Miracle-dz/UniFAR-FTUs huggingface dataset:
Fear conditioning and extinction in alcohol dependence: Evidence for abnormal amygdala reactivity

Fear conditioning and extinction (FCE) are vital processes in adaptive emotion regulation and disrupted in anxiety disorders. Despite substantial comorbidity between alcohol dependence (ALC) and anxiety disorders and reports of altered negative emotion processing in ALC, neural correlates of FCE in this clinical population remain unknown. Here, we used a 2‐day fear learning paradigm in 43 healthy participants and 43 individuals with ALC at the National Institutes of Health. Main outcomes of this multimodal study included structural and functional brain magnetic resonance imaging, clinical measures, as well as skin conductance responses (SCRs) to confirm differential conditioning. Successful FCE was demonstrated across participants by differential SCRs in the conditioning phase and no difference in SCRs to the conditioned stimuli in the extinction phase. The ALC group showed significantly reduced blood oxygenation level‐dependent responses in the right amygdala during conditioning (Cohen's d = .89, P(FWE) = . 037) and in the left amygdala during fear renewal (Cohen's d = .68, P(FWE) = . 039). Right amygdala activation during conditioning was significantly correlated with ALC severity (r = .39, P(Bonferroni) = . 009), depressive symptoms (r = .37, P(Bonferroni) = . 015), trait anxiety (r = .41, P(Bonferroni) = . 006), and perceived stress (r = .45, P(Bonferroni) = . 002). Our data suggest that individuals with ALC have dysregulated fear learning, in particular, dysregulated neural activation patterns, in the amygdala. Furthermore, amygdala activation during fear conditioning was associated with ALC‐related clinical measures. The FCE paradigm may be a promising tool to investigate structures involved in negative affect regulation, which might inform the development of novel treatment approaches for ALC.
Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

Objective We aimed to compare patient’s and physician’s ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. Design Baseline data from two prospective multicentre observational studies. Setting 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. Participants 395 patients (≥13 years old) with persistent asthma. Measures Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0–50; medium 51–80; high 81–100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients’ and physicians’ VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. Results High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65–95) mm; 53% VAS>80) and by physicians (84 (68–95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1 ≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R2=44%). Conclusion Although both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.
Contact with recovered peers: buffering disempowering service experiences and promoting personal recovery in serious mental illness

Background Mental health patients can experience involuntary treatment as disempowering and stigmatising, and contact with recovered peers is cited as important for countering stigma and fostering agency and autonomy integral to recovery. Aims To advance understanding of the interaction between involuntary treatment and contact with recovered peers, and explore hypothesised relationships to mechanisms of self-evaluation relevant to recovery. Method Eighty-nine adults diagnosed with serious mental illness completed items to assess involuntary treatment experience and the extent of prior contact with recovered peers, the Internalised Stigma of Mental Illness Scale, the Self-efficacy for Personal Recovery Scale, the Questionnaire about the Process of Recovery and relevant demographic and clinical scales. Results Contact with recovered peers was found to moderate the effects of involuntary treatment on internalised stigma. Sequential conditional process models (i.e. moderated mediation) then demonstrated that conditional internalised stigma (i.e. moderated by contact with recovered peers) mediated the indirect effect of involuntary treatment on recovery-specific self-efficacy, which in turn influenced recovery. Compared with those with low contact with recovered peers, recovery scores were 3.54 points higher for those with high contact. Conclusions Although study methods limit causative conclusions, findings are consistent with proposals that contact with recovered peers may be helpful for this patient group, and suggest this may be particularly relevant for those with involuntary treatment experience. Directions for future research, to further clarify measurement and conceptual tensions relating to the study of (dis)empowering experiences in mental health services, are discussed in detail.
Secondary complications of spinal cord injury : risk, inter-relationships, and effects on neurological outcomes

ii PREFACE . iv TABLE OF CONTENTS . vii LIST OF TABLES.ix LIST OF FIGURES.x LIST OF ABBREVIATIONS . xi ACKNOWLEDGEMENTS . xiii DEDICATION . xiv CHAPTER
Assessing the role of nocturnal core body temperature dysregulation as a biomarker of neurodegeneration

