Miracle-dz/UniFAR-FTUs huggingface dataset:
Social disadvantage and exposure to lower priced alcohol in off-premise outlets.

INTRODUCTION AND AIMS Greater concentrations of off-premise alcohol outlets are found in areas of social disadvantage, exposing disadvantaged populations to excess risk for problems such as assault, child abuse and intimate partner violence. This study examines whether the outlets to which they are exposed also sell cheaper alcohol, potentially further contributing to income-related health disparities. DESIGN AND METHODS We conducted unobtrusive observations in 295 off-premise outlets in Melbourne, Australia, randomly selected using a spatial sample frame. In semi-logged linear regression models, we related the minimum purchase price for a 750 mL bottle of wine to a national index of socioeconomic advantage for the census areas in which the outlets were located. Other independent variables characterised outlet features (e.g. volume, chain management) and conditions of the local alcohol market (adjacent outlet characteristics, neighbourhood characteristics). RESULTS A one decile increase in socioeconomic advantage was related to a 1.3% increase in logged price. Larger outlets, chains, outlets adjacent to chains, outlets in greater proximity to the nearest neighbouring outlet and those located in areas with more students also had cheaper alcohol. DISCUSSION AND CONCLUSIONS Not only are disadvantaged populations exposed to more outlets, the outlets to which they are exposed sell cheaper alcohol. This finding appears to be consistent with the spatial dynamics of typical retail markets.
Maternal Demographic Determinants of Low Birth Weight Babies in District Jhang (Pakistan)

The study was conducted to investigate the maternal demographic determinants of low birth weight babies in district Jhang, Pakistan. In the study demographic characteristics of mothers of low birth weight babies were observed. These characteristics were residential area, education level, socio-economic status, age of mothers at the time of birth and pregnancy interval. These all mentioned characteristics were taken as independent variables against the dependent variable, low birth weight of infants. A sample size of 220 mothers who gave birth to a low weight baby was surveyed through purposive sampling technique in government hospitals of District Jhang and its Tehsils. Data was entered and analyzed by using SPSS. One way analysis of variance with mean plots was used to find out the mean differences between maternal demographic characteristics and low birth weight of babies. Rural women, comparatively aged women, early married women and low educated women were found to have extremely low birth weight babies. DOI: 10.5901/mjss.2015. v6n4s1p498
Neuropathic Pain Following Nerve Injury

Pain is essential for our wellbeing as it warns us from possible injuries. After injury, pain sensations around injured tissue lead to protective behavior and so indirectly contribute to a faster healing process. Physiological pain is usually acute or subchronic, it progressively diminishes in the process of healing and responds to conventionally used analgesics. However, injury to the somatosensory system may give rise to ongoing pain that persists beyond the healing process of the original injury and is refractory to analgesics. Such pain is termed neuropathic. Neuropathic pain negatively influences quality of life of patients and often interferes with the rehabilitation strategies after nerve injury. Pharmacological treatment or surgical intervention provide only short term alleviation, since adverse effects such as drug tolerance and addictions, motor deficit and worsening pain may emerge over time. Therefore there is a need to identify novel, more effective long term therapies. Cell transplantation and gene therapy present target-oriented therapies minimizing side effects of medication due their local action. Therefore they are promising way to manage chronic neuropathic pain.
Long-term follow-up after bariatric surgery: a systematic review.

