequacy. The subgroup analysis, however, revealed that several obstetric factors were associated with one or more types of labor abnormalities. Active phase disorders were the commonest type of labor abnormalities. Cases were late in reporting to the hospital. Malposition, inadequate pelvis and inadequate uterine contraction were some of the predictors of specific types of labor abnormalities. | 25,086,729 | [
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Filaggrin loss-of-function mutations are not a predisposing factor for atopic dermatitis in an Ishigaki Island under subtropical climate. | Filaggrin (FLG) is a major protein component of the stratum corneum (SC) layer, and FLG loss-of-function mutations are a predisposing factor for atopic dermatitis (AD). Previous cohort studies of children from northern and western Europe have reported FLG loss-of-function mutation frequencies of 15.1-20.9% and 5.8-13.0% in AD and non-AD groups, respectively. To elucidate the association between AD prevalence of FLG loss-of-function mutation carriers and climate conditions, we determined the AD prevalence and FLG loss-of-function mutation frequencies in a cohort of children from Ishigaki Island. Ishigaki Island has a subtropical climate with high humidity (monthly average, 60.8-78.7%) and high temperature (monthly average, 18.5-29.4°C) throughout the year. We diagnosed AD prevalence and analyzed eight FLG loss-of-function mutations in the Japanese population against a cohort of 721 children from the Kyushu University Ishigaki Atopic Dermatitis Study (KIDS) cohort. Parents gave consent for the mutation analysis during their medical examinations from 2001 to 2006. Average AD prevalence was 7.3% per year, and a total of 127 children (17.6%) were diagnosed with AD at least once between 2001 and 2006. The average total serum IgE level differed significantly between the AD and non-AD groups (199.0 and 69.0IU/ml, respectively). Although five kinds of FLG loss-of-function mutations isolated in previous Japanese FLG mutation studies were identified, the FLG loss-of-function mutation frequency in children of the KIDS cohort was not significantly different between the AD and non-AD groups (7.9% and 6.1%, respectively; P=0.174). The FLG loss-of-function mutation frequency was not significantly different between the AD and non-AD groups in a cohort of children from Ishigaki Island, which has a subtropical climate, suggesting that FLG loss-of-function mutations are not always a predisposing factor for AD prevalence. | 25,086,748 | [
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Factors predictive of readmission after hepatic resection for hepatocellular carcinoma. | Hepatic resection is associated with substantial morbidity and resource use. To contain costs and improve outcomes, recent health care regulations focus on reducing hospital readmissions while using readmission rates as a quality measure. The goal of this investigation was to characterize the incidence, patterns, and risk factors for readmission after resection for hepatocellular carcinoma. Patient demographics, operative factors, and perioperative outcomes of 245 patients undergoing hepatic resection at an academic center from 2000 to 2012 were reviewed retrospectively. Factors associated for readmission within 90 days of operation were identified through univariate and multivariate logistic regression analysis. Forty-six patients (18.7%) required hospital readmission. Univariate analysis identified American Society of Anesthesiologists class, preoperative Model for End-stage Liver Disease score and total bilirubin, preexisting vascular disease, acute renal failure, bile leak, peak postoperative total bilirubin, and intraabdominal infection as factors associated with readmission. Intraabdominal infection, postoperative renal failure, and a history of vascular disease were found to be significant on multivariate analysis. Overall, intraabdominal infection was the strongest predictor for readmission. Early readmission after hepatectomy remains relatively common. Postoperative complications and patient comorbidities are the dominant factors in readmission, and we must be mindful of those patients at increased risk for readmission. | 25,086,792 | [
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The effects of weight gain after smoking cessation on atherogenic α1-antitrypsin-low-density lipoprotein. | Although cardiovascular risks decrease after quitting smoking, body weight often increases in the early period after smoking cessation. We have previously reported that the serum level of the α1-antitrypsin-low-density lipoprotein complex (AT-LDL)-an oxidatively modified low-density lipoprotein that accelerates atherosclerosis-is high in current smokers, and that the level rapidly decreases after smoking cessation. However, the effects of weight gain after smoking cessation on this cardiovascular marker are unknown. In 183 outpatients (134 males, 49 females) who had successfully quit smoking, serum AT-LDL levels were measured using an enzyme-linked immunosorbent assay. For all persons who had successfully quit smoking, body mass index (BMI) significantly increased 12 weeks after the first examination (p < 0.01). Among patients with a BMI increase smaller than the median, a significant decrease (p < 0.01) in serum AT-LDL values was found, but no significant changes in serum AT-LDL values were found in patients with a BMI increase greater than the median. The findings suggest that the decrease in serum AT-LDL levels after quitting smoking is influenced by weight gain after smoking cessation. | 25,086,816 | [
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Cumulative incidence and treatment of non-simultaneous bilateral femoral neck fractures in a cohort of one thousand two hundred and fifty patients. | In the Netherlands, over 20,000 patients sustain a hip fracture yearly. A first hip fracture is a risk factor for a second, contralateral fracture. Data on the similarity of the treatment of bilateral femoral neck fractures is only scarcely available. The objectives of this study were to determine the cumulative incidence of non-simultaneous bilateral femoral neck fractures and to describe the patient characteristics and treatment characteristics of these patients. A database of 1,250 consecutive patients with a femoral neck fracture was available. Patients with a previous contralateral femoral neck fractures were identified by reviewing radiographs and patient files. Patient characteristics, previous fractures, hip fracture type and details on treatment were collected from the patient files. One hundred nine patients (9%, 95% confidence interval 7-10%) had sustained a non-simultaneous bilateral femoral neck fracture. The median age at the first fracture was 81 years; the median interval between the fractures was 25 months. Overall, 73% was treated similarly for both fractures in terms of non-operative treatment, internal fixation or arthroplasty. In patients with identical Garden classification (30%), treatment similarity was 88%. The cumulative incidence of non-simultaneous bilateral femoral neck fractures was 9%. Most patients with identical fracture types were treated similarly. The relatively high risk of sustaining a second femoral neck fracture supports the importance of secondary prevention, especially in patients with a prior wrist or vertebral fracture. | 25,086,819 | [
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Distribution of venlafaxine and O-desmethylvenlafaxine in a fatal case. | Venlafaxine is an extensively used antidepressant drug; it is considered to be quite safe and only a few pure cases of fatal poisoning have been reported. Here we describe a fatal case of venlafaxine self-poisoning including detailed tissue distribution of the drug and its metabolite O-desmethylvenlafaxine and the exact time sequence of events, as reported in the patient's clinical record. Qualitative analyses were performed by GC-MS while quantitative analyses were carried out by LC-MS/MS. We then compared our results with those of previously published cases. Fatal venlafaxine poisoning often occurs after the intake of an extremely elevated number of tablets, corresponding to tens of grams of the drug, or it can be due to interaction between the drug and other substances. In the present case, no other drugs or ethanol were found and death occurred 12h after ingesting only 3g of venlafaxine, despite timely medical treatment. | 25,086,830 | [
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Motor features in posterior cortical atrophy and their imaging correlates. | Posterior cortical atrophy (PCA) is a neurodegenerative syndrome characterized by impaired higher visual processing skills; however, motor features more commonly associated with corticobasal syndrome may also occur. We investigated the frequency and clinical characteristics of motor features in 44 PCA patients and, with 30 controls, conducted voxel-based morphometry, cortical thickness, and subcortical volumetric analyses of their magnetic resonance imaging. Prominent limb rigidity was used to define a PCA-motor subgroup. A total of 30% (13) had PCA-motor; all demonstrating asymmetrical left upper limb rigidity. Limb apraxia was more frequent and asymmetrical in PCA-motor, as was myoclonus. Tremor and alien limb phenomena only occurred in this subgroup. The subgroups did not differ in neuropsychological test performance or apolipoprotein E4 allele frequency. Greater asymmetry of atrophy occurred in PCA-motor, particularly involving right frontoparietal and peri-rolandic cortices, putamen, and thalamus. The 9 patients (including 4 PCA-motor) with pathology or cerebrospinal fluid all showed evidence of Alzheimer's disease. Our data suggest that PCA patients with motor features have greater atrophy of contralateral sensorimotor areas but are still likely to have underlying Alzheimer's disease. | 25,086,839 | [
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Assessment of CSF Aβ42 as an aid to discriminating Alzheimer's disease from other dementias and mild cognitive impairment: a meta-analysis of 50 studies. | Mild Alzheimer's disease (AD) is usually difficult to differentiate from other dementias or mild cognitive impairment (MCI). The aim of our study is to evaluate the clinical importance of cerebrospinal fluid (CSF) β-amyloid 42 (Aβ42) in MCI, AD and other dementias, more specifically: frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), Parkinson's disease (PD) with dementia (PDD) and vascular dementia (VaD). Fifty eligible articles were identified by search of databases including PubMed, EMBASE, Elsevier, Springer Link and the Cochrane Library, from January 1990 to May 2014. The random effects model was used to calculate the standardized mean difference (SMD) with corresponding 95% CI by STATA 9.0 software. The subgroup analyses were made on the method (ELISA, xMAP). We found that CSF Aβ42 concentrations were significantly lower in AD compared to MCI (SMD: -0.68, 95% CI: [-0.80, -0.56], z=11.34, P<0.001), FTD (SMD: -1.09, 95% CI: [-1.41, -0.76], z=6.62, P<0.001), PDD (SMD: -0.75, 95% CI: [-1.39, -0.10], z=2.27, P=0.023), VaD (SMD: -0.95, 95% CI: [-1.30, -0.61], z=5.43, P<0.001). In addition, compared to DLB, Aβ42 concentrations are moderately lower in AD (SMD: -0.27, 95% CI: [-0.51, -0.03], z=2.20, P=0.028). Results from this meta-analysis hinted that CSF Aβ42 is a good biomarker for discriminating Alzheimer's disease from other dementias and MCI. | 25,086,857 | [
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Designing questionnaires: healthcare survey to compare two different response scales. | A widely discussed design issue in patient satisfaction questionnaires is the optimal length and labelling of the answering scale. The aim of the present study was to compare intra-individually the answers on two response scales to five general questions evaluating patients' perception of hospital care. Between November 2011 and January 2012, all in-hospital patients at a Swiss University Hospital received a patient satisfaction questionnaire on an adjectival scale with three to four labelled categories (LS) and five redundant questions displayed on an 11-point end-anchored numeric scale (NS). The scales were compared concerning ceiling effect, internal consistency (Cronbach's alpha), individual item answers (Spearman's rank correlation), and concerning overall satisfaction by calculating an overall percentage score (sum of all answers related to the maximum possible sum). The response rate was 41% (2957/7158), of which 2400 (81%) completely filled out all questions. Baseline characteristics of the responders and non-responders were similar. Floor and ceiling effect were high on both response scales, but more pronounced on the LS than on the NS. Cronbach's alpha was higher on the NS than on the LS. There was a strong individual item correlation between both answering scales in questions regarding the intent to return, quality of treatment and the judgement whether the patient was treated with respect and dignity, but a lower correlation concerning satisfactory information transfer by physicians or nurses, where only three categories were available in the LS. The overall percentage score showed a comparable distribution, but with a wider spread of lower satisfaction in the NS. Since the longer scale did not substantially reduce the ceiling effect, the type of questions rather than the type of answering scale could be addressed with a focus on specific questions about concrete situations instead of general questions. Moreover, the low correlation in questions about information provision suggests that only three possible response choices are insufficient. Further investigations are needed to find a more sensitive scale discriminating high-end ratings. Otherwise, a longitudinal within-hospital or a cross-sectional between-hospital comparison of patient care is questionable. | 25,086,869 | [
