Miracle-dz/UniFAR-FTUs huggingface dataset:
Neurologic Outcomes and Postresuscitation Care of Patients With Myoclonus Following Cardiac Arrest*

Objectives: To evaluate the outcomes of cardiac arrest survivors with myoclonus receiving modern postresuscitation care. Design: Retrospective review of registry data. Setting: Cardiac arrest receiving centers in Europe and the United States from 2002 to 2012. Patients: Two thousand five hundred thirty-two cardiac arrest survivors 18 years or older enrolled in the International Cardiac Arrest Registry. Interventions: None. Measurements and Main Results: Eighty-eight percent of patients underwent therapeutic hypothermia and 471 (18%) exhibited myoclonus. Patients with myoclonus had longer time to professional cardiopulmonary resuscitation (8.6 vs 7.0 min; p < 0.001) and total ischemic time (25.6 vs 22.3 min; p < 0.001) and less often presented with ventricular tachycardia/ventricular fibrillation, a witnessed arrest, or had bystander cardiopulmonary resuscitation. Electroencephalography demonstrated myoclonus with epileptiform activity in 209 of 374 (55%), including status epilepticus in 102 of 374 (27%). Good outcome (Cerebral Performance Category 1–2) at hospital discharge was noted in 9% of patients with myoclonus, less frequently in myoclonus with epileptiform activity (2% vs 15%; p < 0.001). Patients with myoclonus with good outcome were younger (53.7 vs 62.7 yr; p < 0.001), had more ventricular tachycardia/ventricular fibrillation (81% vs 46%; p < 0.001), shorter ischemic time (18.9 vs 26.4 min; p = 0.003), more witnessed arrests (91% vs 77%; p = 0.02), and fewer “do-not-resuscitate” orders (7% vs 78%; p < 0.001). Life support was withdrawn in 330 of 427 patients (78%) with myoclonus and poor outcome, due to neurological futility in 293 of 330 (89%), at 5 days (3–8 d) after resuscitation. With myoclonus and good outcome, median ICU length of stay was 8 days (5–11 d) and hospital length of stay was 14.5 days (9–22 d). Conclusions: Nine percent of cardiac arrest survivors with myoclonus after cardiac arrest had good functional outcomes, usually in patients without associated epileptiform activity and after prolonged hospitalization. Deaths occurred early and primarily after withdrawal of life support. It is uncertain whether prolonged care would yield a higher percentage of good outcomes, but myoclonus of itself should not be considered a sign of futility.
Stability, purification, and applications of bromelain: A review

Bromelain is a cysteine protease found in pineapple tissue. Because of its anti‐inflammatory and anti‐cancer activities, as well as its ability to induce apoptotic cell death, bromelain has proved useful in several therapeutic areas. The market for this protease is growing, and several studies exploring various properties of this molecule have been reported. This review aims to compile this data, and summarize the main findings on bromelain in the literature to date. The physicochemical properties and stability of bromelain under different conditions are discussed. Several studies on the purification of bromelain from crude extracts using a wide range of techniques such as liquid–liquid extractions by aqueous two‐phase system, ultrafiltration, precipitation, and chromatography, have been reported. Finally, the various applications of bromelain are presented. This review therefore covers the main properties of bromelain, aiming to provide an up‐to‐date compilation of the data reported on this enzyme. © 2015 American Institute of Chemical Engineers Biotechnol. Prog. , 32:5–13, 2016
Economics, medicine, and health care

