Miracle-dz/UniFAR-FTUs huggingface dataset:
Accidental Hypothermia

Pediatricians may be able to bring the dangers of accidental hypothermia to the attention of their patients at the time of a sports, camp, or college "physical. " People who spend time outdoors must learn to recognize hypothermia-producing weather and water; to know that shivering indicates heat loss exceeding available insulation and body heat production; and to understand that loss of good judgment and hand coordination soon follow uncontrollable shivering. They must not go into areas in which, without proper gear, unfavorable weather conditions or dangerous water may develop, and they must understand that most tragedies from cold result from failure to make camp or to return to safety when weather conditions become unfavorable.
A case of Lennox‐Gastaut syndrome in a patient with FOXG1‐related disorder

Lennox‐Gastaut syndrome (LGS) is a drug‐resistant epileptic encephalopathy of childhood with a heterogeneous etiology. Recently, genome‐wide association studies have led to the identification of new de novo mutations associated with this epileptic syndrome. Herein, we report an 8‐year‐old child with intellectual disability, severe postnatal microcephaly, Rett‐like features, and LGS, carrying a de novo missense mutation in the forkhead box G1 (FOXG1) gene. This gene is responsible for FOXG1 syndrome, characterized by severe postnatal microcephaly, moderate postnatal growth deficiency, mental retardation with poor social interaction, stereotyped behavior and dyskinesias, absent language, sleep disorders, and epilepsy. Nonspecific epilepsy syndromes have been associated with this genetic disorder. Thus, we hypothesize that FOXG1 might be a new candidate gene in the etiology of LGS and suggest screening for this gene in cases of LGS with concomitant microcephaly and clinical features overlapping with Rett syndrome.
Time to Test Incentives to Increase Organ Donation.

29. Delmonico FL, Arnold R, Scheper-Hughes N, Siminoff LA, Kahn J, Youngner SJ. Ethical incentives—not payment—for organ donation. N Engl J Med. 2002;346(25):2002-2005. 30. Salim A, Malinoski D, Schulman D, Desai C, Navarro S, Ley EJ. The combination of an online organ and tissue registry with a public education campaign can increase the number of organs available for transplantation. J Trauma. 2010;69(2): 451-454.
Undermeasuring Overuse--An Examination of National Clinical Performance Measures.

most vulnerable times in their lives—as in any other specialty. Not only are minority physicians more likely to work in underserved areas when their training is complete, but the quality of health care may be better when clinicians and patients are of the same race or ethnicity.5,6 The findings also raise questions, however. For example, it is not clear what makes obstetrics and gynecology so attractive to black and Hispanic trainees. I am unaware of any organized program to attract students or retain trainees who are underrepresentedminorities.DatafromtheAssociationofAmericanMedical Colleges show that between 1980 and 2012, the number of black women graduates of US medical schools increased 4-fold while the number of black men graduating declined.7 Most of the gains for underrepresented minorities in obstetrics and gynecology are likely among black women, partly owing to the high percentage of women entering the specialty. We lack data on the number of black and Hispanic trainees who complete the 4-year obstetrics and gynecology residency or further subspecialty training in urogynecology, maternal fetal medicine, gynecologic oncology, reproductive endocrinology, and infertility or family planning. These subspecialists account for the majority of researchers and medical school faculty and care for many underserved women with complex medical needs. Not only are black and Hispanic physicians underrepresented among medical school faculty, but they are less likely to be promoted, less likely to hold senior faculty and administrative positions, and less likely to be funded by the National Institutes of Health.8,9 Similarly, the number of women in leadership positions within academic institutions is low when compared with the increasing number of women in obstetrics and gynecology and other specialties. It is important to learn what factors contributed to the increase in numbers of women, blacks, and Hispanics in obstetrics and gynecology and whether those factors could improve representation in other specialties. It is also important, however, for obstetrics and gynecology and other specialties in which diversity is improving to monitor their workforce, the quality of postgraduate training, and the advancement of women, blacks, and Hispanics to senior and leadership roles. Progress will stall if women or underrepresented minorities do not advance. Ensuring a diverse physician workforce will require the continuing attention of medical school leadership and health care systems, and interventions to provide opportunities for diverse physicians to join the leadership ranks. Increasing physician diversity is yet another opportunity to improve the quality of care for all of our patients, particularly the most disadvantaged and those with a disproportionate burden of disease.
LQT, HCN, and epilepsy model

