LLukas22/scidocs huggingface dataset:
Climate change impacts, vulnerability and adaptation in Zimbabwe

The IIED Climate Change Working Paper Series aims to improve and accelerate the public availability of the research undertaken by IIED and its partners. In line with the objectives of all climate change research undertaken by IIED, the IIED Climate Change Working Paper Series presents work that focuses on improving the capacity of the most vulnerable groups in developing countries to adapt to the impacts of climate change, and on ensuring the equitable distribution of benefits presented by climate-resilient low carbon development strategies. The series therefore covers issues of and relationships between governance, poverty, economics, equity and environment under a changing climate. The series is intended to present research in a preliminary form for feedback and discussion. Readers are encouraged to provide comments to the authors whose contact details are included in each publication. For guidelines on submission of papers to the series, see the inside back cover. This paper reviews impacts, vulnerability and adaptation to climate change in Zimbabwe, with the intention of providing a broad overview of the key issues related to climate change facing this particular country. It draws on a set of background papers that were produced by the Policy and Advocacy for Climate Change in Zimbabwe project funded by the UK Department for International Development (DfID) and implemented by IIED, the Zimbabwe Regional Environment Organisation (ZERO), and Dialogue on Shelter. These papers examine climate trends, scenarios and projections for Zimbabwe and draw upon a variety of case studies on adaptation projects (see Annex 1). This working paper highlights the main themes, findings and conclusions arising from these studies and examines their implications for future research and policy. While its primary relevance is for policy-makers, practitioners and researchers in Zimbabwe, it is anticipated that the general lessons are relevant for a broader set of countries that are dealing with similar environmental, demographic and institutional challenges, particularly in sub-Saharan Africa.
Cost Effectiveness of Budesonide/Formoterol for Maintenance and Reliever Therapy versus Salmeterol/ Fluticasone plus Salbutamol in the Treatment of Asthma

Introduction: Budesonide/formoterol (Symbicort®) Maintenance And Reliever Therapy (SMART) is an effective and well tolerated treatment option for patients with asthma. We compared the cost effectiveness from a societal perspective of this one-inhaler regimen with that of maintenance salmeterol/fluticasone propionate (Seretide®) plus salbutamol (albuterol) as needed (Seretide® Fixed Combination [SFC]). Study design: A cost-effectiveness analysis was performed based on effectiveness and resource-utilisation data collected prospectively in a randomised, 12-month study performed in 2143 patients in 16 countries. Resource utilisation data were pooled and unit costs (€, year 2003 values) from Italy, France, the UK and Germany were used to generate estimates of direct and total costs per patient per year and cost per severe exacerbation avoided. Methods: Adolescents and adults with asthma (n = 2143; mean forced expiratory volume in 1 second [FEV1] 73% predicted; mean inhaled corticosteroid [ICS] dose 884 µg/day) were randomised to SMART or SFC. The effectiveness measure used was the number of severe exacerbations per patient per year. Direct costs included medication use (budesonide/formoterol 160µg/4.5µg or salmeterol/fluticasone 50µg/100µg, 50µg/250µg or 50µg/500µg plus salbutamol) and nonmedication-related resource use, including days in hospital, emergency room visits, specialist or primary care physician visits and other healthcare provider contacts. Indirect costs, including the number of days when the patient or their carer was unable to attend to their normal daily activities, were also assessed. The study assumed a European societal perspective (i.e. including direct and indirect costs). Results: Treatment with SMART resulted in significantly fewer severe exacerbations per patient per year compared with SFC (0.24 vs 0.31 events per patient per year; p = 0.0025). Resource use was low in both groups. Medication costs accounted for the majority of the total costs. The increased effectiveness of SMART was achieved at a reduced or similar cost compared with SFC. SMART dominated when German unit costs were applied (i.e. there was a statistically significant reduction in both costs and number of exacerbations). In all other countries, the incremental cost-effectiveness ratios showed that there was a reduction in mean total cost per exacerbation avoided; however, this difference was not statistically significant. Conclusion: This analysis demonstrates that, compared with SFC, SMART may be cost effective from a societal perspective for the treatment of patients with asthma in Italy, Germany, France and the UK. SMART provided a reduction in the number of severe exacerbations per patient per year, at no statistically significant increase in cost — or even at a lower cost — compared with SFC plus as-needed reliever salbutamol.
The Economic Future of American Families: Income and Wealth Trends

Selected by Choiceas an Outstanding Academic Book of 1992. 
 
