Miracle-dz/UniFAR-FTUs huggingface dataset:
Are we testing appropriately for low testosterone?: Characterization of tested men and compliance with current guidelines.

INTRODUCTION Direct-to-consumer ads for testosterone replacement therapies have significantly increased over the past several years. Subsequently, testing for low serum testosterone has correspondingly increased. AIMS We sought to determine the testing behaviors of practitioners as well as the characteristics of men who are undergoing testing for low testosterone. METHODS Men aged 18-85 years were queried from the institutional electronic data warehouse from 2009 to 2012. Men were considered "tested" if their serum total testosterone level had been measured for any purpose. Tested men (TM) were compared with those not tested (NT). MAIN OUTCOME MEASURES The frequency and timing of testing for low testosterone as well as patient demographics and clinical characteristics were compared between TM and NT using multivariable logistic regression models. RESULTS Of the 321,674 total men, 10,133 (3.2%) underwent testing with a serum total testosterone (mean age of 55.2 ± 14.1 years). The frequency of testing increased from 2.5% to 3.6% during the study period (P < 0.001). Multivariable analysis demonstrated that TM were significantly (P < 0.001) more likely to be Caucasian and have increased body mass index. In addition, TM were significantly more likely to have comorbid conditions including decreased libido (adjusted odds ratio [aOR] 10.0, 95% confidence interval [CI] 8.5, 11.7), infertility (aOR 4.8, 95% CI 3.6, 6.6), erectile dysfunction (aOR 3.6, 95% CI 3.4, 3.8), osteoporosis (aOR 3.3, 95% CI 2.8, 3.8), depression (aOR 1.7, 95% CI 1.6, 1.8), prostate cancer (aOR 1.7, 95% CI 1.5, 1.8), hypertension (aOR 1.3. 95% CI 1.2, 1.4), chronic obstructive pulmonary disease (aOR 1.2, 95% CI 1.0, 1.4), and benign prostatic hyperplasia (aOR 1.2, 95% CI 1.1, 1.2). Among TM, only 889 (9%) men underwent testing between 7 am and 12 pm. CONCLUSIONS The rate of testosterone testing is increasing with most testing practices directed toward a subset of men with comorbidities that are associated with hypogonadism. Compliance of physicians obtaining early morning serum testosterone levels is low. Further education of practitioners is required to appropriately test patients for hypogonadism.
Pain experienced during vaginal and anal intercourse with other-sex partners: findings from a nationally representative probability study in the United States.

INTRODUCTION Recent U.S. nationally representative data indicate that about 30% of women and 5% of men reported pain occurring during their most recent sexual event; however, little is known about the severity, duration, or context of such pain, or its prevalence during vaginal vs. anal intercourse. AIMS To document the prevalence and characteristics of pain during vaginal and anal intercourse among U.S. women and men (ages 18+) at their most recent other-sex sexual event, including the self-reported severity, duration, and location of their pain; how participants addressed their pain; and partner communication related to the pain. METHODS Data from a subsample of 1,738 women and men in the 2012 National Survey of Sexual Health Behavior, a nationally representative probability survey of Americans ages 18+ collected via the Internet, were analyzed. MAIN OUTCOME MEASURES Participants responded to items about their background characteristics; whether they had vaginal or anal intercourse during their most recent sexual experience; the severity, duration, and location of any pain experienced during said sexual event; and whether they responded to or communicated about the pain. RESULTS About 30% of women and 7% of men reported pain during vaginal intercourse events, and most of the reports of pain were mild and of short duration. About 72% of women and 15% of men reported pain during anal intercourse events, with more of these events including moderate or severe pain (for the women) and of mixed duration. Large proportions of Americans do not tell their partner when sex hurts. CONCLUSION Pain is a relatively common, and often not discussed, aspect of both vaginal and anal intercourse events occurring between women and men. Individual and clinical implications are discussed.
Acute embryonic anoxia exposure favours the development of a dominant and aggressive phenotype in adult zebrafish