Recently, I was surprised by the above-mentioned observation made 188 years ago. I therefore read with great interest the commentary in Epilepsy Currents by Smith and Delisle on the study in Epilepsia by Powell et al. addressing the hyperpolarization-activated cyclic nucleotide (HCN or Ih) gated nonselective cation channels. Both the commentary and article along another recent paper shed light on two of the most important and interrelated organs: the brain and heart. Of interest, as it is evidenced, even their pathologies are related. It is a simple fact that HCN channels are present throughout the brain and heart, but prevailingly only the medial septum in the former and sinoatrial/atrioventricular (SA/AV) nodes in the latter exhibit a pacemaker electrical activity. This calls into question the established global pacemaker role for HCN–pacemaker channels. Despite the advances in understanding all four a (HCN1–4) and auxiliary subunits, a very first and plain question still cannot be answered: Why does the functional expression of HCN channels in a few regions of the heart/ brain result in recurrent high frequency action potentials, but not in the other compartments of these organs? Indeed a specified and crucial function should logically not be a global phenomenon, but rather originate in a minority of cells for many reasons. However, why? Powell et al. has evidenced the transient recurrent arrhythmias (attributed to HCN2 down-regulation) in Genetic Absence Epilepsy Rats from Strasbourg (GAERS). These irregularities occur every ~2 s in Figure 1C (legends are mismatched), and are the consequences of interictal activities in the brain. There is an increase in one or two R–R intervals followed by the compensatory pause/decrease before the subsequent beats. The heart rates (HRs) in two sets of nonepileptic controls (NECs, 420 vs. 314 beats/min) and in the temporal lobe epilepsy (TLE) model compared to GAERS (400 vs. 337) are different in vivo. The same is true for the HR variability as reflected by the standard deviation of R–R (SDRR) intervals in NEC (2 vs. 0.2 msec). These differences could not be attributed solely to saline injections. Because the QTc interval (corrected for HR, first used by Fridericia in 1920) increased (i.e., long QT [LQT]) from 128 to 169 msec in the TLE model, the involvement of K channels are warranted. The most important observation in TLE perhaps is the fact that behaviorally observed seizures matched timely the changes in electrocardiography (ECG), whereas those of electroencephalography (EEG) were delayed by ~15 s. In contrast, the heart response and spike wave discharges (SWDs) in the spontaneous absence epilepsy (AE) model overlap. Mamalyga documented that there is a correlation between the SWDs in WAG/Rij rats and the acceleration of the HR occurring with some latency. There is to some degree also mild arrhythmia in the AE model. Collectively, none of pathologies could be defined either by a single channel/ receptor type or target the one and only one organ/region.
Amyotrophic Lateral Sclerosis.

From the Department of Neurology, University of Massachusetts Medical School, Worcester (R.H.B.); and the Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King’s College London, London (A.A.-C.). Address reprint requests to Dr. Brown at the Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave. N. , Worcester, MA 01655, or at robert . brown@ umassmed . edu.
Trombosis portal aguda y gas intrahepático: a propósito de dos casos

La presencia de gas portal intrahepatico en adultos es un fenomeno multifactorial en el que se comparten factores inflamatorios y protromboticos sistemicos, frecuente en pacientes con cirrosis hepatica avanzada y raro en individuos con higado sano, sin embargo la presencia de focos inflamatorios abdominales y estados de hipercoagulabilidad secundaria a la respuesta inflamatoria sistemica la hace mas frecuente, sus manifestaciones son inespecificas y variables segun la gravedad del cuadro. Presentamos dos pacientes con sintomatologia inespecifica y estudios imagenologicos que reportaron gas portal intrahepatico, uno secundario a enfermedad diverticular y otro a abscesos hepaticos que evolucionaron favorablemente con tratamiento quirurgico, antibiotico y anticoagulante.
Hemorrhagic Shock

Hemorrhagic shock is a type of hypovolemic shock, where intravascular blood loss and consequent alterations in the cell due to the hypoxia result in tissue and organ dysfunction, leading to death, once a certain threshold level is exceeded. Inadequate oxygen delivery results with Na/K ATPase pump dysfunction and cell death by this way, but erythrocytes do not use oxygen for their survival. A depolarizing protein can be a reason under in vivo conditions. In severe injury, rapid loss of 25% and more blood volume cause irreversible shock. For blood restoration, crystalloid solutions temporarily provide a practical approach, but they cannot replace the lost erythrocyte mass occurred due to bleeding, and they have no therapeutic value. Excessive use causes several problems, especially coagulopathy and increases the mortality risk. The prompt transfer of patient to an ultimate center for treatment, use of blood and blood products in the treatment, and a swift restoration of hemorrhage source are essential. Tourniquet use in the extremities and balloon occlusion of the aorta can be lifesaving.
Primary Care Practitioners' Views on Incorporating Long-term Prognosis in the Care of Older Adults.

