Miracle-dz/UniFAR-FTUs huggingface dataset:
Characteristics of central lesions in patients with dizziness determined by diffusion MRI in the emergency department

Background To describe the rate and risk factors of central lesions among patients with dizziness in the emergency department based on diffusion-weighted MRI, which otologists consulted for evaluation of patients with dizziness need to know. Methods 902 Consecutive patients who presented with dizziness symptoms as a chief complaint in the emergency department (ED) of our tertiary referral centre between January 2011 and June 2011 were studied. Central lesions were confirmed by diffusion-weighted MRI. Univariate and multivariate analyses were used for factors predictive of central lesions. Results Of 645 patients who underwent MRI, 23 (3.6%) had acute central lesions (22 infarcts/1 haemorrhage). Univariate analyses revealed that older age, hypertension, atrial fibrillation, non-whirling type of dizziness symptoms and combined neurological symptoms were significantly associated with the development of central lesions (p<0.05). The incidence of central lesions in patients aged in their 40s, 50s, 60s, 70s and ≥80s was 0, 3.9%, 3.4%, 7.4% and 16.7%. Multivariate analyses showed that hypertension (p=0.01, OR=3.42), symptoms of non-whirling type (p=0.03, OR=3.12) and combined neurological symptoms (p<0.01, OR=16.72) were independent predictors of central lesions. Conclusions Although dizziness in the ED is generally benign, the prevalence of acute central lesions was 3.6% among 645 patients with dizziness who underwent MRI. Old age (>50 years), hypertension, non-whirling type of dizziness symptoms and associated neurological symptoms were significant risk factors for central lesions.
Evaluating Crisis Intervention Services for Youth within an Emergency Department: A View from Within

An innovative crisis intervention programme was created at the Children's Hospital of Eastern Ontario in Canada in order to provide emergency assessments for youth presenting with mental health crises. The current investigation presents an overview of the programme and examines the emergency staff's perception and satisfaction with it. Eighty-seven emergency department medical staff completed a survey. Overall, emergency department staff place high value on having access to emergency mental health services, are pleased with the quality of service and appreciate that the crisis intervention worker's presence allows them to spend more time with other patients.
Can we achieve complete remission in locally advanced unresectable Hepatocellular Carcinoma (HCC) by using Sorafenib? Case report and review of literature from Qatar

Patients with HCC continue to have a dismal prognosis, with 1-year and 3-year survival rates of 36 and 17%, respectively. This is in part related to more than two-thirds of tumors being diagnosed at advanced stages, as well as a substantial portion of patients with early HCC failing to receive potentially curative treatments. Systemic therapy for advanced unresectable HCC limited until the discovery of sorafenib, we are reporting a 53 year patient with unresectable HCC achieved complete remission clinically, radiologically and biochemically with sorafenib which is the first case report.
Acute myeloid leukemia ontogeny is defined by distinct somatic mutations.

Acute myeloid leukemia (AML) can develop after an antecedent myeloid malignancy (secondary AML [s-AML]), after leukemogenic therapy (therapy-related AML [t-AML]), or without an identifiable prodrome or known exposure (de novo AML). The genetic basis of these distinct pathways of AML development has not been determined. We performed targeted mutational analysis of 194 patients with rigorously defined s-AML or t-AML and 105 unselected AML patients. The presence of a mutation in SRSF2, SF3B1, U2AF1, ZRSR2, ASXL1, EZH2, BCOR, or STAG2 was >95% specific for the diagnosis of s-AML. Analysis of serial samples from individual patients revealed that these mutations occur early in leukemogenesis and often persist in clonal remissions. In t-AML and elderly de novo AML populations, these alterations define a distinct genetic subtype that shares clinicopathologic properties with clinically confirmed s-AML and highlights a subset of patients with worse clinical outcomes, including a lower complete remission rate, more frequent reinduction, and decreased event-free survival. This trial was registered at www.clinicaltrials. gov as #NCT00715637.
SUGAR TOLERANCE IN CANCER

The insidious onset of a malignant tumor with the lack of positive evidence, in the majority of instances, until the case is far advanced, is perhaps the greatest difficulty in the way of a decided reduction in cancer mortality. Certain well established facts of cancer etiology may be briefly stated in order to explain the basis of the experiments of which this paper constitutes a preliminary report. Broadly speaking, the development of malignant tumors rather frequently follows irritation, though no irritant is specific. It is generally accepted that not every one exposed to the action of any given irritant develops a tumor. In other words, there is an apparent predisposition as well as an actual inciting irritant. Again, broadly speaking, since exact statements are not possible in the present state of our knowledge, this predisposition becomes more evident at a certain period in life, a period spoken of as the
Insights into platelet P2Y12 receptor activation.

