Miracle-dz/UniFAR-FTUs huggingface dataset:
Re: Patient specific advice for in‐hospital cardiac arrest survival rates

Dear Editor, I read with interest the recent letter by Doherty et al. I certainly support the general premise that subgroup data can be useful when having conversations with individual patients about resuscitation success. However, the survival rates published in table 1 are much higher than that noted in the literature. In an earlier publication commenting on the same data, the authors acknowledge that their shortterm survival statistics are better than that of national registries based in the United States and the United Kingdom, and attribute this to the location of care delivery, namely regional versus metropolitan care centers. However, these differences likely go beyond the location of care. Importantly, the authors state that while they did not have access to specific characteristics such as whether the arrest was witnessed or if the patients were in a monitored setting, approximately 40% of arrests occurred in the ED. Patients are more likely to be monitored and frequently attended to in the ED than on general medical or surgical wards. It would be useful to present additional subgroups dichotomized on this basis. It would also be useful to dichotomize the data on the basis of the initial rhythm. It is also worthwhile noting that no mention is made of how many of the cardiac arrest survivors had significant neurological or physical impairment post-resuscitation, with these factors also influencing resuscitation preferences. In addition, while I agree with the statement that emergency physicians are well placed to conduct important discussions with patients regarding their resuscitation status, in practice these discussions do not occur frequently. Importantly, for many patients, discussing resuscitation status is an incremental process, requiring multiple conversations. Emergency physicians certainly have an important role to advance the conversation; however, ideally these conversations should begin before presentation to hospital.
Cognitive Intervention with Musical Stimuli Using Digital Devices on Mild Cognitive Impairment: A Pilot Study

The effect of music therapy on cognitive function has been widely reported; however, its clinical implications remain controversial. Performing therapeutic musical activities in groups using individualized instruments can help overcome the issues of engagement and compliance. We aimed to evaluate the effect of a cognitive intervention with musical stimuli using digital devices on mild cognitive impairment (MCI). In this prospective study, 24 patients with MCI (intervention group, 12; and control group, 12) were enrolled. We developed an electronic device with musical instruments and the Song-based Cognitive Stimulation Therapy protocol (SongCST). Patients in the intervention group underwent a 10-week cognitive intervention involving musical stimuli generated by our device. Effect of the intervention on cognitive function was evaluated by the Mini-Mental State Examination-Dementia Screening (MMSE-DS), Montreal Cognitive Assessment-Korean (MOCA-K), and Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB). In the intervention group, MMSE-DS and MOCA-K scores improved significantly after the 10-week intervention. The changes in MOCA-K and CDR-SB scores were significantly different between the intervention and control groups. Our study showed that music therapy with digital devices has a positive effect on the executive function and overall disease severity in patients with MCI. Our study can facilitate individualization of music therapy using digital devices in groups.
“ … I felt completely stranded”: liminality and recognition of personhood in the experiences of suicidal women admitted to psychiatric hospital

ABSTRACT Purpose: The purpose of this study is to explore how patients experience their suicidality and how they experience being in a psychiatric hospital. Methods: This is part of a field study, and the article is based on data collected in interactions with 11 women who were admitted to a psychiatric hospital and were struggling with suicidality. Data were collected through interviews, conversations, and participatory observation. We analysed the data by means of Systematic Text Condensation, followed by a deductive process where the data and preliminary findings were interpreted in light of the theory of liminality. Results: We found that the patients’ experiences of suicidality and being a patient in a psychiatric acute ward involve “Liminality and weakened sense of personhood,” and from their perspective, “Recognition of personhood” is an important aspect of care. Conclusion: Our study indicates that suicidality and psychiatric hospitalization involve liminality and weakened sense of personhood, aspects that are important to consider in the care of the patients. Professionals need to acknowledge more the importance of recognition of personhood in care, since this can strengthen the patient’s self-worth and empower the person. Lack of recognition may increase the patient’s suffering and suicidality.
A decade after introducing MPOWER, trend analysis of implementation of the WHO FCTC in the Eastern Mediterranean Region

