Miracle-dz/UniFAR-FTUs huggingface dataset:
Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis, hospitalization, or death.

CONTEXT Patients with chronic kidney disease (CKD) experience increased rates of hospitalization and death. Depressive disorders are associated with morbidity and mortality. Whether depression contributes to poor outcomes in patients with CKD not receiving dialysis is unknown. OBJECTIVE To determine whether the presence of a current major depressive episode (MDE) is associated with poorer outcomes in patients with CKD. DESIGN, SETTING, AND PATIENTS Prospective cohort study of 267 consecutively recruited outpatients with CKD (stages 2-5 and who were not receiving dialysis) at a VA medical center between May 2005 and November 2006 and followed up for 1 year. An MDE was diagnosed by blinded personnel using the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. MAIN OUTCOME MEASURES The primary outcome was event-free survival defined as the composite of death, dialysis initiation, or hospitalization. Secondary outcomes included each of these events assessed separately. RESULTS Among 267 patients, 56 had a current MDE (21%) and 211 did not (79%). There were 127 composite events, 116 hospitalizations, 38 dialysis initiations, and 18 deaths. Events occurred more often in patients with an MDE compared with those without an MDE (61% vs 44%, respectively, P = .03). Four patients with missing dates of hospitalization were excluded from survival analyses. The mean (SD) time to the composite event was 206.5 (19.8) days (95% CI, 167.7-245.3 days) for those with an MDE compared with 273.3 (8.5) days (95% CI, 256.6-290.0 days) for those without an MDE (P = .003). The adjusted hazard ratio (HR) for the composite event for patients with an MDE was 1.86 (95% CI, 1.23-2.84). An MDE at baseline independently predicted progression to dialysis (HR, 3.51; 95% CI, 1.77-6.97) and hospitalization (HR, 1.90; 95% CI, 1.23-2.95). CONCLUSION The presence of an MDE was associated with an increased risk of poor outcomes in CKD patients who were not receiving dialysis, independent of comorbidities and kidney disease severity.
Plantarflexion Resistance of Selected Ankle-Foot Orthoses: A Pilot Study of Commonly Prescribed Prefabricated and Custom-Molded Alternatives

Very little objective data have been published regarding the control offered by specific ankle-foot orthosis designs, despite their widespread clinical application. In addition, the proliferation of custom designs and prefabricated variants in recent years has made it increasingly difficult to judge the effectiveness of a particular ankle-foot orthosis before completion of the fitting. A review of the literature showed that no definitive method for measuring load deflection characteristics of orthoses has been established to date. For this pilot study, we investigated the use of a simple digital tensiometer to objectively quantify the plantarflexion resistance supplied at the forefoot for a variety of common orthoses. In the study, the tested orthoses fell into three distinct groupings based on the average static resistance to plantarflexion. These data suggest that nonambulatory orthoses can be readily identified by the minimal plantarflexion resistance offered, whereas ambulatory devices can be classified as those offering moderate plantarflexion resistance versus those that function as a plantarflexion stop. This grouping according to biomechanical performance in the sagittal plane may have clinical significance and therefore may be useful in determining what specific ankle-foot orthosis should be prescribed.
Issues in Screening and Surveillance Colonoscopy

Colorectal cancer (CRC) is a major cause of morbidity and mortality throughout the world. However timely screening and treatment can dramatically impact outcomes. The association with well-defined precancerous lesions and long asymptomatic period provides the oppor‐ tunity for effective screening and early treatment of CRC. The current options for CRC screening are strongly anchored in evidence demonstrating utility in reducing morbidity and mortality. This chapter will review the epidemiology of CRC, risk stratification, strat‐ egies for screening, as well as factors that threaten achieving health equity through appro‐ priate screening programs.
Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006.