This major study addresses the important issue of widening inequality both between generations and among families within the younger generation. The combination of slowing income and growing wealth has hit young families with no college education harder than families with at least some college education, and black families harder than white families--trends that are projected to continue.
The feasibility of triple-drug chemotherapy combination in older adult patients with oesophagogastric cancer: a randomised trial of the Arbeitsgemeinschaft Internistische Onkologie (FLOT65+).

BACKGROUND
We evaluated the feasibility and tolerability of triple- versus double-drug chemotherapy in elderly patients with oesophagogastric cancer.


METHODS
Patients aged 65 years or older with locally advanced or metastatic oesophagogastric cancer were stratified and randomised to infusional 5-FU, leucovorin and oxaliplatin without (FLO) or with docetaxel 50 mg/m(2) (FLOT) every 2 weeks. The study is registered at ClinicalTrials.gov, identifier NCT00737373.


FINDINGS
One hundred and forty three (FLO, 71; FLOT, 72) patients with a median age of 70 years were enrolled. The triple combination was associated with more treatment-related National Cancer Institute Common Toxicity Criteria (NCI-CTC) grade 3/4 adverse events (FLOT, 81.9%; FLO, 38.6%; P<.001) and more patients experiencing a ≥10-points deterioration of European Organization for Research and Treatment of Cancer Quality of Life (EORTC QoL) global health status scores (FLOT, 47.5%; FLO 20.5%; p=.011). The triple combination was associated with more alopecia (P<.001), neutropenia (P<.001), leukopenia (P<.001), diarrhoea (P=.006) and nausea (P=.029).). No differences were observed in treatment duration and discontinuation due to toxicity, cumulative doses or toxic deaths between arms. The triple combination improved response rates and progression-free survival in the locally advanced subgroup and in the subgroup of patients aged between 65 and 70 years but not in the metastatic group or in patients aged 70 years and older.


INTERPRETATION
The triple-drug chemotherapy was feasible in elderly patients with oesophagogastric cancer. However, toxicity was significantly increased and QoL deteriorated in a relevant proportion of patients.


FUNDING
The study was partially funded by Sanofi-Aventis.
Ongoing myocardial damage relates to cardiac sympathetic nervous disintegrity in patients with heart failure.

UNLABELLED
Iodine-123-metaiodobenzylguanidine (123I-MIBG) has been used to assess the integrity and function of the cardiac sympathetic nervous system in patients with heart failure. Heart-type fatty acid binding protein (H-FABP) is released into the circulation when the myocardium is injured, and H-FABP has been recently used as a novel marker for the diagnosis of ongoing myocardial damage.


OBJECTIVE
The aim of the present study was to compare cardiac sympathetic nervous activity assessed by 123I-MIBG imaging with serum levels of H-FABP in patients with heart failure.


METHODS
Fifty patients with chronic heart failure were studied. 123I-MIBG imaging was carried out at 30 min (early) and 240 min (delayed) after the tracer injection. We measured serum levels of H-FABP using a sandwich enzyme linked immunosorbent assay.


RESULTS
Heart to mediastinum (H/M) ratios of 123I-MIBG decreased and washout rate increased with higher New York Heart Association (NYHA) functional class. H-FABP, norepinephrine and brain natriuretic peptide (BNP) levels increased as the severity of NYHA class advanced. Delayed H/M ratio was significantly correlated with H-FABP (r = -0.296, p = 0.029) and BNP (r = -0.335, p = 0.0213). Myocardial washout rate of 123I-MIBG was also correlated with H-FABP (r = 0.469, p < 0.001), norepinephrine (r = 0.433, p = 0.005), and BNP (r = 0.465, p = 0.001).


CONCLUSIONS
These data suggest that cardiac sympathetic nervous activation was associated with ongoing cardiomyocyte damage characterized by an elevated serum level of H-FABP in patients with heart failure. 123I-MIBG imaging is an appropriate approach to evaluate non-invasively not only cardiac sympathetic nervous activity, but also latent ongoing myocardial damage in the failing heart.
Effect of thoracic epidural analgesia on pro-inflammatory cytokines in patients subjected to protective lung ventilation during Ivor Lewis esophagectomy.

