Miracle-dz/UniFAR-FTUs huggingface dataset:
Curbing the opioid epidemic in the United States: the risk evaluation and mitigation strategy (REMS).

HRONIC PAIN IS A MULTIDIMENSIONAL PROBLEM,WITH significant influence on the culture and economy of the United States. Although chronic pain associated with cancer is distinct from that associated with musculoskeletal or functional pain syndromes, common treatment strategies for both include the administration of opioids. Although it appears logical to prescribe potent analgesics to patients with chronic noncancer pain, the data to support the effectiveness of opioids for this indication are limited. 1 Prescription opioid analgesics have been used for decades for the outpatient treatment of acute medical, traumatic, and postoperative pain, as well as for chronic pain associated with malignancy and terminal disease. In the 1980s, a combination of factors, both patient-centered and business-oriented,ledtothebroaderuseofopioidsfortreatment of patients with chronic noncancer pain. This expanded use resulted in the dispensing of large quantities of opioids, of which a consequential, increasing minority was diverted to nonmedical uses, including inappropriate selfmedication and recreational abuse. Even used as prescribed, opioids are associated with significant morbidity and mortality. Reformulation of opioids as extended-release preparations to allow longer dosing intervals for patients in discomfort had the unintended consequence of making available large quantities of high-dose opioids and priming the epidemic of opioid misuse, abuse, addiction, and mortality. Sales of opioid analgesics, includingbothregular-andextended-release,increased4-foldbetween 1999 and 2010. 2 In 2008, more than 14000 deaths were related to the misuse of prescription medications, the vast majority of which were opioid analgesics. 2 Health care professionals, who may have prescribed analgesics to meet Joint Commissionanalgesia standards (and possibly to protect their patient satisfaction scores), 3 have become the primary supplier of the drugs fueling this epidemic. The US Food and Drug Administration (FDA) is tasked with ensuring that medications are effective and safe. However, the FDA is prevented from interfering with the “practice of medicine. ” At the crossroads of these requirements is postmarketing, off-label prescribing, over which the FDA
Attendance to care and treatment clinics (CTCs) and perceived effectiveness of Anti-retroviral Therapy (ART) for people living with HIV/AIDS (PLHAs) in Newala district, Tanzania- a case of Luchinga

Maximum adherence to ART has been recommended for PLHAs for improving treatment outcome. This is through regular attendance to CTC for follow up and refill and completion of prescribed doses as per schedule. This study examined attendance rate to CTC and factors influencing attendance rate by PLHAs living in Luchinga ward enrolled to CTC at the district hospital, as well as perception of stakeholders on the effectiveness of the treatment. This was a cross-sectional descriptive study carried out in the ward between June to July, 2009. About 30 of PLHAs, 41 treatment supporters and 6 key informants were involved in the study. Results from this study shows that attendance rate to CTC was poor by a significant portion of PLHAs. About one-third of the interviewed PLHAs admitted to have attended less than 95% of the appointment and about 37% of treatment supporters indicated similar trend with regard to their patients. Main factors for poor attendance to CTC included long distance, patient felt better after taking few doses of ARV, fear of stigma and patient feeling tired. It was also noted that some patients fail to complete prescribed doses of ARV while at home. Main reason indicated by respondents for this trend was side effects of drugs, patient felt better and patient feel tired. With regard to effectiveness of treatment, although majority of respondents indicated ART to have improved health of PLHAs, however, a noticeable proportion of the respondents (nearly one-third) indicated the treatment hasn’t improved health of PLHAs. Reasons for lack of improvement as perceived by respondents were mainly poor nutrition due to poverty, non-adherence to drugs, and heavy workloads by PLHAs. Based on these findings, policy implications for improving the situation have been indicated.
Late thrombotic events after bioresorbable scaffold implantation: a systematic review and meta-analysis of randomized clinical trials

