Miracle-dz/UniFAR-FTUs huggingface dataset:
Association Between Intermittent Hypoxemia or Bradycardia and Late Death or Disability in Extremely Preterm Infants.

IMPORTANCE Extremely preterm infants may experience intermittent hypoxemia or bradycardia for many weeks after birth. The prognosis of these events is uncertain. OBJECTIVE To determine the association between intermittent hypoxemia or bradycardia and late death or disability. DESIGN, SETTING, AND PARTICIPANTS Post hoc analysis of data from the inception cohort assembled for the Canadian Oxygen Trial in 25 hospitals in Canada, the United States, Argentina, Finland, Germany, and Israel, including 1019 infants with gestational ages of 23 weeks 0 days through 27 weeks 6 days who were born between December 2006 and August 2010 and survived to a postmenstrual age of 36 weeks. Follow-up assessments occurred between October 2008 and August 2012. EXPOSURES Episodes of hypoxemia (pulse oximeter oxygen saturation <80%) or bradycardia (pulse rate <80/min) for 10 seconds or longer. Values were sampled every 10 seconds within 24 hours after birth until at least 36 weeks' postmenstrual age. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of death after 36 weeks' postmenstrual age, motor impairment, cognitive or language delay, severe hearing loss, or bilateral blindness at 18 months' corrected age. Secondary outcomes were motor impairment, cognitive or language delay, and severe retinopathy of prematurity. RESULTS Downloaded saturation and pulse rate data were available for a median of 68.3 days (interquartile range, 56.8-86.0 days). Mean percentages of recorded time with hypoxemia for the least and most affected 10% of infants were 0.4% and 13.5%, respectively. Corresponding values for bradycardia were 0.1% and 0.3%. The primary outcome was ascertained for 972 infants and present in 414 (42.6%). Hypoxemic episodes were associated with an estimated increased risk of late death or disability at 18 months of 56.5% in the highest decile of hypoxemic exposure vs 36.9% in the lowest decile (modeled relative risk, 1.53; 95% CI, 1.21-1.94). This association was significant only for prolonged hypoxemic episodes lasting at least 1 minute (relative risk, 1.66; 95% CI, 1.35-2.05 vs for shorter episodes, relative risk, 1.01; 95% CI, 0.77-1.32). Relative risks for all secondary outcomes were similarly increased after prolonged hypoxemia. Bradycardia did not alter the prognostic value of hypoxemia. CONCLUSIONS AND RELEVANCE Among extremely preterm infants who survived to 36 weeks' postmenstrual age, prolonged hypoxemic episodes during the first 2 to 3 months after birth were associated with adverse 18-month outcomes. If confirmed in future studies, further research on the prevention of such episodes is needed.
Effects of KAATSU training on haemostasis in healthy subjects

The KAATSU training is a novel method for muscle training performed under the reduction of muscle blood flow by a specially-designed belt (KAATSU belt). Under the conditions of restricted muscle blood flow, even short-term, low-intensity exercise such as walk training can induce muscle strength, and increased muscle mass (Takarada et al. 2000a; b; c; Takarada et al., 2002a,b; Abe et al. 2006). In addition, KAATSU femoral blood flow restriction induces lower-body venous pooling and reduces venous return (Takano et al., 2006), resulting in stimulating cardiovascular effects of orthostasis in 1G like lower body negative pressure (LBNP) (Iida et al., 2007). Since the most effective countermeasure regimen to prevent cardiovascular deconditioning in space flight would be a gravitation-like stress combined with exercises, the use of KAATSU in combination with low-intensity resistance exercise would provide a significant countermeasure like LBNP for space flight countering both cardiovascular and musculoskeletal decline. Thus, the KAATSU training may be a promising training in astronauts to prevent cardiovascular deconditioning and muscle atrophy in space flights (Iida et al., 2006) as well as athletes and healthy persons as described previously (Nakajima et al., 2006). Haemostasis is achieved through a delicate equilibrium between the coagulation and fibrinolytic cascades (Wu and Thiagarajan, 1996). Exercises have been shown to affect activation of both the coagulation and fibrinolytic cascades (Davis et al., 1976; Andrew et al., 1986; Boman et al., 1994; Weiss et al., 1998; El-Sayed et al., 2000; Ribeiro et al., 2006). Regular exercise preferentially activates fibrinolysis, which is generally associated with favorable alterations in risk from cardiovascular morbidity, while strenuous exercise may increase blood coagulation, and promote thrombus formation (Hilberg et al., 2002), resulting in exertion-related ischemic events (Giri et al., 1999). Thus, it is likely that effects of exercise on the haemostatis are Effects of KAATSU training on haemostasis in healthy subjects
The effects of age, ethnicity, sexual dysfunction, urinary incontinence, masculinity, and relationship with the partner on the quality of life of men with prostate cancer

