Miracle-dz/UniFAR-FTUs huggingface dataset:
An examination of SANE data: Clinical considerations based on victim‐assailant relationship

Abstract The current study analyzes adult female sexual assault data, collected by sexual assault nurse examiners (SANEs) in New Hampshire, United States, between 1997 and 2007. The purposes of this study were to (1) explore the relationship between patient and assailant, (2) examine patients' physical findings according to assailant type, (3) describe characteristics of both the patients and the assaults, and (4) make care recommendations. Secondary analysis was conducted on data gathered by SANEs from responses to a standardized questionnaire based on the medical/forensic examination of each patient over an 11‐year period. Of the 741 women in this study, 53% were sexually assaulted by a nonstranger, 18% were assaulted by an intimate partner, and 11% were assaulted by a stranger. The relationship between patient and assailant is an important variable that requires SANEs to take a closer look at assessing for lethality, and assisting with safety planning, intervention, and treatment for victims.
The Evolution of Resistance to a Parasite Is Determined by Resources

Given the ubiquity of parasites, it is critical to understand the evolution of defense against them. Using a selection experiment performed across a broad range of host resources, I examine how resistance and associated costs depend on resource availability. Higher resistance to a natural viral pathogen evolves in a host when there are more resources, and this directly suggests a resource-dependent cost of the evolution of resistance. Resistance is traded off with host growth rate, and the costs are stronger under poor resource environments, although adaptation to poor environments reduces these costs. The level of resistance and the costs that are paid for this resistance depend on both the selection environment and the environment in which hosts are assayed, implying that different resistance mechanisms may evolve in different environments. More broadly, the results emphasize that environmental heterogeneity in time and space may underpin variation in immune diversity.
Music Therapy for Children and Adults with Cancer

Music therapy is a complementary therapy that has been used successfully with oncology patients to ease emotional and physical pain and serve as an important outlet for expression. Specifically, music therapy may reduce anxiety, increase relaxation, increase tolerance for treatments, reduce treatmentrelated symptoms, and give patients an identity beyond their cancer diagnosis. It is estimated that as many as 80% of patients with cancer use complementary and alternative medicine (CAM) therapies to address their physical and psychosocial needs.1 Music therapy is one complementary therapy among others that may be used to address the unique challenges of the cancer survivor. People who have experienced music therapy report that it affects them on a physical, emotional, social, and spiritual level.2 Over the past 2 decades, music therapy has gained significant acceptance as a simple and effective tool in oncology and other medical settings. Today, music therapy is offered in many hospitals and other types of medical facilities throughout the world.
Clinical Effectiveness and Cost Benefit of Universal versus Targeted Methicillin-Resistant Staphylococcus aureus Screening upon Admission in Hospitals

Objective. To conduct an exploratory study to evaluate the clinical effectiveness and cost benefit of universal versus targeted screening for methicillin-resistant Staphylococcus aureus (MRSA) to prevent hospital-acquired MRSA infections. Design. Prospective, interventional study, using a case-control design, difference-in-differences, and cost-benefit analyses. Setting. Two community hospitals in Wisconsin. Patients. Consecutive sample of 15,049 adult admissions from April 2009 to July 2010. Interventions. MRSA surveillance performed by polymerase chain reaction (PCR) on samples collected from all adult patients (aged over 18 years) within 30 days before or upon an admission to the hospital. During a 9-month baseline period, targeted screening was conducted at both hospitals. During the 5-month intervention period, all patients admitted to the intervention hospital were screened for MRSA. Infection control measures were consistent at both hospitals. Results. Universal screening was associated with an increase in admission screening of 43.58 percentage points (P<.01), an increase in MRSA detection of 2.95 percentage points (P<.01), and a small, nonsignificant decline in hospital-acquired MRSA infections of 0.12 percentage points (P = .34). The benefit-to-cost ratio was 0.50, indicating that for every dollar spent on universal versus targeted screening, only $0.50 is recovered in avoided costs of hospital-acquired MRSA infection. Conclusion. Compared with targeted screening, universal screening increased the rate of detection of MRSA upon hospital admission but did not significantly reduce the rate of hospital-acquired MRSA infection. Universal screening was associated with higher costs of care and was not cost beneficial.
Grabb and Smith’s Plastic Surgery

