Miracle-dz/UniFAR-FTUs huggingface dataset:
A collaborative expert literature review of pain education, assessment and management

Pain assessment and management in older adults requires a special emphasis on the needs of this population, which is often not considered within general education. The purpose of this study was twofold: to determine the availability of education on pain in older adults around the world, and to present a review and synthesis of published guidelines and key papers on pain assessment and management in older adults. Following on from this study we intend to make recommendations on what work needs to be carried out in future to inform the development of a curriculum or curriculum content specifically dedicated to pain management for older adults. A discussion forum was set up through the Pain in Older Adults Special Interest Group of the International Association for the Study of Pain (IASP) at the end of 2009. This forum was initiated to determine the current level and availability of education available around the world for health professionals on pain in older adults. A number of IASP members from countries.
Women's Functioning Following an Intervention for Partner Violence: New Knowledge for Clinical Practice from a 7-Year Study

Intimate partner violence affects one in three women worldwide, with women who experience violence almost twice as likely to experience poor mental health, especially depression, compared with women who are not abused. To learn the impact of interventions of safe shelter and justice services on improved mental health and behavior functioning, 300 abused women are interviewed every 4 months in a 7-year prospective study. For this paper, abuse, mental health and resiliency status of these women, 1 year after accessing services for the first time, are reported. Measures of mental health (depression, anxiety, post-traumatic stress disorder (PTSD), somatization), and adult behavioral functioning are reported. At 4 months following a shelter stay or justice services, a large effect size was measured for improvement in all mental health measures; however, improvement was the lowest for PTSD. All mental health measures plateaued at 4 months with minimum further improvement at 12 months. Both internal behavioral dysfunctions (withdrawal and somatic complaints) were worse with increased depressive symptoms, as were external behavioral dysfunctions (aggressive and rule-breaking behaviors). A concerning 39.2% of the women had clinical PTSD scores at 12 months following receipt of safe shelter or justice services, compared with a much lower percentage of women with clinical depression (14.2%), clinical somatization (9.4%), and clinical anxiety (13.5%). Depression was a significant positive predictor of internal and external behavioral dysfunctions, indicating that women who had higher levels of depression tended to report more internal dysfunctions (withdrawal, anxiety, somatization) and more external behaviors (aggression and rule-breaking).
Update on the brazilian consensus for the diagnosis and treatment of rheumatoid arthritis

Manoel Barros Bértolo(1), Claiton Viegas Brenol(2), Cláudia Goldenstein Schainberg(3), Fernando Neubarth(4), Francisco Aires Correa de Lima(5), Ieda Maria Laurindo(6), Inês Guimarães Silveira(7), Ivanio Alves Pereira(8), Marco Antonio Rocha Loures(9), Mario Newton de Azevedo(10), Max Victor Carioca de Freitas(11), Milton da Silveira Pedreira Neto(12), Ricardo Machado Xavier(13), Rina Dalva N. Giorgi(14), Sergio Candido Kowalski(15), Sonia Maria Alvarenga Anti(16)
Crianças e adolescentes sobreviventes ao câncer: desafios e possibilidades - DOI: 10.4025/cienccuidsaude.v8i1.7788

Due to the rising cure and survival rates of children and adolescents affected by cancer, interest in survival has increased in different areas of human knowledge. This article reflects on the challenges related to the experience of surviving cancer during childhood-adolescence. Surviving cancer demands the capacity to live with the paradox between acknowledging the condition of being cured and the constant possibility of a relapse. After treatment ends, the child and adolescence carry the burden this experience imposes and which will have a marking effect in their lives. In this sense, both they and their families need help and social support ready to use with a view to a successful life. It is fundamental for health professionals, especially in the nursing area, to make continuous efforts to acknowledge the needs of child and adolescent cancer survivors, so as to create conditions that allow, besides extended survival, a better quality of life.
Dimension Reduction for Objects Composed of Vector Sets

Abstract Dimension reduction and feature selection are fundamental tools for machine learning and data mining. Most existing methods, however, assume that objects are represented by a single vectorial descriptor. In reality, some description methods assign unordered sets or graphs of vectors to a single object, where each vector is assumed to have the same number of dimensions, but is drawn from a different probability distribution. Moreover, some applications (such as pose estimation) may require the recognition of individual vectors (nodes) of an object. In such cases it is essential that the nodes within a single object remain distinguishable after dimension reduction. In this paper we propose new discriminant analysis methods that are able to satisfy two criteria at the same time: separating between classes and between the nodes of an object instance. We analyze and evaluate our methods on several different synthetic and real-world datasets.
Competition-Level Differences on the Lower Quarter Y-Balance Test in Baseball Players.