§ Prostate cancer accounts for 238,590 (28%) of cancer incidence and is the leading cancer in men (NCI, 2015). § It is estimated that one in six men will have prostate cancer in their lifetimes (NCI, 2015). § Prostate cancer treatment options vary; surgery, radiation, hormonal therapy, or watchful waiting. § The side effects of these treatments include sexual dysfunction (30-80%), urinary incontinence (30-74%), and bowel incontinence (3-10%). § These side effects cause a challenge to men’s masculinity, relationship with their partner, and quality of life (QOL). Contributions to QOL
Adaptación peruana del Minimental State Examination (MMSE)

El Minimental State Examination (MMSE) es una de las pruebas cognitivas breves mas utilizadas en el mundo para el tamizaje de pacientes con quejas cognitivas. El MMSE fue disenado originalmente en ingles (1), y posteriormente validado al espanol.
Aspirations and Strategies for Public Health.

Public health is responsible for extraordinary achievements over the past century, such as remarkable gains in life expectancy and substantial decreases in infectious disease mortality, and could make similar critical contributions to health in this century. Public health should be ascendant, but ample evidence suggests that it is on the defensive today, underappreciated, and underfunded. Government actions to improve the health of populations are widely suspect, as illustrated by the controversies involving efforts to curb soda container sizes in New York City, state and federal efforts to limit reproductive health rights, and global efforts to address climate change. By contrast, traditional medicine continues to be privileged. The burgeoning precision medicine agenda and the continuing emphasis on the treatment for cancer have captured the imagination of funding agencies
Screening for Gonorrhea, Chlamydia, and Hepatitis B.

The incidence of STIs is increasing, and these infections cause significant health and economic burden.1 The Centers for Disease Control and Prevention (CDC) reported that an estimated 1.4 million new cases of chlamydia and 350 000 cases of gonorrhea occurred in 2014.2 The highest-risk age group is between 15 and 29 years, but cases are seen at every age. Adding to the burden of the diseases, many infections are undiagnosed and untreated, potentially leading to late-term complications such as pelvic inflammatory disease, neonatal illness, and infertility. The CDC estimates that approximately 24 000 US women develop infertility related to STIs.3 Between 700 000 and 2.2 million people in the United States are infected with hepatitis B.4 Left untreated, 15% to 25% of these people will die of hepatic decompensation or hepatocellular carcinoma. Screening and early diagnosis have the potential to decrease both the complications and transmission of gonorrhea, chlamydia, and hepatitis B
Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries.

IMPORTANCE Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVES To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts-for example prone positioning-in routine clinical practice for patients fulfilling the ARDS Berlin Definition. DESIGN, SETTING, AND PARTICIPANTS The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents. EXPOSURES Acute respiratory distress syndrome. MAIN OUTCOMES AND MEASURES The primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS. RESULTS Of 29,144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS. CONCLUSIONS AND RELEVANCE Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02010073.
Case records of the Massachusetts General Hospital. Case 34-2013. A 69-year-old man with dizziness and vomiting.