IMPORTANCE Bariatric surgery is an accepted treatment for obesity. Despite extensive literature, few studies report long-term follow-up in cohorts with adequate retention rates. OBJECTIVE To assess the quality of evidence and treatment effectiveness 2 years after bariatric procedures for weight loss, type 2 diabetes, hypertension, and hyperlipidemia in severely obese adults. EVIDENCE REVIEW MEDLINE and Cochrane databases were searched from 1946 through May 15, 2014. Search terms included bariatric surgery, individual bariatric procedures, and obesity. Studies were included if they described outcomes for gastric bypass, gastric band, or sleeve gastrectomy performed on patients with a body mass index of 35 or greater, had more than 2 years of outcome information, and had follow-up measures for at least 80% of the initial cohort. Two investigators reviewed each study and a third resolved study inclusion disagreements. FINDINGS Of 7371 clinical studies reviewed, 29 studies (0.4%, 7971 patients) met inclusion criteria. All gastric bypass studies (6 prospective cohorts, 5 retrospective cohorts) and sleeve gastrectomy studies (2 retrospective cohorts) had 95% confidence intervals for the reported mean, median, or both exceeding 50% excess weight loss. This amount of excess weight loss occurred in 31% of gastric band studies (9 prospective cohorts, 5 retrospective cohorts). The mean sample-size-weighted percentage of excess weight loss for gastric bypass was 65.7% (n = 3544) vs 45.0% (n = 4109) for gastric band. Nine studies measured comorbidity improvement. For type 2 diabetes (glycated hemoglobin <6.5% without medication), sample-size-weighted remission rates were 66.7% for gastric bypass (n = 428) and 28.6% for gastric band (n = 96). For hypertension (blood pressure <140/90 mm Hg without medication), remission rates were 38.2% for gastric bypass ( n = 808) and 17.4% for gastric band (n = 247). For hyperlipidemia (cholesterol <200 mg/dL, high-density lipoprotein >40 mg/dL, low-density lipoprotein <160 mg/dL, and triglycerides <200 mg/dL), remission rates were 60.4% for gastric bypass (n = 477) and 22.7% for gastric band (n = 97). CONCLUSIONS AND RELEVANCE Very few bariatric surgery studies report long-term results with sufficient patient follow-up to minimize biased results. Gastric bypass has better outcomes than gastric band procedures for long-term weight loss, type 2 diabetes control and remission, hypertension, and hyperlipidemia. Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections.
Physician practice competition and prices paid by private insurers for office visits.

IMPORTANCE Physician practice consolidation could promote higher-quality care but may also create greater economic market power that could lead to higher prices for physician services. OBJECTIVE To assess the relationship between physician competition and prices paid by private preferred provider organizations (PPOs) for 10 types of office visits in 10 prominent specialties. DESIGN AND SETTING Retrospective study in 1058 US counties in urbanized areas, representing all 50 states, examining the relationship between measured physician competition and prices paid for office visits in 2010 and the relationship between changes in competition and prices between 2003 and 2010, using regression analysis to control for possible confounding factors. EXPOSURES Variation in the mean Hirschman-Herfindahl Index (HHI) of physician practices within a county by specialty (HHIs range from 0, representing maximally competitive markets, to 10,000 in markets served by a single [monopoly] practice). MAIN OUTCOMES AND MEASURES Mean price paid by county to physicians in each specialty by private PPOs for intermediate office visits with established patients (Current Procedural Terminology [CPT] code 99213) and a price index measuring the county-weighted mean price for 10 types of office visits with new and established patients (CPT codes 99201-99205, 99211-99215) relative to national mean prices. RESULTS In 2010, across all specialties studied, HHIs were 3 to 4 times higher in the 90th-percentile county than the 10th-percentile county (eg, for family practice: 10th percentile HHI = 1023 and 90th percentile HHI = 3629). Depending on specialty, mean price for a CPT code 99213 visit was between $70 and $75. After adjustment for potential confounders, depending on specialty, prices at the 90th-percentile HHI were between $5.85 (orthopedics; 95% CI, $3.46-$8.24) and $11.67 (internal medicine; 95% CI, $9.13-$14.21) higher than at the 10th percentile. Including all types of office visits, price indexes at the 90th-percentile HHI were 8.3% (orthopedics; 95% CI, 5.0%-11.6%) to 16.1% (internal medicine; 95% CI, 12.8%-19.5%) higher. Between 2003 and 2010, there were larger price increases in areas that were less competitive in 2002 than in initially more competitive areas. CONCLUSIONS AND RELEVANCE More competition among physicians is related to lower prices paid by private PPOs for office visits. These results may inform work on policies that influence practice competition.
Cómo analizar un ensayo clínico: el estudio ASCOT-BPLA

1. Centro de Ciencias Biomédicas. Universidad de Montevideo. E-mail: esandoya@um.edu. uy * El estudio ASCOT tuvo otra rama destinada a evaluar estatinas: Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial -Lipid Lowering Arm (ASCOTLLA): a multicentre randomised controlled trial. Lancet 2003; 361: 1149-58.
Non-invasive assessment of myocardial contractility from force-frequency relationship in patients with implanted pacemakers: first results.

