Miracle-dz/UniFAR-FTUs huggingface dataset:
Prednisone withdrawal in kidney transplant recipients on cyclosporine and mycophenolate mofetil--a prospective randomized study. Steroid Withdrawal Study Group.

BACKGROUND Prospective randomized trials have shown a reduced rate of acute rejection (AR) in mycophenolate mofetil-treated kidney transplant recipients. We hypothesized that this increased protection from AR could allow successful prednisone (P) withdrawal in cyclosporine/mycophenolate mofetil/P-treated recipients. METHODS A multicenter, prospective, randomized, double-blind trial of P withdrawal at 3 months post-transplant was initiated. Entry criteria were: primary transplant, adult, no AR by 90 days, mycophenolate mofetil dose > or =2 g/day, cyclosporine dose = 5-15 mg/kg/ day, P dose = 10-15 mg/day. Study participants were randomized to have P tapered over 8 weeks (beginning at 3 months posttransplant) to 0 vs. 10 mg/day. Prestudy power analysis determined 500 recipients should be randomized for 80% statistical power to test equivalence of the primary endpoint, AR, or treatment failure at 1 year posttransplant. By design, the study was to be stopped if interim data precluded reaching equivalence. An established data safety monitoring board monitored the study. RESULTS After 266 patients were enrolled, the patient enrollment was stopped (after safety monitoring board review) because of excess rejection in the P withdrawal group. The Kaplan-Meier estimate of the cumulative incidence of rejection or treatment failure within 1 year posttransplant (+/-95% confidence interval) for the maintenance group was 9.8% (4.4%; treatment failure, 14.9%); for the withdrawal group, 30.8% (21.0%; 39.3%). Treatment differences in the distribution of time to event were highly significant (P = 0.0007). Of note, risk was higher in blacks (39.6%) versus nonblacks (16.0%) (P<0.001). At 1 year post-transplant, there was no difference between groups in patient or graft survival. For the patients with functioning grafts at 6 months posttransplant, withdrawal patients had lower cholesterol (P = 0.0005), had higher creatinine (P = 0.03), and were less likely to use antihypertensives (P = 0.001). These differences persist to 1 yr posttransplant. CONCLUSIONS We conclude that for recipients on cyclosporine/mycophenolate mofetil/P with no AR at 90 days, the chance of developing subsequent AR is small; if P is tapered and withdrawn, the risk increases (but the majority remain free of acute and chronic rejection). After withdrawal, the risk of AR is different for blacks versus nonblacks. Withdrawal patients had a lower cholesterol level and less need for antihypertensives.
Intensive versus conventional insulin therapy: A randomized controlled trial in medical and surgical critically ill patients*

Objective:The role of intensive insulin therapy in medical surgical intensive care patients remains unclear. The objective of this study was to examine the effect of intensive insulin therapy on mortality in medical surgical intensive care unit patients. Design:Randomized controlled trial. Settings:Tertiary care intensive care unit. Patients:Medical surgical intensive care unit patients with admission blood glucose of >6.1 mmol/L or 110 mg/dL. Intervention:A total of 523 patients were randomly assigned to receive intensive insulin therapy (target blood glucose 4.4–6.1 mmol/L or 80–110 mg/dL) or conventional insulin therapy (target blood glucose 10–11.1 mmol/L or 180–200 mg/dL). Measurements and Main Outcomes:The primary end point was intensive care unit mortality. Secondary end points included hospital mortality, intensive care unit and hospital length of stay, mechanical ventilation duration, the need for renal replacement therapy and packed red blood cells transfusion, and the rates of intensive care unit acquired infections as well as the rate of hypoglycemia (defined as blood glucose ≤2.2 mmol/L or 40 mg/dL). There was no significant difference in intensive care unit mortality between the intensive insulin therapy and conventional insulin therapy groups (13.5% vs. 17.1%, p = 0.30). After adjustment for baseline characteristics, intensive insulin therapy was not associated with mortality difference (adjusted hazard ratio 1.09, 95% confidence interval 0.70–1.72). Hypoglycemia occurred more frequently with intensive insulin therapy (28.6% vs. 3.1% of patients; p < 0.0001 or 6.8/100 treatment days vs. 0.4/100 treatment days; p < 0.0001). There was no difference between the intensive insulin therapy and conventional insulin therapy in any of the other secondary end points. Conclusions:Intensive insulin therapy was not associated with improved survival among medical surgical intensive care unit patients and was associated with increased occurrence of hypoglycemia. Based on these results, we do not advocate universal application of intensive insulin therapy in intensive care unit patients. Trial Registration:Current Controlled Trials registry (ISRCTN07413772) http://www.controlled-trials.com/ISRCTN07413772/07413772; 2005.
Additional salutary effects of the combination of exercise training and an angiotensin-converting enzyme inhibitor on the left ventricular function of spontaneously hypertensive rats

