Miracle-dz/UniFAR-FTUs huggingface dataset:
Security and skills: the two key issues in health worker migration

Background Migration of health workers from Africa continues to undermine the universal provision of quality health care. South Africa is an epicentre for migration – it exports more health workers to high-income countries than any other African country and imports health workers from its lower-income neighbours to fill the gap. Although an inter-governmental agreement in 2003 reduced the very high numbers migrating from South Africa to the United Kingdom, migration continues to other high-income English-speaking countries and few workers seem to return although the financial incentive to work abroad has lessened. A deeper understanding of reasons for migration from South Africa and post-migration experiences is therefore needed to underpin policy which is developed in order to improve retention within source countries and encourage return. Methods Semi-structured interviews were conducted with 16 South African doctors and nurses who had migrated to the United Kingdom. Interviews explored factors influencing the decision to migrate and post-migration experiences. Results Salary, career progression, and poor working conditions were not major push factors for migration. Many health workers reported that they had previously overcome these issues within the South African healthcare system by migrating to the private sector. Overwhelmingly, the major push factors were insecurity, high levels of crime, and racial tension. Although the wish to work and train in what was perceived to be a first-class care system was a pull factor to migrate to the United Kingdom, many were disappointed by the experience. Instead of obtaining new skills, many (particularly nurses) felt they had become ‘de-skilled’. Many also felt that working conditions and opportunities for them in the UK National Health Service (NHS) compared unfavourably with the private sector in South Africa. Conclusions Migration from South Africa seems unlikely to diminish until the major concerns over security, crime, and racial tensions are resolved. However, good working conditions in the private sector in South Africa provide an occupational incentive to return if security did improve. Potential migrants should be made more aware of the risks of losing skills while working abroad that might prejudice return. In addition, re-skilling initiatives should be encouraged.
Differing Reports of Asthma Symptoms in African Americans and Caucasians

Objective. This pilot study explores the reported symptoms in African Americans and Caucasians with asthma. Methods. Asthma patients in an inner-city pulmonary clinic were given a brief questionnaire of asthma symptoms and the BORG scale, followed by spirometry. Results. African Americans were less likely to report nocturnal awakenings (67% vs. 100%; p = 0.037), complain of dyspnea (33% vs. 75%; p = 0.038), or experience chest pain (13% vs. 75%; p = 0.002) than Caucasians. Conclusions. This is the first study to demonstrate that there are clinically significant differences in the reporting of asthma symptoms between African Americans and Caucasians.
Clinical manifestations of Campylobacter jejuni infection in adolescents and adults, and change in antibiotic resistance of the pathogen over the past 16 years

Abstract Background: Campylobacter jejuni infection, traditionally a paediatric illness, is now seen more frequently in adolescents and adults in northern China. Published surveillance reports on C. jejuni infection in these patients are rare. We aimed to characterize (1) the clinical manifestations of this infection in adolescents and adults, and (2) changes in antibiotic resistance of the pathogen. Methods: We retrospectively examined 492 cases of C. jejuni infection in patients aged ≥ 14 y treated at the Peking University First Hospital, Beijing, China, for the period January 1994 to December 2010. Results: The disease was more common in patients aged 14–24 y and in men (57.9%; p < 0.0001 vs women). The peak incidence was seen between May and October. The infection manifested with acute diarrhoea (< 10 bowel movements per day, loose or mucous stool), fever (mostly low grade), and abdominal cramps and pain. Faecal leukocytes and erythrocytes were demonstrated in, respectively, 90.9% and 79.3% of stool specimens, while leukocytes > 10 per high-power field were detected in 70.3%. In 1994–1998, 44.5% of C. jejuni strains were resistant to fluoroquinolone, 0% to gentamicin, and 0% to cefuroxime; in 2005–2010, resistance increased significantly to 97.9%, 16.7%, and 93.0%, respectively (p < 0.0001). The resistance to erythromycin did not change significantly (3% vs 6.4%, p = 0.4). Conclusions: Manifestations of C. jejuni infection in adolescent and adult patients are similar to those in children. Over the 16-y study period, resistance of C. jejuni to fluoroquinolones, gentamicin, and cefuroxime significantly increased.
Vascular Influences of Calcium Supplementation and Vitamin D–Induced Hypercalcemia in NaCl‐Hypertensive Rats