AIMS In the normal heart, myocardial contractility is augmented at elevated heart rates. This effect is known as force-frequency relationship (FFR). The FFR is altered in failing hearts and may be used to detect myocardial function impairment. Force-frequency relationship measurements usually require invasive techniques and have therefore rarely been used in clinical practice. We studied the feasibility of FFR determination by implanted pacemakers as a non-invasive method in pacemaker patients. METHODS AND RESULTS During follow-up visits in 30 patients with implanted pacemakers and normal heart function, the intracardiac impedance (IZ) was recorded by the pacemaker during incremental pacing at 80, 100, and 120 bpm. The time interval between the ventricular pacing pulse and IZmax (tIZm) and the maximum acceleration of the IZ change during myocardial contraction (IZacc: d2Z/dt2 max) were determined. Isovolumetric acceleration (IVA) was measured in parallel by tissue Doppler echocardiography at the right free wall, the left free wall, and the septum. With increasing pacing rates, the time interval tIZm shortened significantly and maximum acceleration IZacc increased significantly, consistent with the FFR. The best correlation was achieved between IZacc and IVA septal. CONCLUSION Permanent pacemakers offering intracardiac IZ measurements can be used for monitoring FFR changes and, possibly, for low-effort first-line monitoring of myocardial disease.
Difficulties in implantation of a cardiac resynchronization therapy system: causes of failure and importance of operator's experience.

sometimes being modified by heart failure, or the epicardiac veins are not conducive to positioning of a lead which is too large or which is made unstable by the structure of the blood vessel. However, the majority of failures result from operator’s lack of experience: every method requires a learning curve, and stimulation with resynchronization is no exception to this rule. Furthermore, experience needs to be maintained by performing a minimum number of procedures per year. What is the estimated frequency of technical failures of the method? (We will not consider cases which do not respond to treatment; although these are certainly failures of the method, they are often associated with causes different from those which we will be considering and discussing in this article.) Studies report between 4 and 15% of technical failures, all causes combined and for first implantations. 4,5 It is necessary to distinguish failures of cannulation where it is impossible to penetrate the coronary sinus or to advance into it (about 5% of implantations), dissection of the coronary sinus (1‐2% of implantations), and instability of the lead or its positioning in a vein which is unsuitable for resynchronization due to its location, size, or the threshold of stimulation measured in it (2‐5% of implantations). The success or failure of implantation of a left lead obviously depends on the anatomy of the cardiac venous system. 6 In the first place, insertion of the lead into the coronary sinus, directly or most often via an introducer catheter, can be hindered by the Thebesian valve: it exists in 75‐95% of subjects, and therefore is totally absent in only 5‐25% of cases. This valve is most often a membrane which is almost always cribriform, with an upper free border which is concave upwards and which partially occludes the opening of the coronary sinus into the right atrium. This configuration is the most common type (up to 70% of cases). In 9‐ 30% of subjects, the Thebesian valve is so developed that it is almost occlusive or at least is a major obstacle to penetration of the coronary sinus by a catheter or an introducer catheter. The use of a flexible guidewire can be very useful in such cases.
Water as Focus of Problem-Based Learning: An Integrated Curricular Program for Environmental Education in Secondary School.

In this paper, we explore some aspects regarding the introduction of an active learning approach to deal with environmental issues in secondary school during natural sciences lessons. Integrated curricular program and PBL (problem-based learning) are comprehensive approaches designed to engage students in investigation of authentic problems. We used a scenario regarding water as a socio-environmental issue to introduce the hydrosphere curricular topic. Two different ways were used for the presentation of the scenario. Here, we present students’ and teachers’ perceptions about the PBL approach, as well as students’ ideas about water proposed in both cases. Discussion among students was more active, when less input was given. Even though some difficulties arose, PBL approach was appreciated by the majority of students and teachers.
A study of blood soluble P-selectin, fibrinogen, and von Willebrand factor levels in idiopathic and lone atrial fibrillation.