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Multivariate curve resolution applied to in situ X-ray absorption spectroscopy data: an efficient tool for data processing and analysis. | Large datasets containing many spectra commonly associated with in situ or operando experiments call for new data treatment strategies as conventional scan by scan data analysis methods have become a time-consuming bottleneck. Several convenient automated data processing procedures like least square fitting of reference spectra exist but are based on assumptions. Here we present the application of multivariate curve resolution (MCR) as a blind-source separation method to efficiently process a large data set of an in situ X-ray absorption spectroscopy experiment where the sample undergoes a periodic concentration perturbation. MCR was applied to data from a reversible reduction-oxidation reaction of a rhenium promoted cobalt Fischer-Tropsch synthesis catalyst. The MCR algorithm was capable of extracting in a highly automated manner the component spectra with a different kinetic evolution together with their respective concentration profiles without the use of reference spectra. The modulative nature of our experiments allows for averaging of a number of identical periods and hence an increase in the signal to noise ratio (S/N) which is efficiently exploited by MCR. The practical and added value of the approach in extracting information from large and complex datasets, typical for in situ and operando studies, is highlighted. | 25,086,889 | [
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Preparation of stir cake sorptive extraction based on polymeric ionic liquid for the enrichment of benzimidazole anthelmintics in water, honey and milk samples. | In this work, a new stir cake sorptive extraction (SCSE) using polymeric ionic liquid monolith as sorbent was prepared. The sorbent was obtained by in situ copolymerization of an ionic liquid, 1-allyl-3-methylimidazolium bis[(trifluoro methyl)sulfonyl]imide (AMII) and divinylbenzene (DB) in the presence of N,N-dimethylformamide. The influence of the content of ionic liquid and the porogen in the polymerization mixture on extraction performance was studied thoroughly. The physicochemical properties of the polymeric ionic liquid were characterized by infrared spectroscopy, elemental analysis, scanning electron microscopy and mercury intrusion porosimetry. The usefulness of SCSE-AMIIDB was demonstrated by the enrichment of trace benzimidazole anthelmintics. Several parameters affecting the extraction efficiency were investigated, and under the optimized conditions, a simple and effective method for the determination of trace benzimidazoles residues in water, milk and honey samples was established by coupling SCSE-AMIIDB with high performance liquid chromatography/diode array detection (SCSE-AMIIDB-HPLC/DAD). Results indicated that the limits of detection (S/N=3) for target compounds were 0.020-0.072 μg L(-1), 0.035-0.10 μg L(-1) and 0.026-0.076 μg L(-1) in water, milk and honey samples, respectively. In addition, an acceptable reproducibility was achieved by evaluating the repeatability and intermediate precision with relative standard deviations (RSD) of less than 9% and 11%, respectively. Finally, the established AMII-SCSE-HPLC/DAD method was successfully applied for the determination of benzimidazoles residues in milk, honey and environmental water samples. Recoveries obtained for the determination of benzimidazole anthelmintics in spiking samples ranged from 70.2% to 117.6%, with RSD below 12% in all cases. | 25,086,891 | [
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Oxygen transfer in solid-state cultivation under controlled moisture conditions. | The aim of this work was to study oxygen transfer as a function of the initial moisture content in solid-state cultivation under controlled moisture conditions. The use of controlled moisture conditions prevents drastic changes in the medium during cultivation, allowing the use of a pseudo-steady-state model to estimate the overall oxygen mass transfer coefficient (K L a) in the biofilm around the solid particles. Drechslera (Helminthosporium) monoceras, an aerobic mold that produces allergenic proteins, was cultured on wheat bran in a packed bed column bioreactor. The bed height (30 mm) and air flow rate (0.4 L/min) were selected to implement moisture control. The results show that there is an optimal moisture content (35 %) at which a lower biofilm thickness and packing of the bed improves K L a. However, a higher biomass growth was obtained at 45 % moisture. The different patterns of biomass growth demonstrate the importance of the balance between aerial and film growth in solid-state cultivation. These results contribute to the understanding of oxygen transfer in solid fermentation, optimization of processes, and production of allergen extracts from D. (Helminthosporium) monoceras biomass. | 25,086,924 | [
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Hepatic MR imaging techniques, optimization, and artifacts. | This article describes a basic 1.5-T hepatic magnetic resonance (MR) imaging protocol, strategies for optimizing pulse sequences while managing artifacts, the proper timing of postgadolinium 3-dimensional gradient echo sequences, and an effective order of performing pulse sequences with the goal of creating an efficient and high-quality hepatic MR imaging examination. The authors have implemented this general approach on General Electric, Philips, and Siemens clinical scanners. | 25,086,929 | [
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Presurgical planning for hepatobiliary malignancies: clinical and imaging considerations. | There are many considerations in the evaluation of liver malignancy before planned surgical treatment. This article focuses on interpretation of MR imaging of the liver for surgical treatment planning of hepatocellular carcinoma, colorectal cancer metastases, and hilar cholangiocarcinoma. Clinical status, anatomic variants, future liver remnant, and underlying liver disease are all important factors in the decision to proceed with liver resection. The primary objective of preoperative imaging is to correctly identify patients who are candidates for curative intervention and to accurately stage their disease. Treatment planning for these complex patients is best done with a multidisciplinary team approach. | 25,086,939 | [
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A novel CCM1 mutation associated with multiple cerebral and vertebral cavernous malformations. | Cerebral cavernous malformations are relatively rare vascular disorders that may affect any part of the central nervous system. This presentation has been associated with heterozygous mutations in CCM1/KRIT1, CCM2/malcavernin and CCM3/PDCD10. We aimed to investigate the genetic defect underlying multiple cerebral and vertebral cavernous malformations in a multigenerational Italian family. The proband is a 49-year-old man who underwent cerebral MRI in his thirties for persistent haeadache and tingling in his left arm and leg and was diagnosed with multiple supratentorial cavernous angiomas. A right frontal angioma with radiological evidence of a recent bleeding was surgically removed when he was 39 years old and he was thereafter asymptomatic. Magnetic resonance imaging revealed multiple cerebral cavernous malformations in seven members of his familily. Four subjects were asymptomatic. Other family mambers displayed heterogeneous clinical features including seizures and recurrent brain haemorrhages. Sequence analysis in the proband disclosed a novel heterozygous nucleotide substitution (c.263-10A > G) in intron 5 of CCM1. This variant is predicted to create an abnormal acceptor splice site and segregated in affected relatives available for molecular screening. The analysis of CCM1 transcript in proband's lymphocytes confirmed the partial retention of intron 3 resulting in a premature termination codon. Our findings demonstrate that c.263-10A > G mutation is associated with cerebral cavernous malformations. A better knowledge of the disease-associated phenotype may lead to an early diagnosis and to an appropriate clinical surveillance in affected patients. | 25,086,949 | [
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Automated assessment of renal cortical surface roughness from computerized tomography images and its association with age. | Nephrosclerosis occurs with aging and is characterized by increased kidney subcapsular surface irregularities at autopsy. Assessments of cortical roughness in vivo could provide an important measure of nephrosclerosis. The purpose of this study was to develop and validate an image-processing algorithm for quantifying renal cortical surface roughness in vivo and determine its association with age. Renal cortical surface roughness was measured on contrast-enhanced abdominal computed tomography (CT) images of potential living kidney donors. A roughness index was calculated based on geometric curvature of each kidney from three-dimensional images and compared to visual observation scores. Cortical roughness was compared between the oldest and youngest donors, and its interaction with cortical volume and age assessed. The developed quantitative roughness index identified significant differences in kidneys with visual surface roughness scores of 0 (minimal), 1 (mild), and 2 (moderate; P < .001) in a random sample of 200 potential kidney donors. Cortical roughness was significantly higher in the 94 oldest (64-75 years) versus 91 youngest (18-25 years) potential kidney donors (P < .001). Lower cortical volume was associated with older age but not with roughness (r = -0.03, P = .75). The association of oldest age group with roughness (odds ratio [OR] = 1.8 per standard deviation [SD] of roughness index) remained significant after adjustment for total cortex volume (OR = 2.0 per SD of roughness index). A new algorithm to measure renal cortical surface roughness from CT scans detected rougher surface in older compared to younger kidneys, independent of cortical volume loss. This novel index may allow quantitative evaluation of nephrosclerosis in vivo using contrast-enhanced CT. | 25,086,950 | [
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Evaluation of radiation exposure of medical staff during CT-guided interventions. | The purpose of this prospective study was to investigate absolute radiation exposure values and factors that influence radiation exposure of interventionists during CT-guided interventions (CTGIs). To our knowledge, no data exist regarding the radiation dose to which the interventionist is exposed during these procedures. Absolute radiation dose values from a total of 131 CTGIs were analyzed. Radiation dose values were collected by thermoluminescent dosimeters that were positioned above the lead protection being worn, on the forehead, thyroid, chest, gonads, and right and left hand and foot. The radiation doses were analyzed with respect to the experience level of the person performing the procedure, the degree of difficulty measured on a 4-point Likert scale, the lesion size measured on a 3-point Likert scale, and the CT system used. Median whole-body dose was 12 μSv. With the exception of the forehead, all whole-body radiation doses were statistically significantly lower in CTGIs performed using the modern dual-source CT system compared with the 16-slice multi-detector CT. For CTGIs rated as more complex, the radiation exposure of the radiologist performing the procedure was statistically significantly higher, with the exception of the left hand. A statistically significantly lower median whole-body dose was measured for inexperienced compared with experienced radiologists. However, a few dose measurements of more than 1 mSv were found at the right hand. Radiation exposure measured during CTGIs is low (<50 μSv). Because the radiation dose was higher in more-complex interventions and for 16-slice multi-detector row CT, inexperienced radiologists should focus on less-complex procedures. | 25,086,959 | [
