Miracle-dz/UniFAR-FTUs huggingface dataset:
Risk factors for oral cancer in newly diagnosed patients aged 45 years and younger: a case-control study in Southern England.

Background: This case–control study aimed to identify the risk factors for oral cancer in patients aged 45 years and under. Methods: Patients were recruited over a 3-year period between 1999 and 2001 from 14 hospitals in the southeast of England, UK. Results: Fifty-three (80%) newly diagnosed patients with squamous cell carcinoma (SCC) of the oral cavity participated. The mean age of cases at diagnosis was 38.5 years (SD = 7.0) and 53% were male. Patients were interviewed about main risk factors of tobacco, alcohol, cannabis and their consumption of fresh fruit and vegetables in the past. Ninety-one matched control patients were also recruited. Odds ratios (ORs) and 95% confidence intervals (CI) were obtained from adjusted conditional logistic analyses. Significantly elevated ORs were evidenced amongst males who had started to smoke under the age of 16 years (OR = 14.3; 95% CI: 1.1–178.8). A significant reduction in risk was also shown for ex-smokers (OR = 0.2; 95% CI: 0.5–0.8). Consumption of alcohol in excess of recommended amounts also produced an eightfold risk in males (OR = 8.1; 95% CI: 1.6–40.1) and over a fourfold risk of oral cancer from the consumption of excessive amounts of alcohol and having ever smoked (OR = 4.4; 95% CI: 1.1–17.7). Conclusion: The study shows that the traditional behavioural risk factors are present in younger people diagnosed with oral cancer. The relatively short duration of exposure and the substantial number of cases without any known risk factors, particularly amongst females, however, suggest that factors other than tobacco and alcohol may also be implicated in the development of oral cancer in a proportion of these younger patients.
People Under Three: Young Children in Day Care

Acknowledgements Introduction 1. Values and Principles 2. Organizing Space for Living, Learning and Playing 3. The Key Person 4. Managing and Working in a Day Care Centre 5. Babies in Day Care 6. The Treasure Basket 7. The Second Year of Life 8. Heuristic Play with Objects 9. Children in their Third Year 10. Mealtimes 11. Out of Doors 12. Working Relations with Parents 13. Children in Difficulties 14. Families in Difficulties 15. Looking Ahead Suggestions for Further Reading Videos References Organizations concerned with young children and families
Effect of Finerenone on Albuminuria in Patients With Diabetic Nephropathy: A Randomized Clinical Trial.

IMPORTANCE Steroidal mineralocorticoid receptor antagonists, when added to a renin-angiotensin system blocker, further reduce proteinuria in patients with chronic kidney disease but may be underused because of a high risk of adverse events. OBJECTIVE To evaluate the safety and efficacy of different oral doses of the nonsteroidal mineralocorticoid receptor antagonist finerenone, given for 90 days to patients with diabetes and high or very high albuminuria who are receiving an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, placebo-controlled, parallel-group study conducted at 148 sites in 23 countries. Patients were recruited from June 2013 to February 2014 and the study was completed in August 2014. Of 1501 screened patients, 823 were randomized and 821 received study drug. INTERVENTIONS Participants were randomly assigned to receive oral, once-daily finerenone (1.25 mg/d, n = 96; 2.5 mg/d, n = 92; 5 mg/d, n = 100; 7.5 mg/d, n = 97; 10 mg/d, n = 98; 15 mg/d, n = 125; and 25 mg/d, n = 119) or matching placebo (n = 94) for 90 days. MAIN OUTCOMES AND MEASURES The primary outcome was the ratio of the urinary albumin-creatinine ratio (UACR) at day 90 vs at baseline. Safety end points were changes from baseline in serum potassium and estimated glomerular filtration rate. RESULTS The mean age of the participants was 64.2 years; 78% were male. At baseline, 36.7% of patients treated had very high albuminuria (UACR ≥300 mg/g) and 40.0% had an estimated glomerular filtration rate of 60 mL/min/1.73 m2 or lower. Finerenone demonstrated a dose-dependent reduction in UACR. The primary outcome, the placebo-corrected mean ratio of the UACR at day 90 relative to baseline, was reduced in the finerenone 7.5-, 10-, 15-, and 20-mg/d groups (for 7.5 mg/d, 0.79 [90% CI, 0.68-0.91; P = .004]; for 10 mg/d, 0.76 [90% CI, 0.65-0.88; P = .001]; for 15 mg/d, 0.67 [90% CI, 0.58-0.77; P<.001]; for 20 mg/d, 0.62 [90% CI, 0.54-0.72; P < .001]). The prespecified secondary outcome of hyperkalemia leading to discontinuation was not observed in the placebo and finerenone 10-mg/d groups; incidences in the finerenone 7.5-, 15-, and 20-mg/d groups were 2.1%, 3.2%, and 1.7%, respectively. There were no differences in the incidence of the prespecified secondary outcome of an estimated glomerular filtration rate decrease of 30% or more or in incidences of adverse events and serious adverse events between the placebo and finerenone groups. CONCLUSIONS AND RELEVANCE Among patients with diabetic nephropathy, most receiving an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, the addition of finerenone compared with placebo resulted in improvement in the urinary albumin-creatinine ratio. Further trials are needed to compare finerenone with other active medications. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT1874431.
Fathers' versus mothers' social referencing signals in relation to infant anxiety and avoidance: a visual cliff experiment.

