Miracle-dz/UniFAR-FTUs huggingface dataset:
Sifting the evidence—what's wrong with significance tests?

The findings of medical research are often met with considerable scepticism, even when they have apparently come from studies with sound methodologies that have been subjected to appropriate statistical analysis. This is perhaps particularly the case with respect to epidemiological findings that suggest that some aspect of everyday life is bad for people. Indeed, one recent popular history, the medical journalist James Le Fanu's The Rise and Fall of Modern Medicine , went so far as to suggest that the solution to medicine's ills would be the closure of all departments of epidemiology.1 One contributory factor is that the medical literature shows a strong tendency to accentuate the positive; positive outcomes are more likely to be reported than null results.2–4 By this means alone a host of purely chance findings will be published, as by conventional reasoning examining 20 associations will produce one result that is “significant at P=0.05” by chance alone. If only positive findings are published then they may be mistakenly considered to be of importance rather than being the necessary chance results produced by the application of criteria for meaningfulness based on statistical significance. As many studies contain long questionnaires collecting information on hundreds of variables, and measure a wide range of potential outcomes, several false positive findings are virtually guaranteed. The high volume and often contradictory nature5 of medical research findings, however, is not only because of publication bias. A more fundamental problem is the widespread misunderstanding of the nature of statistical significance. #### Summary points P values, or significance levels, measure the strength of the evidence against the null hypothesis; the smaller the P value, the stronger the evidence against the null hypothesis An arbitrary division of results, into “significant” or “non-significant” according to the P value, was not the intention of the …
Anticardiolipin and antibeta2glycoproteinI antibodies in patients with hepatitis B and C infections.

BACKGROUND The clinical significance of antiphospholipid antibodies in patients with chronic hepatitis C virus (HCV) and some other viral infections is controversial. OBJECTIVE To study the prevalence of anticardiolipin antibody (ACLA) and antibeta2glycoproteinI antibody (antibeta2GPI antibody) in HCV and hepatitis B virus (HBV) infected patients and its association with liver clinical parameters. METHODS Serum levels of ACLA, antibeta2GPI antibody as well as platelet count, ALT (alanine transaminase), PT (prothrombine time), disease duration and liver histologic findings of 38 patients with HBV and 15 patients with HCV infections were compared with those of 58 healthy controls. RESULTS Serum titres of ACLA in HCV and HBV patients (13.4 +/-7.1 GPL units/ml), and in each of the HCV (15.18+/-9.91 GPL units/ml) and HBV (12.7 +/- 5.7 GPL units/ml) patients were significantly higher than that of the control group (3.4+/-2.3GPL units/ml). However, there was no significant difference in serum levels of antibeta2GPI antibody from patients with HCV and HBV (3.3 +/- 1.3 GPL units/ml) or HCV alone (2.79 +/- 1.01 GPL units/ml) or HBV alone (3.4+/-1.3GPL units/ml) and that of the control group (3.3+/-1.1GPL units/ml). CONCLUSION The findings suggest that the presence of ACLA has no pathologic significance in patients with HBV and HCV infections.
Cochlear Implants for Younger Children: A Preliminary Description of the Parental Decision Process and Outcomes

The authors conducted a preliminary telephone interview study of a random sample of 35 parents whose children had received cochlear implants through a large-scale implant program. Parents were asked about their child's preimplant and postimplant communications skills, how they learned about implants, and how they arrived at the decision to have their child receive an implant. Results of the interviews suggest, a least for this program, that two types of decision sequences are followed. One type of parent has initial and primary contact through a medical practitioner, uses that source of information exclusively, and is motivated by a desire for a "normal" communication situation. The second type of parent learns about implants from another parent, family member, or teacher. This individual will seek other sources of information and is most often motivated by the child's lack of communication skill. Generally, from parents' perspective, language and speech rather than improved social skills or social contact are the primary benefits of the implant.
Effects of Contact Precautions on Patient Perception of Care and Satisfaction: A Prospective Cohort Study