Dr. Minjee Kim (Neurology): A 69-year-old man was admitted to this hospital because of dizziness and vomiting. The patient had been well until 4:15 a.m. on the day of admission, when he became dizzy, diaphoretic, and weak and had sensations of rocking and counterclockwise movement after he rolled onto his stomach in bed. The symptoms improved when he rolled into the supine position, and he slept until 7 a.m.; on awakening, the symptoms recurred. When walking, he sensed he was tilting to the left but did not fall. The symptoms worsened throughout the morning; they were most severe with head movements and were associated with increasing nausea and, after 10 a.m., vomiting. He called his doctor’s office because of concern that he was having a stroke. He was advised to go the hospital and called emergency medical services. On examination, his skin was pale and dry and the blood pressure was 148/60 mm Hg; the other vital signs and the remainder of the examination were normal. He was brought to the emergency department at this hospital, arriving approximately 9 hours after the onset of symptoms. The patient reported facial tingling in the area surrounding the eyes, including the malar eminence, and a mild headache. He noted that his visual perception momentarily lagged behind his eye movements, and the lag was more severe when looking to the right than to the left. He had no diplopia, blurred vision, tinnitus, decreased hearing, difficulty swallowing, changes in sensation or strength, palpitations, chest pain, fever, or shortness of breath. He reported an episode of self-limited positional vertigo that had occurred several years earlier. He had hypertension, hyperlipidemia, asthma, sleep apnea (for which he intermittently used continuous positive airway pressure at night), depression, meralgia paresthetica (a painful mononeuropathy of the lateral femoral cutaneous nerve), erectile dysfunction, and recurrent localized herpes simplex virus infection. He was left-handed. His daily medications included rosuvastatin, valsartan, hydrochlorothiazide, duloxetine, aspirin, and a multivitamin. He also received, as needed, a topical lidocaine patch for meralgia paresthetica; gabapentin for pain; vardenafil (though he had not taken it recently); fluticasone propionate nasal spray and inhaler, albuterol, and Case 34-2013: A 69-Year-Old Man with Dizziness and Vomiting
Children and the Fly-in/Fly-out lifestyle : employment-related paternal absence and the implications for children

iii TABLE OF CONTENTS v LIST OF TABLES x LIST OF FIGURES xii CHAPTER 1: INTRODUCTION 1 1.1 Aim and Scope of Study 3 1.2 Overview of Thesis 4 CHAPTER 2: FIFO, CHILDREN AND WORK/FAMILY BALANCE 6 2.1 Fly-in/Fly-Out Employment 6 2.1.1 Development of FIFO in Western Australia. 7 2.1.2 FIFO employee demographics and work schedules 10 2.1. 3 Implications of FIFO employment 11 2.2 Work/Family Balance 12 2.2.1 Work/family balance and children. 15 2.2.2 Parental non-standard working hours and children 16 2.2.3 Summary. 20 2.3 FIFO and Family Research: Investigating Employment-related Absence.21 2.3.1 FIFO and child-specific outcomes. 24 2.3. 2 International FIFO research. 25 2.3. 3 Related Industry family research. 28 2.4 Summary 29 CHAPTER 3: FIFO, FATHERS, AND FAMILY ADAPTATION 31 3.1 Researching Paternal Involvement 32 3.1.1 FIFO and paternal accessibility: Time. 32 3.1.2 FIFO and paternal engagement: Contact 33 3.1. 3 FIFO and paternal responsibility: Co-parenting. 34
Effect of a Cerebral Protection Device on Brain Lesions Following Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis: The CLEAN-TAVI Randomized Clinical Trial.

