Miracle-dz/UniFAR-FTUs huggingface dataset:
Clinical implications of multifocality as a prognostic factor in breast carcinoma - a multivariate analysis study comprising 460 cases.

BACKGROUND Multifocality is not listed among prognostic factors in international breast cancer guidelines. This study aims to analyze survival in multiple breast carcinomas (MFMC cc) compared to unifocal ones (UF cc), in order to assess the prognostic impact of multifocality. METHODS The study included 460 breast carcinomas (2002-2006) with a median follow-up time of 104 months (74-134 months). We assessed mortality rates, overall survival at 5 years and 10 years in general, overall survival at 5 and 10 years in MFMC cc compared to UF cc, as well as median survival and survival rate according to age, T status and axillary lymph node status in MFMC cc compared to UF cc. We carried out a multivariate analysis in order to identify independent predictor factors for survival. RESULTS 69/460 (15%) of cases were MFMC cc. Mortality rates were 56.5% in MFMC cc versus 45.1% (UF cc) (P = 0.08). 5-year overall survival was 55.9% in MFMC cc vs. 64.7% UF cc, and the 10-year overall survival was 34.9% MFMC cc vs. 52.7% UF cc (P = 0.27). Median survival in MFMC cc was 78 months (6.5 years), whereas in UF cc it was 126 months (10.5 years). However, in the multivariate analysis, survival was independently influenced only by tumor size and the presence of axillary lymph node metastases (P < 0.0001). CONCLUSION Breast cancer multifocality is associated with higher general mortality rates, lower 5 and 10-year overall survival, yields a lower median survival, but it does not constitute an independent prognostic factor in multivariate analysis.
The Plight of Zimbabwean Unaccompanied Refugee Minors in South Africa: A Call for Comprehensive Legislative Action

Since the economic and social breakdown in Zimbabwe, hundreds of thousands of people have fled the country for South Africa, including thousands of unaccompanied refugee minors. An unaccompanied refugee minor, or a “URM,” is a person under the age of eighteen who has either crossed the border alone or with another child, or who has found himself or herself living in a foreign country without an adult caregiver. Zimbabwean URMs come to South Africa in search of education, shelter, or jobs to support family back in Zimbabwe. Unaccompanied refugee minors who travel to South Africa face a myriad of challenges, including physical safety, life without a parent or guardian, legal and social discrimination, and a constant struggle to find food, shelter, education, health care, and employment. Although these children have rights under international and domestic law, political and other factors combined have denied children the protection and support to which they are legally entitled.
Disentangling the impact of within-host evolution and transmission dynamics on the tempo of HIV-1 evolution

Objective:To determine how HIV-1 risk groups impact transmitted diversity and the tempo of viral evolution at a population scale. Methods:We investigated a set of previously described transmission chains (n = 70) using a population genetic approach, and tested whether the expected differences in proportions of multivariant transmissions are reflected by varying proportions of transmitted diversity between men having sex with men (MSM) and heterosexual (HET) subpopulations – the largest contributors to HIV spread. To assess evolutionary rate differences among the different risk groups, we compiled risk group datasets for subtypes A1, B and CRF01_AE, and directly compared the absolute substitution rate and its synonymous and non-synonymous components. Results:There was sufficient demographic signal to inform the transmission model in Bayesian evolutionary analysis by sampling trees using env data to compare the transmission bottleneck size between the MSM and HET risk groups. We found no indications for a different proportion of transmitted genetic diversity at the population level between these groups. In the direct rate comparisons between the risk groups, however, we consistently recovered a higher evolutionary rate in the male-dominated risk group compared to the HET datasets. Conclusion:We find that the risk group composition affects the viral evolutionary rate and therefore potentially also the adaptation rate. In particular, risk group-specific sex ratios, and the variation in within-host evolutionary rates between men and women, impose evolutionary rate differences at the epidemic level, but we cannot exclude a role of varying transmission rates.
Nursing patients with chronic critical illness and their families: a qualitative study

