Miracle-dz/UniFAR-FTUs huggingface dataset:
Health Care Workers in Danger Zones: A Special Report on Safety and Security in a Changing Environment

Abstract Introduction Violence against humanitarian health care workers and facilities in situations of armed conflict is a serious humanitarian problem. Targeting health care workers and destroying or looting medical facilities directly or indirectly impacts the delivery of emergency and life-saving medical assistance, often at a time when it is most needed. Problem Attacks may be intentional or unintentional and can take a range of forms from road blockades and check points which delay or block transport, to the direct targeting of hospitals, attacks against medical personnel, suppliers, patients, and armed entry into health facilities. Lack of access to vital health care services weakens the entire health system and exacerbates existing vulnerabilities, particularly among communities of women, children, the elderly, and the disabled, or anyone else in need of urgent or chronic care. Health care workers, especially local workers, are often the target. Methods This report reviews the work being spearheaded by the Red Cross and Red Crescent Movement on the Health Care in Danger initiative, which aims to strengthen the protections for health care workers and facilities in armed conflicts and ensure safe access for patients. This includes a review of internal reports generated from the expert workshops on a number of topics as well as a number of public sources documenting innovative coping mechanisms adopted by National Red Cross and Red Crescent Societies. The work of other organizations is also briefly examined. This is followed by a review of security mechanisms within the humanitarian sector to ensure the safety and security of health care personnel operating in armed conflicts. Results From the existing literature, a number of gaps have been identified with current security frameworks that need to be addressed to improve the safety of health care workers and ensure the protection and access of vulnerable populations requiring assistance. A way forward for policy, research, and practice is proposed for consideration. Conclusion While there is work being done to improve conditions for health care personnel and patients, there need to be concerted actions to stigmatize attacks against workers, facilities, and patients to protect the neutrality of the medical mission. Redwood-CampbellLJ, SekharSN, PersaudCR. Health care workers in danger zones: a special report on safety and security in a changing environment. Prehosp Disaster Med. 2014;29(5):1-5.
Integer programming formulations for the two 4‐hop‐constrained paths problem

In this article, we consider the two 4‐hop‐constrained paths problem, which consists, given a graph G = (N,E) and two nodes s,t ∈ N, of finding a minimum cost subgraph in G containing at least two node‐ (resp., edge‐) disjoint paths of length at most 4 between s and t. We give integer programming formulations, in the space of the design variables, for both the node and edge versions of this problem. © 2006 Wiley Periodicals, Inc. NETWORKS, Vol. 49(2), 135–144 2007
New treatments in multiple myeloma: beyond optimal treatment.

The prognosis of multiple myeloma (MM) has remained unchanged for three decades. The first improvement appeared in the 1990s when the Intergroupe Francophone du Myelome (IFM) 90 randomized trial showed the superiority of high-dose therapy supported by autologous stem cell transplantation (ASCT) compared with conventional dose chemotherapy in younger patients (<65 years of age) [1]. These results were confirmed by two other randomized studies [2–3]. But in less than 10 years, treatment of MM has dramatically changed due to the introduction of three novel agents: thalidomide, its analogue lenalidomide, and bortezomib. Compared with chemotherapeutic agents, these new compounds have different modes of action. They target not only the myeloma cell but also the microenvironment which is so important for myeloma cell survival and proliferation.
Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes

