Miracle-dz/UniFAR-FTUs huggingface dataset:
Health-related educational inequalities in paid employment across 26 European countries in 2005–2014: repeated cross-sectional study

Objective The study investigates the trends in health-related inequalities in paid employment among men and women in different educational groups in 26 countries in 5 European regions. Design Individual-level analysis of repeated cross-sectional annual data (2005–2014) from the EU Statistics on Income and Living Conditions. Setting 26 European countries in 5 European regions. Participants 1 844 915 individuals aged 30–59 years were selected with information on work status, chronic illness, educational background, age and gender. Outcome measures Absolute differences were expressed by absolute differences in proportion in paid employment between participants with and without a chronic illness, using linear regression. Relative differences were expressed by prevalence ratios in paid employment, using a Cox proportional hazard model. Linear regression was used to examine the trends of inequalities. Results Participants with a chronic illness had consistently lower labour force participation than those without illnesses. Educational inequalities were substantial with absolute differences larger within lower educated (men 21%–35%, women 10%–31%) than within higher educated (men 5%–13%, women 6%–16%). Relative differences showed that low-educated men with a chronic illness were 1.4–1.9 times (women 1.3–1.8 times) more likely to be out of paid employment than low-educated persons without a chronic illness, whereas this was 1.1–1.2 among high-educated men and women. In the Nordic, Anglo-Saxon and Eastern regions, these health-related educational inequalities in paid employment were more pronounced than in the Continental and Southern region. For most regions, absolute health-related educational inequalities in paid employment were generally constant, whereas relative inequalities increased, especially among low-educated persons. Conclusions Men and women with a chronic illness have considerable less access to the labour market than their healthy colleagues, especially among lower educated persons. This exclusion from paid employment will increase health inequalities.
What Do U.K. Orthopedic Surgery Patients Think About PROMs? Evaluating the Evaluation and Explaining Missing Data

The NHS routinely evaluates the quality of life of patients receiving hip or knee replacement surgery using patient-reported outcome measures (PROMs), but some hospital completion rates are only 30%, restricting data usefulness. Statistics limit insights into how and why data are missing, so qualitative methods were used to explore this issue. Observation periods preceded semistructured interviews with 34 preoperative patients attending an orthopedic outpatient clinic. Interview themes covered: completion time/timing, orientation, setting, measures, and practicalities. Triangulated against observations, pragmatic barriers, and facilitators were considered. Refined themes included completion conditions, patient support, and national delivery. Simple improvements (e.g., quiet zone) could improve completion rates and reducing missing data. Reorganizing preoperative leaflets and their systematic distribution via standardized procedures could reassure patients, enhancing PROMs acceptance, while reducing inquiries and subsequent staff burden. Findings have implications for interpreting national statistics. They indicate that further debate about mandating preoperative PROMs is due.
Enhanced Recovery After Surgery protocol implementation was associated with decreased narcotic use, lower maximum pain scores, and expedited return of baseline functions among medically complex gynecologic oncology patients.

OBJECTIVE Enhanced Recovery After Surgery (ERAS) protocols are designed to mitigate the physiologic stress response created by surgery, to decrease the time to resumption of daily activities, and to improve overall recovery. This study aims to investigate postoperative recovery outcomes following gynecologic surgery before and after implementation of an ERAS protocol. METHODS A retrospective chart review was performed of patients undergoing elective laparotomy at a major academic center following implementation of an ERAS protocol (11/4/2014-7/27/2016) with comparison to a historical cohort (6/23/2013-9/30/2014). The primary outcome was length of hospital stay. Secondary outcomes included surgical variables, time to recovery of baseline function, opioid usage, pain scores, and complication rates. Statistical analyses were performed using Wilcoxon rank sum, Fisher's exact, and chi squared tests. RESULTS One hundred and thirty-three women on the ERAS protocol who underwent elective laparotomy were compared with 121 historical controls. There was no difference in length of stay between cohorts (median 4 days; P = 0.71). ERAS participants had lower intraoperative (45 vs 75 oral morphine equivalents; P < 0.0001) and postoperative (45 vs 154 oral morphine equivalents; P < 0.0001) opioid use. ERAS patients reported lower maximum pain scores in the post-anesthesia care unit (three vs six; P < 0.0001) and on postoperative day 1 (four vs six; P = 0.002). There was no statistically significant difference in complication or readmission rates. CONCLUSIONS ERAS protocol implementation was associated with decreased intraoperative and postoperative opioid use and improved pain scores without significant changes in length of stay or complication rates.
Neurourology and Urodynamics

