Miracle-dz/UniFAR-FTUs huggingface dataset:
Just Getting on with it: Exploring the Service Needs of Mothers Who Care for Young Children with Severe/Profound and Life‐Threatening Intellectual Disability

Background This study interviewed mothers (n= 17) of children aged 4 years and under with severe/profound intellectual disability, some with attendant complex medical, life-limiting conditions. Methods The study explored the mothers' views of the usefulness of the financial, practical and emotional supports being offered to them and their suggestions for service improvements. Results The study reveals these mothers to be engaged in stressful but skilled care of their children with a clear wish to continue caring for their child in the family home. Mothers frequently referred to the process of gaining useful information on services as ‘haphazard’ and most of the services offered to them as uncoordinated, unreliable and difficult to access. The study reveals that many of these children's needs are not being adequately met by either the intellectual disability services or the acute medical services, and some families are forced to privately finance services such as physiotherapy and speech therapy. Conclusions The data reveal that mothers want services offered to them in their own home, particularly short home-based respite, which would offer them short breaks to rest or engage in part-time employment. The study concludes that a reliable and flexible service response, including a comprehensive information and advocacy support is indicated for these families.
Interaction of chlorhexidine with trisEDTA or miconazole in vitro against canine meticillin-resistant and -susceptible Staphylococcus pseudintermedius isolates from two UK regions.

BACKGROUND Topical therapy is an important alternative to systemic antibacterial therapy for treatment of canine superficial pyoderma in light of the emergence of multidrug-resistant staphylococci. Chlorhexidine is widely used in shampoo products alone or in combination with miconazole or tromethamine-ethylenediaminetetraacetic acid (trisEDTA). Comparisons of these combinations have not been made. HYPOTHESIS/OBJECTIVES To determine minimum inhibitory concentrations (MICs) of combinations of chlorhexidine/miconazole and chlorhexidine/trisEDTA in vitro in a collection of Staphylococcus pseudintermedius (SP) from northern (NUK) and southeastern (SEUK) United Kingdom (UK) sources. METHODS MICs of chlorhexidine, miconazole, trisEDTA and combinations of chlorhexidine/miconazole (1:1) or chlorhexidine/trisEDTA (80:16:1 and 80:5:1) were determined for 196 canine SP isolates from NUK [49 meticillin-resistant (MRSP), 50 meticillin-susceptible (MSSP)] and fom SEUK (48 MRSP, 49 MSSP) using agar dilution. RESULTS TrisEDTA alone did not inhibit growth. Chlorhexidine/miconazole MICs (median = 0.5 mg/L) were lower than those of either drug alone (P < 0.05) and lower than chlorhexidine/trisEDTA MICs (median = 1 mg/L; P < 0.0005) in each bacterial type and from both regions, except for miconazole in NUK MSSP. An additive interaction was noted between chlorhexidine and miconazole or trisEDTA (80:16:1 ratio) in 79 and 43 isolates, respectively, whereas antagonism between chlorhexidine and trisEDTA was noted for three isolates. NUK isolates were more susceptible than SEUK isolates (P < 0.05), except MRSP exposed to chlorhexidine and the chlorhexidine/trisEDTA (80:16:1) combination. CONCLUSIONS AND CLINICAL IMPORTANCE These low MICs are likely to be exceeded by topical therapy. Evaluation of the mechanisms by which chlorhexidine combinations interact to reduce MICs is warranted, in view of increasing concerns of biocide tolerance in staphylococci.
Proof of concept of the preventive efficacy of high‐dose recombinant mono‐allergen immunotherapy in atopic dogs sensitized to the Dermatophagoides farinae allergen Der f 2

