Miracle-dz/UniFAR-FTUs huggingface dataset:
Unjustified: The Imbalance of Information and Funding With Noninvasive Prenatal Screening

Background: Noninvasive prenatal screening (NIPS) is the latest in prenatal testing technologies for Down syndrome and other aneuploidies. It joins existing traditional screening and invasive testing. The administration and funding of prenatal testing for aneuploidy has been the subject of several studies evaluating whether women are making informed choices and whether prenatal testing is cost-effective. Methods: A review of professional medical guidelines, studies on informed consent and cost-effectiveness, and how NIPS is currently being administered and covered by private and public insurance was conducted. Results: Since the major medical organizations have recognized NIPS, particularly for women considered high risk, NIPS is being offered to expectant mothers. Increasingly, public and private insurance are covering NIPS based on the medical guidelines, with cost-effectiveness studies justifying its coverage. The same guidelines recommend pre-test counseling and post-test counseling along with providing patient educational materials with each prenatal test result. Consistent with past practice with traditional screening and invasive testing, these patient educational resources are not being provided or covered at the same rate as the testing itself. Conclusions: The administration of prenatal testing continues to only provide one part of the information recommended by medical guidelines: the testing itself. Patients are not receiving the recommended pre- and post-test counseling and educational materials, nor are these being covered to the same extent as the cost of the NIPS test itself. Unless all of the information recommended by the medical guidelines is both provided and covered to the same extent as the testing itself, offering and covering the costs of NIPS is unjustified.
Histological confirmation and biological significance of cartilage canals demonstrated using high field MRI in swine at predilection sites of osteochondrosis

Cartilage canal vessels in epiphyseal cartilage have a pivotal role in the pathogenesis of osteochondrosis/osteochondritis dissecans. The present study aimed to validate high field magnetic resonance imaging (MRI) methods to visualize these vessels in young pigs. Osteochondral samples from the distal femur and distal humerus (predilection sites of osteochondrosis) of piglets were imaged post‐mortem: (1) using susceptibility‐weighted imaging (SWI) in an MRI scanner, followed by histological evaluation; and (2) after barium perfusion using µCT, followed by clearing techniques. In addition, both stifle joints of a 25‐day‐old piglet were imaged in vivo using SWI and gadolinium enhanced T1‐weighted MRI, after which distal femoral samples were harvested and evaluated using µCT and histology. Histological sections were compared to corresponding MRI slices, and three‐dimensional visualizations of vessels identified using MRI were compared to those obtained using µCT and to the cleared specimens. Vessels contained in cartilage canals were identified using MRI, both ex vivo and in vivo; their locations matched those observed in the histological sections, µCT images, and cleared specimens of barium‐perfused tissues. The ability to visualize cartilage canal blood vessels by MRI, without using a contrast agent, will allow future longitudinal studies to evaluate their role in developmental orthopedic disease. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:2006–2012, 2013
Left Ventricular Systolic Asynchrony is Induced Even in the Normal Heart During Increases in Afterload: A Study With Angiotensin II Stress Pulsed Tissue Doppler Imaging

Objective. We investigated whether pulsed tissue Doppler imaging could be useful to detect sensitively a decrease in left ventricular (LV) contractile force and development of systolic asynchrony during an increase in afterload in healthy individuals.Methods. We recorded LV wall motion velocities before and after angiotensin II infusion by pulsed tissue Doppler imaging in 16 healthy individuals and evaluated the differences in the responses in systolic LV function along the short- and long-axes between the basal and apical regions during an acute increase in afterload.Results. After angiotensin II infusion, the systolic blood pressure and LV end-systolic dimension were increased significantly, and the LV ejection fraction was significantly decreased. The peak first and second systolic velocities and the times from the beginning of the Q wave of the electrocardiogram to the peak first systolic velocity of the LV walls along both the short- and long-axes were markedly decreased and prolonged, respectively, in the apical region compared to the basal region.Conclusions. LV systolic asynchrony is induced, even in normal hearts, during an increase in afterload. Pulsed tissue Doppler imaging provides incremental diagnostic information on regional LV systolic function.
Peer support and peer-led family support for persons living with schizophrenia

