Miracle-dz/UniFAR-FTUs huggingface dataset:
Independent Schools Counselling: Profiling the NSPCC Service Experience

Research reported in recent years highlights that many children and young people living in Northern Ireland are struggling to cope with a range of complex issues in their daily lives. The lack of accessible and appropriate professional support means that many children and young people carry these issues to school, where their struggle to cope manifests as behaviour problems contributing to poor engagement and academic achievement. In recognition of the need to support these vulnerable children and young people, the National Society for the Prevention of Cruelty to Children in 2000 established an independent schools counselling service in Northern Ireland. This paper presents a descriptive profile of client and service use between September 2004 and December 2005. Descriptive analysis indicates that the service provides a pragmatic support response to vulnerable children and young people at school: high levels of referral by children and young people themselves, parents and teachers indicate the service is used across all school sectors and management types. Initial status scores for emotional health and well-being as measured by the self-rated Strengths and Difficulties Questionnaire confirms children and young people are presenting to the service with significant difficulties. Implications for the strategic and practice development of an independent schools counselling service in Northern Ireland are discussed
The adoption of low-osmolar contrast agents in the United States: historical analysis of health policy and clinical practice.

OBJECTIVE In this historical analysis of low- and high-osmolar contrast agents, we outline the reasons for the price depreciation, speculate on motivation for universal adoption by many radiologists despite suboptimal reimbursement, and cast light on important shortcomings of economic analyses in the realm of health policy. CONCLUSION Early economic analyses regarding low-osmolar contrast agents concluded that universal adoption was not cost-effective. Over time, the price differential between low- and high-osmolar agents narrowed, yet reimbursement patterns lagged behind the narrowing price differential.
Low tube voltage intermediate tube current liver MDCT: sinogram-affirmed iterative reconstruction algorithm for detection of hypervascular hepatocellular carcinoma.

OBJECTIVE The purpose of this study was to compare image quality and lesion detectability in the evaluation of hypervascular hepatocellular carcinoma (HCC) on low-tube-voltage half-dose liver CT scans subjected to sinogram-affirmed iterative reconstruction (SAFIRE) with the quality and detectability on full-dose scans reconstructed with filtered back projection (FBP). MATERIALS AND METHODS A total of 126 patients with suspected HCC who underwent liver CT including arterial phase scanning at 80 kVp in the dual-source mode (300 mAs for each tube) were included in the study. The half-dose arterial scans were reconstructed with FBP, iterative reconstruction in image space (IRIS), and five SAFIRE strengths (S1-S5) and were compared with full-dose virtual scans (600 mA) reconstructed with FBP. We assessed image noise, contrast-to-noise ratio (CNR) of the liver and blood vessels, and lesionto-liver CNR. Two radiologists evaluated image quality and lesion detectability attained with the different imaging sets. RESULTS Image noise on SAFIRE images was significantly lower than that on the other images, and the CNRs on SAFIRE images were higher than those on half-dose FBP images (p < 0.001). In addition, lesion-to-liver CNR on the half-dose S5 SAFIRE images was higher than on IRIS and full-dose FBP images (p < 0.05). Among the half-dose scans, SAFIRE images had significantly better image quality than FBP images (p < 0.05). Regarding lesion detection, half-dose SAFIRE images were better than half-dose FBP images and were comparable with full-dose FBP images (observer 1, 91.8% vs 96%; observer 2, 98% vs 98%; p > 0.05). CONCLUSION Performing half-dose 80-kVp liver CT with SAFIRE technique may increase image quality and afford comparable lesion detectability of hypervascular HCC at a reduced radiation dose compared with full-dose CT with FBP.
Journal club: How radiation exposure histories influence physician imaging decisions: a multicenter radiologist survey study.

