Miracle-dz/UniFAR-FTUs huggingface dataset:
Insight and other predictors of physical examination refusal in psychotic illness

Background. Poor physical health in psychiatric patients is well recognized, yet factors contributing to physical examination noncompliance in psychotic illness have not been previously studied. Aim. To examine whether insight or any other variables were independent predictors of physical examination noncompliance. Method. A case-note study (N = 200) of inpatient psychiatric patients in four hospitals in London, UK was conducted to examine the relationship between insight and physical examination noncompliance within 24 h of admission and over 2 weeks. Clinical variables including illness severity were also examined. Results. Patients who were noncompliant with physical examinations offered within 24 h and over 2 weeks were associated with lack of insight, higher illness severity, female gender, longer history of illness, current compulsory admission, and previous history of detention. After adjusting for confounding factors, lack of insight, female gender, and previous history of detention were found to be independent predictors of physical examination noncompliance for 24 h and 2 weeks. Conclusion. Lack of insight is highly predictive of physical examination noncompliance for up to 2 weeks, indicating that mental incapacity to consenting to medical care may be common and that more proactive physical screening may be required for these patients.
The effects of acetylcholine and dopamine on carotid chemosensory activity in the rabbit.

1. Intracarotid (I.C.) injection of either acetylcholine (ACh) or dopamine inhibited spontaneous chemosensory activity recorded from the peripheral cut end of the sinus nerve in the anaesthetized rabbit. 2. High doses of ACh (greater than or equal to 50 micrograms I.C.) evoked a slight increase in discharge which preceded the inhibition. This excitation was attributable to a nicotinic action of the drug since it was abolished by mecamylamine. 3. The muscarinic agonist bethanechol inhibited chemoreceptor activity, an effect which was blocked by high doses of atropine, as was the inhibition caused by ACh. Dopamine‐induced inhibition was unaffected by atropine. 4. Atropine, in doses sufficient to abolish the vasodepressor effect of ACh, only slightly reduced the inhibitory action of ACh on the chemoreceptors. Also, the vasodilators sodium nitrite and sodium nitroprusside did not appreciably alter chemosensory discharge. It seems unlikely, therefore, that the inhibitory response to ACh is secondary to vascular changes. 5. The inhibitory response to dopamine, but not that to ACh, was blocked by the dopamine antagonist alpha‐flupenthixol. This implies that inhibition of chemosensory activity evoked by exogenous ACh was not secondary to dopamine release. 6. The implications of the results are discussed, particularly with regard to the possible physiological role of ACh as a modulator of carotid chemosensory activity.
Nonoperative management of blunt splenic injury in adults: age over 55 years as a powerful indicator for failure.

BACKGROUND Selective nonoperative management of adults with blunt splenic injury continues to evolve. Predictive factors associated with successful nonoperative management have primarily been clinical criteria such as hemodynamic stability and the degree of associated injuries. This study evaluates the role of patient selection in the safety and success of nonoperative management of adults with blunt splenic injury. STUDY DESIGN Herein, we present a retrospective analysis of the management and outcome of 135 adult (16 years of age or older) patients with blunt splenic injury at a large urban Level 1 trauma center during a six-year period. RESULT A total of 46 adult patients were treated nonoperatively after blunt splenic injury during the study period. Patient ages ranged from 16 to 93 years (mean, 36.9 years) with 11 patients 55 years of age or older. Nonoperative management was successful in 24 (52 percent) patients. Patients failing nonoperative management were significantly older than patients successfully observed (mean age, 48.1 and 26.7 years, respectively). There were ten (91 percent) failures among the 11 patients 55 years of age or older compared to 12 (34 percent) failures among younger adults despite similar mean computed tomography splenic injury grading and Injury Severity Scores (p < 0.01). Complications were significantly more prevalent in older patients than in younger patients who failed observation (p < 0.01). CONCLUSIONS Nonoperative management of adults with blunt splenic injury commonly fails in older patients independent of other clinical and radiographic variables. We conclude that age over 55 years is a contraindication to nonoperative management of patients with blunt splenic injury.
Retrospective evaluation of bleeding tendency and simultaneous thrombin and plasmin generation in patients with rare bleeding disorders

