(CNN) -- Shelling hit areas near two key cities in eastern Ukraine on Sunday morning, intensifying fears that a ceasefire that took effect less than two days ago may be falling apart. Why is the ceasefire under strain? A variety of fighting factions in the conflict zone -- on both sides -- may not fall directly under a military chain of command. The pro-Russian rebels are mostly volunteer militias; fighting against them on the Ukrainian side are at least some far-right nationalist militias. Controlling these groups is difficult and some may have different aims, including sabotaging the truce. At this point it's been nearly impossible to figure out who's doing the firing and why. The conditions of the ceasefire agreement don't help either. The conditions are vague and at this point there doesn't seem to be an effective mechanism in place inside the conflict zone to monitor and enforce the agreement. Why can't the two sides' leaders control their forces? It's unclear if Kiev has control over all of the fighting forces in eastern Ukraine. Some of the volunteer militias fighting alongside Ukrainian soldiers are far-right nationalists who've been critical of the current government in Kiev, but they're still fighting because they feel Ukraine is under attack by Russia. And who controls the pro-Russian rebels? Is it the local commanders? Is it Russian President Vladimir Putin? None of that is clear. Which side has the most to gain from the truce? If the truce leads to good-faith negotiations and a compromise, then both sides can gain. A compromise could look like something like this: The pro-Russian region of Donbas gets autonomy and self-determination under a federalized Ukrainian government, and in return the rebels drop their demand for independence and Kiev gets to protect Ukraine's sovereignty and territorial integrity. There are elements on both sides that don't want a compromise, and they could certainly have the potential of undermining the truce. What happens next? We wait to see if the overnight shellings and firings are an anomaly or if they're a sign of more violence and more fighting. If the ceasefire sticks, both sides have agreed to hold talks that will address the core issues and demands on both sides that are still unresolved -- including the disarming of the rebels, a guarantee of self-determination for the pro-Russian Donbas region, the fate of Russian-annexed Crimea, constitutional reform, and a solution to the humanitarian crisis in the conflict zone. Obviously if the fighting continues, all bets are off. What effect does this have on the rest of the world? What happens in the coming days will determine the next move by NATO and Western leaders. If the ceasefire falls apart, the West will likely turn up the pressure by following through with sanctions and bolstering Western forces in NATO's Baltic-member states. Moscow has already threatened to respond if that happens. The bottom line is, the conflict will escalate and so will the prospects of a regional conflict -- although at this point that seems unlikely.

Shelling in eastern Ukraine raises fears that a ceasefire may fall apart .
Reza Sayah: It's been nearly impossible to say who's doing firing and why .
It's unclear who has control over fighting forces on either side in east Ukraine .
There are elements on both sides that don't want a compromise .


(CNN) -- Remember when oil giant BP paid billions of dollars to clean up its own mess from the 2010 Gulf oil spill? Then the company agreed to plead guilty to criminal charges and pay an unprecedented $4 billion fine for the spill. In the latest development, Wednesday, BP was essentially told to stand in the corner when it comes to winning new federal contracts -- a potentially huge blow to the company's bottom line. And it's still likely on the hook for civil penalties the federal government hopes to recover for environmental damages. So, is BP being punished enough for the deadly and destructive Deepwater Horizon spill, or too much? It depends on who you ask. This matters. BP says it supports nearly a quarter of a million American jobs and has invested $52 billion in the United States since 2007. Experts suggest punishments ranging from massive fines to banning the company from offshore drilling. However this all shakes out, it likely will send a powerful message to the industry. Families of killed rig workers react to BP settlement . First, here's what happened Wednesday: . The U.S. Environmental Protection Agency said it will block BP from new government contracts due to its "lack of business integrity" stemming from the 2010 explosion and oil spill. It was a tragedy that killed 11 oil workers and dumped 205 million gallons of oil into the Gulf in a slow-moving, 85-day national drama that prosecutors called the worst environmental disaster in U.S. history. This month hasn't been good to BP. The decision follows the London-based company's agreement November 15 to plead guilty to criminal charges including manslaughter, obstruction of Congress and environmental violations related to the explosion and spill -- an agreement that still requires a judge's approval. What it means . Wednesday's EPA decision means BP won't be allowed to compete for new contracts, grants or other business until the company shows it meets federal business standards. As of February, BP had $9 billion in contracts to supply the U.S. government with fuel, most of it destined for military users, said Christine Tiscareno, a London-based analyst with S&P Capital IQ. Those contracts aren't affected by the EPA decision, the agency said. BP said it's already filed paperwork to get back in good graces with the EPA, said the agency is already preparing an administrative agreement to lift the suspension and highlighted what the company says it's done to rectify the situation. "As BP's submissions to the EPA have made clear, the company has made significant enhancements since the accident," the company said in a statement. "The company launched an internal investigation immediately after the accident, publicly released the results, and has been implementing all 26 of the investigation's recommendations." What's ahead . The next big step in the case comes in February, when a civil trial is expected to begin over the government's demand for civil damages under the Clean Water Act. That case could draw huge new fines for the company. The disaster, in addition to claiming 11 lives, caused disruption to countless residents and businesses, many of whom counted on the Gulf for their livelihoods, whether in the oil fields, fishing grounds or tourist beaches. For some, including environmentalists, the company couldn't be fined enough or spend enough money to get back on their good side. "Well, you know, we're discussing the worst environmental disaster in U.S. history," said Matt Dundas, acting campaign director at the environmental group Oceana. "The punishment needs to fit the crime." But, he said, the record $4 billion fine BP is expected to pay as a result of the criminal case is a tenth of the maximum it could have faced, making it small consolation to BP's harshest critics. The fine, while a record for the U.S. justice system, represents less than three months worth of profits for BP. The company reported $5.2 billion in profits in the quarter that ended September 30. Dundas is now rooting for the maximum possible verdict in the civil case -- $50 billion in fines. But he says there's only one punishment that would really get BP and other oil companies to sit up and take steps to prevent what Dundas says is the overwhelming risk of another large oil spill: being kicked out of the game entirely. "I think a terrific minimum would be to bar them from offshore drilling," he said. "That's really the only standard that's going to get oil companies to pay attention." The head of a trade association representing BP and other oil and gas operators in Louisiana and the Gulf of Mexico said Wednesday that BP has already complied with government requirements. "BP has done everything that the federal government has asked and more. ... This new EPA designation is another layer," said Chris John, president of the Louisiana Mid-Continent Oil and Gas Association. "How much is enough, when the economy in America is trying to dig out of the recession, and energy ... is a very important component to getting Americans back to work?" The EPA's decision could have a negative impact beyond BP, he said, affecting other companies in the industry who have also complied with regulators. "The companies that operate out in the Gulf of Mexico, they can go anywhere, they're global. They can drill anywhere in the world," John said. "They have chosen to come back to the Gulf in the past few years. ... This additional statement and designation by the EPA has to play into their decision of where to put their capital." BP didn't directly address whether it believes it has paid enough for the disaster, but noted Wednesday that it has spent $14 billion in response and cleanup costs, $1 million on restoration projects and $9 billion in compensation and expects to spend $7.8 billion more to resolve the majority of outstanding claims. Owning up . The company also pointed out it has acknowledged criminal responsibility, carried out recommendations made by investigators who studied the incident and has taken actions to strengthen safety and drilling standards that exceed federal regulations. Tiscareno, the oil analyst, said that while the costs to BP have been steep, they are bearable for the company. The big question is what happens in February, when the civil case goes to trial. Tiscareno said she expects BP, which has taken a long-term approach to recovering from the spill, will recover financially unless the civil trial nets an "irrational" decision. A huge verdict could pose problems for BP, Tiscareno said, but she said the government can't go too far in gutting the firm because of all the jobs and tax revenues the company provides. BP has invested $52 billion in the U.S. in the last five years, employs 23,000 U.S. residents and indirectly supports nearly 250,000 jobs, the company said Wednesday. "The U.S. needs BP as much as BP needs the U.S.," Tiscareno said. CNN's Kendra Wates and Catherine E. Shoichet contributed to this report.

NEW: Trade association: "BP has done everything that the federal government has asked"
Two years after the oil spill, experts weigh in on possible punishments for BP .
BP says it expects the temporary ban will be lifted soon .
The EPA says the oil giant showed a "lack of business integrity"


Adel Taarabt appeared for QPR for the first time since his public fall-out with Harry Redknapp in Monday afternoon's reserve game against Ipswich Town. The Moroccan's days at Loftus Road appeared to be numbered after his extraordinary spat with Redknapp last month. Taarabt claimed his manager never takes a training session after Redknapp had accused the midfielder of being 'three stone overweight' following the 3-2 defeat to Liverpool. VIDEO Scroll down to watch Harry Redknapp say  Taarabt's camp have told blatant lies . Adel Taarabt has played just three first-team games for QPR this season after returning from loan at AC Milan . Taarabt laughed off claims by QPR manager Harry Redknapp that the midfielder was 'three stone overweight' The 25-year-old was due to play for the club's Under 21s last week, but wasn't included in the draw against Swansea. However, Taarabt came through 90 minutes in the 3-0 win against Ipswich Town as he tries to prove his fitness to his boss. The former Spurs man, who has been hampered by an ankle injury, has been limited to just three appearances for the R's this season after returning from a loan spell at AC Milan. Taarabt hit back at Redknapp during an exclusive interview with Sportsmail last month . Taarabt spent last campaign on loan at Fulham and then Serie A side AC Milan .

Moroccan played 90 minutes for Under 21s in 3-0 win against Ipswich Town .
Taarabt has made just three first-team appearances for the R's this season .
Midfielder was accused of being 'overweight' by manager Harry Redknapp .
Taarabt hit back and claimed Redknapp never took training sessions .


