Miracle-dz/UniFAR-FTUs huggingface dataset:
Neoadjuvant therapy for downstaging of locally advanced hilar cholangiocarcinoma: a systematic review.

BACKGROUND Hilar cholangiocarcinoma is a rare but highly lethal type of cancer. A minority of patients present with resectable disease. Surgery remains the only treatment modality offering a chance of long-term survival. Unresectable patients are typically offered palliative treatment. The aim of this systematic review was to summarize the evidence for neoadjuvant therapy followed by surgical resection in patients presenting with hilar cholangiocarcinoma. METHODS Cochrane databases, Medline, PubMed and EMBASE were systematically searched to identify articles describing neoadjuvant therapy and surgical resection or re-assessment of resectability in patients with hilar cholangiocarcinoma. Included were all articles with original research. Study selection and data extraction were performed separately by two reviewers using a standardized protocol. RESULTS From 732 articles 8 full text articles and 2 abstracts met the inclusion criteria. The 2 abstracts and 1 full text article were case reports, 3 articles were retrospective and 4 were prospective studies (2 phase I and 2 phase II studies). Photodynamic therapy, chemotherapy and radiation therapy were used in various indications in populations that included patients with hilar cholangiocarcinoma, some of which were primarily unresectable. Overall quality of articles was limited. CONCLUSION Current evidence suggests that neoadjuvant therapy in patients with unresectable hilar cholangiocarcinoma can be performed safely and in a selected group of patients can lead to subsequent surgical R0 resection. Surgical resection of downstaged patients should be assessed in properly designed phase II studies.
Vein of Galen Malformations: Long-term functional outcome in 6 cases

Abstract PURPOSE: Vein of Galen Malformations (VOGMs) are rare congenital arteriovenous fistulas that were previously associated with high mortality and morbidity prior to the advent of endovascular treatment approaches. The long-term functional outcome and quality of life of infants and children treated with these approaches, however, are not well characterized. METHODS: The long-term outcomes of a cohort of pediatric patients treated at University of California at San Francisco from 1986–2013 (N = 39) for their VOGMs were assessed using a self-report survey-based approach. The Pediatric Quality of life Inventory (PedsQL), the Functional Disability Inventory (FDI) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) were employed. The results of the surveys were analyzed. RESULTS: We received six surveys from three male and three female patients with a median age of 17.5 years (range 7–22 years). The median length of follow-up since first treatment was 17 years (range 5–19 years). The PedsQL summary scores of the patients in our sample were only slightly lower than norms from healthy controls (78.4 vs. 83.0). The cases in our sample were on an average mildly affected in the domains of physical health, emotional health, social functioning and school functioning. The FDI and WHODAS results revealed that survey respondents had minimal or no disability. CONCLUSION: The long-term neurodevelopmental outcomes of children with VOGM may be good following endovascular treatment. Better long-term follow up is needed, as evidenced by the low rate of survey response.
Percutaneous cholecystostomy is an effective treatment option for acute calculous cholecystitis: a 10-year experience.

BACKGROUND Percutaneous cholecystostomy (PC) can be used to treat patients with acute calculous cholecystitis (ACC) who are considered to be unfit for surgery. However, this procedure has been insufficiently investigated. This paper presents the results of a 10-year experience with this treatment modality. METHODS A retrospective observational study of all consecutive patients treated with PC for ACC in the period from 1 May 2002 to 30 April 2012 was conducted. All data were collected from patients' medical records. RESULTS A total of 278 patients were treated with PC for ACC. Of these, 13 (4.7%) died within 30 days, 28 (10.1%) underwent early laparoscopic cholecystectomy and three (1.1%) patients were lost from follow-up. Of the remaining 234 patients, 55 (23.5%) were readmitted for the recurrence of cholecystitis. In 128 (54.7%) patients, PC was the definitive treatment (median follow-up time: 5 years), whereas 51 (21.8%) patients were treated with elective laparoscopic cholecystectomy. The frequency of recurrence of cholecystitis in patients with contrast passage to the duodenum on cholangiography was lower than that in patients without contrast passage (21.1% versus 36.7%; P = 0.037). CONCLUSIONS The present study, which is the largest ever conducted in this treatment area, supports the hypothesis that PC is an effective treatment modality for critically ill patients with ACC unfit for surgery and results in a low rate of 30-day mortality.
Hepatectomy for hepatocellular carcinoma larger than 10 cm: preoperative risk stratification to prevent futile surgery.