IMPORTANCE Stroke remains a major predictor of mortality after transcatheter aortic valve implantation (TAVI). Cerebral protection devices might reduce brain injury as determined by diffusion-weighted magnetic resonance imaging (DWMRI). OBJECTIVE To determine the effect of a cerebral protection device on the number and volume of cerebral lesions in patients undergoing TAVI. DESIGN, SETTING, AND PARTICIPANTS Investigator-initiated, single center, blinded, randomized clinical trial in higher-risk patients with severe aortic stenosis undergoing TAVI at the University of Leipzig Heart Center. Brain MRI was performed at baseline, 2 days, and 7 days after TAVI. Between April 2013 and June 2014, patients were randomly assigned to undergo TAVI with a cerebral protection device (filter group) or without a cerebral protection device (control group). The last 1-month follow-up occurred in July 2014. INTERVENTIONS TAVI with or without a cerebral protection device (filter system). MAIN OUTCOMES AND MEASURES The primary end point was the numerical difference in new positive postprocedure DWMRI brain lesions at 2 days after TAVI in potentially protected territories. The first hierarchical secondary outcome was the difference in volume of new lesions after TAVI in potentially protected territories. RESULTS Among the 100 enrolled patients, mean (SD) age was 80.0 (5.1) years in the filter group (n = 50) and 79.1 (4.1) years in the control group (n = 50), and the mean (SD) procedural risk scores (logistic EuroScores) were 16.4% (10.0%) in the filter group and 14.5% (8.7%) in the control group. For the primary end point, the number of new lesions was lower in the filter group, 4.00 (interquartile range [IQR], 3.00-7.25) vs 10.00 (IQR, 6.75-17.00) in the control group (difference, 5.00 [IQR, 2.00-8.00]; P < .001). For the first hierarchical secondary end point, new lesion volume after TAVI was lower in the filter group (242 mm3 [95% CI, 159-353]) vs in the control group (527 mm3 [95% CI, 364-830]) (difference, 234 mm3 [95% CI, 91-406]; P = .001). Considering adverse events, 1 patient in the control group died prior to the 30-day visit. Life-threatening hemorrhages occurred in 1 patient in the filter group and 1 in the control group. Major vascular complications occurred in 5 patients in the filter group and 6 patients in the control group. One patient in the filter group and 5 in the control group had acute kidney injury, and 3 patients in the filter group had a thoracotomy. CONCLUSIONS AND RELEVANCE Among patients with severe aortic stenosis undergoing TAVI, the use of a cerebral protection device reduced the frequency of ischemic cerebral lesions in potentially protected regions. Larger studies are needed to assess the effect of cerebral protection device use on neurological and cognitive function after TAVI and to devise methods that will provide more complete coverage of the brain to prevent new lesions. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01833052.
Diatom‐driven recolonization of microbial mat‐dominated siliciclastic tidal flat sediments

ABSTRACT Modern microbial mats and biofilms play a paramount role in sediment biostabilization. When sporadic storms affect tidal flats of Bahía Blanca Estuary, the underlying siliciclastic sediment is exposed by physical disruption of the mat, and in a few weeks' lapse, a microbial community re‐establishes. With the objective of studying colonization patterns and the ecological succession of microorganisms at the scale of these erosional structures, these were experimentally made and their biological recolonization followed for 8 weeks, with replication in winter and spring. Motile pennate diatoms led the initial colonization following two distinct patterns: a dominance by Cylindrotheca closterium in winter and by naviculoid and nitzschioid diatoms in spring. During the first 7 days, cell numbers increased 2‐ to 17‐fold. Cell densities further increased exhibiting sigmoidal community growth, reaching 2.9‐8.9 × 106 cells cm−3 maxima around day 30; centric diatoms maintained low densities throughout. In 56 days after removal of the original mat, filamentous cyanobacteria that dominate mature mats did not establish a significant biomass, leading to the rejection of the hypothesis that cyanobacteria would drive the colonization. The observed dominance of pennate diatoms is attributed to extrinsic factors determined by tidal flooding, and intrinsic ones, e.g. motility, nutrient affinity and high growth rate.
Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial.