Objective. Contact precautions decrease healthcare worker-patient contact and may impact patient satisfaction. To determine the association between contact precautions and patient satisfaction, we used a standardized interview for perceived issues with care. Design. Prospective cohort study of inpatients, evaluated at admission and on hospital days 3, 7, and 14 (until discharged). At each point, patients underwent a standardized interview to identify perceived problems with care. After discharge, the standardized interview and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey were administered by telephone. Responses were recorded, transcribed, and coded by 2 physician reviewers. Participants. A total of 528 medical or surgical patients not admitted to the intensive care unit. Results. A total of 528 patients were included in the primary analysis, of whom 104 (20%) perceived some issue with their care. On multivariable logistic regression, contact precautions were independently associated with a greater number of perceived concerns with care (odds ratio, 2.05 [95% confidence interval, 1.31–3.21]; P<.01), including poor coordination of care (P = .02) and a lack of respect for patient needs and preferences (P = .001). Eighty-eight patients were included in the secondary analysis of HCAHPS. Patients under contact precautions did not have different HCAHPS scores than those not under contact precautions (odds ratio, 1.79 [95% confidence interval, 0.64–5.00]; P = .27). Conclusions. Patients under contact precautions were more likely to perceive problems with their care, especially poor coordination of care and a lack of respect for patient preferences.
Pharmacokinetics of Paracetamol in Adults after Cardiac Surgery

The pharmacokinetics of paracetamol in adults after cardiac surgery have not been described. Twenty patients were randomized to receive either paracetamol 2 g through a nasogastric tube and as a suppository eight hours later or vice versa. Arterial blood samples were taken at 0.5, one, two, four, six and eight hours after dosing. Each patient was studied for 16 h. There were 16 males and three females. One patient was excluded because of sampling errors. The mean age was 59 (SD 8) years and the mean weight 84kg (16). The time-concentration profiles for each individual were used to estimate pharmacokinetic parameters using a non-linear mixed effects model (NONMEM). Population parameter estimates with coefficient of variation (CV%), standardized to a 70 kg person, for a one-compartment model with first order input, lag time and first order elimination were volume of distribution 127 l (28) and clearance 26.4 l/h (29) Rectal paracetamol had an absorption half-life (Tabs) of 2.02 h (31) with a lag time of 0.28h. The absorption half-life for the oral preparation was 1.49h (81) with a lag time of 0.17h. The relative bioavailability of the rectal compared to the oral formulation was 0.98 (18). Concentrations after either nasogastric or rectal paracetamol 2g were below a target concentration of 10 mg/l, which is associated with analgesia. Absorption after nasogastric administration was slow compared to healthy adults (Tabs 0.06 to 0.7h) and the bioavailability was half that expected, due to nasogastric loss. Parameter estimates had large variability. Paracetamol is unlikely to have useful clinical impact in the majority of patients when standard doses (6 g/day) are given on day 1 after cardiac surgery.
Seasonal variation in photosynthetic capacity of montane conifers

Summary 1. The capacity to perform photosynthesis, given appropriate environmental conditions, is reflected by measurements of the maximum quantum yield of photosystem II ( F v / F m ). The seasonal course of F v / F m may help define the length of the annual photosynthetic period in temperate evergreen forests. 2. F v / F m was measured 31 times from September to May on six conifer species located along an altitudinal gradient between 400 and 1400 m a.s. l. in northern Idaho, USA. The species were Western Redcedar ( Thuja plicata Donn ex D. Donn), Douglas Fir ( Pseudotsuga menziesii (Beissn.) Franco), Engelmann Spruce ( Picea engelmannii Parry), Grand Fir ( Abies grandis (Dougl.) Lindl. ), Ponderosa Pine ( Pinus ponderosa Laws.) and Lodgepole Pine ( Pinus contorta Dougl.). 3. Species differed in mean F v / F m , in magnitude of response to maximum and minimum temperature, and in altitude effects other than temperature. For two species F v / F m in spring differed from that in autumn, even when measured at the same air temperature. Regardless of temperature, most species maintained some photosynthetic capacity all winter. 4. A lag of several days to 2 months was observed in the response of F v / F m to ambient temperature. The lag differed among species. It was not observed in Grand Fir, and was as long as 2 months in Western Redcedar. Over all species combined the best overall correlation was with a moving average of maximum temperature over the previous 30 days. 5. The correlation between F v / F m and maximum temperature was generally stronger than that with minimum temperature (average root mean-squared error was reduced by 10%), presumably because maximum temperatures better reflect daytime photoinhibitory conditions. 6. A reduced model predicted F v / F m based on species and maximum temperature; this model can be used to parameterize models describing the annual cycle of photosynthetic capacity for the six conifer species included in this study.
Skeletal Maturation in Juvenile Diabetes Mellitus