CONTEXT Whether decreases in the length of stay during the past decade for patients with heart failure (HF) may be associated with changes in outcomes is unknown. OBJECTIVE To describe the temporal changes in length of stay, discharge disposition, and short-term outcomes among older patients hospitalized for HF. DESIGN, SETTING, AND PARTICIPANTS An observational study of 6,955,461 Medicare fee-for-service hospitalizations for HF between 1993 and 2006, with a 30-day follow-up. MAIN OUTCOME MEASURES Length of hospital stay, in-patient and 30-day mortality, and 30-day readmission rates. RESULTS Between 1993 and 2006, mean length of stay decreased from 8.81 days (95% confidence interval [CI], 8.79-8.83 days) to 6.33 days (95% CI, 6.32-6.34 days). In-hospital mortality decreased from 8.5% (95% CI, 8.4%-8.6%) in 1993 to 4.3% (95% CI, 4.2%-4.4%) in 2006, whereas 30-day mortality decreased from 12.8% (95% CI, 12.8%-12.9%) to 10.7% (95% CI, 10.7%-10.8%). Discharges to home or under home care service decreased from 74.0% to 66.9% and discharges to skilled nursing facilities increased from 13.0% to 19.9%. Thirty-day readmission rates increased from 17.2% (95% CI, 17.1%-17.3%) to 20.1% (95% CI, 20.0%-20.2%; all P < .001). Consistent with the unadjusted analyses, the 2005-2006 risk-adjusted 30-day mortality risk ratio was 0.92 (95% CI, 0.91-0.93) compared with 1993-1994, and the 30-day readmission risk ratio was 1.11 (95% CI, 1.10-1.11). CONCLUSION For patients admitted with HF during the past 14 years, reductions in length of stay and in-hospital mortality, less marked reductions in 30-day mortality, and changes in discharge disposition accompanied by increases in 30-day readmission rates were observed.
Assisted Reproductive Technologies and Pregnancy Outcomes: Mechanistic Insights from Animal Studies

Modern techniques in assisted reproduction have become a common and accepted form of clinical care benefiting an estimated 1 in 10 people of reproductive age who are subfertile or infertile. The success of these technologies relies, to large extent, on the remarkable tolerance of mammalian gametes and the preimplantation embryo to physical manipulations and alterations to their chemical environment. Recent reports from both human and animal studies, however, suggest that our faith in the ability of these "germ cells" to accurately recapitulate the normal process of early development under such conditions may be misplaced. While acknowledging the recognized risk factors of increased maternal age and infertility in human assisted reproductive technology (ART) subjects and the transfer of supernumerary embryos, evidence from animal studies indicates that ART procedures can directly contribute to the variable perinatal outcomes observed and imprinting disorders recently recognized. Controversy surrounds the specific nature and extent of these contributions; however, ovarian stimulation, in vitro maturation and embryo culture, intracytoplasmic sperm injection, and gamete/embryo cryopreservation have all been implicated. These issues are considered in detail in this article, which evaluates the insights that can be gained from studies with animals.
Effects of acetazolamide on central blood pressure, peripheral blood pressure, and arterial distensibility at acute high altitude exposure.

AIMS We assessed the haemodynamic changes induced by exposure to high altitude hypoxia and the effects on them of acetazolamide, a drug prescribed to prevent and treat mountain sickness. METHODS AND RESULTS In 42 subjects (21 males, age 36.8 ± 8.9 years) randomized to double blind acetazolamide 250 mg b.i. d. or placebo, pulse wave velocity and pulse wave parameters were assessed (PulsePen) at baseline; after 2-day treatment at sea level; within 6 h and on 3rd day of exposure to high altitude. Exposure to high altitude significantly increased diastolic (P < 0.005) and mean blood pressure (BP) (P < 0.05, after prolonged exposure) in placebo but not in the acetazolamide group. Therefore, subjects on acetazolamide showed significantly lower values of diastolic (P < 0.005) and mean BP (P < 0.05) at altitude. Furthermore, they also showed significantly lower values of systolic BP (P < 0.05). Pulse wave velocity did not change at high altitude, while the augmentation index, normalized for a theoretical heart rate of 75 b.p.m. , significantly increased (P < 0.05) under placebo, but not under acetazolamide. In a multivariate model, unadjusted augmentation index at high altitude was not affected by BP changes, while significant determinants were heart rate and gender. CONCLUSION Acute exposure to high altitude induced a rise in brachial BP and changes in pulse waveform-derived parameters, independent from changes in mean BP and partly counteracted by treatment with acetazolamide. The impact of acetazolamide on the haemodynamic alterations induced by hypobaric hypoxia may be considered among the beneficial effects of this drug in subjects prone to mountain sickness. CLINICAL TRIAL REGISTRATION EudraCT Number: 2010-019986-27.
Hubungan Antara Dukungan Keluarga Dengan Penyesuaian Diri Perempuan Pada Kehamilan Pertama