By . Wills Robinson . PUBLISHED: . 11:14 EST, 6 March 2014 . | . UPDATED: . 12:19 EST, 6 March 2014 . Members of the feminist punk group Pussy Riot have been attacked by a gang of men inside a Russian McDonalds. Nadya Tolokonnikova and Masha Alyokhina were covered in paint while they sat and had breakfast in the city of Nizhny Novgorod. The pair, who were jailed for hooliganism in 2012, also had pepper spray, green antispetic and metal thrown in their faces during the assault. Scroll down for video . Attacked: Nadya Tolokonnikova and Masha Alyokhina were covered in paint during the assault while they sat and had breakfast in the city of Nizhny Novgorod . Distressed: The pair spoke directly into the camera after the incident . They were visiting the area to inspect a local prison with Peter Verzilov and members of NGO 'Zone of the Rights'. Tolonnikova allegedly left the restaurant with a 'cut forehead' and the group have complained to the police. She was seen getting up from her seat and clutching her face during the incident. while the gang of men continually shouted abuse. When the attack eventually stopped, one of the men held up a sign to the camera while another was seen shouting down the lens. At around 7.00 am the group barged into the fast food restaurant where the musicians and their crew were eating. Gang: They were covered in paint, antiseptic and pepper spray by the group of men . Prolonged: The gang shouted abuse while they continued to launch the liquids at the members of the feminist band . Close: One of the attackers faced up to Nadya Tolokonnikova, preparing to throw something at her . Abuse: The individuals continued to shout at the musicians while a crowd built up behind them . It is not the first time the group have been targeted by members of the public. At the start of the Sochi winter . Olympics, members of the group were whipped and tackled to the ground by Cossacks as . they sang in protest. The . band started to perform an anti-Putin song under a sign advertising the . Winter Olympics. But singer Tolokonnikova was brutally whipped . in the attack and the guitarist was left bloodied and bruised. Last month, Tolokonnikova was filmed saying the anti-government protests in Ukraine were an 'inspiation'. She was also among those arrested during protests outside a Moscow courthouse. Tolokonnikova and Alyokhina were released from seperate prisons on December 23, 2013 after the Russian State Duma approved an amnesty. Speech: An attacker spoke into a camera owned by the NGO 'Zone of the Rights' in the aftermath of the assault . Slogan: One man holds up a sign to the camera before the group leave the restaurant .

Nadya Tolokonnikova and Masha Alyokhina were also pepper sprayed .
The pair were in city of Nizhny Novgorod visiting a local prison .
Alyokhina reportedly left the fast food restaurant with a 'cut forehead'


A Porthcawl RNLI crew with a medic and the coastguard search and rescue helicopter were sent to Sker Beach, near Kenfig Nature Reserve, at 12:50 GMT on Sunday.
Crewman Chris Page said the rider had head injuries and was very cold from lying unconscious on wet sand.
She was treated before being flown to Cardiff's University Hospital of Wales.

A woman has been airlifted to hospital after falling from a horse on a Bridgend county beach.


Verheydt, who had been with Maastricht since 2015, has signed a three-year contract with Harry Kewell's side.
The 25-year-old scored 13 goals in 43 appearances in all competitions last season.
Meanwhile, Watford winger Dennon Lewis, 20, has joined the Reds on a loan deal until 31 December.
Lewis, who made 29 National League appearances on loan at Woking last season, played under Kewell when the Australian was coach of Watford's under-23 team.
Find all the latest football transfers on our dedicated page.

League Two side Crawley Town have signed striker Thomas Verheydt from Dutch second-tier side MVV Maastricht for an undisclosed fee.


The 32-year-old had been playing in the Isthmian Premier Division with Leatherhead following his release by Newport at the end of last season.
Pidgeley has made 260 appearances in spells with nine clubs, including Chelsea, Watford and Millwall.
Forest Green are currently second in the National League table, one point behind leaders Cheltenham Town.
Pidgeley could make his Rovers debut when they host Aldershot on Friday.

National League side Forest Green Rovers have signed goalkeeper Lenny Pidgeley until the end of the season.


The suspected green mamba was found on a ship that had docked in Aberdeen from west Africa last month.
The snake died after it was placed in a freezer by the animal charity after attempts to rehome it with specialist reptile keepers failed.
The snake was later identified as a harmless green tree snake.
Police Scotland said a complaint was under consideration.
Scottish SPCA Ch Supt Mike Flynn said: "We were called out after a green snake arrived in Aberdeen on a boat from Africa.
"The snake was thought to be a green mamba, one of the deadliest snakes in the world. The snake was taken by police escort to our Aberdeenshire animal rescue and rehoming centre.
"Sadly the snake, which staff genuinely believed to be a green mamba, had to be put to sleep after our attempts to rehome it to specialist reptile keepers were unsuccessful."
He added: "We could not keep the snake in our centre due to severe health and safety concerns, as the closest anti-venom is held in Bedford. Green mambas also require a Dangerous Wild Animal Licence which the society does not have.
"The safety of our staff and the public is paramount and as such the snake was placed in a freezer where it passed away.
"The Scottish SPCA is proud of its policy not put healthy animals to sleep. Animals are only put to sleep on veterinary advice if they are too ill or too aggressive to be rehomed, or where we are legally required to do so.
"The decision to euthanise the snake was not taken lightly. Unfortunately, the snake has since been identified as a harmless green tree snake. This has been an honest mistake on the society's part as we genuinely believed this was an extremely deadly snake."
The western green mamba feeds on small animals and rodents and is mainly found in the coastal tropical rainforests of western Africa.
Experts say its bite can be fatal in as little as 30 minutes.

A complaint about the Scottish SPCA putting what was thought to be one of the world's most deadly snakes to sleep is being investigated by police.


The all-rounder has been included in the T20 squad to face Sri Lanka on 5 July at the Ageas Bowl, having been part of the World T20 squad in March.
"It's nice to be involved again," the 26-year-old slow left-armer and right-handed batsman told BBC Radio Solent.
"I wasn't expecting to be as I thought Moeen Ali would, but him being rested hands me another opportunity."
Dawson failed to make an appearance during England's run to the World T20 final in India this year, but his limited-overs performances for Hampshire this season have kept him in contention.
"I'm not sure what team they'll go with," he said.
"I've had some good performances for Hampshire in one-day and T20 cricket and if I keep going with that, hopefully I might get a chance."

Hampshire's Liam Dawson says it would be "amazing" to make his England Twenty20 debut on his home ground.


The Egypt-backed plan had envisaged a regional forum which analysts say might have forced Israel to reveal whether or not it has nuclear weapons.
The proposal was blocked by the US, the UK and Canada. The next review is set for  2020.
Israel neither confirms nor denies it has a stockpile of nuclear weapons.
Speaking after four weeks of negotiations, US Under-Secretary of State Rose Gottemoeller accused Egypt and other Arab countries of "not willing to let go of these unrealistic and unworkable conditions" for future talks.
She also said some participants tried to "cynically manipulate" the whole process.
But Egypt warned that the failure to reach a deal "will have consequences in front of the Arab world and public opinion", the Associated Press news agency reports.
Last month, Egypt had proposed to stage a regional conference - with or without Israel's participation and without an agreed agenda.
Some analysts suggested that this move might have forced Israel - which is not a party to the Treaty on the Non-Proliferation of Nuclear Weapons (NPT) - to publicly clarify its position on nuclear weapons.
Decisions at NPT review conferences - held every five years - are made by consensus.
The failure of the current talks means the next gathering could only be held in 2020 at the earliest.

A UN conference aimed at preventing the proliferation of nuclear weapons has ended in failure after a row over a nuclear-free Middle East proposal.


Mothers-to-be are more likely to get malaria as their immunity is lowered, says the Royal College of Obstetricians and Gynaecologists (RCOG).
Malaria carries serious risks for mother and baby including miscarriage, stillbirth and premature labour.
The tropical disease is transmitted by mosquitoes and causes a fever, flu-like symptoms, vomiting and diarrhoea.
There have been no malaria-related deaths in pregnant or recently pregnant women in the UK in the past decade but the RCOG says it has been receiving inquires from worried women.
In the UK, about 1,500 cases of malaria are reported each year and about 10 people will die, said the RCOG.
It says all non-essential trips to areas with a high risk of malaria should be avoided.
Risk areas include large areas of Africa, Asia including China and India, Central and South America, parts of the Middle East and some Pacific Islands.
If the trip is unavoidable, the college advises women to seek advice from a centre with expertise in malaria which will provide information on ways to reduce the risk of infection.
Women should make sure they are aware of the risk, take out measures such as mosquito nets for bite prevention and take anti-malarial medication.
Philippa Marsden, who chairs the RCOG's patient information committee, said although the risks were still relatively small it was important that women were well-informed.
Cath Broderick of the RCOG women's network said: "If women are worried about symptoms after returning from a high-risk country and think they may have malaria, they should see a doctor immediately and inform them of their recent travels."
Symptoms can take a week or more to develop after being bitten.

Pregnant women should visit countries with a risk of malaria only if their trip is essential, experts are warning.


Researchers at the University of Sheffield said the tumours were effectively "fertilising" the bone to help themselves grow.
The study, in the journal Nature, said it may be possible to protect bone from a tumour's nefarious influence and consequently stop the cancer's spread.
Cancer charities said this opened up "a whole new avenue for research".
Around 85% of breast cancers that spread around the body end up in bone, at which point the cancer is difficult to treat and more deadly.
The scientists, in Sheffield and the University of Copenhagen, discovered patients with secondary cancers had higher levels of an enzyme called LOX being produced by their tumours and released into the blood.
Bone is constantly being broken down and rebuilt. But in a series of experiments on mice, the research team showed LOX was disrupting the process and leaving lesions and holes in the bone.
Using drugs to block LOX prevented the cancer from spreading.
Dr Alison Gartland, a reader in bone and cancer biology at the university, told the BBC News website: "We think it's a significant breakthrough in trying to prevent metastases (secondary tumours) in breast cancer.
"The cancer cells in the primary tumour are actually fertilising the soil for the future growth of itself, LOX is changing the environment in bone to make it better to grow."
The animal tests also showed that a set of osteoporosis drugs called bisphosphonates could prevent the spread of cancer.
Bisphosphonates also interfere with the way bone is recycled in order to strengthen it.
They are already given to some cancer patients, but the Sheffield team believe they could have a much larger role.
The effect was discovered only in oestrogen-negative breast cancers. They account for around a third of cases, but are far more deadly.
Katherine Woods, from Breast Cancer Campaign and Breakthrough Breast Cancer, said: "By unveiling the role that the protein LOX is playing, these results open up a whole new avenue for research and treatments that could stop breast cancer spreading to the bone.
"The research also adds weight to the growing body of evidence supporting the role of bisphosphonates in stopping secondary breast cancer in its tracks.
"The reality of living with secondary breast cancer in the bone is a stark one, which leaves many women with bone pain and fractures that need extensive surgery just when they need to be making the most of the time they have left with friends and family."
The findings may also apply in colon cancer.