BACKGROUND Allergen immunotherapy is currently the only intervention proposed to specifically prevent clinical flares after allergen challenges. The low molecular weight Der f 2 (Df2) is a major allergen in Japanese dogs sensitized to Dermatophagoides farinae house dust mites. OBJECTIVES Pilot, blinded, placebo-controlled experiment testing the efficacy of subcutaneous immunotherapy (SCIT) with high doses of recombinant Df2 conjugated to the maltotriose pullulan (rDf2-P). METHODS Eight Maltese beagle atopic dogs were sensitized to rDf2 then randomized to SCIT with rDf2-P (six dogs) or placebo (two). The immunotherapy consisted of six weekly injections of increasing doses (0.1-10.0 μg) of rDf2-P followed by four monthly injections of 10 μg of this allergen. Epicutaneous rDf2 challenges, rDf2-specific IgE serology and intradermal reactivity, as well as serum cytokine level measurements, were performed throughout the study. RESULTS Subcutaneous injections of placebo did not alter the cutaneous reactivity after rDf2 challenge, while that of the dogs treated with rDf2-P SCIT disappeared in five of six dogs (83%) and was reduced in one of six (17%). During SCIT maintenance, skin lesion scores were significantly lower in dogs receiving SCIT compared to those treated with placebo. This clinical improvement was accompanied by a concurrent, yet not significant, decrease in rDf2-specific IgE serology and immediate intradermal reactivity. Cytokine serum levels were inconclusive. There were no adverse events seen with rDf2-P SCIT. CONCLUSIONS AND CLINICAL IMPORTANCE The new mono-allergen SCIT appears safe and effective for reducing skin lesions after allergen challenges; it deserves further testing in dogs with spontaneous atopic dermatitis.
Comparison of cardiac troponin T and N‐terminal pro‐B‐type natriuretic peptide between fetuses with hemoglobin Bart's disease and nonanemic fetuses

The objective of this study was to compare the levels of fetal serum cardiac troponin T (cTnT), representing cardiac injury, and N‐terminal pro‐B‐type natriuretic peptide (nt‐proBNP), representing cardiac volume overload, between fetuses affected and not affected by hemoglobin (Hb) Bart's disease, as well as between anemic and nonanemic fetuses.
Does a History of Sexual Abuse in Childhood Play a Role in Women's Medical Problems? A Review

ABSTRACT Purpose: To examine possible relations between childhood sexual abuse and women's medical problems. Data sources: Potential articles were retrieved by searching Medline and Psychlit databases using keywords which included incest, sexual abuse and assault, pain, alcohol and substance abuse, eating disorders, anorexia, bulimia, and obesity. Additional references were identified from bibliographies of these articles, from textbooks on child sexual abuse, and by experts in these fields. Study selection: Only those case series, case-control studies, and population-based surveys that were published in peer-reviewed journals were included. Results: Although available literature is sparse and many studies lack methodologic rigor, data suggest that a history of sexual abuse in childhood is common in women with a history of chronic pain (especially pelvic pain), functional bowel disorders, eating disorders, obesity, and alcohol abuse. Conclusions: Given the high prevalence of sexual abuse of girls and its .
Maternal Obesity and Risk of Postcesarean Wound Complications

Abstract Objective To estimate the effect of increasing severity of obesity on postcesarean wound complications and surgical characteristics. Study Design We performed a retrospective cohort study of consecutive cesarean deliveries at a tertiary care facility from 2004 to 2008. Four comparison groups were defined by body mass index (BMI; kg/cm2): < 30 (n = 728), 30 to 39.9 (n = 1,087), 40 to 49.9 (n = 428), or ≥50 (n = 201). The primary outcome was wound complication, defined as wound disruption or infection within 6 weeks postoperatively. Surgical characteristics were compared between groups including administration of preoperative antibiotics, type of skin incision, estimated blood loss (EBL), operative time, and type of skin closure. Results Of the 2,444 women with complete follow-up data, 266 (10.9%) developed a wound complication. Compared with nonobese women (6.6%), increasing BMI was associated with an increased risk of wound complications: BMI 30.0 to 39.9, 9.2%, adjusted odds ratio (aOR) 1.4 (95% confidence interval [CI] 0.99 to 2.0); BMI 40.0 to 49.9, 16.8%, aOR 2.6 (95% CI 1.7 to 3.8); BMI ≥50, 22.9%, aOR 3.0 (95% CI 1.9 to 4.9). Increasing BMI was also associated with increased rates of midline vertical incision, longer operative time, higher EBL, and lower rates of subcuticular skin closure. Conclusion A dose–response relationship exists between increasing BMI and risk of postcesarean wound complications. Increasing obesity also significantly influences operative outcomes.
Randomized controlled trial of the Pentax AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation.