Summary. Rare bleeding disorders (RBDs) are a heterogeneous group of diseases with varying bleeding tendency, only partially explained by their laboratory phenotype. We analysed the separate groups of RBD abnormalities, and we investigated retrospectively whether the novel haemostasis assay (NHA) was able to differentiate between bleeding tendency. We have performed simultaneous thrombin generation (TG) and plasmin generation (PG) measurements in 41 patients affected with deficiencies in prothrombin, factor (F) V, FVII, FX, FXIII and fibrinogen. Parameters of the NHA were classified based on (major or minor) bleeding tendency. Patients with deficiencies in coagulation propagation (FII, FV and FX) and major type of bleedings had diminished TG (expressed as AUC) below 20% of control. FVII deficient patients only had prolonged thrombin lag‐time ratio of 1.6 ± 0.2 (P < 0.05) and normal AUC (92–125%). Afibrinogenemic patients demonstrated PG of 2–29% of normal and appeared to correlate with the type of mutation. Thrombin peak‐height (57 ± 16%) was reduced (not significant) in these patients and AUC was comparable to the reference (102 ± 27%). FXIII‐deficient plasmas resulted in a reduced thrombin peak‐height of 59 ± 13% (P < 0.05) and normal AUC (90 ± 14%). Thrombin peak‐height (P < 0.01) and plasmin potential (P < 0.05) were lower in the major bleeders compared with the minor bleeders. These results provided distinct TG and PG curves for each individual abnormality and differentiation of bleeding tendency was observed for thrombin and PG parameters. Prospective studies are warranted to confirm these retrospective results.
Quality of Life After Operative Fixation of Displaced Acetabular Fractures

Objective: The aim of this study was to determine quality of life (QoL) changes over time after internal fixation of acetabular fractures. Design: This pertains to a prospective cohort study, which was single centered. Setting: The study was conducted at the University Hospital. Patients: One hundred thirty-six patients (108 men, 28 women), age 17–83 years operated for an acetabular fracture during 2004–2008 were prospectively included and followed up for 2 years. Main Outcome Measures: QoL was evaluated via Short Form-36 (SF-36) and Life Satisfaction-11 at 6, 12, and 24 months. Radiographs were evaluated according to Matta at 2 years. Results: The most frequent fracture types were posterior wall (n31), associated anterior-posterior hemitransverse (n34), and associated both column (n29). One hundred twenty-nine patients could be assessed at 2 years, 4 did not respond, and 3 had died. The patients scored lower than norms in all 8 SF-36 domains with improvement over time for Physical Function (P < 0.0001) and Role Physical (P < 0.0001). The patients with postop reduction 0–1 mm scored better (P < 0.001–0.039) in 7 domains, all except vitality (P = 0.07), when compared with patients with residual displacement of ≥2 mm. Life satisfaction did not change with time and showed lower scores than normative in 9 of 11 items. Nineteen patients had undergone total hip replacement, and the strongest predictor was acetabular or femoral head impaction. Conclusions: QoL in surgically treated patients with displaced acetabular fracture keeps improving in physical SF-36 domains over a 2-year period although still lower than norms, and anatomical reduction results in better QoL outcome in most dimensions. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
STRONGER CONVEX (STABILIZING) SELECTION ON HOMOLOGOUS SEXUAL DISPLAY TRAITS IN FEMALES THAN IN MALES: A MULTIPOPULATION COMPARISON IN DROSOPHILA SERRATA