Aims To compare the long-term safety and efficacy of bioresorbable vascular scaffold (BVS) with everolimus-eluting stent (EES) after percutaneous coronary interventions. Methods and results A systematic review and meta-analysis of randomized clinical trials comparing clinical outcomes of patients treated with BVS and EES with at least 24 months follow-up was performed. Adjusted random-effect model by the Knapp-Hartung method was used to compute odds ratios (OR) and 95% confidence intervals (CI). The primary safety outcome of interest was the risk of definite/probable device thrombosis (DT). The primary efficacy outcome of interest was the risk of target lesion failure (TLF). Five randomized clinical trials (n = 1730) were included. Patients treated with Absorb BVS had a higher risk of definite/probable DT compared with patients treated with EES (OR 2.93, 95%CI 1.37-6.26, P = 0.01). Very late DT (VLDT) occurred in 13 patients [12/996 (1.4%, 95%CI: 0.08-2.5) Absorb BVS vs. 1/701 (0.5%, 95%CI: 0.2-1.6) EES; OR 3.04; 95%CI 1.2-7.68, P = 0.03], 92% of the VLDT in the BVS group occurred in the absence of dual antiplatelet therapy (DAPT). Patients treated with Absorb BVS had a trend towards higher risk of TLF (OR 1.48, 95%CI 0.90-2.42, P = 0.09), driven by a higher risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularization. No difference was found in the risk of cardiac death. Conclusion Compared with EES, the use of Absorb BVS was associated with a higher rate of DT and a trend towards higher risk of TLF. VLDT occurred in 1.4% of the patients, the majority of these events occurred in the absence of DAPT.
IL7RA polymorphisms and susceptibility to multiple sclerosis.

To the Editor: Two independent, well-powered studies have recently identified the interleukin-7 receptor α (IL7RA) gene as a susceptibility gene for multiple sclerosis,1,2 thus extending and confirming earlier observations.3,4 A functional, nonsynonymous single-nucleotide polymorphism (SNP), rs6897932, located in the alternatively spliced sixth exon of the gene, was highlighted as the susceptibility-modifying polymorphism, with the C allele increasing the risk of disease (odds ratio, approximately 1.2). 1,2 We genotyped nine haplotype-tagging SNPs in IL7RA in two independent case–control collections from Olmsted County, Minnesota, and Belfast, Northern Ireland, neither of which, to our knowledge, has previously been tested .
Tomographic mapping of human cerebral metabolism

Positron computed tomography was used to investigate changes in the local cerebral metabolic rate for glucose (LCMRGlc) of the visual cortex. Progressive increases in LCMRGlc were found from eyes-closed control to stimulation with white light, alternating black white checkerboard pattern, and a complex visual scene of a park, with the associative visual cortex increasing at a faster rate than the primary visual cortex as the visual scene complexity increased. A graded decrease in LCMRGlc of the visual cortex was found with a stepwise deletion of spontaneous cell firing at the retinal, geniculate and cortical level due to lesions. Lefthight metabolic symmetry of the visual cortex during monocular stimulation confirms 50% crossing of the human visual system. Neonatal blindness showed no apparent degeneration of the visual cortex and was equivalent to eyes-closed controls. The interictal state of a patient with visual seizures demonstrated a hypometabolic visual cortex with a 2.5-fold increase in metabolism during an ictal visual hallucination.
Cementless Fixation in Total Knee Arthroplasty – Past, Present, and Future

Abstract Cementless fixation in total knee arthroplasty (TKA) has had limited use in recent decades due to past failures in the early generation of cementless designs. Screw track osteolysis, poor polyethylene, and metal-backed patellar component failures contributed to a controversial track record and created a reluctance to embrace cementless fixation in TKA; however, these failure mechanisms are correctable. In addition, there is renewed interest in cementless fixation due to the recent development of improved biomaterials, particularly highly porous metals and highly crosslinked polyethylene, as well as time-saving advantages and long-term osseointegration of cementless fixation. There are long-term reports of successful designs of cementless knee arthroplasty that are nearly equal to the results of cemented designs. This article discusses the past history, current long-term results, and future of cementless fixation in TKA.
Étude de prévalence sur les atteintes musculosquelettiques des membres supérieurs chez les chauffeurs d’autobus scolaires