&NA; This 8‐week study investigated the effects of increasing dietary Ca2+ content from 1.0% to 3.0% and hypercalcemia induced by oral 1&agr;‐OH vitamin D3 (1OH‐D3, 1.2 &mgr;g/kg), on arterial tone in NaCl‐hypertensive rats. The high‐Ca2+ diet completely prevented the increase in blood pressure induced by the 6.0% NaCl chow, while plasma total Ca2+ and body weight were not different from controls. The 1OH‐D3 treatment moderately elevated plasma total Ca2+ and attenuated the NaCl‐induced rise in blood pressure, but also impaired weight gain. The tone of isolated mesenteric arterial rings was examined at the end of study. The endothelium‐independent relaxations to nitroprusside, isoproterenol, and cromakalim were impaired in NaCl‐hypertension. Experiments with NG‐nitro‐l‐arginine methyl ester and tetraethylammonium in vitro suggested that both the nitric oxide‐ and hyperpolarization‐mediated components of endothelium‐dependent relaxation to acetylcholine were reduced in NaCl‐hypertensive rats. All of the impaired relaxations in NaCl hypertension were normalized by concomitant Ca2+ supplementation. The 1OH‐D3 treatment did not affect vascular relaxation, but it attenuated maximal contractile responses induced by norepinephrine and KCl by more than 50%. The reduced vasoconstrictor responses could not be explained by increased apoptosis in the vessel wall, but calcification may have played a role, since moderate signs of medial or adventitial calcification were observed in the aortic preparations after the 1OH‐D3 treatment. In conclusion, a high‐Ca2+ diet, which did not cause hypercalcemia, normalized blood pressure and endothelium‐dependent and endothelium‐independent vasorelaxation in NaCl‐hypertensive rats. In contrast, chronic hypercalcemia induced by 1OH‐D3 was associated with moderately lowered blood pressure, possibly because of reduced vasoconstrictor responses in arterial smooth muscle.
An analysis of malaria in pregnancy in Africa.

This article summarizes information and specific evidence regarding the epidemiology of malaria in pregnancy in Africa. Malaria infection is more frequent and severe in primigravidae both during pregnancy and at the time of delivery. A study of pregnant women living under holoendemic conditions in western Kenya showed that the peak prevalence of infection in primigravidae (85.7%) and multigravidae (51.7%) occurred at 13-16 weeks gestation. There were a similar number of recoveries in both groups during the 2nd and 3rd trimesters. The loss of immunity in early pregnancy was equivalent to an 11-fold decrease in the rate of recovery from infection. The recovery seen in late pregnancy suggests that the women mount a satisfactory immune response to malaria infection, reacquiring their prepregnancy immune status at about the time of delivery. The pattern of infection in pregnancy is comparable to that observed in infants and children. What the child achieves over several years, the mother reachieves in 9 months; the pattern is repeated in successive pregnancies. The practical implications of this pattern of malaria in pregnancy are discussed.
A classification scheme for childhood cancer