Mutual mate choice for homologous sexual display traits has been demonstrated in several recent studies yet little attention has been given to quantitative comparison of the strength and form of mate preferences between the sexes. Such comparisons may provide important insight into the evolution of mate choice for honest signals. In particular, because females generally provide the majority of resources for initial offspring development, female displays may trade‐off with fecundity, causing preference evolution to differ between the sexes. Recent theory suggests that adaptive male preferences for honest displays in females are possible under certain conditions and may result in preferences that are convex (i.e., stabilizing) in form. We compared sexual selection on a suite of contact pheromones arising from mutual mate choice using nine separate geographic populations of Drosophila serrata. We show that the convex selection is stronger on females than on males overall in these populations, and that convex selection is the predominate form of nonlinear selection on females but not males.
Pathotypes in the Entomophaga grylli species complex of grasshopper pathogens differentiated with random amplification of polymorphic DNA and cloned-DNA probes

The zygomycetous fungus Entomophaga grylli is a pathogen that shows host-specific variance to grasshopper subfamilies. Three pathotypes of the E. grylli species complex were differentiated by three molecular techniques. In the first method, the three pathotypes showed different fragment patterns generated by random amplification of polymorphic DNA (RAPD). There was little or no interisolate variability in RAPD fragment patterns within each pathotype. Passage of an isolate of pathotype 3, originally from an Australian grasshopper (Praxibulus sp.), through a North America grasshopper resulted in no differences in the resultant RAPD fragment patterns. In the second method, polymorphic RAPD fragments were used to probe the genomic DNA from the three pathotypes, and pathotype-specific fragments were found. In the third method, restriction fragments from genomic DNA of the three pathotypes were cloned and screened for pathotype specificity. A genomic probe specific for each pathotype was isolated. These probes did not hybridize to DNA from Entomophaga aulicae or from grasshoppers. To facilitate the use of RAPD analysis and other molecular tools to identify pathotypes, a method for extracting DNA from resting spores from infected grasshoppers was developed. The DNA from the fractured resting spores was of sufficient integrity to be blotted and probed with the pathotype-specific DNA probes, thus validating the use of these probes for pathotype identification in field-collected grasshoppers.
Osteochondritis Dissecans of the Talus (Transchondral Fractures of the Talus): Review of the Literature and New Surgical Approach for Medial Dome Lesions

A retrospective study of 22 ankles in 22 patients with osteochondral talar dome lesions between 1975 and 1983 has indicated that surgical treatment yields superior results to conservative therapy. Thirteen male and 9 female patients, ages 9 to 72 years, average age 28 years, showed 10 medial lesions (Berndt and Harty classification (stage I (one); stage II/III (nine)) and 12 lateral lesions (stage II/III (5), stage IV (7)). Examination follow-up on 19 patients (86%) has averaged 24 months. The initial diagnosis seen retrospectively on x-rays was missed 43% of the time by emergency room physicians. A history of trauma was verified in 100% of the lateral lesions and 80% of the medial talar dome lesions. Of the 22 ankles, 14 lesions were isolated injuries, while 8 had concomitant fractures, lateral ligament, or peroneal tendon damage. Surgical treatment consisted of removal of the osteochondral fragment, curettage, and drilling of its bed. Two distinct surgical approaches were utilized. Lateral dome lesions were approached through the standard anterolateral incision, while medial dome lesions were approached through the anterior tibial tendon sheath with grooving of the anteromedial distal tibia articular surface. The medial approach allowed the somewhat posteriorly placed medial lesions to be reached, negating the need for a medial malleolar osteotomy and postoperative immobilization. On follow-up, no untoward ankle arthrosis was noted as a result of the grooving of the anteromedial distal tibia. Nineteen of the 22 patients had surgical therapy with 79% excellent or good, 21% fair, and no poor results. Five of the eight patients who elected prolonged conservative therapy finally had surgery. Of the three remaining patients conservatively treated, there were two fair results and one poor result.
Thalamocortical Impulse Propagation and Information Transfer in EEG and MEG