BACKGROUND
Thoracic epidural analgesia (TEA) has a well-known effect on neurohormonal response. Attenuation of stress response by post-operative epidural analgesia has shown beneficial effects such as lower pain scores and less immunological alterations.


OBJECTIVES
Investigation of the combined effects of TEA and protective lung ventilation on pro-inflammatory cytokines and patients' outcome after Ivor Lewis esophagectomy.


STUDY DESIGN
A randomized controlled study.


SETTING
Academic medical center.


METHODS
Thirty patients of the American Society of Anesthesiologists (ASA) I and II were randomly allocated into 2 groups: G1 (n = 15) patients received general anesthesia and were mechanically ventilated with 9 mL/kg during 2 lung ventilations, reduced to 5 mL/kg and 5cm H2O positive end expiratory pressure (PEEP) during one lung ventilation (OLV) or GII) (n = 15) patients received TEA and the same general anesthesia and mechanical ventilation used in G1. Assessment parameters included hemodynamics, pain severity, total analgesic consumption, and measurement of interleukins (IL) (IL-6 and IL-8) at baseline time after anesthetic induction (TBaseline,); at the end of the abdominal stage of the operation (TAbdo,); 15 minutes after initiation and at the end of OLV (TOLV 15) and (TOLV End) respectively; one and 20 hours after the end of the surgical procedure (TPostop1 and TPostop20), respectively, and patient's outcome also recorded.


RESULTS
There was a significant reduction in mean arterial blood pressure (MAP) and pulse rate in GII during the intraoperative period, at Tabdo, TOLV15, and TOLV End (P < 0.05). The mean of systolic blood pressure (SBP) values were significantly lower in GII over all 3 post-operative days (P = 0.001), and the mean diastolic blood pressure (DBP) showed a significant reduction in GII for 16 hours post-operatively (P = 0.001). The mean of heart rate values showed a significant reduction in GII over all 3 post-operative days in comparison to GI (P = 0.001). The mean resting and dynamic VAS scores were significantly reduced in GII at all time periods studied in comparison to G1 (P = 0.001). The daily PCA morphine consumption was markedly decreased in GII compared to GI in the first 3 days post-operatively (P = 0.001). There were significant reductions in blood level of IL-6 and IL-8 in GII compared to G1 over the entire study period (P < 0.05). There were no significant differences in post-operative adverse effects between the 2 groups (P > 0.05). The duration of stay in PACU was significantly decreased in GII (10 ± 2 days) compared to GI (15 ± 3 days) (P = 0.001).


LIMITATIONS
This study is limited by its sample size.


CONCLUSION
Our study concluded that TEA reduced the systemic pro-inflammatory response and provided optimal post-operative pain relief. Although there were no significant differences in adverse events, there was a trend towards improved outcome. Further clinical studies with larger numbers of patients are required.
Combining urinary detection of TMPRSS2:ERG and PCA3 with serum PSA to predict diagnosis of prostate cancer.

OBJECTIVES
We sought to develop a clinical algorithm combining serum PSA with detection of TMPRSS2:ERG fusion and PCA3 in urine collected after digital rectal exam (post-DRE urine) to predict prostate cancer on subsequent biopsy.


MATERIALS AND METHODS
Post-DRE urine was collected in 48 consecutive patients before prostate biopsy at 2 centers; quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was used to detect PCA3 and TMPRSS2:ERG fusion transcript expression. Serum PSA was measured by clinical assay. The performance of TMPRSS2:ERG fusion, PCA3, and serum PSA as biomarkers predicting prostate cancer at biopsy was measured; a clinically practical algorithm combining serum PSA with TMPRSS2:ERG and PCA3 in post-DRE urine to predict prostate cancer was developed.


RESULTS
Post-DRE urine sediment provided informative RNA in 45 patients; prostate cancer was present on subsequent biopsy in 15. TMPRSS2:ERG in post-DRE urine was associated with prostate cancer (OR = 12.02; P < 0.001). PCA3 had the highest sensitivity in predicting prostate cancer diagnosis (93%), whereas TMPRSS2:ERG had the highest specificity (87%). TMPRSS2:ERG had the greatest discriminatory value in predicting prostate cancer (AUC = 0.77 compared with 0.65 for PCA3 and 0.72 for serum PSA alone). Combining serum PSA, PCA3, and TMPRSS2:ERG in a multivariable algorithm optimized for clinical utility improved cancer prediction (AUC = 0.88; specificity = 90% at 80% sensitivity).