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Steady state temperature distribution in dermal regions of an irregular tapered shaped human limb with variable eccentricity. | The investigators in the past have developed some models of temperature distribution in the human limb assuming it as a regular circular or elliptical tapered cylinder. But in reality the limb is not of regular tapered cylindrical shape. The radius and eccentricity are not same throughout the limb. In view of above a model of temperature distribution in the irregular tapered elliptical shaped human limb is proposed for a three dimensional steady state case in this paper. The limb is assumed to be composed of multiple cylindrical substructures with variable radius and eccentricity. The mathematical model incorporates the effect of blood mass flow rate, metabolic activity and thermal conductivity. The outer surface is exposed to the environment and appropriate boundary conditions have been framed. The finite element method has been employed to obtain the solution. The temperature profiles have been computed in the dermal layers of a human limb and used to study the effect of shape, microstructure and biophysical parameters on temperature distribution in human limbs. The proposed model is one of the most realistic model as compared to conventional models as this can be effectively employed to every regular and nonregular structures of the body with variable radius and eccentricity to study the thermal behaviour. | 25,086,970 | [
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The overwintering biology of the acorn weevil, Curculio glandium in southwestern Ontario. | The acorn weevil, Curculio glandium, is a widespread predator of acorns in eastern North America that overwinters in the soil as a larva. It is possible that low temperatures limit its northern geographic range, so we determined the cold tolerance strategy, seasonal variation in cold tolerance, and explored the physiological plasticity of overwintering larvae. Weevil larvae were collected from acorns of red and bur oak from Pelee Island, southwestern Ontario in fall 2010 and 2011. C. glandium larvae are freeze avoidant and larvae collected from bur oak acorns had lower supercooling points (SCPs: -7.6±0.36°C, LT50: -7.2°C) than those collected from red oak acorns (SCPs: -6.1±0.40°C, LT50: -6.1°C). In the winter of 2010-2011, SCPs and water content decreased, however these changes did not occur in 2011-2012, when winter soil temperatures fluctuated greatly in the absence of the buffering effect of snow. To examine whether larvae utilize cryoprotective dehydration, larvae from red oak acorns were exposed to -5°C in the presence of ice for seven days. These conditions decreased the SCP without affecting water content, suggesting that SCP and water content are not directly coupled. Finally, long-term acclimation at 0°C for six weeks slightly increased cold tolerance but also did not affect water content. Thus, although larval diet affects cold tolerance, there is limited plasticity after other treatments. The soil temperatures we observed were not close to lethal limits, although we speculate that soil temperatures in northerly habitats, or in years of reduced snow cover, has the potential to cause mortality in the field. | 25,086,980 | [
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A farnesoid X receptor polymorphism predisposes to spontaneous bacterial peritonitis. | In mice, the farnesoid X receptor is involved in bacterial translocation, which can result in spontaneous bacterial peritonitis in patients with cirrhosis. We investigated if polymorphisms in the farnesoid X receptor gene influence the risk for spontaneous bacterial peritonitis. Laboratory and clinical data of 293 cirrhotic patients with ascites and 226 healthy controls were prospectively collected. The rs56163822, rs11110390 and rs12313471 polymorphisms of the farnesoid X receptor were determined. 115 (39%) patients had spontaneous bacterial peritonitis. Distribution of all farnesoid X receptor genotypes matched the Hardy-Weinberg equilibrium. Patients with spontaneous bacterial peritonitis had a higher frequency of the rs56163822 GT genotype (7.0%) than patients without (1.7%, OR=4.4, p=0.02). This genotype was confirmed as predictor of spontaneous bacterial peritonitis by binary logistic regression analysis (OR=6.8, p=0.018). The farnesoid X receptor rs56163822 GT genotype increases the risk for spontaneous bacterial peritonitis in cirrhotic patients with ascites. | 25,086,996 | [
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The in vitro interference of synthetic progestogens with carp steroidogenic enzymes. | Synthetic progestogens represent a class of pharmaceuticals widely used in oral contraceptives and in hormone replacement therapies. They reach the aquatic environment through wastewater effluents; however, environmental concentrations and effects on non-target organisms are poorly known. Given the important role of progestogens regulating fish spawning processes, this study aimed at assessing the in vitro interference of four currently used progestogens-drospirenone (DRO), levonorgestrel (LNG), norethindrone (NOR) and cyproterone acetate (CPA) - with key enzymatic activities involved in the synthesis of active steroids in carp (Cyprinus carpio). The enzymatic pathways investigated were (a) CYP17 (C17,20-lyase) and CYP11β involved in the synthesis of androgens, (b) CYP19 that catalyses the aromatization of androgens to estrogens, and (c) 20β-hydroxysteroid dehydrogenase (20β-HSD) responsible for the synthesis of maturation-inducing hormones. All tested progestogens significantly inhibited the synthesis of androgens: DRO (IC50: 3.8 μM) was the strongest inhibitor of CYP17 followed by CPA (IC50s: 183 μM). Moreover, NOR (IC50: 0.4 μM), DRO (IC50: 1.8 μM) and CPA (IC50s: 87 μM) inhibited CYP11β. An inhibition by NOR of ovarian CYP19 activity, and by DRO and CPA of 20β-HSD was also observed, but at rather high concentrations (500 μM). Overall, this study highlights the potential of synthetic progestogens, and particularly DRO and NOR, to interfere with the biosynthesis of androgens in carp gonads. | 25,087,002 | [
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Perceived quality of life in chronic obstructive pulmonary disease patients: a cross-sectional study in primary care on the role of illness perceptions. | Previous research has shown that in Chronic Obstructive Pulmonary Disease (COPD) patients, it is important to consider not only physical functioning and complaints but also psychological factors, such as illness perceptions, to explain differences in Health-Related Quality of Life (HRQoL). The objective of this study is to analyse the extent to which the specific dimensions of illness perceptions according to the Common Sense Model (corrected for airflow limitation, dyspnoea and comorbidities) contribute to HRQoL. In a cross-sectional study in primary care, 90 COPD patients completed questionnaires: The Brief Illness Perception Questionnaire, the Medical Research Council dyspnoea scale, the Clinical COPD Questionnaire (CCQ) and the Chronic Respiratory Questionnaire (CRQ). Analyses were performed with multiple linear regression. When corrected for confounders (airflow limitation, dyspnoea and comorbidities), identity (β = .42) and comprehensibility (β = -.16) were associated with HRQoL (CCQ). Identity, comprehensibility and dyspnoea explained 56% of the variation in HRQoL (R2 = .56). Consequences (β = -.50) and treatment control (β = .20) were associated with HRQoL (the CRQ's physical domain). They explained 59% of the variation in the CRQ physical (R2 = .59) domain. Treatment control (β = .19) and emotional response (β = -.33) were associated with the CRQ emotional domain. Patients who experience fewer symptoms attributed to COPD, who have a better understanding of the disease, who experience less impact of COPD in daily life, who experience better treatment control and who have less of an emotional response have better HRQoL. This study indicates that the HRQoL of COPD patients is associated with illness perceptions as well as with the severity of dyspnoea as experienced by patients. Airflow limitation measures or comorbidities do not add to the explanation of HRQoL. The results of this study provide starting points for the development of interventions focusing on illness perceptions to support COPD patients in their disease management and to improve HRQoL. | 25,087,008 | [
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[Assessment of the impact of day care surgery promotion on attending physician consultation rate: a prospective study]. | In order to control health spending, health authorities encourage medical staffs to develop day care surgery. Gynecologic day care surgery can easily be developed. However, consequences of the reduction of hospital stay on the rate of postoperative consultation with the attending physician have not been evaluated. Will day care surgery lead to an increase in postoperative consultation with attending physician rate? Assessment of the impact of day care gynecological surgery on attending physician postoperative consultation rate. This prospective study included 250 women who have gynecologic surgery in the gynecologic unit of a teaching hospital, from April to June 2012. Postoperative consultations with attending physician were identified with a phone questionnaire. Postoperative consultation rate with attending physician was compared between women supported in day care surgery versus conventional surgery. Two hundred and fifty women were included in the study, 166 (66.5%) had a day care surgery while 84 (33.5%) had a traditional hospitalisation for surgery. Mean age of women was significantly lower in the group of day care surgery (42.08 years [40.14-44.03] versus 54.15 years [50.45-57.86], P<0.01). Out of the 166 women with a day care surgery, 49 (30%) went to the attending physician while 25 out of 84 (30%) in the traditional hospitalization group. Postoperative consultation rate with attending physician was not significantly different between women supported in day care surgery compared to those supported in conventional surgery (P>0.05). This study did not find any difference in the postoperative consultation rate with the attending physician after a day care surgery versus surgery in conventional hospitalization in gynecology. This result should be interpreted cautiously as women are different between the two groups (different surgeries, older women with more associated pathologies in the conventional hospitalization group). Vigilance must be maintained on this risk of increasing postoperative consultation rate with attending physician after day care surgery. | 25,087,017 | [
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[Perinatal mortality and quality of clinical management in the Aurore network from 2005 to 2011. Implementation of morbidity and mortality conferences]. | Evaluate the incidence of perinatal mortality and evaluate the percentage of non optimal care management of fatal pregnancies between 2005 and 2011 in the Rhone-Alpes region in France, by the use of the Aurore network. Evaluate the development of morbi-mortality revues (MMR) in this region. Retrospective study of perinatal mortality in the Aurore network, from 2005 to 2011. Systematic analysis of care management (adapted, non adapted, non evaluable), of each perinatal death that occurred in the Aurore network, by a multidisciplinary committee during regional MMR. The incidence of perinatal mortality has diminished from 2005 to 2011 (8,4‰ vs. 6,4‰, P<0.07) as well as the percentage of non adapted care management (13% vs. 5,6%, P<0.001). An underestimation of irregularities in the fetal heart rate was described in 34% of per partum deaths. The percentage of optimal care management was significantly higher when the obstetrician was in the maternity rather than on call at home (P<0.03) and in type 3 maternities compared to type 1 and 2 maternities (P<0.04). The attendance of the MMR organized in the AURORE network progressed between 2006 and 2011. Since 2005, a decrease in perinatal mortality and in non-adapted care management was observed. More studies are necessary to evaluate the link between the development of MMR in this network and the amelioration of these two indicators. | 25,087,019 | [