Infants use signals from others to guide their behavior when confronted with novel situations, a process called 'social referencing' (SR). Via SR, signs of parental anxiety can lead to infant anxiety. Little is known about differences in the effect of paternal and maternal SR signals on child anxiety. Using a visual cliff paradigm, we studied whether SR processes between fathers and their infants differed from mothers and their infants. Eighty-one infants aged 10-15 months were randomly assigned to conduct the visual cliff task with their father (n = 41) or mother (n = 40). The infant was placed on the shallow side of the cliff and the parent, standing at the deep side, was instructed to encourage the infant to cross. Results showed that although mothers showed more intense facial expressions of encouragement than fathers, no differences occurred in how fast, and with how much anxiety, infants crossed the cliff with fathers and mothers. However, path analyses showed that paternal, but not maternal, expressed anxiety was positively associated with infant expressed anxiety and avoidance. For infants who participated with their mother, infants' anxious temperament was negatively associated with infant avoidance of the cliff. Infant anxious temperament moderated the link between paternal expressed anxiety and infant avoidance: the higher the level of infant anxious temperament the stronger the positive association between paternal expressed anxiety and infant's avoidance of the cliff. Lastly, parental encouragement was unrelated to infant expressed anxiety and avoidance. Our results suggest that SR processes between fathers and their infants differ from those between mothers and their infants.
Longitudinal relations among exuberance, externalizing behaviors, and attentional bias to reward: the mediating role of effortful control.

The present study examined the associations between temperamental exuberance during toddlerhood (20 months), attention bias towards reward at the end of kindergarten (76 months), and externalizing behaviors across the kindergarten year. Moreover, we examined the role of effortful control at 48 months on the relation between early exuberance and attention bias. Attention bias towards reward was positively predicted by exuberance, negatively predicted by effortful control, and positively related to externalizing problems. Finally, the longitudinal path between exuberance and attention bias to reward was mediated by effortful control - such that higher toddler exuberance led to increased attention bias towards reward by way of lower effortful control. These results extend the attention bias and socioemotional functioning literature and have implications for the identification of children at risk for behavioral problems.
Bilingual children's long-term outcomes in English as a second language: language environment factors shape individual differences in catching up with monolinguals.

