Miracle-dz/UniFAR-FTUs huggingface dataset:
White Matter Disease and an Incomplete Circle of Willis

Introduction White matter disease occurs as a consequence of small vessel disease; however, hypoperfusion may also play a role. We investigated whether patients with less cerebral vessel anastomosis may develop more white matter disease. Methods Magnetic resonance imaging (1.5t) with intracranial magnetic resonance angiography data was collected on a convenience sample between July 2008 and January 2009. All patients were independently assessed for circle of Willis variants by two researchers and categorized into two groups: those with a complete circle of Willis and those with an incomplete circle of Willis (absent vessels). The complete group was sub-divided into a classical group (entirely normal circle of Willis) and a hypoplastic group (hypoplasia but no absent vessels). White matter disease assessment was conducted for these groups, by two researchers blind to magnetic resonance angiography findings, on all patients over 50 years old. Results The circle of Willis was characterized in 163 patients, while 90 (>50 years) underwent white matter disease assessment. The kappa inter-rater reliability between both circle of Willis assessors and between both white matter disease assessors was 0·57 and 0·63, respectively. The prevalence of circle of Willis variants strongly correlated with the seminal paper by Riggs and Rupp. Independent of age and gender, those with an incomplete circle of Willis (n = 68) exhibited 58% more white matter disease than those with a complete circle of Willis (n = 22) (white matter disease score 6·52 vs. 4·11, respectively, P = 0·03). Patients with absent anterior vessels exhibited more frontal white matter disease than those with intact anterior vessels (3·7 vs. 1·72, P < 0·001). Patients with absent posterior vessels exhibited more occipital white matter disease than those with intact posterior vessels (2·52 vs. 1·34, P = 0·014). Conclusion These data suggest that congenital absence of anastomotic capacity correlates with incident white matter disease, thus alluding to a hypoperfusion mechanism in the development of white matter disease.
Blood Pressure Distribution in the German Population

Many epidemiological studies have addressed various aspects of blood pressure, ranging from descriptions of normal blood pressure distributions in different populations to the influence of age and other factors on blood pressure. However studies consider blood pressure in terms of hypertension, assessing prevalence, treatment and control of hypertension in diverse populations. Very few studies are available dealing with the distribution of blood pressure values in population as percentiles, none of which is from Europe and none of which addresses a wide age range, sex and coexisting cardiovascular risk factors. Therefore, main aim of this thesis was to examine in detail the distribution of blood pressure of a large cross sectional study sample of 35,869 women and men aged 18-99 years. The second aim was to validate the observed age-effects in the cross-sectional German Metabolic and Cardiovascular Risk Study, in the independent, longitudinal and population-based Heinz Nixdorf Recall study, using baseline and 5 year follow up data of 4,157 men and women, aged 45-75 years. This study showed an age-related increase of the systolic blood pressure in all percentiles in both men and women, independent of the intake of antihypertensive medication, and/or presence of Cardiovascular Disease (CVD) or CVD risk factors. This is the first study to provide detailed information on the population distribution of blood pressure readings relating to both sexes, very old individuals and CVD risk factors. Furthermore, the age related increase observed in the systolic blood pressure in the cross sectional study could be confirmed for men and women, aged 45-75 years in the independent, longitudinal Heinz Nixdorf Recall study.
Nurse versus physician-led care for the management of asthma.

BACKGROUND Asthma is the most common chronic disease in childhood and prevalence is also high in adulthood, thereby placing a considerable burden on healthcare resources. Therefore, effective asthma management is important to reduce morbidity and to optimise utilisation of healthcare facilities. OBJECTIVES To review the effectiveness of nurse-led asthma care provided by a specialised asthma nurse, a nurse practitioner, a physician assistant or an otherwise specifically trained nursing professional, working relatively independently from a physician, compared to traditional care provided by a physician. Our scope included all outpatient care for asthma, both in primary care and in hospital settings. SEARCH METHODS We carried out a comprehensive search of databases including The Cochrane Library, MEDLINE and EMBASE to identify trials up to August 2012. Bibliographies of relevant papers were searched, and handsearching of relevant publications was undertaken to identify additional trials. SELECTION CRITERIA Randomised controlled trials comparing nurse-led care versus physician-led care in asthma for the same aspect of asthma care. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS Five studies on 588 adults and children were included concerning nurse-led care versus physician-led care. One study included 154 patients with uncontrolled asthma, while the other four studies including 434 patients with controlled or partly controlled asthma. The studies were of good methodological quality (although it is not possible to blind people giving or receiving the intervention to which group they are in). There was no statistically significant difference in the number of asthma exacerbations and asthma severity after treatment (duration of follow-up from six months to two years). Only one study had healthcare costs as an outcome parameter, no statistical differences were found. Although not a primary outcome, quality of life is a patient-important outcome and in the three trials on 380 subjects that reported on this outcome, there was no statistically significant difference (standardised mean difference (SMD) -0.03; 95% confidence interval (CI) -0.23 to 0.17). AUTHORS' CONCLUSIONS We found no significant difference between nurse-led care for patients with asthma compared to physician-led care for the outcomes assessed. Based on the relatively small number of studies in this review, nurse-led care may be appropriate in patients with well-controlled asthma. More studies in varied settings and among people with varying levels of asthma control are needed with data on adverse events and health-care costs.
Factors associated with dropping out of child and family treatment