The vast majority of patients with idiopathic rapid eye movement sleep behaviour disorder will develop a neurodegenerative α‐synuclein‐related condition, such as Parkinson’s disease or dementia with Lewy bodies. The pathology underlying dream enactment overlaps anatomically with the brainstem regions that regulate circadian core body temperature. Previously, nocturnal core body temperature regulation has been shown to be impaired in Parkinson’s disease. However, no study to date has investigated nocturnal core body temperature changes in patients with idiopathic rapid eye movement sleep behaviour disorder, which may prove to be an early objective biomarker for α‐synucleinopathies. Ten healthy controls, 15 patients with idiopathic rapid eye movement sleep behaviour disorder, 31 patients with Parkinson’s disease and six patients with dementia with Lewy bodies underwent clinical assessment and nocturnal polysomnography with core body temperature monitoring. A validated cosinor method was utilised for core body temperature analysis. No differences in mesor, nadir or time of nadir were observed between groups. However, when compared with healthy controls, the amplitude of the nocturnal core body temperature (mesor minus nadir) was significantly reduced in patients with idiopathic rapid eye movement sleep behaviour disorder, Parkinson’s disease with concurrent rapid eye movement sleep behaviour disorder and dementia with Lewy bodies (p < 0.001, p = 0.043 and p = 0.017, respectively). Importantly, this relationship was not seen in those patients with Parkinson’s disease without rapid eye movement sleep behaviour disorder. In addition, there was a significant negative correlation between amplitude of the core body temperature and self‐reported rapid eye movement sleep behaviour disorder symptoms. Changes in thermoregulatory circadian rhythm may be specifically associated with the pathology underlying rapid eye movement sleep behaviour disorder rather than simply that of α‐synucleinopathy. These findings implicate thermoregulatory dysfunction as a potential early biomarker for development of rapid eye movement sleep behaviour disorder‐associated neurodegeneration, and suggest that subpopulations with differing pathological underpinnings might exist in Parkinson’s disease.
Anterior Segment Optical Coherence Tomography Angiography and Optical Coherence Tomography in the Evaluation of Episcleritis and Scleritis

ABSTRACT Purpose: To evaluate the feasibility of using anterior segment optical coherence tomography (AS-OCT) and AS-OCT angiography (AS-OCTA) in assessing patients with episcleritis and scleritis. Methods: Degree of vascularity [vessel density index (VDI)], measured with AS-OCTA, and sclera thickness [conjunctiva epithelium (CE), conjunctiva/episclera complex (CEC), and episclera/sclera complex (ESC)], measured with AS-OCT were compared. Results: A total of 37 eyes (13 episcleritis, 11 scleritis, 13 controls) were analyzed. VDI was lowest for controls for the various tissue depths (p < .001). Episcleritis versus scleritis revealed a significant difference in VDI at ESC (38.1 ± 11.4% vs 46.4 ± 6.4%; p = .03). Mean sclera thickness was lower in controls for CE (p < .001), CEC (p < .001) but not for ESC (p = .54). Conclusions: The degree of vascularity and tissue thickness were different between episcleritis, scleritis and controls. AS-OCTA and AS-OCT may potentially be useful in evaluating patients with scleral inflammation.
Bimetallic nanoparticles enhance photoactivity of conjugated photosensitizer

Although photodynamic therapy (PDT) of cancer has been continuously improved, its efficiency is still limited by the high toxicity in the absence of irradiation, aggregation and deactivation by biomolecules of the most common photosensitizers (PS). The association of PS to nanoparticles (NPs) can be a promising tool to overcome these limitations and also to enhance PS tumoral selectivity. In addition, the association of PS to metallic NPs may provide the modulation of PS fluorescence and also the enhancement of PS photoactivity due to the electronic coupling with NPs plasmon effect. Adversely to the innumerous work on the coupling of PS to metallic NPs, the application of bimetallic NPs with this goal has not been explored yet. In this work we investigated the physicochemical properties and cytotoxicity of bimetallic gold-platinum NPs (AuPtNPs) conjugated to a chlorin molecule modified with a thiol group. Additionally, chlorin was coupled to AuNPs for comparative purposes since these have been the most commonly used NPs in PDT. The results showed that both platforms promoted the chlorin solubility in water which is crucial in biological applications. Despite the enhancement of photoactivity promoted by both NPs in comparison with chlorin in solution, chlorin-conjugated with AuPtNPs proved to be a more suitable platform for PDT application, since it showed a lower dark citotoxicity, as well as a higher generation of singlet oxygen and cell internalization compared with chlorin-conjugated AuNPs. It is important to highlight that this is the first work reporting on the enhancement of PS photoactivity by its conjugation to AuPtNPs.
Motor cortex can directly drive the globus pallidus neurons in a projection neuron type-dependent manner in the rat