OBJECTIVE The purpose of this article is to evaluate the influence of patient radiation exposure histories on radiologists' imaging decisions. MATERIALS AND METHODS We conducted a physician survey study in three academic medical centers. Radiologists were asked to make an imaging recommendation for a hypothetical patient with a history of multiple CT scans. We queried radiologists' decision making, evaluating whether they incorporated cancer risks from previous imaging, reported acceptance (or rejection) of the linear no-threshold model, and understood linear no-threshold model implications in this setting. Consistency between radiologists' decisions and their linear no-threshold model beliefs was evaluated; those acting in accordance with the linear no-threshold model were expected to disregard previously incurred cancer risks. A Fisher exact test was used to verify the generalizability of results across institutions and training levels (residents, fellows, and attending physicians). RESULTS Fifty-six percent (322/578) of radiologists completed the survey. Most (92% [295/322]) incorporated risks from the patient's exposure history during decision making. Most (61% [196/322]) also reported acceptance of the linear no-threshold model. Fewer (25% [79/322]) rejected the linear no-threshold model; 15% (47/322) could not judge. Among radiologists reporting linear no-threshold model acceptance or rejection, the minority (36% [98/275]) made decisions that were consistent with their linear no-threshold model beliefs. This finding was not statistically different across institutions (p = 0.070) or training levels (p = 0.183). Few radiologists (4% [13/322]) had an accurate understanding of linear no-threshold model implications. CONCLUSION Most radiologists, when faced with patient exposure histories, make decisions that contradict their self-reported acceptance of the linear no-threshold model and the linear no-threshold model itself. These findings underscore a need for educational initiatives.
Cognitive and system factors contributing to diagnostic errors in radiology.

OBJECTIVE In this article, we describe some of the cognitive and system-based sources of detection and interpretation errors in diagnostic radiology and discuss potential approaches to help reduce misdiagnoses. CONCLUSION Every radiologist worries about missing a diagnosis or giving a false-positive reading. The retrospective error rate among radiologic examinations is approximately 30%, with real-time errors in daily radiology practice averaging 3-5%. Nearly 75% of all medical malpractice claims against radiologists are related to diagnostic errors. As medical reimbursement trends downward, radiologists attempt to compensate by undertaking additional responsibilities to increase productivity. The increased workload, rising quality expectations, cognitive biases, and poor system factors all contribute to diagnostic errors in radiology. Diagnostic errors are underrecognized and underappreciated in radiology practice. This is due to the inability to obtain reliable national estimates of the impact, the difficulty in evaluating effectiveness of potential interventions, and the poor response to systemwide solutions. Most of our clinical work is executed through type 1 processes to minimize cost, anxiety, and delay; however, type 1 processes are also vulnerable to errors. Instead of trying to completely eliminate cognitive shortcuts that serve us well most of the time, becoming aware of common biases and using metacognitive strategies to mitigate the effects have the potential to create sustainable improvement in diagnostic errors.
Tuberculous lymphadenitis of the thorax: comparisons of imaging findings between patients with and those without HIV infection.

OBJECTIVE The purpose of this study was to discern differences in the clinical and radiologic presentations of intrathoracic tuberculous lymphadenitis in adult patients with and those without HIV infection. MATERIALS AND METHODS Between 2000 and 2010, 66 patients (28 men, 38 women; mean age, 45 ± 13.9 years) were found to have intrathoracic tuberculous lymphadenitis. Of these patients, 17 (26%) (15 men, two women; mean age, 47 ± 9.9 years) were HIV-seropositive. Thoracic CT scans were evaluated for involved lymph node stations, long-axis diameter of involved lymph nodes, presence of central necrosis in enlarged nodes, and other associated findings. RESULTS In HIV-positive patients, tuberculous lymphadenitis had more multifocal (mean number of involved nodal stations, 8.4 versus 3.6; p < 0.001) nodal involvement, had smaller nodes (mean long-axis diameter, 17 mm versus 21 mm; p = 0.004), and was more frequently associated with lung parenchymal lesions and extrathoracic lymph node and organ involvement (p < 0.05) than in HIV-negative patients. Tuberculous lymphadenitis was the sole manifestation of tuberculous infection in 22 of 49 (45%) HIV-negative patients and in 2 of 17 (12%) HIV-positive patients (p = 0.018). CONCLUSION Tuberculous lymphadenitis in patients with HIV infection is characterized by multiple-station lymphadenitis with extensive lung parenchymal, extrathoracic lymph node, and extrathoracic organ involvement.
Adalimumab for the treatment of severe psoriasis and psoriatic arthritis