AIMS A prothrombotic state with elevated levels of soluble P-selectin (sP-sel), fibrinogen, von Willebrand factor (vWf), and other haemostatic indices has been reported in some patients with atrial fibrillation (AF). Whether these changes are due to AF itself or coexistent cardiovascular diseases remains a matter of debate. Therefore, in the present study, the differences in plasma levels of sP-sel, fibrinogen, and vWf between patients with idiopathic/lone AF and sex-, age-, and risk factor-matched controls were investigated to determine whether AF itself might be associated with a hypercoagulable state. METHODS AND RESULTS Ninety consecutive patients (63 males, 54.1 ± 10.1 years) with idiopathic AF were studied, 60 (43 males, 48.8 ± 7.5 years) of whom were diagnosed as lone AF. Plasma sP-sel and vWf were measured by enzyme-linked immunosorbent assay. Plasma fibrinogen was measured by chromometry. These indices in AF patients were compared with those in sex-, age- and risk factor-matched controls. Compared with the controls, patients with idiopathic AF had higher levels of sP-sel (AF vs. control: 33.4 ± 7.4 vs. 29.2 ± 6.5 ng/mL, P < 0.001) and fibrinogen (AF vs. control: 3.3 ± 0.9 vs. 3.0 ± 0.6 g/L, P = 0.02), but not vWf, whether with the adjustment of covariates or not. As for those < 60 years, between lone AF and age-matched controls, significant difference existed in the levels of sP-sel (AF vs. control: 34.5 ± 7.3 vs. 30.2 ± 7.3 ng/mL, P = 0.002), but not in those of fibrinogen and vWf, whether with the adjustment of covariates or not. CONCLUSIONS Both platelet activation and abnormal changes in coagulation were suggested in idiopathic AF and a platelet activation state in lone AF. This supports the notion that AF per se contributes to a state of hypercoagulation.
Aktuelle Therapie der juvenilen idiopathischen Arthritis mit Biologika

Zusammenfassung Die juvenile idiopathische Arthritis (JIA) ist eine heterogene Gruppe von Erkrankungen mit den gemeinsamen Merkmalen einer chronischen Arthritis unklarer Ätiologie und dem Auftreten im Kindesalter. Die Prognose wird zum Teil von der Anzahl betroffener Gelenke und vom Auftreten extraartikulärer Manifestationen, z. B. einer chronischen Uveitis, bestimmt. Destruierende Verläufe sind bei Vorliegen einer Polyarthritis insbesondere bei systemischem Beginn häufig. Neue Therapiestrategien unter Einsatz von Biologika, einer Gruppe von gentechnologisch produzierten hoch spezifischen antientzündlichen Substanzen, erwiesen sich auch bei zuvor therapieresistenten Patienten als wirksam. Neben den drei Antagonisten des Tumor-Nekrose-Faktors (Etanercept, Adalimumab und Infliximab) stehen Inhibitoren weitere Zytokine, Anakinra, ein IL-1-Reptorantagonist und Tocilizumab, ein Antikörper gegen den Interleukin-6-Rezeptor sowie gegen zellständige Membranproteine gerichtete Antikörper, wie z. B. der CD20-Antikörper Rituximab und das Fusionsprotein Abatacept, gegen ein kostimulatorisches Membranantigen zur Verfügung. Die Aufgabe dieser Übersicht ist die Darstellung der therapeutischen Optionen mit dem aktuellen Repertoire an Biologika, das den differenziellen Einsatz zur Behandlung der juvenilen idiopathischen Arthritis bei Polyarthritis, bei systemischem Verlauf und bei der Uveitis ermöglicht.
JAK inhibitor in CALR-mutant myelofibrosis.

1. Langley JM, Carmona Martinez A, Chatterjee A, et al. Immunogenicity and safety of an inactivated quadrivalent influenza vaccine candidate: a phase III randomized controlled trial in children. J Infect Dis 2013;208:544-53. 2. Domachowske JB, Pankow-Culot H, Bautista M, et al. A randomized trial of candidate inactivated quadrivalent influenza vaccine versus trivalent influenza vaccines in children aged 3-17 years. J Infect Dis 2013;207:1878-87. 3. Krammer F, Palese P. Universal influenza virus vaccines: need for clinical trials. Nat Immunol 2014;15:3-5.
From Detached Concern to Empathy: Humanizing Medical Practice (review)