Breast cancers can manipulate the structure of bone to make it easier to spread there, a study has found.


Test review


I love the stars, but the show is riddled with cliche characters and comedy beats as well as relentlessly predictable story lines. These feel like characters who are shorthand for characters we've already seen, which sometimes is the curse of a new TV show, especially sitcoms. So I guess we'll see?


Great show to watch. It's something that's easy and light hearted with a great budget. I really appreciate the cinematography used as it's different from what's usually on television.


Another Apple tanker crashes into the reef with amazing talent and a story that goes nowhere . Invasion , Foundation, Physical, After Party and now Loot.  Its good they have neough money to keep failing.


This is such a fun, endearing show.  It has a lot of little jokes baked in that do not feel cheesy, even though the whole setting is silly and the plot is predictable.  It makes me feel like I'm hanging out with good friends.  Maya Rudolph is perfect in the role.


Terrible show - didn't laugh once. Acting is sub-par and not sure why it is continuing -


I love Maya Rudolph but geez this was boring and did not give her anything to work with


I tried to enjoy the show - but it's just stupid


Love ya Maya but #comeonman.


So far I am loving it. Maya Rudolph and Joel Kim Booster are amazing.


Maar , er iets nuttigs mee doen ? Zie jij 'm vertrekken ?
M https://t.co/CXSEqjHvIj

However, there is something useful to do with it? Do you see him leave?
M https://t.co/CXSEqjHvIj


RT @MollyJongFast: Laura Ingraham is going to be furious  https://t.co/WbksPfVXis

CSO CarbExplore BV https://t.co/8IoRT28pWm
em Professor Microbiology, University of Groningen https://t.co/ct7sKsJ5EI
Knight in the Order of the Dutch Lion 2008

CSO CarbExplore BV https://t.co/8IoRT28pWm
em Professor of Microbiology, University of Groningen https://t.co/ct7sKsJ5EI
Knight in the Order of the Dutch Lion in 2008


RT @kneeyockartee: Corona has robbed me of many things but the worst has to be the chance to hear WAP in a club. Imagine the scenes like

welkom in de chaos van mijn hoofd. geniet van de constante gedachtestroom.

welcome to the chaos of my head. enjoy the constant stream of thoughts.


RT @GPUpdate_nl: Formule 1-kalender verder in het nauw door coronavirus https://t.co/ZZoLFKcaVx https://t.co/7jbDOylJuJ

RT @GPUpdate_nl: Formula 1 calendar further pressed by coronavirus https://t.co/ZZoLFKcaVx https://t.co/7jbDOylJuJ

OG3NEFAN, F1FAN, passie voor auto's, Empire Of The Sun, Phil Collins, Xbox Online THE POWER RACER, stedentrips

OG3NEFAN, F1FAN, passion for cars, Empire Of The Sun, Phil Collins, Xbox Online THE POWER RACER, city breaks


Freedom has a rythm. "You can feel it"
- https://t.co/Qc2FZpW7rB

CORONA ins the 90's
- https://t.co/4XL60kmsdV

STARTED at INTERNATIONAL EXPORTS in '98 after completing training.

VICTORY PREPARED!
Taking back what they stole from us! https://t.co/c4YimW9YJE

Freedom has a rhythm. "You can feel it"
- https://t.co/Qc2FZpW7rB

CORONA ins the 90's
- https://t.co/4XL60kmsdV

STARTED at INTERNATIONAL EXPORTS in '98 after are completing training.

VICTORY PREPARED!
Taking Back What they stole from us! https://t.co/c4YimW9YJE

Special Agent CIA(DCIS)


Allow `list_datasets` to include private datasets

enhancement

New feature or request

Thanks for opening this issue :)

If it can help, I think you can already use `huggingface_hub` to achieve this:
```python
>>> from huggingface_hub import HfApi
>>> [ds_info.id for ds_info in HfApi().list_datasets(use_auth_token=token) if ds_info.private]
['bigscience/xxxx', 'bigscience-catalogue-data/xxxxxxx', ... ]
```

---------

Though the latest versions of `huggingface_hub` that contain this feature are not available on python 3.6, so maybe we should first drop support for python 3.6 (see #4460) to update `list_datasets` in `datasets` as well (or we would have to copy/paste some `huggingface_hub` code)

Great, thanks @lhoestq the workaround works! I think it would be intuitive to have the support directly in `datasets` but it makes sense to wait given that the workaround exists :)

I am working with a large collection of private datasets, it would be convenient for me to be able to list them.

I would envision extending the convention of using `use_auth_token` keyword argument to `list_datasets` function, then calling:

```
list_datasets(use_auth_token="my_token")
```

would return the list of all datasets I have permissions to view, including private ones. The only current alternative I see is to use the hub website to manually obtain the list of dataset names - this is in the context of BigScience where respective private spaces contain hundreds of datasets, so not very convenient to list manually.


Remove instructions to generate dummy data from our docs

documentation

Improvements or additions to documentation

Note that for me personally, conceptually all the dummy data (even for "canonical" datasets) should be superseded by `datasets-server`, which performs some kind of CI/CD of datasets (including the canonical ones)

I totally agree: next step should be rethinking if dummy data makes sense for canonical datasets (once we have datasets-server) and eventually remove it.

But for now, we could at least start by removing the indication to generate dummy data from our docs.

In our docs, we indicate to generate the dummy data: https://huggingface.co/docs/datasets/dataset_script#testing-data-and-checksum-metadata

However:
- dummy data makes sense only for datasets in our GitHub repo: so that we can test their loading with our CI
- for datasets on the Hub:
  - they do not pass any CI test requiring dummy data
  - there are no instructions on how they can test their dataset locally using the dummy data
  - the generation of the dummy data assumes our GitHub directory structure:
    - the dummy data will be generated under `./datasets/<dataset_name>/dummy` even if locally there is no `./datasets` directory (which is the usual case). See issue:
      - #4742

CC: @stevhliu


Update map docs

The docs for this PR live [here](https://moon-ci-docs.huggingface.co/docs/datasets/pr_4743). All of your documentation changes will be reflected on that endpoint.

This PR updates the `map` docs for processing text to include `return_tensors="np"` to make it run faster (see #4676).


Dummy data nowhere to be found

bug

Something isn't working

Hi @BramVanroy, thanks for reporting.

First of all, please note that you do not need the dummy data: this was the case when we were adding datasets to the `datasets` library (on this GitHub repo), so that we could test the correct loading of all datasets with our CI. However, this is no longer the case for datasets on the Hub.
- We should definitely update our docs.

Second, the dummy data is generated locally:
- in your case, the dummy data will be generated inside the directory:  `./datasets/hebban-reviews/dummy`
- please note the preceding `./datasets` directory: the reason for this is that the command to generate the dummy data was specifically created for our `datasets` library, and therefore assumes our directory structure: commands are run from the root directory of our GitHub repo, and datasets scripts are under `./datasets`

I have opened an Issue to update the instructions on dummy data generation:
- #4744

## Describe the bug
To finalize my dataset, I wanted to create dummy data as per the guide and I ran

```shell
 datasets-cli dummy_data datasets/hebban-reviews --auto_generate
```

where hebban-reviews is [this repo](https://huggingface.co/datasets/BramVanroy/hebban-reviews). And even though the scripts runs and shows a message at the end that it succeeded, I cannot find the dummy data anywhere. Where is it?

## Expected results

To see the dummy data in the datasets' folder or in the folder where I ran the command.

## Actual results

I see the following message but I cannot find the dummy data anywhere.

```
Dummy data generation done and dummy data test succeeded for config 'filtered''.
Automatic dummy data generation succeeded for all configs of '.\datasets\hebban-reviews\'
```

## Environment info
- `datasets` version: 2.4.1.dev0
- Platform: Windows-10-10.0.19041-SP0
- Python version: 3.8.8
- PyArrow version: 8.0.0
- Pandas version: 1.4.3


Fix to dict conversion of `DatasetInfo`/`Features`

_The documentation is not available anymore as the PR was closed or merged._

Fix #4681


Fix multiprocessing in map_nested

The docs for this PR live [here](https://moon-ci-docs.huggingface.co/docs/datasets/pr_4740). All of your documentation changes will be reflected on that endpoint.

As previously discussed:

Before, multiprocessing was not used in `map_nested` if `num_proc` was greater than or equal to `len(iterable)`.
- Multiprocessing was not used e.g. when passing `num_proc=20` but having 19 files to download
- As by default, `DownloadManager` sets `num_proc=16`, before multiprocessing was only used when `len(iterable)>16` by default

Now, if `num_proc` is greater than or equal to ``len(iterable)``, `num_proc` is set to ``len(iterable)`` and multiprocessing is used.
- As by default, `DownloadManager` sets `num_proc=16`, now multiprocessing is used when `len(iterable)>1` by default

After having had to fix some tests (87602ac), I am wondering:
- do we want to have multiprocessing by default?
  - please note that `DownloadManager.download` sets `num_proc=16` by default
- or would it be better to ask the user to set it explicitly if they want multiprocessing (and default to `num_proc=1`)?

Fix #4636.

CC: @nateraw


Deprecate metrics

The docs for this PR live [here](https://moon-ci-docs.huggingface.co/docs/datasets/pr_4739). All of your documentation changes will be reflected on that endpoint.

I mark this as Draft because the deprecated version number needs being updated after the latest release.

Deprecate metrics:
- deprecate public functions: `load_metric`, `list_metrics` and `inspect_metric`: docstring and warning
- test deprecation warnings are issues
- deprecate metrics in all docs
- remove mentions to metrics in docs and README
- deprecate internal functions/classes

Maybe we should also stop testing metrics?


Use CI unit/integration tests

The docs for this PR live [here](https://moon-ci-docs.huggingface.co/docs/datasets/pr_4738). All of your documentation changes will be reflected on that endpoint.