Abstract This study investigated factors related to attendance and continuation in family-oriented treatment at a child guidance clinic. As expected, attendance and continuation were related with chronicity of the presenting problem, nature of the referral source, initial clinical perceptions of the family and predictions about termination, and family attendance in evaluation and treatment sessions. Attendance and continuation in treatment, however, were not related with family socioeconomic status and other demographic factors. The implications of these findings for treatment planning are discussed.
On Automation in Anesthesia

The thesis discusses closed-loop control of the hypnotic and the analgesic components of anesthesia. The objective of the work has been to develop a system which independently controls the intravenous infusion rates of the hypnotic drug propofol and analgesic drug remifentanil. The system is designed to track a reference hypnotic depth level, while maintaining adequate analgesia. This is complicated by inter-patient variability in drug sensitivity, disturbances caused foremost by surgical stimulation, and measurement noise. A commercially available monitor is used to measure the hypnotic depth of the patient, while a simple soft sensor estimates the analgesic depth. Both induction and maintenance of anesthesia are closed-loop controlled, using a PID controller for propofol and a P controller for remifentanil. In order to tune the controllers, patient models have been identified from clinical data, with body mass as only biometric parameter. Care has been taken to characterize identifiability and produce models which are safe for the intended application. A scheme for individualizing the controller tuning upon completion of the induction phase of anesthesia is proposed. Practical aspects such as integrator anti-windup and loss of the measurement signal are explicitly addressed. The validity of the performance measures, most commonly reported in closed-loop anesthesia studies, is debated and a new set of measures is proposed. It is shown, both in simulation and clinically, that PID control provides a viable approach. Both results from simulations and clinical trials are presented. These results suggest that closed-loop controlled anesthesia can be provided in a safe and efficient manner, relieving the regulatory and server controller role of the anesthesiologist. However, outlier patient dynamics, unmeasurable disturbances and scenarios which are not considered in the controller synthesis, urge the presence of an anesthesiologist. Closed-loop controlled anesthesia should therefore not be viewed as a replacement of human expertise, but rather as a tool, similar to the cruise controller of a car. (Less)
Current Status of Acute Stroke Management in Korea: A Report on a Multicenter, Comprehensive Acute Stroke Registry

There are limited data on the utilization of diagnostics and the variation of treatments at the national level in acute stroke care. Clinical Research Center for Stroke – 5th division stroke registry aimed to describe stroke statistics and quality of care in Korea and to implement quality indicators. Clinical Research Center for Stroke – 5th division registry was established in April 2008 and covers pretreatment demographics, medical and stroke severity measures, diagnostic evaluation, hyperacute revascularization, in-hospital management, discharge disposition, quality indicators, and long-term functional outcomes. Consecutive stroke cases from 12 participating centers are registered to a web-based database. Meticulous data management and auditing policy were applied. A total of 14 792 ischemic stroke cases were enrolled from April 2008 to January 2012. The median National Institutes of Health Stroke Scale score was 4 at admission, with median delay of onset to arrival of 14 h. Rate of risk factor management before stroke exceeds more than 80% for hypertension and diabetes. Revascularization procedures were performed in 1736 subjects (12%), and 34% were endovascular (n = 598). Substantial variability was noted in the preferred modality of hyperacute revascularization (range of endovascular recanalization = 6–60%), use of computed tomography (30–93%), and perfusion imaging (2–96%). The Clinical Research Center for Stroke – 5th division registry documented that the current practice of acute stroke care in South Korea largely met the standard of guidelines, but variability of practice still remains. The registry would provide an opportunity to evaluate the quality of stroke care across South Korea and compare it with that of other countries.
Health Service Management Study for Stroke: A Randomized Controlled Trial to Evaluate Two Models of Stroke Care

