Miracle-dz/UniFAR-FTUs huggingface dataset:
A 5-step intervention to help family members in Italy who live with substance misusers

Background: Family members of people with serious alcohol or drug problems are negatively affected by the behaviour and problems of their substance misusing relative. Aims: Conduct a feasibility study, testing whether a intervention successful in the UK, aimed at helping family members of people with alcohol or drug problems (the 5-Step Intervention), would also be applicable in Italy. Method: Feasibility study. Results: It is feasible to deliver this intervention in Italy. Materials were successfully translated and back-translated and were deemed relevant for an Italian context; different health services organizations and their staff were recruited to participate; 52 family members were recruited and received the intervention. Before-and-after comparisons of these family members' physical and psychological symptoms, and their coping methods, showed that major and significant changes were made during and following the intervention. Conclusions: How family members cope with living with a relative with alcohol or drug problems is important. Issues related to the generalizability of the intervention are discussed, including the transferability of therapeutic interventions within Europe at a time of greater trans-European mobility, and the generalizability of the possible intervention to other contexts. Declaration of interest: There are no conflicts of interest.
The Hidden Dimension: Psychodynamics in Compulsive Drug Use

This is a vast book, in its intellectual breadth and its extensive review of pertinent literature. The author has been director of a major medical school alcohol and drug abuse program but is also scholar, physician, philosopher, and psychoanalyst. In describing the intrapsychic experience of the compulsive drug user, Wurmser makes his most important contribution. The author emphasizes and supports with clinical evidence the finding that addicts, except for a few alcoholics and cigarette users, have serious psychopathological conditions that antedate their excessive drug use and that dominate treatment difficulties. The single diagnosis most frequently represented is the "borderline personality organization," extensively described recently by Kohut and Kernberg. In Wurmser's own Methadone Maintenance Program population, 10% of patients were frankly psychotic; 30%, severely paranoid or depressed; 30%, episodically deeply regressed; and only 30% had moderate psychopathological conditions controllable with methadone and the milieu of the treatment facility alone. Through examination
Associations between improved glucose control and patient-reported outcomes after initiation of insulin pump therapy in patients with type 2 diabetes mellitus.

BACKGROUND This study assessed the relationship between changes in glucose control and changes in patient-reported outcomes (PRO)--health-related quality of life (HR-QoL) and treatment satisfaction (TxSat)--in patients with type 2 diabetes initiating insulin pump therapy. METHODS Patients (n = 54) initiating insulin pump therapy (Animas(®) 2020, Animas Corp., West Chester, PA) were studied for 16 weeks. Glucose control was measured with patient-blinded continuous glucose monitoring (CGM) (SEVEN(™), DexCom, San Diego, CA) and unblinded glycosylated hemoglobin (A1C) and seven-point self-monitored blood glucose (SMBG) profiles. HR-QoL was measured using the Diabetes Symptom Checklist-Revised (DSC-R) and the EuroQol-5 Dimensions (EQ-5D). TxSat was measured using the Insulin Delivery System Rating Questionnaire (IDSRQ) clinical efficacy and treatment preference scales. Bivariate correlations assessed associations between measures of change from baseline. RESULTS Decreased A1C was associated only with improvement in IDSRQ clinical efficacy. For CGM and SMBG, reductions in mean glucose concentrations were associated with decreased DSC-R symptoms, improved EQ-5D health utility, and increased IDSRQ perceived clinical efficacy and treatment preference. Reduced glycemic variability was associated with improved EQ-5D health utility and increased IDSRQ treatment preference. CGM and SMBG readings from different times of day/night were differentially associated with all PRO. CONCLUSIONS Findings suggest that A1C, representing an "average" of both high and low blood glucose values throughout the day, may not capture aspects of glucose control with the greatest impact on HR-QoL. Although TxSat was more strongly associated with A1C and mean glucose readings than with glycemic variability, HR-QoL was more strongly associated with glycemic variability.
Microneedle-based intradermal versus subcutaneous administration of regular human insulin or insulin lispro: pharmacokinetics and postprandial glycemic excursions in patients with type 1 diabetes.