IMPORTANCE Norepinephrine is currently recommended as the first-line vasopressor in septic shock; however, early vasopressin use has been proposed as an alternative. OBJECTIVE To compare the effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock. DESIGN, SETTING, AND PARTICIPANTS A factorial (2×2), double-blind, randomized clinical trial conducted in 18 general adult intensive care units in the United Kingdom between February 2013 and May 2015, enrolling adult patients who had septic shock requiring vasopressors despite fluid resuscitation within a maximum of 6 hours after the onset of shock. INTERVENTIONS Patients were randomly allocated to vasopressin (titrated up to 0.06 U/min) and hydrocortisone (n = 101), vasopressin and placebo (n = 104), norepinephrine and hydrocortisone (n = 101), or norepinephrine and placebo (n = 103). MAIN OUTCOMES AND MEASURES The primary outcome was kidney failure-free days during the 28-day period after randomization, measured as (1) the proportion of patients who never developed kidney failure and (2) median number of days alive and free of kidney failure for patients who did not survive, who experienced kidney failure, or both. Rates of renal replacement therapy, mortality, and serious adverse events were secondary outcomes. RESULTS A total of 409 patients (median age, 66 years; men, 58.2%) were included in the study, with a median time to study drug administration of 3.5 hours after diagnosis of shock. The number of survivors who never developed kidney failure was 94 of 165 patients (57.0%) in the vasopressin group and 93 of 157 patients (59.2%) in the norepinephrine group (difference, -2.3% [95% CI, -13.0% to 8.5%]). The median number of kidney failure-free days for patients who did not survive, who experienced kidney failure, or both was 9 days (interquartile range [IQR], 1 to -24) in the vasopressin group and 13 days (IQR, 1 to -25) in the norepinephrine group (difference, -4 days [95% CI, -11 to 5]). There was less use of renal replacement therapy in the vasopressin group than in the norepinephrine group (25.4% for vasopressin vs 35.3% for norepinephrine; difference, -9.9% [95% CI, -19.3% to -0.6%]). There was no significant difference in mortality rates between groups. In total, 22 of 205 patients (10.7%) had a serious adverse event in the vasopressin group vs 17 of 204 patients (8.3%) in the norepinephrine group (difference, 2.5% [95% CI, -3.3% to 8.2%]). CONCLUSIONS AND RELEVANCE Among adults with septic shock, the early use of vasopressin compared with norepinephrine did not improve the number of kidney failure-free days. Although these findings do not support the use of vasopressin to replace norepinephrine as initial treatment in this situation, the confidence interval included a potential clinically important benefit for vasopressin, and larger trials may be warranted to assess this further. TRIAL REGISTRATION clinicaltrials.gov Identifier: ISRCTN 20769191.
CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: Perioperative Fluid Management: Current Consensus and Controversies

The scientific knowledge base that supports clinical decisions about perioperative fluid management continues to evolve. However, despite these advancements in the understanding of the physiology of fluid replacement, the definition of ‘‘optimal’’ perioperative fluid management remains a matter of clinical judgment. With an appreciation of the many factors, both sensible and insensible, that contribute to changes in blood and extracellular fluid volume during surgery, clinicians have tried to create reproducible and generally applicable formulas for replacement of fluid during surgery. These formulas have been challenged recently by the introduction of new tools for monitoring cardiopulmonary function, by the implementation of monitor‐guided protocols for fluid management, and, more recently, by clinical data suggesting that fluid restriction may improve surgical outcomes in some clinical settings. The relative ease of pre‐identified fluid replacement protocols is being slowly replaced by data‐guided interventions that take into account a variety of factors. Clinicians are therefore required to tailor their fluid replacement strategies based on preoperative patient characteristics, the type of surgery and even the type of anesthetic that is utilized. Some of the benefits of this new approach range from relatively ‘‘minor’’ outcomes such as diminished nausea after surgery to preventing postoperative complications such as wound breakdown and cardiopulmonary failure.