This PR:
- Implements separate unit/integration tests
- The fail fast policy is only applied to unit tests: a fail in integration tests does not cancel the rest of the jobs
  - We should implement more robust integration tests: work in progress in a subsequent PR


Download error on scene_parse_150

Something isn't working

Hi! The server with the data seems to be down. I've reported this issue (https://github.com/CSAILVision/sceneparsing/issues/34) in the dataset repo.

```
from datasets import load_dataset
dataset = load_dataset("scene_parse_150", "scene_parsing")

FileNotFoundError: Couldn't find file at http://data.csail.mit.edu/places/ADEchallenge/ADEChallengeData2016.zip
```


Dataset Viewer issue for deepklarity/huggingface-spaces-dataset

dataset-viewer

Related to the dataset viewer on huggingface.co

Thanks for reporting. You're right, workers were under-provisioned due to a manual error, and the job queue was full. It's fixed now.

### Link

https://huggingface.co/datasets/deepklarity/huggingface-spaces-dataset/viewer/deepklarity--huggingface-spaces-dataset/train

### Description

Hi Team,
I'm getting the following error on a uploaded dataset. I'm getting the same status for a couple of hours now. The dataset size is `<1MB` and the format is csv, so I'm not sure if it's supposed to take this much time or not.
```
Status code:   400
Exception:     Status400Error
Message:       The split is being processed. Retry later.
```

Is there any explicit step to be taken to get the viewer to work?

### Owner

Yes


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title

article


A young woman is seen standing in a room and leads into her dancing.

The girl dances around the room while the camera captures her movements.

She continues dancing around the room and ends by laying on the floor.


The video starts with a title logo sequence.

A man and woman are in a living room demonstrating exercises.

The man starts pointing to different areas of the woman's body as she does an exercise.

The woman ends with a final title logo sequence.


Two people are seen moving around a kitchen quickly performing various tasks and sitting down.

They then wax down a ski in the kitchen while continuing to move around.


A dog in socks walks slowly out onto the floor as a lady films him.

The dog turns around and goes back to the other room.


A woman and a man are sitting on the sidewalk playing music.

People stand next to them and watch them play.

A little boy holding a yellow ball walks by.

A man poses for a picture in front of them.


A young girl is seen sitting in a chair with a person standing next to her.

The person next to her then piercing one ear followed by the other.

The person rubs lotion on the piercings afterwards.


A woman is shown riding a camel past pyramids in Egypt.

The camel walks as the woman leans forward.

And hand covers the lens as the harness is shown.


A child mops the floor of a hallway in a house.

The child sets the mop down and plays with her family member.

The child walks into the bedroom area and continues to mop the floor.


A man is seen kneeling down on the floor speaking to the camera.

The man mixes up various ingredients and begins laying plaster on the floor.

He measures the floor and tiles and cuts out a piece of tile to lay on the floor.

He continues laying tiles on the floor while looking back to speak to the camera.


Two lines of young men are walking side by side down a road.

Then one man stands in a field holding a wooden object and begins twisting it.

After,the ball is placed on the ground and he picks it up and hits it as if he's playing baseball.

The ball is thrown back and he its it again.

Shortly after, a field of men are shown and they begin playing a game against one another.

There was a penalty and one players attempts to hit the ball into the goal from the side.

After,everyone is pictured lying down on the ground as if they are dead but one person begins to sit up but gets hit in the head by the ball and lays back down.

Lastly,the screen flashes to a black screen and the words The End are shown.


We show that the mutual fund theorems of Merton (1971) extend to the problem of optimal investment to minimize the probability of lifetime ruin. We obtain four such theorems by considering a financial market both with and without a riskless asset and by considering both constant and random consumption.

We show that the mutual fund theorems of Merton (1971) extend to the problem of optimal investment to minimize the probability of lifetime ruin. We obtain two such theorems by considering a financial market both with and without a riskless asset for random consumption. The striking result is that we obtain two-fund theorems despite the additional source of randomness from consumption.


The self-propelled motion of microscopic bodies immersed in a fluid medium is studied using molecular dynamics simulation. The advantage of the atomistic approach is that the detailed level of description allows complete freedom in specifying the swimmer design and its coupling with the surrounding fluid. A series of two-dimensional swimming bodies employing a variety of propulsion mechanisms -- motivated by biological and microrobotic designs -- is investigated, including the use of moving limbs, changing body shapes and fluid jets. The efficiencies of the mechanisms and the nature of the induced, time-dependent flow fields are found to differ widely among swimmers .

The self-propelled motion of microscopic bodies immersed in a fluid medium is studied using molecular dynamics simulation. The advantage of the atomistic approach is that the detailed level of description allows complete freedom in specifying the swimmer design and its coupling with the surrounding fluid. A series of two-dimensional swimming bodies employing a variety of propulsion mechanisms -- motivated by biological and microrobotic designs -- is investigated, including the use of moving limbs, changing body shapes and fluid jets. The swimming efficiency and the nature of the induced, time-dependent flow fields are found to differ widely among body designs and propulsion mechanisms .


We employ perturbation analysis technique to study trading strategies for multi-asset portfolio  and obtain optimal trading methods for wealth maximization under arbitrary utility functions .

We employ perturbation analysis technique to study multi-asset portfolio optimisation with transaction cost. We allow for correlations in risky assets and obtain optimal trading methods for general utility functions. Our analytical results are supported by numerical simulations in the context of the Long Term Growth Model .


We perform a stability analysis for the utility maximization problem in a general semimartingale model where both liquid and illiquid assets (random endowments) are present. Small misspecifications of preferences (as modeled via expected utility), as well as views of the world or the market model (as modeled via subjective probabilities) are considered. Simple sufficient conditions are given for the problem to be well-posed, in the sense that optimal wealths and marginal utility-based prices are continuous functionals of the inputs .

We perform a stability analysis for the utility maximization problem in a general semimartingale model where both liquid and illiquid assets (random endowments) are present. Small misspecifications of preferences (as modeled via expected utility), as well as views of the world or the market model (as modeled via subjective probabilities) are considered. Simple sufficient conditions are given for the problem to be well-posed, in the sense the optimal wealth and the marginal utility-based prices are continuous functionals of preferences and probabilistic views .


The utilization of multiple post translational modifications (PTMs) in regulating a biological response is ubiquitous in cell signaling. If each PTM contributes an additional, equivalent binding site, then one consequence of an increase in the number of PTMs may be to increase the probability that, upon disassociation, a ligand immediately rebinds to its receptor. How such effects may influence cell signaling systems has been less studied. Here, a self-consistent integral equation formalism for ligand rebinding in conjunction with Monte Carlo simulations are employed to further investigate the effects of multiple, equivalent binding sites on shaping biological responses. Multiple regimes that characterize qualitatively different physics due to the differential prevalence of rebinding effects and their relation to systems-level properties are predicted and studied. Calculations suggest that when ligand rebinding contributes significantly to the dose response, a purely allovalent model can influence the binding curves nonlinearly but other mechanistic ingredients are required to achieve high degrees of biochemical cooperativity. It is our hope that these calculations motivate experiments that can further unravel the many functional consequences of multi-site phosphorylation.


The utilization of multiple phosphorylation sites in regulating a biological response is ubiquitous in cell signaling. If each site contributes an additional, equivalent binding site, then one consequence of an increase in the number of phosphorylations may be to increase the probability that, upon disassociation, a ligand immediately rebinds to its receptor. How such effects may influence cell signaling systems has been less studied. Here, a self-consistent integral equation formalism for ligand rebinding in conjunction with Monte Carlo simulations are employed to further investigate the effects of multiple, equivalent binding sites on shaping biological responses. Multiple regimes that characterize qualitatively different physics due to the differential prevalence of rebinding effects and their relation to systems-level properties are predicted and studied. Calculations suggest that when ligand rebinding contributes significantly to the dose response, a purely allovalent model can influence the binding curves nonlinearly but other mechanistic ingredients are required to achieve high degrees of biochemical cooperativity. It is our hope that these calculations motivate experiments that can further unravel the many functional consequences of multi-site phosphorylation.


The utilization of multiple phosphorylation sites in regulating a biological response is ubiquitous in cell signaling. If each site contributes an additional, equivalent binding site, then one consequence of an increase in the number of phosphorylations may be to increase the probability that, upon disassociation, a ligand immediately rebinds to its receptor. How such effects may influence cell signaling systems has been less studied. Here, a self-consistent integral equation formalism for ligand rebinding  in conjunction with Monte Carlo simulations are employed to further investigate the effects of multiple, equivalent binding sites on shaping biological responses. Multiple regimes that characterize qualitatively different physics due to the differential prevalence of rebinding effects and their relation to systems-level properties are predictedand studied . Calculations suggest that when ligand rebinding contributes significantly to the dose response, a purely allovalent model can influence the binding curves nonlinearly but other mechanistic ingredients are required to achieve high degrees of biochemical cooperativity. It is our hope that these calculations motivate experiments that can further unravel the many functional consequences of multi-site phosphorylation .

The utilization of multiple phosphorylation sites in regulating a biological response is ubiquitous in cell signaling. If each site contributes an additional, equivalent binding site, then one consequence of an increase in the number of phosphorylations may be to increase the probability that, upon disassociation, a ligand immediately rebinds to its receptor. How such effects may influence cell signaling systems has been less studied. Here, a self-consistent integral equation formalism for ligand rebinding , in conjunction with Monte Carlo simulations , is employed to further investigate the effects of multiple, equivalent binding sites on shaping biological responses. Multiple regimes that characterize qualitatively different physics due to the differential prevalence of rebinding effects are predicted . Calculations suggest that when ligand rebinding contributes significantly to the dose response, a purely allovalent model can influence the binding curves nonlinearly . The model also predicts that ligand rebinding in itself appears insufficient to generative a highly cooperative biological response .


A probabilistic structure on sequential dynamical systems is introduced here, the new model will be called Probabilistic Sequential Network, PSN. The morphisms of Probabilistic Sequential Networks are defined using two algebraic conditions , whose imply that the distribution of probabilities in the systems are close . It is proved here that two homomorphic Probabilistic Sequential Networks have the same equilibrium or steady state probabilities  . Additionally, the proof of the set of PSN with its morphisms form the category PSN, having the category of sequential dynamical systems SDS, as a full subcategory is given. Several examples of morphisms, subsystems and simulations are given.