Purpose of review Peer support and peer-led family psychoeducation represent two distinct and complementary recovery-oriented models to support individuals who live with schizophrenia and their families, respectively. The goals of these models focus on improving knowledge, coping, self-care, social support, and self-management strategies. These models represent important capacity-building strategies for people who live with the illness and the people who love them. This brief article is intended to provide the practicing clinician, person living with schizophrenia, and policy maker with a working knowledge of the current state of the literature in these two related fields. Practitioners should consider these resources and integrate them into their care. A person living with schizophrenia could use this review to advocate for appropriate resources and to identify career opportunities. Policy makers could benefit from an understanding of the literature to mitigate financial and cultural barriers to adopting these practices. Recent findings The last 5 years have seen a dramatic expansion of the application of randomized controlled trials (RCTs) to give evidence to match the experience of people in these programs. The field has seen Wellness Recovery Action Plan (WRAP) named as evidence-based practice by the National Registry of Evidence-Based Practices. A RCT was also conducted for another peer-developed and led program called Building Recovery of Individual Dreams & Goals through Education & Support. Family to Family, the largest peer-led family psychoeducation course, was also found to have significant impact after the study and also 6 months later in RCT. Family to Family has also been named as an evidence-based practice. Summary The field of people who are living well with schizophrenia working as resources and supports to others living with the illness is an idea that is growing momentum. This momentum has been matched by the RCT evidence. Peer support as a professional role has an emerging literature that needs to be grown. WRAP and National Alliance on Mental Illness's Family to Family program are evidence-based practices and widely available. Peer support and peer-led family support for persons living with schizophrenia is a nascent field with much potential.
Circadian rhythms and risk for substance use disorders in adolescence

Purpose of review This article explores recent research in adolescent circadian rhythms, neurobiological changes influencing affective regulation and reward responding, and the emergence of substance use and related problems. Recent findings Recent findings have confirmed that adolescents with drug and alcohol problems are also beset by sleep problems, and have advanced our understanding of the relationship between sleep problems and substance involvement in this developmental period. During adolescence, a shift to later preferred sleep times interacts with early school start times to cause sleep loss and circadian misalignment. Sleep loss and circadian misalignment may disrupt reward-related brain function and impair inhibitory control. Deficits or delays in mature reward and inhibitory functions may contribute to adolescent alcohol use and other substance involvement. Summary An integration of the available research literature suggests that changes in sleep and circadian rhythms during adolescence may contribute to accelerated substance use and related problems.
Treatment of the psychiatric problems associated with fragile X syndrome

Purpose of review This work reviews recent research regarding treatment of fragile X syndrome (FXS), the most common inherited cause of intellectual disability and autism spectrum disorder. The phenotype includes anxiety linked to sensory hyperarousal, hyperactivity, and attentional problems consistent with attention deficit hyperactivity disorder and social deficits leading to autism spectrum disorder in 60% of boys and 25% of girls with FXS. Recent findings Multiple targeted treatments for FXS have rescued the phenotype of the fmr1 knockout mouse, but few have been beneficial to patients with FXS. The failure of the metabotropic glutamate receptor 5 antagonists falls on the heels of the failure of Arbaclofen's efficacy in children and adults with autism or FXS. In contrast, efficacy has been demonstrated in a controlled trial of minocycline in children with FXS. Minocycline lowers the abnormally elevated levels of matrix metalloproteinase 9 in FXS. Acamprosate and lovastatin have been beneficial in open-label trials in FXS. The first 5 years of life may be the most efficacious time for intervention when combined with behavioral and/or educational interventions. Summary Minocycline, acamprosate, lovastatin, and sertraline are treatments that can be currently prescribed and have shown benefit in children with FXS. Use of combined medical and behavioral interventions will likely be most efficacious for the treatment of FXS.
An update on anxiety in youth with autism spectrum disorders

Purpose of review Anxiety is one of the most common co-occurring psychiatric conditions in youth with autism spectrum disorders (ASDs). This article reviews recent evidence as well as earlier relevant studies regarding the characteristics, assessment, and treatment of anxiety in youth with ASD. Recent findings It is well established that the prevalence of anxiety in youth with an ASD is significantly greater than the prevalence of anxiety in the general population. Recent studies have highlighted the importance of informant, method, and instrument when measuring anxiety in this population. Despite the high prevalence, findings to date have been unable to identify any consistent risk factors for anxiety. New psychological treatments, including modified cognitive behavioral therapy for youth with high functioning ASD and co-occurring anxiety, are emerging. Pharmacological data, however, are scant. Existing studies show that youth with ASD are at increased risk for behavioral activation when taking SSRIs. Summary Clinicians working with youth with ASD are encouraged to routinely screen for anxiety. Until further data are available, clinical judgment is needed when prescribing treatments, particularly selective serotonin reuptake inhibitors, which require close monitoring of side-effects. Research on risk factors, pathophysiology, and treatment of this condition is needed.
The pathways to mental healthcare worldwide: a systematic review

