Miracle-dz/UniFAR-FTUs huggingface dataset:
Keynesian Multiplier: Does it Matter to Egyptian Economy?

The study aims at investigating the impact of Keynesian multiplier on the four-sector open economy like Egyptian economy and testing the significance of aggregate demand components on Gross domestic product (GDP) over the period (1980-2017), the study adopts a descriptive analytical approach and econometrics methodology. The main findings that the theoretical literature is more likely meet the evidence for developed countries and unlikely for the developing countries. Unit Root tests show that variables are integrated of order one I(1), and they have long term equilibrium relationship. The four-sector multiplier value varied from year to year depending on the value of MPW. The mean value of the multiplier equals to 0.938 times. The significant of the model R indicates that 89.1 % of GDP explained by the independent variables over the study period. The lag consumption, investment, government expenditure and imports are significant at 5% level, while the lag exports is insignificant due to the international demand pattern fluctuations and the most of domestic production directed to supply at local market. For policy recommendations, the policy makers should decrease the leakages from income circular flow and increase the share of investment in GDP by suggesting investment future plan for needed investment projects in addition to applying dampening policy that decrease imports of both unnecessary consumption and luxury goods.
Systemic and Topical Retinoids in the Management of Skin Cancer in Organ Transplant Recipients

BACKGROUND Nonmelanoma skin cancers are the most frequent malignancies in organ transplant patients. Patients who develop multiple new skin cancers may benefit from retinoid chemoprevention. OBJECTIVE The objective of this study was to advise on the use of retinoids in organ transplant recipients. METHODS A summary was performed of the existing literature regarding experience with retinoid chemoprevention for skin cancer in organ transplant patients. RESULTS Systemic retinoids, specifically acitretin, are effective in inhibiting tumor development in organ transplant patients. This effect is only present during therapy, however. Topical retinoids have some effect in the treatment of actinic keratoses. Conclusions and Recommendations. Systemic retinoids can be used for chemoprevention of skin cancer. For a good result, long-term treatment with acitretin is necessary. Side effects, however, limit the use of retinoid chemoprevention. It is advised that treatment be started at a low dose, and patients should be monitored regularly for triglyceride and cholesterol levels and transaminases.
Autocrine overexpression of CTGF maintains fibrosis: RDA analysis of fibrosis genes in systemic sclerosis.

We have used representational difference analysis (RDA) to identify up-regulated genes in skin fibroblasts from fibrotic lesions obtained from patients with systemic sclerosis (scleroderma). RDA of cDNA libraries derived from fibroblasts from involved and uninvolved skin detected several differentially expressed genes. One such gene consistently up-regulated in scleroderma cells coded for human connective tissue growth factor (CTGF). Other studies described here show that the CTGF protein is readily detected in cultures of systemic sclerosis fibroblasts but was not detected in comparable normal cells. High levels of CTGF are also evident in biological fluids from patients with systemic sclerosis. TGFbeta stimulates CTGF production in both normal and systemic sclerosis fibroblasts with the latter found to be higher producers. Moreover, an analysis of constitutive and TGFbeta-induced CTGF gene activation showed altered and elevated transcriptional responses in systemic sclerosis cells compared with controls. CTGF stimulated a two- to threefold increase in proalpha1(I) collagen and fibronectin synthesis by both dermal and lung fibroblasts in culture and promoted significant matrix remodeling of fibroblast-populated three-dimensional collagen lattices. A direct relation between the overexpression of CTGF and elevated collagen synthesis was suggested by the observation that transfection of a CMV-CTGF cDNA construct and protein expression in fibroblasts increased the transcription of a Col 1alpha2 promoter-reporter construct to levels seen in systemic sclerosis fibroblasts. Using Col 1alpha2 promoter deletion constructs the CTGF responsive element was localized to the first 379 bp upstream of the transcriptional start site. These data indicate that there is an overexpression of CTGF in the systemic sclerosis cells, probably due to increased gene transcription, and suggest that the dysregulation of CTGF production is an important factor in fibroblast activation and the excessive deposition of collagen in systemic sclerosis.
Protein calorie malnutrition, nutritional intervention and personalized cancer care