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Quantitative analysis of ligand effects on bioefficacy of nanoemulsion encapsulating depigmenting active. | Efficient skin delivery of active molecules is the main challenge to overcome in order to achieve significant therapeutic efficiency of cosmetics or dermo-pharmaceutical products. Nanocarriers such as nanoemulsions have been envisaged to overcome main challenges of active solubilization, protection and transport to their site of biological action. Nonetheless, their skin permeation is still limited and a new approach is required to significantly improve bioavailability. We here explored the possibility of increasing the whitening activity of a model active, licorice, by implementing a targeting approach of nanoemulsions to melanocyte cells. Targeting requires particle surface modification with specific molecules favoring nanoemulsion/cells contact through ligand-receptor interactions. The uniqueness of our strategy is that unlike classical covalent chemical grafting, we propose a self-assembled strategy based on a selection of amphiphilic ligands able to localize at nanoemulsion droplets interface. Four ligand candidates were thus assayed in terms of formulation and in vitro biological evaluation: a palmitoyl-peptide (palmitoyl-GQPR), a lipidized hyaluronic acid (caproyl-HA) and two amphiphilic actives (polydatin and isopilosine). A functional analysis based on a cellular assay of melanin inhibition was realized. The intrinsic properties of ligand candidates were first evaluated. Then, nanoemulsions encapsulating a drug model, licorice, and targeted with the different ligand candidates were assayed. The use of caproyl-HA significantly improved bioefficacy of the encapsulated licorice, suggesting a better interaction with the cells. The improved value observed was not attributed to a synergetic action as caproyl-HA did not evidence intrinsic melanogenesis modulation activity. In this study, we demonstrated the feasibility of targeting nanoemulsion droplets without chemical covalent modification of nanoemulsion droplets to increase bioefficacy of encapsulated drugs in vitro. | 25,087,020 | [
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Effect of dams' parity and age on daughters' milk yield in Norwegian Red cows. | The effect of age and parity of dams on their daughters' milk yield is not well known. Lactation data from 276,000 cows were extracted from the Norwegian Dairy Herd Recording System and analyzed using a linear animal model to estimate effects of parity and age within parity of dam. The 305-d milk yield of daughters decreased as parity of dam increased. Daughters of first-parity dams produced 149 kg more milk than did daughters of seventh-parity dams. We also observed an effect of age of dam within parity on 305-d milk yield of daughters in first lactation. Dams that were young at first calving gave birth to daughters with a higher milk yield compared with older dams within the same parity. The effect of age within parity of dam was highest for second-parity dams. Extensive use of heifers would have a systematic effect, and age and parity of dam should be included in the model when planning a future strategy. | 25,087,031 | [
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Obesity increases precision errors in total body dual-energy x-ray absorptiometry measurements. | Total body (TB) dual-energy X-ray absorptiometry (DXA) is increasingly being used to measure body composition in research and clinical settings. This study investigated the effect of body mass index (BMI) and body fat on precision errors for total and regional TB DXA measurements of bone mineral density, fat tissue, and lean tissue using the GE Lunar Prodigy (GE Healthcare, Bedford, UK). One hundred forty-four women with BMI's ranging from 18.5 to 45.9 kg/m(2) were recruited. Participants had duplicate DXA scans of the TB with repositioning between examinations. Participants were divided into 3 groups based on their BMI, and the root mean square standard deviation and the percentage coefficient of variation were calculated for each group. The root mean square standard deviation (percentage coefficient of variation) for the normal (<25 kg/m²; n = 76), overweight (25-30 kg/m²; n = 36), and obese (>30 kg/m²; n = 32) BMI groups, respectively, were total BMD (g/cm(2)): 0.009 (0.77%), 0.009 (0.69%), 0.011 (0.91%); total fat (g): 545 (2.98%), 486 (1.72%), 677 (1.55%); total lean (g): 551 (1.42%), 540 (1.34%), and 781 (1.68%). These results suggest that serial measurements in obese subjects should be treated with caution because the least significant change may be larger than anticipated. | 25,087,044 | [
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Droperidol transiently prolongs the QT interval in children undergoing single ventricle palliation. | Historically, droperidol was commonly used for postoperative sedation of critically ill children. A FDA black box warning regarding its arrhythmogenic potential greatly reduced its use. We hypothesized that administration of neuroleptic dose droperidol during volatile anesthesia would transiently prolong the corrected QT interval (QTc) in patients undergoing single ventricle palliation. As part of a prospective study in children undergoing stage 2 or 3 single ventricle palliation, we recorded electrocardiograms preoperatively, after induction of volatile anesthesia, immediately after completion of 30 min intravenous infusion of 75 mcg/kg droperidol, and shortly after arrival in the cardiac intensive care unit. Mean absolute QT intervals and heart rate data were analyzed in a blinded fashion and the longest QT interval was determined. QT intervals were corrected for heart rate (QTc) with the Bazett and Friderici formulae. Any perioperative arrhythmias were recorded. Complete data were available for 62 patients. Volatile anesthesia was associated with significant prolongation of the QTc interval. Administration of droperidol after cardiopulmonary bypass was associated with further significant QTc prolongation. All QTc changes were transient and the postoperative QTc, while still prolonged relative to baseline, was significantly shorter than the QTc immediately postdroperidol. No episodes of Torsades de Pointes (TdP) or ventricular arrhythmias were observed. The administration of a neuroleptic dose of droperidol during volatile anesthesia in patients undergoing single ventricle palliation was associated with a significant prolongation of QTc, which was transient and did not result in TdP or other ventricular arrhythmias in our study population. | 25,087,057 | [
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Lead exposure from aluminum cookware in Cameroon. | Blood lead levels have decreased following the removal of lead from gasoline in most of the world. However, numerous recent studies provide evidence that elevated blood lead levels persist in many low and middle-income countries around the world at much higher prevalence than in the more developed countries. One potential source of lead exposure that has not been widely investigated is the leaching of lead from artisanal aluminum cookware, which is commonly used in the developing world. Twenty-nine samples of aluminum cookware and utensils manufactured by local artisans in Cameroon were collected and analyzed for their potential to release lead during cooking. Source materials for this cookware included scrap metal such as engine parts, radiators, cans, and construction materials. The lead content of this cookware is relatively low (<1000 ppm by X-ray fluorescence), however significant amounts of lead, as well as aluminum and cadmium were released from many of the samples using dilute acetic acid extractions at boiling and ambient temperatures. Potential exposures to lead per serving were estimated to be as high as 260 μg, indicating that such cookware can pose a serious health hazard. We conclude that lead, aluminum and cadmium can migrate from this aluminum cookware during cooking and enter food at levels exceeding recommended public health guidelines. Our results support the need to regulate lead content of materials used to manufacture these pots. Artisanal aluminum cookware may be a major contributor to lead poisoning throughout the developing world. Testing of aluminum cookware in other developing countries is warranted. | 25,087,065 | [
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Dilemmas for international mobilization around child abuse and neglect. | The goal of this commentary is to articulate some issues and dilemmas raised by various efforts to mobilize international action around child abuse and neglect (CAN). We will start by proposing a typology of international mobilization strategies, noting that initiatives to promote CAN programming in new settings have tended to emphasize one of three vectors: governments, professionals, or international NGOs. There are pros and cons to each emphasis, which we discuss. We also review the debates around some of the following dilemmas: Should low-income countries be a top priority for CAN mobilization? Are there cultural and institutional capacities that need to be present in a country in order for CAN programs to work or be ethical? Are some CAN programs more likely to be internationally transferable than others and why so? Has the field adequately considered whether non-CAN programming (e.g., family planning) might actually be more effective at preventing maltreatment than CAN programming? Does the field give adequate acknowledgment that policies and practices emanating from high-resourced and Western countries may not always be the best to disseminate? Are we relying too much on a model of program transplantation over a model of local cultivation? Should we aim for modest rather than ambitious accomplishments in international mobilization? How much emphasis should be placed on the priority dissemination of evidence-based programming? We conclude with some suggestions in the service of clarifying these dilemmas and making some of these decisions more evidence based. | 25,087,071 | [
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Genetic determinants of common epilepsies: a meta-analysis of genome-wide association studies. | The epilepsies are a clinically heterogeneous group of neurological disorders. Despite strong evidence for heritability, genome-wide association studies have had little success in identification of risk loci associated with epilepsy, probably because of relatively small sample sizes and insufficient power. We aimed to identify risk loci through meta-analyses of genome-wide association studies for all epilepsy and the two largest clinical subtypes (genetic generalised epilepsy and focal epilepsy). We combined genome-wide association data from 12 cohorts of individuals with epilepsy and controls from population-based datasets. Controls were ethnically matched with cases. We phenotyped individuals with epilepsy into categories of genetic generalised epilepsy, focal epilepsy, or unclassified epilepsy. After standardised filtering for quality control and imputation to account for different genotyping platforms across sites, investigators at each site conducted a linear mixed-model association analysis for each dataset. Combining summary statistics, we conducted fixed-effects meta-analyses of all epilepsy, focal epilepsy, and genetic generalised epilepsy. We set the genome-wide significance threshold at p<1·66 × 10(-8). We included 8696 cases and 26 157 controls in our analysis. Meta-analysis of the all-epilepsy cohort identified loci at 2q24.3 (p=8·71 × 10(-10)), implicating SCN1A, and at 4p15.1 (p=5·44 × 10(-9)), harbouring PCDH7, which encodes a protocadherin molecule not previously implicated in epilepsy. For the cohort of genetic generalised epilepsy, we noted a single signal at 2p16.1 (p=9·99 × 10(-9)), implicating VRK2 or FANCL. No single nucleotide polymorphism achieved genome-wide significance for focal epilepsy. This meta-analysis describes a new locus not previously implicated in epilepsy and provides further evidence about the genetic architecture of these disorders, with the ultimate aim of assisting in disease classification and prognosis. The data suggest that specific loci can act pleiotropically raising risk for epilepsy broadly, or can have effects limited to a specific epilepsy subtype. Future genetic analyses might benefit from both lumping (ie, grouping of epilepsy types together) or splitting (ie, analysis of specific clinical subtypes). International League Against Epilepsy and multiple governmental and philanthropic agencies. | 25,087,078 | [
