Miracle-dz/UniFAR-FTUs huggingface dataset:
Outpatients Do Not Need to Void after Short Neuraxial Blocks

In Reply:—The recent editorial titled “Innocent Prattle” congratulated Dr. Li et al. for introducing new methodology to examine the epidemiologic patterns of anesthesia-related deaths at the national level. Specifically, they used International Classification of Diseases, 10th Revision (ICD-10) codes to identify anesthesia-related deaths from the multiple-cause-of-death data files maintained by the National Center for Health Statistics for the years 1999 –2005. They then calculated death rates from anesthesia complications based on population data and hospital surgical discharge data. Using their innovative methodology, the authors found that the number of anesthesia-related deaths averaged 316 per year and the number of deaths with an anesthesia complication as the underlying cause averaged 34 per year, for an estimated 30 million anesthetics annually. I also look forward to the application and validation by the scientific community of their techniques to monitor anesthesia safety in the future, but until such time, it is difficult to accept their claims that the United States has experienced a 97% decrease in the anesthesia-related death rate since the late 1940s and that 46.6% of anesthesia-related deaths are attributable to overdose of anesthetics and 42.5% are attributable to adverse effects of anesthetics in therapeutic use. It is incredible claims of improved anesthesia safety that previously led to my analogy to The Emperor’s New Clothes by Hans Christian Andersen. Some of our anesthesia community, like the townspeople in the fable, want to believe that we are somehow special, so they blindly accept these claims of improved anesthesia safety. In my analogy, I play the role of the child who is accused of “innocent prattle” by challenging the claims of Dr. Li et al. in an editorial of the same name. I apologize to Dr. Li et al. if my editorial led them to believe that their work was accused of being prattle. That was certainly not my intention. In fact, I see their role in my analogy as being much more noble.
Review of Proximal Nail Antirotation (PFNA) and PFNA-2 - Our Local Experience

The proximal femoral nail antirotation (PFNA) device was recently introduced as an option for intramedullary management of pertrochanteric hip fractures. We report here local results with this relatively new implant. Sixty-two patients with pertrochanteric or subtrochanteric fractures underwent intramedullary fixation with PFNA devices in our centre during the 14 month period from September 2008 to October 2009. Data for this report were retrieved from clinical case records and operative notes. We recorded the age, gender, length of stay and operative time, preoperative ambulatory status and days required to regain mobility. Fractures were classified using the AO classification (A1, A2 and A3). Complications were also identified.There were 15 male and 47 female patients and the mean age was 74.3 years. The mean surgical duration was 76.1min and the average length of hospitalisation was 14.5 days. Five cases were noted to have femoral shaft fracture and no occurrences of screw cutout. We found that 83.9% of the patients were able to regain preoperative mobility status by 6 months following surgery. We conclude that the PFNA is an effective implant for stabilisation of proximal hip fractures and that the local complication rate is similar to reports from other centres.
Why do we need observational studies of everyday patients in the real-life setting?

Randomized controlled trials (RCTs) are performed with the primary goal of understanding the safety and efficacy of a new therapy in a selected group of patients. Even when evidence from these studies strongly favours a new therapy, its role in routine clinical practice may be unclear because of the considerable differences between its efficacy (in clinical trials) and its effectiveness (in the real-life setting). Real-life studies are observational studies that are essential to document benefits and harms of therapy in a wider population and to determine whether patients in routine practice are achieving expected outcomes. In the first article of this supplement, we discuss the relative strengths and limitations of RCTs and real-life studies and explore the current and potential uses of real-life studies in the field of thrombosis, including identifying new safety signals, assessing outcomes in special populations and raising questions about factors affecting medication adherence and persistence. Real-life studies provide a bridge from the results of RCTs to daily clinical practice.
Effects of Testosterone Replacement on Renal Function and Apoptosis on Mesangial and Renal Tubule Cells in Rats