Background and study aims: Marginal ulcers are one of the most common complications after gastric bypass. Reported incidence varies widely (0.6–16 %) and pathogenesis is unclear. The aim of the present study was to describe characteristics, risk factors, management, and outcomes of endoscopically documented ulcers. Patients and methods: Data from all patients diagnosed with marginal ulcers at endoscopy between 2003 and 2010 were retrospectively reviewed. Results: A total of 103 patients with marginal ulcers presented with pain (63 %) and/or bleeding (24 %), a median of 22 months after surgery. Ulcers were located on the anastomosis (50 %) or the jejunum (40 %); sutures were visible in 35 %, and gastrogastric fistulae in 8 %. The mean pouch length was 5.6 cm. Diabetes (odds ratio [OR] 2.5; P = 0.03), smoking (OR 2.5; P = 0.02), and gastric pouch length (OR 1.2; P = 0.02) were significantly associated with marginal ulcer formation on univariate analysis; diabetes was significantly associated on multivariate analysis (OR 5.6; P = 0.003). The risk of developing a marginal ulcer decreased with time (OR 0.8; P < 0.01) and was not associated with the use of nonsteroidal anti-inflammatory drugs. At first endoscopic follow-up, 67 % of ulcers had healed. Recurrence occurred in four patients and nine patients required surgical revision. Conclusions: The vast majority of marginal ulcers had a favorable outcome after medical treatment. However, 9 % of patients eventually required surgical revision. Therefore, endoscopic follow-up is essential. Diabetes, smoking, and long gastric pouches were significant risk factors for marginal ulcer formation, suggesting increased acid exposure and mucosal ischemia are both involved in marginal ulcer pathogenesis. Management of these factors may prove effective in managing marginal ulcers, and tailoring postoperative proton pump inhibitor therapy to patients with multiple risk factors could be effective.
Hop‐level flow formulation for the survivable network design with hop constraints problem

The hop‐constrained survivable network design problem consists of finding a minimum cost subgraph containing K edge‐disjoint paths with length at most H joining each pair of vertices in a given demand set. When all demands have a common vertex, the instance is said to be rooted. We propose a new extended formulation for the rooted case, called hop‐level multicommodity flow (MCF), that can be significantly stronger than the previously known formulations, at the expense of having a larger number of variables and constraints, growing linearly with the number of edges and demands and quadratically with H. However, for the particular case where H = 2, it can be specialized into a very compact and efficient formulation. Even when H = 3, hop‐level‐MCF can still be quite efficient and it has solved several instances from the literature for the first time. © 2012 Wiley Periodicals, Inc. NETWORKS, 2013
HPV in oral squamous cell carcinoma vs head and neck squamous cell carcinoma biopsies: a meta-analysis (1988-2007).

INTRODUCTION In the literature, there exists a wide range of human papillomavirus (HPV) DNA prevalence for head and neck squamous cell carcinoma (HNSCC), especially in relation to methods of viral detection and the lesion site. We estimated the pooled prevalence of HPV DNA in biopsies of HNSCC generically grouped versus oral squamous cell carcinoma (OSCC) in relation to the method of viral DNA detection, with the primary end point of verifying if these two variables (specification of tumour site and method of HPV DNA identification) influence the datum on HPV assay. METHODS By means of MEDLINE/PubMED/Ovid databases, we selected studies examining paraffin-embedded (PE) biopsies of HNSCC and OSCC. According to the inclusion criteria, 62 studies were analyzed. The following data were abstracted: sample size, HPV DNA prevalence, methods of detection [PCR and in situ hybridization (ISH)] and HPV genotypes. After testing the heterogeneity of the studies by the Cochran Q test, metanalysis was performed using the random effects model. RESULTS The pooled prevalence of HPV DNA in the overall samples (Sigma: 4852) was 34.5%, in OSCC it was 38.1% and in the not site-specific HNSCC was 24.1%. With regard to the detection method, PCR-based studies reported a higher prevalence rate than ISH-based rates (34.8, versus 32.9%) especially in the OSCC subgroup (OSCC PCR based: 39.9%). CONCLUSION These findings support the assumption that a correct distinction of HNSCC by site, together with the use of more sensitive HPV DNA detection methods, should be considered as essential prerogatives in designing future investigations into viral prevalence in head and neck tumors.
Association of the polymorphism of the CAG repeat in the mitochondrial DNA polymerase gamma gene (POLG) with testicular germ-cell cancer.