AbrégéPeu d’études dans la littérature ont recensé les atteintes musculosquelettiques chez les chauffeurs d’autobus scolaires. Cent vingt six chauffeurs ont été invités à compléter un questionnaire auto-administré, dérivé du questionnaire standardisé Nordic, sur leurs symptômes et sur leur exposition au travail. L’étude avait pour objectif d’estimer la prévalence de leurs symptômes au cou et aux épaules. Le taux de participation a été de 80 %. L’exposition a été obtenue par des questions sur le nombre d’heures travaillées par semaine et le type de véhicule utilisé. Les prévalences ont été mesurées pour les problèmes au cou et aux épaules au cours des sept jours précédents la distribution du questionnaire et au cours de la dernière année. Au cours des douze derniers mois, la prévalence de problèmes au cou a été de 38 % et aux épaules de 37 %. Les femmes et les jeunes chauffeurs présentaient plus de problèmes; le risque augmentait avec le nombre d’heures travaillées par semaine. Un effet protecteur a été mesuré avec l’utilisation de la transmission manuelle. Les résultats suggèrent que les chauffeurs d’autobus scolaires présentent plus de problèmes de santé au cou et aux épaules. Les postures contraignantes, les forces, la répétition des mouvements et le stress au travail sont les facteurs de risque suspectés; de nouvelles études seront nécessaires pour préciser le rôle de ces facteurs dans l’étiologie de ces problèmes. AbstractThe aim of this study was to estimate the prevalence of symptoms to the neck and shoulders among schoolbus drivers. One hundred-twenty-six schoolbus drivers were asked to complete a self-administered, anonymous questionnaire derived from the Nordic standardized questionnaire on their symptoms and work exposure. The participation rate was 80%. Further information was obtained through questions on the number of working hours per week and the type of vehicle driven. The prevalence of problems to the neck and shoulders was measured during the previous seven days and the previous year. In the pevious 12 months, the prevalence of problems to the neck was 38% and to the shoulders, 37%. Women and young drivers showed more overall problems; the risk increased with the number of working hours per week. The use of a manual transmission suggested a protective effect. The results of the study showed that schoolbus drivers had more health problems to the neck and shoulders than are found in the general population. Restricted postures, the force necessary to open and close doors, repetitive movements and work related stress are suspected risk factors; more studies will be necessary to further demonstrate the role of such risk factors in the etiology of these health problems.
Influence of national culture on the social construction of health care quality

The purpose of this study is to examine how national culture influences the social constructions of health care quality in the Kuwaiti primary care. Kuwait has a well- developed primary care system, offering a wide range of services in practices distributed throughout the nation, throughout the day, and on a walk-in basis. Despite its extended hours, relative comprehensiveness and affordability, the primary care service in Kuwait appears to be poorly received by the public. This study employed a qualitative research methodology to investigate how the elements of the Kuwaiti national culture shape the social constructions of health care quality. The study proposal was reviewed by the research ethics committees of the University of Surrey and KIMS, and a favourable ethical opinion was obtained. Participant information sheet were given to potential participants and consent obtained before data collection. Semi-structured interviews were conducted with 42 participants from various stakeholder groups. Data analysis identified three themes that represent the experiences of the various stakeholders’ relating to their social constructions of health care quality in primary care: (1) meanings of health, (2) attitudes towards primary care service, and (3) access to primary care. Within the identified themes, a number of sub-themes were identified, including: (a) the meaning of health, (b) responsibility for one’s health, (c) tensions in doctor-patient communication, (d) doctors feeling ‘undervalued’, (e) gender issues, (f) cultural suitability of primary care, (g) primary care work environment, (h) disproportionate distribution, (i) waiting times, and (j) institutional discrimination. The study found that the high-power distance element of national culture impacts the social constructions of health care quality. Perceptions of power differentials across social groups seem to contribute considerably to the social construction of health care quality. The contribution of this study is towards the body of knowledge on the cultural competence of health care provision in high-power distance cultures.
Induction therapy and mTOR inhibition: minimizing calcineurin inhibitor exposure in de novo renal transplant patients