OBJECTIVES Appropriate patient selection is important to achieving good outcomes and obviating futile surgery in patients with huge (≥10 cm) hepatocellular carcinoma (HCC). The aim of this study was to identify independent predictors of futile outcomes, defined as death within 3 months of surgery or within 1 year from early recurrence following hepatectomy for huge HCC. METHODS The outcomes of 149 patients with huge HCCs who underwent resection during 1995-2012 were analysed. Multivariate logistic regression analysis was performed to identify preoperative independent predictors of futility. RESULTS Independent predictors of 3-month mortality (18.1%) were: total bilirubin level >34 μmol/l [P = 0.0443; odds ratio (OR) 16.470]; platelet count of <150 000 cells/ml (P = 0.0098; OR 5.039), and the presence of portal vein tumour thrombosis (P = 0.0041; OR 5.138). The last of these was the sole independent predictor of 1-year recurrence-related mortality (17.2%). Rates of recurrence-related mortality at 3 months and 1 year were, respectively, 6.3% and 7.1% in patients with Barcelona Clinic Liver Cancer (BCLC) stage A disease, 12.5% and 14% in patients with BCLC stage B disease, and 37.8% (P = 0.0002) and 75% (P = 0.0002) in patients with BCLC stage C disease. CONCLUSIONS According to the present data, among patients submitted to hepatectomy for huge HCC, those with a high bilirubin level, low platelet count and portal vein thrombosis are at higher risk for futile surgery. The presence of portal vein tumour thrombosis should be regarded as a relative contraindication to surgery.
Understanding drivers of hospital charge variation for episodes of care among patients undergoing hepatopancreatobiliary surgery.

BACKGROUND Understanding factors associated with variation in hospital charges may help identify means to increase savings. The aim of the present study was to define potential variation in hospital charges associated with hepatopancreatobiliary(HPB) surgery. METHODS Patients who underwent an HPB procedure between 2009-2013 were identified. Total hospital charges were tabulated for room and board, surgical/anaesthesia services, medications, laboratory/radiology services and other miscellaneous charges. RESULTS Approximately 2545 patients underwent either a pancreas (66.8%) or liver/biliary (33.2%) resection. The mean total charges for all patients were $42,357 ± 33,745 (pancreas: $46,352 ± 34,932 versus the liver: $34,303 ± 29,639; P < 0.001). Morbidity (pancreas, range: 7-18%; liver, range: 9-18%) and observed:expected (O:E) length of stay (LOS)(pancreas, range: 0.67-1.64; liver, range: 1.06-3.35) varied among providers (both P < 0.001). While a peri-operative complication resulted in increased total hospital charges (complication: $66,401 ± 55,124 versus no complication: $39,668 ± 29,250; P < 0.001), total charges remained variable even among patients who did not experience a complication (P < 0.001). Surgeons within the lowest quartile of O:E LOS had lower total charges ($33 879 ± $27 398) versus surgeons in the highest quartile ($49,498 ± 40 971) (P < 0.001). Surgeons with the highest O:E LOS had higher across-the-board charges (operating room, highest quartile: $10,514 ± $4496 versus lowest quartile: $7842 ± $3706; medication, highest quartile: $1796 ± $3799 versus lowest quartile: $925 ± $2211; radiology, highest quartile: $2494 ± $4683 versus lowest quartile: $1424 ± $3247; P = 0.001; laboratory, highest quartile: $4236 ± $5991 versus lowest quartile: $3028 ± $3804; all P < 0.001). CONCLUSIONS After accounting for in-hospital complications, the total mean hospital charges for HPB surgery remained variable by case type and provider. While the variation in charges was associated with LOS, provider-level differences in across-the-board charges were also noted.
Awareness about past diagnosis and treatment history: nationwide survey of childhood cancer survivors and their parents