Eutrophication and climate change are increasing the incidence of severe hypoxia in fish nursery habitats, yet the programming effects of hypoxia on stress responsiveness in later life are poorly understood. In this study, to investigate whether early hypoxia alters the developmental trajectory of the stress response, zebrafish embryos were exposed to 4 h of anoxia at 36 h post-fertilization and reared to adults when the responses to secondary stressors were assessed. While embryonic anoxia did not affect basal cortisol levels or the cortisol response to hypoxia in later life, it had a marked effect on the responses to a social stressor. In dyadic social interactions, adults derived from embryonic anoxia initiated more chases, bit more often, entered fewer freezes and had lower cortisol levels. Adults derived from embryonic anoxia also performed more bites towards their mirror image, had lower gonadal aromatase gene expression and had higher testosterone levels. We conclude that acute embryonic anoxia has long-lasting consequences for the hormonal and behavioural responses to social interactions in zebrafish. Specifically, we demonstrate that acute embryonic anoxia favours the development of a dominant and aggressive phenotype, and that a disruption in sex steroid production may contribute to the programming effects of environmental hypoxia.
The recovery journey: Employment support for people with depression and other mental illnesses

Abstract This paper presents the qualitative findings of a larger mixed method study aimed to articulate factors that clients and staff of the Disability Employment Network (DEN) identify in relation to re-engagement into the workforce. The DEN is a supported job training and employment program funded by the Australian Federal Government, established to assist clients with health disabilities, including mental health diagnoses, to seek and retain employment. Two DEN sites participated in the study (one regional and one metropolitan). Semi structured interviews and focus groups were undertaken with seven employment counsellors and 16 clients until data saturation occurred. Analysis of the narrative data identified two overarching emergent concepts articulated by clients and employment counsellors: employment enablers and employment barriers. The notion of recovery and reengagement in the workforce in the context of mental illness is complex. The qualitative results of this study highlight the essential nature of supporting clients’ mental health and vocational needs concurrently through such means as service collaboration, vocational peer support and, importantly, provision of employment support congruent with phase of recovery.
Moving beyond linear food chains: trait-mediated indirect interactions in a rocky intertidal food web

In simple, linear food chains, top predators can have positive indirect effects on basal resources by causing changes in the traits (e.g. behaviour, feeding rates) of intermediate consumers. Although less is known about trait-mediated indirect interactions (TMIIs) in more complex food webs, it has been suggested that such complexity dampens trophic cascades. We examined TMIIs between a predatory crab (Carcinus maenas) and two ecologically important basal resources, fucoid algae (Ascophyllum nodosum) and barnacles (Semibalanus balanoides), which are consumed by herbivorous (Littorina littorea) and carnivorous (Nucella lapillus) snails, respectively. Because crab predation risk suppresses snail feeding rates, we hypothesized that crabs would also shape direct and indirect interactions among the multiple consumers and resources. We found that the magnitude of TMIIs between the crab and each resource depended on the suite of intermediate consumers present in the food web. Carnivorous snails (Nucella) transmitted TMIIs between crabs and barnacles. However, crab–algae TMIIs were transmitted by both herbivorous (Littorina) and carnivorous (Nucella) snails, and these TMIIs were additive. By causing Nucella to consume fewer barnacles, crab predation risk allowed fucoids that had settled on or between barnacles to remain in the community. Hence, positive interactions between barnacles and algae caused crab–algae TMIIs to be strongest when both consumers were present. Studies of TMIIs in more realistic, reticulate food webs will be necessary for a more complete understanding of how predation risk shapes community dynamics.
Floaters may buffer the extinction risk of small populations: an empirical assessment