BACKGROUND chronic critical illness (CCI) is a complex syndrome with a high risk of dying in hospital. Intensive care unit nurses are well-positioned to lead conversations integrating palliative and end-of-life care, yet have reported limited involvement. AIM To generate further understanding of nurses' experiences of patients with CCI and their families. DESIGN AND METHODS This qualitative study followed Thorne's interpretive description methods. In 2012, 16 intensive care unit nurses from one academic hospital participated in interviews. RESULTS Our primary theme was that of internal tension generated through participants' knowledge of patients' anticipated and protracted dying, while wanting to shield families from suffering. This internal tension resulted from responsibilities to preserve hope for patients and families, while at the same time wanting to provide them prognostic information. Participants experienced challenges of: (i) preserving family trust, (ii) determining when and how to engage families in discussions and (iii) providing possibilities of a 'good' death. A secondary theme described constraints to acting on their insights because of interprofessional team dynamics or limited communication, within the team and with the family. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE Internal tension, as experienced by participants reflects the challenges of transition from acute to palliation and end-of-life care, made more complex in CCI, because of its poorly defined terminal stage. Nurses' ability to manage the complex process of supporting hope while gradually providing information to build family understanding of CCI highlights their central role in facilitating what and how prognostic information is given, while managing the emotional implications and family response. To better support nurses do this, we advocate for formal structures enabling nurses to participate in decision-making regarding timing of transitions using palliation and end-of-life care.
Developing absorptive capacity for recombinant innovation

Purpose The purpose of this paper is twofold. First, to understand recombinant innovation (RI) as a potentially significant part of an open innovation (OI) strategy and second, to suggest key routines which would underpin a capability for RI, locating these within the context of enhanced absorptive capacity (AC). Finally, the paper considers how such routines could be developed, drawing on some case examples. Design/methodology/approach The authors start with a literature review on OI and use the lens of AC to explore challenges in finding, assimilating and deploying external knowledge posed by the emerging knowledge-rich context of OI. The authors then explore one OI route – RI – and suggest a model framework for operationalizing it based on routines for search, acquisition, assimilation and deployment. Findings The authors suggest three sets of routines required for RI, around abstract-driven search (ADS), brokerage and cyclic adaptation. As with much of the now widely available toolkit for OI, the challenge is one of moving from potential to realized opportunity and this will require investments in learning and capability building. Originality/value The authors suggest that for organizations to enhance their AC around RI, three core routines are needed: ADS, brokerage and cyclic adaptation.
Is bipolar disorder overdiagnosed?

OBJECTIVE Bipolar disorder, a serious illness resulting in significant psychosocial morbidity and excess mortality, has been reported to be frequently underdiagnosed. However, during the past few years we have observed the emergence of an opposite phenomenon--the overdiagnosis of bipolar disorder. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we empirically examined whether bipolar disorder is overdiagnosed. METHOD Seven hundred psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV (SCID) and completed a self-administered questionnaire, which asked the patients whether they had been previously diagnosed with bipolar or manic-depressive disorder by a health care professional. Family history information was obtained from the patient regarding first-degree relatives. Diagnoses were blind to the results of the self-administered scale. The study was conducted from May 2001 to March 2005. RESULTS Fewer than half the patients who reported that they had been previously diagnosed with bipolar disorder received a diagnosis of bipolar disorder based on the SCID. Patients with SCID-diagnosed bipolar disorder had a significantly higher morbid risk of bipolar disorder than patients who self-reported a previous diagnosis of bipolar disorder that was not confirmed by the SCID (p < .02). Patients who self-reported a previous diagnosis of bipolar disorder that was not confirmed by the SCID did not have a significantly higher morbid risk for bipolar disorder than the patients who were negative for bipolar disorder by self-report and the SCID. CONCLUSIONS Not only is there a problem with underdiagnosis of bipolar disorder, but also an equal if not greater problem exists with overdiagnosis.
The prevalence and significance of hypoalbuminemia in non-variceal upper gastrointestinal bleeding.