Background: Perfect implementation of the six priority policies advocated by the MPOWER package is the most important challenge for member states (MS) to reach tobacco control goals. Methods: A validated checklist set according to the WHO Report on the Global Tobacco Epidemic was filled out five times based on biannual reports from 2011 to 2019 for 22 MS in the Eastern Mediterranean Region. It contained ten topics including smoking prevalence and seven elements of six MPOWER policies and compliances resulting with possible maximum score of 37. High score indicates better implementation. Results: The total score for the region increased from 416 in 2011 to 509 in 2019. Six countries (27% of the region) had more than 75% of total score, whereas 11 countries were between 50% and 75% and five countries had <50% of total score in 2019. In all five reports, Iran was ranked first in the region even in 2019, when it witnessed a 2 point decrease. Iran held the first place alongside with Pakistan and Saudi Arabia with 32 points. The highest score in the indicators was related to the monitoring, reaching from 35 in 2011 to 59 in 2019. The lowest score increase in the indicators was related to the Smoke-free Policy compliance and the prevalence of consumption, reaching from 18 to 20 and 44–48, respectively, between 2011 and 2019. Conclusions: Although several remarkable achievements have been made regarding tobacco control goals, many policy implementation challenges remain and require urgent action by member states in the Eastern Mediterranean region.
Heart Failure in Single Right Ventricle Congenital Heart Disease: Physiologic and Molecular Considerations.

Due to remarkable surgical and medical advances over the past several decades, there are growing numbers of infants and children living with single ventricle congenital heart disease (SV), where there is only one functional cardiac pumping chamber. Nevertheless, cardiac dysfunction and ultimately heart failure is a common complication in the SV population and pharmacologic heart failure therapies have largely been ineffective in mitigating the need for heart transplantation. Given that there are several inherent risk factors for ventricular dysfunction in the setting of SV in addition to probable differences in molecular adaptations to heart failure between children and adults, it is perhaps not surprising that extrapolated adult heart failure medications have had limited benefit in children with SV heart failure. Further investigations into the molecular mechanisms involved in pediatric SV heart failure may assist with risk stratification as well as development of targeted, efficacious therapies specific to this patient population. In this review, we present a brief overview of SV anatomy and physiology, with a focus on patients with a single morphologic right ventricle requiring staged surgical palliation. Additionally, we discuss outcomes in the current era, risk factors associated with the progression to heart failure, present state of knowledge regarding molecular alterations in end-stage SV heart failure and current therapeutic interventions. Potential avenues for improving SV outcomes, including identification of biomarkers of heart failure progression, implications of personalized medicine and stem cell-derived therapies and applications of novel models of SV disease, are proposed as future directions.
Rejoinder to “CACE and meta‐analysis (letter to the editor)” by Stuart Baker

Dr. Baker’s major argument is that in the meta-analysis case study, estimating the effect of epidural analgesia on the occurrence of cesarean section, our approach included only the 10 trials that had complete data for the cross-tabulation of outcome and treatment received for each randomization group, while Baker and Lindeman (2013) used a method they call a “standard CACE meta-analysis” that included data from 15 randomized trials. To respond to this concern, we first demonstrate a way to extend our method to include trials without full noncompliance data, then emphasize the benefits of the Bayesian method. The data—a systematic review of randomized clinical trials of the effect of epidural analgesia in labor on the occurrence of cesarean section—was obtained from Bannister-Tyrrell et al. (2015). Twenty seven studies were reported in their Table 1, but only 9 were included in their exploratory meta-analysis because only 10 trials had full compliance data and 1 of those trials was excluded because it had zero cesarean section events. Using this dataset as an example, we introduce three approaches for estimating CACE in meta-analyses of different complexities under the Bayesian framework.
Sociocultural determinants of adoption of preventive practices for hantavirus: A knowledge, attitudes, and practices survey in Tonosí, Panama

Introduction Hantaviruses are a group of single-stranded RNA viruses carried by small rodent reservoirs, transmitted to humans through inhalation of aerosolized particles of rodent feces, urine, or saliva. In Panama, the Choclo orthohantavirus has been associated with Hantavirus Pulmonary Syndrome (n = 54) and Hantavirus Fever (n = 53). In 2018, there were 107 cases of hantavirus diseases, the majority in the Tonosí district, and 4 deaths. As there is no vaccine or treatment for hantavirus, proper prevention measures by community members is key to stopping outbreaks. Methodology and principal findings We investigated hantavirus knowledge, attitudes, and practices in one corregimiento of Tonosí, Panama to determine what factors influence uptake of prevention practices and high level of knowledge. We conducted a cross-sectional survey with 124 residents covering hantavirus knowledge, attitudes based in the Health Belief Model (perceived severity, perceived susceptibility, perceived obstacles, perceived benefits, and cues to action) and prevention practices. There was an overall high level of knowledge (median score: 4/6), though 20% did not know the route of transmission. The mean number of reported practices performed per person was 8.4 (range: 4–12). Most people had heard of hantavirus through other community members. In linear regression, lower perceived obstacles predicted higher preventive practice score. Reported obstacles to preventive practices included physical restrictions, such as age and health state. In ordinal logistic regression, higher education level and knowing more people who had previously been sick with hantavirus contributed to higher knowledge score. Conclusions Future interventions should focus on removing barriers to performing preventive practices. As most people learned of hantavirus through community members, interventions should be community-based and involve those who have experienced the disease. Any future education materials should address confusions about route of transmission and be targeted at those with a lower education level.
It's costly punishment, not altruistic: Low midfrontal theta and state anger predict punishment.