The high extinction risk of small populations is commonly explained by reductions in fecundity and breeder survival associated with demographic and environmental stochasticity. However, ecological theory suggests that population extinctions may also arise from reductions in the number of floaters able to replace the lost breeders. This can be particularly plausible under harsh fragmentation scenarios, where species must survive as small populations subjected to severe effects of stochasticity. Using a woodpecker study in fragmented habitats (2004–2016), we provide here empirical support for the largely neglected hypothesis that floaters buffer population extirpation risks. After controlling for population size, patch size and the intrinsic quality of habitat, populations in patches with floaters had a lower extinction probability than populations in patches without floaters (0.013 versus 0.131). Floaters, which often replace the lost breeders, were less likely to occur in small and low-quality patches, showing that population extirpations may arise from unnoticed reductions in floater numbers in poor-quality habitats. We argue that adequate pools of the typically overlooked floaters may buffer extirpation risks by reducing the detrimental impacts of demographic and environmental stochasticity. However, unravelling the influence of floaters in buffering stochastic effects and promoting population stability require additional studies in an ample array of species and stochastic scenarios.
Non-Steroidal Anti-Inflammatory Drugs, Lower Oesophageal Sphincter-Relaxing Drugs and Oesophageal Cancer

Background and Aims: The incidence of oesophageal cancer has doubled in the last three decades. Non-steroidal anti-inflammatory drugs (NSAIDs) may be protective, whilst bronchodilators and calcium channel blockers that relax the lower oesophageal sphincter (LOS) may increase gastro-oesophageal reflux and the risk of oesophageal adenocarcinoma. We conducted a case-control study to examine the association between the use of NSAIDs and drugs which relax the LOS and the risk of oesophageal cancer. Methods: In Norfolk, 411 patients with a primary neoplasm of the oesophagus or cardia were matched with 1,644 controls with non-melanotic skin lesions. Data on the use of NSAIDs, bronchodilators and calcium channel blockers was collected. Results: Intake of NSAIDs was less in cases of oesophageal cancer as compared to the control group. The odds ratios (OR) and 95% confidence intervals (CI) for different NSAIDs were as follows: aspirin 0.35 (0.24–0.51); other NSAIDs 0.25 (0.16–0.40), and Cox-2 inhibitors 0.46 (0.20–0.94). LOS-relaxing drugs were consumed more frequently in cases of oesophageal cancer as compared to the controls. The OR for LOS-relaxing drugs was: inhaled bronchodilators 3.2 (95% CI 2.2–4.7); theophylline 1.9 (95% CI 1.3–5.1), and calcium channel blockers 2.4 (95% CI 1.2–5.0). Conclusion: Within the limitations of a case-control study using patients with non-melanotic skin lesions as controls, our results are consistent with the hypothesis that oesophageal cancer has a negative association with NSAID use, and a positive association with drugs that relax the LOS.
Smears and Frozen Sections in Surgical Neuropathology

Smears and Frozen Sections in Surgical Neuropathology Peter C. Burger PB Medical Publishing, Baltimore, MD Copyright 2009, 690 pages, $250.00 Available at www.atlasbooks. com Peter C. Burger's new book is an excellent guide to intraoperative neuropathology consultation. It contains more than 650 pages of concise and informative text and more than 1,500 beautiful colored photomicrographs, gross intraoperative photographs, and black-and-white radiographic images. The text encompasses both basic instruction and advanced diagnostic insights and is thus well suited for the general surgical pathologist and neuropathology resident or fellow, as well as the experienced practitioner. Initial short chapters discuss important general concepts such as effective communication with the surgeon, specimen evaluation, techniques and advantages and disadvantages of smears and frozen sections, Dr Burger's basic diagnostic algorithm, certain problem scenarios during the intraoperative consultation, clinical and radiological considerations, and differential diagnosis by anatomical site and pathological features. The “Clinical and Radiological Considerations” chapter discusses radiological appearances of infiltrative and noninfiltrative tumors, cysts, and hemorrhages and steps to determining if the intraoperative sample is representative of the lesion. The “Differential Diagnosis by Anatomic …
Comparative Analysis of Tunical Plication vs. Intralesional Injection Therapy for Ventral Peyronie's Disease.