Rarely do I finish a book feeling humbled. In her book, From Detached Concern to Empathy, Halpern offers an original way of thinking about the doctorpatient relationship that is so satisfying that one wonders why it took until now. The thesis is simple: promoting patient autonomy must not be understood merely in the negative sense of not interfering in patient decision-making, but rather, it must be understood as a positive obligation to help patients use or regain mental freedom such that they can set and pursue future goals. Only with such mental freedom does one act fully autonomously. Physicians help patients achieve mental freedom not by detached concern, but by engaging empathically with them. What is empathy and how can it be cultivated? Halpern’s central claim is that “empathy requires experiential, not just theoretical, knowing” (p. 72). It incorporates both cognitive and affective capacities and requires that the physician be open to feedback and correction. It is based on emotional reasoning, in which the “empathizer is able to resonate emotionally with, yet stay aware of, what is distinct about the patient’s experience” (p. 85). It requires that physicians “imagine how it feels to experience something, in contrast to imagining that something is the case” (p. 85). In some situations with some patients, a physician’s empathy will resonate spontaneously; otherwise, a physician can promote empathy by cultivating curiosity about what it feels like to be in the patient’s distinct situation (p. 93). The book opens with the case of Ms. G, a middle-aged woman with diabetes who has just had her second above-the-knee amputation and is refusing dialysis, even though she knows that she will die without it. Her refusal follows on the heels of her husband’s attestation post-operatively that he had found another woman and was leaving her. My reaction to the case was that she would be declared mentally incompetent on the basis of her acute depres-
Giant fibrosarcoma of anterior abdominal wall: a rare case report and review literature

Adult type fibrosarcoma is very rare malignant soft tissue tumor. It usually arises in soft tissues of extremities, trunk, head and neck. Fibrosarcoma is essentially a diagnosis of exclusion from other spindle cell mesenchymal malignant neoplasm; by definition negative for epithelial, myogenous and neural markers on immunohistochemistry. To the best of our knowledge, very few cases have been reported in the literature. We here report a case of giant fibrosarcoma arising from anterior abdominal wall in a recurrent dermatofibrosarcoma proturbens and managed with surgical excision and reconstruction with meshplasty.
The electroanatomical remodelling of the left atrium is related to CHADS2/CHA2DS2VASc score and events of stroke in patients with atrial fibrillation.

BACKGROUND Although atrial fibrillation (AF) increases the risk of stroke, its relationship with atrial remodelling has not yet been studied. We hypothesized that the degree of electroanatomical remodelling of the left atrium (LA) is related to CHADS₂/CHA₂DS₂VASc score and events of stroke. METHODS AND RESULTS We compared CHADS₂/CHA₂DS₂VASc score (0, 1, ≥ 2) or events of stroke with mean and regional LA volume [by three-dimensional (3D) computed tomography images] or LA endocardial voltage (by 3D-electroanatomical map) in 348 patients who underwent catheter ablation of AF (78.4% male, 55.4 ± 11.0 years old, paroxysmal AF:persistent AF = 215:133). We graded LA volume index as Grade 1 (< 48.3 mL/m²; n= 80), grade 2 (48.3-63.0 mL/m², n= 82), grade 3 (63.0-99.0 mL/m²; n= 94), and grade 4 (≥ 99.0 mL/m²; n= 92). Results (i) The percentage volume of anterior portion of LA enlarged at the early stage of LA remodelling (Grade 1 vs. grade 2, P= 0.006) and the voltage of posterior venous LA was significantly reduced with the degree of LA remodelling (P= 0.001). (ii) Mean LA volume/body surface area (BSA), especially anterior portion of LA, was greater in patients with high CHADS₂/CHA₂DS₂VASc score (P= 0.002). Mean LA voltage was significantly lower in patients with high CHA₂DS₂VASc score than low score (P= 0.007). (iii) In patients who experience stroke (n= 22), LA volume/BSA, especially anterior LA, was greater (P= 0.012), and LA endocardial voltage was lower (P= 0.039) than those without stroke. CONCLUSION Electroanatomical remodelling of LA, estimated by LA volume and endocardial voltage, has significant relationship with the risk scores or events of stroke in patients with non-valvular AF.