Use of induction therapy with mTOR inhibitor maintenance immunosuppression to facilitate reduced calcineurin inhibitor (CNI) exposure in de novo kidney transplant patients has been explored in a series of randomized trials. These studies have typically employed interleukin‐2 receptor antagonist (IL‐2RA) induction, in low or standard immunological risk recipients. Although no study has directly compared mTOR inhibition plus reduced CNI exposure with or without induction, inclusion of IL‐2RA induction appears to permit a substantial reduction in CNI exposure without the need for high mTOR inhibitor dosing. IL‐2RA induction with an mTOR inhibitor and steroids has consistently shown similar efficacy to standard‐exposure CNI with mycophenolic acid and steroids and may improve renal function among patients who remain on the mTOR inhibitor‐based regimen. With modern mTOR inhibitor dosing, wound healing complications are of less concern and may be no more frequent than in mycophenolic acid‐based regimens. The incidence of cytomegalovirus infection appears lower in patients receiving de novo mTOR inhibition. The available evidence demonstrates that IL‐2RA induction with an mTOR inhibitor can successfully reduce CNI exposure by at least half without a penalty in terms of rejection in low‐ or moderate‐risk de novo transplant recipients and may offer renal and antiviral benefits.
Comparison of presenting complaint vs discharge diagnosis for identifying " nonemergency" emergency department visits.

IMPORTANCE Reduction in emergency department (ED) use is frequently viewed as a potential source for cost savings. One consideration has been to deny payment if the patient's diagnosis upon ED discharge appears to reflect a "nonemergency" condition. This approach does not incorporate other clinical factors such as chief complaint that may inform necessity for ED care. OBJECTIVE To determine whether ED presenting complaint and ED discharge diagnosis correspond sufficiently to support use of discharge diagnosis as the basis for policies discouraging ED use. DESIGN, SETTING, AND PARTICIPANTS The New York University emergency department algorithm has been commonly used to identify nonemergency ED visits. We applied the algorithm to publicly available ED visit data from the 2009 National Hospital Ambulatory Medical Care Survey (NHAMCS) for the purpose of identifying all "primary care-treatable" visits. The 2009 NHAMCS data set contains 34,942 records, each representing a unique ED visit. For each visit with a discharge diagnosis classified as primary care treatable, we identified the chief complaint. To determine whether these chief complaints correspond to nonemergency ED visits, we then examined all ED visits with this same group of chief complaints to ascertain the ED course, final disposition, and discharge diagnoses. MAIN OUTCOMES AND MEASURES Patient demographics, clinical characteristics, and disposition associated with chief complaints related to nonemergency ED visits. RESULTS Although only 6.3% (95% CI, 5.8%-6.7%) of visits were determined to have primary care-treatable diagnoses based on discharge diagnosis and our modification of the algorithm, the chief complaints reported for these ED visits with primary care-treatable ED discharge diagnoses were the same chief complaints reported for 88.7% (95% CI, 88.1%-89.4%) of all ED visits. Of these visits, 11.1% (95% CI, 9.3%-13.0%) were identified at ED triage as needing immediate or emergency care; 12.5% (95% CI, 11.8%-14.3%) required hospital admission; and 3.4% (95% CI, 2.5%-4.3%) of admitted patients went directly from the ED to the operating room. CONCLUSIONS AND RELEVANCE Among ED visits with the same presenting complaint as those ultimately given a primary care-treatable diagnosis based on ED discharge diagnosis, a substantial proportion required immediate emergency care or hospital admission. The limited concordance between presenting complaints and ED discharge diagnoses suggests that these discharge diagnoses are unable to accurately identify nonemergency ED visits.
Clinical implication of an impaired fasting glucose and prehypertension related to new onset atrial fibrillation in a healthy Asian population without underlying disease: a nationwide cohort study in Korea