List of contents Preface to the first edition Preface to the second edition Preface to the third edition 1 Introduction 2 Economics and health economics 2.1 Resource allocation problems 2.2 Supply and demand: the market 2.3 Economic evaluation 2.4 Conclusions 3 The nature of the commodity health care 3.1 Introduction 3.2 Defining health 3.3 Health and health care 3.4 Health care 3.5 Conclusion 4 Health status and other outcome measurement 4.1 Introduction 4.2 Some issues in measuring health 4.3 Quality adjusted life years ('QALYs') 4.4 Other outcomes 4.5 Conclusions 5 Values in health care 5.1 Whose values? 5.2 Valuing outputs 5.3 Que faire? 6 Need, demand and the agency relationship 6.1 Introduction 6.2 Demand and need for health care 6.3 Describing the agency relationship 6.4 Analysing the agency relatcionship 7 The inefficiency of medical ethics 7.1 Introduction 7.2 Ethics and medical ethics 7.3 The relevance of utilitarianism 7.4 Conclusion 8 Just health care: only medicine? 8.1 Introduction 8.2 What is equity? 8.3 Practical difficulties 8.4 An alternative approach based on 'capacity to benefit' 8.5 How should equity be defined? 8.6 Equity and ethics 8.7 What's best? 9 Priority setting in health care 9.1 Introduction 9.2 Priority setting using an explicit economics approach 9.3 QALY league tables 9.4 Priority setting: some other approaches 9.5 Conclusion 10 Health care financing and organisation 10.1 Introduction 10.2 Key features of public systems 10.3 Fair shares for all? 10.4 Fair-sharing and health care 10.5 Other insights from Margolis 10.6 Which system? 11 Some future roads to travel? 11.1 Introduction 11.2 Education 11.3 Information 11.4 Evaluation and monitoring 11.5 Does economic evaluation work? 11.6 Financing, budgeting and remuneration 11.7 Listening to the community 11.8 A final thought Index
Severe necrotizing infection of the perineum: beyond necrosectomy

The evolution of systemic inflammatory response syndrome (SIRS) to septic shock is a continuum that can be stemmed using dedicated and early goal directed interventions. In the setting of necrotizing soft tissue infection, mortality approaches 100% when debridement is delayed or altogether omitted. Volume depletion, vasodilatation, myocardial depression, high metabolism and attendant global hypoxia that precede multi- organ dysfunction syndrome (MODS) and mortality need to be addressed early, avoiding delays in the emergency department, hospital ward, or the intensive care unit. Early goal directed therapy denotes the use of interventions such as administration of crystalloid solutions, vaso-active agents, blood transfusion and inotropic agents to achieve specific targets, namely, a central venous pressure of 8 – 12 mmHg, a mean arterial pressure of 65 – 90 mmHg, a urine output of > 0.5mls/kg/hr, a hematocrit of >30% and a central venous oxygen saturation of > 70% in a patient who is intubated, sedated and paralysed.We present an illustrative case of the management of severe Fournier’s gangrene and how a series of misadventures at home, the A & E and the wards contributed to the inevitable demise.
Neutrophil Gelatinase-Associated Lipocalin as an Early Prognostic Biomarker in Acute Kidney Injury Following Cardiac Surgery.

Critical Care Medicine www.ccmjournal. org e393 In Table 3 in (1), urinary NGAL was separately determined at 1, 3, and 18–24 hours after completion of post– cardiopulmonary bypass surgery. Why the authors do not shorten the septation (1, 3, 6, 12, and 24 hr) to increase the accuracy of the result. Another limitation of the research by Mcllroy et al (1) is that no comparison of NGAL and other well-established prognostic models has been made. As a result, it still remains unclear whether NGAL shows superior prognostic performance than S Cr or the Acute Physiology and Chronic Health Evaluation II, which is a strong predictor of AKI. Meanwhile, the authors did not evaluate fluctuations in NGAL levels and thus could not account for possible variation over time. In addition to NGAL, there are several other useful biomarkers that can be used to predict the severity of AKI, such as urinary volume, urea nitrogen, urinary kidney injury molecule-1, and serum cystatin (8). Therefore, NGAL should be evaluated accompanied with other important markers. Only in this way, we can get accurate information about adverse outcomes and prognostic indication of the patients with AKI. Finally, the research by Mcllroy et al (1) will promote further researches on the relationship of NGAL and AKI after cardiac surgery. The authors received grant support and support for article research from Institutes of Zhedong ICU Center. Their institutions received support for travel, received support for participation in review activities, received support for article writing/review, received provision of writing assistance/equipment, served as a board member, consulted, provided expert testimony, lectured, received payment for article preparation, received royalties, and received support for the development of education presentations.
Impact of an early-exposure geriatrics curriculum in an accelerated baccalaureate-MD program