IMPORTANCE Clinical practice recommendations increasingly advocate that older patients' life expectancy be considered to inform a number of clinical decisions. It is not clear how primary care practitioners approach these recommendations in their clinical practice. OBJECTIVE To explore the range of perspectives from primary care practitioners on long-term prognosis, defined as prognosis regarding life expectancy in the range of years, in their care of older adults. DESIGN, SETTING, AND PARTICIPANTS A qualitative, semistructured interview study was conducted in a large group practice with multiple sites in rural, urban, and suburban settings. Twenty-eight primary care practitioners were interviewed; 20 of these participants (71%) reported that at least 25% of their patient panel was older adults. The audiorecorded discussions were transcribed and analyzed, using qualitative content analysis to identify major themes and subthemes. The study was conducted between January 30 and May 13, 2015. Data analysis was performed between June 10 and September 1, 2015. MAIN OUTCOMES AND MEASURES The constant comparative approach was used to qualitatively analyze the content of the transcripts. RESULTS Of the 28 participants, 16 were women and 21 were white; the mean (SD) age was 46.2 (10.3) years. Twenty-six were physicians and 2 were nurse practitioners. Their time since completing clinical training was 16.0 (11.4) years. These primary care practitioners reported considering life expectancy, often in the range of 5 to 10 years, in several clinical scenarios in the care of older adults, but balanced the prognosis consideration against various other factors in decision making. In particular, patient age was found to modulate how prognosis affects the primary care practitioners' decision making, with significant reluctance among them to cease preventive care that has a long lag time to achieve benefit in younger patients despite limited life expectancy. The participants assessed life expectancy based on clinical experience rather than using validated tools and varied widely in their prognostication time frame, from 2 years to 30 years. Participants often considered prognosis without explicitly discussing it with patients and disagreed on whether and when long-term prognosis needs to be specifically discussed. The participants identified numerous barriers to incorporating prognosis in the care of older adults including uncertainty in predicting prognosis, difficulty in discussing prognosis, and concern about patient reactions. CONCLUSIONS AND RELEVANCE Despite clinical recommendations to increasingly incorporate patients' long-term prognosis in clinical decisions, primary care practitioners encounter several barriers and ambiguities in the implementation of these recommendations.
Association Between the Centers for Medicare and Medicaid Services Hospital Star Rating and Patient Outcomes.

Association Between the Centers for Medicare and Medicaid Services Hospital Star Rating and Patient Outcomes In an effort to help patients choose hospitals based on quality, the Centers for Medicare and Medicaid Services (CMS) recently introduced a 5-star hospital rating system. This rating depends solely on patient experience based on the Hospital Consumer Assessment of Healthcare Providers and Systems, and currently, it does not include measures of quality of care or patients’ health outcomes. Whether hospital stars are associated with better outcomes is unclear, and critics worry that the star rating system may mislead patients into thinking that 5-star hospitals are superior in quality.1-4 Therefore, we investigated whether hospitals with more stars have lower riskadjusted 30-day mortality and readmissions than hospitals with less stars.
Trial Registration at ClinicalTrials.gov between May and October 2005.

BACKGROUND Clinical trial registration allows interested parties to obtain information about ongoing and completed trials, but there are few data indicating the quality of the information provided during the registration process. We used information in the publicly available ClinicalTrials.gov database to describe patterns of trial registration before and after the implementation by journal editors of a new policy requiring registration as a prerequisite for publication. METHODS We reviewed ClinicalTrials.gov records to determine patterns of completion of the "Intervention Name" and "Primary Outcome Measure" data fields for trials registered on May 20 and October 11, 2005, and for trials registered during the interval between these two dates, inclusively. RESULTS During the interval studied, the number of registrations in ClinicalTrials.gov increased by 73 percent from 13,153 to 22,714. The percentage of interventional trials registered by industry with nonspecific Intervention Name entries (attributable to four drug companies) decreased from 10 percent to 2 percent; all other industry and nonindustry records contained specific entries in this field. Of the 2670 studies registered by industry between the two dates, 76 percent provided information in the Primary Outcome Measure field, although these entries varied markedly in their degree of specificity. In the remaining 24 percent of the records, this field was blank. CONCLUSIONS During the summer of 2005, there were large increases in the number of clinical trial registrations. Overall, the data contained in records were more complete in October than they were in May, but there still is room for substantial improvement.
Impact of health care system on socioeconomic inequalities in doctor use

This study examines the impact of health system characteristics on social inequities in health care use in Europe, using data from national surveys in 13 European countries. Multilevel logistic regression models are estimated to separate the individual level determinants of generalist and specialist use from the health system level and country specific factors. The results suggest that beyond the division between public and private funding and cost-sharing arrangements in health system, the role given to the general practitioners and/or the organization of the primary care might be essential for reducing social inequities in health care utilisation.
Plantas do pantanal