BACKGROUND The purpose of this study was to determine the potential for the Pentax AWS and the Glidescope to reduce the difficulty of tracheal intubation in patients at increased risk for difficult tracheal intubation, in a randomized, controlled clinical trial. METHODS Seventy-five consenting patients presenting for surgery requiring tracheal intubation, and who were deemed to possess characteristics indicating an increased risk for difficult tracheal intubation, were randomly assigned to undergo intubation using a Macintosh, AWS, or Glidescope laryngoscope (n=25 patients per group). All patients were intubated by one of three anaesthetists experienced in the use of each laryngoscope. RESULTS Both the Glidescope and the AWS significantly reduced the intubation difficulty score compared with the Macintosh. The rate of successful tracheal intubation was lower with the Macintosh (84%) compared with the Glidescope (96%) or the AWS (100%). There were no differences in the duration of tracheal intubation attempts between the devices. Both the Glidescope and the AWS significantly reduced the need for additional manoeuvres and improved the Cormack and Lehane view obtained at laryngoscopy, compared with the Macintosh. Tracheal intubation with the AWS but not the Glidescope reduced the degree of haemodynamic stimulation compared with the Macintosh laryngoscope. CONCLUSIONS The AWS and the Glidescope laryngoscopes reduced the difficulty of tracheal intubation to a similar extent compared with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation.
Factors Influencing Mothers' Acceptance of Human Papillomavirus Vaccination to Prevent Cervical Cancer in their Daughters.

PURPOSE This study was done to examine mothers' acceptance and its influencing factors in daughters' human papillomavirus (HPV) vaccination to prevent cervical cancer. METHODS From July 20 to August 31, 2010, 220 mothers of unmarried daughters responded to self-administered questionnaires about their acceptance of HPV vaccination for their daughters and the optimal age for HPV vaccination. Descriptive statistics, univariate logistic and multiple logistic regression were used for data analysis with SPSS/WIN 12.0. RESULTS Mothers indicating their willingness to pay for their daughters to receive HPV vaccination accounted for 61.8%, and willingness with health insurance coverage, 84.5%. Mean optimal age for HPV vaccination was 19.78+/-3.96) years. With self-payment the factor influencing mothers willingness was necessity of HPV vaccination (OR=30.45, 95% CI=10.33~89.15). With health insurance coverage, income (OR=3.02, 95% CI: 1.19~7.62), necessity of HPV vaccination (OR=15.05, 95% CI=4.15~54.64), concern about HPV vaccine safety (OR=2.99, 95% CI=1.15~7.76), and experience of Pap test (OR=3.16, 95% CI=1.24~8.05) were factors influencing mothers willingness. Other influencing factors were optimal age for HPV vaccination, knowing about HPV (OR=7.66, 95% CI=2.19~26.82), and age of youngest daughter (OR=3.95, 95% CI=1.34~11.68). CONCLUSION Financial support is anticipated for low income families in a primary approach to increase HPV vaccination. And focusing on earlier age and concerns about vaccination are necessary to gain mothers' acceptance.
Effects of hyperoxic gas mixtures on exercise tolerance in man.

: This study was undertaken to determine the effects of O2-enriched gases on performance. Nine trained subjects ran to exhaustion on the treadmill on five different occasions breathing one of a range of hyperoxic gas mixtures--20%, 40%, 60%, 80%, or 100% O2. Each subject worked at a workload determined to be 110% of that necessary to elicit his maximum O2 uptake. The exercise bouts were scheduled one week apart to minimize the effects of training and fatigue. The subjects were given no cues as to the mixtures being breathed or to their running times. The parameters measured included running time, minute ventilation, and heart rate. The results indicate that the maximum performance time increases significantly as the O2 fraction of the gas is increased. Contrary to other published literature, 100% O2 increases performance significantly over 60% O2. Ventilation at any point in time is decreased when breathing hyperoxic mixtures. This decrease appears to be more a function of breathing frequency than of tidal volume. Terminal heart rates are not significantly different regardless of the O2 fraction of the inspired gas.
Lung recruitment and positive airway pressure before extubation does not improve oxygenation in the post-anaesthesia care unit: a randomized clinical trial.