Objectives To investigate whether the combination of exercise training with the angiotensin-converting enzyme inhibitor lisinopril will have an additional beneficial effect on left ventricular function in spontaneously hypertensive rats. Design Twelve-week-old male rats were assigned to treadmill running (Ht-Ex; 20 m/min at 5° grade, 1 h/day, 5 days/week), or lisinopril treatment (Ht-Lis; 15 mg/kg per day by gavage), or treadmill running while treated with lisinopril (Ht-ExLis), and were compared with a sedentary group (Ht-Sed). Age-matched and sex-matched Wistar-Kyoto rats were controls. Methods After 10 weeks of experimentation, left ventricular morphology and function were assessed from M-mode echocardiograms and transmitral Doppler spectra [early (E) and atrial peak velocities (A), their ratio (E/A), and E-wave deceleration time (Edec time) and slope (Edec slope)]. Results Ht-Sed exhibited prominent concentric left ventricular hypertrophy with systolic and diastolic dysfunctions evidenced by a significantly reduced fractional shortening (%FS) and ‘pseudonormalization’ of left ventricular filling, characterized by an apparently normal E/A ratio despite an underlying left ventricular relaxation abnormality. Exercise training did not significantly alter left ventricular morphology or function. Lisinopril alone attenuated left ventricular hypertrophy and enhanced diastolic function but had no significant effect on systolic function. Combining exercise training with lisinopril treatment increased %FS by 25%, decreased the E/A ratio and Edec slope by 35% and 37%, respectively, and increased Edec time by 82%. Conclusion Our results provide experimental evidence that lisinopril administration, when combined with moderate exercise training, is more promising in attenuating cardiac dysfunction than either agent alone in hypertension of a genetic origin.
Employers' policies for third age employment – the case for action and the rational for reaction

This paper reports on findings from a study which explores employers’ perceptions of the careers of those in third age employment and the extent to which these organisations have in place policies and practices to manage older worker careers. Drawing on interviews with UK HR managers and advisory bodies, the study finds that there was an absence of formal policies which addressed the career needs of older works despite employers being aware of the issue associated with an aging workforce. Instead employers responded to career related requests from older workers on an ad hoc basis as they felt that specific policies for this group of people would potentially create legal issues for the organisation. Employers also believed that the aged workforce had little impact on their business and as a result did not engage in collective dialogue with older workers about their requirements and instead made assumptions about their career needs.
Longitudinal Application of the Medical Outcomes Study 36-Item Short-Form Health Survey With Not-in-Treatment Crack-Cocaine Users

