Miracle-dz/UniFAR-FTUs huggingface dataset:
Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care

Abstract Objective: To compare the cost effectiveness of general practitioners and nurse practitioners as first point of contact in primary care. Design: Multicentre randomised controlled trial of patients requesting an appointment the same day. Setting: 20 general practices in England and Wales. Participants: 1716 patients were eligible for randomisation, of whom 1316 agreed to randomisation and 1303 subsequently attended the clinic. Data were available for analysis on 1292 patients (651 general practitioner consultations and 641 nurse practitioner consultations). Main outcome measures: Consultation process (length of consultation, examinations, prescriptions, referrals), patient satisfaction, health status, return clinic visits over two weeks, and costs. Results: Nurse practitioner consultations were significantly longer than those of the general practitioners (11.57 v 7.28 min; adjusted difference 4.20, 95% confidence interval 2.98 to 5.41), and nurses carried out more tests (8.7% v 5.6% of patients; odds ratio 1.66, 95% confidence interval 1.04 to 2.66) and asked patients to return more often (37.2% v 24.8%; 1.93, 1.36 to 2.73). There was no significant difference in patterns of prescribing or health status outcome for the two groups. Patients were more satisfied with nurse practitioner consultations (mean score 4.40 v 4.24 for general practitioners; adjusted difference 0.18, 0.092 to 0.257). This difference remained after consultation length was controlled for. There was no significant difference in health service costs (nurse practitioner £18.11 v general practitioner £20.70; adjusted difference £2.33, −£1.62 to £6.28). Conclusions: The clinical care and health service costs of nurse practitioners and general practitioners were similar. If nurse practitioners were able to maintain the benefits while reducing their return consultation rate or shortening consultation times, they could be more cost effective than general practitioners.
A prospective study on socioeconomic aspects of fracture of the proximal femur

A prospective survey of hip fracture incidence and outcome was conducted to evaluate their socioeconomic impact. Over the course of 1 year, 404 hip fractures were recorded in 339 women and 65 men following minor or moderate trauma. The subjects' ages were 82.8 + 10.0 years (mean + SD): 84.1 + 9.2 in female and 76.4 + 13.7 in male subjects. The overall annual incidence was 104.4/100,000; the incidence in women was 167.1 versus 35.3 in men, with a crude female‐to‐male ratio of 4.7. However, when adjusted for age, this ratio was 2.7. When adjusted to the 1985 U.S.A. population, the incidence rates were 68.6 overall, 108.8 female, and 26.3 male, and were, respectively, 119.1, 188.8, and 46.1 when adjusted to the 1992 Swiss population. As compared with 105 age‐matched non‐hipfracture fallers studied in the same emergency ward, fracture subjects lived more often in nursing homes and took cardiovascular drugs (p < 0.001). The mean length of stay in the orthopedic ward was 16.3 + 12.0 days (median 14; range 2–193 days), for a total of 6566 bed‐days representing 19.8% of available bed‐days. The mean length of stay in rehabilitation hospitals was 63.6 + 52.6 days (median 50; range 2–349 days), for a total of 17,099 bed‐days, representing 5.2% of available bed‐days. For patients who where independent before fracture, the greater length of stay was associated with advanced age and consumption of cardiovascular drugs. The total cost of hospital stay amounted to approximately $44,000 per patient. Mortality was 3.2% in the orthopedic ward and 10.8% in rehabilitation hospitals, for an overall in‐hospital mortality rate of 10.4%. Overall, the 1‐year mortality was 23.8% (21.5% for women and 35.4% for men), and it was significantly higher than in the general population (p < 0.001). Prognostic factors for mortality were age, sex, consumption of cardiovascular drugs, and previous living circumstances. One year after fracture, 62.6% of the fracture patients had returned to their previous living circumstances, but 17.9% needed a more care‐intensive environment. The likelihood of returning to autonomous living circumstances 1 year after fracture was higher in younger subjects, in females, in those living with a partner, and in those in overall better health before the fracture. This prospective survey highlights the high socioeconomic impact and burden of osteoporotic fractures of the proximal femur.
Germinal Center B-cells