A probabilistic structure on sequential dynamical systems is introduced here, the new model will be called Probabilistic Sequential Network, PSN. The morphisms of Probabilistic Sequential Networks are defined using two algebraic conditions . It is proved here that two homomorphic Probabilistic Sequential Networks have the same equilibrium or steady state probabilities if the morphism is either an epimorphism or a monomorphism . Additionally, the proof of the set of PSN with its morphisms form the category PSN, having the category of sequential dynamical systems SDS, as a full subcategory is given. Several examples of morphisms, subsystems and simulations are given.


We propose a biologically motivated quantity, twinness, to evaluate local similarity between nodes in a network. The twinness of a pair of nodes is the number of connected, labelled subgraphs of size n in which the two nodes possess identical neighbours. The graph animal algorithm is used to estimate twinness for each pair of nodes (for subgraph sizes n=4 to n=12) in four different protein interaction networks (PINs). These include an Escherichia coli PIN and three Saccharomyces cerevisiae PINs - each obtained using state-of-the-art high throughput methods. In almost all cases, the average twinness of node pairs is vastly higher than expected from a null model obtained by switching links. For all n, we observe a difference in the ratio of type A twins (which are unlinked pairs) to type B twins (which are linked pairs) distinguishing the prokaryote E. Coli from the eukaryote S. Cerevisiae . Interaction similarity is expected due to gene duplication, and whole genome duplication paralogues in S. Cerevisiae have been reported to co-cluster into the same complexes. Indeed, we find that these paralogues are over-represented as twins compared to pairs chosen at random. These results indicate that twinness can detect ancestral relationships from currently available PIN data.

We propose a biologically motivated quantity, twinness, to evaluate local similarity between nodes in a network. The twinness of a pair of nodes is the number of connected, labeled subgraphs of size n in which the two nodes possess identical neighbours. The graph animal algorithm is used to estimate twinness for each pair of nodes (for subgraph sizes n=4 to n=12) in four different protein interaction networks (PINs). These include an Escherichia coli PIN and three Saccharomyces cerevisiae PINs -- each obtained using state-of-the-art high throughput methods. In almost all cases, the average twinness of node pairs is vastly higher than expected from a null model obtained by switching links. For all n, we observe a difference in the ratio of type A twins (which are unlinked pairs) to type B twins (which are linked pairs) distinguishing the prokaryote E. coli from the eukaryote S. cerevisiae . Interaction similarity is expected due to gene duplication, and whole genome duplication paralogues in S. cerevisiae have been reported to co-cluster into the same complexes. Indeed, we find that these paralogous proteins are over-represented as twins compared to pairs chosen at random. These results indicate that twinness can detect ancestral relationships from currently available PIN data.


We calculate analytically the critical connectivity K_c of Random Threshold Networks (RTN) for homogeneous and inhomogeneous thresholds, and confirm the results by numerical simulations. We find a super-linear increase of K_c with the (average) absolute threshold |h|, which approaches K_c(|h|) \sim |h|^{\alpha with \alpha \approx }  2  for large |h|, and show that this asymptotic scaling is universal for RTN with Poissonian distributed connectivity and threshold distributions with a variance that grows slower than |h|^{\alpha . Interestingly, we find that inhomogeneous distribution of thresholds leads to increased propagation of perturbations for sparsely connected networks, while for densely connected networks damage is reduced . Further, damage propagation in RTN with in-degree distributions that exhibit a scale-free tail k_{in^{\gamma} is studied; we find that a decrease of \gamma can lead to a transition from supercritical (chaotic) to subcritical (ordered) dynamics}  . Last, local correlations between node thresholds and in-degree are introduced. Here, numerical simulations show that even weak (anti-)correlations can lead to a transition from ordered to chaotic dynamics, and vice versa. Interestingly, in this case the annealed approximation fails to predict the dynamical behavior for sparse connectivities , suggesting that even weak topological correlations can strongly limit its applicability for finite N .

We calculate analytically the critical connectivity K_c of Random Threshold Networks (RTN) for homogeneous and inhomogeneous thresholds, and confirm the results by numerical simulations. We find a super-linear increase of K_c with the (average) absolute threshold |h|, which approaches K_c(|h|) \sim with \alpha \approx } h^2/( 2 \ln{|h| for large |h|, and show that this asymptotic scaling is universal for RTN with Poissonian distributed connectivity and threshold distributions with a variance that grows slower than h^2 . Interestingly, we find that inhomogeneous distribution of thresholds leads to increased propagation of perturbations for sparsely connected networks, while for densely connected networks damage is reduced ^{\gamma} is studied; we find that a decrease of \gamma can lead to a transition from supercritical (chaotic) to subcritical (ordered) dynamics} ; the cross-over point yields a novel, characteristic connectivity K_d, that has no counterpart in Boolean networks . Last, local correlations between node thresholds and in-degree are introduced. Here, numerical simulations show that even weak (anti-)correlations can lead to a transition from ordered to chaotic dynamics, and vice versa. It is shown that the naive mean-field assumption typical for the annealed approximation leads to false predictions in this case, since correlations between thresholds and out-degree that emerge as a side-effect strongly modify damage propagation behavior .


Prophylactic indomethacin therapy in the first twenty-four hours of life for the prevention of patent ductus arteriosus in preterm infants treated prophylactically with surfactant in the delivery room.

Indomethacin reduces the risks of severe intraventricular hemorrhage.

Administration of indomethacin for the prevention of periventricular-intraventricular hemorrhage in high-risk neonates.

Early intravenous indomethacin prolongs respiratory support in very low birth weight infants.

Low-dose indomethacin therapy and extension of intraventricular hemorrhage: a multicenter randomized trial.

Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants.

Randomized low-dose indomethacin trial for prevention of intraventricular hemorrhage in very low birth weight neonates.

Prophylactic indomethacin for prevention of intraventricular hemorrhage in premature infants.

Effects of early indomethacin administration on oxygenation and surfactant requirement in low birth weight infants.

Prevention of symptomatic patent ductus arteriosus with a single dose of indomethacin.

Randomized indomethacin trial for prevention of intraventricular hemorrhage in very low birth weight infants.

[Indomethacin in the prevention of subependymal-intraventricular hemorrhage in preterm newborns with conventional mechanical ventilation].

Indomethacin therapy on the first day of life in infants with very low birth weight.

Indomethacin prophylaxis for patent ductus arteriosus (PDA) in infants with a birth weight of less than 1250 grams.

Abstract:
To determine whether a course of low-dose indomethacin therapy, when initiated within 24 hours of birth, would decrease ductal shunting in premature infants who received prophylactic surfactant in the delivery room.
                Ninety infants, with birth weights of 600 to 1250 gm, were entered into a prospective, randomized, controlled trial to receive either indomethacin, 0.1 mg/kg per dose, or placebo less than 24 hours and again every 24 hours for six doses. Echocardiography was performed on day 1 before treatment and on day 7, 24 hours after treatment. A hemodynamically significant patent ductus arteriosus (PDA) was confirmed with an out-of-study echocardiogram, and the nonresponders were treated with standard indomethacin or ligation.
                Forty-three infants received indomethacin (birth weight, 915 +/- 209 gm; gestational age, 26.4 +/- 1.6 weeks; 25 boys), and 47 received placebo (birth weight, 879 +/- 202 gm; gestational age, 26.4 +/- 1.8 weeks; 22 boys) (P = not significant). Of 90 infants, 77 (86%) had a PDA by echocardiogram on the first day of life before study treatment; 84% of these PDAs were moderate or large in size in the indomethacin-treated group compared with 93% in the placebo group. Nine of forty indomethacin-treated infants (21%) were study-dose nonresponders compared with 22 (47%) of 47 placebo-treated infants (p < 0.018). There were no significant differences between both groups in any of the long-term outcome variables, including intraventricular hemorrhage, duration of oxygen therapy, endotracheal intubation, duration of stay in neonatal intensive care unit, time to regain birth weight or reach full caloric intake, incidence of bronchopulmonary dysplasia, and survival. No significant differences were noted in the incidence of oliguria, elevated plasma creatinine concentration, thrombocytopenia, pulmonary hemorrhage, or necrotizing enterocolitis.
                The prophylactic use of low doses of indomethacin, when initiated in the first 24 hours of life in low birth weight infants who receive prophylactic surfactant in the delivery room, decreases the incidence of left-to-right shunting at the level of the ductus arteriosus.

Abstract: A prospective, random selection, double-blind clinical trial was carried out to determine the efficacy of indomethacin in preventing periventricular-intraventricular hemorrhage (PV-IVH). Babies who were born in our institution, had birth weights less than or equal to 1500 gm, and had no PV-IVH or grade 1 PV-IVH were given either placebo (n = 70) or indomethacin (n = 71), 0.2 mg/kg intravenously at 6 hours of age and 0.1 mg/kg at 18 and 30 hours. Two major outcomes were determined: the development of grades 2 to 4 PV-IVH and the development of severe PV-IVH (i.e., hemorrhages with blood filling greater than 50% of the ventricles and in some cases with associated parenchymal echodensities). Grades 2 to 4 PV-IVH occurred in 16 (23%) of the indomethacin group and 27 (39%) of the placebo group (p less than 0.03). The incidence of severe PV-IVH was 3% in the indomethacin-treated babies and 14% in the control group (p less than 0.02). The influence of other perinatal factors on the incidence of grades 2 to 4 or severe PV-IVH was determined by stepwise logistic regression. Placebo use, early grade 1 PV-IVH, lower birth weight, and higher fraction of inspired oxygen at 6 hours of life were associated with higher estimated odds of the development of grades 2 to 4 PV-IVH. Placebo use, male gender, lower 5-minute Apgar score, and a large base deficit were predictive of severe PV-IVH. Estimated odds ratios of severe PV-IVH with placebo use and male gender were 11.25:1 and 9:1, respectively. Thus indomethacin prophylaxis reduced the relative risk of grades 2 to 4 PV-IVH and severe PV-IVH, but other perinatal variables contributed significantly to the overall risk of PV-IVH.