Background.The Medical Outcomes Study SF-36 has been used infrequently with substance abusers. Objectives.The objectives of this study were to use the SF-36 to assess changes in the health status of crack-cocaine users over time, to determine the characteristics of users who change, to assess the influence of frequency of crack use on SF-36 health status, and to determine the utility of the SF-36 with crack users. Design.A multilevel model was used to analyze data that were collected every 6 months over a 2-year period. Subjects.The sample consisted of 439 not-in-treatment crack-cocaine users. Measures.The SF-36 was administered at baseline and follow-up interviews. Data on the frequency of crack-cocaine use were also collected. Results.On average, SF-36 health status remained fairly static during the study although statistically significant increases in scores occurred on the social functioning and role-emotional subscales. Variation in subjects’ health trajectories occurred but was not, for the most part, explained by individual characteristics. Frequency of crack use was negatively related to scores on the physical functioning, social functioning, and mental health subscales. Most subscales did not reflect what are commonly recognized to be the health-compromising effects of cocaine use, raising questions about the use of the SF-36 with illicit drug users. Conclusions.Changes in crack users’ SF-36 health status were uncommon. Frequency of crack use was negatively associated with health status. Several SF-36 subscales may be helpful in studies involving illicit drug users in which limited assessments of health status are needed.
Effect of a Nutrition Education Program and Diet Modification in Beninese Adolescent Girls Suffering from Mild Iron Deficiency Anemia

A 26-week nutrition intervention, including 4 weeks of nutrition education, combined with an increase in the content and bioavailability of dietary iron for 22 weeks was carried out in 34 intervention and 34 control adolescent girls suffering from mild iron deficiency anemia (IDA). In post-intervention, hemoglobin and serum ferritin were significantly higher in the intervention group, whereas the incidence of IDA was significantly lower in the intervention group compared to the control group. Nutrition knowledge scores were significantly higher in intervention girls compared to control girls. Dietary changes to improve available dietary iron can reduce iron deficiency anemia.
Hostility Is Associated With Increased Platelet Activation in Coronary Heart Disease

Objective To determine whether Potential for Hostility is related to platelet activation (PA) among patients with coronary heart disease (CHD) and healthy controls. Increased PA has been associated with adverse secondary events after myocardial infarction or coronary angioplasty. Methods We tested 32 CHD patients and 23 healthy men and women, aged 45 to 73 years, for PA by using whole blood flow cytometry. PA was measured in blood exiting a bleeding time wound (wound-induced platelet activation) and also in venous blood stimulated in vitro with collagen. Monoclonal antibodies were used to test for fibrinogen receptor activation and fibrinogen receptor binding. All subjects refrained from taking aspirin for at least 14 days before testing; CHD patients stopped nitrates and calcium channel blockers for 24 hours, while continuing to take lipid-lowering medications. Potential for Hostility was assessed, using the Type A Structured Interview. Results Among the CHD patients only, all four of the wound-induced fibrinogen receptor activation indicators (activation and binding) were related to hostility; the relationships were significant for receptor activation at 2 minutes, and for receptor binding at 1 minute (r values = .46, p values = .02). Subjects on lipid-lowering medications had lower PA for most measures. Healthy subjects had higher wound-induced fibrinogen receptor activation at 2 minutes and fibrinogen receptor activation in vitro than the CHD patients (p = .04), but after statistical adjustment for lipid-lowering medications, there were no significant differences between the patients and controls. Conclusions PA was related to hostility among CHD patients, consistent with previous studies indicating a relationship between PA and psychological factors among CHD patients. However, PA was not increased in nonsmoking, nondepressed CHD patients relative to controls.
Transactional cascades of destructive interparental conflict, children's emotional insecurity, and psychological problems across childhood and adolescence