Funding information Pamukkale University Scientific Research Projects Department, Grant/Award Number: 2017TIPF008 Abstract Aims: It has been demonstrated that there are abundant stable microRNAs (miRNAs) in plasma, which is potentially disease‐specific. Adrenergic and muscarinic pathways play an important role in voiding physiology. Alterations in the levels of miRNAs are thought to influence the regulation of these pathways at the molecular level. The aim of this study was to investigate the relationship of miRNAs with overactive bladder pathogenesis and to provide a new perspective to treatment approaches. Methods: This study included patients with an overactive bladder (OAB) diagnosis and a healthy control group. All patients completed a validated OAB‐V8 questionnaire. The relative expression levels of 12 miRNAs were examined in plasma by PCR. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic qualification of miRNAs. Results: The relative expression levels of let‐7b‐5p, miR‐92a‐3p, miR‐98‐5p, miR‐142‐3p, and miR‐200c‐3p were significantly upregulated and miR‐139‐5p was significantly downregulated in patients with OAB and no correlation was determined between the levels of miRNAs with OAB symptom score. Among the miRNAs, miR‐98‐5p provided the highest diagnostic accuracy alone (area under curve [AUC] = 0.79) in ROC analysis. The combination of miR‐98‐ 5p +miR‐139‐5p was seen to be a good indicator (AUC= 0.839). Conclusions: These results suggest that alteration of the miRNA levels can be used as auxiliary parameters to explain the pathophysiology of OAB syndrome and could shed light on new treatment options.
Hypertension in aortic stenosis: relationship with revealed symptoms and functional measures on treadmill exercise.

BACKGROUND The impact of hypertension on symptoms and functional capacity during exercise treadmill test (ETT) in apparently asymptomatic patients with aortic stenosis is poorly understood. METHODS A total of 314 patients (age 65 ± 12 years, 68% men) with moderate or severe asymptomatic aortic stenosis underwent baseline echocardiography and ETT. Hypertension was defined as a history of elevated blood pressure (BP), past or current treatment with antihypertensive agents or a BP at the baseline clinic visit more than 140/90 mmHg. RESULTS There were 229 (73%) patients with hypertension who were older, more likely to have diabetes, hypercholesterolemia and coronary artery disease, larger left atrial diameters, higher left ventricular (LV) mass and a higher proportion of LV hypertrophy than normotensive patients. In a univariate logistic regression analysis hypertension and clinic SBP were not associated with revealed symptoms. In a multivariate logistic regression analysis, lower peak SBP [odds ratio (OR) 1.02;95% confidence interval (CI) 1.00-1.04, P = 0.017] and rapid early rise in heart rate (OR 15.03; 95% CI 6.23-36.24, P < 0.001) were associated with a higher risk of revealed symptoms while the use of antihypertensive treatment was associated with a lower risk of revealed symptoms (OR 0.40; 95% CI 0.18-0.89, P = 0.025), independent of age, obesity, LV ejection fraction and aortic valve area. In a linear regression analysis, after adjustment for age, sex and BMI, hypertension did not retain an association with lower metabolic equivalents (β = -0.06, P = 0.311). CONCLUSION Hypertension in aortic stenosis patients was associated with a high cardiovascular disease burden, but did not interact with symptoms or functional capacity during ETT. Hypertension does not interfere with the clinical interpretation of exercise testing.
Rationale and design of the multicentre randomized trial investigating the efficacy and safety of pulsed infusions of levosimendan in outpatients with advanced heart failure (LevoRep study)

