Miracle-dz/UniFAR-FTUs huggingface dataset:
Patient complaints in general practice seen through the lens of professionalism: a retrospective observational study

Background Professionalism is a key competence for physicians. Patient complaints provide a unique insight into patient expectations regarding professionalism. Research exploring the exact nature of patient complaints in general practice, especially focused on professionalism, is limited. Aim To characterise patient complaints in primary care and to explore in more detail which issues with professionalism exist. Design & setting A retrospective observational study in which all unsolicited patient complaints to a representative out-of-hours general practice (OOH GP) service provider in The Netherlands were analysed over a 10-year period (2009–2019). Method Complaints were coded for general characteristics and thematically categorised using the CanMEDS Physician Competency Framework (CanMEDS) as sensitising concepts. Complaints categorised as professionalism were subdivided using open coding. Results Out of 746 996 patient consultations (telephone, face-to-face, and home visits) 484 (0.065%) resulted in eligible complaint letters. The majority consisted of two or more complaints, resulting in 833 different complaints. Most complaints concerned GPs (80%); a minority (19%) assistants. Thirty-five per cent concerned perceived professionalism lapses of physicians. A rich diversity in the wording of professionalism lapses was found, where ' not being taken seriously ' was mentioned most often. Forty-five per cent related to medical expertise, such as missed diagnoses or unsuccessful clinical treatment. Nineteen per cent related to management problems, especially waiting times and access to care. Communication issues were only explicitly mentioned in 1% of the complaints. Conclusion Most unsolicited patient complaints were related to clinical problems. A third, however, concerned professionalism issues. Not being taken seriously was the most frequent mentioned theme within the professionalism category.
Thermal Tolerance May Slow, But Not Prevent, the Spread of Sargassum horneri (Phaeophyceae) along the California, USA and Baja California, MEX Coastline

Biological invasions have become increasingly prevalent in marine ecosystems, modifying biodiversity and altering the way ecosystems function. Understanding how variation in environmental factors influences the success of non‐native species, especially their early life stages, can be a crucial step in identifying habitats that are under threat of invasion, and in predicting how rapidly and far these species may spread once they arrive in novel habitats. The invasive marine macroalga Sargassum horneri was first observed in Long Beach Harbor, CA, USA in 2003, and has since spread throughout the Southern California Bight and along the Baja California Peninsula, MEX where it now forms dense stands on subtidal rocky reefs and displaces native habitat‐forming macroalgae. We examined how variation in temperature, nutrients, and irradiance affect survival, growth, and development in S. horneri early life stages over a three‐week period. Our experimental treatments consisted of orthogonally crossed temperatures (10, 15, 20, and 25°C), nutrient concentrations (ambient and nutrient‐enriched seawater), and irradiances (50 and 500 µmol photons · m−2 · s−1). Overall, temperature exerted the greatest influence on S. horneri’s germling and juvenile life stages, with moderate temperatures facilitating their greatest survival, growth, and development. In contrast, fewer germlings developed fully under the lowest or highest temperatures, and juvenile survival and growth were reduced, especially when combined with low irradiances. Together, our data suggest that ocean temperatures of or below 10˚C and of or above 25°C may slow, but likely not stop, S. horneri’s northward and southward expansion along the California and Baja California coasts.
The Motor Unawareness Assessment (MUNA): A new tool for the assessment of Anosognosia for hemiplegia

ABSTRACT Introduction: Anosognosia for hemiplegia (AHP) is a condition in which patients with paralysis are unaware of their motor deficits. Research into AHP is important for improving its treatment and providing insight into the neurocognitive mechanism of motor awareness. Unfortunately, most studies use assessments with widely recognized limitations. The study aims at developing a psychometrically validated assessment of AHP. Method: We developed a 40-item Motor Unawareness Assessment (MUNA) and administered it to 131 right-hemisphere stroke patients. Principal Component Analysis (PCA) was used to identify the underlying factor structure. Receiver Operating Characteristics (ROC) analysis was used to determine diagnostic cutoffs, and Area Under the Curve (AUC) analysis used to assess these cutoffs. Relationships with demographic, clinical and neuropsychological variables were explored. Results: Five factors were identified: explicit motor awareness, implicit motor awareness, impaired sense of ownership, agency and illusory movement, and emotional reactions. Established cutoffs had excellent sensitivity and specificity. Clinical, neuropsychological and demographic variables did not predict overall MUNA score but were related to specific subcomponents. Conclusion: The MUNA can differentiate various facets of AHP and provides a detailed profile of (un)awareness. The MUNA can therefore provide robust assessment for research purposes and assist clinicians when developing targeted rehabilitation.
Increasing pre-exposure prophylaxis use and 'net prevention coverage' in behavioural surveillance of Australian gay and bisexual men, 2014-19.