The effect of testosterone replacement in middle-aged rats on renal function and apoptosis of mesangial and renal tubule cells was evaluated. Middle-aged (13-monthold) male Wistar rats were divided into 2 groups, one of which was given high-dose and the other low-dose testosterone replacement for 2 months. Experiments were performed with the testosterone replacement groups and a non-replacement group when they had reached the age of 15 months. Serum levels of total and free testosterone were measured, and renal function was evaluated by glomerular filtration rate (GFR), serum levels of creatinine, blood urea nitrogen (BUN), urinary protein and N-acetyl-β-D-glucosaminidase (NAG). Apoptosis was evaluated by counting the number of terminal deoxynucleotidyl transferase-mediated deUTP-biotin nick end labeling (TUNEL)-positive cells in the mesangial and renal tubule cells. Correlations between total and free testosterone and each parameter were evaluated. Also, 12-week-old rats were evaluated in the same manner as the age control. Among 15-month-old rats, testosterone replacement did not affect serum creatinine, BUN or urinary protein, but the GFR was found to correlate negatively with the total and free testosterone level, and the urinary NAG level was found to correlate positively with the free testosterone level to a significant extent ( P < 0.01). Percentages of apoptosis of mesangial and renal tubule cells were found to correlate positively with the total and free testosterone levels to a significant extent ( P < 0.01). In conclusion, the results of this study suggested that testosterone replacement affected the deterioration of renal function in middle-aged rats.
Adolescents with attention deficit hyperactivity disorder - taking a sexual history

Background Adolescents are having sex and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) are no exception. A number of studies have found an increase in high-risk sexual behaviour in young people with ADHD. Sexual history taking is the first step toward providing reproductive, contraceptive and sexually transmitted disease (STD) counselling. Methods A retrospective review of the clinical notes of fifty adolescent patients aged 12-18 years with a formal diagnosis of ADHD was carried out by two researchers. Consultations with both paediatricians and ADHD nurse specialists were reviewed from the first time the young person was seen over the age of 12 years until the last consultation, with a view to establishing whether a sexual history was taken on any occasion. Results None of the healthcare professionals took a sexual history from any of the adolescents on any occasion despite multiple clinic attendances. Conclusion Adolescents with ADHD are more likely to engage in high-risk sexual behaviour and it is therefore the job of paediatricians and specialist nurses to educate patients regarding their increased risk, re-evaluation of lifestyle behaviours, and preventative measures. The World Health Organisation describes sexual health as a basic human right. Adolescents with ADHD should not be denied the right to holistic healthcare.
Can fish oil in pregnancy and lactation alter maternal and infant immunological responses and prevent allergy in the offspring

We investigated whether the previously reported preventive effect of maternal ω-3 fatty acid supplementation on IgE-associated allergic disease in infancy may be mediated by facilitating a balanced circulating Th2/Th1 chemokine profile in the infant. Vaccine-induced immune responses at 2 y of age were also evaluated. Pregnant women, at risk of having an allergic infant, were randomized to daily supplementation with 1.6 g eicosapentaenoic acid and 1.1 g docosahexaenoic acid or placebo from the 25th gestational week through 3.5 mo of breastfeeding. Infant plasma was analyzed for chemokines (cord blood, 3, 12, 24 mo) and anti-tetanus and anti-diphtheria IgG (24 mo). High Th2-associated CC-chemokine ligand 17 (CCL17) levels were associated with infant allergic disease (p < 0.05). In infants without, but not with, maternal history of allergy, the ω-3 supplementation was related to lower CCL17/CXC-chemokine ligand 11 (CXCL11) (Th2/Th1) ratios (p < 0.05). Furthermore, in nonallergic, but not in allergic infants, ω-3 supplementation was linked with higher Th1-associated CXCL11 levels (p < 0.05), as well as increased IgG titers to diphtheria (p = 0.01) and tetanus (p = 0.05) toxins. Thus, the prospect of balancing the infant immune system toward a less Th2-dominated response, by maternal ω-3 fatty acid supplementation, seems to be influenced by allergic status.
Hardware and Software Support for Virtualization

This book focuses on the core question of the necessary architectural support provided by hardware to efficiently run virtual machines, and of the corresponding design of the hypervisors that run them. Virtualization is still possible when the instruction set architecture lacks such support, but the hypervisor remains more complex and must rely on additional techniques. Despite the focus on architectural support in current architectures, some historical perspective is necessary to appropriately frame the problem. The first half of the book provides the historical perspective of the theoretical framework developed four decades ago by Popek and Goldberg. It also describes earlier systems that enabled virtualization despite the lack of architectural support in hardware. As is often the case, theory defines a necessary-but not sufficient-set of features, and modern architectures are the result of the combination of the theoretical framework with insights derived from practical systems. The second half of the book describes state-of-the-art support for virtualization in both x86-64 and ARM processors. This book includes an in-depth description of the CPU, memory, and I/O virtualization of these two processor architectures, as well as case studies on the Linux/KVM, VMware, and Xen hypervisors. It concludes with a performance comparison of virtualization on current-generation x86- and ARM-based systems across multiple hypervisors.
Pain in Hansen's disease patients

