Miracle-dz/UniFAR-FTUs huggingface dataset:
Poor outcomes after surgery for coarctation repair with hypoplastic arch warrants more extensive initial surgery and close long-term follow-up.

OBJECTIVES Late outcomes of repair of coarctation with arch hypoplasia have not yet been described. Hypertension and arch reobstruction frequently occur after standard coarctation repair and thus we sought to determine the long-term results of repair in the subset of patients with arch hypoplasia at a single institution over a 20-year period. METHODS We reviewed the files of the 305 consecutive patients quoted to have arch hypoplasia who had undergone a coarctation repair in a single institution between 1984 and 2004. Repair was performed through a sternotomy in 74 patients (24%), 58 of them undergoing a repair consisting of an end-to-side anastomosis. RESULTS Early mortality was 9% but there was only 1 death among patients without a major associated anomaly. Eight patients required reintervention before discharge due to residual obstruction. The follow-up was available in 96% of the patients. Only 45% of the patients over 15 years of age had cardiology review in the last 2 years. Survival at 10 and 20 years was 94% (95% CI: 91-97%) and 92% (95% CI: 86-95%), respectively. There were a total of 66 late reinterventions in 49 (18%) patients. Ten- and 20-year freedom from reintervention was 84% (95% CI: 78-88%) and 72% (95% CI: 63-80%), respectively. Ten- and 20-year freedom from reobstruction was 75% (95% CI: 69-80%) and 45% (95% CI: 34-55%), respectively. Patients undergoing end-to-side repair from sternotomy had less arch reobstruction than those undergoing extended end-to-end repair by thoracotomy (92 vs 61% freedom from reobstruction at 10 years, P < 0.001). Only 68% of the patients were normotensive at the last follow-up. Arch obstruction on echocardiogram was associated with an increased prevalence of hypertension (P = 0.018). CONCLUSIONS After coarctation repair, half of the patients with hypoplasia of the transverse arch will develop arch reobstruction and a third will become hypertensive. The technique of end-to-side repair performed through a sternotomy seems to alleviate these issues, and could be offered to a larger proportion of patients with hypoplasia of the aortic arch. Many of these patients are lost to follow-up during adolescence, at a time when ongoing care seems mandatory.
Seizure‐related modulation of systemic arterial blood pressure in focal epilepsy

Cardiorespiratory function alterations are commonly observed with epileptic seizures and may lead to syncope and sudden unexpected death in epilepsy (SUDEP). Although most previous research has focused on controlling heart rate (HR) and respiration, little is known about seizure‐related regulation of systemic blood pressure (BP). Herein, we have investigated whether the periictal modulation of systemic BP and HR depends on seizure characteristics.
Intensive Treatment and Severe Hypoglycemia Among Adults With Type 2 Diabetes.

IMPORTANCE Intensive glucose-lowering treatment among patients with non-insulin-requiring type 2 diabetes may increase the risk of hypoglycemia. OBJECTIVES To estimate the prevalence of intensive treatment and the association between intensive treatment, clinical complexity, and incidence of severe hypoglycemia among adults with type 2 diabetes who are not using insulin. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of administrative, pharmacy, and laboratory data from the OptumLabs Data Warehouse from January 1, 2001, through December 31, 2013. The study included nonpregnant adults 18 years or older with type 2 diabetes who achieved and maintained a hemoglobin A1c (HbA1c) level less than 7.0% without use of insulin and had no episodes of severe hypoglycemia or hyperglycemia in the prior 12 months. MAIN OUTCOMES AND MEASURES Risk-adjusted probability of intensive treatment and incident severe hypoglycemia, stratified by patient clinical complexity. Intensive treatment was defined as use of more glucose-lowering medications than recommended by practice guidelines at specific index HbA1c levels. Severe hypoglycemia was ascertained by ambulatory, emergency department, and hospital claims for hypoglycemia during the 2 years after the index HbA1c test. Patients were categorized as having high vs low clinical complexity if they were 75 years or older, had dementia or end-stage renal disease, or had 3 or more serious chronic conditions. RESULTS Of 31 542 eligible patients (median age, 58 years; interquartile range, 51-65 years; 15 483 women [49.1%]; 18 188 white [57.7%]), 3910 (12.4%) had clinical complexity. The risk-adjusted probability of intensive treatment was 25.7% (95% CI, 25.1%-26.2%) in patients with low clinical complexity and 20.8% (95% CI, 19.4%-22.2%) in patients with high clinical complexity. In patients with low clinical complexity, the risk-adjusted probability of severe hypoglycemia during the subsequent 2 years was 1.02% (95% CI, 0.87%-1.17%) with standard treatment and 1.30% (95% CI, 0.98%-1.62%) with intensive treatment (absolute difference, 0.28%; 95% CI, -0.10% to 0.66%). In patients with high clinical complexity, intensive treatment significantly increased the risk-adjusted probability of severe hypoglycemia from 1.74% (95% CI, 1.28%-2.20%) with standard treatment to 3.04% (95% CI, 1.91%-4.18%) with intensive treatment (absolute difference, 1.30%; 95% CI, 0.10%-2.50%). CONCLUSIONS AND RELEVANCE More than 20% of patients with type 2 diabetes received intensive treatment that may be unnecessary. Among patients with high clinical complexity, intensive treatment nearly doubles the risk of severe hypoglycemia.
WORKLOAD, NECK AND UPPER LIMB PAIN IN SALVADOR’S POPULATION, BAHIA, BRAZIL