OBJECTIVES To assess trends in HIV prevention strategies among Australian gay and bisexual men (GBM) since the introduction of pre-exposure prophylaxis (PrEP), the level of net prevention coverage (the use of safe strategies), and the characteristics of HIV-negative and untested GBM who remain at risk of HIV. DESIGN Repeated behavioural surveillance of GBM recruited from venues, events and online in seven Australian states and territories. METHODS Participants with casual male partners were included. Trends in sexual practices, prevention strategies, net prevention coverage and the characteristics of 'at risk' participants were assessed with binary and multivariate logistic regression. RESULTS 32,048 survey responses (2014-19) were included. The proportion of participants who reported consistent condom use declined (44.6%-23.2%). The proportion who reported any condomless anal intercourse with casual partners (CAIC) increased (37.4%-62.0%) but net prevention coverage also increased (68.1%-74.9%), with higher levels of undetectable viral load (UVL) among HIV-positive participants and rapidly increasing PrEP use by HIV-negative participants. PrEP became the most commonly reported prevention strategy in 2019 (31.1%). The analysis of 'at risk' participants showed that they became more likely to report frequent CAIC but had fewer partners and more partners with UVL or on PrEP. 'At risk' participants became more likely to identify as bisexual and to be born overseas. CONCLUSIONS There has been a rapid, historic shift in HIV prevention among GBM in Australia. Net prevention coverage has increased among GBM and 'at risk' GBM have become less at risk of HIV, facilitating reductions in HIV transmission.
Sudden Unexpected Death in a Child From Acute Myeloid Leukemia

Abstract Acute myeloid leukemia can rarely cause sudden, unexpected death in children. Presentation may be non-specific and death may occur in children with no prior medical history. Herein we present the case of a previously healthy 2-year and 2 month-old White girl, who on autopsy, was found to have acute myeloid leukemia with KMT2A rearrangement extensively involving all major thoracic and abdominal organs. This case is presented to the forensic community to discuss the presentation and findings in sudden death caused by acute leukemia. The case highlights when acute leukemia should enter the differential as a potential cause of death, as well as potential resources available in the postmortem workup of acute leukemias.
Trifluoromethylthiolation of Masked Carbonyl Precursors: Reaction of Trifluoromethylsulfenyl Chloride With Enol Acetates

Incorporation of fluorine and fluorine containing groups such as trifluoromethyl and trifluoromethylthio moieties considerably enhances the biological property and potency of the parent products. This communication describes the results of trifluoromethylthiolation of masked carbonyl precursors such as enol acetates, the mechanism of formation and mass spectral characterization of the compounds formed.
Heparanase expression and activity are increased in platelets during clinical sepsis

Heparanase (HPSE) is the only known mammalian enzyme that can degrade heparan sulfate. Heparan sulfate proteoglycans are essential components of the glycocalyx, and maintain physiological barriers between the blood and endothelial cells. HPSE increases during sepsis, which contributes to injurious glyocalyx degradation, loss of endothelial barrier function, and mortality.
Cluster randomized control trial of nursing home residents’ oral hygiene following the Mouth Care Matters education program for certified nursing assistants

Abstract Aims The purpose of this study was to determine if the number of certified nursing assistants (CNAs) trained with the Mouth Care Matters (MCM) oral health educational program had an impact on nursing facility (NF) resident oral health. Materials and methods Three NFs participated in a cluster randomized control trial. In NF‐A: all CNAs were offered the MCM program, NF‐B: 3 CNAs were offered the MCM program, and NF‐C: Control (no CNAs were offered the MCM program). Demographic information, systemic health data, and oral health data at baseline, 3‐month, and 6‐month intervals were collected and analyzed using Kruskal‐Wallis, Wilcoxon signed‐rank and Wilcoxon rank‐sum tests. A total of 24 dentate residents participated in this study. Plaque control record scores for NF‐A were significantly reduced compared to NF‐B and NF‐C (P < .001 and P = .002 respectively) and gingival bleeding index for NF‐A were significantly reduced compared to NF‐B and NF‐C (P = .002 and P < .001 respectively). Conclusion Increasing the number of CNA's trained in the Mouth Care Matters educational program positively impacted NF residents’ oral hygiene.
Computed Tomography in Patients With Craniosynostosis