In this issue of Blood , Lecchi et al report that lifelong abnormal bleeding episodes in 2 brothers are the result of a homozygous mutation in the gene encoding the P2Y12 receptor that disrupts adenosine diphosphate (ADP)–promoted platelet aggregation. [1][1] ! [Figure][2] ADP simultaneously
Uncontrolled before-after studies: discouraged by Cochrane and the EMJ

The simplest way to evaluate an intervention is to compare outcomes before and after implementation of the intervention. This method is known as an uncontrolled before-after study. The term ‘uncontrolled’ is used to distinguish this design from a controlled before-after study in which the before-after effect of implementation in the intervention group is compared with a control group that has no intervention. With the recent emphasis on improvements in healthcare delivery in particular, the number of uncontrolled before-after studies is increasing. Unfortunately, these present a problem. The use of historical controls in clinical trials has long been recognised to overestimate the benefit of new treatments,1 and has provided misleading information in emergency medicine.2 ,3 For example, uncontrolled before-after data suggested that intravenous thrombolysis could reduce mortality in cardiac arrest,2 whereas subsequent randomised data showed that this treatment increased intracranial haemorrhage and did not reduce mortality.3 Emergency physicians would not generally consider basing their clinical practice on uncontrolled before-after data. …
Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments

Simulation is increasingly valued as a teaching and learning tool in emergency medicine. Bringing simulation into the workplace to train in situ offers a unique and effective training opportunity for the emergency department (ED) multiprofessional workforce. Integrating simulation in a busy department is difficult but can be done. In this article, we outline 10 tips to help make it happen.
Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML study IV.

We studied the influence of comorbidities on remission rate and overall survival (OS) in patients with chronic myeloid leukemia (CML). Participants of the CML Study IV, a randomized 5-arm trial designed to optimize imatinib therapy, were analyzed for comorbidities at diagnosis using the Charlson Comorbidity Index (CCI); 511 indexed comorbidities were reported in 1519 CML patients. Age was an additional risk factor in 863 patients. Resulting CCI scores were as follows: CCI 2, n = 589; CCI 3 or 4, n = 599; CCI 5 or 6, n = 229; and CCI ≥ 7, n = 102. No differences in cumulative incidences of accelerated phase, blast crisis, or remission rates were observed between patients in the different CCI groups. Higher CCI was significantly associated with lower OS probabilities. The 8-year OS probabilities were 93.6%, 89.4%, 77.6%, and 46.4% for patients with CCI 2, 3 to 4, 5 to 6, and ≥7, respectively. In multivariate analysis, CCI was the most powerful predictor of OS, which was still valid after removal of its age-related components. Comorbidities have no impact on treatment success but do have a negative effect on OS, indicating that survival of patients with CML is determined more by comorbidities than by CML itself. OS may therefore be inappropriate as an outcome measure for specific CML treatments. The trial was registered at www.clinicaltrials. gov as #NCT00055874.
A76: Long‐Term Efficacy of Canakinumab in Childhood Colchicine Resistant Familial Mediterranean Fever

Familial Mediterranean fever (FMF) is the most common hereditary autoinflammatory syndrome. FMF is caused by mutations in the MEFV gene which encodes the pyrin protein, that has an important role in the activation of IL‐1β. Evidence from case reports/series and one controlled study supports IL‐1 blockage as a potential treatment for FMF. Canakinumab (CAN) is a selective fully human monoclonal anti‐IL‐1β antibody. This study served as a proof of concept to evaluate the role of CAN in the treatment of pediatric colchicine resistant (CR)‐FMF with a longterm extension.
Psychiatric Battle Casualties from a Biological Viewpoint