Within the B-cell follicle of secondary lymphoid organs, germinal center (GC) reactions produce high affinity antibody-secreting plasma cells (PCs) and memory B-cells necessary for the host's defense against invading pathogens. This process of GC formation is reliant on the activation of antigen-specific B-cells by T-cells capable of recognizing epitopes of the same antigenic complex. The unique architecture of secondary lymphoid organs facilitates these initial GC events through the placement of large clonally-diverse B-cell follicles near equally diverse T-cell zones. Antigen-activated B-cells that receive proper differentiation signals at the T-cell border of the B-cell follicle initiate an early GC B-cell transcriptional profile and migrate to follicular dendritic cell (FDC) networks within the B-cell follicle to seed the GC reaction. Peripheral to FDCs, GC B-cells rapidly divide in dark zones of the GC, and undergo somatic hypermutation of their immunoglobulin (Ig) variable domain. Newly formed GC B-cell clones then migrate into the GC light zone where they compete for antigen and secondary signals presented by FDCs and a specialized subset of CD4+ T-cells known as T-follicular helper (TFH) cells. Survival, proliferative and differentiation signals delivered by mature FDCs and TFH cells initiate transcriptional programs that determine if GC B-cells become memory B-cells or terminally differentiated PCs. To prevent oncogenic transformation and/or the escape of autoreactive clones, there are several regulatory mechanisms that restrict GC B-cell proliferation and survival. Here we will detail the recent advances in GC B-cell biology that relate to their generation and fate-determination as well as their pathogenic potential.
Safety of tenofovir use during pregnancy: early growth outcomes in HIV-exposed uninfected infants

Objective:To evaluate the association of tenofovir disoproxil fumarate (TDF) use during pregnancy with early growth parameters in HIV-exposed, uninfected (HEU) infants. Design:US-based prospective cohort study of HEU children to examine potential adverse effects of prenatal TDF exposure. Methods:We evaluated the association of maternal TDF use during pregnancy with small for gestational age (SGA); low birth weight (LBW, <2.5 kg); weight-for-age z-scores (WAZ), length-for-age z-scores (LAZ), and head circumference-for-age (HCAZ) z-scores at newborn visit; and LAZ, HCAZ, and WAZ at age 1 year. Logistic regression models for LBW and SGA were fit, adjusting for maternal and sociodemographic factors. Adjusted linear regression models were used to evaluate LAZ, WAZ, and HCAZ by TDF exposure. Results:Of 2029 enrolled children with maternal antiretroviral information, TDF was used by 449 (21%) HIV-infected mothers, increasing from 14% in 2003 to 43% in 2010. There was no difference between those exposed to combination regimens with vs. without TDF for SGA, LBW, and newborn LAZ and HCAZ. However, at age 1 year, infants exposed to combination regimens with TDF had significantly lower adjusted mean LAZ and HCAZ than those without TDF (LAZ: −0.17 vs. −0.03, P = 0.04; HCAZ: 0.17 vs. 0.42, P = 0.02). Conclusion:TDF use during pregnancy was not associated with increased risk for LBW or SGA. The slightly lower mean LAZ and HCAZ observed at age 1 year in TDF-exposed infants are of uncertain significance but underscore the need for additional studies of growth outcomes after TDF use during pregnancy.
LLC series resonant converter with auxiliary circuit for hold-up time

Although LLC series resonant converter has advantages of wide operation range and high efficiency, hold up time requirement makes it difficult to optimal design at normal operating condition, results in increasing transformer size and low efficiency. In this paper, LLC series resonant converter with auxiliary circuit is proposed. Compare with conventional LLC series resonant converter, higher gain at the same frequency can be achieved because the proposed converter has a current boost up capability. Therefore, even if ac line is turned off, switching frequency range of LLC series resonant converter can be reduced. With the auxiliary circuit, LLC series resonant converter can achieve high power density and high efficiency at normal operation condition.
Bacterial Oxidation of Dibromomethane and Methyl Bromide in Natural Waters and Enrichment Cultures