Bilingual children experience more variation in their language environment than monolingual children and this impacts their rate of language development with respect to monolinguals. How long it takes for bilingual children learning English as a second language (L2) to display similar abilities to monolingual age-peers has been estimated to be 4-6 years, but conflicting findings suggest that even 6 years in school is not enough. Most studies on long-term L2 development have focused on just one linguistic sub-domain, vocabulary, and have not included multiple individual difference factors. For the present study, Chinese first language-English L2 children were given standardized measures of vocabulary, grammar and global comprehension every year from 4 ½ to 6 ½ years of English in school (ages 8½ to 10½); language environment factors were obtained through an extensive parent questionnaire. Children converged on monolingual norms differentially according to the test, with the majority of children reaching monolingual levels of performance on the majority of tests by 5 ½ years of English exposure. Individual differences in outcomes were predicted by length of English exposure, mother's education, mother's English fluency, child's use of English in the home, richness/quality of the English input outside school and age of arrival in Canada. In sum, the timeframe for bilinguals to catch up to monolinguals depends on linguistic sub-domain, task difficulty and on individual children's language environment, making 4-6 years an approximate estimate only. This study also shows that language environment factors shape not only early-stage but also late-stage bilingual development.
Frontal theta activation associated with error detection in toddlers: influence of familial socioeconomic status.

Error detection is one of the functions of the executive attention network, a brain system involved in executive control that includes the anterior cingulate cortex and other prefrontal regions. Despite the key role of this function in a wide range of life outcomes, very limited research has examined the early development of the network and whether its functional efficacy is related to environmental factors. Electrophysiological studies with adults have shown oscillatory activity in theta (4-7 Hz) range arising from medial frontal cortex that follows the detection of self-committed or observed errors. In the current study, we designed a novel experimental procedure that involved a familiarization phase with simple three-pieces puzzles followed by an experimental phase in which toddlers observed the puzzles being formed either correctly or incorrectly. Observation of incorrect configurations produced increased potentials in midline channels and greater power theta activity for both toddlers (n = 56) and adults (n = 14). In addition, socioeconomic status of the family in general, and parental education in particular, contributed to individual differences in the amplitude of the error-related signal and associated theta power in toddlers, indicating that children raised in lower SES families show poorer activation of the executive attention network. These data demonstrate the influence of environmental factors at the earliest stages of development of the executive attention network. Importantly, the results show that error-detection EEG signals can be used as neural markers of the initial development of executive attention, which can be of great help for the early detection of risk for developmental disorders involving deficits in this function.
Rehabilitation After Immobilization for Ankle Fracture: The EXACT Randomized Clinical Trial.

IMPORTANCE The benefits of rehabilitation after immobilization for ankle fracture are unclear. OBJECTIVES To determine the effectiveness of a supervised exercise program and advice (rehabilitation) compared with advice alone and to determine if effects are moderated by fracture severity or age and sex. DESIGN, SETTING, AND PARTICIPANTS The EXACT trial was a pragmatic, randomized clinical trial conducted from December 2010 to June 2014. Patients with isolated ankle fracture presenting to fracture clinics in 7 Australian hospitals were randomized on the day of removal of immobilization. Of 571 eligible patients, 357 chose not to participate and 214 were allocated to rehabilitation (n = 106) or advice alone (n = 108), with 194 (91%) followed up at 1 month, 173 (81%) at 3 months, and 170 (79%) at 6 months. There were no withdrawals attributed to adverse effects. Recruitment terminated early on December 31, 2013 (planned enrollment, 342; actual, 214), because funding was exhausted. INTERVENTIONS Supervised exercise program and advice about self-management (rehabilitation) (individually tailored, prescribed, monitored, and progressed) or advice alone, both delivered by a physical therapist. MAIN OUTCOMES AND MEASURES Primary outcomes were activity limitation assessed using the Lower Extremity Functional Scale (score range, 0-80; higher scores indicate better activity), and quality of life assessed using the Assessment of Quality of Life (score range, 0-1; higher scores indicate better quality of life), measured at baseline and at 1, 3 (primary time point), and 6 months. RESULTS Mean activity limitation and quality of life at baseline were 30.1 (SD, 12.5) and 0.51 (SD, 0.24), respectively, for advice and 30.2 (SD, 13.2) and 0.54 (SD, 0.24) for rehabilitation, increasing to 64.3 (SD, 13.5) and 0.85 (SD, 0.17) for advice vs 64.3 (SD, 15.1) and 0.85 (SD, 0.20) for rehabilitation at 3 months. Rehabilitation was not more effective than advice for activity limitation (mean effect at 3 months, 0.4 [95% CI, -3.3 to 4.1]) or quality of life (-0.01 [95% CI, -0.06 to 0.04]). Treatment effects were not moderated by fracture severity or age and sex. CONCLUSIONS AND RELEVANCE A supervised exercise program and advice did not confer additional benefits in activity limitation or quality of life compared with advice alone for patients with isolated and uncomplicated ankle fracture. These findings do not support the routine use of supervised exercise programs after removal of immobilization for patients with isolated and uncomplicated ankle fracture. TRIAL REGISTRATION anzctr.org. au Identifier: ACTRN12610000979055.
Muddling through with non-compliant biology : an ethnographic investigation : the meaning and practice of evidence in an NHS thyroid disease out-patients clinic