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Validating archetypes for the Multiple Sclerosis Functional Composite. | Numerous information models for electronic health records, such as openEHR archetypes are available. The quality of such clinical models is important to guarantee standardised semantics and to facilitate their interoperability. However, validation aspects are not regarded sufficiently yet. The objective of this report is to investigate the feasibility of archetype development and its community-based validation process, presuming that this review process is a practical way to ensure high-quality information models amending the formal reference model definitions. A standard archetype development approach was applied on a case set of three clinical tests for multiple sclerosis assessment: After an analysis of the tests, the obtained data elements were organised and structured. The appropriate archetype class was selected and the data elements were implemented in an iterative refinement process. Clinical and information modelling experts validated the models in a structured review process. Four new archetypes were developed and publicly deployed in the openEHR Clinical Knowledge Manager, an online platform provided by the openEHR Foundation. Afterwards, these four archetypes were validated by domain experts in a team review. The review was a formalised process, organised in the Clinical Knowledge Manager. Both, development and review process turned out to be time-consuming tasks, mostly due to difficult selection processes between alternative modelling approaches. The archetype review was a straightforward team process with the goal to validate archetypes pragmatically. The quality of medical information models is crucial to guarantee standardised semantic representation in order to improve interoperability. The validation process is a practical way to better harmonise models that diverge due to necessary flexibility left open by the underlying formal reference model definitions.This case study provides evidence that both community- and tool-enabled review processes, structured in the Clinical Knowledge Manager, ensure archetype quality. It offers a pragmatic but feasible way to reduce variation in the representation of clinical information models towards a more unified and interoperable model. | 25,087,081 | [
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Treatment approach, delivery, and follow-up evaluation for cardiac rhythm disease management patients receiving radiation therapy: retrospective physician surveys including chart reviews at numerous centers. | In a 2-part study, we first examined the results of 71 surveyed physicians who provided responses on how they address the management of patients who maintained either a pacemaker or a defibrillator during radiation treatment. Second, a case review study is presented involving 112 medical records reviewed at 18 institutions to determine whether there was a change in the radiation prescription for the treatment of the target cancer, the method of radiation delivery, or the method of radiation image acquisition. Statistics are provided to illustrate the level of administrative policy; the level of communication between radiation oncologists and heart specialists; American Joint Committee on Cancer (AJCC) staging and classification; National Comprehensive Cancer Network (NCCN) guidelines; tumor site; patient׳s sex; patient׳s age; device type; manufacturer; live monitoring; and the reported decisions for planning, delivery, and imaging. This survey revealed that 37% of patient treatments were considered for some sort of change in this regard, whereas 59% of patients were treated without regard to these alternatives when available. Only 3% of all patients were identified with an observable change in the functionality of the device or patient status in comparison with 96% of patients with normal behavior and operating devices. Documented changes in the patient׳s medical record included 1 device exhibiting failure at 0.3-Gy dose, 1 device exhibiting increased sensor rate during dose delivery, 1 patient having an irregular heartbeat leading to device reprogramming, and 1 patient complained of twinging in the chest wall that resulted in a respiratory arrest. Although policies and procedures should directly involve the qualified medical physicist for technical supervision, their sufficient involvement was typically not requested by most respondents. No treatment options were denied to any patient based on AJCC staging, classification, or NCCN practice standards. | 25,087,083 | [
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Consumption of berries, fruits and vegetables and mortality among 10,000 Norwegian men followed for four decades. | The association between vegetable and fruit consumption and risk of cancer and cardiovascular disease (CVD) has been investigated by several studies, whereas fewer studies have examined consumption of vegetables and fruits in relation to all-cause mortality. Studies on berries, a rich source of antioxidants, are rare. The purpose of the current study was to examine the association between intake of vegetables, fruits and berries (together and separately) and the risk of all-cause mortality and cause-specific mortality due to cancer and CVD and subtypes of these, in a cohort with very long follow-up. We used data from a population-based prospective Norwegian cohort study of 10,000 men followed from 1968 through 2008. Information on vegetable, fruit and berry consumption was available from a food frequency questionnaire. Association between these and all-cause mortality, cause-specific mortality due to cancers and CVDs were investigated using Cox proportional hazard regression models. Men who in total consumed vegetables, fruit and berries more than 27 times per month had an 8-10% reduced risk of all-cause mortality compared with men with a lower consumption. They also had a 20% reduced risk of stroke mortality. Consumption of fruit was inversely related to overall cancer mortality, with hazard rate ratios of 0.94, 0.84 and 0.79 in the second, third and firth quartile, respectively, compared with the first quartile. Increased consumption of vegetables, fruits and berries was associated with a delayed risk of all-cause mortality and of mortality due to cancer and stroke. | 25,087,093 | [
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Assesment of perfusion in glial tumors with arterial spin labeling; comparison with dynamic susceptibility contrast method. | Arterial spin labeling perfusion imaging (ASL-PI) is a non-invasive perfusion imaging method that can be used for evaluation and quantification of cerebral blood flow (CBF). Aim of our study was to evaluating the efficiency of ASL in histopathological grade estimation of glial tumors and comparing findings with dynamic susceptibility contrast perfusion imaging (DSC-PI) method. This study involved 33 patients (20 high-grade and 13 low-grade gliomas). Multiphase multislice pulsed ASL MRI sequence and a first-passage gadopentetate dimeglumine T2*-weighted gradient-echo single-shot echo-planar sequence were acquired for all the patients. For each patient, perfusion relative signal intensity (rSI), CBF and relative CBF (rCBF) on ASL-PI and relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) values on DSC-PI were determined. The relative signal intensity of each tumor was determined as the maximal SI within the tumor divided by SI within symetric region in the contralateral hemisphere on ASL-PI. rCBV and rCBF were calculated by deconvolution of an arterial input function. Relative values of the lesions were obtained by dividing the values to the normal appearing symmetric region on the contralateral hemisphere. For statistical analysis, Mann-Whitney ranksum test was carried out. Receiver operating characteristic curve (ROC) analysis was performed to assess the relationship between the rCBF-ASL, rSI-ASL, rCBV and rCBF ratios and grade of gliomas. Their cut-off values permitting best discrimination was calculated. The correlation between rCBV, rCBF, rSI-ASL and rCBF-ASL and glioma grade was assessed using Spearman correlation analysis. There was a statistically significant difference between low and high-grade tumors for all parameters. Correlation analyses revealed significant positive correlations between rCBV and rCBF-ASL (r=0.81, p<0.001). However correlation between rCBF and rCBF-ASL was weaker (r=0.64, p<0.001). Arterial spin labeling is an employable imaging technique for evaluating tumor perfusion non-invasively and may be useful in differentiating high and low grade gliomas. | 25,087,109 | [
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Intensity rankings of plyometric exercises using joint power absorption. | Athletic trainers and physical therapists often progress patients through rehabilitation by selecting plyometric exercises of increasing intensity in preparation for return to sport. The purpose of this study was to quantify the intensity of seven plyometric movements commonly used in lower-extremity rehabilitation by joint-specific peak power absorption and the sum of the peak power. Ten collegiate athletes performed submaximal plyometric exercises in a single test session: vertical jump, forward jump, backward jump, box drop, box jump up, tuck jump, and depth jump. Three-dimensional kinematics and force platform data were collected to generate joint kinetics. Peak power absorption normalized to body mass was calculated at the ankle, knee, and hip, and averaged across repetitions. Joint peak power data were pooled across athletes and summed to obtain the sum of peak power. Movements were ranked from 1 (low) to 7 (high) based on the sum of peak power and joint peak power (ankle, knee, hip). The sum of peak power did not correspond with standard low, medium, and high subjective intensity ratings or joint peak power in all joints. Mixed model analyses revealed significant variance between the sum of peak power and joint peak power ranks in the forward jump, backward jump, box drop, and depth jump (P<0.05), but not in the vertical jump, box jump up, and tuck jump. Results provide intensity rankings that can be used directly by athletic trainers and physical therapists in developing protocols for rehabilitation specific to the injured joint. | 25,087,112 | [
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[Sexual function, physical handicap]. | While the right to a sexual life for disabled people is not contested, their sexuality cannot be summed up in a debate for or against sexual assistance. In a similar way, sexual function can only be understood in light of all the difficulties related to disability. Medical progress can improve sexual function and solve many problems in order to facilitate access to procreation. However, these are not well known and are reserved to specialized teams. Many disabled persons are totally autonomous in their sexuality, but for some who require medical assistance, it is necessary to support them in a process of creation where therapeutic interventions consist of facilitating or stimulating the patient's own resources. | 25,087,114 | [
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Marine mammals and ocean noise: future directions and information needs with respect to science, policy and law in Canada. | Marine mammals are ecologically and culturally important species, and various countries have specific legislation to protect the welfare of individual marine mammals and the conservation of their populations. Anthropogenic noise represents a particular challenge for conservation and management. There is a large and growing body of research to support the conclusion that anthropogenic noise can affect marine mammal behavior, energetics, and physiology. The legal, policy, and management issues surrounding marine mammals and noise are similarly complex. Our objective is twofold. First, we discuss how policy and legal frameworks in Canada have some important differences from other jurisdictions covered in previous reviews, and provide a useful general case study. Secondly, we highlight some priority research areas that will improve marine mammal conservation and management. Our examples focus on the research needed to meet stated conservation objectives for marine mammal species in waters under Canadian jurisdiction. | 25,087,130 | [
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Health care-associated infection prevention in Japan: the role of safety culture. | Limited data exist on the use of infection prevention practices in Japan. We conducted a nationwide survey to examine the use of recommended infection prevention strategies and factors affecting their use in Japanese hospitals. Between April 1, 2012, and January 31, 2013, we surveyed 971 hospitals in Japan. The survey instrument assessed general hospital and infection prevention program characteristics and use of infection prevention practices, including practices specific to preventing catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP). Logistic regression models were used to examine multivariable associations between hospital characteristics and the use of the various prevention practices. A total of 685 hospitals (71%) responded to the survey. Maintaining aseptic technique during catheter insertion and maintenance, avoiding routine central line changes, and using maximum sterile barrier precautions and semirecumbent positioning were the only practices regularly used by more than one-half of the hospitals to prevent CAUTI, CLABSI, and VAP, respectively. Higher safety-centeredness was associated with regular use of prevention practices across all infection types. Although certain practices were used commonly, the rate of regular use of many evidence-based prevention practices was low in Japanese hospitals. Our findings highlight the importance of fostering an organization-wide atmosphere that prioritizes patient safety. Such a commitment to patient safety should in turn promote the use of effective measures to reduce health care-associated infections in Japan. | 25,087,141 | [
