Miracle-dz/UniFAR-FTUs huggingface dataset:
Exploring perspectives on restraint during medical procedures in paediatric care: a qualitative interview study with nurses and physicians

ABSTRACT The aim of this study was to explore nurses’ and physicians’ perspectives on and reasoning about the use of restraint during medical procedures on newly admitted preschoolers in somatic hospital care. We analysed qualitative data from individual interviews with a video recall session at the end with seven physicians and eight nurses. They had earlier participated in video recorded peripheral vein cannulations on preschool children. The data were collected between May 2012 and May 2013 at a paediatric hospital unit in Norway. The analysis resulted in three main themes: (1) disparate views on the concept of restraint and restraint use (2), ways to limit the use of physical restraint and its negative consequences, and (3) experience with the role of parents and their influence on restraint. Perspectives from both healthcare professions were represented in all the main themes and had many similarities. The results of this study may facilitate more informed and reflective discussions of restraint and contribute to higher awareness of restraint in clinical practice. Lack of guidance and scientific attention to restraint combined with conflicting interests and values among healthcare providers may result in insecurity, individual dogmatism, and a lack of shared discussions, language, and terminology.
Temperature patterns in the early postresuscitation period after pediatric inhospital cardiac arrest*

Objective: To describe the prevalence of postarrest hyperthermia among children during the first 24 hrs after inhospital cardiac arrest and to determine the association of persistent postarrest hyperthermia with neurologic outcome and death before hospital discharge. Design: Multicenter, national registry of inhospital cardiopulmonary resuscitation. Setting: A total of 196 hospitals reporting to the American Heart Association's National Registry of Cardiopulmonary Resuscitation from January 1, 2005 to December 31, 2007. Patients: A total of 547 pediatric patients who suffered inhospital pulseless cardiac arrests reported to the National Registry of Cardiopulmonary Resuscitation, who survived resuscitative efforts and who had the maximum and the minimum temperature in the first 24 hrs postresuscitation reported to the National Registry of Cardiopulmonary Resuscitation. Interventions: None. Measurements and Main Results: Among 547 children with pulseless cardiac arrests, 238 (43.5%) had at least one temperature of ≥38°C, and 30 (5.5%) had “persistent hyperthermia” (i.e., both the minimum and the maximum temperature of ≥38°C) during the first 24 hrs postarrest. After adjusting for potential confounders by multivariate logistic regression, persistent hyperthermia in the first 24 hrs postarrest was associated with unfavorable neurologic outcome (adjusted odds ratio, 2.7; 95% confidence interval, 1.1–6.7), but not with death before hospital discharge (adjusted odds ratio, 1.2; 95% confidence interval, 0.4–3.4). Conclusions: Despite current guidelines to avoid postarrest hyperthermia, a temperature of ≥38°C occurred commonly among children in the first 24 hrs postarrest. Persistent postarrest hyperthermia was associated with unfavorable neurologic outcomes, even after controlling for potential confounding factors.
Palliative care and circumstances of dying in German ALS patients using non‐invasive ventilation

Non‐invasive ventilation (NIV) is known to improve quality of life and to prolong survival in amyotrophic lateral sclerosis (ALS) patients. However, little is known about the circumstances of dying in ventilated ALS patients. In the light of the debate on legalizing euthanasia it is important to provide empirical data about the process of dying in these patients. In a structured interview, 29 family caregivers of deceased ALS patients were asked about their own and the patient's attitude toward physician‐assisted suicide (PAS) and euthanasia, circumstances of dying, and the use of palliative medication. Quantitative and qualitative content analysis was performed on the data. Non‐recurring suicidal thoughts were reported by five patients. Three patients and seven relatives had thought about PAS. Seventeen caregivers described the patients' death as “peaceful”, while choking was reported in six bulbar patients. In final stages of dying, the general practitioner (GP) was involved in the treatment of 10 patients, with palliative medication including sedatives and opiates being administered in eight cases. In conclusion, in contrast to the Netherlands, where 20% of terminal ALS patients die from PAS or euthanasia, only a small minority of our patients seems to have thought about PAS. The legal situation in Germany (where euthanasia is illegal), a bias due to the selection of NIV patients as well as a high percentage of religious patients and those with good levels of social support from family and friends, might account for this. Most of our patients died peacefully at home from carbon dioxide narcosis, but choking was described in some bulbar patients. Thus, palliative care, especially the use of opiates, anxiolytics and sedatives should be optimized, and the involvement of GP should be strongly encouraged, especially in bulbar patients.
Thrombopoietin is ineffective in a mouse model of motor neuron disease