Backround: Psoriasis is a chronic, genetically determined, immunomediated, inflammatory skin disease affecting ∼ 2 – 3% of the Caucasian population. Systemic treatment is required in moderate to severe plaque-type psoriasis forms or psoriatic arthritis. However, cumulative organ toxicity, lack of efficacy over time and other underlying diseases may limit long-term use of conventional treatments. Objectives: TNF-α, serves a key role in potentiating inflammatory responses associated with both psoriasis and psoriatic arthritis. Adalimumab is a fully human anti-TNF-α monoclonal antibody; approved for the treatment of psoriatic arthritis and, more recently, for plaque-type psoriasis. Methods: This review reports the latest progresses made in the clinical use of ‘biologic’ drugs for psoriasis focusing on the clinical management of adalimumab in the treatment of plaque psoriasis and psoriatic arthritis. Results: Adalimumab was shown to be effective in treating both psoriasis and psoriatic arthritis with a rapid onset of action and a good safety profile.
The Effect of RAS on Individuals With Total Hip Replacement and Hip Revision Surgery

iii Acknowledgements . iv List of Tables . viii List of Figures . ix Chapter One: Introduction . 10 Hip surgery statistics . 10 Hip replacement and revision surgery . 11 Overall population aging . 11 Future challenges in providing care to older adults.12 Costs of inactivity and disability . 14 Effects of hip surgery on gait.15 Potential benefits of RAS.15 Chapter Two: Review of Literature . 17 Gait Characteristics of Older Adults . 17 Changes in Gait Following Hip Surgery.18 Gait Training and Physical Therapy . 19 Neurologic Music Therapy . 20 vi NMT and The Rational Scientific Mediating Model . 20 Rhythmic Auditory Stimulation . 21 Rhythm and Perception . 22 Employing RAS in the Clinical Setting . 24 RAS with Traumatic Brain Injury . 24 RAS With Stroke Patients . 25 RAS and Individuals with Parkinson's disease . 26 RAS and the Frail Elderly . 29 RAS and Late Stage Dementia . 30 Chapter 3: Method . 32 Recruitment . 32 Procedure . 36 Music Selection . 39 Interventionist . 40 Data Collection . 40 Chapter 4: Results . 42 Subject Demographics . 42 Intervention Reporting . 44 Fidelity . 44 vii Data Analysis . 46 Chapter 5: Discussion . 50 Results of Cadence, Stride Length, and Velocity.50 Limitations and Future Recommendations . 51 References . 52
Does antiplatelet therapy increase the risk of hemoptysis during percutaneous transthoracic needle biopsy of a pulmonary lesion?

OBJECTIVE The purpose of this article is to evaluate whether antiplatelet therapy increases the occurrence and severity of percutaneous transthoracic needle biopsy (PTNB)-related hemoptysis. MATERIALS AND METHODS Our institutional review board approved this retrospective study, with waiver of informed consent. From May 2007 to December 2009, 1251 patients undergoing 1346 PTNBs constituted our study population. Of these PTNBs, 163 were performed in patients who had suspended antiplatelet therapy for less than 10 days (mean discontinuation time, 2.56 ± 2.35 days), and these patients were classified as antiplatelet agent users: 143 patients with single aspirin (mean discontinuation time, 2.55 ± 2.35 days), 12 patients with single clopidogrel (mean discontinuation time, 2.33 ± 2.10 days), and eight patients with dual-antiplatelet therapy (i.e., aspirin plus clopidogrel; mean discontinuation time, 3.12 ± 2.90 days). The influence of antiplatelet therapy on the occurrence and severity of PTNB-related hemoptysis was retrospectively evaluated. RESULTS Among 1346 PTNBs, there were 128 cases (9.5%) of hemoptysis, including 21 cases of severe hemoptysis (1.6%). Multivariate analysis revealed that dual-antiplatelet therapy (odds ratio [OR], 10.09), female sex (OR, 1.88), smaller lesions (OR, 0.88), deeply located lesions (OR, 1.17), and the use of cutting needles (OR, 3.22) were independent risk factors for overall hemoptysis. For severe hemoptysis, dual-antiplatelet therapy (OR, 13.02), ground-glass nodules (OR, 8.86), and deeply located lesions (OR, 1.24) were proven to be independent risk factors. Single-antiplatelet therapy suspended for less than 10 days was not a significant risk factor for either overall or severe hemoptysis. CONCLUSION Single-antiplatelet therapy suspended for less than 10 days is not an independent risk factor for the occurrence of PTNB-related hemoptysis, whereas dual-antiplatelet therapy increases its risk.
Prostate cancer: comparison of dynamic contrast-enhanced MRI techniques for localization of peripheral zone tumor.