Thyroid diseases number amongst the most widespread and chronic conditions in the population. They are symptomatically vague, difficult to diagnose, and are more prevalent in women than men. Since the hormones produced by the gland control cell metabolism in the body, symptoms of glandular failure are elusively diverse and non-specific and are easily attributable to other diseases or no disease at all. Consequently, a definitive diagnosis conventionally relies on a blood test to measure the function of the gland. However, as observed in the clinic, such a diagnosis is often partial and is not compatible with the clinical symptoms some patients present. Predictably, many patients feel such tests are inaccurate measures of the extent of their disease and do not match their own interpretations of clinical symptoms or experiences of suffering. In response, many clinicians express concern that patients are incorrectly attributing their symptoms to thyroid disease and as a consequence are demanding treatments which are not necessary This qualitative study investigates the indeterminate aspects of thyroid dysfunction by exploring how a contest over meaning is manifest in the clinic, particularly with regards to how embodied clinical symptoms and disembodied biochemical measures are used as evidence for and against decisions over diagnosis and treatment. The thesis identifies that, due to the vague nature of both symptomatic and biochemical evidence, thyroid disease is a location where medicalisation is impossible. Subsequently, using the available discourses of the clinic, specifically EBM and patient centred medicine, clinicians and patients construct various orders of thyroid biology and pathology, in an attempt to satisfy diagnostic strategies and treatment needs. As a consequence the thesis can add to the analytical purchase of the anthropologist Paul Rabinow's concept of biosociality and theories of governmentality more generally. That is, it demonstrates how practices of re-making thyroid biology are possible, not because of a new found molecular control over thyroid biology, but due to the non-compliant nature of thyroid biology and the technical deficiency of current diagnostic and treatment strategies deployed to attend to it within the clinic.
Optimising lifestyle interventions: identification of health behaviour patterns by cluster analysis in a German 50+ survey.

BACKGROUND Many prevention and intervention measures are still targeting isolated behaviours such as tobacco use or physical inactivity. Cluster analysis enables the aggregation of single health behaviours in order to identify distinctive behaviour patterns. The purpose of this study was to group a sample of the over-50 population into clusters that exhibit specific health behaviour patterns regarding regular tobacco use, excessive alcohol consumption, unhealthy diet and physical inactivity. METHODS From the total population of the federal state of Baden-Wuerttemberg, Germany, 982 men and 1020 women aged 50-70 were randomly selected. Subjects were asked by trained interviewers in computer-assisted telephone interviews (CATI) about health behaviour and sociodemographic characteristics. Cluster analysis was conducted to identify distinct health behaviour patterns. Multinomial logistic regression was used to characterize clusters by specific social attributes. RESULTS Five homogeneous health behaviour clusters were identified: 'No Risk Behaviours' (25.3%), 'Physically Inactives' (21.1%), 'Fruit and Vegetable Avoiders' (18.2%), 'Smokers with Risk Behaviours' (12.7%) and 'Drinkers with Risk Behaviours' (22.7%). Whereas the first cluster is the ideal in terms of risk and prevention, the latter two groups include regular users of tobacco and excessive consumers of alcohol, who also engage in other risk behaviours like inactivity and maintaining an unhealthy diet. These two risk groups also exhibit specific sociodemographic attributes (male, living alone, social class affiliation). CONCLUSION Unhealthy behaviours evidently occur in typical combinations. An awareness of this clustering enables prevention and intervention measures to be planned so that multiple behaviours can be modified simultaneously.
Auditory access, language access, and implicit sequence learning in deaf children.

