Miracle-dz/UniFAR-FTUs huggingface dataset:
The Psychiatric Note in the Era of Electronic Communication

The electronic medical record (EMR) is a central component of health care reform and is already implemented in many settings (Blumenthal, 2009). Some clinicians may find this a desirable and others an undesirable development (Baron, 2007; Garg et al., 2005; Mangalmurti et al., 2010; Sittig and Classen, 2010); however, increasing numbers of mental health clinicians now face the challenge of using the EMR wisely and therapeutically in settings in which such systems are now, or soon will be, operative (Mojtabai, 2007). This article illustrates how the EMR can be used to benefit patients and providers while understanding that as with all change there are potential anticipated and unanticipated problems. In most ways, the psychiatric note in the EMR is not radically different from traditional notes in paper medical records. The EMR note continues to address the tasks of documenting the psychiatric assessment, current treatment regimens, outcomes, and future treatment steps. However, the legibility and accessibility of EMR notes greatly increase the degree of “sharedness” of treatment assessment and planning with cotreaters and patients. The increased degree of “sharedness” of the EMR can foster treatment continuity and effective communication between a team of providers. To reap these benefits, the EMR requires us to produce clear, comprehensive but relatively brief notes. Although clear concise notes were desirable in the paper-based medical record, the EMR makes such notes essential. The EMR will be more readily available to the patients and other clinicians, potentially posing issues for the patient clinician alliance but also potentially increasing the opportunities for greater clinician-patient collaboration. While the paper charts were always “permanent,” the new accessibility of an EMR results in notes that are also more easily retrieved. This raises concerns regarding potentially “sensitive” information discussed during mental health treatment. We illustrate the potential benefits and clinical concerns using 2 clinical vignettes in 2 different treatment settings. Dr. A and Dr. H work in settings in which the EMR is being introduced. Dr. A works in a tertiary care academic medical center and treats Mr. J for depression and narcissistic personality disorder with combined medication and psychotherapy. An EMR would make the diagnosis of narcissistic personality disorder more transparent and result in a discussion between Dr. A and his patient that may enhance or threaten their working alliance. Dr. H works at the local community mental health center and treats Mr. B for schizophrenia. Mr. B has ongoing delusions regarding a computer chip in his head, and may react poorly to the news that his notes are now available in electronic format.
Prevalence of malnutrition after major surgery

Since Butterworth first published his paper ‘The skeleton in the hospital closet’ in 1974, it has been known that malnutrition is a significant factor in determining the outcome of illness for many patients (Butterworth, 1974). However, the problem still exists 20 years after this publication appeared. Those who undergo major surgery are at greater risk of malnutrition than most because of the stress and the concomitant increase in metabolic rate caused by the surgery. This paper reports the prevalence of malnutrition in patients who had undergone major surgery within 6 weeks of being surveyed and who were living in the community under their general practitioner's care. One hundred and twenty-three patients (74 men and 49 women) took part in the survey. A total of 13 (10.6%) patients were malnourished, 10 (8.1%) mildly and 3 (2.4%) severely malnourished. The problem was more prevalent in those who had undergone genito-urinary and gastrointestinal surgery, of whom 33% (2 out of 6) and 20.6% (7 out of 34), respectively, were malnourished. Surprisingly, there was a significantly higher proportion of women in the malnourished than in the non-malnourished group (P=0.047). Furthermore, malnourished patients were significantly younger than non-malnourished patients (P=0.034). In surgical patients, pre-operative nutritional assessment, a course of feeding prior to surgery in malnourished patients, and early post-operative feeding in all patients, could help to reduce the incidence of malnutrition in post-operative patients, and consequently reduce the cost to the National Health Service (NHS).
The unveiling of the Warburg effect and the inscribed innovative approach to a radical non toxic anticancer therapy