CONTEXT Decreased performance in dynamic balance has previously been associated with a history of ulnar collateral ligament injury in baseball players. Previous research on dynamic balance in soccer players has shown that test performance depends on competition level. However, dynamic balance has yet to be examined in baseball players. OBJECTIVE To understand normative values and determine differences in dynamic balance, as measured by the Lower Quarter Y-Balance Test, across competition levels in baseball players. DESIGN Cross-sectional study. SETTING Preseason physical examinations. PATIENTS OR OTHER PARTICIPANTS Dynamic balance was measured in 88 high school (HS), 78 collegiate (COL), and 90 professional (PRO) baseball players. MAIN OUTCOME MEASURE(S) All participants completed the Lower Quarter Y-Balance Test using the standard protocol. In unilateral stance, they reached with 1 foot in the anterior, posteromedial, and posterolateral directions. We calculated 1-way analyses of variance to compare performance, composite score, and reach asymmetry for each direction as well as the sum of the asymmetry values (P < .05). Composite score was calculated by averaging the maximum normalized reach scores. Reach asymmetry was determined by calculating bilateral differences in reach ability. RESULTS In comparison with the HS and COL groups, the PRO players exhibited greater posteromedial (P < .01; effect size index [ESI]HS = 1.06, ESICOL = 0.95) and posterolateral reach (P < .01; ESIHS = 0.82, ESICOL = 0.84) as well as a greater composite score (P < .01; ESIHS = 0.60, ESICOL = 0.87). In contrast, HS baseball players exhibited increased anterior reach (P < .01; ESICOL = 0.60, ESIPRO = 0.39) compared with the COL and PRO cohorts. No significant differences in reach asymmetry were observed among groups. CONCLUSIONS Lower extremity dynamic balance performance differed based on the baseball players' competition level. These baseline data may be helpful in identifying low-performing athletes who might benefit from neuromuscular interventions.
Policies, Procedures, and Practices Regarding Sport-Related Concussion in Community College Athletes.

CONTEXT College sport organizations and associations endorse concussion-management protocols and policies. To date, little information is available on concussion policies and practices at community college institutions. OBJECTIVE To assess and describe current practices and policies regarding the assessment, management, and return-to-play criteria for sport-related concussion (SRC) among member institutions of the California Community College Athletic Association (CCCAA). DESIGN Cross-sectional study. SETTING Web-based survey. PATIENTS OR OTHER PARTICIPANTS A total of 55 head athletic trainers (ATs) at CCCAA institutions. MAIN OUTCOME MEASURE(S) Data about policies, procedures, and practices regarding SRC were collected over a 3-week period in March 2012 and analyzed using descriptive statistics, the Fisher exact test, and the Spearman test. RESULTS Almost half (47%) of ATs stated they had a policy for SRC assessment, management, and return to play at their institution. They reported being in compliance with baseline testing guidelines (25%), management guidelines (34.5%), and return-to-play guidelines (30%). Nearly 31% of ATs described having an SRC policy in place for academic accommodations. Conference attendance was positively correlated with institutional use of academic accommodations after SRC (r = 0.44, P = .01). The number of meetings ATs attended and their use of baseline testing were also positively correlated (r = 0.38, P = .01). CONCLUSIONS At the time of this study, nearly half of CCCAA institutions had concussion policies and 31% had academic-accommodation policies. However, only 18% of ATs at CCCAA institutions were in compliance with all of their concussion policies. Our findings demonstrate improvements in the management of SRCs by ATs at California community colleges compared with previous research but a need for better compliance with SRC policies.
New Evidence for an “Older” Therapy

Lost amidst the focus on medication or short-term cognitive behavioral treatments for psychiatric symptom management, psychodynamic/psychoanalytic psychotherapy has been undervalued or devalued by insurance companies—and perhaps by the general public as well. My colleagues who practice psychodynamic psychotherapy have struggled with insurance company demands to produce “treatment plans” for sessions of eight or ten weeks, complete with behavioral objectives. Complex human problems, with tangled roots in childhood trauma and pain, cannot be resolved in a few sessions. Nor can medication alone achieve resolution of such complex deep-seated problems. No doubt my therapist colleagues are heartened by new research published in American Psychologist (Shedler, 2010). Author Jonathan Shedler reviewed a number of meta-analyses encompassing 160 studies of psychodynamic therapy, concluding that it is highly effective for a wide range of mental health problems. Effect sizes (indicating the degree of change produced by treatment) were large, even for personality disorders that are commonly viewed as having a poor prognosis. In brief, we have fresh new evidence for the efficacy of an “older” therapy that is often dismissed as too lengthy, too costly, and (in the latest buzzword language) “not evidence-based. ” Shedler’s study shows that psychodynamic therapy works, and its effects continue to grow even after remission of symptoms and termination of the therapeutic relationship. This kind of therapy fosters insight into those “powerful forces below the surface of things,” in the words of psychology professor Mike Nash at my university. Nash points out, “We like to think we understand ourselves and our relationships in the bright light of reason, but more often we are blind to the powerful forces that operate below the surface of things . The shadows of our past fall across how we love, how we parent, how we work, and who we think we are. Our lives are enriched and expanded as we come to claim more and more of these shadows as aspects of ourselves” (Nash, 2010, p. 11). Psychiatric-mental health nurses have a role in sharing Shedler’s research findings. We have cringed as the tenets of psychoanalysis have been distorted by historians, comedians, and popular media. We have seen the benefits that accrue when our patients engage in the intensive self-examination that takes place within the crucible of the therapeutic relationship. We ourselves can testify to personal benefits, because many of us undertook depth therapy during our years of educational preparation as psychiatric nurses. After therapy, we, like our clients, have continued to apply the insights we achieved about identity, intimate relationships, losses, and fears. It’s a journey of discovery that continues.
Chronic Obstructive Airflow Disease and Sleep Studies1–3