Abstract: One hundred twenty-two preterm infants were enrolled in a placebo-controlled, double-blind trial using intravenous indomethacin for the prevention of periventricular-intraventricular hemorrhage (PVH-IVH). Before random assignment, data on the infants were stratified according to low-weight (500 to 999 g) or high-weight (1000 to 1500 g) subgroups. Cranial sonography was used to document the absence of PVH-IVH before enrollment and the occurrence of PVH-IVH during the 7-day protocol. Indomethacin, 0.1 mg/kg, or placebo was administered before 12 hours of age and at 24, 48, and 72 hours of age. Five patients receiving indomethacin and six receiving placebo were withdrawn before completion of the study. In the remaining 111 patients, the indomethacin and placebo groups were comparable with respect to gestational ages, maternal complications, Apgar scores, ventilatory requirements, complications of prematurity, and mortality rate. PVH-IVH developed in six of 56 infants who received indomethacin and 11 of 55 infants who received placebo (P = 0.174). Analysis of the individual strata showed that the indomethacin-treated infants in the low-weight subgroup sustained a higher mortality rate (11/17 vs 3/16; P = 0.008) without a reduction in the incidence of PVH-IVH. Infants in the indomethacin-treated high-weight subgroup demonstrated a significantly lower incidence of PVH-IVH (2/39 vs 8/39; P = 0.04), but the frequency of high-grade hemorrhages was comparable for both indomethacin- and placebo-treated groups. In summary, the prophylactic administration of intravenous indomethacin for the prevention of PVH-IVH cannot be recommended for infants less than 1000 g. In preterm infants between 1000 and 1500 g birth weight, indomethacin significantly reduced the incidence of PVH-IVH.

Abstract: Infants weighing 1500 g at birth requiring either intermittent positive pressure ventilation or continuous positive airway pressure by 12 hours of age were entered in a randomized double blind controlled trial to test the efficacy of early intravenous indomethacin therapy in preventing chronic pulmonary disease of prematurity. Of the 30 newborns enrolled, 15 were treated with indomethacin and 15 were treated with placebo at 12, 24 and 36 hours of age. The groups were similar for birth weight, gestational age, sex, hyaline membrane disease and intracranial hemorrhage. Infants in the placebo group were successfully weaned from intermittent positive pressure ventilation at an earlier age than infants in the indomethacin group (p less than 0.05). Furthermore, chronic pulmonary disease of prematurity was similar in the two groups despite a reduction in the incidence of patent ductus arteriosus in the indomethacin group.

Abstract: We enrolled 61 neonates of 600 to 1250 gm birth weight with evidence of low-grade intraventricular hemorrhage at 6 to 11 hours of age in a prospective, randomized, placebo-controlled trial to test the hypothesis that indomethacin (0.1 mg/kg given intravenously at 6 to 12 postnatal hours and every 24 hours for two more doses) would prevent extension of intraventricular hemorrhage. Twenty-seven infants were assigned to receive indomethacin; 34 infants received saline placebo. There were no significant differences between the two groups in birth weight, gestational age, sex, Apgar scores, percentage of infants treated with surfactant, or distribution of hemorrhages at the time of the first cranial sonogram (echo-encephalogram). Within the first 5 days, 9 of 27 indomethacin-treated and 12 of 34 saline solution-treated infants had extension of their initial intraventricular hemorrhage (p = 1.00). Four indomethacin-treated and three saline solution-treated infants had parenchymal extension of the hemorrhage. Indomethacin was associated with closure of a patent ductus arteriosus by the fifth day of life (p = 0.003). There were no differences in adverse events attributed to indomethacin. We conclude that in very low birth weight infants with low grade intraventricular hemorrhage within the first 6 postnatal hours, prophylactic indomethacin therapy promotes closure of the patent ductus arteriosus and is not associated with adverse events, but does not affect the cascade of events leading to parenchymal involvement of intracranial hemorrhage.

Abstract:
The prophylactic administration of indomethacin reduces the frequency of patent ductus arteriosus and severe intraventricular hemorrhage in very-low-birth-weight infants (those with birth weights below 1500 g). Whether prophylaxis with indomethacin confers any long-term benefits that outweigh the risks of drug-induced reductions in renal, intestinal, and cerebral blood flow is not known.
                Soon after they were born, we randomly assigned 1202 infants with birth weights of 500 to 999 g (extremely low birth weight) to receive either indomethacin (0.1 mg per kilogram of body weight) or placebo intravenously once daily for three days. The primary outcome was a composite of death, cerebral palsy, cognitive delay, deafness, and blindness at a corrected age of 18 months. Secondary long-term outcomes were hydrocephalus necessitating the placement of a shunt, seizure disorder, and microcephaly within the same time frame. Secondary short-term outcomes were patent ductus arteriosus, pulmonary hemorrhage, chronic lung disease, ultrasonographic evidence of intracranial abnormalities, necrotizing enterocolitis, and retinopathy.
                Of the 574 infants with data on the primary outcome who were assigned to prophylaxis with indomethacin, 271 (47 percent) died or survived with impairments, as compared with 261 of the 569 infants (46 percent) assigned to placebo (odds ratio, 1.1; 95 percent confidence interval, 0.8 to 1.4; P=0.61). Indomethacin reduced the incidence of patent ductus arteriosus (24 percent vs. 50 percent in the placebo group; odds ratio, 0.3; P<0.001) and of severe periventricular and intraventricular hemorrhage (9 percent vs. 13 percent in the placebo group; odds ratio, 0.6; P=0.02). No other outcomes were altered by the prophylactic administration of indomethacin.
                In extremely-low-birth-weight infants, prophylaxis with indomethacin does not improve the rate of survival without neurosensory impairment at 18 months, despite the fact that it reduces the frequency of patent ductus arteriosus and severe periventricular and intraventricular hemorrhage.

Abstract: We admitted 36 preterm neonates (600 to 1250 gm birth weight) with normal 6-hour echoencephalograms to a randomized, placebo-controlled prospective trial to determine whether a low dose of indomethacin would prevent germinal matrix or intraventricular hemorrhage and permit adequate urinary output. Between the sixth and tenth postnatal hours, indomethacin (0.1 mg/kg) or placebo was administered intravenously every 24 hours for a total of three doses. Cardiac ultrasound studies to assess the status of the ductus arteriosus were performed at 6 postnatal hours and on day 5. Urinary output, serum electrolytes, serum indomethacin levels, and renal and clotting functions were monitored. No differences in birth weight, gestational age, or Apgar scores were noted between the two groups of infants. Two indomethacin-treated infants and three infants given placebo had significant urinary output difficulties, requiring that the study medication be withheld. Of 19 infants given indomethacin, two had germinal matrix or intraventricular hemorrhage, in comparison with 8 of 17 infants given saline solution (p = 0.02). Of the infants who had a left-to-right patent ductus arteriosus shunt before treatment, 64% of the indomethacin-treated and 33% of the saline solution-treated infants no longer had a patent ductus arteriosus on day 5. Ductal status appeared unrelated to the development of germinal matrix or intraventricular hemorrhage.

Abstract: The impact of early prophylactic use of intravenous indomethacin on the incidence and severity of periventricular-intraventricular hemorrhage and patent ductus arteriosus in 199 oxygen-requiring premature infants (less than or equal to 1300 g birth weight) was prospectively investigated. The trial was controlled, the infants were randomized, and the investigators were unaware of the group assignments. Patients with minimal (grade I) or no periventricular-intraventricular hemorrhage determined by prestudy echoencephalography were randomized within two birth weight subgroups (500 to 899 and 900 to 1300 g) to receive either prophylactic indomethacin (n = 99) or an equal volume of saline-vehicle placebo (n = 100). The first dose (0.2 mg/kg) was given within 12 hours of delivery and two subsequent doses (0.1 mg/kg) were administered at 12 hourly intervals. Prophylactic indomethacin significantly reduced the incidence of grades II to IV periventricular-intraventricular hemorrhage. Intraventricular hemorrhage was half as common in infants given prophylactic indomethacin as in control infants (23% v 46%, P less than .002). The reduction was manifested in both birth weight subgroups. Results of this study also confirmed a lower incidence of clinically significant patent ductus arteriosus in infants who received prophylactic indomethacin in contrast to those who received placebo (11% v 42%, P less than .001). No significant differences were found between treatment and control groups in the duration of oxygen therapy, mechanical ventilation, or hospitalization or in the incidence of pneumothorax, chronic lung disease, sepsis, necrotizing enterocolitis, retinopathy of prematurity, or death. Early prophylactic indomethacin initiated within 12 hours of delivery is effective in reducing the incidence of intraventricular hemorrhage as well as clinically significant patent ductus arteriosus in very low birth weight premature infants.

Abstract: A previous study found that early intravenous indomethacin administration prolonged respiratory support in very low birth weight infants. We have, therefore, designed a randomized, double blind controlled study to evaluate the oxygenation, and surfactant requirements in preterm low birth weight infants receiving early indomethacin administration. Premature neonates who received surfactant therapy and on mechanical ventilation were prospectively randomized to receive either placebo or indomethacin (0.2 mg/kg intravenously at 12 postnatal hours and every 24 h for two more doses). Oxygenation was assessed by FiO2 required and arterial/alveolar oxygen (a/A O2) ratio during the first 48 h of life. The doses of surfactant were compared between the two groups. Twenty-seven infants (n = 14 of early indomethacin and n = 13 of placebo group) fulfilled inclusion criteria. At admission to the study, there were no differences in the birth weight, gestational age, sex, Apgar scores, a/A O2 ratio, and FiO2. The control group exhibited a significant improvement in oxygenation (FiO2 requirement and a/A O2 compared with the early indomethacin group at 24 (P = 0.026 and 0.02, respectively) and 48 h of life (P = 0.037 and 0.026, respectively). The requirement of surfactant was significantly larger in the early indomethacin group (P = 0.029). Early indomethacin administration increases oxygen and surfactant requirement.

Abstract: To determine the efficacy of indomethacin to prevent the occurrence of symptomatic patent ductus arteriosus (PDA), a randomized clinical trial was conducted involving 32 preterm infants weighing 750 to 1500 g at birth who had hyaline membrane disease. By random assignment, 15 infants were given a single dose of indomethacin, 0.2 mg/kg intravenously, 24 hours after birth. Seventeen infants composed a control group for which indomethacin was reserved as treatment for symptomatic PDA. Birth weight, gestational age, male/female ratio, black/white ratio, and severity of disease were similar for both groups. Only one of the 14 survivors who received prophylactic indomethacin had symptomatic PDA, compared with nine of the 16 survivors in the control group (P = 0.007). There was no difference between the groups in development of bronchopulmonary dysplasia, duration of time endotracheal intubation, was required, duration in oxygen, duration to reach full feedings and regain birth weight, and duration of hospital stay. There was no difference between the two groups in incidence of intraventricular hemorrhage, and none developed necrotizing enterocolitis. These results indicate that the use of prophylactic indomethacin is beneficial in prevention of symptomatic PDA; the lack of differences in pulmonary sequelae or other complications may have been related to a population sample size not large enough to impart sufficient statistical power.