Background In patients with craniosynostosis, imaging remains up to the discretion of the plastic surgeon or neurosurgeon. To inform best practice guidelines, we sought to obtain data surrounding the frequency at which craniofacial surgeons order computed tomography (CT), as well as indications. We hypothesized that we would identify considerable variation in both imaging and associated indications. Methods We surveyed members of the American Society of Maxillofacial Surgeons and the American Society of Craniofacial Surgeons to measure the frequency of preoperative and postoperative head CTs, as well as indications. Initial items were piloted with 2 craniofacial surgeons and 1 neurosurgeon, using interviews to ensure content validity. χ2 Tests were used to measure associations between operative volume, years in practice, and imaging. Results Eighty-five craniofacial surgeons responded (13.8% response rate), with the majority (63.5%) having performed a craniosynostosis operation in the last month. Only 9.4% of surgeons never order preoperative CTs. Of those who do, the most common indications included diagnosis confirmation (31.2%) and preoperative planning (27.3%). About 25% of surgeons always obtain postoperative head CTs, usually to evaluate surgical outcomes (46.7%). Only 13.3% of respondents order 2 or more postoperative scans. Higher operative volume was associated with a lower likelihood of ordering preoperative head CTs (P = 0.008). Conclusions The majority of surgeons obtain preoperative head CTs, whereas only 25% obtain CTs postoperatively, often to evaluate outcomes. Because outcomes may be evaluated clinically, this is a poor use of resources and exposes children to radiation. Consensus guidelines are needed to create best practices and limit unnecessary studies.
Childhood disadvantage, neurocognitive development and neuropsychiatric disorders: Evidence of mechanisms

Supplemental Digital Content is available in the text Purpose of review Children living in socioeconomically disadvantaged households have excess risks of neurodevelopmental and neuropsychiatric problems. The purpose of this review is to synthesize evidence for mechanisms that may contribute to these excess risks. Recent findings The majority of the 60 studies included in our review focused on children's neurocognitive development and behavioural problems. About half conducted mediation analyses of factors in the family and neighbourhood environments, including access to resources (e.g. cognitive inputs within the home environment) and exposure to stressors (e.g. negative parenting practices), as well as neurobiological embedding of childhood disadvantage. In addition, many studies conducted moderation analyses of factors that were hypothesized to interact with (i.e. exacerbate or mitigate) the harmful effects of childhood disadvantage. Summary Many of the factors that contribute to the excess risk of neurodevelopmental and neuropsychiatric problems among children in disadvantaged households are potentially modifiable (e.g. cognitively stimulating materials, parental language input, cultural resources, parental stress and psychopathology, negative parenting, neighbourhood violence). If their causality is ultimately established, they could be targets for the prevention and reduction of disparities. The continued search for mechanisms should not detract from work to reduce and hopefully eliminate children's exposure to disadvantage.
The Effect of Background Noise on Immediate Free Recall of Words in Younger and Older Listeners with Hearing Loss

Abstract Background Auditory working memory is a crucial factor for complex cognitive tasks such as speech-in-noise understanding because speech communication in noise engages multiple auditory and cognitive capacities to encode, store, and retrieve information. An immediate free recall task of words has been used frequently as a measure of auditory working memory capacity. Purpose The present study investigated performance on the immediate free recall of words in quiet and noisy conditions for hearing-impaired listeners. Research Design Fifty hearing-impaired listeners (30 younger and 20 older) participated in this study. Lists of 10 phonetically and lexically balanced words were presented with a fixed presentation rate in quiet and noise conditions. Target words were presented at an individually determined most comfortable level (MCL). Participants were required to recall as many of the words in an arbitrary order immediately after the end of the list. Serial position curves were determined from the accuracy of free recall as a function of the word position in the sequence. Data Collection and Analysis Three-way analyses of variance with repeated measures were conducted on the percent-correct word recall scores, with two independent within-group factors (serial position and listening condition) and a between-group factor (younger, older). Results A traditional serial position curve was found in hearing-impaired listeners, yet the serial position effects depended on the listening condition. In quiet, the listeners with hearing loss were likely to recall more words from the initial and final positions compared with the middle-position words. In multi-talker babble noise, more difficulties were observed when recalling the words in the initial position compared with the words in the final position. Conclusion Without a noise, a traditional U-shaped serial position curve consisting of primacy and recency effects was observed from hearing-impaired listeners, in accord with previous findings from normal-hearing listeners. The adverse impact of background noise was more pronounced in the primacy effect than in the recency effect.
Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*