INTRODUCTION Approximately 10% of Peyronie's disease (PD) patients present with ventral curvatures and, as such, there is a paucity of data describing the optimal approach for treatment. AIM This study aims to compare the outcomes of surgery (tunical plication [TP]) and intralesional injection (ILI) therapy (interferon-α2b) in men with ventral PD. MATERIALS AND METHODS Retrospective data were collected from two centers: Tulane University (ILI) and Technical University of Munich (TP). Collected variables included patient demographics, pre- and post-treatment sexual function, rigorous penile measurements (curvature, length, and penile vascular findings), and post-treatment outcomes. RESULTS A total of 35 patients with ventral PD (21 ILI and 14 TP) were included in the study. There were no significant differences between the two groups prior to the interventions. There was a significantly better improvement in mean curvature with TP (46.4 degrees) as compared with ILI (9.3), P < 0.0001. TP was also associated with a significantly higher rate of ≥20% improvement in curvature as compared with ILI (100% vs. 67%, P = 0.027). Although there was no significant difference in post-treatment change in Sexual Health Inventory for Men (SHIM) scores between the groups, 36% of the ILI patients noted an improved SHIM score as compared with none in the TP group. Erect penile length was preserved or improved in 67% of the ILI group vs. 14% of the TP group, P = 0.005. CONCLUSIONS TP confers a better overall improvement in penile curvature as compared with ILI in patients with ventral PD. Preserved or improved erect penile length and SHIM scores may be observed in patients undergoing ILI. 12:2492-2498.
Adaptation in response to environmental unpredictability

Understanding how organisms adaptively respond to environmental fluctuations is a fundamental question in evolutionary biology. The Mediterranean region typically exhibits levels of environmental unpredictability that vary greatly in habitats over small geographical scales. In cyclically parthenogenetic rotifers, clonal proliferation occurs along with occasional bouts of sex. These bouts contribute to the production of diapausing eggs, which allows survival between growing seasons. Here, we studied two diapause-related traits in rotifers using clones from nine Brachionus plicatilis natural populations that vary in the degree of environmental unpredictability. We tested the hypothesis that the level of environmental unpredictability is directly related to the propensity for sex and inversely related to the hatching fraction of diapausing eggs. We found significant levels of genetic variation within populations for both traits. Interestingly, a positive correlation between pond unpredictability—quantified in a previous study from satellite imagery—and the propensity for sex was found. This correlation suggests a conservative, bet-hedging strategy that provides protection against unexpectedly short growing seasons. By contrast, the hatching fraction of diapausing eggs was not related to the level of environmental predictability. Our results highlight the ability of rotifer populations to locally adapt to time-varying environments, providing an evolutionarily relevant step forward in relating life-history traits to a quantitative measure of environmental unpredictability.
An interdisciplinary momentary confluence of events model to explain, minimize, and prevent pediatric patient falls and fall-related injuries.

PURPOSE This article reviews theoretical, empirical, and clinical evidence to support the hypothesis that pediatric patient fall episodes are rarely predictable; rather, falls and fall-related injuries occur during the momentary convergence of child, parent, and caregiver human factors, and environmental, biomechanical, and system factors. CONCLUSIONS We propose an interdisciplinary pediatric fall and injury prevention model to guide future research toward interventions to prevent or minimize pediatric patient falls and injuries. PRACTICE IMPLICATIONS When falls and near miss falls occur, nurses' detailed descriptions of each model component are critical to discovery of more effective pediatric fall and injury prevention methods.
Non‐attendance in chronic disease clinics: a matter of non‐compliance?

paterson bl, charlton p & richard s (2010) Journal of Nursing and Healthcare of Chronic Illness2, 63–74 Non-attendance in chronic disease clinics: a matter of non-compliance? Aim. To identify the personal, contextual and mediating factors that influence non-attendance in specialty chronic disease clinics. Background. Non-attendance in chronic disease clinics is an ongoing problem that can increase patients’ vulnerability to serious complications, affect continuity of care, contribute to long wait times, engender negative patient–provider relationships, and increase costs to the health system. Methods. Literature for this review was obtained by an extensive search of health and social science computerised bibliographic databases using the search terms participation, attendance, non-attendance, attrition, dropout, missed appointment, no show with diabetes, chronic disease and chronic illness care. Results. Twenty-eight research studies met our criteria for inclusion in the review. Analyses revealed that non-attendance at chronic disease clinics is influenced by a myriad of factors encompassed as personal and clinical factors, and factors pertaining to the nature and operations of the clinic. Conclusions. The factors that influence attendance are complex and multifactoral. A range of strategies are needed to address the myriad of patient-related and health-system factors to increase attendance rates and ultimately improve health outcomes. Relevance to clinical practice. A critical analysis of factors that affect attendance is important to begin to develop a greater awareness and understanding among health providers of the implications and reasons for missed appointments. The results can help to improve patient–provider relationships and deliver services that better meet patients’ needs and expectations.
Relationship between the color of soybean past and antioxidative activity