Abstract: We admitted 48 preterm neonates (600 to 1250 gm birth weight, normal 6-hour echoencephalograms) to a randomized prospective indomethacin or placebo trial for the prevention of neonatal intraventricular hemorrhage. Beginning at 6 postnatal hours, indomethacin or placebo was administered intravenously every 12 hours for a total of five doses. Cardiac ultrasound studies to assess the status of the ductus arteriosus were performed at 6 postnatal hours and on day 5. Urinary output, serum electrolytes, and renal and clotting functions were monitored. No differences in birth weight, gestational age, Apgar scores, or ventilatory needs were noted between the two groups. Six infants given indomethacin had intraventricular hemorrhage, compared to 14 control infants (P = 0.02). The indomethacin-treated group had significant decreases in serum prostaglandin values 30 hours after the initiation of therapy. The overall incidence of patent ductus arteriosus was 82% at 6 postnatal hours; 84% of the indomethacin-treated infants experienced closure of the ductus, compared to 60% of the placebo-treated patients. Closure of the ductus was not related to incidence of intraventricular hemorrhage. We speculate that indomethacin may provide some protection against neonatal intraventricular hemorrhage by acting on the cerebral microvasculature.

Abstract: The results of a double blind study to evaluate the efficiency of prophylactic endovenous indomethacin versus placebo for prevention of intraventricular hemorrhage (IVH) in newborn infants between 28 to 36 weeks of age who were intubated at the delivery room and required mechanical ventilation in NICU are presented. Fourty six patients required mechanical ventilation, but 14 neonates had IVH evaluated by ultrasound when were admitted to the Unit. At least 32 infants were studied, 16 for each group. There were no differences between the groups in weight, gestational age, sex and delivery way. The mobility was the same in relation to hialine membrane disease, sepsis, pneumonie and pneumotorax. The placebo group had more frequency of PDA and mortality (P < 0.5). There were no differences in mean airway pressure and arterial gases, also in glucose, platelets and urinary volume. The indomethacin group had mayor urinary density and FeNa but the results were always in normal ranges. The IVH was the same in both groups. We concluded that the indomethacin at the levels used did not produced alterations, and if the IVH is not prevented, were observed lesser severity of the same and the frequency of PDA and mortality are lesser. But still is necessary more number of cases for best conclusions.

Abstract: To investigate the optimal timing for treatment of small premature infants, we performed a double-blind, controlled trial of indomethacin therapy on the first day of life in 104 infants weighing between 700 and 1300 gm. Infants were given indomethacin or placebo at a mean age of 15 hours. Eleven of the 56 infants given placebo developed large left-to-right shunts through a patent ductus arteriosus. In contrast, only two of the 51 infants given indomethacin developed large shunts (P less than 0.025). There were no significant differences in incidence of surgical ligation, duration of oxygen therapy, duration of endotracheal intubation, days required to regain birth weight, or incidence of complications. However, the power of the tests of significance was low because of the small number of patients. Thus, although the incidence of large left-to-right ductus shunts was decreased in the indomethacin group, morbidity was not otherwise altered for the entire group of patients, possibly because of the relatively low incidence (21%) of large shunts in the placebo group. We conclude that although treatment with indomethacin on the first day of life appears to be safe, there is little advantage to its use in centers where the incidence of large shunts through a patent ductus arteriosus is relatively low.

Abstract:
Very low birth weight (VLBW, less than 1500 g) and extremely low birth weight infants (ELBW, less than 1000 g) are the premature infants that are most likely to develop symptomatic PDA. Intravenous indomethacin has proven effective in prevention of PDA in many prospective trials. This strategy will be a useful adjunctive therapy for premature infants in Thailand.
                To answer the following questions: 1. Will multiple doses of intravenous indomethacin, given to VLBW infants within the first day of life, effectively prevent the occurrence of symptomatic PDA? Are there any side effects or complications? 2. Will this strategy be more beneficial in ELBW?
                The study included thirty VLBW infants born at Ramathibodi Hospital, with birth weights ranging from 630 to 1230 g. They were randomized into 2 groups of 15 infants each. One group received 3 doses of intravenous indomethacin at the dosage of 0.2 mg/kg initially and then 0.1 mg/kg every 12 hours for 2 more doses; the second group received a placebo. The study was performed by a double blind control.
                Sixteen infants developed symptomatic PDA, 4 in the indomethacin group and 12 in the placebo group. The decrease in incidence of PDA is statistically significant. But when the data was analyzed separately for the VLBW and ELBW groups. The effects were only significantly different in ELBW but not yet significant in the VLBW group. There was a statistically significant difference in the incidence of severe intraventricular hemorrhage (IVH) (grade 3 or higher) in the ELBW infants.
                Intravenous indomethacin therapy given to VLBW infants with a birth weight of less than 1250 g decreased incidence of symptomatic PDA with no significant permanent side effects. The effect was markedly noticeable in ELBW infants. Incidence of severe IVH was also markedly decreased in the ELBW infants who received indomethacin.

Prophylactic indomethacin has short-term benefits for preterm infants including a reduction in the incidence of symptomatic PDA, PDA surgical ligation, and severe intraventricular haemorrhage. However, there is no evidence of effect on mortality or neurodevelopment.


White phosphorus burns and massive hemolysis.

The treatment of chemical burns: specialized diagnostic, therapeutic, and prognostic considerations.

First aid for phosphorus burns involves the common sense measures of acting promptly to remove the patient's clothes, irrigating the wound(s) with water or saline continuously, and removing phosphorus particles. There is no evidence that using copper sulphate to assist visualisation of phosphorus particles for removal is associated with better outcome, and some evidence that systemic absorption of copper sulphate may be harmful. We have so far been unable to identify any other comparisons relevant to informing other aspects of the care of patients with phosphorus burns. Future versions of this review will take account of information in articles published in languages other than English, which may contain additional evidence based on treatment comparisons.


Trial of long-term anticoagulant therapy in the treatment of small stroke associated with a normal carotid arteriogram.

CEREBRAL VASCULAR DISEASE IN RELATION TO LONG-TERM ANTICOAGULANT THERAPY.

Anticoagulant therapy in cerebral infarction. Report on cooperative study.

CEREBRAL APOPLEXY. A CLINICAL, RADIOLOGICAL, ELECTROENCEPHALOGRAPHIC AND PATHOLOGICAL STUDY WITH SPECIAL REFERENCE TO THE PROGNOSIS OF CEREBRAL INFARCTION AND THE RESULT OF LONG-TERM ANTICOAGULATION THERAPY.

Abstract: The clinical features of 49 patients who had sustained small strokes in the internal carotid artery territory, who were normotensive, free from cardiac or other relevant disease, and who each had a normal appropriate single vessel angiogram are presented. These were randomized into two groups: group A, 25 patients, who received only supportive treatment; group B, 24 patients who were treated with anticoagulants for an average period of 18 months. There was a reduced incidence of neurological episodes during the administration of anticoagulant therapy but, after treatment was discontinued, there was no significant difference between the two groups. In view of the relatively benign prognosis for this syndrome, unless special facilities exist for the personal control of anticoagulant treatment, the dangers may outweigh the benefits.

Compared with control, there was no evidence of benefit from long-term anticoagulant therapy in people with presumed non-cardioembolic ischaemic stroke or transient ischaemic attack, but there was a significant bleeding risk.


Computer-aided retraining of memory and attention in people with multiple sclerosis: a randomized, double-blind controlled trial.

Neuropsychological counseling improves social behavior in cognitively-impaired multiple sclerosis patients.

An evaluation of cognitive-behaviour therapy for depression in patients with multiple sclerosis.

Efficacy of stress-inoculation training in coping with multiple sclerosis.

A randomized clinical trial of a wellness intervention for women with multiple sclerosis.

Evaluation of cognitive assessment and cognitive intervention for people with multiple sclerosis.

Effects of treatment for depression on fatigue in multiple sclerosis.

Group psychotherapy: benefits in multiple sclerosis.

Telephone-administered cognitive-behavioral therapy for the treatment of depressive symptoms in multiple sclerosis.

Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis.

Unit management of depression of patients with multiple sclerosis using cognitive remediation strategies: a preliminary study.

Effects of neuropsychological treatment in patients with multiple sclerosis.

Symptom management and adjustment of patients with multiple sclerosis: a 4-year longitudinal intervention study.

Abstract:
Cognitive compromise is one of the main contributing factors to activity and participation restrictions in people with multiple sclerosis (MS). Computer-aided programs are used for retraining memory and attention, but data on the efficacy of these interventions are scarce.
                To assess the efficacy of computer-aided retraining of memory and attention in people with MS impaired in these abilities.
                Randomized, double-blind, controlled trial.
                Outpatients (n=82) with subjective complaints of poor attention or memory, confirmed by a score <80th percentile in at least two tests of the Brief Repeatable Battery of Neuropsychological Tests (BRBNT).
                Participants were randomized to two computer-assisted retraining interventions: memory and attention (study arm), and visuo-constructional and visuo-motor coordination (control arm). Both groups received 16 training sessions over 8 weeks.
                Improvement of 20% or more in at least two BRBNT test scores at 8 weeks compared to baseline (primary end point). Changes in depression and health-related quality of life.
                An improvement occurred in 45% of study patients vs. 43% of control patients (odds ratio 1.07, 95% confidence interval 0.44-2.64). The study treatment was better than the control treatment only on the word list generation test (p=0.016).
                This trial does not support the efficacy of specific memory and attention retraining in MS.

