Miracle-dz/UniFAR-FTUs huggingface dataset:
Treating patients with colorectal cancer in rural and urban areas: a qualitative study of the patients' perspective.

OBJECTIVES The aim of the present study was to explore the perspectives of patients receiving treatment for colorectal cancer and compare priorities and attitudes in rural and urban areas. METHOD A qualitative study was carried out involving four focus groups in the Aberdeen and Northern Centre for Haematology, Oncology and Radiotherapy. The sample comprised 22 patients at various stages of treatment for colorectal cancer and 10 of their relatives from different locations of Northeast Scotland and Shetland. The main themes generated by participants were identified, and similarities and differences between urban and rural patients were noted within these themes. RESULTS Components of care that were important to rural and urban patients were speed of referral to specialists for treatment and issues of communication including test results and delivery of bad news. Tensions were perceived at the interface of primary and secondary care and these were blamed for delays in referral and communication breakdowns. For some, the referral process comprised a series of barriers to be overcome, and there were additional hurdles for remote patients referred initially to local (non-specialist) hospitals. Rural patients appeared to be less demanding than their urban counterparts when evaluating their care, and this was extended to the acceptance of some clear transport problems. CONCLUSIONS For patients, the most important components of cancer care were similar, whether rural or urban residents. The main differences for rural patients were lower expectations of care and more hurdles before reaching specialist care. These differences might explain the trend to more advanced disease at diagnosis in rural patients if they lead to significant delays. GPs have major influences on this and all the patients' priorities.
Is sex necessarily a risk factor to depression?

Synopsis To isolate and quantify possible determinants of any increased prevalence of depressive disorders in women we studied a select group of men and women, initially similar in terms of a number of putative social determinants of depression, and reviewed the sample five years later when social role diversity was anticipated. We used the Diagnostic Interview Schedule (DIS) to generate DSM-III and RDC diagnoses to estimate lifetime depressive disorders, and established (via corroborative reports) the likely accuracy of those data. Despite lifetime depression being a relatively common experience, no significant sex differences in depressive episodes were demonstrated, suggesting the possible irrelevance of biological factors in determining any sex difference. As there was not major social role divergence over the five year study, we interpret the lack of a sex difference as a consequence, and suggest that findings support the view that social factors are of key relevance in determining any female preponderance in depression described in general population studies.
Determinants of compliance in rheumatoid arthritic patients assessed in their home environment.

Patient compliance with prescriber's medication instructions was investigated in 178 rheumatoid arthritis patients treated in community practice. The compliance rate in the sample subjects was estimated to be 63.5%. Disease activity, measured objectively with erythrocyte sedimentation rate (ESR) and subjectively by duration of morning stiffness, was a major incentive for adherence to the treatment regimen. Among subjects with active disease (ESR greater than 20 mm in 1 h), the rate of compliance was 73.8%, but this fell to 52.7% among those with a normal ESR (i.e. ESR less than or equal to 20 mm in 1 h). The motivations and perceptions of the subjects concerning their drug therapy also affected compliance. Compliance was however less dependent on perceptions when active inflammation was present.
Modes of death in the pediatric intensive care unit: Withdrawal and limitation of supportive care

Objective:To determine the frequency of withdrawal or limitation of supportive care for children dying in a pediatric intensive care unit (ICU). Design:Retrospective review of medical records. Setting:Pediatric ICU in a tertiary care children's hospital. Patients:All children dying in the pediatric ICU over a 54-month period (n = 300). Interventions:Medical record review. Measurements and Main Results:Data recorded for each patient included diagnosis, mode of death, and whether the child was brain dead. Each patient was assigned to one of the following mode of death categories: brain dead; active withdrawal of supportive care (meaning removal of the endotracheal tube); failed cardiopulmonary resuscitation; allowed to die without cardiopulmonary resuscitation (do-not-resuscitate status). A total of 300 patients were identified. Diagnoses included postoperative congenital heart disease (n = 56), head trauma (n = 38), near-miss sudden infant death syndrome (n = 28), pneumonia (n = 22), sepsis (n = 21), near-drowning (n = 21), various anoxic insults (n = 20), multiple trauma (n = 17), and patients with other diagnoses (n = 77). Mode of death was active discontinuation of support in 95 (32%) patients, do-not-resuscitate status in 78 (26%), brain death in 70 (23%), and failed cardiopulmonary resuscitation in 57 (19%). Conclusions:In a large, multidisciplinary pediatric ICU, the most common mode of death was active withdrawal of support. In addition, more than half (173/300, 58%) of children dying in the pediatric ICU underwent either active withdrawal or limitation (do-not-resuscitate status) of supportive care. (Crit Care Med 1993; 21:1798–1802)
Monoclonal antibodies that recognize calcium-dependent structures of human thrombospondin. Characterization and mapping of their epitopes.