Punishment in economic games has been interpreted as "altruistic. " However, it was shown that punishment is related to trait anger instead of trait altruism in a third-party dictator game if compensation is also available. Here, we investigated the influence of state anger on punishment and compensation in the third-party dictator game. Therefore, we used movie sequences for emotional priming, including the target states anger, happy, and neutral. We measured the Feedback-Related Negativity (FRN) and midfrontal theta band activation, to investigate an electro-cortical correlate of the processing of fair and unfair offers. Also, we assessed single-trial FRN and midfrontal theta band activation as a predictor for punishment and compensation. We found that punishment was linked to state anger. Midfrontal theta band activation, which has previously been linked to altruistic acts and cognitive control, predicted less punishment. Additionally, trait anger led to enhanced FRN for unfair offers. This led to the interpretation that the FRN depicts the evaluation of fairness, while midfrontal theta band activation captures an aspect of cognitive control and altruistic motivation. We conclude that we need to redefine "altruistic punishment" into "costly punishment," as no direct link of altruism and punishment is given. Additionally, midfrontal theta band activation complements the FRN and offers additional insights into complex responses and decision processes, especially as a single trial predictor.
Unwarranted imaging for distant metastases in patients with newly diagnosed ductal carcinoma in situ and stage I and II breast cancer

Background In 2012, the American Society of Clinical Oncology (ASCO) released a Choosing Wisely Top Five list that included a recommendation against ordering advanced imaging tests to screen for metastases among asymptomatic patients with early breast cancer. Our provincial breast cancer staging guideline was subsequently updated. We report on the use of unwarranted bone scanning (BS), computed tomography (CT), nonbreast magnetic resonance imaging (MRI) and positron emission tomography (PET) among women diagnosed with stage 0–II breast cancer in Alberta in 2011–2015. Methods The cohort was retrospectively ascertained from the Alberta Cancer Registry. We used additional provincial data sources to obtain information about diagnostic imaging tests completed from biopsy to surgical date plus 4 months. The reason for each BS, CT, MRI and PET was abstracted. We calculated the frequency of advanced imaging tests completed for routine metastatic screening. Results Of 10 142 patients included, 2887 (28.5%) had at least 1 advanced imaging test completed for routine metastatic screening. Of these 2887 patients, 438 (15.2%) had a follow-up BS, CT, MRI or PET, and 28 patients (1.0%) had a nonbreast imageguided biopsy. Use of routine advanced imaging tests did not change clearly over time. Conclusion Our results demonstrate persistent use of advanced imaging tests for routine metastatic screening among patients with stage 0–II breast cancer despite the release of the ASCO Choosing Wisely recommendations and the update of our provincial breast cancer staging guideline. Investigation of strategies for guideline translation to improve upon value-based care of patients with early breast cancer is warranted.
Case Report of Isolated Gastric Metastasis of Pancreatic Cancer From a Diagnostic Biopsy: Management of a Rare Oncologic Entity

Pancreatic ductal adenocarcinoma behaves aggressively, with surgically resectable disease having the best chance of long-term survival. Recurrence after surgery and adjuvant therapy is commonly due to distant metastatic disease and is typically managed with systemic therapies, not surgery. We present a rare case of an isolated gastric metastasis due to endoscopic ultrasound-guided with fine-needle aspiration (EUS-FNA) needle tract seeding that was managed surgically. Treatment was informed by input from a mutlidisciplinary team of medical, surgical, and radiation oncologists, radiologists, and pathologists. Rising carbohydrate antigen (CA)19-9 levels suggested disease recurrence, but the tumor’s unusual location and slow growth made diagnosing the cause difficult, resulting in the late identification of the tumor. Palliative resection was performed, rending the patient with no evidence of disease followed by normalized CA19-9 levels. This case highlights the importance of multidisciplinary decision-making in detecting and treating the uncommon but significant tumor seeding with EUS-FNA biopsies in pancreatic ductal adenocarcinoma.
Influence of fast-track programs on patient-reported outcomes in total hip and knee replacement (THR/TKR) at Swedish hospitals 2011–2015: an observational study including 51,169 THR and 8,393 TKR operations

