Miracle-dz/UniFAR-FTUs huggingface dataset:
The Implications of Regional Variations in Medicare Spending: The Content, Quality, and Accessibility of Care

What is the problem and what is known about it so far? Medicare is the public health insurance program for Americans over age 65. Medicare spending in different geographic regions of the United States varies widely. For example, in 1996, the average spending for each Medicare patient was $8414 in Miami and $3441 in Minneapolis. Reasons for this variation include regional differences in prices, in general health, and in the amount of health care services that patients and doctors use. If higher health care spending in a region led to healthier and more satisfied patients, we might think that the money was well spent. If higher spending did not result in these benefits, we would worry about waste. Why did the researchers do this particular study? To see whether Medicare patients who live in regions that spend more on Medicare receive better-quality care. Who was studied? Using national Medicare data, the researchers studied 614,503 patients hospitalized for hip fracture, 195,429 patients hospitalized for colon cancer, and 159,393 patients hospitalized for heart attacks during 19931995. In addition, the authors studied 18,190 typical Medicare patients who had completed a survey. How was the study done? The researchers divided the United States into 306 regions based on where people go for hospital care. They then calculated how much the Medicare program spent during the last 6 months of life for people who died in each region during July 1994December 1997. Next, they divided the 306 regions into five groups according to the spending levels. The researchers used end-of-life spending as a measure of general Medicare spending. The researchers then looked at the type of services used, the quality of care, and the access to care across regions of different Medicare spending levels. What did the researchers find? For the four patient groups, measures of health were similar across the five spending levels. However, those who lived in high-spending regions had 60% more care (mostly due to more frequent doctor visits, tests, and minor procedures and more specialist and hospital care) than those who lived in low-spending regions. Yet the researchers found no evidence of better quality of care, better access to care, or better patient satisfaction in high-spending regions. In fact, patients in the highest-spending regions received some preventive services less often than patients in lower-spending regions. What were the limitations of the study? The researchers looked at a limited number of patient groups and a limited number of measures of quality and access to care. It is possible that quality of care and access might be better for other conditions or for other measures. What are the implications of the study? Medicare patients who live in areas that spend more on Medicare do not necessarily get better care than those who live in regions that spend less.
Developmental Regulation of Placental Insulin-Like Growth Factor (IGF)-II and IGF-Binding Protein-1 and -2 Messenger RNA Expression During Primate Pregnancy1

Abstract The present study was conducted to determine the developmental expression of placental insulin-like growth factor (IGF)-II, IGF-binding protein (IGFBP)-1 and -2, and IGF-II receptor mRNA expression during baboon pregnancy and whether estrogen, the levels of which increase with advancing pregnancy, regulates placental trophoblast IGF-II mRNA expression. Levels of the IGF-II 6.1-kilobase (kb) and 4.9-kb mRNA transcripts determined by Northern blot analysis progressively increased three- to fourfold in placental syncytiotrophoblast and whole-villous tissue between early (Day 60), mid (Day 100), and late (Day 170) baboon gestation (term = 184 days). In contrast, syncytiotrophoblast IGFBP-1 and -2 mRNA levels decreased, and IGF-II receptor mRNA expression remained relatively constant, with advancing baboon pregnancy. Placental cytotrophoblast IGF-II mRNA levels determined by competitive reverse transcription-polymerase chain reaction on Day 54 of gestation were increased (P < 0.05) almost twofold at 18 h after acute administration of estradiol to baboons, whereas long-term estrogen treatment had no effect. We propose that these changes in trophoblast IGF expression would provide a mechanism for enhancing net bioavailability and bioreactivity of IGF-II locally to promote the growth and development of the placenta and, consequently, of the fetus during primate pregnancy.
Debilitating Lung Disease Among Surface Coal Miners With No Underground Mining Tenure