Monoclonal antibodies (mAbs) raised against reduced and alkylated thrombospondin (TSP) were screened for the ability to react with Ca2+-replete TSP versus EDTA-treated TSP. Two mAbs designated A6.1 and D4.6 were found to react much more strongly with TSP after EDTA treatment. The dissociation constants for these mAbs were measured in 5 mM EDTA and found to be 6 X 10(-10) M for A6.1 and 7 X 10(-9) M for D4.6. Binding to A6.1 was undetectable in the presence of 1 mM Ca2+ while binding of D4.6 occurred with about 100-fold lower affinity. The Ca2+ concentration dependence of A6.1 binding was broad with a midpoint near 50 microM free Ca2+ while that of D4.6 showed a sharp transition below 0.1 microM. Upon dialysis of EDTA-treated TSP into Ca2+ containing buffer, the binding of the mAbs was prevented or decreased, indicating reversibility of the conformational transition induced by the initial removal of Ca2+ . Mg2+ can compete with the Ca2+ binding sites involved in mAb binding, but TSP dialyzed from Ca2+ into Mg2+ binds the two mAbs as well as EDTA-treated TSP, indicating that Mg2+ cannot maintain the Ca2+-replete structure of TSP. The proteolytic fragments of TSP with which the two mAbs react were determined by probing Western blots of digests of TSP with the mAbs. A6.1 reacts with the 70-kDa fragment generated by chymotrypsin in EDTA which contains the interchain disulfide bonds of TSP and the binding site(s) for type V collagen (Mumby, S. M., Raugi, G. J., and Bornstein, P. (1984) J. Cell Biol. 98, 646-652). D4.6 reacts with fragments of 140 and 120 kDa found in digests of Ca2+-replete TSP which are absent from digests in EDTA. Electron microscopy of rotary shadowed, carbon-coated replicas of TSP mAb complexes confirms the Ca2+ sensitivity of mAb binding and has been used to localize the epitopes for both mAbs on the three-dimensional structure of TSP.
Development of a rating scale for primary depressive illness.

This is an account of further work on a rating scale for depressive states, including a detailed discussion on the general problems of comparing successive samples from a ‘population’, the meaning of factor scores, and the other results obtained. The intercorrelation matrix of the items of the scale has been factor-analysed by the method of principal components, which were then given a Varimax rotation. Weights are given for calculating factor scores, both for rotated as well as unrotated factors. The data for 152 men and 120 women having been kept separate, it is possible to compare the two sets of results. The method of using the rating scale is described in detail in relation to the individual items.
High-intensity cycle interval training improves cycling and running performance in triathletes

Abstract Effective cycle training for triathlon is a challenge for coaches. We compared the effects of two variants of cycle high-intensity interval training (HIT) on triathlon-specific cycling and running. Fourteen moderately-trained male triathletes (O2peak 58.7 ± 8.1 mL kg−1 min−1; mean ± SD) completed on separate occasions a maximal incremental test (O2peak and maximal aerobic power), 16 × 20 s cycle sprints and a 1-h triathlon-specific cycle followed immediately by a 5 km run time trial. Participants were then pair-matched and assigned randomly to either a long high-intensity interval training (LONG) (6–8 × 5 min efforts) or short high-intensity interval training (SHORT) (9–11 × 10, 20 and 40 s efforts) HIT cycle training intervention. Six training sessions were completed over 3 weeks before participants repeated the baseline testing. Both groups had an ∼7% increase in O2peak (SHORT 7.3%, ±4.6%; mean, ±90% confidence limits; LONG 7.5%, ±1.7%). There was a moderate improvement in mean power for both the SHORT (10.3%, ±4.4%) and LONG (10.7%, ±6.8%) groups during the last eight 20-s sprints. There was a small to moderate decrease in heart rate, blood lactate and perceived exertion in both groups during the 1-h triathlon-specific cycling but only the LONG group had a substantial decrease in the subsequent 5-km run time (64, ±59 s). Moderately-trained triathletes should use both short and long high-intensity intervals to improve cycling physiology and performance. Longer 5-min intervals on the bike are more likely to benefit 5 km running performance.
Effects of Ciprofloxacin on the Stereoselective Disposition of Mexiletine in Man