BACKGROUND A possible association between the polymorphic CAG repeat in the DNA polymerase gamma (POLG) gene and the risk of testicular germ-cell tumours (TGCT) was investigated in this study. The hypothesis was prompted by an earlier preliminary study proposing an association of the absence of the common 10-CAG-long POLG allele with testicular cancer as well as previously reported in some European populations' association with male subfertility, which is a condition carrying an increased risk of TGCT. PATIENTS AND METHODS The number of CAG repeats in both POLG alleles was established in 243 patients with TGCT and in 869 controls by the analysis of the genomic DNA fragment. RESULTS A significantly higher proportion of men homozygous allele of other than the common 10 CAG repeats was found among the patients with TGCT in comparison to the controls (4.9% versus 1.3%, respectively, P = 0.001). The vast majority of the homozygous patients had a seminoma (11 of 12; 97%), despite that only about half (55%) of the studied patients had this tumour type. CONCLUSIONS The findings indicate that the POLG polymorphism may be a contributing factor in the pathogenesis of TGCT particularly in seminoma, but the mechanisms remain to be elucidated.
Standard precaution and incidence of needle stick injury during children vaccination among nurses working in maternal and child health centers in El-Minia governorate

Background: Persons administering vaccines should follow necessary precautions to minimize risk for spreading disease. Nurses have a significant role in this process and are responsible for implementing several infection control strategies. Syringes and needles used for injections must be sterile and disposable to minimize the risk of contamination. The Centers for disease Control and prevention (CDC) estimates that each year 384,000 needle sticks injuries (NSI) and other sharp – related percutaneous injuries are sustained by hospital – based healthcare personnel, an average of over 1,000 sharp injuries per day. The estimate is not including other health care settings, such as emergency services, outpatient Clinics home based care and nursing homes. Objective: This study aims to identify the standard precaution and the Incidence of Needle Stick Injury Among nurses working in Maternal and Child Health Centers during Children vaccination in El-Minia Governorate Material and Method: Cross sectional study was utilized to meet the aim of the study, this study was conducted in the ten(10) minister center of health (MCH) at EL- Minia from May to August 2012, the Nurses participated in this study included (100) Nurses who are working in (M CH) center after receiving their consents for participation. Observation checklist was done to observe the nurses performance before, during and after child vaccine and procedure toward universal precaution. Results: that the highest frequency of nurses were in the age intervals 30<40 years with main age (34.3 ± 9.4) all sample were females and secondary school degree in nursing. More than have of them 55%were having 10:20 years of experience in nursing, Relation between nurse's incidences of needle stick injury and their experience, show statistically significant differences. Also the relation between nurse's incidences of need stick injury and their training, were good with statistically significant differences Conclusion: The study showed a high prevalence of needle stick injuries and low of using standard precaution among nurses during vaccination the child so suggests that every MCH must have an infection control committee for observation the using of standard precaution and training the nurses for prevention of needle stick injury.
Routine Pathological Evaluation of Neuroma Specimens: Is There a Rationale?

The routine pathological analysis of therapeutically resected traumatic or postoperative neuroma specimens to confirm diagnosis and rule out occult malignancy remains a controversial issue. Some experts advocate histological analysis of all specimens, and others rely on institutional policy. A retrospective chart review of all patients who underwent excision of clinically diagnosed neuroma over a 6-year period at one institution by a single surgeon was initiated. The correlation of preoperative diagnoses with histological analysis and cost of analyzing specimens individually and over the 6-year period was calculated. Of 515 neuromas resected, 100 were sent for pathological review. Every submitted specimen was histologically confirmed to be a traumatic neuroma, and none of the specimens harbored occult malignancy. Ultimately, no treatment plan was altered after final histology was confirmed. The cost to analyze each specimen (Current Procedural Terminology code 88305) was $495, expressed in U.S. dollars. If every specimen was analyzed, a total cost of $254,925 would have be incurred over the 6-year period. Routine pathological analysis of clinically and intraoperatively confirmed neuromas must be questioned in terms of standard of care requirements given its failure to aid in treatment plans as well as its significant cost to health care systems.
‘You can't wrap them up in cotton wool!’ Constructing risk in young people's access to outdoor play