Objectives : To describe the populational profile of adults affected by neck and upper limb pain (NULP) and to relate the characteristics of this type of pain with the predominantly physical, psychic and mixed workloads. Methods: A cross-sectional study was conducted in a sample of 2,297 individuals of > 20 years old, in Salvador-Brazil. A standardized questionnaire was applied to collect data about socio-demographic characteristics. Workers were grouped according to predominantly physical, psychic and mixed workloads, and associations were verified against the characteristics of those affected in comparison to individuals without reports of pain in the neck and upper limbs. The prevalence of pain was estimated by the OR adjusted (95% CI). Univariate analyses and logistic regression were performed. Results: NULP was found in 222 individuals (9.47%), and predominated in women and widowers exposed to physical workloads; moderate alcohol consumption was the protector in this occupational condition; for psychic workloads, being a woman and belonging to high social class appeared to be associated with the presence of pain in the region; for mixed workloads, being single appeared as a factor with less chance of association with NULP. Conclusion: NULP presents high populational prevalence, and workloads can influence such conditions. Being a woman or widow exposed to physical loads increase the risk of having NULP; When the worloads are psychic, the same occurs to women and people at higher social levels. Moderate use of alcohol was associated with less chance of NULP for physical load and being single, for mixed load.
A feasibility trial of an Internet‐delivered and transdiagnostic cognitive behavioral therapy treatment program for anxiety, depression, and disability among adults with epilepsy

Anxiety and depression are highly prevalent in people with epilepsy (PWE) and contribute to increased disability. Unfortunately, there are numerous barriers (e.g., cost, distance, and stigma) and service gaps (e.g., lack of services and trained clinicians) that prevent many PWE from accessing traditional face‐to‐face psychological services. The aim of the present study was to examine the feasibility of a new transdiagnostic Internet‐delivered cognitive behavioral therapy (iCBT) program, the Chronic Conditions Course, to simultaneously treat symptoms of anxiety, depression, and disability.
Regulatory review of novel therapeutics--comparison of three regulatory agencies.

BACKGROUND The upcoming reauthorization of the Prescription Drug User Fee Act focuses on improving the review process for new drug applications at the Food and Drug Administration (FDA). METHODS Using publicly available information from the FDA, the European Medicines Agency (EMA), and Health Canada, we compared the time for completion of the first review and the total review time for all applications involving novel therapeutic agents approved by the three regulatory agencies from 2001 through 2010 and determined the geographic area in which each novel therapeutic agent was first approved for use. RESULTS There were 510 applications for novel therapeutic agents approved from 2001 through 2010--225 by the FDA, 186 by the EMA, and 99 by Health Canada; among the applications, there were 289 unique agents. The median length of time for completion of the first review was 303 days (interquartile range, 185 to 372) for applications approved by the FDA, 366 days (interquartile range, 310 to 445) for those approved by the EMA, and 352 days (interquartile range, 255 to 420) for those approved by Health Canada (P<0.001 for the comparison across the three agencies). The median total review time was also shorter at the FDA than at the EMA or Health Canada (P=0.002). Among the 289 unique novel therapeutic agents, 190 were approved in both the United States and Europe (either by the EMA or through the mutual recognition process), of which 121 (63.7%) were first approved in the United States; similarly, 154 were approved in both the United States and Canada, of which 132 (85.7%) were first approved in the United States. CONCLUSIONS For novel therapeutic agents approved between 2001 and 2010, the FDA reviewed applications involving novel therapeutics more quickly, on average, than did the EMA or Health Canada, and the vast majority of these new therapeutic agents were first approved for use in the United States. (Funded by the Pew Charitable Trusts.).
Stable haemodynamics associated with no significant electrocardiogram abnormalities is a good prognostic factor of survival for acute type A aortic dissection repair.