ABSTRACT Current standard geriatric curricula and exposure of students to the elderly may be insufficient to influence students’ interest in geriatric medicine. We developed an innovative curriculum to address this gap. This study aimed to identify knowledge, skill, and attitude changes of first-year students in an accelerated baccalaureate-MD program toward geriatrics after participation in an early-exposure geriatrics curriculum (GC). The GC consisted of fifteen 3-hr interactive teaching sessions facilitated by various health professionals. This was a single group, pre- and post-intervention study using a knowledge test and attitude survey. To assess the effectiveness of this curriculum, students also completed an Objective Structured Clinical Exam (OSCE) on falls, cognitive and functional assessment, and delivering bad news. Twenty-seven baccalaureate-MD students (mean age = 18.8 years) participated in the GC intervention between January and April 2015. The post-GC showed significant improvement in knowledge (P = 0.013), skills, and attitude (P < 0.01) toward older adults. Students as a group overall met the standard of 85% of possible points in all three OSCE cases. This study shows that an early-exposure geriatric education intervention is associated with an increase in students’ knowledge, skills, and attitudes in caring for older adults.
Rehabilitation Practitioners' Prioritized Care Processes in Hip Fracture Post-Acute Care

ABSTRACT Aims: Occupational and physical therapy in post-acute care (PAC) has reached the point where quality indicators for hip fracture are needed. This study characterizes the practitioners' prioritized hip fracture rehabilitation practices, which can guide future quality improvement initiatives. Methods: Ninety-two practitioners participating in a parent mixed methods study were asked to rank a series of evidence-based best practices across five clinical domains (assessment, intervention, discharge planning, caregiver training, and patient education). Results: Prioritized practices reflected patient–practitioner collaboration, facilitating an effective discharge, and preventing adverse events. The highest endorsed care processes include: developing meaningful goals with patient input (84%) in assessment, using assistive devices in intervention (75%) and patient education (65%), engaging the patient and caregiver (50%) in discharge planning, and fall prevention (60%) in caregiver education. Conclusions: Practitioners identified key care priorities. This study lays the foundation for future work evaluating the extent to which these practices are delivered in PAC.
Expression of Macrophage Colony-Stimulating Factor (M-CSF) and Its Receptor in Streptozotocin-Induced Diabetic Rats

Purpose: To demonstrate the expression and location of macrophage colony-stimulating factor (M-CSF) and its receptor (CSF-1R) in the retinas of diabetic rats, as well as in vitreous human proliferative diabetic retinopathy (PDR). Methods: The retinas of streptozotocin-induced diabetic rat were studied. Real-time PCR was applied to evaluate M-CSF and its receptor CSF-1R mRNA expression in the retinas. The protein levels of M-CSF and CSF-1R were evaluated by Western blot analysis. Cellular sources of M-CSF and CSF-1R were determined by double-immunofluorescence staining. M-CSF levels in vitreous samples from patients with PDR were measured by ELISA. Results: M-CSF and CSF-1R mRNA were upregulated in the retinas as early as two weeks after the onset of diabetes and increased over time. A similar pattern was observed for M-CSF/CSF-1R protein expression levels. Double-immunofluorescence staining revealed that increased M-CSF immunoreactivity occurred mainly in the nerve fiber layer in diabetic retinas, co-localizing with glial fibrillary acidic protein. Increased CSF-1R immunoreactivity was observed in OX-42-labeled microglia and ganglion cells in the ganglion cell layer. The vitreous level of M-CSF was elevated in patients with PDR compared to control subjects. Conclusions: The early upregulation of MCSF/CSF-1R signaling may be an important regulatory pathway among neurons, microglia, and glia in diabetic retinopathy.
Morphological Properties of Siloxane-Hydrogel Contact Lens Surfaces

