Miracle-dz/UniFAR-FTUs huggingface dataset:
Managing sexual abuse disclosure by adult psychiatric patients – some suggestions

The main principle of the Children Act 1989 is that the welfare of a child at risk of abuse or neglect takes precedence over all other considerations. In complying with the Act, these considerations may include the principle of medical confidentiality and the health and safety of some adult patients. Nowhere is this more poignantly illustrated than in the case of childhood sexual abuse disclosure by a distressed psychiatric patient who may be unprepared or unwilling to cooperate with the immediate reporting and ensuing investigation of their abuse as required by the Act.
Response to Peter Joseph

The authors' reply : We would like to thank Dr Joseph for his interest and comments on our editorial 1 accompanying the excellent systematic review by Bhaskaran et al . 2 As Dr Joseph points out, one of the systematic review's findings was a weak negative association between ozone exposure and the incidence of myocardial infarction. As Bhaskaran et al indicate, a reduction in ozone concentrations is likely to be a marker of increased combustion-derived fine particulate matter (PM2.5) from vehicle exhaust. Sarnat similarly found that ambient concentrations of O3, NO …
Imaging-based screening: understanding the controversies.

OBJECTIVE The goals of this article are to provide an overview of controversial aspects of imaging-based screening and to elucidate potential risks that may offset anticipated benefits. CONCLUSION Current controversial topics associated with imaging-based screening include false-positive results, incidental findings, overdiagnosis, radiation risks, and costs. Alongside the benefits of screening, radiologists should be prepared to discuss these additional diagnostic consequences with providers and patients to better guide shared decision making regarding imaging-based screening.
New Perspectives in the Diagnosis and Treatment of Tuberculosis

The global burden of TB is enormous and TB is still the leading cause of death from a single and curable infectious disease. World wide 8.8 million incident new and relapse cases of active TB disease occurred with an estimated incidence of 128 per 100,000 population in 2010 [4]. Most TB cases occurred in Asia (59%) followed by Africa (26%) while smaller proportions of cases occurred in Eastern Mediterranean Region (7%), European region (5%) and Region of the Americas (3%). India and China accounted for 40% while 22 high TB burden countries accounted for 82% of all estimated TB cases. Globally, an estimated 1.1 million (13%) of incident TB patients (mostly in Africa) were coinfected with HIV. The 12 million prevalent TB cases world wide resulted in 1.45 million deaths in 2010 (including 0.35 million HIVseropositive TB patients) [4].
Feasibility Study of 3-T DWI of the Prostate: Readout-Segmented Versus Single-Shot Echo-Planar Imaging.

OBJECTIVE The purpose of this prospective study was to assess the clinical utility of generalized autocalibrating partial parallel acquisition (GRAPPA)-accelerated readout-segmented echo-planar imaging (rs-EPI) DWI and compare it with standard single-shot EPI ( ss-EPI) DWI in visualization of the prostate during 3-T MRI. SUBJECTS AND METHODS One hundred sixteen consecutively registered patients (mean age, 63.5 years; range 24-93 years) underwent 3-T MRI that included rs-EPI DWI and standard ss-EPI DWI with identical FOVs, slices, acceleration factors, b values, and image postprocessing procedure. The datasets were independently evaluated by two blinded radiologists. Images were evaluated for sharpness, anatomic distortion, imaging contrast, lesion conspicuity, detailed anatomic visualization, and overall image quality on a 5-point Likert scale (1, nondiagnostic; 5, excellent). RESULTS The kappa values were 0.73 for image sharpness, 0.71 for anatomic distortion, 0.54 for imaging contrast, 0.56 for lesion conspicuity, 0.61 for detailed anatomic visualization, and 0.63 for overall image quality (all p < 0.05), indicating moderate to substantial agreement between the two observers. The mean Likert scores for standard ss-EPI and rs-EPI were as follows: image sharpness, 2.9 and 4.6; distortion level, 2.8 and 4.4; contrast, 3.1 and 3.8; lesion conspicuity, 3.0 and 4.0; structure, 3.1 and 4.2; and overall image quality, 3.1 and 4.2. The rs-EPI DWI sequence was associated with significantly better image quality and fewer susceptibility artifacts than was ss-EPI (all p < 0.05). The rs-EPI sequence was considered better overall in 90% of cases. CONCLUSION The technique of rs-EPI DWI combined with GRAPPA enables robust prostate imaging with high image quality and may provide great benefit in routine clinical practice.
Effect of dietary supplementation of concentrated pomegranate juice on blood lipids in type 2 diabetic patients with hyperlipidemia