A classification scheme for childhood cancer We welcome the class8cation proposed by Birch and Marsden (1987) for childhood tumours. For presentation of cancer registry statistics another potentially useful standard classification is the WHO-sponsored International Classification of Tumours (IHCT), the well-known “blue books”. From 1978 WHO has published International Classification of Diseases for Oncology (ICD-0) codes corresponding to each entity in the IHCT. Unfortunately, only one ICD-0 code is given for each entity, but of course other codes (corresponding to terms used in other classifications) might quite reasonably be applied to the same tumour. In fact, during 1983 in the names Cancer Registry (TCR), 38 ICD-0 codes were applied to breast carcinoma registrations. Only 8 of these belonged to the set of 16 codes that are recognized for breast carcinomas by IHCT. As a result, we could not, strictly speaking, publish a histological breakdown using IHCT for 60% of the breast carcinoma cases. Clearly this state of affairs is unsatisfactory and a more generally applicable classification is desirable-preferably one which: (a) minimizes transfers between ICD-0 chapters; (b) maintains fairly large categories (in order to reduce the effects of diagnostic transfer); (c) makes reasonable sense histogenetically; and (d) is relevant to aetiology, age, sex or prognosis. We too have devised a classiJication system based on the ICD-0, although ours is intended mainly for adults. At present we are evaluating its use as a tool for exploring our data set, but we hope to use it also as a basis for presenting Cancer Registration statistics in due course-supplemented when appropriate by other ICD-0-linked classifications such as the National Cancer Institute’s Working Formulation of Non-Hodgkin ’s Lymphomas (Rosenberg, 1982). Our classification is presented in Table I. It should be understood that for each site, we would not present a breakdown of histological types in exactly this form. Rather, we use it as a ffamework from which we derive a more condensed Table, the entries in which may vary according to the tumour site and the data quality. We would welcome comments and suggestions towards producing a simple, standard histological classification for Cancer Registries which will, like the simplified staging scheme proposed by MacLennan et al. (1978), enable a mass of hitherto indigestible data to be summarized and provide a useful instrument for epidemiologists and clinicians alike. However, no standard histological class8cation will be of use i f histological verification rates are low. While this is unlikely to be a problem for childhood cancers, it is a major limitation with tumours for adults. Yours sincerely, Paul SILCOCKS and Helen THORNTON-JONES ICRF Carlcer Epidemiology and Clinical Trials Unit, Radclge Infirmary, Oxford OX2 GHE; and Thames Cancer Registry, Sutton, Surrey SM2 SP4, UK.
"Phoenix jaw"-bone regeneration of the necrotic mandible between pathological fractures: an unusual but evocative course of bisphosphonate-related osteonecrosis.

Management of advanced bisphosphonate-related osteonecrosis of the jaw, particularly in cases of pathological fractures with extraoral fistulas, is a challenging responsibility for craniomaxillofacial specialists. Although a periosteal reaction is occasionally observed in cases with extensive sequestra, few reports have documented circumferential periosteal osseous formation resulting in bone repair. We present the case of a 78-year-old woman who was treated for breast cancer and received intravenous bisphosphonates. She had bisphosphonate-related osteonecrosis of the jaw with bilateral pathological fractures of the mandible. During the course of minimally invasive treatment, the necrotic segment was separated with circumferential exposure, and new bone spontaneously formed with osseous union to the unilateral fractured stump. The present case typically highlights the potential of periosteal osteogenesis to regain an acceptable state even for patients with severe "bis-phossy jaw," particularly those with pathological fractures, although we do not advocate the universality of the phenomenon presented as "phoenix jaw. "
The burden of selected cancers in the US: health behaviors and health care resource utilization

Objective To characterize the disease burden among survivors of those cancers having the highest incidence in the US. Methods Adult (≥18 years) survivors of the 11 most frequently diagnosed cancers were identified from publically available data sources, including the Surveillance Epidemiology and End Results 9 1973–2012, National Health Interview Survey 2013, and the Medical Expenditure Panel Survey 2011. Chi-square tests and one-way analyses of variance were utilized to assess differences between cancer survivors and non-cancer controls in behavioral characteristics, symptoms and functions, preventative screenings, and health care costs. Results Hematologic malignancies, melanoma, and breast, prostate, lung, colon/rectal, bladder, kidney/renal, uterine, thyroid, and pancreatic cancers had the highest incidence rates. Breast cancer had the highest incidence among women (156.4 per 100,000) and prostate cancer among men (167.2 per 100,000). The presence of pain (P=0.0003), fatigue (P=0.0005), and sadness (P=0.0012) was consistently higher in cancer survivors 40–64 years old vs. non-cancer controls. Cancer survivors ≥65 years old had higher rates of any functional limitations (P=0.0039) and reported a lack of exercise (P<0.0001) compared with the non-cancer controls. However, obesity rates were similar between cancer survivors and non-cancer controls. Among cancer survivors, an estimated 13.5 million spent $169.4 billion a year on treatment, with the highest direct expenditures for breast cancer ($39 billion), prostate cancer ($37 billion), and hematologic malignancies ($25 billion). Prescription medications and office-based visits contributed equally as the cost drivers of direct medical spending for breast cancer, while inpatient hospitalization was the driver for prostate (52.8%) and lung (38.6%) cancers. Conclusion Understanding the resource utilization implications, health, and well-being of cancer survivors can inform approaches to interventions for improving long-term care.
Prevalence, incidence and stability of drinking problems among whites, blacks and Hispanics: 1984-1992.