Objective: To characterize exposure histories and respiratory disease among surface coal miners identified with progressive massive fibrosis from a 2010 to 2011 pneumoconiosis survey. Methods: Job history, tenure, and radiograph interpretations were verified. Previous radiographs were reviewed when available. Telephone follow-up sought additional work and medical history information. Results: Among eight miners who worked as drill operators or blasters for most of their tenure (median, 35.5 years), two reported poor dust control practices, working in visible dust clouds as recently as 2012. Chest radiographs progressed to progressive massive fibrosis in as few as 11 years. One miner's lung biopsy demonstrated fibrosis and interstitial accumulation of macrophages containing abundant silica, aluminum silicate, and titanium dust particles. Conclusions: Overexposure to respirable silica resulted in progressive massive fibrosis among current surface coal miners with no underground mining tenure. Inadequate dust control during drilling/blasting is likely an important etiologic factor.
Occult hepatitis B virus infection in HBs antigen‐negative hepatocellular carcinoma in a Japanese population: Involvement of HBx and p53

Hepatitis B virus (HBV) genome was reported to be detected in serum or liver tissues in hepatocellular carcinoma (HCC) patients negative for hepatitis B surface antigen (HBsAg). Hepatitis B × (HBx) and p53 protein were reported to play an important role in HBV‐related hepatocarcinogenesis. To clarify latent HBV infection in HBsAg‐ and anti‐hepatitis C virus (anti‐HCV)‐negative HCC in a Japanese population and involvement of HBx and p53 protein in these patients, we performed the sensitive and specific nested polymerase chain reaction (PCR) and immunohistochemical analysis. Of 1,024 HCC patients we saw between 1974 and 1998, 66 (6.4%) were negative for HBsAg and anti‐HCV. Serum DNA was amplified by nested PCR by using specific primers of surface (S), core (C) and X regions in 26 patients negative for HBsAg and anti‐HCV. Eighteen (69%) patients were positive for either S, C, or X region and the results of PCR were confirmed by Southern blotting. Of 18 PCR‐positive patients, 3 were positive for anti‐HBs and 9 were positive for anti‐HBc, however, one was negative for any HBV markers. In HBsAg‐negative and PCR‐positive patients, the positive rates of expression of HBx and p53 were 8/13 (62%) and 7/13 (54%), being comparable to those in HBsAg‐positive HCC patients. The results of the present study suggest that high prevalence of HBV infection is observed in HBsAg‐negative HCC in a Japanese population and expression of HBx and p53 is consistent with a role, in these patients, for the transforming ability of these proteins. J. Med. Virol. 62:151–158, 2000. © 2000 Wiley‐Liss, Inc.
Fatal residential fires: who dies and who survives?

CONTEXT The United States has one of the highest fire fatality rates in the developed world, and three quarters of these deaths are in residential fires. OBJECTIVE To compare characteristics of those who die and those who survive in the same residential fire. DESIGN Data on fatal residential fires were collected from the medical examiner and interviews with local fire officials. SETTING North Carolina. SUBJECTS Persons in residential fires with at least 1 fatality in a 1-year period. MAIN OUTCOME MEASURE Dying vs surviving a fatal residential fire that occurred with more than 1 person at home. RESULTS Of the 190 decedents, 124 (65%) were male, 78 (41%) were home alone, and 69 (53%) of 130 adults who had blood alcohol measured were intoxicated (blood alcohol content >22 mmol/L [100 mg/dL]). Of the 254 persons present during fires in which more than 1 person was at home, 112 died. Individuals more likely to die (high-vulnerability group) were younger than 5 years or 64 years or older, had a physical or cognitive disability, or were impaired by alcohol or other drugs (risk of death for group, odds ratio [OR], 4.01; 95% confidence interval [CI], 2.29-7.03). The presence of an adult with no physical or cognitive disabilities who was unimpaired by alcohol or other drugs (a potential rescuer) reduced the risk of death in the high-vulnerability group (OR, 0.49; 95% CI, 0.24-0.99) but not the low-vulnerability group. Overall, a functioning smoke detector lowered the risk of death (OR, 0.39; 95% CI, 0.18-0.83). CONCLUSIONS Smoke detectors were equally effective in both low- and high-vulnerability populations. The high-vulnerability group was more likely to survive if, in addition to a smoke detector, a potential rescuer was present. Further research should seek to identify prompts that facilitate speedy egress from a burning structure and that can be incorporated into residential fire alarm systems.
In vivo fundus autofluorescence in macular dystrophies.

