Miracle-dz/UniFAR-FTUs huggingface dataset:
Polypharmacy and falls in older people: Balancing evidence-based medicine against falls risk

Abstract The term polypharmacy has negative connotations due to its association with adverse drug reactions and falls. This spectrum of adverse events widens when polypharmacy occurs among the already vulnerable geriatric population. To date, there is no consensus definition of polypharmacy, and diverse definitions have been used by various researchers, the most common being the consumption of multiple number of medications. Taking multiple medications is considered a risk factor for falls through the adverse effects of drug–drug or drug–disease interactions. Falls studies have determined that taking ≥ 4 drugs is associated with an increased incidence of falls, recurrent falls, and injurious falls. In light of existing evidence, careful and regular medication reviews are advised to reduce the effect of polypharmacy on falls. However, intervention studies on medication reviews and their effectiveness on falls reduction have been scarce. This article reviews and discusses the evidence behind polypharmacy and its association with falls among older individuals, and highlights important areas for future research.
Effects of polycystic ovary syndrome on health-related quality of life

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 5–10% of women of reproductive age. The health risks associated with PCOS include infertility, diabetes, metabolic syndrome and endometrial cancer. In this article, we review the tools used to assess health-related quality of life (HRQL) and the current state of knowledge of the effects of PCOS on HRQL in adult women and adolescent girls. A significant body of evidence consistently demonstrates that PCOS has a negative impact on women’s HRQL. This impact does not necessarily correlate with clinical measures of disease severity. There is evidence that the effect on HRQL may be mediated by obesity, infertility concerns and menstrual dysfunction. Cross-cultural studies suggest that the effect of PCOS on the HRQL of an individual patient may be specific to the perception, values and culture of that patient.
Performance measurement models and their influence on net fundraising of investment funds

This article aims to analyze the relation between third- and fourth-order conditions and risk factors and their adequacy to return, performance, and net fundraising. The factors used to determine fund performance and, consequently, their relation with fundraising are: market return, size, book-to-market, profitability, investment, co-skewness, and co-kurtosis. The funds constituting the sample are those classified as Free Stocks (within the period from April 2001 to April 2015). Methodologically, this study has two phases. The first one refers to estimating the parameters that represent fund sensitivity to the factors and the comparison of the capital asset pricing models (CAPM), Fama-French-Carhart 4-factor (FFC), FamaFrench 5-factor (FF5), Fama-French 5-factor with momentum (FF5M), added or not with co-moments, by means of the fixed-effects procedure. The second one deals with verifying the relation between performance and net fundraising. The models were reestimated through moving time windows, so that the alpha calculated on each of them represented fund performance within the immediately subsequent period. We also estimated the relation fundraising-performance through cross-section regressions, with rates and age as control variables. The results showed that the co-skewness and co-kurtosis coefficients are not that relevant for determining performance and net fundraising of investment funds. Among the risk factors, market, size, and momentum are the significant parameters for fund returns. The FFC and FF5M models are those with greater explanatory power regarding return specification. There is also evidence of convexity in the relation between performance and fundraising.
Comfort with proxy consent to research involving decisionally impaired older adults: do type of proxy and risk-benefit profile matter?

ABSTRACT Background: Dementia research often requires the participation of people with dementia. Obtaining informed consent is problematic when potential participants lack the capacity to provide it. We investigated comfort with proxy consent to research involving older adults deemed incapable of this decision, and examined if comfort varies with the type of proxy and the study's risk-benefit profile. Methods: We surveyed random samples of five relevant groups (older adults, informal caregivers, physicians, researchers in aging, and Research Ethics Board members) from four Canadian provinces. Respondents were presented with scenarios involving four types of proxies (non-assigned, designated in a healthcare advance directive with or without instructions specific to research participation, and court-appointed). Given a series of risk-benefit profiles, respondents indicated whether they were comfortable with proxy consent to research for each scenario. Results: Two percent of the respondents felt proxy consent should never be allowed. In all groups, comfort depended far more on the risk-benefit profile associated with the research scenario than with type of proxy. For research involving little or no risk and potential personal benefits, over 90% of the respondents felt comfortable with substitute consent by a designated or court-appointed proxy while 80% were at ease with a non-assigned proxy. For studies involving serious risks with potentially greater personal benefits, older adults and informal caregivers were less comfortable with proxy consent. Conclusions: A large majority of Canadians are comfortable with proxy consent for low-risk research. Further work is needed to establish what kinds of research are considered to be low risk.
Target Setting and Allocative Inefficiency in Lending: Evidence from Two Chinese Banks