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Risk factors for catheter-associated urinary tract infection in Italian elderly. | Catheter-associated urinary tract infections (CAUTIs) are the most common cause of hospital-acquired infections, especially in elderly patients. Data on CAUTIs in older persons in acute care settings are lacking, however. This study aimed to describe the epidemiology of CAUTIs and related outcomes (ie, length of stay and mortality), in patients admitted to an acute geriatric care hospital in central Italy. A CAUTI surveillance program was implemented from October 2011 to April 2012, according to the Centers for Disease Control and Prevention's National Healthcare Safety Network methodology. A total of 2773 patients aged ≥65 years were included in the study, and 483 catheterized patients were monitored for the risk of CAUTI. The catheterization rate was 16.7% (95% confidence interval [CI], 15.3%-18.2%), and the overall CAUTI incidence rate was 14.7/1000 device-days (95% CI, 11.7-18.3/1000). Mortality was significantly higher in catheterized patients with a CAUTI compared with noncatheterized patients (19.2% vs 10.5%; P < .05). Female sex (odds ratio [OR], 1.31; 95% CI, 1.06-1.67), increasing age (≥90 years: OR, 2.76; 95% CI, 2.00-3.83), and longer hospital stay before catheter insertion (≥15 days: OR, 2.90; 95% CI, 2.20-3.83) were independent risk factors for catheterization; increasing age (>90 years: OR, 2.75; 95% CI, 1.03-7.35), and duration of hospital stay before catheter insertion (OR, 2.41; 95% CI, 1.12-5.51) were associated with CAUTIs. These results underscore the importance of the proper choice of patients for catheterization, particularly in individuals aged >90 years. | 25,087,142 | [
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Does the presence of oral care guidelines affect oral care delivery by intensive care unit nurses? A survey of Saudi intensive care unit nurses. | Mechanically ventilated patients rely on nurses for their oral care needs, signifying the importance of nurses in intensive care units (ICUs). This study aimed to evaluate the impact of oral care guidelines on the oral care delivered to mechanically ventilated patients by ICU nurses. A total of 215 nurses were enrolled. Demographic data and oral care practices were recorded through a self-administered survey. Participants governed by oral care guidelines had significantly higher oral care practice scores than their counterparts from ICUs without similar guidelines (P = .034; t = 2.13). Oral care guidelines in ICUs can contribute to reduction of morbidity and mortality caused by ventilator-associated pneumonia. | 25,087,146 | [
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A century for progress in the diagnosis of Wilson disease. | The diagnosis of Wilson disease has evolved from the original description of a neurological syndrome by Wilson and other contemporaries at the turn of the 20th century to where we recognize that there is a spectrum of clinical liver and neuropsychiatric disease diagnosed by a combination of clinical and biochemical tests and more recently by molecular genetic analysis. The history of the evolution of the findings that help us establish a diagnosis of Wilson disease are presented in the following brief summary of a century of progress toward this end. | 25,087,157 | [
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Nicking enzyme and graphene oxide-based dual signal amplification for ultrasensitive aptamer-based fluorescence polarization assays. | In this work, two different configurations for novel amplified fluorescence polarization (FP) aptasensors based on nicking enzyme signal amplification (NESA) and graphene oxide (GO) enhancement have been developed for ultrasensitive and selective detection of biomolecules in homogeneous solution. One approach involves the aptamer-target binding induced the stable hybridization between an aptamer probe and a fluorophore-labeled DNA probe linked to GO, and forms a nicking site-containing duplex DNA region due to the enhancement of base stacking. The second analytical method involves the target induced the assembly of two aptamer subunits into an aptamer-target complex, and then hybridizes with a fluorophore-labeled DNA probe linked to GO, forming a nicking site-containing duplex DNA region. The formation of the duplex DNA region in both methods triggers the NESA process, resulting in the release of many short DNA fragments carrying the fluorophore from GO, generating a significant decrease of the FP value that provides the readout signal for the amplified sensing process. By using the NESA coupled GO enhancement path, the sensitivity of the developed aptasensors can be significantly improved by four orders of magnitude over traditional aptamer-based homogeneous assays. Moreover, these aptasensors also exhibit high specificity for target molecules, which are capable of detecting target molecule in biological samples. Considering these qualities, the proposed FP aptasensors based NESA and GO enhancement can be expected to provide an ultrasensitive platform for amplified analysis of target molecules. | 25,087,158 | [
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[Chikungunya fever - A new global threat]. | The recent onset of epidemics caused by viruses such as Ebola, Marburg, Nipah, Lassa, coronavirus, West-Nile encephalitis, Saint Louis encephalitis, human immunodeficiency virus, dengue, yellow fever and Venezuelan hemorrhagic fever alerts about the risk these agents represent for the global health. Chikungunya virus represents a new threat. Surged from remote African regions, this virus has become endemic in the Indic ocean basin, the Indian subcontinent and the southeast of Asia, causing serious epidemics in Africa, Indic Ocean Islands, Asia and Europe. Due to their epidemiological and biological features and the global presence of their vectors, chikungunya represents a serious menace and could become endemic in the Americas. Although chikungunya infection has a low mortality rate, its high attack ratio may collapse the health system during epidemics affecting a sensitive population. In this paper, we review the clinical and epidemiological features of chikungunya fever as well as the risk of its introduction into the Americas. We remark the importance of the epidemiological control and mosquitoes fighting in order to prevent this disease from being introduced into the Americas. | 25,087,211 | [
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A framework for post-registration development. | In May 2014 the chief nursing officer for Wales launched a new governance framework for post-registration nurse education in Wales. This article describes how the framework was developed and how it will be used in practice. | 25,087,265 | [
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Left cecal displacement in a cow. | Left cecal displacement is described in a 4-year-old cow. This is the first reported case in the literature. Diagnosis was made at laparotomy. | 25,087,302 | [
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A model of risk reduction for older adults vulnerable to nursing home placement. | Because of the cost of nursing home care and desire of older adults to stay in their homes, it is important for health care providers to understand the factors that place older adults at risk for nursing home placement. This integrative review of 12 years of research, as published in 148 articles, explores the risk factors for nursing home placement of older adults. Using the framework of the vulnerable populations conceptual model developed by Flaskerud and Winslow (1998), we explored factors related to resource availability, relative risks, and health status. Important factors include socioeconomic status, having a caregiver, the availability and use of home- and community-based support services, race, acute illness particularly if hospitalization is required, medications, dementia, multiple chronic conditions, functional disability, and falls. Few intervention studies were identified. Development of evidence-based interventions and creation of policies to address modifiable risk factors are important next steps. | 25,087,327 | [
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[Organization of the National Neurofibromatosis Register and areas of application]. | The neurofibromatosis is a rare genetic disease with increased tumor growing ability and different special symptoms (Riccardi-criteria). The National NF Register has been organized by NF Hungary in 2011. The idea was initiated by hungarian neurofibromatosis experts. The register contains data about the primary care physician, the hospital and the patient. The data are recorded by retrospective method and followed in time, so the register can track progress. Furthermore, the register has valid nutrition, physical activity and psychological data, so the users are able to make comparisons with the clinical information. 225 persons are registerd in the system on NF Hungary and 37 patients belong to the NF National Register. The number of patients, who are members of the registry, is always increasing. From the 37 persons 22 are females (60%) and 15 males (40%), 18 adults (48%) and 19 minors (52%). NF Register is a very useful system to do research and to draw public health and popolazione conclusions. The register enhances the morbidity details (time of manifestation, progression, prognostic factors, prognosis), thereby could improve the cooperation and the coverage of the patients. The system is open to the patients as well, so it can give them information about new scientific results, new medical treatments and currently availavable medications. | 25,087,378 | [
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[Analysis of the data of patients presenting for emergency treatment with vertigo]. | Analyzing the medical record data of patients with the main symptom of vertigo in "Kaposi M6r" Hospital's Emergency Department. Retrospective evaluation of patients's medical history with vertigo related diagnoses according to BNO classification. In the year of 2010, 18 000 patients were presented to ED. In 471 cases the symptoms were vertigo related which makes up 3% of the total. Almost half, 46% of these patients were brought in by ambulance medical car. The ratio of women was twice as high as of the men. One fifth, 19% of patients with vertigo gained admission to the ward and 81% of them were discharged in 24 hours. According to the interviews, 4 types of vertigo have been identified: "whirling style" vertigo in 37% of the cases, dizziness in 33% of the cases, presyncope in 12% and "light headedness" in 9%. The remaining 9% couldn't be classified. Vertigo is common presenting symptom in emergency department, however it rarely indicates severe condition. The diagnostic value of vertigo classification based on history and brain CT result in identifying the severity of the background condition is questionable. We found that in recognizing the cases which need prompt intervention, thorough neurological examination and the clarification of the vertigo's circumstances proved to be helpful. | 25,087,379 | [
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[Effect of 30-day space flight and subsequent readaptation on the signaling processes in m. longissimus dorsi of mice]. | Some steps of anabolic and catabolic signaling pathways were investigated in postural/tonic m. longissimus dorsi of mice following the 30-day orbital flight of biosatellite "Bion-M1" and 8-day recovery. Western blotting was used for determining insulin receptor substrate 1 (IRS-1) and AMR-activated protein kinase (AMPK) involved in reciprocal regulation of anabolic and catabolic pathways, as well as E3-ligase MURF-1, and elongation factor eEF2. Functioning of the IGF-1-dependent IRS-1 signaling pathway was activated in the recovery period only. Though the content of ubiquitinligase MURF-1 showed an increase after flight, on completion of the recovery period it did not exceed the pre-flight level unambiguously. | 25,087,406 | [
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[Water disinfection by the combined exposure to super-high frequency energy and available chlorine produced during water electrolysis]. | The article reports the results of studying the effects on polluted water of SHF-energy together with the residual free (active) chlorine as a by-product of electrolysis action on dissolved chlorine-containing salts. Purpose of the studies was to evaluate input of these elements to the water disinfection effect. The synergy was found to kill microorganisms without impacts on the physicochemical properties of processed water or nutrient medium; therefore, it can be used for water treatment, and cultivation of microorganisms in microbiology. | 25,087,412 | [