Substantial physical and emotional changes happen during pregnancy. Even though pregnancy is only a short periode in woman’s life, it determines the physical and psychological quality not only for pregnant woman herself but also for the baby. Pregnant women who are able to develop appropriate adjustment during pregnancy can manage the challenges and changes that happen, so the physical and psychological well being of the mother and baby can be maintained. This research sets out to understand how far the relationship between family support and women’s adjustment during their first pregnancy . The hypothesis is: there is a positive relationship between family support and women’s adjustment during their first pregnancy. Subjects of this research were 56 women who underwent their first pregnancy (primigravida). The subjects came from three Public Health Centres of Yogyakarta municipality. Those Public Health Centers were Tegalrejo, Jetis, and Pakulaman. Data were collected by using Family Support Scale which contains 45 items and Adjustment Scale which contains 35 items. Both of the scales had been tested on 40 respondents that had the same characteristics with research subjects. The respondents were from Mergangsan, Danurejan II, and Umbulharjo II Public Health Centres. The result shows positive correlation between family support and women’s adjustment. The correlation coeffisien (r) is 0,7311 ; p < 0,01 and the determination coefficient (r2) is 0,5346. It means that the research hypothesis is supported by the result of the data analysis. Keyword: family support, adjustment, first pregnancy
English for professional academic purposes: writing for scholarly publication

English is now unquestionably the language of international scholarship and an important medium of research communication for non-native English speaking academics around the world. While accurate figures are hard to come by, perhaps one in five of the world's population now speaks English with reasonable competence (Crystal, 2003) and the language is rapidly coming to dominate the dissemination of knowledge. Universities in many countries now require staff to present at international conferences and, more crucially, publish in major, high-impact, peer reviewed Anglophone journals as a pre-requisite for tenure, promotion and career advancement. As a consequence, EAP practitioners increasingly find themselves called upon to venture into this unfamiliar terrain to improve the writing for publication skills of colleagues from other departments. In this chapter I address this growing area of academic literacy support, focusing on English for Professional Academic Purposes (EPAP): research and instruction with the goal of facilitating academic publication and presentation in English.
Cross-Border Exposures and Financial Contagion

Integrated financial markets provide opportunities for expansion and improved risk sharing, but also pose threats of contagion risk through cross-border exposures. This paper examines cross-border contagion risk over the period 1999-2006. To that purpose we use aggregate cross-border exposures of seventeen countries as reported in the BIS Consolidated Banking Statistics. We find that a shock which affects the liabilities of one country may undermine the stability of the entire financial system. Particularly, a shock wiping out 25% (35%) of US (UK) cross-border liabilities against non-US (non-UK) banks could lead to bank contagion eroding at least 94% (45%) of the recipient countries’ banking assets. We also find that since 2006 a shock to Eastern Europe, Turkey and Russia affects most countries. Our simulations also reveal that the “speed of propagation of contagion” has increased in recent years resulting in a higher number of directly exposed banking systems. Finally we find that contagion is more widespread in geographical proximities.
Physicians' perceptions, preparedness for reporting, and experiences related to impaired and incompetent colleagues.