Summary: Measures of functional connectivity and information transfer between the thalamus and the cortex can provide detailed insight into brain function. Employing magnetoencephalography and electrical median nerve stimulation, it has been recently proposed that impulse propagation along the thalamocortical fiber tract can be described by a single moving dipole source. Other studies, however, using electroencephalography observed dipole clustering in the thalamus and the cortex. To assess the source of these conflicting results, we simultaneously recorded somatosensory evoked potentials and fields in 12 healthy volunteers. Using a single dipole model for the time interval of 10 to 30 milliseconds after stimulus onset, we found continuous thalamocortical dipole movement in 10 volunteers and dipole clustering in the precortical near thalamic and cortical regions in 2 volunteers. Thus, independent of the recording method, both clustering and movement can be observed. The degree of temporal overlap between the precortical near thalamic and the cortical activity distinguished the volunteers exhibiting clustering and those exhibiting movement. In a subsequent simulation study, we could show that both dipole clustering and dipole movement can occur, depending on the temporal overlap of the precortical and cortical activities. In conclusion, we propose a two-dipole model to better account for precortical and cortical activity and information transfer.
A national survey of provisions in clinical-trial agreements between medical schools and industry sponsors.

BACKGROUND Concerned about threats to the integrity of clinical trials in a research environment increasingly controlled by private interests, the International Committee of Medical Journal Editors (ICMJE) has issued revised guidelines for investigators' participation in the study design, access to data, and control over publication. It is unclear whether research conducted at academic institutions adheres to these new standards. METHODS From November 2001 through January 2002, we interviewed officials at U.S. medical schools about provisions in their institutions' agreements with industry sponsors of multicenter clinical trials. A subgroup of the respondents were also asked about coordinating-center agreements for such trials. RESULTS Of the 122 medical schools that are members of the Association of American Medical Colleges, 108 participated in the survey. The median number of site-level agreements executed per institution in the previous year was 103 (interquartile range, 50 to 210). Scores for compliance with a wide range of provisions--from ensuring that authors of reports on multicenter trials have access to all trial data (1 percent [interquartile range, 0 to 21]) to addressing the plan for data collection and monitoring (10 percent [interquartile range, 1 to 50])--demonstrated limited adherence to the standards embodied in the new ICMJE guidelines. Scores for coordinating-center agreements were somewhat higher for most survey items. CONCLUSIONS Academic institutions routinely engage in industry-sponsored research that fails to adhere to ICMJE guidelines regarding trial design, access to data, and publication rights. Our findings suggest that a reevaluation of the process of contracting for clinical research is urgently needed.
Migration processes and self-rated health among marriage migrants in South Korea

Background. Research on migrant health mostly examines labor migrants, with some attention paid to the trauma faced by refugees. Marriage migrants represent an understudied vulnerable population in the migration and health literature. Objectives. Drawing on a Social Determinants of Health (SDH) approach, we use a large Korean national survey and stratified multivariate regressions to examine the link between migration processes and the self-rated health of Korea's three largest ethnic groups of marriage migrants: Korean-Chinese, Vietnamese, and Han Chinese. Results. We find that post-migration socioeconomic status and several social integration factors are associated with the health of marriage migrants of all three groups. Specifically, having more social relationships with Koreans is associated with good health among marriage migrants, while having more social relationships with co-ethnics is associated with worse health. Marriage migrants' perceived social status of their natal and marital families is a better predictor of their health than more objective measures such as their education attainment and that of their Korean husbands. The post-migration social gradients among all ethnic groups demonstrate a dose-response effect of marital family's social standing on marriage migrants' health, independent of their own education and the social standing of their natal families. Lastly, we find some ethnicity-specific predictors such as the association between higher educational level and worse health status among the Vietnamese. This variability by group suggests a more complex set of SDH occurred during the marriage migration processes than a basic SDH framework would predict. Conclusion. Using a new immigrant destination, South Korea, as an example, we conclude that migration and health policies that reduce ethnicity-specific barriers and offer integration programs in early post-migration stages may offer a pathway to good health among marriage migrants.
Managing acute appendicitis