Previous epidemiologic studies suggest that a high intake of fruits and vegetables is associated with a reduced risk of coronary heart disease (1). The beneficial effect could be related to minor components, especially flavonoids, which are proposed to exert their action by inhibiting LDL oxidation and platelet aggregation (2). Pomegranate is native to Iran and it is a rich source of flavonoids. The potential cardio protective effects of pomegranate juice have rarely been investigated in humans. In healthy men, intake of 50 ml pomegranate juice/d for 2 weeks decreased LDL susceptibility to aggregation and retention and increased the activity of serum paroxonase by 20% but didn’t have any significant effect on the plasma lipid profile (3). The present study was undertaken to determine whether concentrated pomegranate juice (CPJ) beneficially alters plasma lipid concentrations in type 2 diabetic patients with hyperlipidemia (cholesterol or triglyceride>200 mg/dl). For this reason 22 patients with type 2 diabetes without any other chronic diseases, were recruited from Iranian Diabetes Society and signed the consent form to participate in this study. These patients were instructed to follow the American Heart Association step I lipid-lowering diet for 8 weeks before CPJ consumption. In this pre-study period a 24-hour food recall and a food record (containing flavonoids-rich foodstuffs) were completed every 10 days. At the end of week 8 (baseline), anthropometric measurements were performed by standard methods and biochemical indices including total cholesterol, HDL cholesterol and triglyceride were measured (Zist-Chem, Tehran, Iran). LDL cholesterol was found using the Freidwald equation, and total cholesterol/LDL cholesterol and LDL cholesterol/HDL cholesterol were calculated. Thereafter the patients consumed 40gr CPJ for next 8 weeks. CPJ was provided from Nariran Inc and was free from added sugar and any other additive. Similarly during this period, dietary intake was assessed on a regular basis every 10 days. At the end of this period anthropometric measurements and blood indices were re-evaluated. These results were compared with the baseline by Wilcoxon-signed test. P-value was considered significant at P < 0.05. There were 14 women (63.6%) and 8 men (36.4%) in this study. Mean (±SD) age, weight and duration of diabetes were 52.5 (±5.2) years, 71.5 (±10.3) kg and 7.9 (±6.6) years, respectively. After consumption of PJC significant reductions were seen in total cholesterol (P < 0.006), LDL-c (P < 0.006), LDL-c/HDL-c (P < 0.001) and Total-c /HDL-c (P < 0.001). But there were no significant changes in triacylglycerol and HDL-c. Weight, level of physical activity and the intake of nutrients and flavonoid-rich foodstuffs did not change during CPJ supplementation period. This study showed that CPJ supplementation could modify heart disease risk factors in this group of type 2 diabetic patients. Therefore, its inclusion in their diets might be
Benzodiazepine‐related traffic accidents in young and elderly drivers

The relation of BZD use to impaired driving skills has been well established by both experimental and epidemiologic studies. There has been a concern that elderly people might be more affected than younger people, but for this the empirical evidence is less clear. The present study will examine the differences in risk of injurious traffic accidents after BZD use in older adults (60+) compared with those younger. Also the differences in effect of short acting and long acting BZD and, more tentatively, differences in effect of first‐time and long term will be considered. The study design is an epidemiologic cohort study for which data was received from the Saskatchewan Health Data Bases. The study population consists of 225 796 persons above 20 with a first BZD prescription, and 97 862 controls. All first‐time users were eligible for entering the repeat users cohort if they received three prescriptions within any 5 month period. New users increased their risk of injurious traffic accidents within the first 4 weeks of the BZD prescription at an OR=3·1 (1·5–6·2). Persons under 60 had a risk of OR=3·2 (1·3–8·1), while older people had OR=2·8 (1·0–8·4). For individual BZD, flurazepam showed the largest increase in risk at OR=5·1; stratified for age the OR was 6·1 for the under 60 and 3·4 for the over 60 age groups. The number of traffic accidents in the repeat use population was very small, but they hint at the possibility that repeat users have a lower risk than new users. These results need to be confirmed and the recommendations are that further studies be done to ferret out relations among the various potential influences of age, type of BZD and length of use. © 1998 John Wiley & Sons, Ltd.
Detrimental drinking patterns: Empirical validation of the pattern values score of the Global Burden of Disease 2000 study in 13 countries