Objective To assess the awareness of past medical history and long-term care issues of childhood cancer survivors (CCS) in Korea. Methods A nationwide survey was conducted on CCS and their parents in 10 regional cancer centers in Korea. Answers regarding cancer diagnosis and treatment history were compared with the treatment summary and categorized into three ('specific,' 'general,' and 'no') or two ('yes' and 'no') groups. Results Out of 343 contacts, 293 dyads completed the survey, and 281 dyads were analyzed. Awareness of cancer diagnosis was mostly specific for parents (76.5%) and CCS (35.2%). Awareness of anti-cancer treatment exposure was mostly general (84.6% for surgery, 67.9% for chemotherapy, and 53.9% for hematopoietic stem cell transplantation) rather than specific. In particular, more than half of the parents were not aware of the exposure to cardiotoxic agents (72.9%) or radiation therapy (56.3%). Providing information about long-term side effects and prevention of secondary cancer was significantly correlated only with more concern and more follow-up visits (P ≤ 0.001, respectively), without correlation with more specific awareness of exposure to cardiotoxic agents or radiation. Conclusion(s) Most of the parents of CCS were not aware of treatment-related risk factors necessary for long-term care. Providing information was significantly correlated with more concern and more follow-up visits, without improving corresponding knowledge about their past medical history. Effort aimed towards improving awareness about risk factors, the manner of providing information, and the patient referral system within which we use this information is warranted.
Good practice in social care: the views of people with severe and complex needs and those who support them.

This paper reports findings drawn from a study of good practice in English social care for adults with disability and older people with severe and complex needs. People with severe and complex needs are a relatively small proportion of adult social care service users, but they are growing in numbers and have resource-intensive needs. The study involved qualitative research with adults with disability and older people with severe and complex needs, family carers and members of specialist organisations (n = 67), focusing on the features of social care services they considered to be good practice. Data were collected between August 2010 and June 2011. The approach to data collection was flexible, to accommodate participants' communication needs and preferences, including face-to-face and telephone interviews, Talking Mats(©) sessions and a focus group. Data were managed using Framework and analysed thematically. Features of good practice were considered at three levels: (i) everyday support; (ii) service organisation; and (iii) commissioning. Findings relating to the first two of these are presented here. Participants emphasised the importance of person-centred ways of working at all levels. Personalisation, as currently implemented in English social care, aims to shift power from professionals to service users through the allocation of personal budgets. This approach focuses very much on the role of the individual in directing his/her own support arrangements. However, participants in this study also stressed the importance of ongoing professional support, for example, from a specialist key worker or case manager to co-ordinate diverse services and ensure good practice at an organisational level. The paper argues that, despite the recent move to shift power from professionals to service users, people with the most complex needs still value support from professionals and appropriate organisational support. Without these, they risk being excluded from the benefits that personalisation, properly supported, could yield.
Formal home-care utilisation by older adults in Ireland: evidence from the Irish Longitudinal Study on Ageing (TILDA).

The aim of this study was to provide a population-based estimate of the utilisation of publicly financed formal home care by older adults in Ireland and to identify the principal characteristics of those utilising formal home care. Data were collected through computer-aided personal interviews from a representative sample of community living older adults in Ireland. The interviews were conducted between 2009 and 2011 as part of the first wave of the Irish Longitudinal Study on Ageing (TILDA). The study is cross-sectional in design and limited to participants aged 65 years and older (n = 3507). Results reveal that 8.2% (95% CI 7.1%-9.3%) of participants utilised publicly financed formal home care in the form of home help and/or personal care. Key determinants of formal home-care utilisation were Instrumental Activity of Daily Living (IADL) difficulty (Adj OR 3.8, 95% CI 2.7-5.3), older age (Adj OR 3.4, 95% CI 2.4-4.8) and living alone (Adj OR 2.6, 95% CI 1.9-3.8). Almost half of those utilising formal care did not self-report an Activity of Daily Living (ADL) difficulty or an IADL difficulty. Government policy aims to reduce the need for long-term residential care by providing formal home care for older adults with low to moderate levels of dependency. This requires an increasing emphasis on personal care provision in the home. No evidence was found in this study to suggest that a shift in emphasis from formal domestic to personal care is taking place in Ireland. The absence of standardised assessment and eligibility criteria are deemed to be barriers to reorientation of the system. From a health services perspective, the current situation is not sustainable into the future and requires a focused policy response.
The effects of television advertisements for junk food versus nutritious food on children's food attitudes and preferences