BACKGROUND/AIMS Hypoalbuminemia occurs in a variety of disease states and is associated with an increased rate of complications during hospitalization, resulting in an increased length of stay. However, there are no data about hypoalbuminemia in patients with non-variceal upper gastrointestinal bleeding. The purpose of this study is to evaluate the prevalence of hypoalbuminemia in patients with non-variceal upper gastrointestinal bleeding and to examine its significance in relation to severity and outcome of bleeding. METHODOLOGY This is a retrospective analysis of data collected prospectively on consecutive patients admitted to the Emergency Department of Taichung Veterans General Hospital with upper GI bleeding, and variceal bleeding was excluded. Hypoalbuminemia is defined as serum albumin < 3.5 g/dL. The outcome assessments in the hypoalbuminemia and normal albumin groups were compared. RESULTS There were three hundred and twenty-nine patients with non-variceal upper GI bleeding identified from July 2000 to January 2001. Two hundred and fifty were male, and 79 were female. Their ages ranged from 21 to 90 (64.60 +/- 14.84) years. Of these 329 patients eligible for the study, hypoalbuminemia was seen in 204 (62.0%). When compared to patients with normal serum albumin, the hypoalbuminemia group was older (66.81 +/- 13.45 vs. 60.98 +/- 16.29 years, P < 0.01), had more associated with underlying diseases (78.4% vs. 57.6%, P < 0.01), and had more leukocytosis (47.5% vs. 35.2%, P < 0.05), had lower hemoglobin (71.1% vs. 29.6% P < 0.01), and elevated BUN (85.3% vs. 72.8%, P < 0.01) at admission. In addition, these patients had longer hospital stay (6.82 +/- 9.45 vs. 2.38 +/- 3.48 days, P < 0.01), greater requirements of blood transfusion (5.76 +/- 7.43 vs. 1.38 +/- 2.20 units, P < 0.01), need of therapeutic endoscopy (41.7% vs. 16.0%, P < 0.01), with higher rebleeding rate (13.2% vs. 0%, P < 0.01), surgery rate (5.4% us. 0.8% P < 0.05), and mortality rate (9.3% vs. 0%, P < 0.01). CONCLUSIONS Hypoalbuminemia is common in patients with non-variceal upper GI bleeding, appears to reflect the severity of the bleeding episode, and is associated with a more complicated course.
Population genetics of anthelmintic resistance in parasitic nematodes

SUMMARY A key aim of anthelmintic resistance research is to identify molecular markers that could form the basis of sensitive and accurate diagnostic tests. These would provide powerful tools to study the origin and spread of anthelmintic resistance in the field and to monitor strategies aimed at preventing and managing resistance. Molecular markers could also form the basis of routine diagnostic tests for use in surveillance and clinical veterinary practice. Much of the research conducted to date has focused on the investigation of possible associations of particular candidate genes with the resistance phenotype. In the future, as full parasite genome sequences become available, there will be an opportunity to apply genome-wide approaches to identify the genetic loci that underlie anthelmintic resistance. Both the interpretation of candidate gene studies and the application of genome-wide approaches require a good understanding of the genetics and population biology of the relevant parasites as well as knowledge of how resistance mutations arise and are selected in populations. Unfortunately, much of this information is lacking for parasitic nematodes. This review deals with a number of aspects of genetics and population biology that are pertinent to these issues. We discuss the possible origins of resistance mutations and the likely effects of subsequent selection on the genetic variation at the resistance-conferring locus. We also review some of the experimental approaches that have been used to test associations between candidate genes and anthelmintic resistance phenotypes and highlight implications for future genome-wide studies.
Relationships Between Adolescent Sexual Outcomes and Exposure to Sex in Media: Robustness to Propensity-Based Analysis.