In addition to volume, patterns of drinking have an effect on disease and injury. Depending on the prevailing way alcohol is coghnsumed (i.e. on drinking patterns), mortality and morbidity should vary across cultures even if per capita consumption is about the same. In a Comparative Risk Analysis (CRA), the WHO estimated for the year 2000 the Global Burden of Disease stemming from alcohol consumption by including both dimensions of intake (volume and patterns). For this purpose, a detrimental drinking pattern scale was developed. This scale used expert ratings of six dimensions of the prevailing drinking patterns in each country. The present study attempts first to replicate the expert ratings based on survey data from 13 countries. Secondly, it compares the scaling of individual level data with the scaling of aggregate level data. For the latter, such survey measures as percentage usually drinking with meals and percentage usually getting drunk when drinking to approximate the pattern scoring system used in CRA were constructed. Aggregate and individual level analyses resulted in similar orderings of countries on a one‐dimensional scale. There was a good correspondence between the orderings and country's values on the CRA detrimental drinking pattern scale. The ordering of countries varied if men and women were scaled separately. The results indicated a bias of expert ratings towards focusing on male drinking patterns. From analysis of the survey data, the patterns in Nigeria appeared relatively more detrimental than the CRA score based on expert ratings, while the patterns in Finland appeared less detrimental. Future attempts to include drinking patterns in addition to volume should take gender differences into account.
Importance of Genomic Profiling: Applications for Breast Cancer Diagnosis, Prognosis and Prediction of Response

Breast cancer accounts for 30% of all tumors. Current incidence rates are high, and the estimated lifetime risk for women is 12.5% (i.e., 1 in 8 women will be diagnosed with cancer of the breast during their lifetime). Classically, breast cancer has been divided into two subgroups, which have different outcomes and prognoses depending on their response to hormone therapy (sensitive and insensitive). Other traditional prognostic markers include axillary lymph node status, tumor size, nuclear grade and histological grade. In the last decade, new technologies for analyzing the genomic profiles of human tumors have substantially improved our knowledge of the molecular classification of breast cancer. This development improves diagnostic accuracy and enhances the ability to individualize therapy for breast cancer, thereby leading to direct implications for patient management.
Guia para prática clínica: fisioterapia em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC)

INTRODUCTION: In the context of international collaboration for the development of practice guidelines, the Royal Dutch Society for Physical Therapy (Koninklijk Nederlands Genootschap voor Fysiotherapie, KNGF) has developed guidelines for the clinical practice of physical therapy in patients with Chronic Obstructive Pulmonary Disease (COPD). It has also stimulated its translation into other languages to make it accessible to international audiences. OBJECTIVES: The present document brings the Portuguese version of the KNGF Clinical Practice Guidelines for physical therapy in COPD patients. Its purpose was to describe evidence-based physical therapy for COPD patients with impairments in pulmonary function, peripheral and respiratory muscle function, exercise capacity, mucus clearance and quality of life, in addition to limitations in physical activity in daily life due to dyspnea and/or exercise intolerance. CONCLUSION: The guideline provides practical and therapeutic recommendations based on currently available scientific evidence to help the physical therapist provide the best possible treatment to COPD patients.
Thulium pumped mid-infrared 0.9-9μm supercontinuum generation in concatenated fluoride and chalcogenide glass fibers.