BACKGROUND Atelectasis is known to develop during anaesthesia and after operation atelectasis leads to impaired oxygenation. Lung recruitment manoeuvres, positive end-expiratory pressure (PEEP), and continuous positive airway pressure (CPAP) have been proposed for reduction of atelectasis but their benefits have not been shown to persist after operation. We proposed that a combination of these techniques before extubation would improve oxygenation after operation. METHODS Adult patients undergoing elective surgery requiring tracheal intubation and an arterial catheter were randomized to receive either: a lung recruitment manoeuvre of 40 cm H(2)O for 15 s, 30 min before the end of anaesthesia, followed by 10 cm H(2)O of PEEP and then 10 cm H(2)O of CPAP from return of spontaneous breathing until extubation; or no lung recruitment manoeuvre, <or=5 cm H(2)O PEEP, and no CPAP. Arterial blood gases were taken at randomization and 1 h after extubation. The primary endpoint of the study was the change in (a-a)DO(2) between these times. Statistical analysis of the two groups was done by chi(2) or unpaired t-test as appropriate. RESULTS Twenty-two patients were recruited to each group. There were no significant differences between the groups before randomization. There was no significant difference in the change in (a-a)DO(2) between the groups (P=0.82). CONCLUSIONS Postoperative oxygenation is not improved by a combination of a lung recruitment manoeuvre and maintenance of a positive airway pressure until extubation. Further research is needed to elucidate the mechanism of atelectasis on emergence from anaesthesia and to evaluate more invasive clinical strategies such as post-extubation CPAP. Trial registered at URL http://www.controlled-trials.com Identification number: ISRCTN32464251 (http://www.controlled-trials.com/ISRCTN32464251).
Myocardial protection during coronary artery bypass surgery

Optimal myocardial protection relies on adequate delivery of the cardioplegic solution to all parts of the heart. Complete occlusion of a coronary artery represents a challenge for adequate delivery of cardioplegia and hence for adequate preservation of the myocardial area subserved by the occluded vessel. A total of 151 coronary artery bypass surgery patients were investigated in four prospective, randomized clinical trials. The aims were 1. to monitor the metabolic changes and energy state of the myocardium during and after normothermic and mild hypothermic antegrade or retrograde blood cardioplegias, 2. to estimate myocardial injury and postoperative haemodynamic recovery and 3. to determine whether ischaemic preconditioning preceding normothermic retrograde blood cardioplegia offers any additional benefits compared with retrograde cardioplegia alone. Both normothermic (37”C), especially when delivered at a flow rate of 200 ml/min, and mild hypothermic (28-29°C) retrograde blood cardioplegia offered safe myocardial protection during coronary artery bypass grafting, when delivered in a near-continuous fashion. Mild hypothermia with low flow rates (120-130 ml/min) seemed to offer somewhat better myocardial protection than normothermia, since the efflux of adenosine degradation products and CK-MB during the first 8 h after aortic cross-clamp removal was significantly less prominent. Preconditioning preceding retrograde cardioplegia did not offer any benefits compared with retrograde cardioplegia alone. There were no differences in myocardial lactate production, oxygen extraction or tissue high-energy phosphates between the preconditioned and control groups during cardiopulmonary bypass. Mild hypothermic retrograde blood cardioplegia delivered at 200 ml/min resulted in anaerobic metabolism in the right ventricular myocardium, but tissue levels of high-energy phosphates were relatively well preserved, which is probably the cornerstone for unproblematic recovery of function. There were only minor differences in haemodynamic recovery between the groups. This thesis is based on the following studies: I. Kaukoranta P, Lepojarvi M, Nissinen J, Raatikainen P, Peuhkurinen KJ. Normothermic versus mild hypothermic retrograde blood cardioplegia: A prospective, randomized study. Ann Thouac Surg 1995: 60: 1087-1093. 11. Raatikainen P, Kaukoranta P, Lepojarvi M, Nissinen J, Peuhkurinen K. Myocardial energy metabolism and functional recovery in coronary bypass surgery: A comparative study between continuous retrograde warm and mild hypothermic blood cardioplegia. Int J Angiol 1997: 6: 91-98. 111. Kaukoranta PK, Lepojarvi MVK, Ylitalo KV, Kiviluoma KT, Peuhkurinen KJ. Normothermic retrograde blood cardioplegia with or without preceding ischemic preconditioning. Ann Thorac Surg 1997 63: 1268-1274. IV. Kaukoranta PK, Lepojarvi MVK, Kiviluoma KT, Ylitalo KV, Peuhkurinen KJ. Protection of right and left ventricular myocardium during mild hypothermic antegrade versus retrogarde blood cardioplegia. Ann Thorac Surg (accepted).
Is the short axis view of the fetal heart useful in improving the diagnostic accuracy of outlet ventricular septal defects?