ABSTRACT Bacterial oxidation of14CH2Br2 and14CH3Br was measured in freshwater, estuarine, seawater, and hypersaline-alkaline samples. In general, bacteria from the various sites oxidized similar amounts of14CH2Br2 and comparatively less 14CH3Br. Bacterial oxidation of14CH3Br was rapid in freshwater samples compared to bacterial oxidation of 14CH3Br in more saline waters. Freshwater was also the only site in which methyl fluoride-sensitive bacteria (e.g., methanotrophs or nitrifiers) governed brominated methane oxidation. Half-life calculations indicated that bacterial oxidation of CH2Br2 was potentially significant in all of the waters tested. In contrast, only in freshwater was bacterial oxidation of CH3Br as fast as chemical removal. The values calculated for more saline sites suggested that bacterial oxidation of CH3Br was relatively slow compared to chemical and physical loss mechanisms. However, enrichment cultures demonstrated that bacteria in seawater can rapidly oxidize brominated methanes. Two distinct cultures of nonmethanotrophic methylotrophs were recovered; one of these cultures was able to utilize CH2Br2 as a sole carbon source, and the other was able to utilize CH3Br as a sole carbon source.
From Genomes to GENE-omes: Exome Sequencing Concept and Applications in Crop Improvement

Exome sequencing represents targeted capture and sequencing of 1–2% of ‘high-value genomic regions’ (subset of the genome) which are enriched for functional variants and harbors low level of repetitive regions. We discuss here an overview of exome sequencing, ways to approach plant exomes, and advantages and applicability of this powerful approach in deciphering functional regions of genomes. Though initially this approach was developed as an alternative to whole genome sequencing (WGS), but the multitude of benefits conferred by sequence capture via hybridization approaches created a niche for itself to solve many of biological riddles, particularly for resolving phylogenetic distances. The technique has also proved to be successful in understanding the basis of natural and induced molecular variation, marker development and developing genomic resources for complex, wild and non-model species, which are still intractable for WGS efforts. Thus, with profound applications of this powerful sequencing strategy, near future is expected to witness a collective expansion of both techniques, i.e., sequence capture via hybridization for evolutionary and ecological research and WGS approaches for its universal accessibility.
Cancer-related patient education: an overview of the last decade of evaluation and research.

PURPOSE/OBJECTIVES To provide an overview of cancer-related patient-education research to determine future research needs. DATA SOURCES A literature search of peer-reviewed articles from 1989-1999. Databases that were searched included Medline, CINAHL, HealthStar, ERIC, CancerLit, and PubMed. DATA SYNTHESIS 176 articles were analyzed and synthesized into narrative form. CONCLUSIONS Patients with cancer want and benefit from information, especially when making treatment decisions. Education helps patients manage side effects and improves adherence. Literacy is an important factor in materials development. The efficacy of computer-assisted learning, audio and video programs, and telephone interventions is supported in a variety of patient groups. Pain education can improve pain control, but the impact on fatigue has not been well researched. IMPLICATIONS FOR NURSING PRACTICE Patient education is an important component of nursing care. Research has confirmed its impact in many areas but questions still remain.
Phenotypic differences between Th1 and Th17 cells and negative regulation of Th1 cell differentiation by IL‐17

Recent evidence fromseveral groups indicates that IL‐17‐producing Th17 cells, rather than, as once was thought, IFN‐γ‐producing Th1 cells, can represent the key effector cells in the induction/development of several autoimmune and allergic disorders. Although Th17 cells exhibit certain phenotypic and developmental differences from Th1 cells, the extent of the differences between these two T cell subsets is still not fully understood. We found that the expression profile of cell surface molecules on Th17 cells has more similarities to that of Th1 cells than Th2 cells. However, although certain Th1‐lineage markers [i.e., IL‐18 receptor α, CXCR3, and T cell Ig domain, mucin‐like domain‐3 (TIM‐3)], but not Th2‐lineage markers (i.e., T1/ST2, TIM‐1, and TIM‐2), were expressed on Th17 cells, the intensity of expression was different between Th17 and Th1 cells. Moreover, the expression of CTLA‐1, ICOS, programmed death ligand 1, CD153, Fas, and TNF‐related activation‐induced cytokine was greater on Th17 cells than on Th1 cells. We found that IL‐23 or IL‐17 can suppress Th1 cell differentiation in the presence of exogenous IL‐12 in vitro. We also confirmed that IL‐12 or IFN‐γ can negatively regulate Th17 cell differentiation. However, these cytokines could not modulate such effects on T cell differentiation in the absence of APC.
Net aboveground biomass declines of four major forest types with forest ageing and climate change in western Canada's boreal forests