BACKGROUND This study assessed pharmacokinetics (PK) and pharmacodynamic postprandial glycemia (PPG) in patients with type 1 diabetes mellitus (T1DM) after a standardized liquid meal following insulin lispro (IL) or regular human insulin (RHI) given by microneedle-based intradermal (ID) versus subcutaneous (SC) delivery. RESEARCH DESIGN AND METHODS In this randomized, open-label, five-way crossover study, 29 T1DM patients received IL and RHI (0.125 U/kg) at 2 min and 17 min premeal, respectively, by both the SC and ID routes and also received RHI by the ID route at 2 min premeal. Blood glucose was stabilized at 120 mg/dL prior to a standardized 82-g carbohydrate liquid meal. ID delivery used a 34-gauge 1.5-mm steel microneedle, and SC delivery used a 31-gauge 8-mm syringe needle. RESULTS The 90-min PPG (blood glucose area under the curve for 0-1.5 h) for ID RHI was 14% lower than SC RHI at -17 min (P < 0.0001) and 11% lower than ID RHI at -2 min (P = 0.0006). PPG did not differ between ID RHI and SC IL, both at -2 min (P = 0.8345). ID IL PPG was lower than SC, both at -2 min, but not significantly (P = 0.10). Both ID IL and ID RHI PK data showed significantly faster uptake and time to maximum concentration, higher maximum concentration, and shorter systemic circulating duration versus SC dosing. ID IL and RHI delivery was generally well tolerated. CONCLUSIONS PPG with RHI administered ID via microneedle was improved versus SC delivery when dosed 17 min premeal. ID RHI provided similar control of PPG as SC IL immediately premeal. Further studies of ID insulin delivery via steel microneedles are warranted.
Diagnostic characteristics of lower limb venous compression ultrasonography in suspected pulmonary embolism: a meta‐analysis

Essentials Lower limb ultrasonography (CUS) could be useful in suspected pulmonary embolism (PE). We performed a metaanalysis on the diagnostic characteristics of CUS in suspected PE. With a sensitivity of 41%, proximal CUS would be positive in one of every 7.3 patients. Complete CUS has a higher sensitivity but specificity for PE is too low to use it in suspected PE.
Genetic risk factors for venous thrombosis in the elderly in a case–control study

Essentials Risk of venous thrombosis (VT) related to common genetic variants in those aged 70+ is unknown. We studied Factor V Leiden, prothrombin mutation, non‐O blood group and family history (FH) of VT. Risk of VT was increased 2.2‐, 1.4‐, 1.3‐ and 2.1‐fold respectively. FH is easy to obtain and can be implemented in clinical decision rules of VT risk in the elderly.
Specificity in pollination and consequences for postmating reproductive isolation in deceptive Mediterranean orchids

The type of reproductive isolation prevalent in the initial stages of species divergence can affect the nature and rate of emergence of additional reproductive barriers that subsequently strengthen isolation between species. Different groups of Mediterranean deceptive orchids are characterized by different levels of pollinator specificity. Whereas food-deceptive orchid species show weak pollinator specificity, the sexually deceptive Ophrys species display a more specialized pollination strategy. Comparative analyses reveal that orchids with high pollinator specificity mostly rely on premating reproductive barriers and have very little postmating isolation. In this group, a shift to a novel pollinator achieved by modifying the odour bouquet may represent the main isolation mechanism involved in speciation. By contrast, orchids with weak premating isolation, such as generalized food-deceptive orchids, show strong evidence for intrinsic postmating reproductive barriers, particularly for late-acting postzygotic barriers such as hybrid sterility. In such species, chromosomal differences may have played a key role in species isolation, although strong postmating–prezygotic isolation has also evolved in these orchids. Molecular analyses of hybrid zones indicate that the types and strength of reproductive barriers in deceptive orchids with contrasting premating isolation mechanisms directly affect the rate and evolutionary consequences of hybridization and the nature of species differentiation.
Preface to the Second Printing of This Supplement