Grabb and Smith’s Plastic Surgery is a comprehensive single volume text that covers the vast realm of plastic and reconstructive surgery. The book is written by a compilation of excellent authors who are all leaders in the field of plastic and reconstructive surgery. The book is organized into 8 parts, which are subdivided into a total of 93 chapters. The book commences with Part I, which provides a comprehensive review of the fundamental principles, techniques, and physiology of plastic and reconstructive surgery. Parts II through VIII examine the discipline through an anatomicallybased approach, with additional sections devoted to congenital anomalies and esthetic surgery. Compared with the 5th edition, the subject matter in almost all areas has been expanded. This expanded content parallels the current advancements in plastic and reconstructive surgery, such as (1) soft-tissue augmentation, fat grafting, and laser resurfacing for esthetic surgery, (2) autologous tissue reconstruction, microsurgery, and nipple reconstruction for reconstructive breast surgery, (3) principles and techniques for local wound care, and (4) principles and techniques for complex burn reconstruction and radiation injury. The text would most benefit residents in the field of plastic and reconstructive surgery, as well as residents in related surgical subspecialties, physician assistants, nurse practitioners, and medical students. The text would also be an exceptional complement to the library of a practicing surgeon. Lisa Spiguel, MD Chicago, IL The cost of the book (at $210) is more than adequate for such a comprehensive text, and the price includes an accompanying CD that provides a computer-based PDF file of the text. Within each section, the CD allows one to perform focused searches for topics of interest. In addition, the CD incorporates an accessible image bank of all diagrams, charts, and images provided in each chapter. David H. Song, MD Chicago, IL
Efavirenz Pharmacokinetics During the Third Trimester of Pregnancy and Postpartum

Background: The impact of pregnancy on efavirenz (EFV) pharmacokinetics is unknown. Methods: International Maternal Pediatric Adolescent AIDS Clinical Trials P1026s is an on-going, prospective, nonblinded study of antiretroviral pharmacokinetics in HIV-infected pregnant women that included a cohort receiving 600 mg EFV once daily as part of combination antiretroviral therapy. Intensive steady-state 24-hour blood sampling was performed during the third trimester and at 6–12 weeks postpartum. Maternal and umbilical cord blood samples were drawn at delivery. Pharmacokinetics targets were the estimated 10th percentile EFV area under the curve (AUC) in nonpregnant historical controls (40.0 mcg·hr−1·mL−1) and a trough concentration of 1 mcg/mL. Results: Twenty-five women were enrolled during the third trimester: median (range) age was 29.3 (18.9–42.9) years, weight 69.0 (40–130) kg, and gestational age 32.9 (30.1–38.7) weeks. Median (range) EFV AUC0–24, Cmax, and C24 hours were 55.4 mcg·hr−1·mL−1 (13.5-220.3), 5.4 mcg/mL (1.9–12.2), and 1.6 mcg/mL (0.23–8.13), respectively. EFV AUC and Cmax did not differ during pregnancy and postpartum but C24 hours was lower during the third trimester (1.6 vs. 2.1 mcg/mL, P = 0.01). During the third trimester, 5 of 25 (20%) women had an EFV AUC below the target and 3 of 25 (12%) had a trough concentration below 1 mcg/mL. EFV cord blood/maternal concentration ratio was 0.49 (0.37–0.74). All women had a HIV-1 RNA viral load less than 400 copies per milliliter at delivery and 19 (76%) had a viral load below 50 copies per milliliter. One child was perinatally HIV infected. Three women were exposed to EFV throughout the first 6 weeks of pregnancy. EFV was well tolerated, and among the 25 infants, no congenital anomalies or newborn complications were reported. Conclusions: Changes in EFV pharmacokinetics during pregnancy compared with postpartum are not sufficiently large enough to warrant a dose adjustment during pregnancy.
Birdsong Performance and the Evolution of Simple (Rather than Elaborate) Sexual Signals

Sexual signals are often elaborate as a result of sexual selection for signals of individual quality. Contrary to expectation, however, the elaboration of signals such as birdsong is not related to the strength of sexual selection across species. With a comparative study across wood warblers (family Parulidae), we show a compromise between advertising the performance of trills (syllable repetitions) and song complexity, which can result in the evolution of simple, rather than elaborate, song. Species with higher trill performance evolved simple songs with more extensive trilled syntax. This advertises trill performance but reduces syllable diversity in songs. These two traits are commonly sexually selected in songbirds, but indexes of sexual selection were not related to either in wood warblers. This is consistent with sexual selection targeting different traits in different species, sometimes resulting in simple signals. We conclude that the evolution of sexual signals can be unpredictable when their physiology affords multiple or, as here, opposing ways of advertising individual quality.
Theoretical Predictions for How Temperature Affects the Dynamics of Interacting Herbivores and Plants