Biomass change of the world's forests is critical to the global carbon cycle. Despite storing nearly half of global forest carbon, the boreal biome of diverse forest types and ages is a poorly understood component of the carbon cycle. Using data from 871 permanent plots in the western boreal forest of Canada, we examined net annual aboveground biomass change (ΔAGB) of four major forest types between 1958 and 2011. We found that ΔAGB was higher for deciduous broadleaf (DEC) (1.44 Mg ha−1 year−1, 95% Bayesian confidence interval (CI), 1.22–1.68) and early‐successional coniferous forests (ESC) (1.42, CI, 1.30–1.56) than mixed forests (MIX) (0.80, CI, 0.50–1.11) and late‐successional coniferous (LSC) forests (0.62, CI, 0.39–0.88). ΔAGB declined with forest age as well as calendar year. After accounting for the effects of forest age, ΔAGB declined by 0.035, 0.021, 0.032 and 0.069 Mg ha−1 year−1 per calendar year in DEC, ESC, MIX and LSC forests, respectively. The ΔAGB declines resulted from increased tree mortality and reduced growth in all forest types except DEC, in which a large biomass loss from mortality was accompanied with a small increase in growth. With every degree of annual temperature increase, ΔAGB decreased by 1.00, 0.20, 0.55 and 1.07 Mg ha−1 year−1 in DEC, ESC, MIX and LSC forests, respectively. With every cm decrease of annual climatic moisture availability, ΔAGB decreased 0.030, 0.045 and 0.17 Mg ha−1 year−1 in ESC, MIX and LSC forests, but changed little in DEC forests. Our results suggest that persistent warming and decreasing water availability have profound negative effects on forest biomass in the boreal forests of western Canada. Furthermore, our results indicate that forest responses to climate change are strongly dependent on forest composition with late‐successional coniferous forests being most vulnerable to climate changes in terms of aboveground biomass.
Impact of a tobacco curriculum on smoking behaviour and attitudes toward smoking in dental students in Japan: a three-year follow-up study.

AIM Dental professionals have the potential to influence global smoking rates. This study evaluated the impact of a tobacco curriculum on smoking behaviour and attitudes toward smoking in dental students. METHODS Immediately before and three years after the implementation of a tobacco curriculum with a no-smoking policy, a questionnaire was administered to students to obtain information about their smoking behaviour and attitudes toward smoking. RESULTS The number of students who responded to the questionnaire was 580 in 2003 and 554 in 2006. The smoking rate decreased significantly from 35% in 2003 to 26% in 2006; however, analysis of data for each school year suggested that this was due to the prevention of smoking initiation rather than quitting smoking. Attitudes toward patient smoking and public policy were more positive in non-smokers than in current smokers. Improvement in attitudes toward patient smoking was smaller in current smokers than in non-smokers. Little improvement occurred in attitudes toward public policy in both non- and current smokers. CONCLUSIONS Implementation of a tobacco curriculum was effective in preventing smoking initiation and improving attitudes toward patient smoking in students. Further measures are necessary to improve attitudes toward public policy and to discourage smoking among students.
Markers of inflammation and coagulation may be modulated by enteral feeding strategy.

BACKGROUND Although enteral nutrition (EN) is provided to most mechanically ventilated patients, the effect of specific feeding strategies on circulating markers of coagulation and inflammation is unknown. METHODS Markers of inflammation (tumor necrosis factor [TNF]-α, interleukin [IL]-1β, interferon [IFN]-γ, IL-6, IL-8, IL-10, IL-12) and coagulation (tissue factor [TF], plasminogen activator inhibitor-1) were measured at baseline (n = 185) and 6 days (n = 103) in mechanically ventilated intensive care unit patients enrolled in a randomized controlled study of trophic vs full-energy feeds to test the hypothesis that trophic enteral feeds would be associated with decreases in markers of inflammation and coagulation compared to full-energy feeds. RESULTS There were no differences in any of the biomarkers measured at day 6 between patients who were randomized to receive trophic feeds compared to full-energy feeds. However, TF levels decreased modestly in patients from baseline to day 6 in the trophic feeding group (343.3 vs 247.8 pg/mL, P = .061) but increased slightly in the full-calorie group (314.3 vs 331.8 pg/mL). Lower levels of TF at day 6 were associated with a lower mortality, and patients who died had increasing TF levels between days 0 and 6 (median increase of 39.7) compared to decreasing TF levels in patients who lived (median decrease of 95.0, P = .033). CONCLUSIONS EN strategy in critically ill patients with acute respiratory failure does not significantly modify inflammation and coagulation by day 6, but trophic feeds may have some modest effects in attenuating inflammation and coagulation.
Age and sex as factors of response to RSV infections among those with previous history of wheezing