Supplemental Digital Content is available in the text. OBJECTIVE: Management of patients experiencing massive pulmonary embolism-related cardiac arrest is controversial. Venoarterial extracorporeal membranous oxygenation has emerged as a potential therapeutic option for these patients. We performed a systematic review assessing survival and predictors of mortality in patients with massive PE-related cardiac arrest with venoarterial extracorporeal membranous oxygenation use. DATA SOURCES: A literature search was started on February 16, 2020, and completed on March 16, 2020, using PubMed, Embase, Cochrane Central, Cinahl, and Web of Science. STUDY SELECTION: We included all available literature that reported survival to discharge in patients managed with venoarterial extracorporeal membranous oxygenation for massive PE-related cardiac arrest. DATA EXTRACTION: We extracted patient characteristics, treatment details, and outcomes. DATA SYNTHESIS: About 301 patients were included in our systemic review from 77 selected articles (total screened, n = 1,115). About 183 out of 301 patients (61%) survived to discharge. Patients (n = 51) who received systemic thrombolysis prior to cannulation had similar survival compared with patients who did not (67% vs 61%, respectively; p = 0.48). There was no significant difference in risk of death if PE was the primary reason for admission or not (odds ratio, 1.62; p = 0.35) and if extracorporeal membranous oxygenation cannulation occurred in the emergency department versus other hospital locations (odds ratio, 2.52; p = 0.16). About 53 of 60 patients (88%) were neurologically intact at discharge or follow-up. Multivariate analysis demonstrated three-fold increase in the risk of death for patients greater than 65 years old (adjusted odds ratio, 3.08; p = 0.03) and six-fold increase if cannulation occurred during cardiopulmonary resuscitation (adjusted odds ratio, 5.67; p = 0.03). CONCLUSIONS: Venoarterial extracorporeal membranous oxygenation has an emerging role in the management of massive PE-related cardiac arrest with 61% survival. Systemic thrombolysis preceding venoarterial extracorporeal membranous oxygenation did not confer a statistically significant increase in risk of death, yet age greater than 65 and cannulation during cardiopulmonary resuscitation were associated with a three- and six-fold risks of death, respectively.
A randomized phase 2/3 study of R-CHOP vs CHOP combined with dose-dense rituximab for DLBCL: the JCOG0601 trial.

Rituximab plus cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP) is the standard of care for untreated diffuse large B-cell lymphoma (DLBCL). However, the schedule for rituximab administration has not been optimized. To compare standard R-CHOP with CHOP plus dose-dense weekly rituximab (RW-CHOP) in patients with untreated DLBCL, we conducted a phase 2/3 study (JCOG0601, jRCTs031180139). Patients were randomly assigned to R-CHOP (CHOP-21 with 8 doses of rituximab once every 3 weeks [375 mg/m2]) or RW-CHOP (CHOP-21 with 8 doses of weekly rituximab [375 mg/m2]) groups. The primary end point of the phase 2 component was percent complete response (%CR) of the RW-CHOP arm, whereas that of the phase 3 component was progression-free survival (PFS). Between December 2007 and December 2014, 421 untreated patients were randomly assigned to R-CHOP (213 patients) or RW-CHOP (208 patients). The %CR in the RW-CHOP arm was 85.3% and therefore met the prespecified decision criteria for the phase 2 component. With a median follow-up of 63.4 months, the 3-year PFS and overall survival were 79.2% and 88.7% in the R-CHOP arm and 80.3% and 90.4% in the RW-CHOP arm, respectively. There was no significant difference in PFS (hazard ratio, 0.95; 90.6% confidence interval, 0.68-1.31). Although the safety profile and efficacy of RW-CHOP was comparable with R-CHOP and its tolerability was acceptable, weekly rituximab in combination with CHOP during the early treatment period did not improve PFS in untreated patients with DLBCL. This trial was registered at jrct.niph. go.jp as #jRCTs031180139.
HuB and HuD repress telomerase activity by dissociating HuR from TERC

Abstract The ubiquitous RNA-binding protein HuR (ELAVL1) promotes telomerase activity by associating with the telomerase noncoding RNA TERC. However, the role of the neural-specific members HuB, HuC, and HuD (ELAVL2–4) in telomerase activity is unknown. Here, we report that HuB and HuD, but not HuC, repress telomerase activity in human neuroblastoma cells. By associating with AU-rich sequences in TERC, HuB and HuD repressed the assembly of the TERT–TERC core complex. Furthermore, HuB and HuD competed with HuR for binding to TERC and antagonized the function of HuR that was previously shown to enhance telomerase activity to promote cell growth. Our findings reveal a novel mechanism controlling telomerase activity in human neuroblastoma cells that involves a competition between HuR and the related, neural-specific proteins HuB and HuD.