JUSTIFICATIVA E OBJETIVOS: O comprometimento dos nervos perifericos e uma caracteristica marcante da hanseniase, podendo causar incapacidade fisica e deformidade no paciente. O objetivo deste estudo foi analisar as caracteristicas clinico-epidemiologicas dos pacientes hansenicos com queixas algicas, com o intuito de elaborar acoes de saude direcionadas ao diagnostico precoce e tratamento da doenca. METODO: Estudo retrospectivo em 732 prontuarios de pacientes com diagnostico presuntivo ou confirmado de hanseniase, atendidos no Centro de Referencia Dermatologica em Fortaleza; atendidos no periodo de janeiro a dezembro de 2008. Foi considerada incapacidade fisica a presenca de deformidade nos olhos como lagoftalmo, triquiase, opacidade corneana e diminuicao da acuidade visual, maos em garra, maos ou pes caidos, contratura de tornozelos e reabsorcao ossea. RESULTADOS: Do total de pacientes analisados 65,9% apresentava perda de sensibilidade tatil, termica ou dolorosa, o que indicava acometimento de fibras cutâneas, sendo que 4,31% deles apresentavam dor intensa a palpacao de algum nervo, sendo mais acometidos, respectivamente o tibial (50%), o ulnar (43,8%), o radial (21,9%) e o fibular (21,9%). Os sintomas precedentes nesses pacientes foram manchas brancas ou avermelhadas (56,2%), diminuicao de sensibilidade (40,6%), diminuicao de forca muscular (15,6%) e incapacidade fisica (12,5%). CONCLUSAO: A incidencia de manifestacoes cutâneas foi a mais prevalente, seguida das manifestacoes neurologicas, sendo os nervos radial, fibular, ulnar e tibial os mais acometidos nos pacientes que apresentavam queixas algicas.
Knowledge Translation: A Concept for Occupational Therapy?

593 The evidence-based practice (EBP) concept has ignited rigorous discussion within the occupational therapy literature. In the September/October 2006 issue of the American Journal of Occupational Therapy (AJOT), for example, the issue of EBP was reframed as an issue of knowledge translation (Corcoran, 2006). This reframing has contributed to a growing discussion about knowledge, evidence, practice, the individual occupational therapist, and his or her professional community. A substantial dialogue around the use of research in occupational therapy practice first emerged in the 1980s in AJOT (Baum, 1987; Gilfoyle, 1984; Grady, 1987; Johnson, 1981; McLain, 1987; Ottenbacher, 1987; Ottenbacher, Barris, & Van Deusen, 1986; Reed, 1984). This dialogue sought to enter the evidence-based forum from the perspective of rehabilitation. However, this lens differed little from that of medicine, where the emphasis was on empirically based evidence use by the “rational” occupational therapist. Since that period, the dialogue in the broader field of health has expanded into a systems-level approach to research utilization, where the individual user is situated within an environment influenced by organizational values, organizational and team structure (Ilott, 2003), and interpersonal interaction (McCluskey, 2004). This contemporary perspective is known as knowledge translation and is articulated in the definition put forward by the Canadian Institute of Health Research (CIHR) (2005): Knowledge translation is the exchange, synthesis, and ethically sound application of knowledge—within a complex system of interactions among researchers and users—to accelerate the capture of the benefits of research for Canadians through improved health, more effective services and products, and a strengthened health care system. [italics added]
Comparing the combination effect of propofol- ketamine and propofol-alfentanil on hemodynamic stability during induction of general anesthesia in the elderly.

Background: Propofol (Diprivan), a modern intravenous hypnotic drug, produces a reduction in both cardiac index (CI) and mean arterial pressure (MAP) due to its sympatholytic activity. S-Ketamine (Ketanest), a potent analgesic, in contrast, causes an increase in both CI and MAP due to its sympathomimetic activity. This study was performed to compare the combination effects of propofol-ketamine and propofol-alfentanil on hemodynamic stability during induction of general anesthesia. Methods: In a prospective study, 100 patients over 60 (ASA I, II) scheduled for elective lower abdominal interventions were randomly divided into two groups. For induction of general anesthesia, after injection of midazolam, the first group (A) received alfentanil and propofol and the second group (B) received S-ketamine and propofol. Each group received atracurium as muscle relaxant. Blood pressure (BP) and heart rate (HR) were measured before and 1 and 5 minutes after induction of anesthesia. Results: The increase in HR and decrease in MAP were statistically significant in both groups 1 and 5 minutes after general anesthesia. The increase in HR and decrease in MAP were significantly more in Group A, 1 and 5 minutes after general anesthesia. Conclusion: The dose of S-ketamine administered during induction of general anesthesia may not be enough to neutralize the cardio-depressant effect of propofol. A better hemodynamic activity was observed in Group B compared to Group A due to partial neutralization of the opposing action.
On Optimal Selection of Summary Statistics for Approximate Bayesian Computation