This study assessed the therapeutic efficacy of thrombopoietin (TPO) in the mouse model of ALS using two treatment paradigms. TPO was administered either daily or in 13-day treatment cycles to SOD1-G93A mice. Quantitative analysis of platelet levels, VEGF and TGF-β1 trophic factors were assessed. The effect of TPO on disease progression was analyzed by behavioral analysis and clinical examination. TPO treatment increased levels of platelets and TGF-β1 but not VEGF. This treatment did not affect onset or survival in these mice. Although biologically active, demonstrated by increased platelet and TGF-β1 levels, rmTPO did not attenuate disease progression in ALS mice.
Treatment with lithium carbonate does not improve disease progression in two different strains of SOD1 mutant mice

It has been shown that chronic treatment with lithium carbonate (Li2CO3) in presymptomatic SOD1G93A transgenic male mice, a model of ALS, was able to remarkably increase their lifespan through the activation of autophagy and the promotion of mitochondriogenesis and neurogenesis. This prompted us to test the lithium effect also in female SOD1G93A mice with two phenotypes of different disease severity. Female SOD1G93A mice of C57BL/6J or 129S2/Sv genetic background were treated daily with Li2CO3 37 mg/kg (1 mEq/kg) i.p. starting from age 75 days until death. Grip strength, latency to fall on rotarod and body weight were monitored twice weekly. At the time of death the spinal cord was removed to assess the number of motor neurons and to measure the expression of a marker of autophagy (LCII) and the activity of mitochondrial complex IV. We observed a significant anticipation of the onset and reduced survival in 129Sv/G93A and no effect in C57/G93A mice treated with lithium compared to vehicle treated mice. Moreover, lithium neither exerted neuroprotective effects nor increased the expression of LCII and the activity of mitochondrial complex IV in the spinal cord. The present study does not identify any therapeutic or neuroprotective effect of lithium in SOD1G93A female mice.
Degradation of the extracellular matrix components by bacterial‐derived metalloproteases: Implications for inflammatory bowel diseases

Background: Proteolytic degradation of the extracellular matrix, a feature of mucosal homeostasis and tissue renewal, also contributes to the complications of intestinal inflammation. Whether this proteolytic activity is entirely host‐derived, or, in part, produced by the gut microbiota, is unknown. Methods: We screened the bacterial colonies for gelatinolytic activity from fecal samples of 20 healthy controls, 23 patients with ulcerative colitis, and 18 with Crohn's disease (CD). In addition, the genes encoding metalloproteases were detected by conventional or real‐time polymerase chain reaction (PCR). Results: Gelatinolytic activity was found in approximately one‐quarter of samples regardless of the presence of inflammation and without any attempt to enhance the sensitivity of the culture‐based screen. This was associated with a diversity of bacteria, particularly in CD, but was predominantly linked with Clostridium perfringens. Culture supernatants from C. perfringens degraded gelatin, azocoll, type I collagen, and basement membrane type IV collagen, but different isolates varied in the degree of proteolytic activity. Results were confirmed by detection of the C. perfringens colA gene (encoding collagenase) in fecal DNA, again regardless of the presence or absence of inflammation. However, the biologic significance and potential implications of microbial‐derived proteolytic activity were confirmed by reduced transepithelial resistance (TER) after exposure of rat distal colon to culture supernatants of C. perfringens in Ussing chambers. Conclusions: The study shows that microbial‐derived proteolytic activity has the capacity to contribute to mucosal homeostasis and may participate in the pathogenesis of inflammatory bowel disease. (Inflamm Bowel Dis 2010)
Distinguishing orofacial granulomatosis from crohn's disease: Two separate disease entities?1