UNTIL recent years casualties of war have not been unique but they are now tending to be of a special kind not common in peacetime. This tendency is especially marked with psychiatric reactions, like battle exhaustion, which occur in considerable numbers during major conflicts but almost never at other times. As a result, those of us who have had the good fortune not to have seen such cases, when we need to know about them must have recourse to elderly pamphlets, books or films which were produced in a different idiom and in ignorance of present day knowledge and attitudes. This essay is meant to provoke interest and comment especially among those who have seen such casualties and who mayor may not agree with the attempt to fit the recorded war-time experience to more modern scientific work.
Design principles for carbon emissions reduction programs.

Thegoal,articulatedbyPresidentObamain2009,ofreducingU.S. carbon emissions 17% from the 2005 level by 2020 iseminentlyachievablewithoutnewtechnologyorappreciablesacriﬁce by energy users. However, achieving it will in partrequire sophisticated energy efﬁciency and conservationprograms.Toovercomeinstitutionalandbehavioralbarriers,these programs will need to implement six principles ofeffectivedesignderivedfrom30yearsofbehavioralandsocialscience research. We focus on the household sector, butbelieveourgeneralconclusionslikelyapplytoothersectorsas well.We recently developed an analysis for the householdsector senergy use in homes and for nonbusiness travel ofwhat we call Reasonably Achievable Emissions Reductions(RAER) (
Phase 1/2 study of carfilzomib plus melphalan and prednisone in patients aged over 65 years with newly diagnosed multiple myeloma.

This phase 1/2 dose-escalation study investigated the combination of carfilzomib with melphalan and prednisone (CMP) in patients aged >65 years with newly diagnosed multiple myeloma (MM). Melphalan and prednisone were administered orally on days 1 to 4; carfilzomib was IV administered on days 1, 2, 8, 9, 22, 23, 29, and 30 of a 42-day cycle. Patients received up to 9 cycles of CMP. In the phase 1 dose-escalation portion, the primary objectives were to determine the incidence of dose-limiting toxicities during the first cycle of CMP treatment to define the maximal tolerated dose (MTD) of carfilzomib. In the phase 2 portion, the primary objective was to evaluate the overall response rate (ORR) of CMP. In the phase 1 portion of the study, 24 patients received CMP at carfilzomib dosing levels of 20 mg/m(2), 27 mg/m(2), 36 mg/m(2), and 45 mg/m(2). The MTD was established as 36 mg/m(2). In the phase 2 portion of the study, 44 patients were enrolled at the MTD. Among 50 efficacy-evaluable patients treated at the MTD, the ORR was 90%. The projected 3-year overall survival rate was 80%. The combination of CMP was observed to be effective in elderly patients with newly diagnosed MM. This trial was registered at www.clinicaltrials. gov as #NCT01279694 (Eudract identifier 2010-019462-92).
New models of care for advanced lung disease

Abstract Chronic lung disease is growing in prevalence and patients are living longer with long-term illness and a high-symptom burden: as these diseases are so common there are now millions of affected individuals and their families living with the sequelae worldwide. This has profound effects on the individual concerned (who is often highly symptomatic with breathlessness), their family, and on health services. There is a growing recognition that the historical model of medical management aimed at the disease alone is not meeting patients' needs and leading to high levels of unscheduled use of medical services at high financial cost and without health gain leading to further frustration for the patient. Service models for palliative care aimed at patients with a rapid deterioration from good health to death can also fail to meet the needs of this group. This paper examines new models of care for patients with advanced lung disease, outlining three services in some detail with a brief review of available evidence. It calls for new ways of evaluating the impact of such services.
Maintaining a Healthy Workforce

The study describes the health maintenance practices and utilization of complementary and alternative therapies by nurses and nursing students from Canada, Hawaii and American Samoa. Forecasts of an ongoing nursing shortage coupled with a focus on healthy behavior provided an impetus to describe actual practices of self-care and use of alternative therapies. The study addresses the dearth of knowledge in this area. Nurses and students were asked to anonymously complete a two-part survey that enumerated their perspectives on alternative therapies usage and self-care. Indicators of self-care included sleep, nutrition, exercise, and time. Use of alternative therapies is an integral part of self-care for the nurses and students in the three study regions.
Hemostatic efficacy, safety, and pharmacokinetics of a recombinant von Willebrand factor in severe von Willebrand disease.