Purpose of review Pathways-to-care studies represent a valid and cost-effective tool to provide information on patients’ access to psychiatric care. However, no direct comparison of data concerning the pathways to mental healthcare, at the world level, is available yet. Recent findings Data obtained from different countries of the world may offer a global perspective on psychiatric pathways to mental healthcare, highlighting the strengths and weaknesses of different mental health systems and reflecting cultural, economic, social and political differences. We evaluated all studies that used a standardized methodology to describe pathways to mental healthcare of all adult patients, presenting for the first time to psychiatric services. Summary Our findings highlight that considerable variations of pathways to mental healthcare across different countries still exist. A consensus on the quality standards of psychiatric care should be reached and actions to ensure their implementation in low-middle income countries should be taken in the near future. The role of primary care doctors and social networks still represent an unsolved issue for psychiatric care worldwide. Stigma and discrimination towards patients with mental illnesses may still represent a relevant limiting factor for equal delivery of mental healthcare.
Service provision to physicians with mental health and addiction problems

Purpose of review Physicians are reluctant to ask for help when they suffer from substance use disorders and/or other mental illnesses (i.e. when they become ‘sick doctors’). This can result in greater morbidity/mortality and may lead to significant problems in medical practice. This review aims to describe the nature and development of programs that specifically treat sick doctors [Physician Health Programs (PHPs)]. Recent findings PHPs were first developed in the United States in the late 1970s. The purpose was to identify and treat physicians with problems resulting from mental health issues, mainly substance use disorders. Since then, other PHPs have been developed in Canada, Australia, and the United Kingdom, trying to reach sick doctors, offering counseling or other preventive interventions when needed. New models to help sick doctors, such as the Spanish PHP, were also developed. Counseling and support services for sick doctors have been implemented elsewhere in Europe (e.g. Norway and Switzerland). Summary PHPs provide interventions specifically designed for physicians and other medical professionals with substance use and other mental health problems. The balance between guaranteeing safe practice and yet encouraging all physicians to ask for help when in trouble raises questions regarding how these programs should be designed.
Epidemiology of posttraumatic stress disorder: prevalence, correlates and consequences

Purpose of review This review discusses recent findings from epidemiological surveys of traumatic events and posttraumatic stress disorder (PTSD) globally, including their prevalence, risk factors, and consequences in the community. Recent findings A number of studies on the epidemiology of PTSD have recently been published from diverse countries, with new methodological innovations introduced. Such work has not only documented the prevalence of PTSD in different settings, but has also shed new light on the PTSD conditional risk associated with specific traumatic events, and on the morbidity and comorbidities associated with these events. Summary Recent community studies show that trauma exposure is higher in lower-income countries compared with high-income countries. PTSD prevalence rates are largely similar across countries, however, with the highest rates being found in postconflict settings. Trauma and PTSD-risk factors are distributed differently in lower-income countries compared with high-income countries, with sociodemographic factors contributing more to this risk in high-income than low-income countries. Apart from PTSD, trauma exposure is also associated with several chronic physical conditions. These findings indicate a high burden of trauma exposure in low-income countries and postconflict settings, where access to trained mental health professionals is typically low.
Effects of a short self-management intervention for patients with asthma and diabetes: Evaluating health-related quality of life using then-test methodology

Despite intensive outpatient care and optimized medical treatment, some patients with chronic illnesses experience prolonged difficulties in the self-management of their illness and fail to attain optimal disease control. The present study describes the effects of an intervention programme aimed at improving self-management and quality of life among patients with asthma and diabetes. The intervention was based on insights from self-regulation theory and proactive coping theory. Patients with asthma (N = 70) and diabetes (N = 55) were randomly assigned to an intervention group or control group (standard care). In addition to a conventional pre-test–post-test–follow-up design, the then-test methodology was employed to examine the effects on quality of life. The present study showed no intervention effects on self-efficacy, self-care activities or proactive coping. The same was true for quality of life when measured with the conventional design. However, positive intervention effects for asthma patients were found on global quality of life and physical health when measured with the then-test procedure. These results accentuate the value of including then-tests when measuring intervention outcomes. Additional subgroup analyses showed that patients who scored relatively high on optimism at baseline, benefited more from the intervention than did patients who scored relatively low on optimism.
How precise is precision medicine for schizophrenia?