631RESENHA / REVIEWMissao na Selva. Emil Odebrecht (1835-1912), umprussiano no Brasil. Moacir Werneck de Castro. Riode Janeiro: AC&M, 1994.Ja havia resenhado o livro de Moacir Werneck deCastro sobre Fritz Muller, mas neste ele se superou.Logo no inicio, uma frase do Doutor Blumenausobre o vale do Itajai, naquela epoca: “Aqui pareceque tudo parou no primeiro dia da Criacao” asseme-lha-se a definicao de Euclides da Cunha para a Ama-zonia: “Terra ainda quente do Genesis”. Muito interessante a descricao da area em que seergueria a cidade de Blumenau.Foi muito agradavel encontrar a formacao da Colo-nia Itajai, atual cidade de Brusque, onde iniciei a mi-nha carreira de pesquisador.Com respeito as amizades de Odebrecht, edestacada a importância da Sociedade dos Atirado-res, como a que conheci em Brusque, no papel denucleo de onde nasceram outras associacoes impor-tantes para o desenvolvimento da colonia.O grande parteiro de Blumenau, Friedenreich, quese registrara na colonia como veterinario, por ser fo-ragido da justica, aqui aparece como medico diploma-do e com pratica na Alemanha.Um debate sobre a construcao da ferrovia para oplanalto, entre os tres grandes pioneiros de Blume-nau, Odebrecht, Fritz Muller e Friedenreich, realizadonuma clareira da floresta, e do maior interesse para oentendimento da mentalidade desses grandes homens.Com base na correspondencia trocada entre osmembros daqui e da Alemanha, o autor reconstitui avida da famflia Odebrecht.Deixa a melhor impressao o respeito que Ode-brecht tinha pelos indios e a sua revolta contra asmatancas, as vezes patrocinadas por autoridadesgovernamentais.Ao comentar a atuacao de Odebrecht na Repar-ticao dos Telegrafos, o autor aproveita para incluiruma pequena biografia do Barao de Capanema,figurailustre de brasileiro pouco conhecido.Em boa hora, o autor anexou ao livro o diario daexpedicao de Odebrecht as cabeceiras dos formado-res do rio Itajai-Acu. Ali pode ser visto a durezaque e o trabalho de um engenheiro explorador.Mario B. Aragao
Association of Specific Dietary Fats With Total and Cause-Specific Mortality.

IMPORTANCE Previous studies have shown distinct associations between specific dietary fat and cardiovascular disease. However, evidence on specific dietary fat and mortality remains limited and inconsistent. OBJECTIVE To examine the associations of specific dietary fats with total and cause-specific mortality in 2 large ongoing cohort studies. DESIGN, SETTING, AND PARTICIPANTS This cohort study investigated 83 349 women from the Nurses' Health Study (July 1, 1980, to June 30, 2012) and 42 884 men from the Health Professionals Follow-up Study (February 1, 1986, to January 31, 2012) who were free of cardiovascular disease, cancer, and types 1 and 2 diabetes at baseline. Dietary fat intake was assessed at baseline and updated every 2 to 4 years. Information on mortality was obtained from systematic searches of the vital records of states and the National Death Index, supplemented by reports from family members or postal authorities. Data were analyzed from September 18, 2014, to March 27, 2016. MAIN OUTCOMES AND MEASURES Total and cause-specific mortality. RESULTS During 3 439 954 person-years of follow-up, 33 304 deaths were documented. After adjustment for known and suspected risk factors, dietary total fat compared with total carbohydrates was inversely associated with total mortality (hazard ratio [HR] comparing extreme quintiles, 0.84; 95% CI, 0.81-0.88; P < .001 for trend). The HRs of total mortality comparing extreme quintiles of specific dietary fats were 1.08 (95% CI, 1.03-1.14) for saturated fat, 0.81 (95% CI, 0.78-0.84) for polyunsaturated fatty acid (PUFA), 0.89 (95% CI, 0.84-0.94) for monounsaturated fatty acid (MUFA), and 1.13 (95% CI, 1.07-1.18) for trans-fat (P < .001 for trend for all). Replacing 5% of energy from saturated fats with equivalent energy from PUFA and MUFA was associated with estimated reductions in total mortality of 27% (HR, 0.73; 95% CI, 0.70-0.77) and 13% (HR, 0.87; 95% CI, 0.82-0.93), respectively. The HR for total mortality comparing extreme quintiles of ω-6 PUFA intake was 0.85 (95% CI, 0.81-0.89; P < .001 for trend). Intake of ω-6 PUFA, especially linoleic acid, was inversely associated with mortality owing to most major causes, whereas marine ω-3 PUFA intake was associated with a modestly lower total mortality (HR comparing extreme quintiles, 0.96; 95% CI, 0.93-1.00; P = .002 for trend). CONCLUSIONS AND RELEVANCE Different types of dietary fats have divergent associations with total and cause-specific mortality. These findings support current dietary recommendations to replace saturated fat and trans-fat with unsaturated fats.