Background: Orofacial granulomatosis (OFG) is a rare chronic inflammatory disease of unknown etiology sharing histological features with Crohn's disease (CD). This study aimed to 1) define the clinical presentation of OFG, 2) establish differentiating features for those with CD, 3) examine if onset of OFG is predictive of CD, and 4) establish differentiating features for children. Methods: Data were extracted from medical notes (n = 207) for demographics, clinical features, blood parameters, diagnosis of CD, and treatment's for patients with OFG. Results: Ninety‐seven patients (47%) were female. The lips (184/203; 91%) and buccal mucosa (151/203; 74%) were mainly affected. Forty‐six (22%) had intestinal CD. Ulcers (24/46; 46% versus 29/159; 15%, P = <0.001) were more common in patients with CD as was a raised C‐reactive protein (24/33; 73% versus 60/122; 49%, P = 0.016) and abnormal full blood count (19/41; 46% versus 35/150; 23%). The buccal‐sulcus (12/44; 27% versus 20/158; 13%, P = 0.019) was more often affected in those with CD. Half the patients with CD were diagnosed prior to onset of OFG. The remainder were diagnosed after. The incidence of CD is similar for children (16/69; 23%) and adults (29/132; 22%), although oral onset in childhood is more likely to occur prior to diagnosis of CD. Conclusions: OFG mainly presents in young adults with lip and buccal involvement. Abnormalities in inflammatory markers, hematology and oral features of ulceration, and buccal‐sulcal involvement are factors more commonly associated with CD. Initial presentation of OFG does not necessarily predict development of CD, although this is more likely in childhood. (Inflamm Bowel Dis 2011;)
Intelligent location models for next generation location-based services

To become truly ubiquitous, next generation location-based services (LBS) will have to rely on mobile platforms upon which multiple sensors and measurement systems have been integrated to provide continuous, three-dimensional positioning and orientation. Such technologies are explored today for example in mobile mapping systems, vehicle navigation systems and mobile robot navigation. Next-generation LBS also need theoretically sound methods to translate position into location information. The article addresses this problem: the transformation of position into meaningful and reliable location, and the transformation of location knowledge into positioning constraints. It suggests by this way an intelligent location model that integrates sensor fusion with spatial knowledge fusion via a feedback cycle. It is shown that this feedback cycle consists of three layers: spatial constraints, temporal constraints and spatiotemporal constraints.
Iliosacral Screw Placement With Ultrasound-Based Navigation versus Conventional Fluoroscopy

Summary This study presents early results of the clinical experience of computer-assisted surgery (CAS) applied to percutaneous iliosacral screwing compared with an historical series of patients treated by percutaneous fluoroscopy. Four patients were instrumented with a CAS, with 10 screws being inserted. Thirty patients were treated by percutaneous fluoroscopic screwing, with 51 screws inserted. The follow up included operative time, the parameters of the radiation exposure, the neurologic examination, the screw placement evaluation on computed tomography scan, antalgic drug consumption, pain, Majeed grading, and the loosening implants. In the CAS group, the radiation time by patient was 0.35 minutes and by screw 0.14 minutes. No outside bone trajectories and no postoperative neurologic deficit were found. In the fluoroscopic group, the radiation time by patient was 1.03 minutes and 0.6 minutes by screw. Twelve screws had outside bone trajectories. In 7 patients, iatrogenic neurologic deficit was found. The average operative time was 50 minutes in the CAS group and 35 minutes in the fluoroscopic group. The present CAS technique shows better placement of iliosacral screws without outside bone trajectories and lower radiation exposure.
Accurate map-based indoor navigation on the mobile