CONTEXT Peer monitoring and reporting are the primary mechanisms for identifying physicians who are impaired or otherwise incompetent to practice, but data suggest that the rate of such reporting is lower than it should be. OBJECTIVE To understand physicians' beliefs, preparedness, and actual experiences related to colleagues who are impaired or incompetent to practice medicine. DESIGN, SETTING, AND PARTICIPANTS Nationally representative survey of 2938 eligible physicians practicing in the United States in 2009 in anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics, and psychiatry. Overall, 1891 physicians (64.4%) responded. MAIN OUTCOME MEASURES Beliefs about and preparedness for reporting and experiences with colleagues who practice medicine while impaired or who are incompetent in their medical practice. RESULTS Sixty-four percent (n = 1120) of surveyed physicians agreed with the professional commitment to report physicians who are significantly impaired or otherwise incompetent to practice. Nonetheless, only 69% (n = 1208) of physicians reported being prepared to effectively deal with impaired colleagues in their medical practice, and 64% (n = 1126) reported being so prepared to deal with incompetent colleagues. Seventeen percent (n = 309) of physicians had direct personal knowledge of a physician colleague who was incompetent to practice medicine in their hospital, group, or practice. Of those with this knowledge, 67% (n = 204) reported this colleague to the relevant authority. Underrepresented minorities and graduates of non-US medical schools were less likely than their counterparts to report, and physicians working in hospitals or medical schools were most likely to report. The most frequently cited reason for taking no action was the belief that someone else was taking care of the problem (19% [n = 58]), followed by the belief that nothing would happen as a result of the report (15% [n = 46]) and fear of retribution (12% [n = 36]). CONCLUSION Overall, physicians support the professional commitment to report all instances of impaired or incompetent colleagues in their medical practice to a relevant authority; however, when faced with these situations, many do not report.
Bias and trials stopped early for benefit.

al and the earlier report by Zietman et al were that (1) at 5 years, a significantly higher proportion of men remained free of biochemical failure in the higher-dose radiation group (80.4%) vs the conventional-dose treatment group (61.4%) and that (2) at a median of 9.4 years following treatment, there were no significant differences in key functional parameters between conventional-dose and high-dose treatment, such as urinary obstruction, urinary incontinence, bowel problems, and decreased sexual function. Furthermore, at a median follow-up time of 8.9 years, long-term cancer control was still significantly higher in the highdose vs conventional-dose treatment groups. We suspect that these findings about symptoms probably were not necessarily only “because eventually the patients will adapt and stop complaining” (as Vikram suggests), but instead may represent important and meaningful outcomes for patients. Similarly, Talcott et al also found that patients who had received conventional doses were significantly more concerned about control of their cancer than patients who had received high doses, and also tended to express more regret. The quality-of-life consequences for men treated for prostate cancer and the psychological toll experienced by men concerned with disease recurrence should not be underestimated. The results from the study by Talcott et al add to the evidence that physicians can use when discussing treatment options for men with early prostate cancer by showing that high-dose radiation treatment is not associated with worse long-term adverse effects than conventional-dose treatment.
The relationship between glycaemic variability and cardiovascular complications in patients with acute myocardial infarction and type 2 diabetes: a report from the DIGAMI 2 trial.