ABSTRACT The purpose of this research has been deciphering the Warburg paradox, the biochemical enigma unsolved since 1923. We solved it by demonstrating that its specific character, i.e. the forced aerobic lactate exportation, represents a crucial metabolic device to counteract the cytotoxic effect produced by an excess of pyruvate at the connection of glycolysis with the Krebs cycle. This solution was verified by exposing cancer cells of different histogenesis to pyruvate concentrations higher than the physiological ones, after showing that these concentrations are totally innocuous when injected into mice. The mechanism of the pyruvate cytotoxicity relies on the saturation of the respiratory chain, leading to a negative shift of the cytosolic NADP/NADPH ratio and the consequent restriction of the purine synthesis and the related cell apoptosis. The reducing equivalents generated by glycolysis and by cytosolic metabolism compete each other for their disposal trough the respiratory chain; this makes it that the cytotoxicity of pyruvate is inversely related to the mitochondrial number and efficiency of various cell types. Thus, the cytotoxicity is high in anaplastic cancer stem cells, whose mitochondria are extremely few and immature (cristae-poor); on the contrary, no inhibition is brought about in adult differentiated cells, physiologically rich of mature mitochondria. All this generates the pyruvate anticancer selectivity, together with the lack of a general toxicity, making pyruvate represent an ideal candidate for a radical non toxical anticancer treatment.
Identification of endogenous normalizers for serum MicroRNAs by microarray profiling: U6 small nuclear RNA is not a reliable normalizer

We read with great interest the article entitled ‘‘Ethnic Differences in Viral Dominance Patterns in Patients with Hepatitis B Virus and Hepatitis C Virus Dual Infection,’’ recently published by Nguyen et al. in this journal. The study was designed to evaluate and compare the demographic, clinical, and viral characteristics of multiethnic patients infected by hepatitis virus admitted at two large liver centers in the United States. The investigators defined the study design as a matched case-control study, in which the case group included patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) dual infection, and the control group comprised patients with HBV monoinfection. However, in our opinion, there is an important methodological issue in the reported data: The main conclusion of the article was not about the comparison between cases and controls, but rather it underscored a secondary analysis with cases only in which ethnic differences were examined in terms of viral dominance patterns among HBV and HCV dual-infected patients. It is our opinion that the investigators deviated from the scope of the case-control study originally proposed, because it is clear that the investigation was not delineated to test the hypothesis that ended up becoming the core conclusion, including the title of the article. Therefore, the investigators’ conclusions regarding viral dominance were not consistent with the a priori study aims proposed.
Behavioral Reasons for Relinquishment of Dogs and Cats to 12 Shelters

The Regional Shelter Relinquishment Study sponsored by the National Council on Pet Population Study and Policy (NCPPSP) is a national research project designed to explore the characteristics of relinquished dogs and cats, their owners, and the reasons for relinquishment. The NCPPSP Regional Shelter Study found that behavioral problems, including aggression toward people or nonhuman animals, were the most frequently given reasons for canine relinquishment and the second most frequently given reasons for feline relinquishment. No association was found between category of relinquishment (behavioral, mixed, nonbehavioral) and gender, number of times mated (males), number of litters (females), purebred status, declaw status, and number of visits to the veterinarian within the past year, for either dogs or cats. Associations were found between category of relinquishment and number of pets in the household, number of pets added to the household, neuter status of female dogs and cats, neuter status of male dogs, training level, age of pet relinquished, length of ownership, and pets acquired from shelters. Associations also were found between the state in which the pet was relinquished and income level of owner.
Driving Behavior Under the Influence of Cannabis or Cocaine