ABSTRACT Purpose: The aim of this study was to quantitatively characterize the micromorphology of contact lens (CL) surfaces using atomic force microscopy (AFM) and multifractal analysis.Materials and Methods: AFM and multifractal analysis were used to characterize the topography of new and worn siloxane-hydrogel CLs made of Filcon V (I FDA group). CL surface roughness was studied by AFM in intermittent-contact mode, in air, on square areas of 25 and 100 μm2, by using a Nanoscope V MultiMode (Bruker). Detailed surface characterization of the surface topography was obtained using statistical parameters of 3-D (three-dimensional) surface roughness, in accordance with ISO 25178-2: 2012.Results: Before wear, the surface was found to be characterized by out-of-plane and sharp structures, whilst after a wear of 8 h, two typical morphologies were observed. One morphology (sharp type) has a similar aspect as the unworn CLs and the other morphology (smooth type) is characterized by troughs and bumpy structures. The analysis of the AFM images revealed a multifractal geometry. The generalized dimension Dq and the singularity spectrum f(α) provided quantitative values that characterize the local scale properties of CL surface geometry at nanometer scale.Conclusions: Surface statistical parameters deduced by multifractal analysis can be used to assess the CL micromorphology and can be used by manufacturers in developing CLs with improved surface characteristics. These parameters can also be used in understanding the tribological interactions of the back surface of the CL with the corneal surface and the front surface of the CL with the under-surface of the eyelid (friction, wear, and micro-elastohydrodynamic lubrication at a nanometer scale).
The Influence of Optical Coherence Tomography Measurements of Retinal Nerve Fiber Layer on Decision-Making in Glaucoma Diagnosis

ABSTRACT Purpose: To quantify the influence of spectral domain optical coherence tomography (SDOCT) on decision-making in patients with suspected glaucoma. Methods: A prospective cross-sectional study involving 40 eyes of 20 patients referred by community optometrists due to suspected glaucoma. All patients had disc photographs and standard automated perimetry (SAP), and results were presented to 13 ophthalmologists who estimated pre-test probability of glaucoma (0–100%) for a total of 520 observations. Ophthalmologists were then permitted to modify probabilities of disease based on SDOCT retinal nerve fiber layer (RNFL) measurements (post-test probability). The effect of information from SDOCT on decision to treat, monitor, or discharge was assessed. Agreement among graders was assessed using intraclass correlation coefficients (ICC) and correlated component regression (CCR) was used to identify variables influencing management decisions. Results: Patients had an average age of 69.0 ± 10.1 years, SAP mean deviation of 2.71 ± 3.13 dB, and RNFL thickness of 86.2 ± 16.7 μm. Average pre-test probability of glaucoma was 37.0 ± 33.6% with SDOCT resulting in a 13.3 ± 18.1% change in estimated probability. Incorporating information from SDOCT improved agreement regarding probability of glaucoma (ICC = 0.50 (95% CI 0.38 to 0.64) without SDOCT versus 0.64 (95% CI 0.52 to 0.76) with SDOCT). SDOCT led to a change from decision to “treat or monitor” to “discharge” in 22 of 520 cases and a change from “discharge” to “treat or monitor” in 11 of 520 cases. Pre-test probability and RNFL thickness were predictors of post-test probability of glaucoma, contributing 69 and 31% of the variance in post-test probability, respectively. Conclusions: Information from SDOCT altered estimated probability of glaucoma and improved agreement among clinicians in those suspected of having the disease.
Characterization of flow conditions in 2 L and 20 L wave bioreactors® using computational fluid dynamics

Characterization of flow conditions is of great importance to control cell growth and cell damage in animal cell culture because cell viability is influenced by the flow properties in bioreactors. Alternative reactor types like Wave Bioreactors® have been proposed in recent years, leading to markedly different results in cell growth and product formation. An advantage of Wave Bioreactors® is the disposability of the Polyethylenterephthalet‐bags after one single use (fast setup of new production facilities). Another expected advantage is a lower shear stress compared to classical stirred‐tank reactors, due to the gentle liquid motion in the rocking cellbag. This property would considerably reduce possible cell damage. The purpose of the present study is to investigate in a quantitative manner the key flow properties in Wave Bioreactors®, both numerically and experimentally. To describe accurately flow conditions and shear stress in Wave Bioreactors® using numerical simulations, it is necessary to compute the unsteady flow applying Computational Fluid Dynamics (CFD). Corresponding computations for two reactor scales (2 L and 20 L cellbags) are presented using the CFD code ANSYS‐FLUENT®. To describe correctly the free liquid surface, the present simulations employ the Volume of Fluid (VOF) method. Additionally, experimental measurements have been carried out to determine liquid level, flow velocity and liquid shear stress, which are used as a validation of the present CFD simulations. It is shown that the obtained flows stay in the laminar regime. Furthermore, the obtained shear stress levels are well below known threshold values leading to damage of animal cells. © 2009 American Institute of Chemical Engineers Biotechnol. Prog. , 2010
Computers in White Coats: How to Devise Useful Clinical Decision Support Software.