Abstract: We studied the effectiveness of a newly-developed cognitive-behavioral intervention in 15 patients with marked cognitive impairment and behavior disorder. The design was a single-blind test of a neuropsychological intervention, with pre- and post-treatment assessments of personality and social behavior. MS patients underwent neurological examination and neuropsychological testing at baseline. The patients were then randomly assigned to neuropsychological counseling or standard, non-specific supportive psychotherapy. The active 12-week treatment emphasized enhancement of insight through education, social skills training, and behavior modification. All patients were re-examined within 2 weeks of the termination of treatment. Neuropsychological technicians were blind to treatment condition. Both groups showed evidence of cognitive impairment and personality/behavior disorder prior to treatment and were well matched on demographic, disability, and cognitive measures. Patients who underwent neuropsychological counseling showed significant positive response on measures of social behavior (e.g. excessive ego-centric speech) compared to those who underwent standard counseling. We conclude that these data support the use of non-pharmacological, neuropsychological counseling in patients with acquired, MS-associated behavior disorder.

Abstract: Twenty depressed multiple sclerotic patients were randomly allocated either to cognitive-behaviour therapy or to a waiting list control condition. Assessment of depressive symptoms was conducted at pre-treatment, post-treatment, and a four-week follow-up. In comparison to the waiting list condition, cognitive-behaviour therapy was found to result in clinically and statistically significant improvement on most measures. Although the mechanism by which such treatment achieves its effects is unclear, these results clearly support the use of cognitive-behavioural treatments for depression in this population.

Abstract:
To examine the effects of a wellness intervention program for women with multiple sclerosis (MS) on health behaviors and quality of life (QOL).
                Randomized clinical trial.
                Community setting in the southwestern United States.
                Convenience sample of 113 women with physician-confirmed MS (mean age, 45.79y).
                The 2-phase intervention program included lifestyle-change classes for 8 weeks, then telephone follow-up for 3 months. Participants were followed over an 8-month period.
                A series of self-report instruments to measure barriers, resources, self-efficacy for health behaviors, health promotion behaviors, and health-related QOL were completed at baseline, 2 months (after the classes), 5 months (after telephone follow-up), and at 8 months. Principal outcomes measures were health-promoting behaviors (scores on the Health Promoting Lifestyle Profile II) and QOL (scores on the Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36] scales).
                Hierarchical linear modeling techniques revealed a statistically significant group by time effect for self-efficacy for health behaviors, health-promoting behaviors, and the mental health and pain scales of the SF-36.
                These data provide initial support for the positive effects of wellness interventions to improve health behaviors and selected dimensions of QOL for women with MS.

Abstract:
Cognitive problems in multiple sclerosis are common but any possible benefits of treatment remain uncertain. The aim of the study was to evaluate the benefits of providing a psychology service, including cognitive assessment and intervention, to patients with multiple sclerosis.
                The study was a single blind randomised controlled trial. A total of 240 patients with clinically definite, laboratory supported, or clinically probable multiple sclerosis were recruited from an multiple sclerosis management clinic and assessed on a brief screening battery. They were randomised into three groups. The control group received no further intervention. The assessment group received a detailed cognitive assessment, the result of which was fed back to staff involved in the patients' care. The treatment group received the same detailed cognitive assessment and a treatment programme designed to help reduce the impact of their cognitive problems. Patients were followed up 4 and 8 months later on the general health questionnaire (GHQ-28), extended activities of daily living scale, SF-36, everyday memory questionnaire, dysexecutive syndrome questionnaire, and memory aids questionnaire.
                The three groups were compared on the outcome measures at 4 and 8 months after recruitment. There were few significant differences between the groups and those that occurred favoured the control group. Overall, the results showed no effect of the interventions on mood, quality of life, subjective cognitive impairment or independence.
                The study failed to detect any significant effects of cognitive assessment or cognitive intervention in this cohort of people with multiple sclerosis.

Abstract:
There has long been a belief that depression contributes to fatigue in multiple sclerosis (MS) although supporting data are minimal at best. Clinical guidelines for the treatment of fatigue include recommendations for the treatment of depression in the absence of clear empirical support. The goal of this study was to examine the effects of treatment for depression on fatigue in MS.
                Sixty patients with a relapsing form of MS and moderate to severe depression were randomly assigned to one of three validated 16-week treatments for depression: individual cognitive behavioral therapy, group psychotherapy, or sertraline. Assessments at baseline and treatment cessation included the primary outcome measure, fatigue assessment instrument (FAI), and Beck depression inventory (BDI).
                The total FAI and the global fatigue severity subscale were significantly reduced over the course of treatment (p values <.02). Other subscales did not change significantly. Secondary analyses showed change in global fatigue severity was associated with change in BDI (p =.03) but change in total FAI was only marginally related to change in BDI (p =.05). These relationships were due entirely to change in mood (p values <.02) and not to change in cognitive or vegetative symptoms (p values >.17).
                These findings suggest that treatment for depression is associated with reductions in the severity of fatigue symptoms, and that this relationship is due primarily to treatment related changes in mood.

Abstract: This study investigates the relationship between group psychotherapy and the psychologic adjustment of patients with a primary diagnosis of multiple sclerosis (MS). It was speculated that such a program would decrease both patient depression and anxiety, at the same time increasing self-concept and self-direction. Forty-one hospitalized MS patients were screened for mental status, then administered a test battery consisting of the Depression 30, IPAT Anxiety Scale, Nowicki-Strickland Internal-External Scale, and Rosenberg Self-Esteem Scale. Following this, patients were matched into triads on the basis of pretest scores. Each member of the triad was then randomly assigned to one of three groups: insight-oriented, current events, control (nontreatment). At the end of 50 group sessions, all patients were reassessed using the same test battery. Results were analyzed by means of analysis of covariance and the nonparametric Friedman test. Post-hoc procedures were performed with the following results: 1) the insight-oriented therapy group was significantly less depressed than both the current events group and the control group and 2) both the therapy and the current events groups were significantly more internally oriented than the control. Not only does group therapy per se seem to benefit the MS patient, but any supervised group involvement appears to improve significantly patient emotional state.

Abstract: This study examined the efficacy of an 8-week telephone-administered cognitive-behavioral therapy (CBT) for the treatment of depressive symptomatology in multiple sclerosis (MS) patients. The treatment, Coping with MS (CMS), included a patient workbook designed to structure the treatment, provide visual aids, and help with homework assignments. Thirty-two patients with MS, who scored at least 15 on the Profile of Mood States Depression-Dejection scale, were randomly assigned to either the telephone CMS or to a usual-care control (UCC) condition. Depressive symptomatology decreased significantly in the CMS condition compared with the UCC condition. Furthermore, adherence to interferon beta-1a, a disease-modifying medication for the treatment of MS, was significantly better at the 4-month follow-up among patients who received CMS as compared with those in the UCC condition.

Abstract: This study compared the efficacy of 3 16-week treatments for depression in 63 patients with multiple sclerosis (MS) and major depressive disorder (MDD): individual cognitive-behavioral therapy (CBT), supportive-expressive group therapy (SEG). and the antidepressant sertraline. Significant reductions were seen from pre- to posttreatment in all measures of depression. Intent-to-treat and completers analyses using the Beck Depression Inventory (BDI; A. T. Beck, C. H. Ward. M. Medelson. J. Mock, & J. Erbaugh, 1961) and MDD diagnosis found that CBT and sertraline were more effective than SEG at reducing depression. These results were largely supported by the BDI-18, which eliminates BDI items confounded with MS. However, the Hamilton Rating Scale for Depression (M. Hamilton, 1960) did not show consistent differences between treatments. Reasons for this inconsistency are discussed. These findings suggest that CBT or sertraline is more likely to be effective in treating MDD in MS compared with supportive group treatments.

Abstract: Multiple sclerosis (MS) is a chronic, often progressive neurologic disorder characterized by cerebral and spinal cord lesions. Patients with advanced MS often require continuous supervision in a long-term skilled nursing facility. Many of these patients experience clinical levels of depression. For this experiment, we randomly assigned MS patients living in a skilled nursing facility to either a control condition or an extended treatment protocol. The protocol consisted of assigning individual certified nursing assistants (CNAs) to each patient, in-service training for the CNAs, and the use of memory notebooks. All patients completed the short version of the Beck Depression Inventory and several measures of cognitive functioning at the start and end of the study. The results indicate statistically and clinically significant improvements in the depression of patients in the treatment but not in the control condition. These results led to recommendations for the treatment of MS patients living in long-term skilled nursing facilities and for additional research.

Abstract: The chronic and progressive nature of multiple sclerosis (MS) often excludes patients from neuropsychological treatment. At the Multiple Sclerosis Rehabilitation Hospital, Haslev, 40 patients with mild to moderate cognitive and behavioral impairment associated with MS were randomized to either specific cognitive treatment (20 pts) by direct training, compensatory strategies and neuropsychotherapy, or to non-specific, deliberately diffuse mental stimulation (20 pts). Treatment was for a mean of 46 days. The effects of treatment were evaluated by neuropsychological tests before treatment, immediately after treatment (short-term effects) and 6 months later (long-term effects). After short-term treatment, effects on cognitive measures were not convincing, but on the Beck Depression Inventory (BDI) the specific cognitive treatment group reported significantly less depression. After 6 months only this group showed an effect, since the visuo-spatial memory was improved. However, the depression ratings (BDI) were almost maintained from the short-term level. Interestingly, the non-specific treatment group rated themselves as significantly more depressed. Conclusively, it is worth while to offer specific neuropsychological treatment to MS patients with cognitive and behavioral dysfunction.

Abstract: The researchers studied the effectiveness of a nursing intervention in promoting adjustment and symptom management in individuals with multiple sclerosis (MS). This was a 4-year longitudinal study to determine whether the 4-week intensive outpatient program was effective in increasing adjustment to MS and if the treatment effect would last over time. A sample of 27 individuals with MS participated in the study. Treatment participants had significant improvements in symptom management at the 4-year follow up. This improvement was attributable to signficant improvements in sleep and fatigue levels. Although adjustment and self-efficacy scores improved in the treatment group over time, this improvement was not superior to the control group. This was anticipated because the behavioral changes would precede improvement in adjustment to life following the diagnosis of MS.

The diversity of psychological interventions identified indicates the many ways in which they can potentially help people with MS. No definite conclusions can be made from this review. However there is reasonable evidence that cognitive behavioural approaches are beneficial in the treatment of depression, and in helping people adjust to, and cope with, having MS.