CONCLUSIONS
A clinical algorithm specifying biopsy for all patients with PSA ≥ 10 ng/ml, while restricting biopsy among those with PSA <10 ng/ml to only those with detectable PCA3 or TMPRSS2:ERG in post-DRE urine, performed better than the individual biomarkers alone in predicting prostate cancer.
ECOLOGICAL PROBLEMS OF THE DALINUOER LAKE

This paper generalized the ecological evolution of the Dalinuoer Lake and the problems existed at present, and put forward some suggestions on the conservation of ecological balance.
Effects of traditional Japanese massage therapy on various symptoms in patients with Parkinson's disease: a case-series study.

OBJECTIVES
Massage therapy is one of the most commonly used complementary therapies for patients with Parkinson's disease (PD). The aim of this preliminary study was to evaluate the effects of traditional Japanese massage therapy on various symptoms of patients with PD.


DESIGN
The study design was a case series study.


SETTING
The study was conducted at the Center for Integrative Medicine, Tsukuba University of Technology, Japan.


SUBJECTS
The subjects were 10 patients with idiopathic PD (mean age, 69.6±7.7 years; range, 55-85 years) who presented for consultation with a neurologist between February and April 2009 and who desired massage therapy in conjunction with standard pharmaceutical treatment.


INTERVENTION
The intervention comprised a 30-minute session of traditional Japanese massage in conjunction with standard conventional medication.


OUTCOME MEASURES
The outcome measures were as follows: Gait speed in the 20-m walk test (10-m walk and return) for gait disturbance, angular range of shoulder joint motion for frozen shoulder, and a visual analogue scale (VAS) for assessing the severity of each of various symptoms (hypophonia, shoulder stiffness, muscle pain, heaviness or lassitude of a body part, and fatigue), as determined before and after the massage session.


RESULTS
(1) Patients with gait disturbance showed improved gait speed, (2) those with frozen shoulder showed improved range of motion of the shoulder joint, and (3) VAS scores for assessing the severity of other subjective symptoms were improved.


CONCLUSIONS
These results suggest that traditional Japanese massage therapy used in combination with medication is effective for alleviating various symptoms in patients with PD and may contribute to enhancing their health-related quality of life. Larger studies with a control group are required to verify these findings.
Evaluation of a self-efficacy enhancement program to prevent pressure ulcers in patients with a spinal cord injury.

AIM
This study developed a self-efficacy enhancement program and evaluated its effects on the self-care behaviors, self-care knowledge, and self-efficacy regarding pressure ulcer prevention in patients with a spinal cord injury.


METHODS
This was a multicenter randomized controlled trial. Six hospitals were invited to recruit patients with a spinal cord injury who were undergoing rehabilitation after receiving acute treatment. These hospitals were randomly allocated into experimental (three hospitals) or control (three hospitals) groups and 47 patients participated (24 in the experimental group and 23 in the control group). The experimental group was given an 8 week self-efficacy enhancement program for pressure ulcer prevention. The self-efficacy enhancement program consisted of small-group face-to-face intervention (education and skills training), education with computer animation, phone counseling, face-to-face counseling, and self-management records. The control group only received a pressure ulcer prevention information booklet. Self-care knowledge, self-efficacy, self-care behaviors, and pressure ulcer incidence were measured at baseline and after the 8 week self-efficacy enhancement program.


RESULTS
The experimental group showed a significantly greater improvement in self-care knowledge, self-efficacy, and self-care behaviors for pressure ulcer prevention than did the control group. One participant in the control group developed a pressure ulcer, while none of the participants in the experimental group developed a pressure ulcer; this difference was not statistically significant.