We study the consequences of month-end lending incentives for Chinese bank managers. Using data from two banks, one state-owned and the other partially privatized, we show a clear increase in lending in the final days of each month, resulting from both more loan issuance and higher value per loan. We estimate that daily lending is 92 percent higher in the last 5 days of each month as a result of loan targets, with only a small amount plausibly attributable to shifting loans forward from the following month. End-of-month loans are 1.6 percentage points (12 percent) more likely to be classified as bad in the years following issuance relative to mid-month loans. Our work highlights the distortionary effects of target-setting on capital allocation, in a context in which such concerns have risen to particular prominence in recent years.
Association of Suicide Rates of Elderly Persons with Fertility Rates

A negative correlation between societal suicide rates and social integration has been reported, but rarely specifically examined for suicide rates of the elderly although suicide rates of elderly persons are among the highest. The associations of suicide rates of elderly persons and fertility rates for 81 countries were examined using data from the World Health Organisation and United Nations. Fertility rates were considered a proxy measure for social integration. Multiple regression analysis indicated that suicide rates for males and females in the age bands 65–74 years and 75+ years were independently (negative) correlated with fertility rates. Fertility rates, as a measure of social integration, may interact with, modify and mediate the effect of cultural factors on suicide rates of elderly persons.
Key predictors of post-trauma symptomatology in military peacekeeping veterans

Several studies have shown a relationship between social resources and levels o f posttrauma symptomatology. The present study was designed to test a model in which feelings of loneliness mediate both the effect o f exposure to potentially traumatic events and social support in the development o f chronic posttraumatic stress disorder (PTSD). To test this model, 246 Australian Defence Force peacekeepers were surveyed after their return to Australia from duty in Rwanda. They completed measures of trauma exposure, general mental health, PTSD, social support and loneliness. The model was partially supported, with loneliness mediating the effect o f support but not the level o f trauma exposure. The findings are discussed in relation to theoretical and clinical implications.
Utility of a Noninvasive 2-Gene Molecular Assay for Cutaneous Melanoma and Effect on the Decision to Biopsy

Importance Expression of long intergenic non–protein coding RNA 518 (LINC00518) and preferentially expressed antigen in melanoma (PRAME) genes, obtained via noninvasive adhesive patch biopsy, is a sensitive and specific method for detection of cutaneous melanoma. However, the utility of this test in biopsy decisions made by dermatologists has not been evaluated. Objective To determine the utility of the pigmented lesion assay (PLA) for LINC00518/PRAME expression in decisions to biopsy a series of pigmented skin lesions. Design, Setting, and Participants In this secure web-based, multiple-reader–multiple-case study, 45 board-certified dermatologists each evaluated 60 clinical and dermoscopic images of clinically atypical pigmented lesions, first without and then with PLA gene expression information and were asked whether the lesions should be biopsied. Data were collected from March 24, 2014, through November 13, 2015. Interventions Participants were given a report for each lesion, which included the results of an assay for expression of LINC00518/PRAME and a PLA score with data on the predictive values of the information provided. Main Outcomes and Measures Biopsy sensitivity and specificity with vs without PLA data. Results Forty-five dermatologists (29 male and 16 female) performed the evaluation. After incorporating the PLA into their decision as to whether to biopsy a pigmented lesion suggestive of melanoma, dermatologists improved their mean biopsy sensitivity from 95.0% to 98.6% (P = .01); specificity increased from 32.1% to 56.9% (P < .001) with PLA data. Conclusions and Relevance The noninvasive PLA enables dermatologists to significantly improve biopsy specificity while maintaining or improving sensitivity. This result may increase the number of early melanomas biopsied and reduce the number of benign lesions biopsied, thereby improving patient outcomes and reducing health care costs.
Protective mechanisms of the common fibular nerve in and around the fibular tunnel: A new concept

The most frequent site at which the common fibular nerve is affected by compression, trauma, traction, masses, and surgery is within and around the fibular tunnel. The aim of this study was to determine whether there were protective mechanisms at this site that guard against compression of the nerve. Twenty‐six lower limbs of 13 preserved adult cadavers (11 males and two females) were used. Proximal to the entrance of the tunnel, three anatomical configurations seemed to afford the required protection for the nerve: reinforcement of the deep fascia; tethering of the common fibular nerve to both the tendon of the biceps femoris and the reinforced fascia; and the particular arrangement of the deep fascia, fibular head, and soleus and gastrocnemius muscles. At the entrance of the tunnel, contraction of the first segment of fibularis longus muscle could afford the required protection. In the tunnel, contraction of the second and third segments of fibularis longus muscle could guard against compression of the nerve. The tough fascia on the surface of fibularis longus muscle and the fascial band within it, which have long been accused of compression of the nerve, may actually be elements of the protective mechanisms. We conclude that there are innate, anatomical protective mechanisms which should be taken into consideration when decompressing the common fibular nerve. To preserve these mechanisms whenever possible, the technique should be planned and varied according to the underlying etiology. Clin. Anat. 22:738–746, 2009. © 2009 Wiley‐Liss, Inc.
Implementation of a novel emergency surgical unit significantly improves the management of gallstone pancreatitis.