OBJECTIVE The objective of this study was to compare the performance of different methodologies for interpretation of dynamic contrast-enhanced MRI (DCE-MRI) in localization of peripheral zone prostate cancer. MATERIALS AND METHODS Forty-three men (mean age, 59±8 years) with biopsy-proven prostate cancer who underwent prostate MRI including DCE-MRI before prostatectomy were included. Two observers independently reviewed DCE-MRI data using three methodologies: qualitative, in which kinetic curves of signal intensity versus time were generated for foci showing rapid enhancement on subtracted contrast-enhanced images; semiquantitative, in which a biexponential heuristic model was used to generate color-coded maps depicting maximum slope and washout of contrast enhancement; and quantitative, in which a Tofts model was used to generate color-coded influx rate transfer constant (Ktrans) and efflux rate transfer constant (Kep) maps. Findings were stratified by whether suspicious foci showed evidence of washout with each method and compared with histopathologic results in each sextant. RESULTS There was similar accuracy for the semiquantitative and quantitative models for both observers irrespective of requiring evidence of washout. For the more experienced observer, requiring washout resulted in lower sensitivity and higher specificity for the qualitative and semiquantitative models. Also for the more experienced observer, use of either a semiquantitative or quantitative model provided greater sensitivity compared with a qualitative model when requiring washout. There was no association between tumor detection and Gleason score for any DCE-MRI methodology for either reader. CONCLUSION For the experienced reader, sensitivity for peripheral zone tumor was increased by use of either a semiquantitative or quantitative model compared with a qualitative model and decreased by requiring washout. We failed to identify a difference in performance between semiquantitative and quantitative models.
Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients.

OBJECTIVE Acute appendicitis is the most common condition requiring emergency surgery in children. Differentiation of perforated from nonperforated appendicitis is important because perforated appendicitis may initially be managed conservatively whereas nonperforated appendicitis requires immediate surgical intervention. CT has been proved effective in identifying appendiceal perforation. The purpose of this study was to determine whether perforated and nonperforated appendicitis in children can be similarly differentiated with ultrasound. MATERIALS AND METHODS This retrospective study included 161 consecutively registered children from two centers who had acute appendicitis and had undergone ultra-sound and appendectomy. Ultrasound images were reviewed for appendiceal size, appearance of the appendiceal wall, changes in periappendiceal fat, and presence of free fluid, abscess, or appendicolith. The surgical report served as the reference standard for determining whether perforation was present. The specificity and sensitivity of each ultrasound finding were determined, and binary models were generated. RESULTS The patients included were 94 boys and 67 girls (age range, 1-20 years; mean, 11 ± 4.4 [SD] years) The appendiceal perforation rate was significantly higher in children younger than 8 years (62.5%) compared with older children (29.5%). Sonographic findings associated with perforation included abscess (sensitivity, 36.2%; specificity, 99%), loss of the echogenic submucosal layer of the appendix in a child younger than 8 years (sensitivity, 100%; specificity, 72.7%), and presence of an appendicolith in a child younger than 8 years (sensitivity, 68.4%; specificity, 91.7%). CONCLUSION Ultrasound is effective for differentiation of perforated from nonperforated appendicitis in children.
Serial CT findings of nodular bronchiectatic Mycobacterium avium complex pulmonary disease with antibiotic treatment.