OBJECTIVE To document the deviation from normal of fundus autofluorescence in patients with inherited macular dystrophies. METHODS The intensity and spatial distribution of fundus autofluorescence was documented in 118 patients with inherited macular dystrophies by means of a confocal laser scanning ophthalmoscope, and the images were compared with the fundus appearance and fluorescein angiograms. RESULTS Background autofluorescence appears to be elevated in all forms of macular dystrophies examined. The pale deposits at the level of the retinal pigment epithelium in disorders such as Best disease, adult vitelliform macular dystrophy, and fundus flavimaculatus were consistently associated with higher levels of autofluorescence than the background signal. There was no strong correlation between the intensity of autofluorescence and the fluorescein angiographic sign of a dark choroid. Increased levels of autofluorescence were present in a subject with a mutation known to cause macular dystrophy but in whom there were no manifest ophthalmoscopic or functional abnormalities. CONCLUSIONS All dystrophies examined have in common accumulation of autofluorescent material in the retinal pigment epithelium to a greater degree than that seen with age. The abnormal high background autofluorescence associated with inherited macular dystrophies confirms the impression derived from histological studies that these disorders affect the entire retinal pigment epithelium. The lack of correlation between autofluorescence and the presence of a dark choroid implies that there may be different fluorophores in different disorders. The pale deposits at the level of the retinal pigment epithelium-Bruch membrane seen in macular dystrophies have similar autofluorescence characteristics. This technique may be useful in detecting the abnormal phenotype in early disease.
Genetics of murine craniofacial morphology: diallel analysis of the eight founders of the Collaborative Cross

Using eight inbred founder strains of the mouse Collaborative Cross (CC) project and their reciprocal F1 hybrids, we quantified variation in craniofacial morphology across mouse strains, explored genetic contributions to craniofacial variation that distinguish the founder strains, and tested whether specific or summary measures of craniofacial shape display stronger additive genetic contributions. This study thus provides critical information about phenotypic diversity among CC founder strains and about the genetic contributions to this phenotypic diversity, which is relevant to understanding the basis of variation in standard laboratory strains and natural populations. Craniofacial shape was quantified as a series of size‐adjusted linear dimensions (RDs) and by principal components (PC) analysis of morphological landmarks captured from computed tomography images from 62 of the 64 reciprocal crosses of the CC founder strains. We first identified aspects of skull morphology that vary between these phenotypically ‘normal’ founder strains and that are defining characteristics of these strains. We estimated the contributions of additive and various non‐additive genetic factors to phenotypic variation using diallel analyses of a subset of these strongly differing RDs and the first eight PCs of skull shape variation. We find little difference in the genetic contributions to RD measures and PC scores, suggesting fundamental similarities in the magnitude of genetic contributions to both specific and summary measures of craniofacial phenotypes. Our results indicate that there are stronger additive genetic effects associated with defining phenotypic characteristics of specific founder strains, suggesting these distinguishing measures are good candidates for use in genotype–phenotype association studies of CC mice. Our results add significantly to understanding of genotype–phenotype associations in the skull, which serve as a foundation for modeling the origins of medically and evolutionarily relevant variation.
Serglycin Is Essential for Maturation of Mast Cell Secretory Granule*

To address the biological function of the scarcely studied intracellular proteoglycans, we targeted the gene for serglycin (SG), the only known committed intracellular proteoglycan. SG-/- mice developed normally and were fertile, but their mast cells (MCs) were severely affected. In peritoneum there was a complete absence of normal granulated MCs. Furthermore, peritoneal cells and ear tissue from SG-/- animals were devoid of the various MC-specific proteases. However, mRNA for the proteases was present in SG+/+, SG+/-, and SG-/- tissues, indicating that SG is essential for the storage, but not expression, of the MC proteases. Experiments, in which the differentiation of bone marrow stem cells into mature MCs was followed, showed that secretory granule maturation was compromised in SG-/- cells. Moreover, SG+/+ and SG+/- cells, but not SG-/- cells, synthesized proteoglycans of high anionic charge density. Taken together, we demonstrate a key role for SG proteoglycan in MC function.
Subjective Probabilities on Subjectively Unambiguous Events

This paper suggests a behavioral definition of (subjective) ambiguity in an abstract setting where objects of choice are Savage-style acts. Then axioms are described that deliver probabilistic sophistication of preference on the set of unambiguous acts. In particular, both the domain and the values of the decision-maker's probability measure are derived from preference. It is argued that the noted result also provides a decision-theoretic foundation for the Knightian distinction between risk and ambiguity.
Prenatal substance exposure: What predicts behavioral resilience by early adolescence?