This phase 3 trial evaluated the safety and hemostatic efficacy of a recombinant von Willebrand factor (rVWF) for treatment of bleeds in severe von Willebrand disease (VWD). rVWF was initially administered together with recombinant factor VIII (rFVIII) and subsequently alone, as long as hemostatic factor VIII activity (FVIII : C) levels were maintained. Pharmacokinetics (PK) were evaluated in a randomized cross-over design (rVWF vs rVWF:rFVIII at 50 IU VWF:ristocetin cofactor activity [RCo]/kg). Bleed control for all treated bleeds (N = 192 bleeds in 22 subjects) was rated good or excellent (96.9% excellent; 119 of 122 minor, 59 of 61 moderate, and 6 of 7 major bleeds) on a 4-point scale (4 = none to 1 = excellent). A single infusion was effective in 81.8% of bleeds. Treatment success, defined as the number of subjects with a mean efficacy rating of <2.5, was 100%. The PK profile of rVWF was not influenced by rFVIII (mean VWF:RCo terminal half-life: 21.9 hours for rVWF and 19.6 hours for rVWF:rFVIII). FVIII : C levels increased rapidly after rVWF alone, with hemostatic levels achieved within 6 hours and sustained through 72 hours after infusion. Eight adverse events (AEs; 6 nonserious AEs in 4 subjects and 2 serious AEs [chest discomfort and increased heart rate, without cardiac symptomatology] concurrently in 1 subject) were associated with rVWF. There were no thrombotic events or severe allergic reactions. No VWF or FVIII inhibitors, anti-VWF binding antibodies, or antibodies against host cell proteins were detected. These results show that rVWF was safe and effective in treating bleeds in VWD patients and stabilizes endogenous FVIII : C, which may eliminate the need for rFVIII after the first infusion. This trial was registered at www.clinicaltrials. gov as #NCT01410227.
Efforts to reduce homemaker/home health aide turnover in a home care agency

The Visiting Nurse Association (VNA) of the Denver area conducted an action research project that identified and reduced high turnover rates of homemakers and home health aides. The research team worked to minimize attrition in the VNA's professional staff, which had annual turnover in excess of 95% and staffing losses as high as 60% from the first to the second day of employment. Through a collaborative effort within the organization, the team decreased turn over and reduced staffing losses to 25%, resulting in a first-year savings to the VNA of more than $5,900. Key words: reduction of home health aide turnover
Treatment of acne: an update

This article reviews the current literature and outlines principles of therapy for acne vulgaris. The treatment selected for each individual case should be based on lesion type, severity of acne, presence of scarring and the psychosocial disability caused by the disease. Clear patient guidelines regarding possible adverse effects and realistic expectations that take into account patient preferences are required to achieve compliance.
Trust in Relationships Between Primary Health Care Organisations

In Victoria the primary health care sector is in a period of change intended to strengthen the integration of a complex service system through a process of partnership development based on collaboration. The partnerships are voluntary alliances of the primary care service providers, usually within a locality of two to three local government areas. Their purpose is to improve the health and wellbeing of the local population by strengthening inter-agency coordination in the areas of needs identification, planning and service delivery. Trust is a key issue in this process. This paper is a report of the first stage of a study to explore trust in the context of relationships between organisations in the primary care sector.
Validation study of a transcutaneous carbon dioxide monitor in patients in the emergency department

Background: Transcutaneous carbon dioxide tension (TcPco2) monitors offer a non-invasive method of continuously measuring arterial carbon dioxide tensions. The concordance between the TcPco2 measurement and the value obtained from arterial blood gas sampling (Paco2) was measured in patients attending the emergency department. Methods: A prospective observational cohort study was performed in 49 adult patients who were undergoing arterial blood gas sampling as part of their assessment. Blood gas sampling and recording of the TcPco2 level from the monitor was done simultaneously. Concordance between the two values (Paco2 and TcPco2) was demonstrated using the method described by Bland and Altman. Results: The mean difference was 0.02 kPa (95% CI −0.11 to 0.15). The Pearson’s correlation coefficient was 0.94 (p<0.001) and the Bland-Altman limits of agreement were ±0.9 kPa. Conclusions: In adult patients, concordance between carbon dioxide measurements by transcutaneous monitor and arterial blood sampling is good. Using the transcutaneous method, patients may be monitored non-invasively which may reduce the need for repeated blood gas sampling.
INPP4B, a new player in the chemoresistance of AML.