Advanced chronic heart failure (CHF) is a clinical syndrome with high morbidity and mortality that often requires inotropic support for the alleviation of symptoms and congestion. There are no definite evidence‐based data on the safety and efficacy of intermittent infusions of inotropic agents in this severe clinical condition. The purpose of the LevoRep study is to clarify whether pulsed infusions of the new inotropic agent levosimendan administered in an outpatient setting can safely improve exercise capacity, quality‐of–life (QoL), and outcome in advanced CHF patients.
The role of the cerebellum in adaptation: ALE meta‐analyses on sensory feedback error

It is widely accepted that unexpected sensory consequences of self‐action engage the cerebellum. However, we currently lack consensus on where in the cerebellum, we find fine‐grained differentiation to unexpected sensory feedback. This may result from methodological diversity in task‐based human neuroimaging studies that experimentally alter the quality of self‐generated sensory feedback. We gathered existing studies that manipulated sensory feedback using a variety of methodological approaches and performed activation likelihood estimation (ALE) meta‐analyses. Only half of these studies reported cerebellar activation with considerable variation in spatial location. Consequently, ALE analyses did not reveal significantly increased likelihood of activation in the cerebellum despite the broad scientific consensus of the cerebellum's involvement. In light of the high degree of methodological variability in published studies, we tested for statistical dependence between methodological factors that varied across the published studies. Experiments that elicited an adaptive response to continuously altered sensory feedback more frequently reported activation in the cerebellum than those experiments that did not induce adaptation. These findings may explain the surprisingly low rate of significant cerebellar activation across brain imaging studies investigating unexpected sensory feedback. Furthermore, limitations of functional magnetic resonance imaging to probe the cerebellum could play a role as climbing fiber activity associated with feedback error processing may not be captured by it. We provide methodological recommendations that may guide future studies.
Getting It Right First Time: the national survey of surgical site infection rates in NHS trusts in England.

INTRODUCTION Surgical site infections are associated with increased morbidity and mortality in patients. The Getting It Right First Time surgical site infection programme set up a national survey to review surgical site infection rates in surgical units in England. The objectives were for frontline clinicians to assess the rates of infection following selected procedures, to examine the risk of significant complications and to review current practice in the prevention of surgical site infection. METHODS A national survey was launched in April 2017 to assess surgical site infections within 13 specialties: breast surgery, cardiothoracic surgery, cranial neurosurgery, ear, nose and throat surgery, general surgery, obstetrics and gynaecology, ophthalmology, oral and maxillofacial surgery, orthopaedic surgery, paediatric surgery, spinal surgery, urology and vascular surgery. All participating trusts prospectively identified and collected supporting information on surgical site infections diagnosed within the six-month study period. RESULTS Data were received from 95 NHS trusts. A total of 1807 surgical site infection cases were reported. There were variations in rates reported by trusts across specialties and procedures. Reoperations were reported in 36.2% of all identified cases, and surgical site infections are associated with a delayed discharge rate of 34.1% in our survey. CONCLUSION The Getting It Right First Time surgical site infection programme has introduced a different approach to infection surveillance in England. Results of the survey has demonstrated variation in surgical site infection rates among surgical units, raised the importance in addressing these issues for better patient outcomes and to reduce the financial burden on the NHS. Much work remains to be done to improve surgical site infection surveillance across surgical units and trusts in England.
The usability of six physical performance tasks in a rehabilitation population with chronic low back pain

