Miracle-dz/UniFAR-FTUs huggingface dataset:
Music Therapists' Self-Care: Examining the Effectiveness of Educational Preparation for Clinical Practice.

The purpose of this study was to explore the effectiveness of undergraduate academic and clinical training programs for music therapy in addressing the subject of personal growth, as it relates to the development of critical self-awareness and self-care strategies. The study further attempted to identify which self-care strategies are being used by practicing music therapy clinicians and how a practice of self-care impacts their work with distressed and/or traumatized individuals. An electronic survey sent to all board-certified music therapists (MT-BCs) (N = 6369) generated a demographic profile of music therapy practitioners who identified their clientele as distressed and/or traumatized. The survey doubled as a means to identify a sample population for participation in face-to-face interviews. These interviews disclosed the clinicians’ perception of the effectiveness of their educational programs in preparing them to work with trauma-informed populations. An arts-based response further provided qualitative information corroborating the interviews. An open-ended survey questionnaire sent to academic directors of AMTA approved program directors (N = 79), investigated whether curricula related to self-care was included. The results revealed that 63.83% of MT-BCs (bachelor, masters, and doctorate levels) identified their clientele as distressed and/or traumatized. Specifically, 45.03% were bachelor-level clinicians. Results of the survey questionnaire to academic program directors (n = 16; 20.25% responding) indicated that 50% did not include a dedicated unit on self-care in their curricula. Interviews with clinicians exposed that 37.5% graduated from either graduate or undergraduate programs where the topic of self-care was not
Levosimendan in cardiogenic shock : The magic drug for every patient ?

should be done to confirm the efficacy and safety of each laxative. For example, one study reported that the use of lactulose was frequently associated with diarrhea (10). As diarrhea is another major complication in critically ill patients (1), and as it can cause the loss of water, electrolytes, and nutrients, the safety of the laxatives in this aspect should further be studied. Constipation is one possible problem that prevents critically ill patients from being discharged from the ICU, but no systematic guidelines seem to be readily available for its management (2). We should establish effective strategies not only to encourage gastric emptying but also to relieve constipation, to reduce the morbidity and mortality associated with impaired gastrointestinal motility. Takashi Asai, MD, PhD Department of Anesthesiology Kansai Medical University Moriguchi City, Osaka Japan
Current evidence supporting a role of cannabinoid CB1 receptor (CB1R) antagonists as potential pharmacotherapies for drug abuse disorders

Since the discovery of the cannabinoid CB1 receptor (CB1R) in 1988, and subsequently of the CB2 receptor (CB2R) in 1993, there has been an exponential growth of research investigating the functions of the endocannabinoid system. The roles of CB1Rs have been of particular interest to behavioral pharmacologists because of their selective presence within the central nervous system (CNS) and because of their association with brain-reward circuits involving mesocorticolimbic dopamine systems. One potential role that has become of considerable recent focus is the ability of CB1Rs to modulate the effects of drugs of abuse. Many drugs of abuse elevate dopamine levels, and the ability of CB1R antagonists or inverse agonists to attenuate these elevations has suggested their potential application as pharmacotherapies for treating drug abuse disorders. With the identification of the selective CB1R antagonist, SR141716, in 1994, and its subsequent widespread availability, there has been a rapid expansion of research investigating its ability to modulate the effects of drugs of abuse. The preliminary clinical reports of its success in retarding relapse in tobacco users have accelerated this expansion. This report critically reviews preclinical and clinical studies involving the ability of CB1R antagonists to attenuate the effects of drugs of abuse, while providing an overview of the neuroanatomical and neurochemical points of contact between the endocannabinoid system and systems mediating abuse-related effects. Behavioural Pharmacology 16: 275–296 c 2005 Lippincott Williams & Wilkins.
SR 141716A differentially attenuates the behavioral effects of D-THC in rhesus monkeys