Health Education Systems, Inc (HESI) is pleased to sponsor the second printing of the supplement to CIN: Computers, Informatics, Nursing and Nurse Educator, which contains published research articles focused on HESI testing. Two recently published, peer-reviewed research articles expand the selection of articles provided in the original supplement and offer additional support for the use of HESI examinations throughout the curriculum. The evidence-based research provided in these articles describe HESI examinations as psychometrically sound measures, useful in preparing students for the NCLEXRN, as well as evaluating student performance from program entry to exit in traditional and accelerated nursing curricula. The authors of these articles describe HESI examinations as reliable and valid measures for benchmarking program outcomes, measuring student achievement, and guiding remediation prior to licensure candidacy. The ongoing nature of such research exemplifies HESI’s commitment to supporting excellence in nursing education and practice. That commitment was strengthened by the company’s recent acquisition in January 2006 by Elsevier, a leading publisher of content and remediation resources for nursing. The full array of quality HESI testing products—custom, specialty, and exit examinations, now labeled as Evolve REACH powered by HESI—are enhanced by Elsevier’s remediation resources. This combination of resources contributes to the goal of HESI and Elsevier—to provide excellent products for nursing education.
Immunochip analysis identifies novel susceptibility loci in the human leukocyte antigen region for acquired thrombotic thrombocytopenic purpura

Essentials Genetic predisposition to acquired thrombotic thrombocytopenic purpura (aTTP) is mainly unknown. Genetic risk factors for aTTP were studied by Immunochip analysis and replication study. Human leukocyte antigen (HLA) variant rs6903608 conferred a 2.5‐fold higher risk of developing aTTP. rs6903608 and HLA‐DQB1*05:03 may explain most of the HLA association signal in aTTP.
Predictors of active cancer thromboembolic outcomes: validation of the Khorana score among patients with lung cancer: comment

1 South K, Freitas MO, Lane DA. Conformational quiescence of ADAMTS-13 prevents proteolytic promiscuity. J Thromb Haemost 2016; 14: 2011–22. 2 South K, Luken BM, Crawley JT, Phillips R, Thomas M, Collins RF, Deforche L, Vanhoorelbeke K, Lane DA. Conformational activation of ADAMTS13. Proc Natl Acad Sci USA 2014; 111: 18578–83. 3 Muia J, Zhu J, Gupta G, Haberichter SL, Friedman KD, Feys HB, Deforche L, Vanhoorelbeke K, Westfield LA, Roth R, Tolia NH, Heuser JE, Sadler JE. Allosteric activation of ADAMTS13 by von Willebrand factor. Proc Natl Acad Sci USA 2014; 111: 18584–9.
Amyloidosis-where are we now and where are we heading?

CONTEXT Amyloidoses are disorders of diverse etiology in which deposits of abnormally folded proteins share distinctive staining properties and fibrillar ultrastructural appearance. Amyloidosis ultimately leads to destruction of tissues and progressive disease. With recent advances in the treatment of systemic amyloidoses the importance of an early diagnosis of amyloid, and a correct diagnosis of its type, has been realized. OBJECTIVE To summarize current recommendations for the diagnosis of amyloidosis. DATA SOURCES Presentation given at the 4th Annual Renal Pathology Society Satellite meeting in Istanbul based on discussions and recommendations formulated during an interactive diagnostic session held at the XIth International Symposium on Amyloidosis in Woods Hole, Massachusetts. CONCLUSIONS Congo red stain is currently the gold standard for amyloid detection and the goal is to detect amyloid early. Diagnosis of the amyloid type must be based on the identification of amyloid protein within the deposits and not solely by reliance on clinical or DNA studies. However, the latter are recommended for confirmation of the amyloid type based on evaluation of the protein in deposits. Immunohistochemistry must be performed and interpreted with caution and inconclusive results must be evaluated further using the more sophisticated methods available in referral centers. An adequate amount and quality of tissue must be available for amyloid diagnosis and typing with emphasis on the use of fresh tissue and greater use of abdominal fat biopsy. The development of new technologies underscores the need for regular review of recommendations and standards for the clinical diagnosis of amyloidosis.
Sociality and health: impacts of sociality on disease susceptibility and transmission in animal and human societies