Objective: To examine the influence of task experience on the difference between test and retest and to assess test-retest reliability and limits of agreement of six performance tasks in chronic low back pain patients. These measures will be used to define the clinical usability. Design: Test-retest of six performance tasks in a group of patients with no experience and a group of patients after previous experience with these tasks. Setting: Three rehabilitation centres. Subjects: Fifty-three patients with non-specific chronic low back pain. Main measures: Five-minute walking, 50-ft (15 m) fast walking, sit-to-stand, loaded forward reach, 1-min stair-climbing and Progressive Isoinertial Lifting Evaluation (PILE). To assess the influence of task experience, differences between test and retest between both groups were tested using Mann-Whitney test. For both groups together, intraclass correlation coefficients (ICCs) and the limits of agreement using Bland and Altman plots were calculated. Results: Thirty patients with no task experience and 23 patients who had already undertaken the tasks on at least two occasions participated. Both groups showed similar differences between test and retest. The test-retest reliability for the total study population was good to very high: ICC varied from 0.74 to 0.99. For the total study population, the limits of agreement expressed as percentage of the mean score of each task was low to moderate for 5-min walking and 1-min stair-climbing (21% and 20% respectively), moderate for 50-ft (15 m) fast walking, sit-to-stand and forward reach (33%, 29% and 36% respectively) and high for the PILE (48%). Conclusions: Task experience did not significantly influence test-retest differences. All tasks showed sufficient test-retest reliability. Based on the natural variability of the tasks, the 5-min walking and stair-climbing task, and to a lesser degree the 50-ft (15 m) walking, sit-to-stand and loaded forward reach, seem clinically useful. There are major concerns about the usability of the PILE.
Preservation of categorical perception for speech in autism with and without speech onset delay

Recent accounts of autistic perception, including Bayesian accounts, hypothesize a reduced influence of prior knowledge on perception across different domains in the autism spectrum (AS). The purpose of this study was to investigate the influence of prior linguistic knowledge, in the form of phonemic categorical knowledge, on speech perception in adults with AS condition. As phonemic categorical knowledge is shaped by language experience and abilities, we furthermore distinguished AS participants with (AS‐SOD) or without a history of speech onset delay (AS‐noSOD); the control group comprises typical individuals matched for age, nonverbal intelligence, and reading abilities. We also controlled for the influence of auditory‐verbal short‐term retention capacities by administering word list and nonword list repetition tasks. We did not observe any reduced influence of prior phonemic knowledge on the perception of speech stimuli nor did we observed any increased perceptual abilities for atypical variants of speech stimuli or nonspeech auditory stimuli, either between the two autistic groups or relative to the control group. Short‐term memory abilities appeared to be superior in the AS‐noSOD group relative to the AS‐SOD and control groups, but this strength could be accounted for by their higher vocabulary knowledge. The preservation of categorical perception in verbal autistic adults observed in this study challenges models claiming a reduced influence of prior knowledge on perception across domains in the AS. Autism Res 2019. © 2019 International Society for Autism Research, Wiley Periodicals, Inc.
Electrochemotherapy for large cutaneous recurrence of breast cancer: A phase II clinical trial

Abstract Background. Cutaneous recurrences of breast cancer may cause considerable discomfort due to ulceration, oozing, and pain and can also be difficult to treat. Electrochemotherapy is a localised anticancer treatment using electric pulses to make cell membranes permeable, augmenting uptake of chemotherapeutic drugs, and thus enabling highly efficient tumour cell kill. This is the first systematic investigation of electrochemotherapy for larger cutaneous recurrences of breast cancer. Patients and methods. We conducted a phase II trial for patients with cutaneous recurrences where no further treatment options were available. Primary endpoint was objective response evaluated by clinical examination. Secondary endpoints included response evaluated by PET/CT, change in lung diffusion capacity, patient reported symptoms, and distress related to bodily appearance. Treatment consisted of bleomycin injection followed by application of electric pulses. Results. Seventeen heavily pre-treated patients received electrochemotherapy. Twelve patients were evaluable (follow-up > 8 weeks). CT showed four (33%) patients achieving over 50% tumour volume reduction, clinical examination showed one CR and one PR (OR 17%). Symptomatic relief included decreasing exudates, odour, and bleeding. Treatment was well tolerated; the main side effect was post-treatment pain. Conclusion. This first phase II study indicates that electrochemotherapy is a promising treatment alternative for cutaneous recurrences of breast cancer.
Coupled flap and edge wise blade motion due to a quadratic wind force definition