The prototypic cannabinoid CB1 antagonist SR 141716A is one important pharmacologic tool for examining CB1 receptors that mediate the behavioral and physiologic effects of D-tetrahydrocannabinol (D-THC). This study examined the effects of SR 141716A on the rate-decreasing, hypothermic and discriminative stimulus effects of D-THC in rhesus monkeys. In monkeys (n = 4) responding under a multiple fixed ratio (FR-10:FR-10) schedule of food presentation and stimulus–shock termination, the potency of i.m. D-THC to decrease responding in the food component (ED50 = 0.64 mg/kg) was threefold greater than its potency in the stimulus–shock termination component (ED50 = 2.14 mg/kg). In the same monkeys, hypothermia was induced by D-THC at a dose (e.g. 0.32 mg/kg) that did not alter responding in either schedule component; the maximum decrease was 2.18C at a dose of 3.2 mg/kg. A dose of 0.32 mg/kg of SR 141716A, significantly attenuated D-THC-induced hypothermia without attenuating the rate-decreasing effects of D-THC in either component of the multiple schedule. The largest dose of i.m. SR 141716A that was studied, 1.0 mg/kg, significantly decreased rectal temperature and responding in the food component but did not significantly decrease responding in the stimulus–shock termination component of the multiple schedule. In a separate group of monkeys (n = 3) that discriminated i.v. D-THC (0.1 mg/kg) while responding under an FR-5 schedule of stimulus–shock termination, SR 141716A (0.32 and 1 mg/kg) significantly increased the ED50 of the D -THC by 2.3and 3.7-fold, respectively. Collectively, these results demonstrate that the behavioral effects of D-THC are not equally attenuated by SR 141716A. Behavioural Pharmacology 16:363–372 c 2005 Lippincott Williams & Wilkins.
The Effect of Cubicle and Straw Yard Housing on the Behaviour, Production and Hoof Health of Dairy Cows

An experiment is described where 40 spring-calving dairy cows were allocated to be housed in a deep straw yard or a cubicle house from November to April, in order to examine the effects on behaviour, milk production and hoof health. Cows in straw yards spent longer lying down and feeding, except during oestrus when they increased their time spent standing proportionately more than cows in cubicles. In the straw yard cows spent longer in associative behaviour during oestrus and had fewer unsuccessful mounting attempts. There were no differences in milk production or composition but cows in the straw yard lost more weight after calving. Cows in the cubicles had a reduction in heel depth, which is a predisposing factor to lameness. It is concluded that a straw yard system for dairy cows allows greater opportunity to display normal behaviour, leads to better hoof health and provides acceptable levels of production.
Open Reduction and Internal Fixation Versus Hemiarthroplasty in the Management of Complex Articular Fractures and Fracture-dislocations of the Proximal Humerus

Background This study compares open reduction and internal fixation (ORIF) versus hemiarthroplasty (HA) in the management of proximal humerus fracture-dislocations and complex articular humeral head fractures. Methods The records of consecutive patients with Neer 3- and 4-part fracture-dislocations, surgical neck fracture-dislocations with severe articular impaction, and any head-split fracture treated surgically at our institution were studied retrospectively. Constant–Murley scores, Disability of the Arm, Shoulder and Hand (DASH), American Shoulder and Elbow Surgeons Shoulder (ASES), and Short Form Health Survey (SF-36) scores were obtained and compared between ORIF versus HA treatment. Results Thirty patients were included in the analysis: 15 treated with ORIF were compared to 15 treated with HA with an average follow-up of 60 months. The mean Constant score (72 ± 15 vs 54 ± 19; P = .007), DASH score (13 ± 17 vs 29 ± 18; P = .006), ASES score (87 ± 13 vs 66 ± 22; P = .003), and SF-36 physical composite score (PCS) (50 ± 11 vs 40 ± 11; P = .02) all favored the ORIF group. Because of the potential confounding variable posed by including younger patients, we performed a subgroup analysis of patients older than 50 years. In this group, the Constant, DASH, ASES, and PCS scores remained significantly better in the ORIF group. Conclusion Results of this retrospective study show improved patient-reported outcomes and quality of life scores in patients undergoing ORIF for complex proximal humerus fractures as compared to patients undergoing HA, despite a higher revision rate in the ORIF cohort. When considering patients older than 50 years, outcomes after ORIF were better than HA.
The Effect of Nutritional Education Program Based on Health Belief Model (HBM) on the Knowledge of Fasting Type 2 Diabetic Patients