Developmental psychology plays a central role in shaping evidence-based best practices for prelingually deaf children. The Auditory Scaffolding Hypothesis (Conway et al., 2009) asserts that a lack of auditory stimulation in deaf children leads to impoverished implicit sequence learning abilities, measured via an artificial grammar learning (AGL) task. However, prior research is confounded by a lack of both auditory and language input. The current study examines implicit learning in deaf children who were (Deaf native signers) or were not (oral cochlear implant users) exposed to language from birth, and in hearing children, using both AGL and Serial Reaction Time (SRT) tasks. Neither deaf nor hearing children across the three groups show evidence of implicit learning on the AGL task, but all three groups show robust implicit learning on the SRT task. These findings argue against the Auditory Scaffolding Hypothesis, and suggest that implicit sequence learning may be resilient to both auditory and language deprivation, within the tested limits. A video abstract of this article can be viewed at: https://youtu.be/EeqfQqlVHLI [Correction added on 07 August 2017, after first online publication: The video abstract link was added. ].
ANGPTL3 Inhibition in Homozygous Familial Hypercholesterolemia.

Evinacumab, a monoclonal antibody that blocks ANGPTL3, was administered to nine adults with homozygous familial hypercholesterolemia. At 4 weeks, LDL cholesterol was reduced by a mean of 49%, with a mean absolute change from baseline of −157 mg per deciliter.
Instrumental learning and cognitive flexibility processes are impaired in children exposed to early life stress

Abstract Children who experience severe early life stress show persistent deficits in many aspects of cognitive and social adaptation. Early stress might be associated with these broad changes in functioning because it impairs general learning mechanisms. To explore this possibility, we examined whether individuals who experienced abusive caregiving in childhood had difficulties with instrumental learning and/or cognitive flexibility as adolescents. Fifty‐three 14–17‐year‐old adolescents (31 exposed to high levels of childhood stress, 22 control) completed an fMRI task that required them to first learn associations in the environment and then update those pairings. Adolescents with histories of early life stress eventually learned to pair stimuli with both positive and negative outcomes, but did so more slowly than their peers. Furthermore, these stress‐exposed adolescents showed markedly impaired cognitive flexibility; they were less able than their peers to update those pairings when the contingencies changed. These learning problems were reflected in abnormal activity in learning‐ and attention‐related brain circuitry. Both altered patterns of learning and neural activation were associated with the severity of lifetime stress that the adolescents had experienced. Taken together, the results of this experiment suggest that basic learning processes are impaired in adolescents exposed to early life stress. These general learning mechanisms may help explain the emergence of social problems observed in these individuals.
Surgical or Transcatheter Aortic-Valve Replacement.

1. The DCCT/EDIC Research Group. Frequency of evidencebased screening for retinopathy in type 1 diabetes. N Engl J Med 2017; 376: 1507-16. 2. Wong TY, Mwamburi M, Klein R, et al. Rates of progression in diabetic retinopathy during different time periods: a systematic review and meta-analysis. Diabetes Care 2009; 32: 2307-13. 3. Scanlon PH. The English National Screening Programme for diabetic retinopathy 2003-2016. Acta Diabetol 2017; 54: 515-25. 4. Wang LZ, Cheung CY, Tapp RJ, et al. Availability and variability in guidelines on diabetic retinopathy screening in Asian countries. Br J Ophthalmol 2017 March 14 (Epub ahead of print). 5. Moreton RB, Stratton IM, Chave SJ, Lipinski H, Scanlon PH. Factors determining uptake of diabetic retinopathy screening in Oxfordshire. Diabet Med 2017 March 11 (Epub ahead of print).