Mexiletine is extensively metabolized in man, with less than 10% of the dose being excreted unchanged in urine. Clinical drug-drug interaction studies as well as in vitro drug metabolism studies suggest that CYP1A2, in addition to CYP2D6, is involved in the metabolism of mexiletine in man. Therefore, the objective of the study was to determine whether potential inhibition of CYP1A2 by the quinolone antibiotic agent ciprofloxacin would alter the stereoselective disposition of mexiletine. Nineteen healthy men (10 smokers and 9 nonsmokers) received a single 200-mg oral dose of racemic mexiletine hydrochloride on 2 occasions: once alone and once during concomitant administration of ciprofloxacin 750 mg BID (starting 3 days before and up to 2 days after the administration of mexiletine). Serial blood and urine samples were collected for 48 hours, and pharmacokinetic parameters were derived. Total clearances of R-(−)- and S-(+)-mexiletine were 42% and 63% higher in smokers compared with nonsmokers (P < 0.05). This observation is in agreement with increased clearance of mexiletine under conditions of increased CYP1A2 activity. On the other hand, ciprofloxacin administration only marginally decreased R-(−)- and S-(+)-mexiletine clearances (2 to 5 L/h; P < 0.05) secondary to a decrease in mexiletine nonrenal clearance. In conclusion, the increase in mexiletine nonrenal clearance in smokers and its decrease during the combined administration of ciprofloxacin confirm the role of CYP1A2 in the overall clearance of the drug. Nevertheless, results obtained in this study suggest that no major drug interaction is to be expected during the concomitant administration of ciprofloxacin and mexiletine in patients.
The impact of initial fludarabine therapy on transformation to Richter syndrome or prolymphocytic leukemia in patients with chronic lymphocytic leukemia: analysis of an intergroup trial (CALGB 9011)

Abstract The impact of initial fludarabine therapy on transformation to Richter syndrome (RS) or prolymphocytic leukemia (PLL) in patients with chronic lymphocytic leukemia (CLL) is uncertain. We studied the outcomes of 521 patients with CLL who were randomized to initial fludarabine (F), chlorambucil (C) or F + C therapy on an intergroup trial (CALGB 9011). RS developed in 34 (7%) patients and PLL in 10 (2%). RS and PLL occurred in 14 (7%) and three (2%) of 188 patients randomized to F; nine (5%) and four (2%) of 191 patients treated with C; and 11 (8%) and three (2%) of 142 receiving F + C, respectively. Four percent of the 206 patients with Rai stage III/IV developed PLL, compared to only 1% of the 315 patients with Rai stage I/II (p = 0.02). Initial fludarabine therapy in patients with CLL did not impact transformation to RS or PLL, nor were any other baseline characteristics predictive for such transformation in this series.
Role of heavy-ion nuclear reactions in determining on-orbit single event error rates

Simulations show that neglecting ion-ion interaction processes (both particles having Z>1) results in an underestimation of the total on-orbit single event upset error rate by more than two orders of magnitude for certain technologies. The inclusion of ion-ion nuclear reactions leads to dramatically different SEU error rates for CMOS devices containing high Z materials compared with direct ionization by the primary ion alone. Device geometry and material composition have a dramatic effect on charge deposition in small sensitive volumes for the spectrum of ion energies found in space, compared with the limited range of energies typical of ground tests.
Sex-related differences in stimulated hypothalamic-pituitary-adrenal axis during induced gonadal suppression.