Although enhanced immune reaction caused by the respiratory syncytial virus (RSV) in allergen‐sensitized animal model has been reported, RSV illnesses in children already sensitized or having recurrent wheezing episodes have not been completely studied. In addition, the reason for male dominances in RSV infection at young ages was also inconclusive. Therefore, gender analysis in recurrent wheezing children with RSV infection can shed light on asthma pathogenesis. We studied the clinical features and the laboratory data of RSV infections in children who had recurrent wheezing histories. The subjects with RSV infection consisted of 98 boys and 58 girls. The children under 4 yr of age were 123 (78.8%) in number. Children with pneumonia were 78 and those with febrile episode were 119. Children above 1 yr of age were highly sensitized with mite antigen (75/96, 78.1%). The clinical symptoms and signs differed according to their ages. Children in each age group behaved differently in their immune reaction to RSV. Above all, 3‐yr‐old children deteriorated clinically during acute RSV infection, accompanied by transient elevated C‐reactive protein (CRP) and suppressed blood eosinophil counts. Clinical features differed in several points between boys and girls. In general, the white blood cell count and the CRP levels were higher in girls in every age group. Blood eosinophil counts at the acute illness were significantly higher in boys than girls aged 2 and 3< yr. Age and gender comparison in already sensitized children might suggest a clue to asthma pathogenesis.
Transfemoral versus Transapical Aortic Implantation for Aortic Stenosis Based on No Significant Difference in Logistic EuroSCORE: A Meta-Analysis

Abstract Background Transcatheter aortic valve implantation (TAVI) has gained increasing acceptance for patients with severe aortic stenosis (AS). The present meta-analysis was performed to assess if the transapical (TA) approach has any benefit in reduction of mortality and complications relative to the transfemoral (TF) approach for patients with AS. Methods All relevant studies comparing TF-TAVI and TA-TAVI from January 2002 to November 2013 were retrieved from Medline and Embase databases. The relative risk (RR) and 95% confidence interval (CI) were used to evaluate the difference between two groups. Heterogeneity assumption was assessed by an I 2 test. The random-effect model or fixed-effect model was used to estimate summary effect based on I 2 test. Results Nine studies conformed to the predefined criteria, including 666 patients in the TF-TAVI group and 457 patients in the TA-TAVI group. No difference was found in all-cause mortality at 30 days and beyond 1 year between the two groups (30 days: 9.2% versus 11.4%; RR, 0.72; 95% CI, 0.47 to 1.11; p = 0.14 and beyond 1 year: RR, 0.96; 95% CI, 0.59 to 1.56; p = 0.86). There was a trend toward increased incidence of stroke in patients in the TF-TAVI group (4.7% versus 2.6%; RR, 1.64; 95% CI, 0.75 to 3.58; p = 0.21), and the incidence of vascular complication and postoperative heart block were significantly increased in patients having TF-TAVI (vascular complications: 14.7% versus 7.1%; RR, 2.04; 95% CI, 1.15 to 3.61; p = 0.01 and heart block: 13.4% versus 4.6%; RR, 2.53; 95% CI, 1.10 to 5.83; p = 0.03). Additionally, more patients in the TF-TAVI group required permanent pacemaker relative to the TA-TAVI group (10.8% versus 3.4%; RR, 2.74; 95% CI, 1.41 to 5.32; p = 0.003). Conclusions Among patients with AS with no significant difference in logistic EuroSCORE, TA-TAVI has a lower risk of vascular complication and postoperative heart block but a similar incidence of stroke and mortality compared with TF-TAVI. Accordingly, TA approach is a promising and feasible option for the patients with severe AS.