Editor—Like many others will have been, I was astonished at the assertion in Benjamin and Patel's leader that mortality from negative appendicectomy (1.5%) exceeded that of appendicectomy for acute appendicitis (0.2%). 1 It is clear from reading their source document, that this is a seriously misleading statistic, the figure of 1.5% representing the mortality of comorbidity rather than that of the appendicectomy itself.2 In a study of all 805 deaths from appendicitis or appendicectomy in Scotland (population 5 million) over 10 years to 1963, mortality from appendicectomy for appendicitis was 0.62%, and that from negative appendicectomy was 0.06%. Seventy one of the 605 patients (11.7%) for whom clinical records could be studied had previously been treated non-operatively for suspected appendicitis, and 55 of them died from gangrenous or perforated appendicitis.3 For patients aged 12-29, in whom diagnostic difficulty is greatest, mortality from appendicectomy for appendicitis and for negative appendicectomy was 0.16% and 0.02%; the death rate from missed appendicitis—difficult to calculate exactly—was at least 0.04%. Attempting to project these results to the then competing management strategies I described as conservative (operating on around 60% of patients admitted with possible appendicitis) and radical (operating on 80% of such admissions) for patients in the age group 12-29,4 I estimated that avoidable mortality (death from missed appendicitis plus that from negative appendicectomy) from the two approaches was virtually identical at 1.13 and 1.07 patients per 10 000 admissions—figures which then represented 0.6 avoidable deaths per year in Scotland. It is hard to believe that all the advances described by Benjamin and Patel since then can have done all that much to improve these statistics. Two other observations are relevant. Firstly, appendicectomy but not appendicitis runs in families. Secondly, conservative surgeons become radical surgeons when dealing with medical and nursing colleagues and their families when they present with possible appendicitis. In this field at least, surgery—like general practice—combines the skills of a behavioural with those of a biomedical science. Jones ends his review of the contemporary management of suspected acute appendicitis by saying that we can be sure that emphasis on technology at the expense of clinical evaluation will diminish, rather than improve, the quality of care for patients with acute abdominal pain—a truth that surely has much wider applications.5
Dietary beta-carotene intake and the risk of epithelial ovarian cancer: a meta-analysis of 3,782 subjects from five observational studies.

OBJECTIVE The etiology of epithelial ovarian cancer is unknown. Prior work suggests that high dietary beta-carotene intake is associated with a decreased risk of this tumor although this association remains speculative. A meta-analysis was performed to evaluate this suspected relationship. METHODS Using previously described methods, a protocol was developed for a meta-analysis examining the association between high dietary beta-carotene intake versus low intake and the risk of epithelial ovarian cancer. Literature search techniques, study inclusion criteria and statistical procedures were prospectively defined. Data from observational studies were pooled using a general variance based meta-analytic method employing confidence intervals previously described by Greenland. The outcome of interest was a summary relative risk (RRs) reflecting the risk of ovarian cancer associated with high beta-carotene intake versus low dietary intake. Sensitivity analyses were performed when necessary to evaluate any observed statistical heterogeneity. RESULTS Five observational studies enrolling 3,782 subjects were initially pooled in a meta-analysis subsequent to an analysis showing a lack of statistical heterogeneity. The meta-analysis showed a summary relative risk of 0.84 with a 95% confidence interval of 0.75-0.94, a statistically significant result. These data suggest that high (versus low) dietary intake of beta-carotene is associated with a sixteen percent decrease in ovarian cancer risk. Sensitivity analyses showed no impact of study design or differences in quantitative measure of beta-carotene intake across studies on the summary relative risk. CONCLUSIONS High dietary intake of beta-carotene appears to represent a protective factor for the development of ovarian cancer although its magnitude is modest. Further work is needed to clarify factors that may modify the effects of beta-carotene in vivo.