The basal ganglia (BG) are critical for the control of motor behaviors and for reinforcement learning. Here, we demonstrate in rats that primary and secondary motor areas (M1 and M2) make functional synaptic connections in the globus pallidus (GP), not usually thought of as an input site of the BG using optogenetics and morphological analysis. The cortical excitation in the GP was as strong as that in the STN. GP neurons projecting to the striatum were preferentially innervated by the motor cortex. Morphological observation revealed that the density of axonal boutons from motor cortices in the GP was approximately 30% of that in the striatum, but was comparable to that in the STN. M1 and M2 projected differentially to the BG in terms of topography and substructures. These results suggest that cortico-pallidal innervation is an additional excitatory input to the BG, and can affects behaviors via the cortex-basal ganglia-thalamus loop.
AN EXPERIENCE WITH BREAST DISEASE IN A SURGICAL UNIT OF A TEACHING HOSPITAL OF LAHORE

Breast cancer is the most common malignancy in women in Pakistan. Our patients suffer from the disease at a younger age than that reported in Western literature. A significant proportion of cases are 35 years old or younger. Our objective was to study the clinical features of the disease, risk factor profile and trends among women with breast cancer at our institution. A prospective case series of 205 women presenting with breast disease and undergoing treatment at Surgical Unit IV, Jinnah Hospital, Lahore, was conducted from January, 1999 to December, 2003. The result showed that 30.73% of the patients had benign breast disease whereas 69.26% were diagnosed as having breast cancer. The commonest benign disease was fibroadenoma (60.3%). Mean age of the cancer patients was 34.56 years ± 11.5 years. Among the cancer group, the commonest presentation was a painless lump (83.8%). The risk factor profile included positive family history of breast cancer in first degree relatives in 11.97% of the patients with breast cancer, nulliparity in 7.75% and oral contraceptive use in 14.08%. The commonest histological type was infiltrating ductal carcinoma (85.2%). Most of the patients presented at stage III (59.85%). Mammography was done in 48% and breast ultrasonograghy in 52% of the patients. Among these 69.7% of the patients underwent modified radical mastectomy and 16.2% had radical mastectomy. Breast conservation was offered to 14.08% patients. Adjuvant chemotherapy was administered to49% patients and 81% received adjuvant radiotherapy. It was thus concluded that women with breast cancer treated at our institution presentsd at a younger age than Western women. Interestingly, majority of our patients have none of the established risk factors for the disease. Despite advances in diagnostic modalities, most of our patients were diagnosed at advanced stages of breast cancer due to late presentation. There is a great need for creating awareness regarding breast cancer amongst women in Pakistan.
Upper gastrointestinal endoscopic findings in patients presenting to Tamale Teaching Hospital, Ghana

dyspepsia (18.4%), recurrent vomiting (8.9%), hematemesis (6.7%), and dysphagia (6.4%). Important endoscopic findings were gastric ulcer (25.6%), gastritis (22.1%), gastroesophageal reflux disease (17.3%),duodenal ulcer (10.3%),UGI bleeding (6.7%), gastric tumor (4.6%), and esophageal tumor (4.1%). Conclusion: The prevalence of severe UGI disease in this patient cohort suggests that additional centers are needed in northern Ghana for more timely detection.
Acetaminophen use in pregnancy: Examining prevalence, timing, and indication of use in a prospective birth cohort.

BACKGROUND Previous studies of prenatal acetaminophen use have not addressed what indications and maternal co-factors describe acetaminophen use. OBJECTIVE The objective of this study was to describe these parameters in a well-characterised, prospective birth cohort. METHODS Data were drawn from the MotherToBaby study of pregnant women enrolled from 2004 to 2018. Daily acetaminophen diaries were calculated for all exposed women with complete dose and duration information. Descriptive statistics were used to assess maternal characteristics associated with acetaminophen use. Prevalence by 2-year interval was described, and linear regression was used to test for trend. Indication of use and dose per indication were summarised. RESULTS Of 2441 subjects, 1515 (62%) reported use of acetaminophen. Over the 15-year period, there was a decline in use of 2.5% for each 2-year period (test for trend = 0.001) with 58% reporting acetaminophen use in 2017-2018. Among women with acetaminophen use in pregnancy (n = 1515), 58% reported <10 days of use, 13% reported 10-19 days of use, 9% reported 20-44 days of use, and 9% reported 45 or more days of use. Twelve per cent had undefined duration of use. Increasing duration of exposure was associated with tobacco use, obesity, self-reported depression or anxiety, and antidepressant use. The most frequently reported indication was headache, however, indication varied by duration of use, with more women reporting use for sleep or pain/injury in the categories with the longest duration of use. Median dose per exposed day was highest among those reporting use for sleep, and higher doses were more frequently reported for arthritis, injury, and pain. CONCLUSION Acetaminophen is used by the majority of pregnant women, and some continue to use for many weeks in pregnancy. Given the heterogeneity in duration of use, indication, and dose, studies that estimate the risk of adverse outcomes associated with acetaminophen must carefully consider these factors.
The Prognostic Role of CD8+ T Lymphocytes in Childhood Adrenocortical Carcinomas Compared to Ki-67, PD-1, PD-L1, and the Weiss Score