INTRODUCTION Emergency surgery is changing rapidly with a greater workload, early subspecialisation and centralisation of emergency care. We describe the impact of a novel emergency surgical unit (ESU) on the definitive management of patients with gallstone pancreatitis (GSP). METHODS A comparative audit was undertaken for all admissions with GSP before and after the introduction of the ESU over a six-month period. The impact on compliance with British Society of Gastroenterology (BSG) guidelines was assessed. RESULTS Thirty-five patients were treated for GSP between December 2013 and May 2014, after the introduction of the ESU. This was twice the nationally reported average for a UK trust over a six-month period. All patients received definitive management for their GSP and 100% of all suitable patients received treatment during the index admission or within two weeks of discharge. This was a significantly greater proportion than that prior to the introduction of the ESU (57%, p=0.0001) as well as the recently reported national average (34%). The mean length of total inpatient stay was reduced significantly after the ESU was introduced from 13.7 ± 4.7 days to 7.8 ± 2.1 days (p=0.03). The mean length of postoperative stay also fell significantly from 6.7 ± 2.6 days to 1.8 ± 0.8 days (p=0.001). CONCLUSIONS A dedicated ESU following national recommendations for emergency surgery care by way of using dedicated emergency surgeons and a streamlined protocol for common presentations has been shown by audit of current practice to significantly improve the management of patients presenting to a busy district general hospital with GSP.
Habitual Minimalist Shod Running Biomechanics and the Acute Response to Running Barefoot

Abstract The aim of the study was to determine whether habitual minimalist shoe runners present with purported favorable running biomechanithat reduce running injury risk such as initial loading rate. Eighteen minimalist and 16 traditionally cushioned shod runners were assessed when running both in their preferred training shoe and barefoot. Ankle and knee joint kinetics and kinematics, initial rate of loading, and footstrike angle were measured. Sagittal ankle and knee joint stiffness were also calculated. Results of a two-factor ANOVA presented no group difference in initial rate of loading when participants were running either shod or barefoot; however, initial loading rate increased for both groups when running barefoot (p=0.008). Differences in footstrike angle were observed between groups when running shod, but not when barefoot (minimalist:8.71±8.99 vs. traditional: 17.32±11.48 degrees, p=0.002). Lower ankle joint stiffness was found in both groups when running barefoot (p=0.025). These findings illustrate that risk factors for injury potentially differ between the two groups. Shoe construction differences do change mechanical demands, however, once habituated to the demands of a given shoe condition, certain acute favorable or unfavorable responses may be moderated. The purported benefits of minimalist running shoes in mimicking habitual barefoot running is questioned, and risk of injury may not be attenuated.
A Very Simple Goals- and Risk-Based Asset Pricing Model (or Asset Pricing with Heterogeneous Investors)

Prof, Andre Perold has shown how the Capital Asset Pricing Model (with implications for asset pricing and risk-adjusted performance) can be derived from maximizing the Sharpe ratio as opposed to the traditional approach of assuming that investors maximize the utility of wealth. More recently, Goals-based Investing (GBI) is becoming the norm for investors and Prof. Robert Merton has suggested that theory needs to accommodate the fact that investors maximize relative (wealth divided by the present value of the goal) and not absolute wealth. Individuals save for a range of goals (e.g., retirement, a child’s college expenses) and each has a unique set of cash flows. The paper first argues for the creation of a new class of relative risk-free fixed income securities for each goal as proposed for a number of countries by Prof. Merton. These instruments will typically be interest-only real bonds (linked to the appropriate inflation index), with a forward start date, and pay coupons for the period required for the respective goal. The second contribution of this paper is to use the Perold approach and show that with two such goals/instruments and the traditional risk-free asset, all risky assets can be priced and optimal asset allocation recommendations derived, without requiring a formal utility function, risk aversion parameter or market portfolio. All that is needed is the assumption that investors maximize risk-adjusted returns relative to the goal-replicating asset and specify risk goals much like traditional investors would specify. The asset pricing model is derived from the simple idea that a relatively risk-free asset for one goal is a risky asset for another, and hence these two assets, plus the absolute risk-free rate allow us to triangulate to establish returns for all other assets. This approach also lends itself easily to an asset pricing model with heterogeneous investors and effective risk-adjusted performance measures.
Selective Stimulation of Hepatitis C Virus and Pestivirus NS5B RNA Polymerase Activity by GTP*