Abstract Policy approaches towards risk in relation to young people's leisure activities are characterized by uncertainty. While some organizations have sought to emphasize the need to reduce or even eliminate the risk of ‘unintentional injuries’ in outdoor play, others highlight the dangers in excessively restricting young people's access to the outside world. Drawing on semi-structured interviews with families in the South Wales area, this paper argues that while parents are not in the grips of ‘paranoia’ (Furedi 2001) they are wrestling with competing sets of social expectations, as well as their own rational and emotive judgements. Young people tended to respond to their parents' concerns by demonstrating their street-wisdom, claiming sanctuary behind the notion of ‘accident’ and asserting their moral right to access the outside world.
Meta-Analysis to Determine the Diagnostic Value of 2- 18 Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography in Assessing Residual Tumors after Systemic Therapy for Metastatic Seminoma

Background: A meta-analysis was performed to determine the value of 2-18fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for assessing viable tumor residuals after chemotherapy in patients with pure seminoma. Materials and methods: This review included five studies published between 1999 and 2010 with a total of 130 patients who underwent both computed tomography (CT) and FDG-PET scanning for residual tumor detection after systemic therapy. We compared the sensitivity and specificity of FDG-PET and CT (tumor size ≤ or > 3 cm) in identifying vital tumor tissue. Results: On the average, FDG-PET had higher specificity (92% vs. 59%) and sensitivity (72% vs. 63%) as well as a higher positive predictive value (PPV) than the solely size-based CT assessment of residual tumors (70% vs. 28%). PEt also tended to have a higher negative predictive value (93% vs. 86%). Conclusion: The present evaluation of currently available data indicates that FDG-PET is superior to CT in detecting viable tumor residuals after chemotherapy in patients with metastatic seminoma. Its application can thus be recommended.
rTMS age-dependent response in treatment-resistant depressed subjects: a mini-review

Background In old age, depressive syndromes often affect people with chronic medical illnesses, cognitive impairment, and disability, which can worsen the outcomes of other medical disorders and promote disability. Repetitive magnetic transcranial stimulation (rTMS) is a simple and effective treatment in patients with treatment-resistant depression. Therefore the use of rTMS could be of particular potential benefit in treatment-resistant elderly patients, who often cannot tolerate the higher doses of drugs needed or show phenomena of intolerance and interaction. However, several studies assessing the efficacy of rTMS found smaller response rates in elderly patients when compared to younger samples. Nevertheless, the correlation between age and response is still a controversial issue, and there is no strong evidence to date. The aim of our study was to retest the effectiveness and safety of low-frequency rTMS in a 3 weeks active treatment in a group of resistant-depressed patients, and to investigate the role of age in the response to stimulation treatment. Methods Enrolled in this study were 102 treatment-resistant depressed patients. The patients were treated with low-frequency rTMS over the right dorso-lateral prefrontal cortex (DLPFC) for 3 weeks with a simple protocol (420 pulses per session for 15 sessions). At baseline, at the end of the second week, and at the end of the third week of treatment, the Hamilton Depression Rating Scale (HAM-D) and the Hamilton Anxiety Rating Scale (HAM-A) were administered. Results Low-frequency rTMS on the prefrontal dorsolateral right area resulted in a statistically significant reduction of mean HAM-D scores in the entire group of patients at the end of treatment. The responder's rate in the whole group at the end of the third week was 56.86%. A significant inverse relationship between HAM-D reduction and age was found in the “older” (>60 years old) group, not in the “younger” (<60 years old) group. Conclusion Results from this study show that low-frequency rTMS over the right DLPFC, with a relatively low number of pulses (420 pulses per session) and a relatively short period of treatment, is effective in the treatment of resistant patients (in a sample also including elderly patients) in a 3-weeks treatment protocol with a low reduction with the progress of age. Furthermore, we found a greater response in younger patients and an inverse correlation between age and treatment response. Adaptations of the protocol according to age are reviewed.
Prevalence of MTHFR C677T and MS A2756G polymorphisms in major depressive disorder, and their impact on response to fluoxetine treatment