OBJECTIVES Acute type A aortic dissection (AAD) is a medical emergency with high mortality even with emergency repair. We explored the prognostic factors of in-hospital mortality for AAD repair. METHODS One hundred and thirty-three consecutive patients operated on for AAD between 1997 and 2011 were enrolled in our study. They were assigned to the in-hospital mortality or the survival group. We evaluated 101 variables to predict in-hospital mortality. All data were collected retrospectively. RESULTS The 30-day mortality, including intraoperative deaths, was 12.8% (17/133 patients) and in-hospital mortality was 18.0% (24/133). Univariate analysis disclosed 10 significant prognostic factors. Multivariate analysis confirmed that preoperative shock or hypotension (odds ratio (OR) = 4.71; P = 0.004), an initial 24 h of bleeding >1500 ml (OR = 5.17; P = 0.01) and age ≥ 75 years (OR = 3.70; P = 0.019) were independent prognostic factors of in-hospital mortality. On the contrary, an electrocardiogram (ECG) showing no abnormalities (OR = 0.22; P = 0.008) is a good prognostic factor for survival. Interestingly, patients with stable haemodynamics without abnormal ECG findings had an excellent result of 1.6% (1/63) in-hospital mortality. CONCLUSIONS Stable haemodynamics and no significant abnormal ECG findings predicted excellent in-hospital survival. Cardiac surgeons and cardiologists should be aware of these positive predictors when treating patients diagnosed with AAD.
Surgical treatment of polymicrogyria‐related epilepsy

The role of resective surgery in the treatment of polymicrogyria (PMG)–related focal epilepsy is uncertain. Our aim was to retrospectively evaluate the seizure outcome in a consecutive series of patients with PMG‐related epilepsy who received, or did not receive, surgical treatment, and to outline the clinical characteristics of patients who underwent surgery.
Omega-3 polyunsaturated fatty acid biomarkers and coronary heart disease: pooling project of 19 cohort studies

IMPORTANCE— The role of ω -3 polyunsaturated fatty acids for primary prevention of coronary heart disease (CHD) remains controversial. Most prior longitudinal studies evaluated self-reported consumption rather than biomarkers. OBJECTIVE— To evaluate biomarkers of seafood-derived eicosapentaenoic acid (EPA; 20:5 ω -3), docosapentaenoic acid (DPA; 22:5 ω -3), and docosahexaenoic acid (DHA; 22:6 ω -3) and plant-derived α -linolenic acid (ALA; 18:3 ω -3) for incident CHD. DATA SOURCES— A global consortium of based on defined strata, including age (<60 or ≥60years), sex (male or female), race/ethnicity (white, black, Hispanic, or Chinese), LA and AA biomarker concentrations (less than or greater than or equal to the median value in each study), type 2 diabetes (yes or no), statin use (yes or no), regular aspirin use (yes or no), year of biomarker sampling (before 2000 or 2000 or later), and (for ALA) EPA, DPA, and DHA biomarker concentration (less than or greater than or equal to the median value in each study). Effect estimates in each study-specific strata were pooled, and the statistical significance of differences between subgroups of potential sources of heterogeneity was assessed using meta-regression. Inameta-analysis 13 of 7 studies with available genetic data, we also examined potential interaction by variants in FADS (OMIM208150) desaturase genes (rs174546, rs968567), pooling study-specific estimates using an additive genetic model (eMethods in the Supplement). Within each study, interaction terms for each single-nucleotide polymorphism (SNP) were constructed as across-product term of the ω -3 PUFA biomarker (continuous) by the SNP (ordinal: 0,1, or 2 T alleles), including the main effects in the model; these interaction terms were pooled using meta-analysis. AA levels, year of biomarker sampling, presence or absence of diabetes, statin use, and aspirin use. By contrast, effect modification by ethnicity was observed for select exposure-outcome pairings. Separate analyses by biomarker compartment provided further insights, with generally stronger inverse associations in phospholipids and total plasma for EPA, DPA, and DHA. This investigation provides the most comprehensive estimates to date of the associations between seafood and plant-based ω -3 PUFAs, assessed using biomarkers, and primary incidence of CHD in generally healthy, free-living populations around the world. In randomized clinical trials, long-chain ω -3 PUFAs benefit multiple major cardiovascular risk factors, including triglyceride levels, blood pressure, heart rate, heart rate variability, endothelial function, and myocardial oxygen demand. 1,10 Compared with many other single nutrients, these demonstrated physiologic benefits provide strong biologic plausibility to support an effect on clinical events. Both EPA and DHA are also precursors to bioactive lipid metabolites, including specialized proresolving mediators 36 and cytochrome P450– generated monoepoxides, 37 that could contribute to lower CHD risk. Our findings are
National trends in patient safety for four common conditions, 2005-2011.