Objective. The purpose of this study is first to describe perceptions of driving under the influence of cannabis or cocaine among clients in treatment and, second, to assess whether these perceptions are related to the frequency of driving under the influence of cannabis or cocaine. Methods. A questionnaire was administered to clients in treatment for abuse of either cocaine or cannabis, many of whom also had a problem with alcohol; additional groups of clients consisted of those in smoking cessation and gambling programs (N = 1021). Open-ended and close-ended questions were used to assess self-reported effects of cannabis or cocaine on driving and frequency of driving under the influence of cannabis, cocaine, or alcohol. Results. Two dimensions of driving behavior under the influence of cocaine or cannabis were found in both qualitative and quantitative analyses: 1) physical effects and 2) reckless styles of driving. Common physical effects for both drugs were heightened nervousness, greater alertness, and poorer concentration. In terms of driving behavior, cautious or normal driving was commonly reported for cannabis, whereas reckless or reduced driving ability was frequently reported for cocaine. When comparing negative physical effects and reckless style of driving with frequency of driving under the influence of cannabis or cocaine, increased negative physical effects from cannabis were inversely related to frequency of driving under the influence of cannabis (p = .001), but other relationships were not significant. Conclusions. The findings indicate that both cannabis and cocaine have detrimental but different effects on driving. The negative physical effects of cannabis may reduce the likelihood of driving under the influence of cannabis.
CHEMICAL CHANGES OCCURRING IN THE BODY AS THE RESULT OF CERTAIN DISEASES: I. THE EFFECTS OF DIARRHEA, VOMITING, DEHYDRATION AND OLIGURIA ON THE ACID-BASE BALANCE OF THE PLASMA OF INFANTS WITH MASTOIDITIS

Recently Peters, Bulger and others 1 have discussed from a broader point of view than usual the acid base equilibrium of the plasma of adults in health and in disease. For several years we have had a similar interest in the chemical changes taking place in the blood of sick infants and children. Because the normal blood of the infant differs somewhat from that of the adult, containing about 10 per cent less electrolyte and protein, and because rapid and serious changes of great magnitude are frequently encountered in disease, it was thought that our observations might be of some interest, both in emphasizing the significance of the chemical changes in certain diseases already thoroughly discussed by Peters and his associates, and in pointing out changes occurring as the result of diseases more peculiar to infancy and childhood. 2 It is the purpose in this paper to present data secured
Effects of a College Community Campaign on Drinking and Driving with a Strong Enforcement Component

Objectives: A program of publicized intensive enforcement of minimum drinking age law and drinking and driving laws was implemented in a college community. The effects on driving at various blood alcohol concentrations (BACs) were evaluated, particularly for drivers ages 16–24 targeted by the program. Methods: Objective measures of driver BACs were collected through nighttime roadside surveys before and during the program in the experimental college community and a comparison college community. Logistic regression models estimated the program's effects on the likelihood of driving at various BAC thresholds in the program community, after accounting for BAC patterns in the comparison community. Results: Relative to the comparison community, consistent reductions in driving at various BAC levels (positive BAC and BAC at least 0.02, 0.05, or 0.08%) were achieved in the experimental community. Reductions were greatest for 16- to 20-year-olds (from 66% for positive BAC to 94% for BAC ≥ 0.05%), followed by 21- to 24-year-olds (from 32% for positive BAC to 71% for BAC ≥ 0.08%) and drivers 25 and older (from 23% for positive BAC to 53% for BAC ≥ 0.08%). All reductions for 16- to 20-year-olds were significant (p < 0.05), and all except the reduction for BAC ≥ 0.08 percent were significantly greater than the corresponding reductions for drivers 25 and older. Reductions for 21- to 24-year-olds were significant for BACs at least 0.02, 0.05, and 0.08 percent, but they were not significantly greater than the corresponding reductions for drivers 25 and older. Although large, reductions for drivers 25 and older were not significant, based on 95 percent confidence intervals. Conclusions: A college community program with a strong enforcement component produced substantial reductions in drinking and driving among teenagers and young adults and smaller reductions among older adults. It is hoped that this will encourage colleges and communities to incorporate enforcement into interventions directed at alcohol use among young people.
Under the Influence: A History of Nitrous Oxide and Oxygen Anaesthesia