Adrenocortical carcinoma (ACC) is a rare disease among children. Our goal was to identify prognostic biomarkers in 48 primary ACCs from children (2.83 ± 2.3 y; mean age ± SD) by evaluating the tumor stage and outcome for an age of diagnosis before or after 3 years, and association with ACC cluster of differentiation 8 positive (CD8+) cytotoxic T lymphocytes (CD8+-CTL) and Ki-67 immunohistochemical expression (IHC). Programmed death 1(PD-1)/Programmed death-ligand 1 (PD-L1) immunohistochemistry (IHC) in ACC was analyzed in a second, partially overlapping cohort (N = 19) with a similar mean age. All patients and control children were carriers of the germline TP53 R337H mutation. Survival without recurrence for less than 3 years and death unrelated to disease were excluded. Higher counts of CD8+-CTL were associated with patients diagnosed with ACC at a younger age and stage I, whereas a higher percentage of the Ki-67 labeling index (LI) and Weiss scores did not differentiate disease free survival (DFS) in children younger than 3 years old. No PD-1 staining was observed, whereas weakly PD-L1-positive immune cells were found in 4/19 (21%) of the ACC samples studied. A high CD8+-CTL count in ACC of surviving children is compelling evidence of an immune response against the disease. A better understanding of the options for enhancement of targets for CD8+ T cell recognition may provide insights for future pre-clinical studies.
Workplace Violence against Female Nurses: a Survey in Critical Care Units

Background and Objectives: Workplace violence against female nurses is a significant and increasing prob- lem. This study aimed to investigate workplace violence against female nurses in three general hospitals of Ilam (Western Iran) and identify factors influencing its incident. METHODS: Seventy seven nurses were randomly selected and surveyed. The data were collected using an author-designed instrument. The survey instrument consisted of 26 items on the demographic and employ- ment characteristics of the participants (sex, age, work experience, marital status, degree of education, and the working department), and 19 multiple-choice questions related to verbal/physical abuse by the pa- tients (5 items), verbal/physical abuse by the patients' visitors (5 items), and the nurse reactions (9 items). The validity and reliability of the questionnaire were examined using the CVI and Test-retest methods. T- test and ANOVA were used for comparison of the mean values. The correlation between the variables was explored using Pearson's coefficient. FINDINGS: Overall, 83.1 % and 22.1 % of the participants had faced with verbal and physical violence by the pa- tients during the last year, respectively. Moreover, 88.3 % and 31.2 % of the nurses had experienced verbal and physical assaults by the patients' companions, respectively. Most nursing staff believe that reporting aggressive evident is not useful at all. A significant correlation was found between the physical assaults by patients and the nurses' age (P CONCLUSIONS: Our results revealed a high rate of workplace violence against the female nurses. To alleviate this problem, public training together with legally pursuing the individuals committing aggressive violence is essential. The fact that young and single nurses are more prone to violence shows the importance of employing experienced nurses in certain healthcare activities. KEYWORDS: Workplace violence, Nursing staff, Hospital, Hospital management, Health care system, Health care services Language: en
We just don't talk about it: Men living with urinary incontinence and multiple sclerosis

For people with multiple sclerosis (MS), urinary incontinence can become central to their experiences of managing the consequences of the disease. The Research Unit at the Royal District Nursing Service in South Australia conducted a study between October and December 1998 that aimed to understand how people living with multiple sclerosis manage urinary incontinence. This paper reports the findings from a participatory action research group consisting of four men who lived with MS and urinary incontinence, two continence nurse advisors (CNA) and the researcher. Incontinence was found to be a subject that men had found difficult to talk about previously. Themes that emerged from the conversations with the men were: planning your life around toilets; today will not be the same as tomorrow; managing myself; and motivated to make changes. The men and the CNA experienced a valuable exchange of knowledge about living with incontinence. We consider it essential that the voices of these men are clearly heard so that health-care providers may be responsive and sensitive to their clients' needs.