BACKGROUND Changes in adverse-event rates among Medicare patients with common medical conditions and conditions requiring surgery remain largely unknown. METHODS We used Medicare Patient Safety Monitoring System data abstracted from medical records on 21 adverse events in patients hospitalized in the United States between 2005 and 2011 for acute myocardial infarction, congestive heart failure, pneumonia, or conditions requiring surgery. We estimated trends in the rate of occurrence of adverse events for which patients were at risk, the proportion of patients with one or more adverse events, and the number of adverse events per 1000 hospitalizations. RESULTS The study included 61,523 patients hospitalized for acute myocardial infarction (19%), congestive heart failure (25%), pneumonia (30%), and conditions requiring surgery (27%). From 2005 through 2011, among patients with acute myocardial infarction, the rate of occurrence of adverse events declined from 5.0% to 3.7% (difference, 1.3 percentage points; 95% confidence interval [CI], 0.7 to 1.9), the proportion of patients with one or more adverse events declined from 26.0% to 19.4% (difference, 6.6 percentage points; 95% CI, 3.3 to 10.2), and the number of adverse events per 1000 hospitalizations declined from 401.9 to 262.2 (difference, 139.7; 95% CI, 90.6 to 189.0). Among patients with congestive heart failure, the rate of occurrence of adverse events declined from 3.7% to 2.7% (difference, 1.0 percentage points; 95% CI, 0.5 to 1.4), the proportion of patients with one or more adverse events declined from 17.5% to 14.2% (difference, 3.3 percentage points; 95% CI, 1.0 to 5.5), and the number of adverse events per 1000 hospitalizations declined from 235.2 to 166.9 (difference, 68.3; 95% CI, 39.9 to 96.7). Patients with pneumonia and those with conditions requiring surgery had no significant declines in adverse-event rates. CONCLUSIONS From 2005 through 2011, adverse-event rates declined substantially among patients hospitalized for acute myocardial infarction or congestive heart failure but not among those hospitalized for pneumonia or conditions requiring surgery. (Funded by the Agency for Healthcare Research and Quality and others.).
Prevalence of HIV in Blood donors in NWFP

At blood bank PGMI, LRH Peshawar a study was done on 23278 blood donars ragarding their HIV screening the blood donars incldued were form different areas of NWFP. All of them were healthy and were between the age group; of 18 - 60 years. They included both male and female sexes. They were from different communities among 23378 blood donors only 2 donors were positive for HIV. Both the positive donors were male.
Remission in epilepsy: How long is enough?

The International League Against Epilepsy (ILAE) has proposed to expand the definition of remission to 10 years seizure‐free with the last 5 years off antiepileptic drugs (AEDs). We examined if a 10‐year remission is needed to predict the lowest recurrence risk.
Reducing the gap between the school and university mathematics: university lecturers' perspective

This paper deals with a very practical issue. In many countries there is a gap between school and university mathematics. The transition period from school to university can be hard for many students. Even students with good marks in school mathematics experience psychological difficulties at university and sometimes fail the first year university mathematics courses. Often the pass rate in the first year university mathematics is around 50%. Different parties – school teachers, university lecturers, first year university students, administrators, researchers – might have different views on the reasons for the gap and the ways to narrow or fill it. The purpose of this paper is to present responses of university lecturers worldwide to a short survey concerning the transition period between the school and university mathematics.
Azithromycin for Acute Exacerbations of Asthma : The AZALEA Randomized Clinical Trial.