Extract: Skeletal maturation has been examined in a group of diabetic children using their nondiabetic siblings as controls. Serial examinations were done over a five-year period.The diabetic children have a significantly retarded bone age, whether assessed by examination of the hand or of the foot. However, their nondiabetic siblings had comparable retardation of skeletal maturation. Thus, in comparison with his normal sibling, the skeletal development of the diabetic child does not appear to have been affected by his disease process.There is no significant difference between the development of the hand and the foot for either group of children. When the skeletal maturation of the hand and foot is compared for each child, the correlation is 0.998. No significant trend can be demonstrated for the relation between skeletal development discrepancy and chronological age. The initial retardation of about six months at ten years of age and the progressive retardation of about one and a half months during the next three years of life are equivalent to a decrement of a half month in skeletal age for each year of chronological age since birth.Speculation: The moderate, but significant, retardation of both groups of children when compared to the published standards requires explanation. These groups follow a pattern similar to that reported for the children in the longitudinal study of growth in Denver. The most likely factors producing these patterns are the result of sample or standard selection. The children used for the standards in the Atlases were predominantly from families whose socioeconomic level was definitely above average, whereas the diabetic population was more normally distributed in this context.The high correlation between hand and foot in this series indicates the importance of using the detailed assessment technique described in the Atlas Standards and used for this study. Furthermore, the high degree of correlation found between the hand and the body as a whole by REYNOLDS and OSAKAWA [19] would suggest that the hand or the foot is equally representative of total body skeletal maturation.
Two-parameter locus of boundary crisis: mind the gaps!

Boundary crisis is a mechanism for destroying a chaotic attractor when one parameter is varied. In a two-parameter setting the locus of boundary crisis is associated with curves of homo- or heteroclinic tangency bifurcations of saddle periodic orbits. It is known that the locus of boundary crisis contains many gaps, corresponding to channels (regions of positive measure) where a non-chaotic attractor persists. One side of such a subduction channel is a saddle-node bifurcation of a periodic orbit that marks the start of a periodic window in the chaotic regime; the other side of the channel is formed by a homo- or heteroclinic tangency bifurcation associated with the saddle periodic orbit involved in the saddle-node bifurcation. We present a two-parameter study of boundary crisis in the Ikeda map, which models the dynamics of energy levels in a laser ring cavity. We confirm the existence of many gaps on the boundary- crisis locus. However, the gaps correspond to subduction channels that can have a rather different structure compared to what is known in the literature.
The El Ni�o Cycle: A Natural Oscillator of the Pacific Ocean—Atmosphere System

Research conducted during the past decade has led to an understanding of many of the mechanisms responsible for the oceanic and atmospheric variability associated with the El Ni�o—Southern Oscillation (ENSO). However, the reason for one of the fundamental characteristics of this phenomena, its quasi-periodicity, has remained unclear. Recently available evidence from a number of sources now suggests that the ENSO "cycle" operates as a natural oscillator based on relatively simple couplings between the tropical atmospheric circulation, the dynamics of the warm upper layer of the tropical ocean, and sea surface temperatures in the eastern equatorial Pacific. This concept and recent field evidence supporting the natural coupled oscillator hypothesis are outlined.
Error management and the evolution of cognitive bias.