In this issue of Blood , [Rijal et al][1] have identified the inositol polyphosphate 4-phosphatase II (INPP4B) as a poor prognostic marker in acute myeloid leukemia (AML), driving chemoresistance through a novel gain-of-function mechanism independent of its phosphatase functions. [1][2] Although
B7-H3 ameliorates GVHD.

In this issue of Blood , results from [Veenstra et al][1] highlight an important role of the B7-superfamily member B7-H3 (CD276) in allogeneic bone marrow transplantation. [1][2] ! [Figure][3] (A) (Top) Transfer of allogeneic T cells into B7-H3–deficient animals leads to an increased GVHD
Effects of Fat Polymorphic Transformation and Nonfat Particle Size Distribution on the Surface Changes of Untempered Model Chocolate, Based on Solid Cocoa Mass.

This study aims to understand the bloom process in untempered chocolate by investigating the polymorphic transformation of cocoa butter and changes in chocolate surface. Cocoa mass with varying particle size distributions (PSD) were used to produce untempered model chocolate. Optical microscopy showed that during 25 d of storage, the chocolate surface gradually became honeycombed in appearance with dark spots surrounded by white sandy bloom areas. In conjunction with X-ray diffraction this indicates that the polymorphic transformation of form IV cocoa butter to more stable form V crystals caused the observed surface changes with the most significant changes occurring within 6 d. As bloom developed the surface whiteness increased, but the PSD of nonfat particles showed limited impact on the changes in whiteness. Moreover, scanning electron microscopy showed separated fat crystals on fat-rich dark spots and empty spaces between particles in bloom areas suggesting redistribution of fat in the chocolate matrix. PRACTICAL APPLICATION The results reported in this work can facilitate the understanding of fat bloom formation in untempered chocolate with respect to the changes in microstructure and surface appearances. It also contributes to show the details of IV-to-V polymorphic transformation in the fat phase as time went by.
Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women.

Iron supplements acutely increase hepcidin, but the duration and magnitude of the increase, its dose dependence, and its effects on subsequent iron absorption have not been characterized in humans. Better understanding of these phenomena might improve oral iron dosing schedules. We investigated whether the acute iron-induced increase in hepcidin influences iron absorption of successive daily iron doses and twice-daily iron doses. We recruited 54 nonanemic young women with plasma ferritin ≤20 µg/L and conducted: (1) a dose-finding investigation with 40-, 60-, 80-, 160-, and 240-mg labeled Fe as [(57)Fe]-, [(58)Fe]-, or [(54)Fe]-FeSO4 given at 8:00 am fasting on 1 or on 2 consecutive days (study 1, n = 25; study 2, n = 16); and (2) a study giving three 60-mg Fe doses (twice-daily dosing) within 24 hours (study 3, n = 13). In studies 1 and 2, 24 hours after doses ≥60 mg, serum hepcidin was increased (P < .01) and fractional iron absorption was decreased by 35% to 45% (P < .01). With increasing dose, fractional absorption decreased (P < .001), whereas absolute absorption increased (P < .001). A sixfold increase in iron dose (40-240 mg) resulted in only a threefold increase in iron absorbed (6.7-18.1 mg). In study 3, total iron absorbed from 3 doses (2 mornings and an afternoon) was not significantly greater than that from 2 morning doses. Providing lower dosages (40-80 mg Fe) and avoiding twice-daily dosing maximize fractional absorption. The duration of the hepcidin response supports alternate day supplementation, but longer-term effects of these schedules require further investigation. These clinical trials were registered at www.ClinicalTrials. gov as #NCT01785407 and #NCT02050932.