Importance Guidelines recommend against antibiotic use to treat asthma attacks. A study with telithromycin reported benefit, but adverse reactions limit its use. Objective To determine whether azithromycin added to standard care for asthma attacks in adults results in clinical benefit. Design, Setting, and Participants The Azithromycin Against Placebo in Exacerbations of Asthma (AZALEA) randomized, double-blind, placebo-controlled clinical trial, a United Kingdom-based multicenter study in adults requesting emergency care for acute asthma exacerbations, ran from September 2011 to April 2014. Adults with a history of asthma for more than 6 months were recruited within 48 hours of presentation to medical care with an acute deterioration in asthma control requiring a course of oral and/or systemic corticosteroids. Interventions Azithromycin 500 mg daily or matched placebo for 3 days. Main Outcomes and Measures The primary outcome was diary card symptom score 10 days after randomization, with a hypothesized treatment effect size of -0.3. Secondary outcomes were diary card symptom score, quality-of-life questionnaires, and lung function changes, all between exacerbation and day 10, and time to a 50% reduction in symptom score. Results Of 4582 patients screened at 31 centers, 199 of a planned 380 were randomized within 48 hours of presentation. The major reason for nonrecruitment was receipt of antibiotics (2044 [44.6%] screened patients). Median time from presentation to drug administration was 22 hours (interquartile range, 14-28 hours). Exacerbation characteristics were well balanced across treatment arms and centers. The primary outcome asthma symptom scores were mean (SD), 4.14 (1.38) at exacerbation and 2.09 (1.71) at 10 days for the azithromycin group and 4.18 (1.48) and 2.20 (1.51) for the placebo group, respectively. Using multilevel modeling, there was no significant difference in symptom scores between azithromycin and placebo at day 10 (difference, -0.166; 95% CI, -0.670 to 0.337), nor on any day between exacerbation and day 10. No significant between-group differences were observed in quality-of-life questionnaires or lung function between exacerbation and day 10, or in time to 50% reduction in symptom score. Conclusions and Relevance In this randomized population, azithromycin treatment resulted in no statistically or clinically significant benefit. For each patient randomized, more than 10 were excluded because they had already received antibiotics. Trial Registration clinicaltrials.gov Identifier: NCT01444469.
Journeys into Teaching: Pathways Created by Overseas-Trained Teachers into a Career Secondary School Teaching in New Zealand

New Zealand-trained teachers have good reasons to teach abroad, change careers or retire and there are sound reasons to hire overseas-trained teachers (OTTs) to fill vacancies. Securing work in a new country can be difficult and it makes social and economic sense to facilitate this process. This thesis reports on the journeys of six OTTs documenting the individual pathways navigated; from teaching in their country of origin to securing a permanent placement as a secondary school teacher in New Zealand. This study explores the pathways OTTs navigated in order to teach in New Zealand. It investigates the challenges they faced, the supports they encountered and the suggestions they had to offer others in a similar situation. The participants were OTTs at secondary schools in the Wellington region of New Zealand and most had emigrated from the United Kingdom. Participants taught different subjects and had varying lengths of teaching experience. They had immigrated to and successfully found a post in New Zealand between January 2006 and January 2012. The interpretive paradigm was used as the theoretical grounding for this research as this places importance on the subjective experiences of those interviewed. Qualitative data were collected using semi-structured interviews as part of a collective, case study design. A thematic approach to data analysis was used and the data were compared and contrasted under the themes of challenges, supports and suggestions. Findings that concurred with previous research were that OTTs faced challenges from bureaucracy, culture shock and financial stress; and that networking, professional development, luck and maintaining a positive attitude were supportive. Participants suggested preparation, networking, interagency co-operation, a positive attitude and relief teaching could assist other OTTs. The findings were used to formulate a suggested pathway that might facilitate the journeys of future OTTs.