This paper introduces a theme issue presenting the latest developments in research on the impacts of sociality on health and fitness. The articles that follow cover research on societies ranging from insects to humans. Variation in measures of fitness (i.e. survival and reproduction) has been linked to various aspects of sociality in humans and animals alike, and variability in individual health and condition has been recognized as a key mediator of these relationships. Viewed from a broad evolutionary perspective, the evolutionary transitions from a solitary lifestyle to group living have resulted in several new health-related costs and benefits of sociality. Social transmission of parasites within groups represents a major cost of group living, but some behavioural mechanisms, such as grooming, have evolved repeatedly to reduce this cost. Group living also has created novel costs in terms of altered susceptibility to infectious and non-infectious disease as a result of the unavoidable physiological consequences of social competition and integration, which are partly alleviated by social buffering in some vertebrates. Here, we define the relevant aspects of sociality, summarize their health-related costs and benefits, and discuss possible fitness measures in different study systems. Given the pervasive effects of social factors on health and fitness, we propose a synthesis of existing conceptual approaches in disease ecology, ecological immunology and behavioural neurosciences by adding sociality as a key factor, with the goal to generate a broader framework for organismal integration of health-related research.
Control and coordination of bladder and urethral function in the brainstem of the cat

Stimulation and lesion experiments in the pontine tegmentum of 34 cats, with urodynamic measurements both pre‐ and peroperatively and during up to 4 months of follow‐up, have confirmed the existence of two different brainstem regions concerned with lower urinary tract function. In the dorsolateral pontine tegmentum, a compact, dorsomediolaterally located M region, corresponding to Barrington's micturition centre, reacts specifically to electrical stimulation, causing prompt relaxation of the anal and urethral striated sphincters followed after about 2 s by detrusor contraction, as in normal micturition. Bilateral lesions in this M region lead to a 2–9 week period of urinary retention, during which detrusor activity is depressed and the bladder capacity increases. Stimulation in a larger, more diffuse, more laterally located L region elicits sphincter activity: contraction of the striated urethral sphincter together with an increase in the anal‐sphincter EMG, or relaxation of the striated urethral sphincter together with either a decrease or an increase in the anal‐sphincter EMG. Provided lethal respiratory complications can be avoided, bilateral lesions in this L region lead after a few days to a state, lasting up to 2 months, in which there is urinary incontinence accompanied by a decrease in the bladder capacity and detrusor overactivity. Neither type of lesion leads to true detrusor‐urethra dyssynergia. However, because the amplitude of anal‐sphincter EMG sometimes increases when the striated urethral sphincter relaxes, observations of the anal‐sphincter EMG can misleadingly suggest dyssynergia. Brainstem mapping of the results of stimulation suggests a motor pathway running from the M to the L region and another descending caudally from the L region. The observations suggest that the M region forms a true micturition centre, facilitating the detrusor voiding contraction and also (via the presumptive connection with the L region) ensuring synergic sphincter relaxation. The L region appears not only to relay this voiding sphincter relaxation, but to be responsible for control of the pelvic floor and its sphincters in general, and for helping to maintain urinary continence.
Impact of telemedicine assessment on glycemic variability in children with type 1 diabetes mellitus.