Cancer patients often experience weight loss caused by protein calorie malnutrition (PCM) during the course of the disease or treatment. PCM is expressed as severe if the patient has two or more of the following characteristics: obvious significant muscle wasting, loss of subcutaneous fat; nutritional intake of <50% of recommended intake for 2 weeks or more; bedridden or otherwise significantly reduced functional capacity; weight loss of >2% in 1 week, 5% in 1 month, or 7.5% in 3 months. Cancer anorexia-cachexia syndrome (CACS) is a multifactorial condition of advanced PCM associated with underlying illness (in this case cancer) and is characterized by loss of muscle with or without loss of fat mass. Cachexia is defined as weight loss of more than 5% of body weight in 12 months or less in the presence of chronic disease. Hence with a chronic illness on board even a small amount of weight loss can open the door to cachexia. These nutritional challenges can lead to severe morbidity and mortality in cancer patients. In the clinic, the application of personalized medicine and the ability to withstand the toxic effects of anti-cancer therapies can be optimized when the patient is in nutritional homeostasis and is free of anorexia and cachexia. Routine assessment of nutritional status and appropriate intervention are essential components of the effort to alleviate effects of malnutrition on quality of life and survival of patients.
Central reassessment of GH concentrations measured at local treatment centers in children with impaired growth: consequences for patient management.

OBJECTIVE GH deficiency is diagnosed in children if serum GH fails to rise above a predefined cutoff value in response to at least two stimuli. Diagnostic decisions based on this testing are highly variable between centers and depend on the GH assays used. Considering the large spectrum of commercially available GH assays, we wanted to evaluate the agreement between assays, and to test whether assay-related variability of diagnostic decisions could be reduced by reassessment of peak GH concentrations in a reference center. DESIGN We reanalysed 699 peak GH serum samples obtained after GH testing of 382 children and adolescents from 19 centers using three reference assays and compared these results with those obtained with the local assays. A subgroup of 132 patients tested with the combination of insulin hypoglycemia test and arginine test was evaluated for changes in the assignment to the diagnostic group of GH deficiency. RESULTS The mean difference between methods ranged from 5.4 to 10.3 mU/l, slopes of the regression lines from 1.28 to 1.65. Significant non-linearity was detected in five of six assay comparisons, indicating that most assay results cannot be interconverted by the use of a factor. Overall agreement between reference and local assays was only moderate. Significant changes in diagnostic assignment occurred when different assays were used on the same patient (P<0.0001-P<0.0023). Based on GH remeasurement by one reference assay, 36 of 132 patients were categorized differently, with 35 patients changing into the GH-deficient group. Similar findings were obtained with the other reference assays. CONCLUSIONS To decrease variability in GH testing related to assays and cutoff values, we recommend nationwide reassessment of GH peak sera in reference centers. Decisions to treat GH deficiency should incorporate the reference center results.
Monitoring Worksite Clinic Performance Using a Cost-Benefit Tool

Objective: The purpose of this study was to explore the usefulness of continuously assessing the return on investment (ROI) of worksite medical clinics as a means of evaluating clinic performance. Methods: Visit data from January 1, 2007, to December 31, 2008, were collected from all the on-site clinics operated for the Pepsi Bottling Group. An average system-wide ROI was calculated from the time of each clinic’s opening and throughout the study period. A multivariate linear regression model was used to determine the association of average ROI with penetration/utilization rate and plant size. Results: A total of 26 on-site clinics were actively running as of December 2008. The average ROI at the time of start up was 0.4, which increased to 1.2 at ∼4 months and 1.6 at the end of the first year of operation. Overall, it seems that the cost of operating a clinic becomes equal to the cost of similar care purchased in the community (ROI = 1) at ∼3 months after a clinic’s opening and flattens out at the end of the first year. The magnitude of the ROI was closely related to the number of visits (a function of the penetration/utilization rate) and the size of the plant population served. Conclusion: Serial monitoring of ROIs is a useful metric in assessing on-site clinic performance and quantifying the effect of new initiatives aimed at increasing a clinic’s cost effectiveness.
Subclinical Peripheral Artery Disease in Patients Undergoing Peritoneal Dialysis: Risk Factors and Outcome