OBJECTIVE This article reports on the prevalence, incidence and stability of dependence-related problems and social consequences from drinking among whites, blacks and Hispanics between 1984 and 1992. METHOD A probability sample of 1,777 whites, 1,947 blacks and 1,453 Hispanics from the U.S. adult household population was interviewed in 1984. In 1992 a subsample consisting of 788 whites, 723 blacks and 703 Hispanics was reinterviewed. Interviews averaging 1 hour in length were conducted in respondents' homes by trained interviewers. RESULTS The prevalence of a number of alcohol-related problems, the stability and incidence of dependence-related problems and the incidence of social consequences from drinking are higher among Hispanic than among white men. Dependence-related problems are more stable among black than among white men. Among women, the incidence of dependence-related problems and social consequences from drinking is higher among blacks than whites. Hispanic women have a higher incidence of social consequences from drinking than white women. Having a problem at Time 1 correlates only moderately with having a problem at Time 2, independent of ethnicity. CONCLUSIONS In general, Hispanics and blacks continue to be more at risk than whites for developing a number of alcohol-related problems. These two ethnic groups should be the focus of renewed efforts to address alcohol problems and inequalities in income distribution, employment, education and lack of access to adequate health care.
A virtual trial framework for quantifying the detectability of masses in breast tomosynthesis projection data.

PURPOSE Digital breast tomosynthesis (DBT) is a promising breast cancer screening tool that has already begun making inroads into clinical practice. However, there is ongoing debate over how to quantitatively evaluate and optimize these systems, because different definitions of image quality can lead to different optimal design strategies. Powerful and accurate tools are desired to extend our understanding of DBT system optimization and validate published design principles. METHODS The authors developed a virtual trial framework for task-specific DBT assessment that uses digital phantoms, open-source x-ray transport codes, and a projection-space, spatial-domain observer model for quantitative system evaluation. The authors considered evaluation of reconstruction algorithms as a separate problem and focused on the information content in the raw, unfiltered projection images. Specifically, the authors investigated the effects of scan angle and number of angular projections on detectability of a small (3 mm diameter) signal embedded in randomly-varying anatomical backgrounds. Detectability was measured by the area under the receiver-operating characteristic curve (AUC). Experiments were repeated for three test cases where the detectability-limiting factor was anatomical variability, quantum noise, or electronic noise. The authors also juxtaposed the virtual trial framework with other published studies to illustrate its advantages and disadvantages. RESULTS The large number of variables in a virtual DBT study make it difficult to directly compare different authors' results, so each result must be interpreted within the context of the specific virtual trial framework. The following results apply to 25% density phantoms with 5.15 cm compressed thickness and 500 μm(3) voxels (larger 500 μm(2) detector pixels were used to avoid voxel-edge artifacts): 1. For raw, unfiltered projection images in the anatomical-variability-limited regime, AUC appeared to remain constant or increase slightly with scan angle. 2. In the same regime, when the authors fixed the scan angle, AUC increased asymptotically with the number of projections. The threshold number of projections for asymptotic AUC performance depended on the scan angle. In the quantum- and electronic-noise dominant regimes, AUC behaviors as a function of scan angle and number of projections sometimes differed from the anatomy-limited regime. For example, with a fixed scan angle, AUC generally decreased with the number of projections in the electronic-noise dominant regime. These results are intended to demonstrate the capabilities of the virtual trial framework, not to be used as optimization rules for DBT. CONCLUSIONS The authors have demonstrated a novel simulation framework and tools for evaluating DBT systems in an objective, task-specific manner. This framework facilitates further investigation of image quality tradeoffs in DBT.
Endothelial progenitor cells predict long-term prognosis in patients with stable angina treated with percutaneous coronary intervention: five-year follow-up of the PROCREATION study.