Background and purpose — Fast-track care programs have been broadly introduced at Swedish hospitals in elective total hip and knee replacement (THR/TKR). We studied the influence of fast-track programs on patient-reported outcomes (PROs) 1 year after surgery, by exploring outcome measures registered in the Swedish arthroplasty registers. Patients and methods — Data were obtained from the Swedish Knee and Hip Arthroplasty Registers and included TKR and THR operations 2011–2015 on patients with osteoarthritis. Based on questionnaires concerning the clinical pathway and care programs at Swedish hospitals, the patients were divided in 2 groups depending on whether they had been operated in a fast-track program or not. PROs of the fast-track group were compared with not fast-track using regression analysis. EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS were analyzed for both THR and TKR operations. The PROMs for TKR also included KOOS. Results — The differences of EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS 1 year after surgery were small but all in favor of fast-track for both THR and TKR, also in subscales of KOOS for TKR except KOOS QoL. However, the effect sizes as measured by Cohens’ d formula were < 0.2 for all PROs, in both THR and TKR. Interpretation — Our results indicate that the fast-track programs may be at least as good as conventional care from the perspective of PROs 1-year postoperatively.
Reproductive morphophysiology of the male scorpion mud turtle (Kinosternon scorpioides Linnaeus, 1766) in captivity

Abstract Kinosternon scorpioides, popularly known as scorpion mud turtle (jurará in Brazil), is a fresh water species. There is little information about its reproduction and the present study aims to morphologically characterize the reproductive organs of male K.scorpioides bred in captivity in two seasons of the year. The reproductive tracts of adult animals under went macroscopic ultrastructural analysis of the lumen, as well as scanning electron and transmission microscopy. Macroscopically, the male genital organs consist of a pair of testicles, epididymis, the vas deferens and a penis. Testicles, epididymis and deferents ducts were characterized by reproductive activity during the rainy season and reproductive inactivity in the dry period. The morphometry regarding the tubular and luminal diameter and epithelial height of the testicles, epididymis and deferents ducts showed changes along the studied periods. The rainy season presented higher averages than the dry period. The penis did not show any changes during both periods. It was concluded that K. scorpioides exhibits reproductive seasonality.
Effects of Fish Predators on the Mass-Related Energetics of a Keystone Freshwater Crustacean

Little is known about how predators or their cues affect the acquisition and allocation of energy throughout the ontogeny of prey organisms. To address this question, we have been comparing the ontogenetic body-mass scaling of various traits related to energy intake and use between populations of a keystone amphipod crustacean inhabiting freshwater springs, with versus without fish predators. In this progress report, we analyze new and previously reported data to develop a synthetic picture of how the presence/absence of fish predators affects the scaling of food assimilation, fat content, metabolism, growth and reproduction in populations of Gammarus minus located in central Pennsylvania (USA). Our analysis reveals two major clusters of ‘symmorphic allometry’ (parallel scaling relationships) for traits related to somatic versus reproductive investment. In the presence of fish predators, the scaling exponents for somatic traits tend to decrease, whereas those for reproductive traits tend to increase. This divergence of scaling exponents reflects an intensified trade-off between somatic and reproductive investments resulting from low adult survival in the face of size-selective predation. Our results indicate the value of an integrated view of the ontogenetic size-specific energetics of organisms and its response to both top-down (predation) and bottom-up (resource supply) effects.
Effects of transcutaneous electrical nerve stimulation on physical symptoms in advanced cancer patients receiving palliative care

Transcutaneous electrical nerve stimulation (TENS) is primarily used for pain, but might be useful for various other physical symptoms, including nausea, fatigue, dyspnea, and constipation. However, few studies have used TENS for treating the physical symptoms of patients with advanced cancer. In this crossover trial, we assess the effects of TENS on pain and other physical symptoms in 20 in-patients with advanced cancer receiving palliative care. For 5-day phases between wash out periods of 5 days, patients received TENS or non-TENS. TENS was delivered at four points: the center of the back for mainly nausea and dyspnea, on the back at the same dermatomal level as the origin of the pain (100 Hz), and on both ankle joints for constipation (10 Hz). The intensity of pain and the total opioid dose used during phases were recorded. Physical symptoms were evaluated using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 Palliative Care (QLQ-C15-PAL). Hematological and biochemical data were recorded before and after the TENS phase. The average pain and total number of opioid rescue doses were significantly reduced by TENS. TENS tended to improve nausea and appetite loss, but not constipation. There were no effects on hematological and biochemical parameters. Use of TENS could safely improve pain, nausea, and appetite loss in patients with advanced cancer. Although it cannot be used as a substitute for opioids and other pharmaceutical treatment, it may be useful to support palliative care.