NS5B of the hepatitis C virus is an RNA template-dependent RNA polymerase and therefore the key player of the viral replicase complex. Using a highly purified enzyme expressed with recombinant baculoviruses in insect cells, we demonstrate a stimulation of RNA synthesis up to 2 orders of magnitude by high concentrations of GTP but not with ATP, CTP, UTP, GDP, or GMP. Enhancement of RNA synthesis was found with various heteropolymeric RNA templates, with poly(C)-oligo(G)12 but not with poly(A)-oligo(U)12. Several amino acid substitutions in polymerase motifs B, C, and D previously shown to be crucial for RdRp activity were tested for GTP stimulation of RNA synthesis. Most of these mutations, in particular those affecting the GDD motif (motif C) strongly reduced or completely abolished activation by GTP, suggesting that the same NTP-binding site is used for stimulation and RNA synthesis. Since GTP did not affect the overall RNA binding properties or the elongation rate, high concentrations of GTP appear to accelerate a rate-limiting step at the level of initiation of RNA synthesis. Finally, enhancement of RNA synthesis by high GTP concentrations was also found with NS5B of the pestivirus classical swine fever virus, but not with the 3D polymerase of poliovirus. Thus, stimulation of RdRp activity by GTP is evolutionarily conserved between the closely related hepaciviruses and pestiviruses but not between these and the more distantly related picornaviruses.
Going undercover: Online domestic tourism marketing communication in closed and open Facebook groups

Due to the importance of social media for domestic tourism consumers, small-medium enterprises (SMEs) include online marketing using Facebook in their strategic communication efforts. Using unique tactics to embed unidentified messages, they exploit open and closed Facebook groups under the disguise of organic users. This study evaluates the entrance of small domestic tourism business owners into Israeli Facebook groups, analyzing their consumer engagement tactics using virtual ethnography (netnography) as a research method. Netnography is a qualitative approach to data collection in virtual communities. In this research, the procedure was multistep: observation, qualitative data collection of closed and open tourism Facebook groups, and analysis and presentation of results as well as their implications. Key findings indicate that SME marketing efforts mimic organic user activities, exploiting virtual characteristics on Facebook groups (e.g. a sense of community, belonging, and trust). Another notable phenomenon is the undisclosed marketing communication tool kit employed to transmit message. It includes tactics such as separation of private and business profiles, exploitation of family relations, and repeat recommendations. This research adds to the understanding of online tourism marketing in virtual communities by analyzing the messaging optimization tool kit for targeting Facebook-using audiences.
English Language Teaching and the Lingua Franca Core in East Asia

In recent years, English language teaching has seen a trend away from continued dependence on native-speaker norms in favour of teaching based on English as a Lingua Franca (ELF). In particular, this involves the Lingua Franca Core (LFC) of those features of English pronunciation that are claimed to ensure intelligibility but at the same time permit substantial local variation. The suggestion is that there is no need to teach features of pronunciation that are outside the LFC. This paper provides an overview of the implications of these LFC proposals for teaching English in East Asia, in particular by considering which features of pronunciation cause breakdowns in communication.
197: THE EFFECT OF FISH-OIL SUPPLEMENTATION ON MATERNAL AND NEONATAL OUTCOMES: A TRIPLE BLIND RANDOMIZED CONTROLLED TRIAL

Background and aims: To evaluate the effect of fish oil supplementation on pregnancy outcomes in mother and newborn. Method: This randomized, triple-blinded placebo-controlled trial was conducted on 150 pregnant women aged 18–35 from February 2014 to April 2015 in Tabriz, Iran. Participants assigned to receive either 1000 mg fish oil supplements containing 180 mg eicosapentaenoic acid and 120 mg docosahexanoic acid from week 20 of gestation to birth. Primary outcome measure was birth weight. Gestational duration, preterm labour, low birth weight (LBW), length, and head circumference, maternal serum DHA and EPA level at 35–37 weeks were also examined. The statistical analysis was intent-to-treat. Results: Demographic characteristics were similar in both groups (P>0.05). The mean (SD) birth weight in the fish oil and placebo groups were 3256g (362) and 3172g (447), respectively (adjusted MD=84.1g; [95% CI –24.8, 193.2]). Five (7.6%) neonates in the placebo versus no case in the fish oil group were born with LBW (p=0.02). The rate of preterm labour was lower in the fish oil group (adjusted OR=0.74; [95% CI 0.16, 3.42]). However, there were no statistically significant differences in the maternal outcomes (P>0.05) with exception of the proportion of maternal serum DHA fatty acid at 35–37 weeks (P<0.001). Conclusion: Although low dose fish oil supplementation increased birth weight, its effect was not statistically significant. The frequency of LBW was significantly reduced in the intervention group but the observed reduction needs to be confirmed in future larger investigations using different doses of omega-3.