We present FootPath, a self-contained, map-based indoor navigation system. Using only the accelerometer and the compass readily available in modern smartphones, we accurately localise a user on her route and provide her with turn-by-turn instructions to her destination. To compensate for inaccuracies in step detection and heading estimation, we match the detected steps onto the expected route using sequence alignment algorithms from the field of bioinformatics. As our solution integrates well with OpenStreetMap, it allows painless and cost-efficient collaborative deployment, without the need for additional infrastructure.
Acute Lung Injury in Children—Kids Really Aren’t Just “Little Adults”

Objective: To describe the planned aims and methodology of the Pediatric Acute Lung Injury Consensus Conference. Design: Consensus conference of experts in pediatric acute lung injury. Methods: A panel of 26 experts in pediatric acute lung injury will meet over the course of one year to develop a better taxonomy to define pediatric acute lung injury, specifically predisposing factors, etiology, and pathophysiology. A modified Delphi approach that emphasizes strong professional agreement will be utilized. Results: The Pediatric Acute Lung Injury Consensus Conference will aim for consensus development on the following topics related to pediatric acute lung injury: 1) definition, incidence, and epidemiology; 2) comorbidities and severity; 3) ventilatory support; 4) pulmonary-specific ancillary treatment; 5) nonpulmonary treatment; 6) monitoring; 7) noninvasive support and ventilation; 8) extracorporeal support; and 9) morbidity and long-term outcomes. Conclusions: The importance of this effort for improving care and guiding future research in pediatric acute lung injury is clear. Despite the many epidemiologic, interventional, and outcome studies undertaken by pediatric intensivists worldwide, our understanding of this disease process is limited, and morbidity and mortality remain unacceptably high. By consolidating the knowledge and expertise of the leaders of the field of pediatric acute lung injury, we hope to develop a framework for future progress.
The Effect of Atropine on Rhythm and Conduction Disturbances During 322 Critical Care Intubations*

Objectives: Our objectives were to describe the prevalence of arrhythmia and conduction abnormalities before critical care intubation and to test the hypothesis that atropine had no effect on their prevalence during intubation. Design: Prospective, observational study. Setting: PICU and pediatric/neonatal intensive care transport. Subjects: All children of age less than 8 years intubated September 2007–2009. Subgroups of intubations with and without atropine were analyzed. Intervention: None. Measurement and Main Results: A total of 414 intubations were performed in the study period of which 327 were available for analysis (79%). Five children (1.5%) had arrhythmias prior to intubation and were excluded from the atropine analysis. Atropine was used in 47% (152/322) of intubations and resulted in significant acceleration of heart rate without provoking ventricular arrhythmias. New arrhythmias during intubation were related to bradycardia and were less common with atropine use (odds ratio, 0.14 [95% CI, 0.06–0.35], p < 0.001). The most common new arrhythmia was junctional rhythm. Acute bundle branch block was observed during three intubations; one Mobitz type 2 rhythm and five ventricular escape rhythms occurred in the no-atropine group (n = 170). Only one ventricular escape rhythm occurred in the atropine group (n = 152) in a child with an abnormal heart. One child died during intubation who had not received atropine. Conclusions: Atropine significantly reduced the prevalence of new arrhythmias during intubation particularly for children over 1 month of age, did not convert sinus tachycardia to ventricular tachycardia or fibrillation, and may contribute to the safety of intubation.
Novel pharmacological treatment strategies for posttraumatic stress disorder

ABSTRACT Introduction: A wide range of medications have been studied for posttraumatic stress disorder (PTSD) and a number are registered for this indication. Nevertheless, current pharmacotherapies are only partially effective in some patients, and are minimally effective in others. Thus novel treatment avenues need to be explored. Areas covered: In considering novel pharmacological agents for the treatment of PTSD, this paper takes a translational approach. We outline how advances in our understanding of the underlying neurobiology of PTSD may inform the identification of potential new treatment targets, including glutamatergic, noradrenergic and opioid pathways. Expert commentary: Continued investigation of the neural substrates and signalling pathways involved in responses to trauma may inform the development of novel treatment targets for future drug development for PTSD. However, the translation of preclinical findings to clinical practice is likely to be complex and gradual.
The Correlation Between Dual-color Chromogenic In Situ Hybridization and Fluorescence In Situ Hybridization in Assessing HER2 Gene Amplification in Breast Cancer