How best to summarize large and complex datasets is a problem that arises in many areas of science. We approach it from the point of view of seeking data summaries that minimize the average squared error of the posterior distribution for a parameter of interest under approximate Bayesian computation (ABC). In ABC, simulation under the model replaces computation of the likelihood, which is convenient for many complex models. Simulated and observed datasets are usually compared using summary statistics, typically in practice chosen on the basis of the investigator's intuition and established practice in the field. We propose two algorithms for automated choice of efficient data summaries. Firstly, we motivate minimisation of the estimated entropy of the posterior approximation as a heuristic for the selection of summary statistics. Secondly, we propose a two-stage procedure: the minimum-entropy algorithm is used to identify simulated datasets close to that observed, and these are each successively regarded as observed datasets for which the mean root integrated squared error of the ABC posterior approximation is minimized over sets of summary statistics. In a simulation study, we both singly and jointly inferred the scaled mutation and recombination parameters from a population sample of DNA sequences. The computationally-fast minimum entropy algorithm showed a modest improvement over existing methods while our two-stage procedure showed substantial and highly-significant further improvement for both univariate and bivariate inferences. We found that the optimal set of summary statistics was highly dataset specific, suggesting that more generally there may be no globally-optimal choice, which argues for a new selection for each dataset even if the model and target of inference are unchanged.
Statistical Applications in Genetics and Molecular Biology A Mixture-Model Approach for Parallel Testing for Unequal Variances

Testing for unequal variances is usually performed in order to check the validity of the assumptions that underlie standard tests for differences between means (the t-test and anova). However, existing methods for testing for unequal variances (Levene's test and Bartlett's test) are notoriously non-robust to normality assumptions, especially for small sample sizes. Moreover, although these methods were designed to deal with one hypothesis at a time, modern applications (such as to microarrays and fMRI experiments) often involve parallel testing over a large number of levels (genes or voxels). Moreover, in these settings a shift in variance may be biologically relevant, perhaps even more so than a change in the mean. This paper proposes a parsimonious model for parallel testing of the equal variance hypothesis. It is designed to work well when the number of tests is large; typically much larger than the sample sizes. The tests are implemented using an empirical Bayes estimation procedure which `borrows information' across levels. The method is shown to be quite robust to deviations from normality, and to substantially increase the power to detect differences in variance over the more traditional approaches even when the normality assumption is valid.
Age changes in the lumbar intervertebral disc studied with magnetic resonance and cryomicrotomy

This is an original evaluation made on the correlation between sagittal gross and histologic cryomicrotome sections and magnetic resonance (MR) images of the lumbar intervertebral discs according to age groups. Age‐related structural changes were recognized in the anatomic sections and MR images of the discs in cadavers from birth to 73 years of age. In T2‐weighted MR images, the nucleus and fibrocartilaginous inner anulus have a bright signal while the peripheral annular fibers have a low signal intensity. With aging the discs become progressively more fibrous: the peripheral anulus widens and becomes densely fibrous and the inner anulus extends centrally to encroach upon the nucleus, sometimes producing a bilobed nucleus. In the newborn the components of the disc are sharply demarcated with a large, centrally located nucleus pulposus and a relatively narrow anulus fibrosus. In the adult, the nucleus and inner anulus continue to have a relatively bright signal in MR images and characteristically contain a dark band of low signal intensity which does not correspond to clefts or tears of the disc but to increased fibrous tissue content. The thickened peripheral annular fibers have a very low signal intensity. By the eighth decade of life the discs have a very high fibrous content throughout, indicated in MR images by a decreased signal intensity with no sharp distinction between nucleus and anulus in the anatomic sections. The dark band in the central portion of the disc remains as a characteristic feature in MR images of the adult disc. Degenerative changes in the discs are identified in MR images by contrasting signal intensities.
A multidimensional approach to the adoption of innovation

Summary form only given. The argument presented here proposes that one aspect of the complexity of innovation relates to the multidimensional nature of the construct. Specifically, when referring to the adoption of a given innovation or set of innovations, underspecification of the innovation(s) being studied becomes problematic in that there may be little or no comparison of findings across studies. The result may be not only a lack of understanding about the adoption of innovation but differing degrees of misunderstanding of the adoption of innovation. This paper suggests the use of multidimensional categorization schemes provides greater understanding about organizational precursors to the adoption of innovation.