CONCLUSIONS
The self-efficacy enhancement program enabled patients with a spinal cord injury to engage in continued self-care behaviors and helped them to improve their knowledge and self-efficacy concerning pressure ulcer prevention.
Influence of glacial cycles and tectonics on natural subsidence in the Po Plain (Northern Italy): Insights from 14C ages

[1] Samples rich in organic matter were collected from boreholes in the southern part of the Po Plain (Italy), a rapidly subsiding sedimentary basin. New 14C dates, obtained from these samples, and 14C data from the literature allowed for the evaluation of the rates of natural subsidence in the area. These range from 0 to 5 mm/yr. Most areas show rates around 1 and 2 mm/yr. The obtained subsidence rates are comparable with burial rates obtained from archaeological data. These data are interpreted in terms of long-term (related to tectonics and geodynamics) and short-term (glacial cycle) processes. It is concluded that approximately 50% of the subsidence rates are related to tectonics, geodynamics and sediment load/compaction while the other half is controlled by ice melting. The effects of the glacial cycle through time are discussed. It is shown that the southeastern Po Plain generally behaves as a far-field area in relation to the high-latitude ice caps. Deviations from this behavior observed in the northeastern part of the Po Plain are tentatively interpreted as the effects of ice formation and melting in the Alps during the last glacial cycle.
Erythropoietin therapy, hemoglobin targets, and quality of life in healthy hemodialysis patients: a randomized trial.

BACKGROUND AND OBJECTIVES
The effects of different hemoglobin targets when using erythropoiesis-stimulating agents on quality of life are somewhat controversial, and predictors of change in quality of life in endstage renal disease have not been well characterized.


DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
Five hundred ninety-six incident hemodialysis patients without symptomatic cardiac disease were randomly assigned to hemoglobin targets of 9.5 to 11.5 g/dl or 13.5 to 14.5 g/dl for 96 weeks, using epoetin_alfa as primary therapy. Patients and attending physicians were masked to treatment assignment. Quality of life, a secondary outcome, was prospectively recorded using the Kidney Disease Quality of Life (KDQoL) questionnaire at weeks 0, 24, 36, 48, 60, 72, 84, and 96, with prespecified outcomes being fatigue and quality of social interaction.


RESULTS
The mean age and prior duration of dialysis therapy of the study population were 50.8 and 0.8 yr. Mortality was low, reflecting the relatively healthy group enrolled. Of 20 domains within the KDQoL only the prespecified domain of fatigue showed significant change over time between the two groups. Improvement in fatigue scores in the high-target group ranged from 3.2 to 7.9 over time (P = 0.007) compared with change in the low-target group. Higher body mass index and lower erythropoietin dose at baseline were independent predictors of improvement in multiple KDQoL domains.


CONCLUSIONS
In relatively healthy hemodialysis patients, normal hemoglobin targets may have beneficial effects on fatigue. Improvement in multiple domains of quality of life is associated with higher body mass index and lower erythropoietin requirements.
Interobserver agreement in describing video capsule endoscopy findings: a multicentre prospective study.

BACKGROUND AND AIM
Few studies have specifically addressed interobserver agreement in describing lesions identified during capsule endoscopy. The aim of our study is to evaluate interobserver agreement in the description of capsule endoscopy findings.


MATERIALS AND METHODS
Consecutive short segments of capsule endoscopy were prospectively observed by 8 investigators. Seventy-five videos were prepared by an external investigator (gold standard). The description of the findings was reported by the investigators using the same validated and standardized capsule endoscopy structured terminology. The agreement was assessed using Cohen's kappa statistic.


RESULTS
As concerns the ability to detect a lesion, the agreement with the gold standard was moderate (kappa 0.48), as well as the agreement relating to the final diagnosis (κ 0.45). The best agreement was observed in identifying the presence of active bleeding (κ 0.72), whereas the poorest agreement concerned the lesion size (κ 0.32). The agreement with the GS was significantly better in endoscopists with higher case/volume of capsule endoscopy per year. Diagnostic concordance was better in the presence of angiectasia than in the presence of polyps or ulcers/erosions.


CONCLUSIONS
Correct lesion identification and diagnosis seem more likely to occur in presence of angiectasia, and for readers with more experience in capsule endoscopy reading.
Application of using Hybrid Renewable Energy in Saudi Arabia

One of the major world wide concerns of the utilities is to reduce the emissions from traditional power plants by using renewable energy and to reduce the high cost of supplying electricity to remote areas. Hybrid power systems can provide a good solution for such problems because they integrate renewable energy along with the traditional power plants. In Kingdom of Saudi Arabia a remote village called Al-Qtqt, was selected as a case study in order to investigate the ability to use a hybrid power system to provide the village with its needs of electricity. The simulation of this hybrid power system was done using HOMER software. Keywordshybrid, renewable energy, HOMER, photovoltaic, wind energy