CONTEXT Sex-related differences in the stress response are well described in the animal literature but in humans are inconsistent and appear to reflect both the method used to stimulate the hypothalamic-pituitary-adrenal (HPA) axis and the age of the subjects. Sex-related differences in reproductive steroid levels further confound efforts to define the specific role of the sex of the individual in stress axis responsivity. OBJECTIVE The aim of this study was to address this role independent of differences in reproductive steroid levels. We compared HPA axis response to pharmacological (CRH) and physiological (exercise) stressors in two groups of young to middle-aged (18-45 yr) men (n = 10 and 8) and women (n = 12 and 13) undergoing gonadal suppression with leuprolide acetate (monthly im injection of 7.5 mg in men and 3.75 mg in women). DESIGN Exercise and CRH stimulation tests were performed during induced hypogonadal conditions. SETTING The study was conducted at a National Institutes of Health Clinical Center Outpatient Clinic. PATIENT OR OTHER PARTICIPANTS: Male and female normal volunteers participated in the study. MAIN OUTCOME MEASURES The main outcome measures were stimulated ACTH and cortisol levels. RESULTS Both CRH (1 microg/kg) stimulation and graded treadmill exercise stimulation occurred in the month after the second leuprolide injection to ensure gonadal suppression. Despite the absence of sex differences in estradiol or testosterone at the time of testing, men showed increased stimulated ACTH (repeated-measures ANOVA for CRH, P < 0.005) and cortisol (repeated-measures ANOVA for exercise, P < 0.05) compared with women. Among the summary measures, area under the curve (AUC) for cortisol was significantly greater in men than women after exercise. Although the AUC for ACTH was not significantly different across sexes, the initial AUC (0-30 min) was significantly greater in men for both procedures. No significant sex differences were found in a measure of adrenal responsivity, the cortisol to ACTH ratio, for either procedure. Cortisol-binding globulin levels did not differ between men and women and were not correlated with stimulated HPA axis measures. These data confirm earlier reports of sex differences in stimulated HPA axis activity and demonstrate that these differences exist even under induced hypogonadal conditions (i.e. in the absence of characteristic differences in reproductive steroids).
Overcoming cultural barriers for innovation and knowledge sharing

– This paper aims to identify the cultural barriers that set back knowledge production and sharing in organizations of the Municipality of Caguas at the Commonwealth of the Puerto Rico in order to find effective ways to overcome them. The purpose is to explore how the enterprise promotes efficiency among employees and how they develop a suitable environment for knowledge production and sharing. , – The qualitative research consists of in‐depth interviews, carried out to management personnel, and questionnaires submitted to the employees. Two hypotheses are developed and tested using the results obtained from four organizations, public and private. , – The interview responses show that at the managerial level both private and public agencies have overcome the identified barriers that set back the knowledge sharing, while from the questionnaires it is found at the employee level that several cultural barriers such as organizational environment, emotional intelligence and managers' commitment are still present. , – Although limited by the small sample of critical actors, this study includes international and regional organizations that serve the Municipality of Caguas. The results may set a basis to develop a methodology to analyze the presence or absence of cultural barriers in other organizations, and municipalities of Puerto Rico. , – This investigation may be used to develop standard procedures to cope with culture differences when establishing a suitable environment for knowledge production and sharing among employees.
Multivariate analysis of morphometric characteristics to evaluate risk factors for cranial cruciate ligament deficiency in Labrador retrievers.