Understanding behavioral resilience among at-risk adolescents may guide public policy decisions and future programs. We examined factors predicting behavioral resilience following intrauterine substance exposure in a prospective longitudinal birth-cohort study of 136 early adolescents (ages 12.4-15.9 years) at risk for poor behavioral outcomes. We defined behavioral resilience as a composite measure of lack of early substance use initiation (before age 14), lack of risky sexual behavior, or lack of delinquency. Intrauterine substance exposures included in this analysis were cocaine, tobacco, alcohol, and marijuana. We recruited participants from Boston Medical Center as mother-infant dyads between 1990 and 1993. The majority of the sample was African American/Caribbean (88%) and 49% female. In bivariate analyses, none and lower intrauterine cocaine exposure level predicted resilience compared with higher cocaine exposure, but this effect was not found in an adjusted model. Instead, strict caregiver supervision (adjusted odds ratio [AOR] = 6.02, 95% confidence interval (CI) [1.90, 19.00], p = . 002), lower violence exposure (AOR = 4.07, 95% CI [1.77, 9.38], p < .001), and absence of intrauterine tobacco exposure (AOR = 3.71, 95% CI [1.28, 10.74], p = .02) predicted behavioral resilience. In conclusion, caregiver supervision in early adolescence, lower violence exposure in childhood, and lack of intrauterine tobacco exposure predicted behavioral resilience among a cohort of early adolescents with significant social and environmental risk. Future interventions should work to enhance parental supervision as a way to mitigate the effects of adversity on high-risk groups of adolescents. (PsycINFO Database Record
Environmental correlates of physical activity in youth – a review and update

Obesogenic environments are thought to underlie the increased obesity prevalence observed in youth during the past decades. Understanding the environmental factors that are associated with physical activity (PA) in youth is needed to better inform the development of effective intervention strategies attempting to halt the obesity epidemic. We conducted a systematic semi‐quantitative review of 150 studies on environmental correlates of youth PA published in the past 25 years. The ANalysis Grid for Environments Linked to Obesity (ANGELO) framework was used to classify the environmental correlates studied. Most studies retrieved used cross‐sectional designs and subjective measures of environmental factors and PA. Variables of the home and school environments were especially associated with children’s PA. Most consistent positive correlates of PA were father’s PA, time spent outdoors and school PA‐related policies (in children), and support from significant others, mother’s education level, family income, and non‐vocational school attendance (in adolescents). Low crime incidence (in adolescents) was characteristic of the neighbourhood environment associated with higher PA. Convincing evidence of an important role for many other environmental factors was, however, not found. Further research should aim at longitudinal and intervention studies, and use more objective measures of PA and its potential (environmental) determinants.
The impact of obesity on female reproductive function

Obesity may be described as the new worldwide epidemic, and its serious impact on morbidity and mortality are well known. As more and more women become obese, the reproductive problems associated with obesity present an ever‐growing challenge to physicians involved in their fertility care. The spectrum of reproductive problems associated with obesity encompasses a wide range of disorders including infertility problems, miscarriage and pregnancy complications. In this review, we aim to discuss the impact of obesity on the various aspects of female reproductive function with focus on the clinical aspects of fertility problems in obese women. We finally comment on the available therapeutic options available to this group of women.
Automatic Sex-Liking and Sex-Failure Associations in Men With Sexual Dysfunction