Background The most effective and efficient model for providing organized stroke care remains uncertain. This study aimed to compare the effect of two models in a randomized controlled trial. Methods Patients with acute stroke were randomized on day one of admission to combined, co-located acute/rehabilitation stroke care or traditionally separated acute/rehabilitation stroke care. Outcomes measured at baseline and 90 days post-discharge included functional independence measure, length of hospital stay, and functional independence measure efficiency (change in functional independence measure score ÷ total length of hospital stay). Results Among 41 patients randomized, 20 were allocated co-located acute/rehabilitation stroke care and 21 traditionally separated acute/rehabilitation stroke care. Baseline measurements showed no significant difference. There was no significant difference in functional independence measure scores between the two groups at discharge and again at 90 days postdischarge (co-located acute/rehabilitation stroke care: 103·6 ± 22·2 vs. traditionally separated acute/rehabilitation stroke care: 99·5 ± 27·7; P = 0·77 at discharge; co-located acute/rehabilitation stroke care: 109·5 ± 21·7 vs. traditionally separated acute/rehabilitation stroke care: 104·4 ± 27·9; P= 0·8875 at 90 days post-discharge). Total length of hospital stay was 5·28 days less in co-located acute/rehabilitation stroke care compared with traditionally separated acute/rehabilitation stroke care (24·15 ± 3·18 vs. 29·42 ± 4·5, P = 0·35). There was significant improvement in functional independence measure efficiency score among participants assigned to co-located acute/rehabilitation stroke care compared with traditionally separated acute/rehabilitation stroke care (co-located acute/rehabilitation stroke care: median 1·60, interquartile range: 0·87–2·81; traditionally separated acute/rehabilitation stroke care: median 0·82, interquartile range: 0·27–1·57, P = 0·0393). Linear regression analysis revealed a high inverse correlation (R2 = 0·89) between functional independence measure efficiency and time spent in the acute stroke unit. Conclusion This proof-of-concept study has shown that co-located acute/rehabilitation stroke care was just as effective as traditionally separated acute/rehabilitation stroke care as reflected in functional independence measure scores, but significantly more efficient as shown in greater functional independence measure efficiency. Co-located acute/rehabilitation stroke care has potential for significantly improved hospital bed utilization with no patient disadvantage.
Prediction of Recanalization in Acute Stroke Patients Receiving Intravenous and Endovascular Revascularization Therapy

Background and purpose The study aims to assess the recanalization rate in acute ischemic stroke patients who received no revascularization therapy, intravenous thrombolysis, and endovascular treatment, respectively, and to identify best clinical and imaging predictors of recanalization in each treatment group. Methods Clinical and imaging data were collected in 103 patients with acute ischemic stroke caused by anterior circulation arterial occlusion. We recorded demographics and vascular risk factors. We reviewed the noncontrast head computed tomographies to assess for hyperdense middle cerebral artery and its computed tomography density. We reviewed the computed tomography angiograms and the raw images to determine the site and degree of arterial occlusion, collateral score, clot burden score, and the density of the clot. Recanalization status was assessed on recanalization imaging using Thrombolysis in Myocardial Ischemia. Multivariate logistic regressions were utilized to determine the best predictors of outcome in each treatment group. Results Among the 103 study patients, 43 (42%) received intravenous thrombolysis, 34 (33%) received endovascular thrombolysis, and 26 (25%) did not receive any revascularization therapy. In the patients with intravenous thrombolysis or no revascularization therapy, recanalization of the vessel was more likely with intravenous thrombolysis (P = 0·046) and when M1/A1 was occluded (P = 0·001). In this subgroup of patients, clot burden score, cervical degree of stenosis (North American Symptomatic Carotid Endarterectomy Trial), and hyperlipidemia status added information to the aforementioned likelihood of recanalization at the patient level (P < 0·001). In patients with endovascular thrombolysis, recanalization of the vessel was more likely in the case of a higher computed tomography angiogram clot density (P = 0·012), and in this subgroup of patients gender added information to the likelihood of recanalization at the patient level (P = 0·044). Conclusion The overall likelihood of recanalization was the highest in the endovascular group, and higher for intravenous thrombolysis compared with no revascularization therapy. However, our statistical models of recanalization for each individual patient indicate significant variability between treatment options, suggesting the need to include this prediction in the personalized treatment selection.
Size matters for single-cell C4 photosynthesis in Bienertia

Abstract Bienertia cycloptera belongs to a diverse set of plants, recently discovered to perform C4 photosynthesis within individual mesophyll cells. How these plants accomplish high photosynthetic efficiency without adopting Kranz anatomy remains unanswered. By modelling the processes of diffusion, capture, and release of carbon dioxide and oxygen inside a typical Bienertia mesophyll cell geometry, we show that a spatial separation as low as 10 &mgr;m between the primary and the secondary carboxylases, can, on its own, provide enough diffusive resistance to sustain a viable C4 pathway at 20 °C, with a CO2 leakage <35%. This critical separation corresponds to a cell diameter of 50 &mgr;m, consistent with the observed range where Bienertia's mesophyll cells start to develop their characteristic mature anatomy. Our results are robust to significant alterations in model assumptions and environmental conditions, their applicability extending even to aquatic plants.
Primary seed dormancy: a temporally multilayered riddle waiting to be unlocked