OBJECTIVE The objective of our study was to analyze the serial CT findings of patients with the nodular bronchiectatic form of Mycobacterium avium complex (MAC) pulmonary disease treated with antibiotic therapy. MATERIALS AND METHODS Between January 2005 and December 2009, MAC lung disease was diagnosed in 475 patients at a single tertiary referral hospital. Of the 475 patients, 339 had a CT pattern of disease consistent with the nodular bronchiectatic form. Among these 339 patients, 110 patients treated with a combination of antibiotics for 1 year were selected for this study. Two independent chest radiologists reviewed retrospectively the chest CT scans of 101 patients (M. avium disease [n = 57] and M. intracellulare disease [n = 44]) in whom serial CT scans had been obtained at the beginning of and at 12 months after standardized therapy. Each CT study was assessed for the presence and extent of lung parenchymal abnormalities (maximum score, 30). RESULTS After 12 months of antibiotic therapy, 84 patients (83%) had a decrease in the overall CT score, three (3%) had an increase, and 14 (14%) had no change in disease extent. The decrease in total CT score was statistically significant (overall score difference, 2.54; p < 0.0001). Cellular bronchiolitis showed the largest decrease in extent (difference in mean pre and posttreatment scores, -1.02, -1.07, and -0.94 for MAC, M. avium, and M. intracellulare diseases, respectively). Before treatment, patients with M. intracellulare disease showed more extensive disease than patients with M. avium disease (total CT score, 13.31 vs 11.10; p = 0.025). CONCLUSION In the nodular bronchiectatic form of MAC pulmonary disease, lung parenchymal abnormalities show a significant decrease in extent on CT after antibiotic treatment and the decrease is mainly related to the improvement of cellular bronchiolitis.
The Reliability and Validity of the 20-Meter Shuttle Test as a Predictor of Peak Oxygen Uptake in Edinburgh School Children, Age 13 to 14 Years

This study examined the reliability and validity of the 20-meter shuttle test as a predictor of peak VO2 in Edinburgh school children. Thirty-three children (15 boys, 18 girls) performed three shuttle tests and three laboratory treadmill tests of peak VO2. Multiple regression analysis revealed that the prediction of peak VO2 (ml·kg−1·min−1) from shuttle run performance was improved by including skinfold thickness measurements in the prediction models, particularly with the female group. Predictive power was greatest for females when using maximal shuttle speed (kmhr−1) best of three repeat tests and triceps skinfold thickness (mm) (R2 = .85, SEE = 2.4), and for males when using maximal shuttle speed (km·hr−1) best of three repeat tests and the sum of the triceps and subscapular skinfolds (R2 = .68, SEE = 3.23). When using shuttle run performance to predict peak VO2 (ml·kg−1·min−1) in children of this age group, body composition measures must be included in the equation.
Reducing the Use of Short-acting Nifedipine by Hypertensives Using a Pharmaceutical Database

Abstract : Objective: In view of the widespread concerns against prescribing short-acting nifedipine in the treatment of hypertension, the Veterans Health Administration initiated efforts to decrease the common but unapproved use of that agent for treating high blood pressure. Methods: A multitiered approach was implemented, using a national pharmaceutical database to assess drug utilization, followed by educational or remedial intervention at each tier. The first tier of the study determined the total quantity of short-acting nifedipine dispensed, the second tier evaluated data on the prescriptions for the drug, and the third and fourth tiers evaluated patient-specific information to determine to whom and why the drug was prescribed. Results: The first intervention demonstrated a 34 percent decrease in the total quantity of short-acting nifedipine dispensed, compared with the previous year. And action or change was noted in 78 percent of prescriptions in the second intervention. In the third intervention, short-acting nifedipine was prescribed for hypertension in 46.5 percent of the remaining 559 patients, 96 percent of which resulted in an intervention. The final intervention (75 patients) resulted in one prescribed short-acting nifedipine for hypertension under special circumstances. Conclusion: A tiered approach, using a national pharmaceutical database, complemented by local education and intervention, assisted in reducing the use of short-acting nifedipine for hypertension.