Fluorescence in situ hybridization (FISH) is regarded as the gold standard method for detecting HER2 gene amplification. Chromogenic in situ hybridization (CISH) is a promising alternative to FISH because CISH has the advantages of being a method evaluated by bright-field microscopy and the generated chromogenic signals are also stable. This study presents a dual color CISH for simultaneous detection of the HER2 gene and chromosome 17. The CISH method performs a chromogenic detection “on top” of the Food and Drug Administration (FDA)-approved HER2 FISH pharmDx method, where the fluorochrome-labeled probes are detected using enzyme-labeled antibodies and visualized by chromogenic enzymatic reactions. The HER2 status (amplified/not amplified and HER2 ratios) was evaluated by the CISH method and compared with results obtained by the FDA-approved FISH method. Of the 72 successfully investigated invasive breast carcinomas, both FISH and CISH detected HER2 amplification in 24 cases and nonamplification was detected in 47 cases. One case showed a discrepancy between FISH and CISH. The concordance between CISH and FISH was found to be almost perfect (98.6%). The correlation between the HER2 ratios obtained by the 2 methods showed excellent correlation (correlation coefficient 0.95). In conclusion, it is possible by dual-color CISH method to demonstrate HER2 genes and chromosome 17 genes, in the same tissue section and reliably assess HER2 status. The CISH method is a very promising alternative to the FISH method.
Role of genetic testing in patients undergoing percutaneous coronary intervention

ABSTRACT Introduction: Variability in individual response profiles to antiplatelet therapy, in particular clopidogrel, is a well-established phenomenon. Genetic variations of the cytochrome P450 (CYP) 2C19 enzyme, a key determinant in clopidogrel metabolism, have been associated with clopidogrel response profiles. Moreover, the presence of a CYP2C19 loss-of-function allele is associated with an increased risk of atherothrombotic events among clopidogrel-treated patients undergoing percutaneous coronary interventions (PCI), prompting studies evaluating the use of genetic tests to identify patients who may be potential candidates for alternative platelet P2Y12 receptor inhibiting therapies (prasugrel or ticagrelor). Areas covered: The present manuscript provides an overview of genetic factors associated with response profiles to platelet P2Y12 receptor inhibitors and their clinical implications, as well as the most recent developments and future considerations on the role of genetic testing in patients undergoing PCI. Expert commentary: The availability of more user-friendly genetic tests has contributed towards the development of many ongoing clinical trials and personalized medicine programs for patients undergoing PCI. Results of pilot investigations have shown promising results, which however need to be confirmed in larger-scale studies to support the routine use of genetic testing as a strategy to personalize antiplatelet therapy and improve clinical outcomes.
Design and validation of a novel combined ex-vivo testing medium for investigating forces in the glenohumeral joint

Background:Generating accurate simulations of the forces in the glenohumeral joint is essential for investigating normal and pathologic shoulder function. It forms the basis for evaluating fracture treatment, joint replacement design, and fixation. However, because of its complex anatomy and large range-of-motion, measuring the dynamic in-vivo forces and kinematics of the shoulder joint remains a challenging problem in the field of biomechanics. This paper describes the development and validation of a new combined testing medium for the glenohumeral joint. Methods:The study uses a combined approach of in-vitro and in-silico testing and validates against gold standard in-vivo data. Functional motions and activities of daily living are simulated and compared. Results:Results show similar loading profiles during motion simulation and areas of high stress generation. When compared with previous data, recorded results from the mechanical testing rig show high conformity. Comparison shows 3.95% error during 45° abduction and 4.22% error at 75° abduction. Conclusions:The developed testing medium provides repeatable and reproducible results for forces within the glenohumeral joint. This can now be used to further understand joint kinematics, injuries, fracture propagation, and fixation. It will also provide a valuable training aid for a complex joint. Better understanding, testing, and training of new techniques, tools and traumas are now possible and will aid in reducing injury prevalence, severity, healing time, and ultimately improve quality of life.