OBJECTIVES To determine the combination of conformation characteristics of the pelvic limbs of Labrador Retrievers that best discriminates between limb at risk to develop cranial cruciate ligament (CCL) disease and limbs at low risk using radiographs, computerized tomography (CT) images, and dual-energy X-ray absorptiometry (DEXA). STUDY DESIGN Cross-sectional clinical study. ANIMALS Twelve clinically normal and 9 unilaterally CCL-deficient Labrador Retrievers. METHODS The pelvic limbs of normal dogs were considered as non-predisposed to CCL disease and the contralateral limbs of CCL-deficient dogs as predisposed. Conformation variables, obtained from femur and tibial radiographs, pelvic limb CT images and DEXA studies, of predisposed pelvic limbs were compared with the conformation variables from pelvic limbs of the low-risk group. An ROC curve analysis was used to assess the discriminating properties of conformation variables for several combinations. RESULTS We determined that a combination of tibial plateau angle (TPA) and femoral anteversion angle (FAA) measured on radiographs was optimal for discriminating predisposed and non-predisposed limbs for CCL disease in Labrador Retrievers. CONCLUSIONS Assessing predisposition to CCL disease with a combination of conformational measurements is better than using univariate parameters. In the future, TPA and FAA may be used to screen dogs suspected of being susceptible to CCL disease.
Genetics of consanguinity and inbreeding in health and disease

Abstract Context: Inbreeding increases the level of homozygotes for autosomal recessive disorders and is the major objective in clinical studies. The prevalence of consanguinity and the degree of inbreeding vary from one population to another depending on ethnicity, religion, culture and geography. Global epidemiological studies have revealed that consanguineous unions have been significantly associated with increased susceptibility to various forms of inherited diseases. Objective: The study aimed to determine the role of consanguinity in human health and to highlight the associated risks for various diseases or disorders. Methods: PubMed and Google Scholar search engines were used to explore the published literature on consanguinity and its associated risks using the key words “consanguinity”, “prevalence”, “inbreeding depression”, “coefficient of inbreeding”, “child health”, “mortality”, “human health”, “homozygosity” and “complex diseases” in different combinations. The studies were screened for eligibility on the basis of their epidemiological relevance. Results: This comprehensive assessment highlights the deleterious consequences in populations with a higher prevalence of consanguinity among different countries worldwide. Conclusions: To avoid the inbreeding load there is the need to improve socioeconomic and educational status and to increase public awareness of reproductive health and anticipated deleterious effects. Pre-marital and pre-conception counselling of consanguineous populations should be an integral part of health policy to train people and make people aware of its harmful consequences. Furthermore, runs of homozygosity (ROH) and whole-exome sequencing (WES) are useful tools in exploring new genomic signatures for the cause of inbreeding depression.
Mortality in British vegetarians: review and preliminary results from EPIC-Oxford.

BACKGROUND Three prospective studies have examined the mortality of vegetarians in Britain. OBJECTIVE We describe these 3 studies and present preliminary results on mortality from the European Prospective Investigation into Cancer and Nutrition-Oxford (EPIC-Oxford). DESIGN The Health Food Shoppers Study and the Oxford Vegetarian Study were established in the 1970s and 1980s, respectively; each included about 11 000 subjects and used a short questionnaire on diet and lifestyle. EPIC-Oxford was established in the 1990s and includes about 56 000 subjects who completed detailed food frequency questionnaires. Mortality in all 3 studies was followed though the National Health Service Central Register. RESULTS Overall, the death rates of all the subjects in all 3 studies are much lower than average for the United Kingdom. Standardized mortality ratios (95% CIs) for all subjects were 59% (57%, 61%) in the Health Food Shoppers Study, 52% (49%, 56%) in the Oxford Vegetarian Study, and 39% (37%, 42%) in EPIC-Oxford. Comparing vegetarians with nonvegetarians within each cohort, the death rate ratios (DRRs), adjusted for age, sex and smoking, were 1.03 (0.95, 1.13) in the Health Food Shoppers Study, 1.01 (0.89, 1.14) in the Oxford Vegetarian Study, and 1.05 (0.86, 1.27) in EPIC-Oxford. DRRs for ischemic heart disease in vegetarians compared with nonvegetarians were 0.85 (0.71, 1.01) in the Health Food Shoppers Study, 0.86 (0.67, 1.12) in the Oxford Vegetarian Study, and 0.75 (0.41, 1.37) in EPIC-Oxford. CONCLUSIONS The mortality of both the vegetarians and the nonvegetarians in these studies is low compared with national rates. Within the studies, mortality for major causes of death was not significantly different between vegetarians and nonvegetarians, but the nonsignificant reduction in mortality from ischemic heart disease among vegetarians was compatible with the significant reduction previously reported in a pooled analysis of mortality in Western vegetarians.