This book is essentially a compilation of articles by the author, originally published over the years since 1965 in the British Journal of Anaesthesia . A preface summarizes both the highlights and the author's own personal experience with nitrous oxide including autoexperimentation. The opening chapter is about Joseph Priestley and his discovery of oxygen. Here we are treated to a glimpse into the life of a one-time 18th-century minister and later tutor—always a well-to-do gentleman and scholar. The chapters continue in the same intimate style through Sir Humphrey Davy's researches in relation to inhalation anesthesia and go on to the gradual acceptance of nitrous oxide anesthesia in Great Britain, its manufacture and storage, ending with experience in ambulatory patients. The text is interspersed with quotes from contemporary writings along with the author's interpretations of the events described. The end result is a colorful, fascinating expose of the history of the most
Estimation of Fatality and Injury Risk by Means of In-Depth Fatal Accident Investigation Data

Objective: In this article the factors affecting fatality and injury risk of road users involved in fatal accidents are analyzed by means of in-depth accident investigation data, with emphasis on parameters not extensively explored in previous research. Methods: A fatal accident investigation (FAI) database is used, which includes intermediate-level in-depth data for a harmonized representative sample of 1300 fatal accidents in 7 European countries. The FAI database offers improved potential for analysis, because it includes information on a number of variables that are seldom available, complete, or accurately recorded in road accident databases. However, the fact that only fatal accidents are examined requires for methodological adjustments, namely, the correction for two types of effects on a road user's baseline risk: “accident size” effects, and “relative vulnerability” effects. Fatality and injury risk can be then modeled through multilevel logistic regression models, which account for the hierarchical dependences of the road accident process. Results: The results show that the baseline fatality risk of road users involved in fatal accidents decreases with accident size and increases with the vulnerability of the road user. On the contrary, accident size increases nonfatal injury risk of road users involved in fatal accidents. Other significant effects on fatality and injury risk in fatal accidents include road user age, vehicle type, speed limit, the chain of accident events, vehicle maneuver, and safety equipment. In particular, the presence and use of safety equipment such as seat belt, antilock braking system (ABS), and electronic stability program (ESP) are protection factors for car occupants, especially for those seated at the front seats. Conclusions: Although ABS and ESP systems are typically associated with positive effects on accident occurrence, the results of this research revealed significant related effects on accident severity as well. Moreover, accident consequences are more severe when the most harmful event of the accident occurs later within the accident chain.
Long‐term outcome of Japanese patients with type 1 autoimmune hepatitis

The long‐term outcome of patients with autoimmune hepatitis (AIH) in Japan has not been well‐defined. The aim of this study was to clarify the outcome of this disease over a long follow‐up period compared with that of the general Japanese population as well as that among patients. A total of 203 AIH patients were enrolled for a mean follow‐up period of 131 months. All patients were treated with corticosteroids with or without azathioprine. The overall survival of AIH patients was similar to that of the general population in Japan. The prognosis of AIH subgroups divided according to disease severity, sex, incidence of relapse, liver histology, presence of cirrhosis, probable or definite AIH score, antibody to hepatitis B core antigen antibody positivity, or human leukocyte antigen DR4–positivity did not differ greatly among patients. However, the prognosis of patients experiencing two or more relapses was significantly poorer than that of patients with remission or a single relapse both in univariate (P < 0.001) and multivariate (P = 0.020) analyses. The development of liver malignancy was also a possibility among AIH patients with multiple relapses. Severe adverse effects of corticosteroids were rare, even in patients who underwent long‐term treatment. Conclusion: Repeated relapses of AIH are significantly associated with a poorer long‐term prognosis in Japan. AIH patients can expect a similar prognosis to that of the general population, provided they are adequately managed with continuous low doses of immunosuppressive therapy, especially after the first relapse. (HEPATOLOGY 2012)
Hepatitis delta virus infects the cells of hepadnavirus‐induced hepatocellular carcinoma in woodchucks