AIMS Hyperglycaemia during hospitalization for acute myocardial infarction (AMI) is a risk predictor, but attempts to improve the prognosis by insulin-based glucose control have not been consistently successful. Increased glycaemic variability, a potential effect of insulin treatment, has been linked to a worse prognosis in critically ill patients. The present aim was to study the possibility of such a relation in patients with type 2 diabetes (T2DM) and AMI. METHOD AND RESULTS We studied 578 T2DM patients who had glucose levels measured hourly while receiving an insulin-glucose infusion during the first 48 h of hospitalization for AMI. Three measures of glycaemic variability: root mean square error (RMSE), range, and slope were studied in relation to a composite endpoint of mortality, stroke, and reinfarction and to mortality. In unadjusted analyses, the mean level of glycaemic variability did not differ between patients who died during 12 months of follow-up compared with those who survived. In a Cox regression model adjusting for age and previous congestive heart failure, there was no increased risk for the composite endpoint associated with increased glycaemic variability; RMSE: hazard ratio (HR) 1.09 [95% confidence interval (CI) 0.93-1.27; P = 0.28], range: HR 1.01 (95% CI: 0.98-1.05; P = 0.47), and slope: HR 1.01 (95% CI: 0.99-1.04; P = 0.40). There was furthermore no increased risk in mortality; RMSE HR 1.14 (95% CI: 0.93-1.38; P = 0.21), range HR 1.03 (95% CI: 0.98-1.08; P = 0.28), and slope HR 1.01 (95% CI: 0.98-1.04; P = 0.55). CONCLUSION The 1-year risk for death, reinfarction, or stroke did not relate to glycaemic variability in T2DM patients with AMI treated with insulin infusion.
ESC Working Group on Valvular Heart Disease position paper--heart valve clinics: organization, structure, and experiences.

BACKGROUND With an increasing prevalence of patients with valvular heart disease (VHD), a dedicated management approach is needed. The challenges encountered are manifold and include appropriate diagnosis and quantification of valve lesion, organization of adequate follow-up, and making the right management decisions, in particular with regard to the timing and choice of interventions. Data from the Euro Heart Survey have shown a substantial discrepancy between guidelines and clinical practice in the field of VHD and many patients are denied surgery despite having clear indications. The concept of heart valve clinics (HVCs) is increasingly recognized as the way to proceed. At the same time, very few centres have developed such expertise, indicating that specific recommendations for the initial development and subsequent operating requirements of an HVC are needed. AIMS The aim of this position paper is to provide insights into the rationale, organization, structure, and expertise needed to establish and operate an HVC. Although the main goal is to improve the clinical management of patients with VHD, the impact of HVCs on education is of particular importance: larger patient volumes foster the required expertise among more senior physicians but are also fundamental for training new cardiologists, medical students, and nurses. Additional benefits arise from research opportunities resulting from such an organized structure and the delivery of standardized care protocols. CONCLUSION The growing volume of patients with VHD, their changing characteristics, and the growing technological opportunities of refined diagnosis and treatment in addition to the potential dismal prognosis if overlooked mandate specialized evaluation and care by dedicated physicians working in a specialized environment that is called the HVC.
Copyright 2009 by Human Factors and Ergonomics Society, Inc. All rights reserved. 10.1518/107118109X12524442636986

Anesthesiologists in the operating room vigilantly monitor their patient’s vital signs during surgical procedures. The vital signs are displayed on a monitor that may be located in an awkward position and out of view of the anesthesiologist (who may be busy performing procedures on the patient). A head-mounted display (HMD) can help anesthesiologists monitor the patient’s vital signs no matter where they are, or where they are looking, in the operating room. HMDs have been tested in simulated and real operating rooms, but no study has investigated whether the worsened inattentional blindness phenomenon found with head-up displays in aviation would also affect HMDs in anesthesia. Experiment 1 shows that the HMD did not worsen participants’ ability to report unexpected events, but it did let them look towards the simulated patient for longer. Experiment 2 shows that participants using the HMD are slower to detect a change in a waveform and quicker to detect a change in numbers when working with a simulated patient. Experiment 3, a clinical trial, replicated the finding that the HMD lets participants look towards the patient for more time. We assess the prospects for HMDs in clinical contexts.
Reducing opioid abuse and diversion.

tionship between race and risk of opioid overdose death, but we were not able to include these as variables. We also did not have data on differences in patient preferences and opioid-taking behavior that may also contribute to differences in overdose rates. In light of the known racial disparities in opioid prescribing, it is plausible that black individuals are less likely to receive both the benefits of pain reduction and the risk of overdose associated with opioid medications. The potential determinants of these racial disparities, including clinician behavior, patient-clinician interaction, and patient presentation and preferences, should be a focus of further research.