Abstract This study examined the transactional interplay among dimensions of destructive interparental conflict (i.e., hostility and dysphoria), children's emotional insecurity, and their psychological problems from middle childhood and adolescence. Participants were 232 families, with the first of five measurement occasions occurring when children were in first grade (M age = 7 years). Cross-lagged, autoregressive models were conducted with a multiple-method, multiple-informant measurement approach to identify developmental cascades of interparental and child cascades. Results indicated that emotional insecurity was a particularly powerful mediator of prospective associations between interparental conflict (i.e., dysphoria and hostility) and child adjustment during adolescence rather than childhood. In reflecting bidirectionality in relationships between interparental and child functioning, children's psychological problems predicted increases in interparental dysphoria during childhood and adolescence. Although emotional insecurity was not identified as a proximal predictor of interparental difficulties, an indirect cascade was identified whereby insecurity in early adolescence was associated with increases in teen psychological problems, which in turn predicted greater interparental dysphoria over time. Results are interpreted in the context of how they advance transactional formulation of emotional security theory and its resulting translational implications for clinical initiatives.
The integration of vertical alignment in teacher collaborative planning in the international baccalaureate primary years program: Two qualitative case studies in Europe and the United States

This qualitative research study aimed to answer the question, “How do IBPYP teachers in a naturalistic collaborative approach experience the vertical alignment of their Program Of Inquiry? ” The International Baccalaureate Primary Years Program (IBPYP) provides no explicit content, external examination, or moderation and the Standards and Practices are intentionally left broad to accommodate all the International Baccalaureate (IB) schools. This contextual exploratory study investigated how teachers structured their curriculum with alignment in mind based on the guidance they received. Two case studies in a private international IBPYP school in Europe that followed the IBPYP standards alone and a publically funded national school in the U.S. that followed an additional layer of national standards sought to uncover the experiences and strategies the IBPYP teachers developed. Four themes emerged from semi-structured group interviews of K-5 classroom teachers: (1) Teachers’ assumptions about collaborative planning demonstrated that collaboration doesn’t just happen and requires pre-requisite structure and ability to deal with conflicts; (2) Teachers’ assumptions about curriculum and curriculum alignment revealed the perception that all teachers are responsible for curriculum alignment and disclosed some related barriers; (3) Teachers’ challenges in planning their Program Of Inquiry detailed the design steps and challenges. (4) Alignment processes and strategies summarized the perspectives and strategies used in schools, and the need for explicit IBPYP curriculum alignment guidance.
Different Effects of FK506, Rapamycin, and Mycophenolate Mofetil on Glucose-Stimulated Insulin Release and Apoptosis in Human Islets

Pancreatic islet transplantation has the potential to be an effective treatment for type 1 diabetes mellitus. While recent improvements have improved 1-year outcomes, follow-up studies show a persistent loss of graft function/survival over 5 years. One possible cause of islet transplant failure is the immunosuppressant regimen required to prevent alloimmune graft rejection. Although there is evidence from separate studies, mostly in rodents and cell lines, that FK506 (tacrolimus), rapamycin (sirolimus), and mycophenolate mofetil (MMF; CellCept) can damage pancreatic β-cells, there have been few side-by-side, multiparameter comparisons of the effects of these drugs on human islets. In the present study, we show that 24-h exposure to FK506 or MMF impairs glucose-stimulated insulin secretion in human islets. FK506 had acute and direct effects on insulin exocytosis, whereas MMF did not. FK506, but not MMF, impaired human islet graft function in diabetic NOD.scid mice. All of the immunosuppressants tested in vitro increased caspase-3 cleavage and caspase-3 activity, whereas MMF induced ER-stress to the greatest degree. Treating human islets with the GLP-1 agonist exenatide ameliorated the immunosuppressant-induced defects in glucose-stimulated insulin release. Together, our results demonstrate that immunosuppressants impair human β-cell function and survival, and that these defects can be circumvented to a certain extent with exenatide treatment.
Oral fluid testing as an alternative to urine testing for drugs of abuse in inpatient forensic settings: giving patients choice