Error management theory (EMT) proposes that when the costs of different types of errors are asymmetrical in their fitness consequences, natural selection will create biased cognitive mechanisms that maximize the least costly error (Haselton & Buss, 2000; Haselton & Nettle, 2006). Since the time of its initial publication, EMT has produced dozens of new hypotheses and empirical results characterizing human cognition. With a focus on the last decade of research developments, we summarize evidence of error management biases across a variety of social psychological domains, ranging from perceptions of romantic attraction to social prejudices, cooperative behaviors, and the judgment of personality traits. We then cover emerging theoretical developments, such as the role of context in affecting the magnitude of biases predicted by EMT. We conclude by addressing a recent challenge to the theory – the notion that selection should preserve true beliefs, and therefore is expected only to bias behavior, and not underlying beliefs (cognition), in order to manage error costs (McKay & Dennett, 2009; McKay & Efferson, 2010). We discuss several hypotheses about why, in order to manage error costs, selection targets beliefs.
Cerebral monitoring in patients undergoing carotid endarterectomy using a triple assessment technique.

OBJECTIVES Selective shunting during carotid endarterectomy (CEA) is advocated to reduce shunt related stroke. Cerebral monitoring is essential for temporary carotid shunting. Many techniques are available for cerebral monitoring, however, none is superior to monitoring the patient's neurological status (awake testing) while performing the procedure under local anaesthesia (LA). Cerebral oximetry (CO) and trans-cranial Doppler (TCD) has previously been used to show the adequacy of cerebral circulation in patients undergoing CEA. The aim of this study is to assess the reliability of CO and TCD in predicting the need for shunting compared to the awake testing. METHODS Patients scheduled for CEA under LA were included. Patients converted to general anaesthesia (GA) and patients with no TCD window were excluded from the study. The Somanetics INVOS(®) CO was used for ipsilateral cerebral monitoring in all patients, in addition to TCD and awake testing. The percentage fall in CO regional oxygen saturation (rSO(2)), and decline in the mean flow velocity (FVm) in TCD following carotid artery clamping recorded. A drop in rSO(2) of ≥20% or FVm of ≥50% was considered an indicator of cerebral ischaemia that may predict the need for carotid shunting. Patients only shunted based on awake testing. RESULTS Forty-nine patients underwent triple assessment. The median clamp time was 24 min. 8/49 patients (16.3%) needed carotid shunting based on awake testing. In this group, six patients had ≥20% drop in rSO(2), and ≥50% drop in FVm. However, two patients had a non-significant drop in both rSO(2) and FVm (false negative). In the non-shunted group (41/49), one patient had a significant drop in rSO(2) (false positive) while 10/41 patients had a >50% drop in FVm. This represents sensitivity of 75%, and specificity of 97.5% for CO compared to sensitivity of 75% and specificity of 75% for TCD in prediction of shunting. The positive predictive value and negative predictive value were 85.7 and 95.2%, respectively for CO, compared to 37.5 and 93.9% for TCD. CONCLUSIONS TCD is less accurate than CO in predicting the need for carotid shunting during CEA. A combination of both methods does not add to the accuracy of detecting the need for carotid shunting.
Relationship of the internal jugular vein to the common carotid artery: implications for ultrasound-guided vascular access