Abstract Objective To examine the prevalence of the C677T polymorphism of the methylene tetrahydrofolate reductase (MTHFR) gene and the A2756G polymorphism of methionine synthase (MS), and their impact on antidepressant response. Methods We screened 224 subjects (52% female, mean age 39 ± 11 years) with SCID-diagnosed major depressive disorder (MDD), and obtained 194 genetic samples. 49 subjects (49% female, mean age 36 ± 11 years) participated in a 12-week open clinical trial of fluoxetine 20–60 mg/day. Association between clinical response and C677T and A2756G polymorphisms, folate, B12, and homocysteine was examined. Results Prevalence of the C677T and A2756G polymorphisms was consistent with previous reports (C/C = 41%, C/T = 47%, T/T = 11%, A/A = 66%, A/G = 29%, G/G = 4%). In the fluoxetine-treated subsample (n = 49), intent-to-treat (ITT) response rates were 47% for C/C subjects and 46% for pooled C/T and T/T subjects (nonsignificant). ITT response rates were 38% for A/A subjects and 60% for A/G subjects (nonsignificant), with no subjects exhibiting the G/G homozygote. Mean baseline plasma B12 was significantly lower in A/G subjects compared to A/A, but folate and homocysteine levels were not affected by genetic status. Plasma folate was negatively associated with treatment response. Conclusion The C677T and A2756G polymorphisms did not significantly affect antidepressant response. These preliminary findings require replication in larger samples.
Pathological characteristics of very young (< or = 30 years) breast cancer patients: a single-institution experience from Turkey.

Breast cancer rarely occurs in young women. Our knowledge about disease presentation, prognosis and treatment effects is largely dependent upon older series. Breast cancer in women <35 years of age occurs rarely (2%–4% of all breast cancer). Age <35 is an independent risk factor of recurrence and death [1]. There is little information about very young breast cancer patients (£30 years of age) in the literature. The aim of the study was to compare pathological risk factors of women with breast cancer aged £30 (very young group) with women with breast cancer aged 31–50 years (young group). One thousand and thirty-eight consecutive breast cancer patients presenting at Hacettepe University Institute of Oncology between years 2004 and 2007 were evaluated. In all, 422 (40.0%) of the patients were premenopausal and £50 years; 116 (11.1%) and 44 (4.2%) patients were £35 and £30 years of age, respectively. Median ages of the diagnosis in very young and young breast cancer groups were 28 and 41, respectively. In the ‘very young’ group, when compared with the ‘young’ breast cancer patients, percentages of tumors classified as estrogen receptor negative (48.5% versus 38.1%, P = 0.26), progesterone receptor negative (43.3% versus 39.4%, P = 0.70), HER2/neu positive (38.1% versus 22.2%, P = 0.23), and grade 3 (52.9% versus 39.4%, P = 0.14) tend to be higher although statistically not significant. Triple-negative breast cancers were more frequent in very young groups (30.4% versus 18.6%, P = 0.21). There were no statistical differences in extracapsular extension in metastatic axillary nodes, neural invasion, and lymphovascular invasion of tumors between the two age groups. There were also no differences between the two groups for pathological tumor size (T), frequency of positive lymph nodes (N), and distant metastasis at diagnosis (M). In our small cohort study population, we observed that very young patients (£30) tended to have poorer pathological prognostic factors compared with the young breast cancer patients. In our study population, the percentage of younger breast cancer (£35) (11.1%) is higher compared with the literature [2–5]. Tumors occurring in very young patients are reported to have a particularly aggressive biological behavior leading to a somewhat unfavorable prognosis, which was described extensively in the preadjuvant systemic therapy era [3, 6]. Several reports about age and prognosis as seen in our report conclude that features like higher grade represent a relevant aspect for discriminating between very young and young premenopausal breast cancer patients [1–6]. The results of the present study indicate that very young patients in our institution are having more high grade, triple-negative and HER-2-positive tumors representing poorer prognostic features than young premenopausal breast cancer patients.