Hepatitis delta virus (HDV) is a natural subviral agent of human hepatitis B virus (HBV). HDV enhances liver damage during concomitant infection with HBV. The molecular pathogenesis of HDV infection remains poorly understood. To advance our understanding of the relationship between HDV infection and liver cancer, it was determined whether HDV could infect in vivo the cells of hepadnavirus‐induced hepatocellular carcinoma (HCC). Woodchucks (Marmota monax) that were chronically infected with HBV‐related woodchuck hepatitis virus (WHV) and already developed HCCs were used as an experimental model. The locations of HCCs within the livers were determined using ultrasound imaging followed by open surgery. One week after surgery the WHV carrier woodchucks were superinfected with WHV‐enveloped HDV (wHDV). Six weeks later the animals were sacrificed and HDV replication in normal liver tissues and in center masses of HCCs was evidenced by Northern analysis, real‐time polymerase chain reaction assay, and immunohistochemistry. Based on accumulation levels of HDV RNAs and numbers of infected cells, the efficiency of wHDV infection appears to be comparable in most HCCs and normal liver tissues. Conclusion: Cells of WHV‐induced HCCs are susceptible to HDV infection in vivo, and therefore express functional putative WHV receptors and support the steps of the attachment/entry governed by the hepadnavirus envelope proteins. Because others previously hypothesized that hepadnavirus‐induced HCCs are resistant to reinfection with a hepadnavirus in vivo, our data suggest that if such a resistance exists it likely occurs via a block at the post‐entry step. The demonstrated ability of HDV to infect already formed HCCs may facilitate development of novel strategies further dissecting the mechanism of liver pathogenesis associated with HDV infection. (HEPATOLOGY 2012;56:76–85)
Sex determination and the control of Sox9 expression in mammals

In mouse sex determination, the presence or absence of Sertoli cells in the developing gonad is essential for the decision to form either a testis or an ovary. The transcription factor SOX9 has emerged as the master regulator of Sertoli cell differentiation during testis development and thus the crucial gene to determine sex. It is the target of two sets of regulatory controls, one positive and one negative, where one set tries to gain dominance over the other in the early gonad and then to establish and maintain the activity or silence of Sox9 throughout life. The data reveal the importance of the positive regulatory loops to reinforce initial decisions, whereas the maintenance of the gonadal phenotype appears to rely on the active repression of the opposite pathway.
Assessing a Country's Drink Driving Situation: An Overview of the Method Used in 6 Low- and Middle-Income Countries

The International Center for Alcohol Policies (ICAP) has developed an international program to reduce drink driving as part of its strategy for Global Actions on Harmful Drinking. The program focuses on capacity building, training, and the implementation, monitoring, and evaluation of regional and local pilot projects in 6 participating low- and middle-income countries. The first step in developing an effective program that addresses specific problems in a region or country is to assess the current drink driving situation. In order to meet this key requirement, ICAP developed a situation assessment approach based largely on the recommendations of Chapter 2 of the good practice manual on drinking and driving produced by the Global Road Safety Partnership (GRSP) under the auspices of the United Nations (UN) Road Safety Collaboration. The aim of the assessment was to provide the foundation for preparing a prioritized and effective suite of projects using the good practice recommended by the GRSP/UN manual. Its output is intended to assist with determining program objectives, design, and evaluation so that the benefits from the investments in drink driving programs can be maximized and data led, focusing on the priorities identified by the assessment. The situation assessment approach was produced as a set of guidelines containing a detailed and structured list of questions. The questions are organized into 6 main groups or elements and they enable a comprehensive and systematic collection of existing information about the extent and nature of the drink driving problem, the strengths and weaknesses of the current prevention practices, and the capacity for improvements. Situation assessments using these guidelines have been completed in the 6 focus countries and the resulting information is now being used for capacity building and developing appropriate and relevant pilot projects, taking into consideration the country's culture with respect to transportation, enforcement, health care, and alcohol consumption.