Background Peripheral artery disease (PAD) is highly prevalent among patients in end-stage renal disease. The ankle–brachial index (ABI) is believed to be highly correlated with the subclinical PAD of lower extremities but little is known about the associated risk factors and outcome for PAD and ABI in patients on peritoneal dialysis (PD). Methods We performed a cohort study of 153 patients from a single center receiving stable PD for more than 3 months. These patients were screened for subclinical PAD using the ABI measurement. The ABI was measured and a ratio of <0.9 was considered abnormal. Clinical outcomes included actuarial patient and technique survival in this study. Results 30 patients were classified into a subclinical PAD group. The prevalence of PAD (subclinical and overt) in our PD center was 19.61% (30/153). Advanced age, preexisting diabetes, preexisting cardiovascular and/or cerebrovascular disease (CVD), lower renal Kt/V urea, lower renal creatinine clearance (WCrCl), lower serum albumin level, and higher serum triglyceride level were risk factors for PAD in our PD center. Bivariate analysis showed that ABI was positively correlated with residual renal Kt/V urea and WCrCl, but was not correlated with peritoneal Kt/V urea and WCrCl. Patient and technique survival rates were significantly lower in the low ABI group than in the normal ABI group. Conclusions ABI is highly correlated with advanced age, preexisting diabetes, preexisting CVD, serum albumin, serum triglyceride, and residual renal clearance in PD patients. Also, lower ABI is independently associated with a high risk of patient mortality and PD technique failure.
Periodic onset of bubble shape instabilities and their influence on the spherical mode

Bubbles insonified by ultrasound can exhibit shape deformations and no more oscillate upon a purely spherical mode. Understanding and predicting the appearance of surface oscillations is essential for typical applications based on the acoustic response of bubbles (e.g. the use of contrast agents in echographic imaging), partly because shape modes can contribute to the monopole emission of sound by the bubble. In this work, we present a set of controlled experiments aiming at recording high-resolved temporal dynamics of surface oscillations of micrometer-sized bubbles. Single bubbles nucleated by a focused laser pulse and trapped in an amplitude-modulated ultrasonic field are captured by a high-speed CCD camera with an acquisition rate of 180 kfps. A proper expansion of the bubble interface coordinate over the Legendre's polynomials basis allows to obtain all the modal amplitudes corresponding to spherical and nonspherical oscillating modes. The slowly varying amplitude-modulated ultrasonic field causes beats of the spherical oscillations which alternate between low-amplitude phases and high-amplitude phases. Surface instabilities develop on the highamplitude phases while they disappear on the low-amplitude ones, thus leading to a periodic onset of the bubble shape modes. Analyzing the experimental results reveals that several shape modes exist simultaneously in the bubble dynamics, some of them not being parametrically triggered by the breathing mode. Comparisons with numerical simulations allow to support that these modes come from nonlinear interactions between spherical and nonspherical oscillations. Another consequence of nonlinear coupling effects observed in our experiments is the substantial modification of the breathing mode induced by the surface oscillations.
Human cortical bone: the SiNuPrOs model