Current models of sexual functioning imply an important role for both automatic and controlled appraisals. Accordingly, it can be hypothesized that erectile dysfunction may be due to the automatic activation of negative appraisals at the prospect of sexual intercourse. However, previous research showed that men with sexual dysfunction exhibited relatively strong automatic sex-positive instead of sex-negative associations. This study tested the robustness of this unexpected finding and, additionally, examined the hypothesis that perhaps more specific sex-failure versus sex-success associations are relevant in explaining sexual dysfunction and distress. Male urological patients (N = 70), varying in level of sexual functioning and distress, performed two Single-Target Implicit Association Tests (ST-IATs) to assess automatic associations of visual erotic stimuli with attributes representing affective valence (“liking”; positive versus negative) and sexual success versus sexual failure. Consistent with the earlier findings, the lower the scores on sexual functioning, the stronger the automatic sex-positive associations. This association was independent of explicit associations and most prominent in the younger age group. Automatic sex-positive and sex-failure associations showed independent relationships with sexual distress. The relationship between sexual distress and sex-failure associations is consistent with the view that automatic associations with failure may contribute to sexual distress.
Lineal energy and radiation quality in radiation therapy: model calculations and comparison with experiment

Microdosimetry is a recommended method for characterizing radiation quality in situations when the biological effectiveness under test is not well known. In such situations, the radiation beams are described by their lineal energy probability distributions. Results from radiobiological investigations in the beams are then used to establish response functions that relate the lineal energy to the relative biological effectiveness (RBE). In this paper we present the influence of the size of the simulated volume on the relation to the clinical RBE values (or weighting factors). A single event probability distribution of the lineal energy is approximated by its dose average lineal energy () which can be measured or calculated for volumes from a few micrometres down to a few nanometres. The clinical RBE values were approximated as the ratio of the α-values derived from the LQ-relation. Model calculations are presented and discussed for the SOBP of a 12C ion (290 MeV u−1) and the reference 60Co γ therapy beam. Results were compared with those for a conventional x-ray therapy beam, a 290 MeV proton beam and a neutron therapy beam. It is concluded that for a simulated volume of about 10 nm, the α-ratio increases approximately linearly with the -ratio for all the investigated beams. The correlation between y and α provides the evidence to characterize a radiation therapy beam by the lineal energy when, for instance, weighting factors are to be estimated.
What Matters Most? Assessing the Influence of Demographic Characteristics, College-Specific Risk Factors, and Poly-drug Use on Nonmedical Prescription Drug Use

Abstract Objective: Although prior recent research has revealed a significant relationship between the nonmedical use of prescription drugs, demographic characteristics, college-specific risk factors, and other substance use among college students, there remains a need to conduct a comparative analysis on the differential impact these factors may have on predicting nonmedical prescription drug use. Participants and Methods: In 2008 a convenience sample of 599 undergraduate students attending a southeastern university completed a self-report survey measuring substance use behaviors. Results: Males, Greeks, and freshman were more likely than females, non-Greeks, and upperclassman to use nonmedical prescription drugs in the past year. Multivariate analyses, however, indicate that the excessive use of alcohol and other illicit drugs are more influential than demographic and college-specific risk factors. Conclusion: Poly-drug use was found to be the most significant predictor of the use of nonmedical prescription drugs as compared to demographic and college-specific risk factors.
Infections and Organ Transplantation: New Challenges for Prevention and Treatment—A Colloquium

Paolo A. Grossi, Alessandro Nanni Costa, Deirdre Fehily, Emily A. Blumberg, Matthew J. Kuehnert, Jay A. Fishman, Michael G. Ison, Roberta Lattes, Camille N. Kotton, Daniele Lilleri, Anne Kabanova, Antonio Lanzavecchia, Giuseppi Gerna, Raymund R. Razonable, Patrizia Comoli, Marco Zecca, Sabrina Basso, Fabrizio Ginevri, Alessandra Grossi, Francesco P. Schena, Antoni Rimola, Patrizia Burra, Elenora De Martin, Kryssia Isabel Rodriguez-Castro, Stefano Fagiuoli, Luisa Pasulo, Raffaele Bruno, Pietro Andreone, Elisabetta Loggi, Fabio Arena, Gian Maria Rossolini, Gabriele Sganga, and Valerio Cozza