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[The role of standardization of the spa and resort-based treatment of the patients based at a neurological health resort]. | The present paper was designed to summarize the experience with the standard use of the spa and resort-based treatment of the patients with the lesions in separate nerves, nerve roots and plexuses as well as polyneuropathies. It was shown that the existing standard helps to resolve certain marketing problems but is not sufficiently adequate for the choice of the set of therapeutic modalities on an individual basis. The importance of the correct choice of the combination of the methods for the treatment of neurological disorders and the achievement of the desired outcome of the disease is emphasized. The prognostically significant predictors of the effectiveness of the spa and resort-based treatment have been identified. | 25,087,416 | [
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[The influence of intravenous laser therapy on the endothelial function and the state of microcirculation in the patients presenting with rheumatoid arthritis]. | The objective of the present work was to study effects of low-level laser irradiation on the endothelial function and selected parameters of microcirculation in the patients presenting with rheumatoid arthritis. This study included 132 patients at the age varying from 18 to 85 years presenting with rheumatoid arthritis. They were divided into 2 groups. The patients of the main group (n = 102) underwent daily intravenous laser blood irradiation during 10 days. The control group was comprised of 30 patients. Laser therapy was performed with the help of a laser therapeutic device Matrix - VLOK ("Matrix", Russia) using alternation of two radiating heads: KI-VLOK-63 (wavelength 0.63 pm, for 15 minutes) and KI-VLOK-365 (wavelength 0.365 microm, for 5 minutes) in the continuous emission regime. The parameters of interest were measured before and after the treatment. The overall duration of intravenous laser irradiation of blood was 10 days without a break for the weekend. The data obtained suggest the improvement of the endothelial function and the microcirculation indices. | 25,087,414 | [
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A new vision for advanced nursing practice. | Part one of this series suggests that the post-Francis era requires a perspective on advanced nursing practice that emphasises, celebrates and rewards the development of core nursing skills, values and attitudes rather than extending the role of the nurse into medical territory. This article offers some thoughts and ideas that attempt to move the focus away from the notion of advanced practice as the development of a particular role towards the idea of advancing practice as a team of like-minded professionals working together in practice innovation units for the benefit and wellbeing of patients. | 25,087,441 | [
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The protective role of thymoquinone in the prevention of gentamicin ototoxicity. | To investigate the potential protective effect of thymoquinone in gentamicin-induced ototoxicity through auditory brain stem responses (ABR) testing and histomorphological evaluation of the cochlea. This study was conducted on 48 adult female Sprague-Dawley rats that were randomized into 4 groups. Group 1 received intraperitoneal gentamicin; group 2 received intraperitoneal gentamicin plus corn oil solution; group 3 received intraperitoneal thymoquinone; and group 4 received intraperitoneal gentamicin plus thymoquinone. All groups received the drugs (once daily) in the above-mentioned protocols over 15 days. After conducting repeated ABR measurements, the rats were sacrificed, and their cochleae were isolated. ABR thresholds were preserved in the gentamicin plus thymoquinone group when compared with the group receiving gentamicin alone. There were fewer TUNEL-positive cells and caspase-3 and caspase-9 expressions were weaker in the inner and outer hairy cells of the organ of Corti in the gentamicin plus thymoquinone group compared with the group receiving gentamicin alone. The ABR values and number of apoptotic cells did not significantly increase in the group receiving gentamicin plus thymoquinone when compared to the group receiving gentamicin alone. Again, the cochlear histomorphological findings were supportive of the auditory findings. In light of these findings, we conclude that gentamicin-induced ototoxicity may be prevented by thymoquinone use in rats. | 25,087,465 | [
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Cardiovascular effects of the angiotensin type 2 receptor. | The angiotensin type 2 receptor, AT2R, has been described as having opposite effects to the angiotensin type 1 receptor, AT1R. Although the quantities of the AT2R found in the adult are low, its expression rises in pathological situations. The AT2R has three major signaling pathways: activation of serine/threonine phosphatases (promoting apoptosis and antioxidant effects), activation of the bradykinin/NO/cGMP pathway (promoting vasodilation), and activation of phospholipase A2 (associated with regulation of potassium currents). The AT2R appears to have effects in vascular remodeling, atherosclerosis prevention and blood pressure lowering (when associated with an AT1R inhibitor). After myocardial infarction, the AT2R appears to decrease infarct size, cardiac hypertrophy and fibrosis, and to improve cardiac function. However, its role in the heart is controversial. In the kidney, the AT2R promotes natriuresis. Until now, treatment directed at the renin-angiotensin-aldosterone system has been based on angiotensin-converting enzyme inhibitors or angiotensin type 1 receptor blockers. The study of the AT2R has been revolutionized by the discovery of a direct agonist, C21, which promises to become part of the treatment of cardiovascular disease. | 25,087,493 | [
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Low-dose capsule filling of inhalation products: critical material attributes and process parameters. | The aim of the present work was to identify the material attributes and process parameters of a dosator-nozzle capsule filling machine that are critical in low-fill weight capsule filling for inhalation therapies via hard-gelatin capsules. Twelve powders, mostly inhalation carriers, some fines and one proprietary active pharmaceutical ingredient (API), were carefully characterized and filled into size 3 capsules. Since different process conditions are required to fill capsules with powders that have very different material attributes, the powders were divided into two groups. A design of experiments (DOE) based exclusively on process parameters was developed for each group, to identify the critical material attributes (CMA) and critical process parameters (CPP). The fill weight (4-45 mg) of the group I powders (larger particles, higher density, better flowability and less cohesion) correlated with the nozzle diameter (1.9-3.4mm), the dosing chamber length (2.5-5mm), the powder layer depth (5-12.5mm) and the powder density (bulk and tapped density). The RSDs were acceptable in most cases, even for very low doses. The fill weight (1.5-21 mg) of group II powders (very fine and low dense particles with a particle size <10 μm, poor flowability and higher cohesion) depended also on the nozzle diameter (1.9-2.8mm), the dosing chamber length (2.5-5mm) and the powder layer depth (5-10mm), albeit in a different way, indicating that for these powders dosator filling was not volumetric. Moreover, frictional (wall friction angle) and powder-flow characteristics (bulk density and basic flowability energy) have an influence on the mass. Thus, in summary, group I and group II powders can be filled successfully via dosator systems at low fill weights. However, the group II powders were more challenging to fill, especially without automated process control. This study is the first scientific qualification of dosator nozzles for low-fill weight (1-45 mg) capsule filling. | 25,087,508 | [
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Using morphological awareness instruction to improve written language skills. | Written English is a morphophonemic language. Researchers have documented that a conscious awareness of the morphological structure of English morphology is predictive of students' written language skills and that morphological awareness instruction leads to improvements in morphological awareness and in other written language skills. The purpose of this tutorial is to provide specific information to clinical scientists and other educators for integrating morphological awareness instruction into their written language instruction. The authors first define morphological awareness and provide an overview of the research on the effects of morphological awareness intervention on improving morphological awareness and written language skills. Measures used to assess morphological awareness ability are then discussed, followed by suggestions for how clinical scientists and other educators can provide morphological awareness instruction to improve the written language skills of the students they serve. By integrating morphological awareness instruction into the services they provide, clinical scientists and other educators will be providing their students with a strong tool to aid written language skills. | 25,087,512 | [
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Mechanistic basis for functional promiscuity in the TNF and TNF receptor superfamilies: structure of the LIGHT:DcR3 assembly. | LIGHT initiates intracellular signaling via engagement of the two TNF receptors, HVEM and LTβR. In humans, LIGHT is neutralized by DcR3, a unique soluble member of the TNFR superfamily, which tightly binds LIGHT and inhibits its interactions with HVEM and LTβR. DcR3 also neutralizes two other TNF ligands, FasL and TL1A. Due to its ability to neutralize three distinct different ligands, DcR3 contributes to a wide range of biological and pathological processes, including cancer and autoimmune diseases. However, the mechanisms that support the broad specificity of DcR3 remain to be fully defined. We report the structures of LIGHT and the LIGHT:DcR3 complex, which reveal the structural basis for the DcR3-mediated neutralization of LIGHT and afford insights into DcR3 function and binding promiscuity. Based on these structures, we designed LIGHT mutants with altered affinities for DcR3 and HVEM, which may represent mechanistically informative probe reagents. | 25,087,510 | [
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Shared responsibility for electronic records: governance in perinatal data entry. | This paper presents research undertaken as part of a larger research project to examine the factors that influence midwives when entering perinatal data. A grounded theory methodology was used to undertake qualitative interviews with 15 participants from 12 different hospitals across Queensland, Australia using three different systems for perinatal data collection. The findings surrounding accountability are presented revealing that a shift in governance relating to responsibility and accountability is not occurring in midwifery units across Queensland. Without assignation of responsibility for entries and accountability for mistakes or omissions, perinatal data records can be left incomplete or inaccurate. Increasing use of electronic health records and creation of digital hospitals indicates these issues are highly relevant in planning for these services. | 25,087,522 | [
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Fitting clinical workflow: the case for wound care in a residential aged care home. | Residential aged care homes have, or are in the process of implementing, electronic health record (EHR) systems to improve quality of care and reduce cost. For the system to deliver benefits, it must support nursing tasks and be seamlessly integrated into the nursing workflow. To identify whether and how an EHR system can do this most effectively, direct observation was conducted in a residential aged care home on nurses' use of EHR for wound care. The work processes of wound care and its documentation were investigated. Problems in the use of EHR were identified: 1) functional deficiencies of the EHR system which included a lack of functions to remind nurses of the existence of a wound chart, unavailability of an existent function when needed and a lack of sufficient detail in the information provided; 2) a lack of mobile devices to allow nurses to access the EHR system at the point-of-care, resulting in nurses using paper for point-of-care documentation. The findings suggest that continuous improvement in both the EHR system and its management is required to achieve integration of people, task, process and technology for the optimal benefits of EHR. | 25,087,539 | [