Background and Objectives: Studies have shown that many people with diabetes are fasting in the holy month of Ramadan. Ramadan fasting causes several changes in metabolism, habit and lifestyle that are associated with an increased risk of hypoglycemia and hyperglycemia in diabetic patients. An educational program based on behavioral science theory in the field of diet and medication changes, proper physical activity during Ramadan fasting, recognizing risks and symptoms of fasting complications and the management may improve the diabetic patients' ability in changing lifestyle, reduce the risk of fasting complications and weight and metabolic control during Ramadan. This study aimed to investigate the effect of nutritional education program based on health belief model (HBM), on the knowledge of type 2 diabetic patients who fast in Ramadan. Materials and Methods: This randomized clinical trial was conducted on 53 type 2 diabetic patients referring to the Diabetes Clinic of Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences and tending to fast during Ramadan, who were recruited based on the research inclusion criteria. The subjects were randomly assigned into two groups of intervention (n=28) and control (n=25). A week before Ramadan, the intervention group was educated based on HBM. In a week before and after Ramadan, the data on demography, HBM components and knowledge were collected through face-toface interview by trained nutritionists. Results: The research results revealed that the education program in the intervention group significantly increased the HBM components such as perceived severity, perceived benefits, perceived barriers, and self-efficacy comparing to the baseline and the control group (P<0.005). At the end of the study, there was a significant difference in the scores of knowledge about fasting conditions and medications, nutrition and physical activity between the two groups (P<0.001, P=0.049 and P=0.013, respectively). The educational intervention significantly increased the total knowledge score, as well as the fasting conditions and medications and blood glucose control scores compared to the baseline values; also in comparison with the control group, the scores of fasting conditions and medications, blood glucose control and total knowledge increased significantly in the intervention group. Conclusions: The findings showed an increase the knowledge level and improvement in the HBM components in the intervention group compared with the control group. It seems that focused Ramadan education could increase Ramadan knowledge of patients and empower them to proper management of diabetes during the holy Ramadan.
R-citalopram counteracts the antidepressant-like effect of escitalopram in a rat chronic mild stress model

The selective serotonin (5-HT) reuptake inhibitor, citalopram, is a racemic mixture of the stereoisomers, S-(+)-citalopram (escitalopram) and R-(−)-citalopram (R-citalopram). R-citalopram has been shown to counteract the 5-HT enhancing properties of escitalopram in acute studies in animals. In the present study we report, for the first time, on an interaction between R-citalopram and escitalopram after repeated dosing in a rat chronic mild stress (CMS) model of depression. The effect of escitalopram (2.0, 3.9 and 7.8 mg/kg per day), R-citalopram (7.8 mg/kg per day) and escitalopram 3.9 mg/kg per day plus R-citalopram 7.8 mg/kg per day were studied and compared to the effect of citalopram (8.0 mg/kg per day), imipramine and R-fluoxetine (8.9 mg/kg per day). Significant effects relative to a vehicle-treated group were achieved from week 1 for escitalopram (3.9 and 7.8 mg/kg per day), from week 2 for citalopram (8.0 mg/kg per day), from week 3 for R-fluoxetine (8.9 mg/kg per day) and from week 4 for escitalopram (2.0 mg/kg per day) and imipramine (8.9 mg/kg per day). R-citalopram (7.8 mg/kg per day) and escitalopram (3.9 mg/kg per day) plus R-citalopram (7.8 mg/kg per day) did not differ significantly from vehicle. There were no drug-induced effects in non-stressed control groups. In conclusion, escitalopram showed a shorter time to response in the rat CMS model of depression than citalopram, which was faster acting than R-fluoxetine and imipramine. R-citalopram counteracted the effect of escitalopram. The mechanism of action of R-citalopram is, at the moment unclear, but may be relevant to the improved clinical antidepressant activity seen with escitalopram in comparison with citalopram, and may also indicate an earlier response to escitalopram compared to other selective serotonin reuptake inhibitors (SSRIs).
Discharge Bias by Time-Specific Measures or Stratification of Reporting of In-Hospital ICU Mortality by Hospital Bed Size To the