The effects of television advertisements for junk food versus nutritious food on children's food attitudes and preferences . Dixon H.G. , Scully M.L. , Wakefield M.A., White V.M. & Crawford D.A. ( 2007 ) Social Science and Medicine , 65 , 1311 – 1323 . DOI: 10.1016/j.socscimed. 2007.05. 011.
National Mosquito (Diptera: Culicidae) Survey in The Netherlands 2010–2013

ABSTRACT From 2010 onwards, a nationwide mosquito monitoring scheme has been conducted in The Netherlands with the aim of gaining crucial information about mosquito (Diptera: Culicidae) species composition, geographical distributions, biodiversity, and habitat preferences. The results of this study are based on 778 randomly sampled mosquito locations. These are divided into three main habitat types: urban, rural-agricultural, and natural areas. Twenty-seven mosquito species were found: 26 indigenous and 1 exotic, Aedes japonicus japonicus (Theobald, 1901). The preliminary results are presented here, with details of their species distribution and seasonality. Monitoring the temporal and spatial distribution of mosquitoes is an essential step in the risk analysis of emerging mosquito-borne diseases.
Neutrophil CD64 in early-onset neonatal sepsis

Background: Neonatal sepsis is a life threatening disease with an incidence of 3.5 to 8 cases per 1,000 live births; and mortality rate 16 to 30%. Cytokines, produced by monocytes, macrophages, and endothelial cells in response to infectious stimuli are important proinflammatory mediators in the early phases of the sepsis syndrome. Elevated serum levels of interleukin-6 (IL-6) had been found in both neonatal and adult sepsis. However, for neonatal sepsis, little is known about a group of molecules playing a central role in the innate immune system. Among them is the neutrophil CD64 which is expressed on neutrophil surface in many inflammatory conditions. Objective: To study the neutrophil CD64 expression in neonates with early onset sepsis and its relation to other laboratory markers as IL6, CRP, total leucocytic count and platelet count. Methods: This study comprised 30 neonates with a gestational age of 28 to 40 weeks with a picture of early onset neonatal sepsis within 48 hours of life admitted to neonatal care unit, Suzan Mubarak Hospital, El-Minia University, Egypt during the period from February, 2008 to January, 2009 and 20 healthy neonates age and sex matched as a control group. Neutrophil surface expression of CD64 was quantified with flow cytometry. We measured plasma IL6, C-reactive protein, complete blood count and blood culture. Results: Neutrophil CD64 expression was increased significantly in neonates with neonatal sepsis than controls (p=0.001). Cases with history of premature rupture of membranes (PROM) ≥48 hours, with positive blood culture or poor outcome had the highest levels of neutrophil CD64 expression (528±50.7, 558±58.4 and 560.9±43.9 relative fluorescence units (RFU) respectively). A significant positive correlation was found between CD64 levels and the levels of IL6 (r=0.71, p=0.001),C-reactive protein (r=0.74, p=0.001) and total leucocytic count (r=0.76 ,p=0.01) and negative correlation with gestational age (r=-0.92, p=0.001) and body weight (r=-0.92, p=0.006), but there was no correlation between it and platelet count (r=-0.32, p=0.08). Conclusion: Neutrophil CD64 expression is increased in neonates with early-onset neonatal sepsis and correlated well with other laboratory markers of sepsis. Keywords: Neonatal sepsis, Cytokines, Neutrophil CD64, IL6, PROM Egypt J Pediatr Allergy Immunol 2010;8(1):19-25
Algumas considerações sobre o processo de desinstitucionalização

Este artigo, desenvolve algumas consideracoes sobre o processo de desinstitucionalizacao. Para tanto, considera as dificuldades em se reverter a concepcao e o estigma da loucura na sociedade, conformada ao longo da historia, assim como, a consolidacao de uma infra estrutura necessaria a esse processo, a qual mantem relacao direta com todos os sujeitos sociais e determinacoes politicas.
I just can't please them all and stay sane: Adult child caregivers’ experiences of family dynamics in care‐giving for a parent with dementia in Australia