Twenty-six patients with chronic obstructive airflow disease (23 also complained of excessive daytime somnolence) were monitored during sleep, using noninvasive techniques, for evaluation of respiratory and sleep variables. Ten of the 26 had a second more extensive evaluation, including measurement of endoesophageal pressure; 5 underwent a study of nocturnal hemodynamics, with measurement of systemic and pulmonary pressures; 5 received O2 in air during sleep under controlled conditions. Eight of the studied patients underwent tracheostomy and were restudied postoperatively. Both sleep stage and type of abnormal respiratory event during sleep affected oxygenation levels. A mean of 92 % of all abnormal respiratory events during sleep contained an obstructive component. Apneic events may affect systemic and pulmonary arterial pressures during sleep. Administration of O2 in air may, in some cases, be detrimental to the sleeping patient. Tracheostomy unexpectedly improved the daytime, awake blood gas readings .
Is This Patient Having a Myocardial Infarction

When faced with a patient with acute chest pain, clinicians must distinguish myocardial infarction (MI) from all other causes of acute chest pain. If MI is suspected, current therapeutic practice includes deciding whether to administer thrombolysis or primary percutaneous transluminal coronary angioplasty and whether to admit patients to a coronary care unit. The former decision is based on electrocardiographic (ECG) changes, including ST-segment elevation or left bundle-branch block, the latter on the likelihood of the patient’s having unstable high-risk ischemia or MI without ECG changes. Despite advances in investigative modalities, a focused history and physical examination followed by an ECG remain the key tools for the diagnosis of MI. The most powerful features that increase the probability of MI, and their associated likelihood ratios (LRs), are new ST-segment elevation (LR range, 5.7-53.9); new Q wave (LR range, 5.3-24.8); chest pain radiating to both the left and right arm simultaneously (LR, 7.1); presence of a third heart sound (LR, 3.2); and hypotension (LR, 3.1). The most powerful features that decrease the probability of MI are a normal ECG result (LR range, 0.1-0.3), pleuritic chest pain (LR, 0.2), chest pain reproduced by palpation (LR range, 0.2-0.4), sharp or stabbing chest pain (LR, 0.3), and positional chest pain (LR, 0.3). Computer-derived algorithms that depend on clinical examination and ECG findings might improve the classification of patients according to the probability that an MI is causing their chest pain. JAMA. 1998;280:1256-1263
Women's existential experiences within Swedish abortion care

Objective. To explore Swedish women's experiences of clinical abortion care in relation to their need for existential support. Methods. Individual in-depth interviews with 24 women with previous experience of unwanted pregnancy and abortion. Participants were recruited between 2006 and 2009. Interviews were analysed by latent content analysis. Findings. Although the women had similar experiences of the abortion care offered, the needs they expressed differed. Swedish abortion care was described as rational and neutral, with physical issues dominating over existential ones. For some women, the medical procedures triggered existential experiences of life, meaning, and morality. While some women abstained from any form of existential support, others expressed a need to reflect upon the existential aspects and/or to reconcile their decision emotionally. Conclusion. As women's needs for existential support in relation to abortion vary, women can be disappointed with the personnel's ability to respond to their thoughts and feelings related to the abortion. To ensure abortion care personnel meet the physical, psychological and existential needs of each patient, better resources and new lines of education are needed to ensure abortion personnel are equipped to deal with the existential aspects of abortion care.
Oxytetracycline and Gentamicin: Two Clinically relevant Antimicrobials Widely Used by Costa Rican Farmers. Implications of Their Use Outside Clinical Cettings and Request for Action