Correspondence to Lynn E. DeLisi, MD, Department of Psychiatry, VA In the years we have been compiling these annual reviews on the latest issues discussed about schizophrenia, various publicized buzz words have come and gone.This year the most popular termseems tobe ‘precision medicine’ [1], that is, individualizing treatment of patients suffering from heterogeneous disorders, such as cancer, obesity, and neurological disorders, employing different biological markers that can serve as targets for specific medicines. Precision medicine is the belief that ‘one medication’ is not likely to help all, despite treatment trials that show it is effective in patient groups as a whole. The field of ‘precision medicine’ could also be broadened to include prediction of future illness and of outcome over the course of the disease. Practicing precision medicine would allow us to make use of the ever advancing fields of genetics and brain imaging to develop markers for therapeutic targets and to treat patients individually based on specific targets rather than ill-defined disease entities. US President Obama, in early January of 2015, announced The National Institutes of Health Precision Medicine Initiative [2]. This would strengthen efforts to use ‘big data’ (very large datasets) for extrapolating to individualized care in the clinic and to develop methods to ensure reproducibility of such data [3]. Reaching the ultimate goals of precision medicine will also require discussions of the ethical issues involved in integrating and sharing big data from populations of study participants [4,5]. There is even a new journal for peer review publications on this topic named the Journal of Precision Medicine, which has free Internet access. Publications on the use of the principles of precision medicine in neuropsychiatry are already available [6,7], also focusing on schizophrenia [8]. They describe the need to focus on determining the level of risk, on the early pathophysiological mechanisms responsible for illness, and their combination with patient-specific molecular underpinnings of the disease, the goal being to provide personalized and individually centered treatments.
Epidemiology of eating disorders in Africa

Purpose of review This is the first review of studies on the epidemiology of eating disorders on the African continent. Recent findings The majority of articles found through our search did not assess formal diagnoses, but only screened for eating attitudes and behaviors. Only four studies – including only one recent study – provided specific epidemiological data on anorexia nervosa, bulimia nervosa, and/or eating disorder not otherwise specified (EDNOS). No cases of anorexia nervosa according to Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria were found among a total of 1476 (young) females. The combined point-prevalence rate of bulimia nervosa is 0.87% (95% CI 0.22–1.51) and of EDNOS is 4.45% (95% CI 2.74–6.16) in young women in Africa. Summary The epidemiological study of eating disorders in Africa is still in its infancy. Over time in total four studies providing epidemiological data on specific, formally assessed eating disorders were found. No cases of anorexia nervosa were reported in African epidemiological studies, which concurs with the very low prevalence rates of anorexia nervosa in Latin Americans and in African Americans in the USA. With the DSM-5 criteria for anorexia nervosa, some women in the African studies would have fulfilled the criteria for anorexia nervosa. The prevalence rate of bulimia nervosa in women in Africa is within the range reported for western populations, as well as African Americans and Latin Americans.
HYPOTHERMIA FOR CARDIOVASCULAR SURGERY: ACIDOSIS IN REWARMING PERIOD

A report has been made of a series of cases in which severe metabolic acidosis arose, during the rewarming period following hypothermia for cardiac surgery. A further series is reported, showing that this syndrome is not encountered when care is taken to avoid (a) shivering, (b) peripheral vasoconstriction, (c) respiratory alkalosis during cooling and operation, and (d) when spontaneous respiration is established at the earliest opportunity, postoperatively. The differential diagnosis of the causes of severe acidosis in the rewarming period and the treatment of the acute acidotic syndrome are discussed.
Late pulmonary sequelae after treatment of childhood cancer

Objective â€“ Increasingly successful treatment of childhood cancer during the last decades, resulting in a number of long term survivors, has made it possible to study late sequelae of this treatment in sizable cohorts of survivors. The aims were to determine the frequency and severity of pulmonary late sequelae among children treated for cancer to identify treatment risk factors and the methods for continued followup. Materials and methods â€“ In 255 of the 1020 survivors, at least 18 years old, 5 years after treatment, who agreed with the examination protocol, testing was performed at the time of their follow up appointment. It was conducted 5 to 37 (mean 18) years after diagnosis. The examinations included physical examination, chest radiograms and pulmonary function testing. Results â€“ Radiograms revealed 79 abnormalities in 53 patients and were most frequently found in patients with Hodgkinâ€™s disease (20/67) or non-Hodgkinâ€™s lymphoma treated with mediastinal radiotherapy (RT) (10/31), in patients with brain tumor treated with RT to the central nervous axis (CNA) (7/15), in Wilmsâ€™ tumor patients, who had abdominal RT, scoliosis was found. (6/15). Lung function tests showed abnormal values, mostly restrictive changes, in 59 of 237 patients. Conclusion â€“ Late pulmonary sequelae after treatment of childhood cancer are rare serious or life-threatening complications. Radiographic and pulmonary function abnormalities were most frequently found in patients who had mediastinal or CNA RT. Regular follow-up of these patients is therefore recommended. Spirometry has been a useful test for detection of pulmonary sequelae. Routinely follow-up radiography is always indicated in clinical suspicion of secondary tumors.