We theoretically demonstrate a novel approach for generating Mid-InfraRed SuperContinuum (MIR SC) by using concatenated fluoride and chalcogenide glass fibers pumped with a standard pulsed Thulium (Tm) laser (T(FWHM)=3.5ps, P0=20kW, ν(R)=30MHz, and P(avg)=2W). The fluoride fiber SC is generated in 10m of ZBLAN spanning the 0.9-4. 1μm SC at the -30dB level. The ZBLAN fiber SC is then coupled into 10cm of As2Se3 chalcogenide Microstructured Optical Fiber (MOF) designed to have a zero-dispersion wavelength (λ(ZDW)) significantly below the 4. 1μm InfraRed (IR) edge of the ZBLAN fiber SC, here 3. 55μm. This allows the MIR solitons in the ZBLAN fiber SC to couple into anomalous dispersion in the chalcogenide fiber and further redshift out to the fiber loss edge at around 9μm. The final 0.9-9μm SC covers over 3 octaves in the MIR with around 15mW of power converted into the 6-9μm range.
The bovine pituitary-adrenocortical axis and milk yield.

Summary A review is given of the available literature concerning the relationship between the bovine pituitary‐adrenocortical axis and milk yield in dairy cattle. A severe drop in milk yield (more than 50%) can be induced by a single or repeated intramuscular injection of at least 200 IU ACTH or by a single intramuscular injection of 14.6 mg dexamethasone. Sixty minutes after an intravenous injection, both 200 IU ACTH and 100 mg cortisol are equivalent to a plasma cortisol concentration of at least 31 ng/ml. Thus the decrease in milk yield after an intramuscular injection of more than 200 IU ACTH can hardly be induced by cortisol only. The fact that bovine plasma hardly binds any dexamethasone, in sharp contrast with bovine mammary epithelial tissue, is a possible explanation of the special part which dexamethasone plays in milk yield.
Impact of Pentoxifylline and Vitamin E on Ribavirin-inducedHemolytic Anemia in Chronic Hepatitis C Patients:An Egyptian Survey

Background: The present study aimed to elucidate the impactof combined pentoxifylline and high-dose vitamin Esupplementation on Ribavirin (RBV)-induced hemolytic anemiain patients with chronic hepatitis C (CHC). Patients and methods: A total of 200 treatment-na�ve chronicCHC patients were randomized into two groups to receive eitherthe standard antiviral therapy and pentoxifylline (800 mg) andhigh-dose vitamin E (1000 IU) daily (combined group) orstandard antiviral therapy and placebo (control group). Theywere followed-up to assess occurrence of anemia and virologicalresponses respectively.Results: Dose modification of RBV due to anemia wassignificantly lower in combined group (8.5%) compared to controlgroup (21.5%) (p < 0.05). Withdrawal from therapy due to severeanemia (Hb < 8.5 gm/dl) was recorded only in six (28.6%)patients of the control group. Both end of treatment response(ETR) and sustained virological response (SVR) were significantlyhigher in combined group compared to control (p < 0.05). Conclusion: Pentoxifylline and vitamin E can ameliorate RBVassociatedhemolysis; improve compliance and virologicclearance, when combined with the standard antiviral therapyin patients with CHC.Abbreviations: RBV: Ribavirin; ETR: End of treatmentresponse; SVR: Sustained virological response.
Titrating Steroids on Exhaled Nitric Oxide in Children With Asthma: A Randomized, Controlled Trial