This mini-review deals with oxytetracycline and gentamicin: two clinically-relevant antimicrobials that find extensive usage in horticulture and other productive activities. The manuscript begins with a few words on their mechanism of action and clinical utility. Thereafter I address the most important mechanisms of acquired or intrinsic resistance described to date and some implications of the unrestricted use of these drugs outside clinical settings. A number of reports on the occurrence of antimicrobial-resistance genes and antimicrobial-resistant bacteria in agroecosystems illustrates that a threat exists and justifies the plea for monitoring programs and environmental risk assessments with which the article concludes.
Tobacco smoking in older people

Smoking remains prevalent in elderly people in the UK and similar countries. The adverse health effects of current smoking continue to accumulate in old age and stopping smoking in old age confers benefits on function, morbidity and mortality. Many elderly people wish to stop smoking and many are successful. Structured support from health and social care workers improves quit rates and nicotine replacement therapy can be an effective aid to smoking cessation in old age. Doctors and other healthcare staff should use the opportunities of patient contact to encourage older smokers to quit. Cognitive impairment is a barrier to successful smoking cessation.
Anaesthesia for a minor procedure in a patient with fontan physiology

Fontan procedure is a palliative surgery done for patients born with single ventricle physiology. An understanding of the hemodynamic alterations in such a patient is important for successful perioperative management. We have discussed the anaesthetic considerations in a 12 year-old girl with complex congenital heart disease ultimately palliated by a Fontan operation, who was posted for Botox injections for upper limb spasticity under general anaesthesia.
Adaptation of the near-surface wind to the development of sand transport

A model of wind-blown sand transport is described with particular emphasis on the feedback between the grain cloud and the near-surface wind. The results from this model are used to develop Owen's (1964) hypothesis that ‘the grain layer behaves, so far as the flow outside it is concerned, as increased aerodynamic roughness whose height is proportional to the thickness of the layer’. The hypothesis is developed to show the influence this dynamic roughness has on the turbulent boundary layer above the saltation layer. Two processes are identified which influence the path of the system towards equilibrium. The first is the feedback between the near-surface wind and the grain cloud in which the quantity of sand transported is limited by the carrying capacity of the wind. The second is due to the temporal development of an internal boundary layer in response to the additional roughness imposed on the flow above the grain layer by the grain cloud. A similarity is noted between the temporal response of a turbulent boundary layer to sand transport and the spatial response of a turbulent boundary layer downstream of a step increase in surface roughness. Finally it is noted that the work may have important implications for transport rate prediction in unsteady winds.
A new species of Cacatuocotyle (Monogenea, Dactylogyridae) parasitizing Astyanax spp. (Characiformes, Characidae) from Brazil, including molecular data and a key to species identification

The present study describes Cacatuocotyle papilionis n. sp. (Monogenea, Dactylogyridae) from the skin of the characid fishes Astyanax lacustris (Lütken, 1875) (=Astyanax altiparanae Garutti & Britski, 2000) and Astyanax fasciatus (Cuvier, 1819) (Characiformes, Characidae) from the Southeast of Brazil, supported by morphological and molecular data. The new species differs from all congeners, mainly due to the morphology of the ventral bar (resembling a butterfly), accessory piece, and the number of rings of the male copulatory organ (MCO), comprising a coiled tube with 4.5–5.5 counterclockwise rings. The first molecular data for this monogenean genus is provided in this study, using the partial sequences of the ribosomal gene (28S), as well as providing an identification key to the species.
Early Active Mobilization of Tendon Transfers

textabstractLeprosy, also known as Hansen's Disease, has been known since biblical times. The causative organism Mycobacterium leprae is unique among bacteria in that it has an affinity to involve, infect and destroy peripheral nerves, especially those of the limbs. The disability problems in Leprosy are mainly due to the nerve trunks affected by the disease resulting in diminution or loss of sensation, paralysis of muscles producing deformities and autonomic nerve function impairment leading to loss of sweating, dryness and cracks in the hands and feet. The affected nerve from the initial stage of involvement advances to the stage of damage and finally to a stage of destruction. In the stage of initial involvement, the nerves are thickened, tender, and painful but have no loss of function. In the subsequent stage of damage there is loss of sweating and sensibility, muscle weakness or complete paralysis. These two stages of nerve involvement and damage are amenable to prompt and adequate treatment by multi drug therapy (MDT) and steroids and recovery of lost nerve functions in possible. In the subsequent stage of nerve destruction, the involved nerve is completely damaged and cannot recover function to any useful level with all available treatment. This stage is diagnosed when the nerve has been completely paralyzed for at least one year. Leprosy involves three kinds of peripheral nerves. They are (1) dermal nerves, which are fine nerves in the skin; (2) cutaneous nerves, which are thicker nerves that are palpable under the skin and (3) major nerve trunk, which are large nerves of the limbs.