Many models that have been developed for cortical bone oversimplify much of the architectural and physical complexity. With SiNuPrOs model, a more complete approach is investigated: it is multiscale because it contains five structural levels and multi physic because it takes into account simultaneously structure (with various properties: elasticity, piezoelectricity, porous medium), fluid and mineralization process modelization. The multiscale aspect is modeled by using 18 structural parameters in a specific application of the mathematical theory of homogenization and 10 other physical parameters are necessary for the multi physic aspect. The modelization of collagen as a piezoelectric medium has needed the development of a new behaviour law allowing a better simulation of the effect of a medium considered as evolving during a mineralization process. Then the main interest of SiNuPrOs deals with the possibility to study, at each level of the cortical architecture, either the elastic properties or the fluid motion or the piezoelectric effects or both of them. All these possibilities constitute a very large work and all this mass of information (fluid aspects, even at the nanoscopic scale, piezoelectric phenomena and simulations) will be presented in several papers. This first one is only devoted to the presentation of this model with an application to the computation of elastic properties at the macroscopic scale. The computational methods have been packed into software also called SiNuPrOs and allowing a large number of predictive simulations corresponding to various different configurations.
Intra-tissue steroid profiling indicates differential progesterone and testosterone metabolism in the endometrium and endometriosis lesions.

CONTEXT Aberrant sex steroid signaling is suggested to promote endometriosis growth by several mechanisms, and the tissue concentrations of sex steroids are key determinants of the hormone action. However, their concentrations are only superficially known in the endometrium and endometriosis lesions. OBJECTIVE This study sought to evaluate whether the tissue steroid hormone concentrations in endometriosis differ from the endometrium or serum. MAIN OUTCOME MEASURES Steroid analysis of serum and tissue specimens of women with endometriosis (n = 60) and healthy controls (n=16) was measured, and supporting data from quantitative RT-PCR for steroidogenic enzymes and explant cultures of a subset of specimens is provided. RESULTS Endometrial tissue progesterone (P4) concentrations reflected the serum P4 levels during the menstrual cycle, whereas in endometriosis lesions, the cycle-dependent change was missing. Remarkably high tissue T concentrations were measured in endometriosis lesions independent of the cycle phase, being 5-19 times higher than the corresponding serum levels. Tissue/serum ratio of T was further increased in patients with contraceptive medication. The altered tissue steroid concentrations in endometriosis were in line with the expression of various steroidogenic enzymes in the lesions, of which HSD3B2 showed constantly high expression, whereas CYP11A1 expression was low. Furthermore, the high concentration of sex steroids detected in the ovarian lesions involves their production by the lesion and by the adjacent ovarian tissue. CONCLUSIONS Endometriosis lesions present with progestin and androgen metabolism, which are different from that of the endometrium, and the lesions are characterized by high tissue T and a loss of cyclical changes in tissue P4 concentration.
Tympanic membrane temperature as a measure of core temperature

BACKGROUND Ear thermometers are becoming popular as a method for measuring deep body (core) temperature. AIM To determine the variability of a single user’s tympanic membrane (ear) temperature measurements. SUBJECTS Forty two, afebrile, healthy children, and 20 febrile children with acute burns. RESULTS In afebrile children measurements made in both ears (and within just a few minutes of each other) differed by as much as 0.6°C. Operator measurement error, sw of three consecutive measurements, in the same ear, was 0.13°C. In the group of febrile, burned children, core temperature was measured hourly at a number of sites (ear, rectum, axilla, bladder). A peak in core temperature occurred approximately 10–12 hours after the burn. Measurement error was calculated in 14 febrile, burned children with a peak temperature in excess of 38°C. For the left ear, measurement error was 0.19°C and for the right ear, 0.11°C. In the febrile children agreement between the ears was poor. The limits of agreement were 0.4°C to −0.8°C. It was not possible to predict the occasions when the temperature differences between the ears would be large or small. CONCLUSIONS The measurement error of one recording from the next is probably acceptable at about 0.1 to 0.2°C. To limit the variations in temperature of one ear to the other, measurements should be restricted to one of the ears whenever possible and the same ear used throughout the temperature monitoring period. Nurses and parents should take more than one temperature reading from the same ear whenever possible.
Mortality from malignant neoplasms among workers of an asbestos processing plant in Poland: results of prolonged observation.