Adolescent sexual health is a substantial problem in the U.S., and two recent studies have linked adolescent sexual behavior and/or outcomes to youths' exposure to sex in the media. Both studies had longitudinal survey designs and used covariate-adjusted regression analysis. Steinberg and Monahan (2010) reanalyzed data from one of these studies (Brown et al., 2006) using a propensity-score approach, arguing that this method better addresses the possibility of unobserved confounders. Based on their reanalysis, which found no relationship between media exposure and sexual behavior, they concluded that "Adolescents' Exposure to Sexy Media Does Not Hasten the Initiation of Sexual Intercourse. " We subject data from the second study (Collins et al., 2004; Chandra et al., 2008) to reanalysis using a propensity-score approach. We find only modest reductions in two of the three previously documented associations, and no reduction in the third. Based on these findings, we conclude that there is an association between exposure to sex in the media and adolescent sexual outcomes. While the evidence does not prove causality, it is sufficient to advise caution among parents, develop interventions for youth, and work with media producers and distributors to reduce youth exposure to sexual content.
Prophage Genomics

The majority of the bacterial genome sequences deposited in the National Center for Biotechnology Information database contain prophage sequences. Analysis of the prophages suggested that after being integrated into bacterial genomes, they undergo a complex decay process consisting of inactivating point mutations, genome rearrangements, modular exchanges, invasion by further mobile DNA elements, and massive DNA deletion. We review the technical difficulties in defining such altered prophage sequences in bacterial genomes and discuss theoretical frameworks for the phage-bacterium interaction at the genomic level. The published genome sequences from three groups of eubacteria (low- and high-G+C gram-positive bacteria and gamma-proteobacteria) were screened for prophage sequences. The prophages from Streptococcus pyogenes served as test case for theoretical predictions of the role of prophages in the evolution of pathogenic bacteria. The genomes from further human, animal, and plant pathogens, as well as commensal and free-living bacteria, were included in the analysis to see whether the same principles of prophage genomics apply for bacteria living in different ecological niches and coming from distinct phylogenetical affinities. The effect of selection pressure on the host bacterium is apparently an important force shaping the prophage genomes in low-G+C gram-positive bacteria and gamma-proteobacteria.
Role of voltage‐gated potassium channels in the fate determination of embryonic stem cells

Embryonic stem cells (ESCs) possess two unique characteristics: self‐renewal and pluripotency. In this study, roles of voltage‐gated potassium channels (Kv) in maintaining mouse (m) ESC characteristics were investigated. Tetraethylammonium (TEA+), a Kv blocker, attenuated cell proliferation in a concentration‐dependent manner. Possible reasons for this attenuation, including cytotoxicity, cell cycle arrest and differentiation, were examined. Blocking Kv did not change the viability of mESCs. Interestingly, Kv inhibition increased the proportion of cells in G0/G1 phase and decreased that in S phase. This change in cell cycle distribution can be attributed to cell cycle arrest or differentiation. Loss of pluripotency as determined at both molecular and functional levels was detected in mESCs with Kv blockade, indicating that Kv inhibition in undifferentiated mESCs directs cells to differentiate instead of to self‐renew and progress through the cell cycle. Membrane potential measurement revealed that Kv blockade led to depolarization, consistent with the role of Kv as the key determinant of membrane potential. The present results suggest that membrane potential changes may act as a “switch” for ESCs to decide whether to proliferate or to differentiate: hyperpolarization at G1 phase would favor ESCs to enter S phase while depolarization would favor ESCs to differentiate. Consistent with this notion, S‐phase‐synchronized mESCs were found to be more hyperpolarized than G0/G1‐phase‐synchronized mESCs. Moreover, when mESCs differentiated, the differentiation derivatives depolarized at the initial stage of differentiation. This investigation is the first study to provide evidence that Kv and membrane potential affect the fate determination of ESCs. J. Cell. Physiol. 224:165–177, 2010 © 2010 Wiley‐Liss, Inc.
Inhibition of Prostaglandin D2 Production by Trihydroxy Fatty Acids Isolated from Ulmus davidiana var. japonica