Outlet ventricular septal defects (VSDs) are usually suspected on the five‐chamber view of the fetal heart; however, postnatal confirmation occurs only in a small number of cases. The aim of this study was to evaluate if the systematic assessment of the short axis view may improve the prediction of prenatally detected outlet VSDs.
HLA in Japanese Insulin‐Dependent Diabetes Mellitus

Ninety‐four Japanese patients with insulin‐dependent diabetes mellitus (IDDM) and 388 healthy randomly selected Japanese were HLA typed. Significantly increased frequencies of Bw54, Cwl, DR4, B17 (Bw58), DR3 and DRw9 were observed. Simultaneously, the frequencies of Bw52 and DR2 in the patients were found to be significantly low as compared with those in helathy Japanese controls. It was suggested that one of the susceptibility genes to IDDM, which is associated with B8, DR3 haplotypes in Caucasoids, might be associated with B17 (Bw58), DR3 haplotypes in Japanese and in Chinese. Another susceptibility gene to IDDM associated with DR4 in Caucasoids might be associated with both DR4 and DRw9 in Japanese. A very rare variant of properdin factor B allotypes (BF*FT or BF*F075) was shown to be associated significantly with Japanese IDDM and with Bw52, DRw9 haplotypes.
Out-of-theatre tracheal intubation: prospective multicentre study of clinical practice and adverse events.

BACKGROUND Tracheal intubation is commonly performed outside the operating theatre and is associated with higher risk than intubation in theatre. Recent guidelines and publications including the 4th National Audit Project of the Royal College of Anaesthetists have sought to improve the safety of out-of-theatre intubations. METHODS We performed a prospective observational study examining all tracheal intubations occurring outside the operating theatre in nine hospitals over a 1 month period. Data were collected on speciality and grade of intubator, presence of essential safety equipment and monitoring, and adverse events. RESULTS One hundred and sixty-four out-of-theatre intubations were identified (excluding those where intubation occurred as part of the management of cardiac arrest). The most common indication for intubation was respiratory failure [74 cases (45%)]. Doctors with at least 6 month's experience in anaesthesia performed 136 intubations (83%); consultants were present for 68 cases (41%), and overall a second intubator was present for 94 procedures (57%). Propofol was the most common induction agent [124 cases (76%)] and 157 patients (96%) received neuromuscular blocking agents. An airway rescue device was available in 139 cases (87%). Capnography was not used in 52 cases (32%). Sixty-four patients suffered at least one adverse event (39%) around the time of tracheal intubation. CONCLUSIONS Out-of-theatre intubation frequently occurs in the absence of essential safety equipment, despite the existing guidelines. The associated adverse event rate is high.
The location of sites and effect of semiconductor diode trans-scleral cyclophotocoagulation on the buphthalmic equine globe.

PURPOSE To determine appropriate location and energy settings for trans-scleral cyclophotocoagulation (TSCPC) for buphthalmic equine globes. ANIMALS Eleven horses with a buphthalmic eye blinded by glaucoma presented for enucleation. METHODS Globe and corneal dimensions were measured via ultrasonography and calipers, and TSCPC was performed under general anesthesia immediately prior to enucleation. Part 1: In nine globes, sixty sites were lasered 4 mm posterior to the limbus in the dorsotemporal and ventrotemporal quadrants at settings of 1500 milliwatts and 1500 ms. Globes were processed and sectioned sagitally over the temporal aspect in two blocks, each with five histologic sections examined by light microscopy. A digital imaging system was used to determine the location and length of the pars plicata on one slide from each block. Part 2: Based on results in Part 1, two globes were measured and lasered using the same time and energy settings at the following distances posterior to the limbus: 8 mm dorsally, 6 mm dorsotemporally, 5 mm ventrotemporally, and 5 mm ventrally. RESULTS Globe and corneal dimensions exceeded normal values in all globes. Part 1: In all nine globes, photocoagulation affected the anterior ciliary processes and iris base and in 8/9 coagulation of the pectinate ligaments was noted. Part 2: In both globes, coagulation was confined to the pars plicata. CONCLUSIONS The previously recommended TSCPC sites are located too far anteriorly for a buphthalmic globe. Buphthalmic equine globes should have TSCPC performed at the following distances posterior to the limbus: 6-8 mm dorsally, 5-6 mm dorsotemporally, 4-5 mm ventrotemporally, and 4-5 mm ventrally.