OBJECTIVES The study on mortality from cancer among workers of an asbestos plant manufacturing asbestos yarn, cloth, cords, packings, stuffing, brake linings and asbestos-rubber sheets was launched in the 1980s. The present paper discusses the results of further tracing of asbestos workers of the same plant. MATERIALS AND METHODS The study cohort covered 4497 workers employed at the asbestos plant in 1945-1980. The follow-up of the cohort continued until 31 December 1999. Deaths by causes were analyzed using standardized mortality ratio (SMR) calculated by the person-years method. The mortality pattern of the general population of Poland was used as reference. RESULTS The availability of the cohort was 93.1% (2805 men and 1382 women were traced). Mortality from malignant neoplasms in total (281 deaths among men, SMR = 118, 95%CI: 105-133 and 135 deaths among women, SMR = 159, 95%CI: 133-188) as well as that from lung cancer (102 deaths among men, SMR = 126, 95%CI: 103-153 and 18 deaths among women, SMR = 259, 95%CI: 153-409) were significantly higher than in the general population. Unlike earlier stages of analysis, the present study revealed an increased risk of pleural mesothelioma (2 deaths among men, SMR = 510, 95%CI: 62-1842 and 3 deaths among women, SMR = 2033, 95%CI: 419-5941). Mortality analysis among workers with asbestosis and in those without diagnosed asbestosis, did not reveal direct association between the risk of asbestos-induced lung cancer and previously diagnosed asbestosis. CONCLUSIONS The prolonged cohort tracing showed an increased risk of asbestos-related cancers. It concerned mainly workers hired by the plant between 1945-1955, when the working condition were most strenuous.
Ventricular discrepancy as a sonographic sign of coarctation of the fetal aorta: how reliable is it?

The purpose of this study was to assess the predictive value and sensitivity of discrepant ventricular size for fetal aortic coarctation. Postnatal follow‐up data were obtained in 42 fetuses in whom ventricular size discrepancy (left ventricle smaller than right ventricle) was recognized on an obstetrical sonogram. Additionally, from postnatal records, we identified infants with coarctation who had had an obstetrical sonogram after 16 weeks. Fourteen of the 42 fetuses had coarctation or other aortic arch obstruction after birth (33% positive predictive value). Eight (62%) of 13 fetuses with ventricular discrepancy recognized before 34 weeks had coarctation, compared with six (21%) true positive cases among 29 recognized after 34 weeks (P = 0.01, Fisher's exact test). Of 21 infants with coarctation, ventricular discrepancy had been recognized by prenatal sonography in 13 (62% sensitivity). Ventricular discrepancy has moderate sensitivity and mediocre positive predictive value for coarctation. The limitations of this finding for diagnosing coarctation, particularly a higher false positive rate after 34 weeks, must be recognized, but it is still a useful sign to identify this potentially ductus‐dependent lesion.
Rehabilitation after traumatic brain injury in adults.

PURPOSE Traumatic brain injury (TBI) stands as a major public health problem and one of the most important challenges for neurological rehabilitation. This review discusses advances that have occurred in the past 10 years in rehabilitation after severe TBI in adults. METHOD First, theoretical concepts, goals of rehabilitation and organization of resources are reviewed. Then specific questions that arise in the rehabilitation of severe TBI patients are considered. RESULTS Three phases are distinguished in post-traumatic evolution. Acute rehabilitation takes place during coma and arousal states. Specific aims are to prevent orthopaedic and visceral complications, and to provide sensory stimulations with the hope of accelerating arousal. Secondly subacute (generally inpatient) rehabilitation is designed to facilitate and accelerate recovery of impairments, and to compensate for disabilities. Motility, cognition, behaviour, personality and affect should be simultaneously addressed in an holistic approach. Physical as well as psychological independence and self-awareness are the major goals to emphasize. A third, post-acute rehabilitation phase includes outpatient therapy for achieving physical, domestic and social independence, reduction of handicaps and re-entry into the community. CONCLUSIONS Problems with returning home, obtaining financial independence, driving, returning to work, participating in social relationships and leisure activities, and the importance of psychosocial adjustment and self-acceptance, are outlined. Questions about economic aspects and rehabilitation in the future are addressed.