The stem and root barks of Ulmus davidiana var. japonica (Ulmaceae) have been used to treat inflammatory diseases including mastitis, rhinitis, sinusitis, and enteritis. In an ongoing study focused on the discovery of natural anti‐inflammatory compounds from natural products, a methanol extract of the stem and root barks of U. davidiana var. japonica showed anti‐inflammatory activities. Activity‐guided fractionation of the methanol extract yielded a new trihydroxy fatty acid, 9,12,13‐trihydroxyoctadeca‐10(Z),15(Z)‐dienoic acid (1), and a known compound, pinellic acid (2). These two trihydroxy fatty acids 1 and 2 inhibited prostaglandin D2 production with IC50 values of 25.8 and 40.8 μM, respectively. These results suggest that 9,12,13‐trihydroxyoctadeca‐10(Z),15(Z)‐dienoic acid (1) and pinellic acid (2) are among the anti‐inflammatory principles in this medicinal plant. Copyright © 2012 John Wiley & Sons, Ltd.
Multinational Enterprises, Employee Safety and the Socially Responsible Supply Chain: The Case of Bangladesh and the Apparel Industry

This article address the issue of employee safety and the social responsibility of multinational apparel retailers who contract with Bangladesh manufacturers in their global supply chain. Both the Alliance for Bangladesh Worker Safety and the Accord on Fire and Building Safety in Bangladesh have been identified as the two primary facilitators for global apparel industry efforts to actively address this serious human rights issue; thus, they have the potential to help drive the success of the industry's corporate citizenship efforts to successfully manage the issue of fire and building safety in Bangladesh. The article further explores these relationships within the context of the &#8220;global corporate citizenship&#8221; concept, and develops a rationale for the limits of a socially responsible supply chain. In the context of global corporate citizenship, the article describes the existing state of these two industry organizations remediation efforts to ensure a stable supply chain in Bangladesh, and offers an analysis of existing industry nonmarket strategy approaches to improving contractor's factory fire and building safety environments for their employees. Lastly, a comprehensive set of nonmarket strategies for multinational apparel retailers is recommended when addressing their global corporate citizenship commitments to a safe working environment for Bangladesh garment manufacturing employees.
Relearning Movements: Modification of an Incorrectly Timed Reversal Movement

The main purpose of this study was to examine if an inaccurately acquired motor response can be relearned through the provision of a limited number of correct KR trials. 26 subjects were assigned to one of three experimental groups: a no-KR group, an erroneous KR group, and a relearning group who were given correct KR after 125 trials of erroneous KR. Analysis showed a significant temporal correction of the reversal movement when the erroneous KR was replaced by valid verbal information during acquisition. This adaptation, however, was attenuated during retention, indicating that the limited number of correct KR trials did not wash out the effect of the invalid information provided during the first phase of acquisition.
Effective immunity to dental caries: gastric intubation of Streptococcus mutans whole cells or cell walls induces protective immunity in gnotobiotic rats

Gnotobiotic rats were given Streptococcus mutans 6715 whole cells (WC), purified cell walls (CW), or cell wall lysate by gastric intubation (GI), and assessments were made of humoral immune responses in serum and saliva and of caries protection. Levels of secretory immunoglobulin A (IgA) and IgG antibodies to S. mutans WC in saliva samples from experimental rats were determined by an enzyme-linked immunosorbent assay. Serum antibody levels of the IgM, IgG, and IgA isotypes were also determined. Similar levels of salivary antibodies were induced in rats given S. mutans WC or CW by GI, whereas lower salivary antibody titers were observed in rats given cell wall lysate by the oral route. The level of serum antibodies in the various groups of rats also reflected the oral antigen used. The specificity of salivary IgA and serum IgG antibodies in the various groups of rats was determined by enzyme-linked immunosorbent assay with lipoteichoic acid, serotype g carbohydrate, dextran, CW, and WC as coating antigens. Salivary IgA and serum IgG antibodies in rats given S. mutans WC or CW by GI were primarily directed to lipoteichoic acid and serotype g carbohydrate. The presence of salivary IgA antibodies to S. mutans in rats given either S. mutans WC or CW by GI correlated with a significant reduction in the levels of plaque, numbers of viable S. mutans in plaque, and caries scores when compared with the control animals (infected only). These results demonstrate that particulate antigens of S. mutans induce salivary immune responses when given by GI to gnotobiotic rats and that the presence of these antibodies correlates with caries protection.