Background and objective For cannulation of the internal jugular vein (IJV), ultrasound increases the number of first pass successes and reduces the rate of mechanical complications. A frequent complication of IJV access is the accidental injury of the common carotid artery (CCA), which can be dangerous in some circumstances. Landmarks and palpation of the CCA are used when ultrasound is not available. These conventional methods are based on the lateral position of the IJV to the CCA, and physicians traditionally employ head rotation to increase the success rates of IJV cannulation. Ultrasound scanning strictly from the anterior to posterior is not possible for this process because the probe must be adequately coupled to compensate for the curvature of the neck. Scans have been performed from different angles lateral to the neck, but misleadingly depict the relationship of the IJV to the CCA. In this study, the authors examined the effect of scanning at a 45° angle at the level of the cricoid on the depiction of the IJV in relation to the CCA. Furthermore, the influence of 30° head rotation to the contralateral side was also investigated. Method The relationship of the IJV to the CCA was recorded using ultrasound in 600 patients. Patients were placed in a supine position and the probe was coupled at the level of the cricoid, scanning at an angle of 45° from the lateral side of the neck. Based on the ultrasound images, the position of the IJV in relation to the CCA was recorded using a segmented grid. The centre of the vein (cross-section of the vertical and longitudinal diameter) determined the segment classification, in which the top of the ultrasound image was defined as the anterior. Additionally, in 300 patients, the head was rotated to the contralateral side at 30° to examine the impact of head rotation on the position of the IJV. Results The IJV was found in the lateral segment in only 3.0–3.3% of the patients. It was found in the anteromedial segment more frequently on the left side compared to the right side (P < 0.005). On the right side, the IJV was shown more frequently in the anterolateral position (P < 0.0001). Head rotation at 30° in 300 of the 600 patients caused a significant change of the IJV position in the left anteromedial segment, in that it frequently placed the IJV towards the anterior and anterolateral segment (P < 0.05). There was no significant impact of head rotation on the IJV representation on the right side. Atypical positions of the IJV (posterior, medial or thrombosis) were found in some cases. Conclusion Ultrasound images used for IJV access usually depict the vein as being anterior to the CCA and only to a minor extent in the lateral position. This positioning is important for needle processing in order to avoid accidental arterial puncture and to identify atypical positions of the IJV. To determine the ideal puncture site, images of the neck vessels along their entire pathway should be obtained when using ultrasound for vascular access.
Assessing the causes and scales of the leaf economics spectrum using venation networks in Populus tremuloides

The leaf economics spectrum (LES) describes global interspecific correlations between leaf traits. Despite recent theoretical advances, the biological scale at which LES correlations emerge and the physiological and climatic causes of these correlations remains partially unknown. Here, we test an extant theory based on universal trade‐offs in leaf venation networks that predicts that (i) the LES primarily originates within individuals; (ii) minor vein density drives LES trait correlations; and (iii) between individuals, LES correlations reflects variation in minor vein density driven by water availability. To test these predictions, we sample leaves within and between clones of Populus tremuloides across a wide climate gradient. We show that predictions i) and iii) are supported but ii) is only partially supported. To account for this discrepancy, we develop a more general venation theory. This theory describes linkages between vein density, leaf area and leaf thickness that can modulate LES correlations across scales. This theory helps to identify multiple selective pressures that can drive trait covariation underlying the LES. Synthesis. Our results broaden the range of biological scales at which the leaf economics spectrum (LES) is found and highlight the complex causal roles of venation networks in LES correlations. This study points to the need to better understand the coupling between venation networks, leaf size and climate to fully understand the LES.
The Effect of Neonatal Intensive Care Unit Noise on the Habituation of Neonatal Chicks

Abstract : Prematurely born human neonates may experience weeks, even months, of auditory stimulation different from that known to exist in the uterus. Unlike full term neonates, many preterms do not demonstrate a consistent response decrement (i.e., habituation) to repeated stimuli. Habituation is regarded as an indicator of central nervous system competence. The purpose of this experiment was to investigate the effect of Neonatal Intensive Care Unit (NICU) noise on the ability of neonatal chicks to habituate. Use of an animal model allowed for examination of this effect in isolation of confounding variables encountered in the population of sick preterm neonates. Neonatal human and chick auditory development is similar in both structural sequence and function at birth. The effects of age, auditory experience, and test condition were tested in a two-by- two-by-two blocked design. Results indicated that 4-day-old chicks exposed to NICU noise failed to habituate to a white noise stimulus. These findings support recommendations for reducing auditory stimulation in the NICU. Although the results of animal research cannot be directly applied to the human situation, such research can indicate areas of potential risk meriting further investigation.