e684 www.ccmjournal. org October 2014 • Volume 42 • Number 10 intervention likely influenced participant behaviors via the Hawthorne effect (3). Additionally, no mention is made about the ethicist’s prestudy activities and involvement with ICU teams. Absence of a significant difference between study arms may be because variables, such as length of stay, were already reduced, in part, due to previous ethics competencies of the clinical staff, ethics capacity-building efforts, or a positive ethical climate of the institution. Second, the study focuses on a narrow set of outcome measures which may not reflect ethically important procedural aspects of healthcare decision making, such as patients’ abilities to exercise their legally protected rights as well as surrogates’ and clinicians’ abilities to fulfill their ethical responsibilities. Furthermore, cost reduction is only part of the economic equation as an ethically appropriate outcome may incur greater costs for certain patients. Perception of quality of care is also debatable as a measure of effective ethics consultations because the ethically strongest option will not necessarily be personally satisfying to each patient, surrogate, or clinician. Third, 79% of the sample was decisionally incapable and the ethicist tried to determine participant preferences and values relevant to treatment via their surrogates. Although we agree the absence of designated surrogates may create ethical challenges, a surrogate’s unfamiliarity with relevant patient preferences and values could prove equally challenging. Although it is appropriate to facilitate discussion of a patient’s best interests where their wishes or values are unknown, we recommend encouraging discussions and documentation of patient wishes before ICU admission. This advance care planning approach is a different sort of proactive ethics activity. Clinical ethicists may not be the most appropriate people to lead these discussions with patients; however, they may assist the organization’s initiatives to promote, obtain, and act on such discussions. Finally, the authors note that the “enthusiasm” for ethics consultation is growing because it is considered an effective way to address ethical challenges. Although this may be true, we suggest the practice of clinical ethics is not limited to individual patient cases. It is also about supporting “everyday” clinical practices and activities by cultivating environments in which—to paraphrase Frank’s insights—people are continually responsive to one another, and so patients, families, and clinicians feel they are achieving the greatest possible good given the circumstances (4). All authors are paid to conduct ethics consultations as part of their respective roles as Bioethicists at the University Health Network.
Phases of Digoxin Use for HF With Sinus Rhythm

In 1673, William Harvey wrote “that the heart is to be regarded as the primary cause of life. ” In 1705, Thomas Sydenham, an English physician, linked dropsy to difficulty in breathing purges that gave the beginnings of the concept of heart failure (HF) for which digitalis, described by Withering in 1801, was the first natural remedy to be used. Withering was most impressed with diuretic effects, but he also observed that digitalis had power over the motion of the heart to a degree, yet unobserved in any other medicine. Despite this auspicious history, digoxin use in HF is now in serious question as shown in a placebo-controlled trial in severely ill patients given modern antifailure therapy and as supported by the accompanying article. With this background, the current status of digoxin therapy needs overview,
Factors underlying the use of long-acting and permanent family planning methods in Nigeria: A qualitative study.

The data analyzed in this report were derived from a multimethod qualitative study conducted in Benue and Oyo States of Nigeria in July and August 2011. The findings reveal the myriad of challenges associated with demand for and provision of long-acting contraceptive methods (the intrauterine device [IUD] and the hormonal implant) and permanent contraceptive methods (tubal ligation and vasectomy) in Nigeria. The findings from this study have important implications for demand generation and service provision and recommendations are provided to strengthen the FP program in Nigeria.
Behavioral effects in adult rats of chronic prepubertal treatment with the cannabinoid receptor agonist