Critical Care Medicine www.ccmjournal. org 1449 The rate of alarms in clinical care is, well, alarming. Some quality control would be gratefully accepted. In this issue of Critical Care Medicine, Chen et al (1) from the critical care redoubt in Pittsburgh report on a combined effort by clinicians and data scientists—results made possible only through fusion of substantial clinical elbow grease and large-scale computing—to address the fundamental challenge of telling true alarms from false. Four clinicians each spent 100 hours (! ) inspecting the 973 alarm records analyzed. The result—a computerized decision as to whether the alarm was true or not—promises a clinically significant reduction in alarm frequency with no clinically significant increase in risk to patients. This is not the only article on this topic, but we feel this major work stands apart by pounding home the notion that the hardest part of computer programming to support clinical decisions has nothing to do with computers. We are all witness to the torrent of new computer algorithms and smartphone apps intended to provide clinical decision support in the care of patients, from multi-lead electrocardiograms to colposcopy. There is little question that they provide additional information to bedside practitioners, but there are so many algorithms and apps now—how do we know which will help? And, with so much promise in this field, many data scientists and app developers are turning toward healthcare— what criteria must they satisfy to develop a quality product? One vision is that decision support should synthesize new and nonobvious information that can point the clinician in unanticipated directions or serve as a tiebreaker when clinical scenarios are ambiguous. Increasingly, crossdisciplinary teams like Chen et al (1) at Pittsburgh and Carnegie-Mellon gather together with this kind of goal. Now what do they do? We—from left to right, a clinical cardiologist, a mathematician, and a new-generation hybrid model—have watched and worked in this field for as many as 15 years. Here is our suggested prescription.
Patient-Perceived and Laboratory-Measured Halos Associated with Diffractive Bifocal and Trifocal Intraocular Lenses

ABSTRACT Purpose: To examine and assess the halos generated in distance vision by multifocal intraocular lenses (IOLs) using both in vitro objective and in vivo subjective methods. Setting: The objective method was carried out in the optics laboratory of the Applied Optics and Image Processing Group (Universitat Politècnica de Catalunya -Barcelona). The psychophysical and subjective methods were carried out in the Instituto de Oftalmología Avanzada Madrid Innova Ocular. Design: Optical bench results and prospective evaluation of consecutive cases. Methods: The IOLs examined were TECNIS®one-piece bifocals with addition powers of +4.00 D, +3.25 D, and +2.75 D and the trifocals AT-LISA-tri® and FineVision®. In the objective assessment, we examined halos around the far focus images of a pinhole formed by each IOL in an optical bench. For the in vivo study, we recruited 100 patients who had been bilaterally implanted one month earlier with the IOLs under study. Participants were subjected to psychophysical halometry (Halo v1.0) on the eye with better, distance-corrected, visual acuity and were required to subjectively grade halos by responding to the question “How much do halos bother you? ” Results: The objective method revealed that the halo size increased with addition power and that the two trifocals gave rise to a double-halo pattern. Scores in the halometry also indicated a direct relationship between the halo size and addition power. The subjective results indicated fewer complaints about halos associated with the trifocal than bifocal IOLs. Conclusions: The addition power of the tested IOLs affected both laboratory-measured and patient-perceived halos. Trifocal lenses generated fewer complaints about halos. Precise: Multifocal intraocular lenses (MIOLs) give rise to halos observed by patients under conditions of dim lighting. This study compares laboratory characterized halos generated by five MIOLs with patient-perceived halos.