Purpose of the Study. To evaluate whether titrating inhaled corticosteroids (ICSs) on the fraction of nitric oxide in exhaled air (FeNO) improves asthma management in children. Study Population. A total of 85 children (aged 6–18 years) with asthma who had been using ICSs at a constant dose for at least 3 months. Methods. Children were randomly allocated to 1 of 2 groups stratified for baseline FeNO and dose of ICSs. In one group, ICS doses were determined by FeNO and symptoms according to an algorithm; in the other group, only symptoms influenced ICS dosing. The study duration was 12 months, with 5 visits at 3-month intervals. FeNO was measured at each visit, and the ICS dose was then adapted to FeNO and/or symptom scores that were recorded during the previous 2 weeks. Results. The cumulative ICS dose was not different between groups. Within the FeNO group, no significant change in FeNO was found, whereas in the symptom group there was a significant increase in FeNO (P = .035). In the FeNO group, hyperresponsiveness improved more than in the symptom group (2.5 vs 1.1 methacholine doubling dose; P = .04). Eight prednisone courses were prescribed for 7 patients in the FeNO group versus 18 courses in 10 patients in the symptom group, but this difference was not statistically significant (P = .60). There was no difference between groups in forced expiratory volume in 1 second (FEV1) or symptom scores. Conclusion. In children with asthma, 1 year of steroid titration on FeNO did not result in higher steroid doses and did improve airway hyperresponsiveness and inflammation. Reviewer Comments. I am still not sure what to make of eNO. If monitoring FeNO and making treatment decisions on the basis of the values leads to better asthma outcomes, then it would be a useful tool. Because the FeNO group did not end up receiving a higher cumulative ICS dose, we have to assume that they got more when they needed it and less when they did not. However, the clinical results seem inconsistent. I suppose it is a good thing to have a higher methacholine PD20 (the dose provoking a 20% fall in FEV1) and a lower FeNO, but I would have been happier to see a difference in FEV1 and symptom scores, or if the difference in the number of episodes requiring prednisone courses had been statistically significant. Although I am not sure that I can share the authors’ conclusion that “the time has come to introduce FeNO in to the routine assessment of children with asthma,” I believe we should pay attention to future studies on FeNO monitoring and clinical asthma outcomes.
Antidepressant effect of aqueous and hydroalcoholic extracts of Lavandula officinalis in forced swim test and tail suspension test in male mice

Background: Lavandula officinalis has anti-anxiety and sedative properties. In the present study, the antidepressant effect of aqueous and hydroalcoholic extracts of Lavandula officinalis was investigated in forced swim test (FST) and tail suspension test (TST) in male mice. Material and Methods: In this experimental study, 72 male mice were randomly divided into 9 groups of 8 mice. Negative and positive control groups received normal saline (10 ml/kg), fluoxetine (20mg/kg) and imipramine (30mg/kg) respectively and treatment groups received extracts of Lavandula officinalis (100, 200 and 400 mg/kg). Immobility, swimming and climbing behaviors were recorded within 6 minutes. Results: Lavandula officinalis extracts (except the aqueous extract at a dose of 100mg/kg in FST) compared to control group significantly and dose-dependently reduced the duration of immobility time in both of tests (p<0.001). These extracts (except the aqueous extract at a dose of 100mg/kg in FST) significantly and dose-dependently increased swimming time (p<0.001) without significant change of climbing time. Conclusion: Lavandula officinalis has considerable antidepressant effect and has similar effects to fluoxetine. Keyword: Lavandula, Mice, Plant Extracts, Tail Suspension
World incidence of AKI: a meta-analysis.

BACKGROUND AND OBJECTIVES The burden of AKI around the globe has not been systematically examined. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A systematic review (2004-2012) of large cohort studies was conducted to estimate the world incidence of AKI and its stages of severity and associated mortality, and to describe geographic variations according to countries, regions, and their economies. AKI definitions were reclassified according to the Kidney Disease Improving Global Outcomes (KDIGO) staging system. Random-effects model meta-analyses and meta-regressions were used to generate summary estimates and explore sources of heterogeneity. RESULTS There were 312 studies identified (n=49,147,878) , primarily in hospital settings. Most studies originated from North America, Northern Europe, and Eastern Asia, from high-income countries, and from nations that spent ≥5% of the gross domestic product on total health expenditure. Among the 154 studies (n=3,585,911) that adopted a KDIGO-equivalent AKI definition, the pooled incidence rates of AKI were 21.6% in adults (95% confidence interval [95% CI], 19.3 to 24.1) and 33.7% in children (95% CI, 26.9 to 41.3). The pooled AKI-associated mortality rates were 23.9% in adults (95% CI, 22.1 to 25.7) and 13.8% in children (95% CI, 8.8 to 21.0). The AKI-associated mortality rate declined over time, and was inversely related to income of countries and percentage of gross domestic product spent on total health expenditure. CONCLUSIONS Using the KDIGO definition, 1 in 5 adults and 1 in 3 children worldwide experience AKI during a hospital episode of care. This analysis provides a platform to raise awareness of AKI with the public, government officials, and health care professionals.