The wind force on turbine blades, consisting of a drag and lift component, depends nonlinearly on the relative wind velocity. This relative velocity comprises mean wind speed, wind speed fluctuations and the structural response velocity. The nonlinear wind excitation couples the flap wise and edge wise response of a turbine blade. To analyze this motion coupling, an isolated blade is modelled as a continuous cantilever beam and corresponding nonlinear expressions for the drag and lift force are defined. After reduction of the model on the basis of its principal modes, the nonlinear response up to the second order is derived with the help of a Volterra series expansion and the harmonic probing technique. This technique allows for response analysis in the frequency domain, via which the combined flap and edge wise responses can easily be visualized. As a specific case, the characteristics of the NREL5 turbine blades are adopted. For both non-operating and operating conditions, blade responses in a turbulent wave field, based on a Kaimal spectrum, are determined. The second-order responses are shown to cause additional motion coupling, and moreover, are proven not to be negligible straightforwardly.
Delayed Onset Muscle Soreness and Topical Analgesic Alter Corticospinal Excitability of the Biceps Brachii.

INTRODUCTION The interactive effect of delayed onset muscle soreness (DOMS) and a topical analgesic on corticospinal excitability was investigated. METHODS Thirty-two participants completed Experiments A (No DOMS) and B (DOMS). For each experiment participants were randomly assigned to two groups: 1) topical analgesic gel (Topical Analgesic, n=8), or 2) placebo gel (Placebo, n=8) group. Prior to the application of gel (pre-gel), as well as 5, 15, 30, and 45 min post-gel, motor evoked potential (MEP) area, latency, and silent period, as well as cervicomedullary MEP (CMEP) and maximal compound motor unit action potential (Mmax) areas and latencies were measured. In addition, pressure-pain threshold (PPT) was measured pre-DOMS and at the same time points in Experiment B. RESULTS In Experiment A, neither group showed a significant change for any outcome measure. In Experiment B, both groups exhibited a significant decrease in PPT from pre-DOMS to pre-gel. Following the application of topical analgesic, but not placebo, there was a significant increase in PPT at 45 min post-gel, respectively compared to pre-gel and a main effect of time for the silent period to increase compared to pre-gel. Participants with DOMS had reduced MEP and CMEP areas, and increased corticospinal silent periods compared to those who did not have DOMS. CONCLUSION These findings suggest that DOMS reduced corticospinal excitability and following the administration of menthol-based topical analgesic there was a reduction in pain, which was accompanied by increased corticospinal inhibition.
A Position Paper on IgM-Enriched Intravenous Immunoglobulin Adjunctive Therapy in Severe Acute Bacterial Infections: The TO-PIRO SCORE Proposal.

IgM-enriched immunoglobulins (IgM) may be useful in patients with severe acute bacterial infections. The evidence for the administration of IgM is not extensive and a definitive consensus has never been reached on its best use in patients with acute infections as well as in critically ill patients. However, the official indication in several countries, including Italy, is quite wide and mainly refers to supportive treatment of patients with acute severe bacterial infections. A multidisciplinary meeting of Italian Experts in Infectious Diseases, Anesthesia and Critical Care, Pneumology, Microbiology and Oncohaematology aimed to produce a statement on the best practical methodological score that could improve the use of IgM in patients with different infections, variable severity of disease and etiology. The Expert Panel reviewed the literature and the available guidelines, discussed the experience and eventually proposed to adapt the PIRO score to the practical methodological needs of a simple tool that could guide the administration of IgM.