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Coping with information silos: an examination of the medication management process in residential aged care facilities (RACFs). | The aim of this study was to examine the actions of geographically dispersed process stakeholders (doctors, community pharmacists and RACFs) in order to cope with the information silos that exist within and across different settings. The study setting involved three metropolitan RACFs in Sydney, Australia and employed a qualitative approach using semi-structured interviews, non-participant observations and artefact analysis. Findings showed that medication information was stored in silos which required specific actions by each setting to translate this information to fit their local requirements. A salient example of this was the way in which community pharmacists used the RACF medication charts to prepare residents' pharmaceutical records. This translation of medication information across settings was often accompanied by telephone or face-to-face conversations to cross-check, validate or obtain new information. Findings highlighted that technological interventions that work in silos can negatively impact the quality of medication management processes in RACF settings. The implementation of commercial software applications like electronic medication charts need to be appropriately integrated to satisfy the collaborative information requirements of the RACF medication process. | 25,087,543 | [
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Analysis of operating theatre utilisation to drive efficiency and productivity improvements. | There is an urgent need in the acute health system to use resources as efficiently as possible. One such group of resources are operating theatres, which have an important impact on patient flow through a hospital. Data-driven insights into the use of operating theatres can suggest improvements to minimise wastage and improve theatre availability. In this paper, a short extract of surgical data from participating Queensland public hospitals was statistically analysed to examine the effects of session type, session specialty, scheduling the longest case first and day of the week on theatre utilisation. It was found that day-long sessions (as opposed to separate morning or afternoon sessions), mid-week sessions, certain specialties (eg. neurosurgery sessions) and not doing the longest case first were most beneficial to theatre utilisation. Awareness of these findings is important in any redesign activity aimed at improving flow performance. | 25,087,544 | [
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[Two cases of acute onset of focal cortical reflex myoclonus following acute aseptic meningoencephalitis with positive anti-glutamate receptor autoantibody]. | Patient 1 was a 40-year-old man, who suffered from right leg myoclonus 1 week after an episode of fever and headache. Myoclonus disappeared 4 months after administration of clonazepam. Patient 2 was a 42-year-old man, who suffered from right leg myoclonus, attacks of speech arrest and a generalized tonic-clonic seizure. His symptoms disappeared after steroid-pulse therapy, but right leg myoclonus and episodic impairment of consciousness recurred within a month. He underwent another steroid-pulse therapy and his symptoms disappeared. In both patients, cerebrospinal fluid (CSF) study showed pleocytosis and elevated protein level, electrophysiological study showed cortical reflex by stimulation of the right tibial nerve, and brain MRI showed the high intensity area in the left parietal lobe. In addition, on electroencephalogram (EEG) spikes at vertex preceded myoclonic jerk of the right tibialis anterior muscle in both patients. These findings indicate that focal cortical reflex myoclonus was accompanied by acute central nervous system (CNS) infection. Furthermore, in both patients, autoantibody against glutamate receptor subunits ε2 was detected both in serum and CSF, which also suggest that autoimmune mechanism contributed in the pathophysiology of acute development of focal cortical reflex myoclonus. | 25,087,554 | [
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[Beneficial effects of 3,4-diaminopyridine in a 26-year-old woman with DOK7 congenital myasthenic syndrome who was originally diagnosed with facioscapulohumeral dystrophy]. | We report a 26-year-old woman who had respiratory dysfunction and muscle weakness at birth and was diagnosed with facioscapulohumeral dystrophy at the age of 5. The extent of muscle weakness fluctuated daily or weekly and deteriorated in menstrual periods. At the age of 12, she noted improvements in symptoms when taking procaterol hydrochloride and began to take it regularly. After that, her condition stabilized. At the age of 26, she visited our hospital presenting with ptosis, muscle weakness in the face, trunk, and proximal limbs, and easy fatigability. Serum CK was normal; anti-acetylcholine receptor and anti-muscle specific tyrosine kinase antibodies were negative. A repetitive stimulation test in the trapezius muscle showed a waning phenomenon. Gene analysis for congenital myasthenic syndrome (CMS) revealed a new mutation in the DOK7 gene; the diagnosis of CMS was confirmed. Her symptoms worsened with ambenonium chloride but improved with 3,4-diaminopyridine. Our findings suggest that daily or weekly fluctuation and worsening with a menses in muscle weakness is an important diagnostic feature of CMS. | 25,087,557 | [
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Development and validation of a risk score predicting risk of colorectal cancer. | Quantifying the risk of colorectal cancer for individuals is likely to be useful for health service provision. Our aim was to develop and externally validate a prediction model to predict 5-year colorectal cancer risk. We used proportional hazards regression to develop the model based on established personal and lifestyle colorectal cancer risk factors using data from 197,874 individuals from the 45 and Up Study, Australia. We subsequently validated the model using 24,233 participants from the Melbourne Collaborative Cohort Study (MCCS). A total of 1,103 and 224 cases of colorectal cancer were diagnosed in the development and validation sample, respectively. Our model, which includes age, sex, BMI, prevalent diabetes, ever having undergone colorectal cancer screening, smoking, and alcohol intake, exhibited a discriminatory accuracy of 0.73 [95% confidence interval (CI), 0.72-0.75] and 0.70 (95% CI, 0.66-0.73) using the development and validation sample, respectively. Calibration was good for both study samples. Stratified models according to colorectal cancer screening history, that additionally included family history, showed discriminatory accuracies of 0.75 (0.73-0.76) and 0.70 (0.67-0.72) for unscreened and screened individuals of the development sample, respectively. In the validation sample, discrimination was 0.68 (0.64-0.73) and 0.72 (0.67-0.76), respectively. Our model exhibited adequate predictive performance that was maintained in the external population. The model may be useful to design more powerful cancer prevention trials. In the group of unscreened individuals, the model may be useful as a preselection tool for population-based screening programs. | 25,087,576 | [
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Differences in evaluation methods of trunk sway using different MoCap systems. | The position of the trunk can be negatively influenced by many diseases. Several methods can be used for identifying defects in balance and coordination as a result of pathology of the musculoskeletal or nervous system. The aim of this article is to examine the relationship between the three methods used for analysis of trunk sway and compare two fundamentally different MoCap systems. We used a camera system and a 3DOF orientation tracker placed on subject's trunk, and measured inclination (roll) and flexion (pitch) during quiet stance. Ten healthy participants in the study were measured with eyes open and closed. The pitch versus roll plots of trunk were formed, and the area of the convex hull, area of confidence ellipse and total length of the trajectory of the pitch versus roll plot were calculated. The statistical analysis was performed and strong correlation between the area of the convex hull and area of the confidence ellipse was found. Also, the results show moderate correlation between the area of the confidence ellipse and total length of the trace, and moderate correlation between the area of the convex hull and total length of the trace. In general, the different MoCap systems show different areas and lengths but lead to the same conclusions. Statistical analysis of the participants with eyes open and eye closed did not show significant difference in the areas and total lengths of the pitch versus roll plots. | 25,087,580 | [
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Preparation, photophysical characterization, and modeling of LDS722/Laponite 2D-ordered hybrid films. | A novel hybrid material with promising optical properties for nonlinear optical applications is presented, as formed by LDS 722 organic dye confined in Laponite clay. Thin films of the hybrid material with different dye loadings have been prepared. The film thickness, the dye and water content, and the clay swelling due to guest molecule incorporation have been characterized. Then, the photophysical properties of the thin films have been studied in detail using experimental methods and molecular simulation. As the dye load increases, the hybrid films present a hypsochromic shift in absorption and a bathochromic shift in emission. The former is attributed to the increasing strength of solvation of the dye donor group, while the latter is ascribed to a switch from an intramolecular to an intermolecular charge-transfer process as the dye load increases. The LDS 722 molecules are preferentially oriented in the host clay almost in parallel to the platelet surfaces, inducing macroscopic order that makes the material responsive to polarized light. | 25,087,605 | [
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Light-induced vibration in the hearing organ. | The exceptional sensitivity of mammalian hearing organs is attributed to an active process, where force produced by sensory cells boost sound-induced vibrations, making soft sounds audible. This process is thought to be local, with each section of the hearing organ capable of amplifying sound-evoked movement, and nearly instantaneous, since amplification can work for sounds at frequencies up to 100 kHz in some species. To test these fundamental precepts, we developed a method for focally stimulating the living hearing organ with light. Light pulses caused intense and highly damped mechanical responses followed by traveling waves that developed with considerable delay. The delayed response was identical to movements evoked by click-like sounds. This shows that the active process is neither local nor instantaneous, but requires mechanical waves traveling from the cochlear base toward its apex. A physiologically-based mathematical model shows that such waves engage the active process, enhancing hearing sensitivity. | 25,087,606 | [
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Hydrogenation of sulfoxides to sulfides under mild conditions using ruthenium nanoparticle catalysts. | The first demonstration of the hydrogenation of sulfoxides under atmospheric H2 pressure is reported. The highly efficient reaction is facilitated by a heterogeneous Ru nanoparticle catalyst. The mild reaction conditions enable the selective hydrogenation of a wide range of functionalized sulfoxides to the corresponding sulfides. The high redox ability of RuO(x) nanoparticles plays a key role in the hydrogenation. | 25,087,622 | [
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Inhibition of human enterovirus 71 replication by pentacyclic triterpenes and their novel synthetic derivatives. | A large number of bioactive pentacyclic triterpenoids have been shown to have multiple biological activities. This study was conducted to evaluate the inhibitory activities of 6 newly synthesized and novel pentacyclic triterpenoids against enterovirus 71 (EV71). The parent compound, ursolic acid (UA), showed the greatest inhibitory activity against EV71, while oleanolic acid (OA), asiatic acid (AA), and synthetic derivatives of 18-β-glycyrrhetinic acid (GA) and OA also exhibited inhibitory effects, although to lesser extents. The results suggest these compounds show potential for further optimization as antiviral candidates for treatment of EV71 infections. | 25,087,628 | [
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0.14... |
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