Concern about climate change has spurred experimental tests of how warming affects species’ abundance and performance. As this body of research grows, interpretation and extrapolation to other species and systems have been limited by a lack of theory. To address the need for theory for how warming affects species interactions, we used consumer-prey models and the metabolic theory of ecology to develop quantitative predictions for how systematic differences between the temperature dependence of heterotrophic and autotrophic population growth lead to temperature-dependent herbivory. We found that herbivore and plant abundances change with temperature in proportion to the ratio of autotrophic to heterotrophic metabolic temperature dependences. This result is consistent across five different formulations of consumer-prey models and over varying resource supply rates. Two models predict that temperature-dependent herbivory causes primary producer abundance to be independent of temperature. This finding contradicts simpler extensions of metabolic theory to abundance that ignore trophic interactions, and is consistent with patterns in terrestrial ecosystems. When applied to experimental data, the model explained 77% and 66% of the variation in phytoplankton and zooplankton abundances, respectively. We suggest that metabolic theory provides a foundation for understanding the effects of temperature change on multitrophic ecological communities.
Low Cerebrospinal Fluid Concentrations of the Nucleotide HIV Reverse Transcriptase Inhibitor, Tenofovir

Background:Tenofovir is a nucleotide HIV reverse transcriptase inhibitor whose chemical properties suggest that it may not penetrate into the central nervous system in therapeutic concentrations. The study's objective was to determine tenofovir's penetration into cerebrospinal fluid (CSF). Methods:CNS HIV Antiretroviral Therapy Effects Research is a multicenter observational study to determine the effects of antiretroviral therapy on HIV-associated neurological disease. Single random plasma and CSF samples were drawn within an hour of each other from subjects taking tenofovir between October 2003 and March 2007. All samples were assayed by mass spectrometry with a detection limit of 0.9 ng/mL. Results:One hundred eighty-three participants (age 44 ± 8 years; 83 ± 32 kg; 33 females; CSF protein 44 ± 16 mg/dL) had plasma and CSF samples drawn 12.2 ± 6.9 and 11 ± 7.8 hours post dose, respectively. Median plasma and CSF tenofovir concentrations were 96 ng/mL [interquartile range (IQR) 47–153 ng/mL] and 5.5 ng/mL (IQR 2.7–11.3 ng/mL), respectively. Thirty-four of 231 plasma (14.7%) and 9 of 77 CSF samples (11.7%) were below detection. CSF to plasma concentration ratio from paired samples was 0.057 (IQR 0.03–0.1; n = 38). Median CSF to wild-type 50% inhibitory concentration ratio was 0.48 (IQR 0.24–0.98). Seventy-seven percent of CSF concentrations were below the tenofovir wild-type 50% inhibitory concentration. More subjects had detectable CSF HIV with lower (⩽7 ng/mL) versus higher (>7ng/mL) CSF tenofovir concentrations (29% versus 9%; P = 0.05). Conclusions:Tenofovir concentrations in the CSF are only 5% of plasma concentrations, suggesting limited transfer into the CSF, and possibly active transport out of the CSF. CSF tenofovir concentrations may not effectively inhibit viral replication in the CSF.
Ending Pediatric AIDS and Achieving a Generation Born HIV-Free

Abstract:In the 30 years of the AIDS pandemic, the devastating effects of HIV on infants and young children have often been overlooked and neglected. However, the ability to prevent mother-to-child transmission of HIV (PMTCT), or vertical transmission, has been one of the most significant prevention success stories in the global AIDS response. New HIV infections in children have been virtually eliminated in high-income countries and programmatic efforts have shifted to low-income and middle-income countries, particularly in sub-Saharan Africa, home to the vast majority of pediatric AIDS cases.Over the past decade, the dramatic scale-up of PMTCT programs has saved millions of lives and has provided a foundation for HIV prevention and care and treatment programs that are integrated within maternal and child health services. Although some countries in sub-Saharan Africa are now approaching universal PMTCT coverage, global access to PMTCT for HIV-positive pregnant women remains at nearly 50%. Recently, a new global plan has focused efforts and resources to keep HIV-positive mothers healthy and to virtually eliminate new pediatric infections by 2015.What programmatic and technical innovations will be necessary to overcome current service gaps and implementation barriers? How can countries continue the current momentum with sustainable locally-led programs that address the epidemic in women and children? And how can the vital perspectives of communities and people living with HIV help drive these efforts? Successfully addressing these and other issues will be key to ending HIV infections in children and creating an AIDS-free generation within the next decade.
Enemies Maintain Hyperdiverse Tropical Forests