BACKGROUND Experimental and in vitro studies have related glycemic variability (GV) with activation of oxidative stress, which could be involved in the micro- and macrovascular damage found in diabetes mellitus and in acute complications such as hypoglycemia. Some GV indexes are currently integrated in specialized Web sites for the analysis and assessment of diabetes patients through telemedicine. We aimed to identify the impact of telemedicine on metabolic control and GV in prepubescent patients with type 1 diabetes mellitus (T1DM). SUBJECTS AND METHODS Eighty patients between 6 and 10 years old were eligible for enrollment. Participation was accepted by the parents of only 15 (18%) patients, of whom 13 (86%) completed the study. These 13 patients were assessed fortnightly for 3 months through Accu-Chek (Roche, Mannheim, Germany) Smart Pix software; this period was compared with a subsequent 4-month period without telemedical support. The variables analyzed were mean glycated hemoglobin (HbA1c), mean blood glucose (MBG), and indexes of GV (SD, low blood glucose index [LBGI], high blood glucose index [HBGI], and the average daily risk range [ADRR]). In both periods, the patients attended their regular appointments. The statistical analysis was carried out with nonparametric tests (the Wilcoxon and Friedman tests, P<0.017). RESULTS At the end of the assessment phase, mean HbA1c levels were significantly reduced (P=0.012) with no significant reductions in the LBGI (P=0.115), ADRR (P=0.552), or SD (P=0.700). No significant increases were observed in MBG (P=0.861) or the HBGI (P=0.807). HbA1c and the LBGI, ADRR, and SD indexes increased when telemedical assistance was suspended, whereas MBG and the HBGI showed a nonsignificant reduction. CONCLUSIONS Telemedical assessment for 3 months in children improved metabolic control, by reducing HbAlc values and, to a lesser extent, by decreasing GV, without increasing acute complications. Metabolic control was reduced when the advice was suspended.
Collaborating to Obtain Phonological Acquisition Data for Local Schools.

PURPOSE Twelve school-based speech-language practitioners enlisted the assistance of a university clinical phonologist to help them implement a collaborative research project for their school system in order to investigate phonological acquisition. METHOD The school practitioners transcribed speech samples of 520 typically developing children between the ages of 2:6 and 8:0 (years:months). Responses were coded for syllable/word structures (e.g., final consonant deletion) and phoneme classes (e.g., velar deficiencies). RESULTS The 3-year-olds in this sample had acquired all major phoneme classes except liquids. For the older participants, /l/ was acquired between 4 and 5 years of age and /r/ between 5 and 6 years of age. Although the strident phoneme class had reached the criterion for acquisition by age 3 years, sibilant lisps were still common until the age of 7 years. Another finding was the rare occurrence of omissions. CLINICAL IMPLICATIONS The practitioners resolved that when determining whether a preschooler would be eligible to receive treatment services as a part of their caseloads, consistent speech sound omissions appeared to be a critical indicator and should be considered a higher priority than substitutions and/or distortions. CONCLUSION The collaborative effort between the university clinical phonologist and the school-based speech-language practitioners was considered to be a valuable experience and a model for future collaborative partnerships.
Effect of two Spanish breeds and diet on beef quality including consumer preferences.

BACKGROUND Farmers in dry mountain areas are changing their management strategies to improve livestock farming efficiency, by using different forages or different breeds. The effect of breed (Parda de Montaña vs. Pirenaica) and finishing diet (grazing on meadows vs. a total mixed ration (50% alfalfa, 40% maize grain, 10% straw)) on carcass characteristics and meat quality of steers was studied. RESULTS Parda de Montaña had a greater (P < 0.01) amount of intramuscular fat than Pirenaica. The finishing diet did not influence carcass fat color, but fatty acid composition was slightly affected. Finishing steers on a total mixed ration increased the percentage of fat of the 10th rib (P < 0.001). Supplementation with concentrates increased the diet energy concentration and also increased the dressing percentage. CONCLUSIONS Both breeds had similar carcass characteristics. Consumers preferred beef from the Pirenaica breed because of its greater tenderness. Consumers did not differentiate between beef from animals fed different finishing diets. However, consumers who like meat very much preferred meat aged in a cooler at 4 °C for 15 days rather than 8 days.