Abstract Primary seed dormancy is an important adaptive plant trait whereby seed germination is blocked under conditions that would otherwise be favorable for germination. This trait is found in newly produced mature seeds of many species, but not all. Once produced, dry seeds undergo an aging time period, called dry after‐ripening, during which they lose primary dormancy and gradually acquire the capacity to germinate when exposed to favorable germination conditions. Primary seed dormancy has been extensively studied not only for its scientific interest but also for its ecological, phenological, and agricultural importance. Nevertheless, the mechanisms underlying primary seed dormancy and its regulation during after‐ripening remain poorly understood. Here we review the principal developmental stages where primary dormancy is established and regulated prior to and during seed after‐ripening, where it is progressively lost. We attempt to identify and summarize what is known about the molecular and genetic mechanisms intervening over time in each of these stages.
Older People Maintaining Mental Health Well-Being through Resilience: An Appreciative Inquiry Study in Four Countries

Aim. To explore the experience and strategies of mental health well-being through resilience in older people across the four participating countries. Background. While there is increasing evidence of the way older people maintain physical well-being, there has not been the same emphasis when examining the ways in which older people enhance their resilience and so promote mental health well-being. Design. An Appreciative Inquiry approach was used. Method. A convenience sample of 58 people over the age of 65 years from Australia, UK, Germany, and South Africa were interviewed. Data were analysed using thematic analysis. Results. Participants described their experiences of mental health well-being in relation to: social isolation and loneliness; social worth; self-determination; and security. Strategies utilised include promoting resilience by maintaining community connections and relationships, keeping active, and emotional, practical and spiritual coping. Conclusion. The findings highlight the importance of maintaining mental health well-being through resilience. Although there were some variations between countries, these strategies for maintaining well-being transcended culture and nation. Relevance to clinical practice. Listening to older people through research such as the current study will help to determine what help is needed and how healthcare and policy makers can assist.
Prescription drug expenditures of immigrants in the USA

Given the substantial growth rate of the immigrant population, it is critical to examine immigrants' prescription drug expenditure patterns to encourage medication adherence. The aim was to examine and compare prescription drug expenditures and out‐of‐pocket (OOP) payment by respondents' US citizenship/nativity status and years spent in the USA, and identify factors associated with these expenditure differences.
Out-patient geriatric assessment by a hospital- based general practitioner: Results and financial implications

ABSTRACT Norway has few specialists in geriatric medicine, but geriatric services are supposed to be implemented in all local hospitals. I assessed a model for hospital out-patient geriatric service headed by a general practitioner. The service was organised in a local hospital. 266 elderly patients were referred for geriatric assessment. Main outcome measures were ICD-9 diagnostic categories, general patient well-being before and after assessment, patients' and referring doctors' satisfaction, and cost of the service and income received. Age, gender and diagnoses were within the same range as in other studies of out-patient geriatric assessment. Two hundred and three (85.3%) out of 238 patients reached in follow-up interviews were satisfied with the service and reported improved general well-being. Referring doctors reported satisfaction with the service. The service was financed by charges paid by the patients and a capitation fee from the social security. Cost per patient was £ 94 (1070 NOK). The study shows that in Norway a GP can implement an outpatient geriatric service which improves the patients' general well-being and is cost effective. Key words: general practitioner, geriatric assessment, financial implications, local hospital, out-patient clinic, patient well-being
RADIATION-INDUCED HEAD AND NECK TUMORS

Among about 11,000 children irradiated for tinea capitis in Israel, an excess of head and neck tumors was found after a follow-up of 12 to 23 years (Modan, B. et al., Lancet, 1:277, 1974). The numbers of neoplasms in cases vs. comparable controls were brain, malignant 8 vs 1, benign 8 vs 1; parotid gland, malignant 4 vs 0, benign 3 vs 1; and thyroid, malignant 12 vs 2. There was no excess of leukemia of lymphoma, and benign thyroid neoptasms were not studied. The excess of malignant thyroid tumors was puzzling because the dose absorbed should have only been 6.5 rad.
F-fluorodeoxyglucose positron emission tomography–computed tomography for preoperative lymph node staging in patients undergoing radical cystectomy for bladder cancer: A prospective study

F-fluorodeoxyglucose positron emission tomography–computed tomography for preoperative lymph node staging in patients undergoing radical cystectomy for bladder cancer: A prospective study Maryam Hitier-Berthault, Catherine Ansquer, Julien Branchereau, Karine Renaudin, Françoise Bodere, Olivier Bouchot and Jérôme Rigaud Department of Urology Clinic, Department of Nuclear Medicine, and Department of Pathology, Hôtel Dieu, Nantes University Hospital Center, Nantes, France