BACKGROUND The association between endothelial progenitor cells (EPCs) at the time of percutaneous coronary intervention (PCI) and the subsequent long-term clinical outcome remains undefined. To address this issue, a pre-specified analysis of the PROgenitor Cells role in Restenosis and progression of coronary ATherosclerosis after percutaneous coronary intervention (PROCREATION) study was done. METHODS AND RESULTS A total of 155 patients with stable angina treated with PCI had flow cytometry before PCI. Patients had a 5-year follow-up. Primary outcome was the composite of major adverse cardiac or cerebrovascular events (MACCE), that is, death, stroke, myocardial infarction, and revascularization. During follow-up, MACCE occurred in 65 of 155 patients (42%). There were no significant differences in clinical and angiographic variables between patients with or without MACCE, apart from a different extent of coronary atherosclerosis. The incidence of MACCE increased significantly over tertiles of CD34+/KDR+/CD45- cells and CD133+/KDR+/CD45- cells, with rates of 25%, 39%, and 69% (P=0.0001), and 26%, 44%, and 59% (P=0.003), respectively. On multivariate analysis it was estimated that the increase in CD34+/KDR+/CD45- cells was associated with a 35% higher risk for MACCE (hazard ratio [HR], 1.75; 95% confidence interval [CI]: 1.07-1.99; P=0.001), and the increase in CD133+/KDR+/CD45- cells was associated with a 25% higher risk for MACCE (HR, 1.35; 95% CI: 1.01-1.74; P=0.03). CONCLUSIONS Assessment of subpopulations of circulating EPCs in patients with stable angina treated with PCI can improve characterization of long-term prognosis (ClinicalTrials.gov: NCT01575431).
Studying the mediating role of subculture in relationship of job satisfaction and organizational commitment in Islamic Azad University-shiraz branch

The main purpose of this research was to investigate the mediating role of organizational subculture between job satisfaction, organizational commitment in Islamic Azad university – shiraz branch. the sample was 200 educational sectors persons (faculty members) and service staffs which were selected by stratified randomized sampling. Structural equation analysis was conducted to obtain the best fit model and to determine the direction of the causal effect between job satisfaction and commitment, and the role of subculture as a mediating variable. Results showed the casual relationship between organizational commitment and job satisfaction and highlighted the important role of subculture as a mediator. Keyword: subculture, job satisfaction, organizational commitment
Symbolic Analysis of Brain Dynamics Detects Negative Stress

The electroencephalogram (EEG) is the most common tool used to study mental disorders. In the last years, the use of this recording for recognition of negative stress has been receiving growing attention. However, precise identification of this emotional state is still an interesting unsolved challenge. Nowadays, stress presents a high prevalence in developed countries and, moreover, its chronic condition often leads to concomitant physical and mental health problems. Recently, a measure of time series irregularity, such as quadratic sample entropy (QSEn), has been suggested as a promising single index for discerning between emotions of calm and stress. Unfortunately, this index only considers repetitiveness of similar patterns and, hence, it is unable to quantify successfully dynamics associated with the data temporal structure. With the aim of extending QSEn ability for identification of stress from the EEG signal, permutation entropy (PEn) and its modification to be amplitude-aware (AAPEn) have been analyzed in the present work. These metrics assess repetitiveness of ordinal patterns, thus considering causal information within each one of them and obtaining improved estimates of predictability. Results have shown that PEn and AAPEn present a discriminant power between emotional states of calm and stress similar to QSEn, i.e., around 65%. Additionally, they have also revealed complementary dynamics to those quantified by QSEn, thus suggesting a synchronized behavior between frontal and parietal counterparts from both hemispheres of the brain. More precisely, increased stress levels have resulted in activation of the left frontal and right parietal regions and, simultaneously, in relaxing of the right frontal and left parietal areas. Taking advantage of this brain behavior, a discriminant model only based on AAPEn and QSEn computed from the EEG channels P3 and P4 has reached a diagnostic accuracy greater than 80%, which improves slightly the current state of the art. Moreover, because this classification system is notably easier than others previously proposed, it could be used for continuous monitoring of negative stress, as well as for its regulation towards more positive moods in controlled environments.