Understanding tropical forest tree diversity has been a major challenge to ecologists. In the absence of compensatory mechanisms, two powerful forces, drift and competition, are expected to erode diversity quickly, especially in communities containing scores or hundreds of rare species. Here, I review evidence bearing on four compensatory mechanisms that have been subsumed under the terms “density dependence” or “negative density dependence”: (1) intra- and (2) interspecific competition and the action of (3) density-responsive and (4) distance-responsive biotic agents, as postulated by Janzen and Connell. To achieve ontological integration, I examine evidence based on studies employing seeds, seedlings, and saplings. Available evidence points overwhelmingly to the action of both host-generalist and host-restricted biotic agents as causing most seed and seedling mortality, implying that species diversity is maintained via top-down forcing. The overall effect of most host-generalist seed predators and herbivores is to even out the distribution of surviving propagules. Spatially restricted recruitment appears to result mainly, if not exclusively, from the actions of host-restricted agents, principally microarthropods and fungi, that attack hosts in a distance-dependent fashion as Janzen and Connell proposed. Near total failure of propagules close to reproductive conspecifics ensures that successful reproduction occurs through a scant rain of dispersed seeds. Densities of dispersed seeds and seedlings arising from them are so low as to generally preclude the operation of density dependence, at least during early ontogenetic stages. I conclude that Janzen and Connell were essentially correct and that diversity maintenance results from top-down forcing acting in a spatially nonuniform fashion.
Profiles of Patients With Intellectual Disability and Mental Illness in Specialized and Generic Units in an Ontario Psychiatric Hospital

In a mental health system where limited specialized services exist for individuals with intellectual disability (ID), patients using such services should be those with the most complex needs. The purpose of this study was to compare the profile of patients with ID served in a specialized unit (n = 40) to those in generic units (n = 141) within one psychiatric teaching hospital in Ontario. Based on previous research, it was hypothesized that specialized patients would differ in terms of psychiatric diagnoses, service needs, overall level of functioning, and length of stay when compared with their counterparts in generic units. A retrospective review of select data from the Resident Assessment Instrument–Mental Health (RAI-MH) and Global Assessment of Functioning (GAF) was conducted for patients with ID discharged from all units of our hospital from 2006 to mid-2009. Though patients were demographically similar, those in the specialized unit stayed in the hospital longer than generic patients. Differences in psychiatric diagnoses, reasons for referral, overall functioning, and medication use were also found.
Ecological Opportunity and Diversification in a Continental Radiation of Birds: Climbing Adaptations and Cladogenesis in the Furnariidae

Ecological theories of adaptive radiation predict that ecological opportunity stimulates cladogenesis through its effects on competitive release and niche expansion. Given that key innovations may confer ecological opportunity, we investigated the effect of the acquisition of climbing adaptations on rates of cladogenesis in a major avian radiation, the Neotropical bird family Furnariidae, using a species-level phylogeny. Morphological specializations for vertical climbing originated in the woodcreepers ∼23 million years ago, well before that adaptation occurred in woodpeckers (Picidae) or in other potential competitors in South America. This suggests that the acquisition of climbing adaptations conferred ample ecological opportunity to early woodcreepers. Nonetheless, we found that increases in speciation rates in Furnariidae did not coincide with the acquisition of climbing adaptations and that the relationship between the accumulation of climbing adaptations and rates of speciation was negative. In addition, we did not detect a diversity-dependent decline in woodcreeper diversification rates consistent with saturation of the trunk-climbing niche. These findings do not support the hypothesis that ecological opportunity related to trunk foraging stimulated cladogenesis in this radiation. The negative effect of climbing on diversification may be mediated by an indirect positive effect of climbing on dispersal ability, which may reduce speciation rates over evolutionary timescales.
Effect of different larval rearing temperatures on the productivity ( Ro ) and morphology of the malaria vector Anopheles superpictus Grassi ( Diptera : Culicidae ) using geometric morphometrics

Temperature affects both the biology and morphology of mosquito vectors. Geometric morphometrics is a useful new tool for capturing and analyzing differences in shape and size in many morphological parameters, including wings. We have used this technique for capturing the differences in the wings of the malaria vector Anopheles superpictus, using cohorts reared at six different constant temperatures (15°, 20°, 25°, 27°, 30°, and 35° C) and also searched for potential correlations with the life tables of the species. We studied wing shape in both male and female adults, using 22 landmarks on the wing in relation to ecological parameters, including the development rate. The ecological zero was calculated as 9.93° C and the thermal constant as 296.34 day-degrees. The rearing temperature affects egg, larval, and pupal development and also the total time from egg to adult. As rearing temperatures increased, longevity decreased in both sexes. In An. superpictus, Ro value and productivity correlated with the statistically significant gradual deformations in the wing shape related to size in both sexes. These deformations directly linked to differences in immature rearing temperatures. Analysis using PCA and UPGMA phenograms showed that although wings of females became narrower dorsoventrally as the temperature increased, they became broader in males. Comparisons of the wing landmarks indicated the medial part of the wing was most affected by larval rearing temperatures, showing relatively more deformations. Algorithmic values of the life tables were determined in correlation with the results of geometric morphometrics. Comparisons of centroid sizes in the cohorts showed that overall wing size became smaller in both sexes in response to higher rearing temperatures. Journal of Vector Ecology 34 (1): 32-42. 2009. Keyword Index: Anopheles superpictus, geometric morphometrics, temperature, life tables, relative warps.