Family caregivers of people with dementia who live within the community often experience stress and poor quality of life due to their care-giving role. While there are many factors that affect this, one influential factor is the family context. This study focussed on adult child caregivers. It examined the specific ways that family dynamics contribute to adult child caregivers' distress in the context of caring for a parent with dementia. Semi-structured interviews were conducted with 17 participants who were adult child primary caregivers for a parent with dementia who was living within the community. Interviews were audiotaped and transcribed verbatim. Transcripts were analysed using thematic analysis. Four themes were identified that represented areas of particular concern and distress for the caregivers: family expectations and caregivers' lack of choice in adopting the care-giving role; denial and differential understandings of dementia among family members; differential beliefs and approaches to care-giving among family members; and communication breakdown between family members. The findings demonstrate several avenues for further research including the development of interventions to support adult child caregivers and address problematic family dynamics within the context of caring for a parent with dementia.
Adherence to and effects of physical activity on health in adults with asthma

The background and purpose of the paper were to investigate factors that distinguished between adults with asthma who had participated in a 10-week exercise programme, but differed in exercise maintenance during a 3-year follow-up period, and to investigate if there was a change in daily physical activity level and influence on asthma after 3 years between the two groups. The participants were 21 adults and formed two contrast groups: 10 who had continued to exercise twice a week for 3 years after the 10-week exercise programme, and 11 who discontinued regular training. Semi-structured interviews were used: Exercisers differed from non-exercisers by having acquired asthma in adulthood, having pre-programme training experience, and interest and clear expectations of the exercise. Three years later, all 21 participants were physically active in daily life, less limited by their disease, and better able to control their asthma irrespective of being adherent with exercise recommendations. The study findings would suggest that physical activities in daily life are sufficient to maintain a good physical condition.
News Media and Health Care Providers at the Crossroads of Medical Adverse Events

In 2005, Indiana Governor Mitch Daniels issued an executive order that mandated Indiana health and medical professionals to report adverse event data. Although the mandate was designed to improve patient safety, the long-term success of mandatory reporting systems depends on maximizing effective reporting of adverse events and presenting these data in ways that will change the systems causing the medical errors. Perceptions of key constituents play a role in whether reporting is more or less effective in the short term and beneficial to patients in the long term. In this study, we sought to gauge perceptions of two stakeholders integral to the success of this mandated reporting: health care providers, who report adverse events to the State; and the news media, who report results from this government-mandated reporting to the public.
A Risk Model for the Lyme Disease Vector Ixodes scapularis (Acari: Ixodidae) in the Prairie Provinces of Canada

Abstract Lyme disease is emerging in Canada due to geographic range expansion of the tick vector Ixodes scapularis Say. Recent areas of emergence include parts of the southeastern Canadian Prairie region. We developed a map of potential risk areas for future I. scapularis establishment in the Canadian Prairie Provinces. Six I. scapularis risk algorithms were developed using different formulations of three indices for environmental suitability: temperature using annual cumulative degree-days > 0 °C (DD > 0 °C; obtained from Moderate Resolution Imaging Spectroradiometer satellite data as an index of conditions that allow I. scapularis to complete its life cycle), habitat as a combined geolayer of forest cover and agricultural land use, and rainfall. The relative performance of these risk algorithms was assessed using receiver-operating characteristic (ROC) area under the curve (AUC) analysis with data on presence–absence of I. scapularis obtained from recent field surveillance in the Prairie Provinces accumulated from a number of sources. The ROC AUC values for the risk algorithms were significantly different (P < 0.01). The algorithm with six categories of DD > 0 °C, habitat as a simple dichotomous variable of presence or absence of forest, and normalized rainfall had the highest AUC of 0.74, representing “fair to good” performance of the risk algorithm. This algorithm had good (>80%) sensitivity in predicting positive I. scapularis surveillance sites, but low (50%) specificity as expected in this region where not all environmentally suitable habitats are expected to be occupied. Further prospective studies are needed to validate and perhaps improve the risk algorithm.