色調の異なる味噌の表面色と80%エタノール抽出液のDPPHラジカル消去能を測定し, 味噌の熟成中に生成したメラノイジンの生成量と抗酸化性の関係を調べた。 さらに, 0.5M-L-リジンと0.5M-D-グルコースの等量混液によるアミノカルボニル反応液の着色度とDPPHラジカル消去能の関係からもメラノイジンの生成量と抗酸化性との関係を検討した。 1) 味噌の表面色の明度とDPPHラジカル消去能の間には, 相関係数r=-0.755 (α‹0.05) で有意な負の相関が認められた。 2) 味噌の熟成過程におけるアミノカルボニル反応で生成したメラノイジンが多く, 赤褐色化の進んだ味噌ほどDPPHラジカル消去能が高値を示した。 3) 大豆の抗酸化成分を多く含む豆味噌の八丁味噌や赤だしは, 米味噌や麦味噌と比較してDPPHラジカル消去能がかなり高かった。 4) 0.5MのL-リシンとD-グルコースの等量混合液によるアミノカルボニル反応液には, 着色度とDPPHラジカル消去能の間に相関係数r=0.961 (α‹0.01) で強い正の相関関係が認められた。
Hierarchical complexity and the size limits of life

Over the past 3.8 billion years, the maximum size of life has increased by approximately 18 orders of magnitude. Much of this increase is associated with two major evolutionary innovations: the evolution of eukaryotes from prokaryotic cells approximately 1.9 billion years ago (Ga), and multicellular life diversifying from unicellular ancestors approximately 0.6 Ga. However, the quantitative relationship between organismal size and structural complexity remains poorly documented. We assessed this relationship using a comprehensive dataset that includes organismal size and level of biological complexity for 11 172 extant genera. We find that the distributions of sizes within complexity levels are unimodal, whereas the aggregate distribution is multimodal. Moreover, both the mean size and the range of size occupied increases with each additional level of complexity. Increases in size range are non-symmetric: the maximum organismal size increases more than the minimum. The majority of the observed increase in organismal size over the history of life on the Earth is accounted for by two discrete jumps in complexity rather than evolutionary trends within levels of complexity. Our results provide quantitative support for an evolutionary expansion away from a minimal size constraint and suggest a fundamental rescaling of the constraints on minimal and maximal size as biological complexity increases.
Morphological integration in the appendicular skeleton of two domestic taxa: the horse and donkey

Organisms are organized into suites of anatomical structures that typically covary when developmentally or functionally related, and this morphological integration plays a determinant role in evolutionary processes. Artificial selection on domestic species causes strong morphological changes over short time spans, frequently resulting in a wide and exaggerated phenotypic diversity. This raises the question of whether integration constrains the morphological diversification of domestic species and how natural and artificial selection may impact integration patterns. Here, we study the morphological integration in the appendicular skeleton of domestic horses and donkeys, using three-dimensional geometric morphometrics on 75 skeletons. Our results indicate that a strong integration is inherited from developmental mechanisms which interact with functional factors. This strong integration reveals a specialization in the locomotion of domestic equids, partly for running abilities. We show that the integration is stronger in horses than in donkeys, probably because of a greater degree of specialization and predictability of their locomotion. Thus, the constraints imposed by integration are weak enough to allow important morphological changes and the phenotypic diversification of domestic species.