Human and animal studies provide evidence for vulnerable periods of brain development for deleterious effects of cannabinoids. We have recently shown that pubertal chronic cannabinoid treatment leads to long-lasting behavioral deficits, whereas a comparable treatment in adult rats did not affect the animals’ behavior. In the present study we examined the effects of an identical chronic cannabinoid treatment in juvenile rats, just before the onset of puberty. Treatment with the synthetic cannabinoid agonist WIN 55,212-2 (WIN) (1.2 mg/kg) or vehicle was extended over 25 days throughout the prepubertal period (postnatal days 15–40) in juvenile rats. The rats received a total of 20 injections intraperitoneally. Adult rats were tested for object recognition memory, performance in a progressive ratio (PR) operant behavior task, locomotor activity and prepulse inhibition (PPI) of the acoustic startle response. Juvenile chronic WIN administration had no effect on object recognition memory, PR performance and locomotor activity in adulthood. However, a PPI deficit was observed in WIN-treated rats when tested as adults that could be reversed by the acute administration of the dopamine receptor antagonist haloperidol (0.1 mg/kg). Additionally, juvenile cannabinoid treatment reduced the number of rearings, as well as the time spent in the center of the open field in adult rats, suggesting increased anxiety. Juvenile chronic cannabinoid treatment induced behavioral disturbances in adult rats that are less severe than those observed after pubertal cannabinoid administration. However, based on the observations of sensorimotor gating deficits and increased anxiety, we conclude that the prepubertal developmental phase, in addition to puberty, also represents a vulnerable time period for persistent adverse effects of cannabinoids. Behavioural Pharmacology 16:447–453
Norepinephrine in anthrax-associated shock : Even worse than figs ? *

ternational collaboration with the aim to address these challenges in a multicenter study with participants from 30 centers and 4 continents is, therefore, greatly appreciated. This impressive number reflects the enthusiasm of all collaborators, which is definitely needed if we want to see microvascular imaging to become a crucial element of hemodynamic monitoring in the future. Michael Fries, MD Department of Anesthesiology University Hospital RWTH Aachen Aachen, Germany
Vancomycin for methicillin-resistant Staphylococcus aureus pneumonia: The good, the bad, and the ugly*

(4, 7). Future studies will need to explore these variations. Ultimately, there must be confidence and trust in the medical system. The approach toward the criteria for declaration of death, as well as the DCD policy of an observation period, must be determined by the critical care and neurologic communities to avoid any conflict of interest that might be present from the transplant community. This study supports the goal of maintaining that confidence. This study was performed by neurologists and intensivists at one of the largest trauma centers in the world. During a DCD, such data are routinely recorded, and the authors very elegantly put together a dataset that helps clarify some of the uncertainty in this issue, and will help work toward the establishment of more standardized, data-driven, national DCD protocols that the critical care community and the general public trust to protect the integrity and dignity of the donor’s life, and that also preserves the donor’s wish to provide another person with a well-functioning transplant. Kenneth J. Woodside, MD Division of Transplant and Hepatobiliary Surgery Department of Surgery Case Western Reserve University University Hospitals Case Medical Center Cleveland, OH
Identification of keratin19-positive cancer stem cells associating human hepatocellular carcinoma using 18F-fluorodeoxyglucose positron emission tomography

Purpose The current lack of tools for easy assessment of cancer stem cells (CSCs) prevents the development of therapeutic strategies for hepatocellular carcinoma (HCC). We previously reported that keratin 19 (K19) is a novel HCC-CSC marker, and that positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) is an effective method for predicting postoperative outcome in HCC. Herein, we examined whether K19+ HCC-CSCs can be tracked using 18F-FDG-PET. Experimental Design K19 and glucose transporter-1 (GLUT1) expression was evaluated by immunohistochemistry in 98 HCC patients who underwent 18F-FDG-PET scans before primary tumor resection. Standardized uptake values (SUV) for primary tumors and tumor-to-nontumor SUV ratios (TNR) were calculated using FDG accumulation levels, and values were compared among K19+/K19− patients. Using HCC cell lines encoding with a K19 promoter-driven enhanced green fluorescence protein, 18F-FDG uptake and GLUT1 expression were examined in fluorescence-activated cell sorting (FACS)-isolated K19+/K19− cells. Results Research. on February 6, 2021. © 2016 American Association for Cancer clincancerres.aacrjournals. org Downloaded from Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Author Manuscript Published OnlineFirst on September 23, 2016; DOI: 10.1158/1078-0432.CCR-16-0871