Background and aims The abuse of illicit substances is very common amongst forensic psychiatry populations and is known to be one of the most potent risk factors for interpersonal violence. Forensic psychiatry units hence strive to keep themselves as free as possible from illicit substances and in Scotland drugs of abuse have traditionally been screened for by means of urine testing. The aim of this study is to examine patients’ preferences for drug testing methods and to compare the acceptability of urine testing versus oral fluid testing (OFT) within a secure hospital setting. Methods Patients in three continuing care wards at the State Hospital, Carstairs were offered the choice of either urine or oral fluid testing. We developed protocols and recording forms and trained staff in the administration of the OFT. We recorded the sampling time for OFT and urine, and the views of patients and staff on the testing procedures over a six month period. Results Sixty-two samples were taken, with 53 (85%) opting for OFT and nine (15%) opting for urine sampling. The average time taken for OFT was 13 minutes, while the average time taken for urine sampling was 33 minutes. The majority of patients and staff rated oral fluid and urine testing as comfortable and easy. Patients recorded comments on 46 (87%) of OFT samples, only two of which were negative. In general they preferred the OFT because it was quicker and easier and they commented on it being more dignified and private. Patients recorded comments on five (55%) of urine samples, with one of the primary reasons for opting for urine sampling appearing to be a reluctance to try new things, though a few said they did not want to have anything in their mouths. Staff returned comments on 24 (45%) of OFT samples and one (11%) of urine samples. Comments on the OFT were overwhelmingly positive and pointed out the relative speed and ease of this sampling method. Conclusions We concluded that the pilot study was successful. OFT was found to be generally preferred by patients and staff. Although there was an additional financial cost, this was considered to be outweighed by the significant benefits arising from offering patients choice, the preservation of patient dignity and staff time savings. The option of OFT has now been extended to all patients within the State Hospital. Practitioners will wish to consider the value of OFT in forensic psychiatry inpatient settings given the benefits identified within this study.
Room-Air Versus Oxygen Administration for Resuscitation of Preterm Infants: The ROAR Study

OBJECTIVE: We conducted a blinded, prospective, randomized control trial to determine which oxygen-titration strategy was most effective at achieving and maintaining oxygen saturations of 85% to 92% during delivery-room resuscitation. METHODS: Infants born at 32 weeks' gestation or less were resuscitated either with a static concentration of 100% oxygen (high-oxygen group) or using an oxygen-titration strategy starting from a concentration of 100% (moderate-oxygen group), or 21% oxygen (low-oxygen group). In the moderate- and low-oxygen groups, the oxygen concentration was adjusted by 20% every 15 seconds to reach a target oxygen saturation range of 85% to 92%. Treatment failure was defined as a heart rate slower than 100 beats per minute for longer than 30 seconds. RESULTS: The moderate-oxygen group spent a greater proportion of time in the target oxygen saturation range (mean: 0.21 [95% confidence interval: 0.16–0.26]) than the high-oxygen group (mean: 0.11 [95% confidence interval: 0.09–0.14]). Infants in the low-oxygen group were 8 times more likely to meet the criteria for treatment failure than those in the high-oxygen group (24% vs 3%; P = .022). The 3 groups did not differ significantly in the time to reach the target oxygen saturation range. CONCLUSIONS: Titrating from an initial oxygen concentration of 100% was more effective than giving a static concentration of 100% oxygen in maintaining preterm infants in a target oxygen saturation range. Initiating resuscitation with 21% oxygen resulted in a high treatment-failure rate.
Macroeconomic determinants of migration from Romania to Italy

Taken into account various economic theories trying to explain the reasons that stay behind the decision to migrate to another country, this study uses empirical data to identify some macroeconomic motives for migrating from Romania to Italy. According to the estimations based on fast ridge regression, the stock of Romanian immigrants from Italy in the period 2002-2016 was influenced by: the real GDP per capita in Romania, real GDP per capita in Italy and life expectancy at birth in Italy. The number of Romanian migrants attracted each year in Italy in a period marked also by the global financial crisis (2007-2016) was related to factors like: real GDP per capita in Italy life expectancy at birth in Italy, unemployment rate and taxes on income, profits and capital gains in Italy. The overall results indicated that the better standard of life in Italy was a good incentive for Romanian migrants. , 05-10