Aims For healthy populations without comorbidities, whether prehypertension and impaired fasting glucose (IFG) are associated with new onset atrial fibrillation (AF) is not well known. Methods and results We included 366 507 subjects (age ≥20 years) not diagnosed with non-valvular AF from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) from 2003 to 2008. In total, 139 306 subjects diagnosed with AF-related comorbidities were excluded, and a 227 102 healthy population was followed up until 2013. The body mass index (BMI), blood pressure (BP), and fasting blood glucose (BG) level were acquired during National health check-ups. Subjects with IFG [hazard ratio (HR) 1.16, P = 0.017] had a higher AF risk and the diastolic BP (HR 1.11, P = 0.045) was a stronger indicator for an AF incidence than the systolic BP. After dividing the subjects into two mutually exclusive groups, AF incidence was increased dramatically by the combination effect of both prehypertension and an IFG in BMI <25 kg/m2 group, but, in BMI ≧25 kg/m2 group, did not show this tendency. An IFG related to AF risk was more prominent in the BMI <25 kg/m2 population (HR 1.18, P = 0.025) than those with a BMI ≥25 kg/m2, and subjects with both an IFG and prehypertension had a greater AF risk (HR 1.27, P = 0.016) than those without. Conclusion Even in a healthy Asian populations without comorbidities, prehypertension and IFG were important risk factors of AF. Specifically, when prehypertension, including systolic and diastolic BPs, was finally combined with the IFG, the risk of new onset AF was increased especially in the BMI <25 kg/m2 group.
An alpha-melanocyte-stimulating hormone analogue in erythropoietic protoporphyria.

To the Editor: Patients with erythropoietic protoporphyria, a rare inherited disease, accumulate photosensitizing protoporphyrin in the dermis, which results in severe dermal pain and incapacitating phototoxic reactions when the skin is exposed to visible light, primarily blue light (the Soret band, with the strongest absorbance among the porphyrins). 1 Current treatments are partially effective at best (unpublished data). A beneficial effect of melanogenesis induced by natural sunlight or by ultraviolet radiation has been described in anecdotal reports.2,3 Afamelanotide (Nle4-D-Phe7–α-melanocyte–stimulating hormone, formerly called CUV1647) is an α-melanocyte–stimulating hormone analogue that induces epidermal melanin formation.4 Here, we describe the responses .
Long-term results of rabbit antithymocyte globulin and basiliximab induction.

To the Editor: In our recently reported prospective, randomized, international clinical trial comparing rabbit antithymocyte globulin and basiliximab in renal transplantation (ClinicalTrials.gov number, NCT00235300),1 we observed that induction treatment with rabbit antithymocyte globulin was as safe as and more effective than basiliximab at 1 year in preventing acute rejection in patients who had received kidney transplants from deceased donors and who were at increased risk for acute rejection or delayed graft function. Whether the apparent benefits of rabbit antithymocyte globulin over basiliximab persist is unknown. The duration of follow-up in a clinical study is limited by whether patients are willing .
The discard of deceased donor kidneys in the UK

It is essential to minimize the unnecessary discard of procured deceased donor kidneys, but information on discard rates and the extent to which discard can be avoided are limited. Analysis of the UK Transplant Registry revealed that the discard rate of procured deceased donor kidneys has increased from 5% in 2002‐3 to 12% in 2011‐12. A national offering system for hard‐to‐place kidneys was introduced in the UK in 2006 (the Declined Kidney Scheme), but just 13% of kidneys that were subsequently discarded until 2012 were offered through the scheme. In order to examine the appropriateness of discard, 20 consecutive discarded kidneys from 13 deceased donors were assessed to determine if surgeons agreed with the decision that they were not implantable. Donors had a median (range) age of 67 (31–80) yr. Kidneys had been offered to a median of 3 (1–12) centers before discard. Four (20%) of the discarded kidneys were thought to be usable, and nine (45%) were possibly usable. As a result of these findings, major changes to the UK deceased donor kidney offering system have been implemented, including simultaneous offering and broader entry criteria for hard‐to‐place kidneys. Organizational changes are necessary to improve utilization of deceased donor kidneys.