Miracle-dz/UniFAR-FTUs huggingface dataset:
Re: "Methods of covariate selection: directed acyclic graphs and the change-in-estimate procedure".

I read with great interest the recent paper by Weng et al. (1), in which the authors compared a directed acyclic graph (DAG) full model and 3 DAG and change-in-estimate combined procedures. I wish to comment on the reported sampling distribution-based standard error. I hope this comment can help to clarify why the results on sampling distributionbased standard errors reported by Weng et al. (1) are not consistent with the theoretical results established in the paper by Robinson and Jewell (2). The sampling distribution-based standard error reported by Weng et al. (1) for the combined procedures is not the same as the standard error considered by Robinson and Jewell (2); therefore, the results on standard errors reported by Weng et al. do not contradict the theoretical results derived by Robinson and Jewell. The 3 combined procedures—DAG-GS CE, DAG-GS P, and DAG-S SE—may select the full model and other reduced models (which omit some covariates) as the final model. According to Drake and McQuarrie (3) and Gail et al. (4), omitting covariates leads to estimation bias. Because the biases associated with different reduced models are different (3, 4), the 1,000 odds ratio estimates obtained from a combined procedure, in each scenario considered by Weng et al. (1), can be viewed as a sample from a mixture of distributions with different mean values. Consequently, the reported sampling distributionbased standard error in the paper by Weng et al. (1) combines the within-model variability and between-model variability (i.e., the variability of different biases associated with reduced models), similar to the total sum of squares decomposition in a standard unbalanced 1-way analysis of variance. On the other hand, the variance and standard error considered in the paper by Robinson and Jewell (2), which is equivalent to the within-model variability for a given reduced model, is not the same as the reported sampling distribution-based standard error in the paper by Weng et al. (1). For the purpose of comparison of sampling distributionbased standard errors between the DAG full model and the 3 combined procedures, as well as comparison of sampling distribution-based standard errors between any 2 model selection procedures, an alternative sampling distributionbased standard error could be presented using the withinmodel variability.
Holding the patient's life in my hands: Swedish registered nurse anaesthetists' perspective of advocacy.

BACKGROUND Anaesthesia often induces a state of unconsciousness that includes inability to communicate and influence the situation. The patient has to rely on the nurse anaesthetist to speak up for her/him as well as maintain her/his dignity and safety. Consequently, the nurse anaesthetist can be likened to the patient's advocate. AIM The aim of the study was to describe advocacy in anaesthesia care during the perioperative phase from the perspective of the registered nurse anaesthetist. METHOD Data for this qualitative descriptive study were collected during March and April, 2011. Individual interviews were conducted with a purposive sample of 20 nurse anaesthetists from two hospitals in Sweden. The audio-taped interviews were transcribed verbatim and analysed by means of qualitative content analysis. FINDINGS The main theme, Holding the patient's life in my hands, described the nurse anaesthetists' perception of advocacy and comprised three subthemes: providing dignified care, providing safe care and a moral commitment. CONCLUSION Acting as the patient's advocate includes important health and well-being issues and could be stressful for the nurse anaesthetists'. A work environment where the nurse anaesthetists' can make their voices heard and feel that their opinion regarding the patient's best interests is taken seriously would be desirable, as all health professionals should ideally focus on those in their care.
Linolenic acid improves oocyte developmental competence and decreases apoptosis of in vitro-produced blastocysts in goat

Summary The effects of α-linolenic acid (ALA) on developmental competence of oocytes in goats were evaluated in this study. Initially, the level of ALA in small and large antral follicles was determined to be in a range of 0.018–0.028 mg/ml (64.6–100.6 μM, respectively). In vitro maturation was performed in the presence of various concentrations (10, 50, 100, or 200 μM) of ALA. Cumulus expansion, meiotic maturation, levels of intracellular glutathione (GSH), embryonic cleavage, blastocyst formation following parthenogenetic activation (PA) and in vitro fertilization (IVF), number of total and apoptotic cells in blastocyst, and expression of Bax, Bcl-2, and p53 genes in blastocyst cells were determined. Compared with the control, no improvement was observed in cumulus expansion in ALA-treated groups. At 50 μM concentration, ALA increased meiotic maturation rate but had no effect on GSH level. When oocytes treated with 50 μM ALA were subsequently used for PA or IVF, a higher rate of blastocyst formation was observed, and these embryos had a higher total cell number and a lower apoptotic cell number. Expression analyses of genes in blastocysts revealed lesser transcript abundances for Bax gene, and higher transcript abundances for Bcl-2 gene in 50 μM ALA group. Expression of p53 gene was also less observed in ALA-treated blastocysts. Our results show that ALA treatment at 50 μM during in vitro maturation (IVM) had a beneficial effect on maturation of goat oocytes and this, in turn, stimulated embryonic development and regulated apoptotic gene expression.
Screening phytochimique de quelques plantes médicinales ivoiriennes utilisées en pays Krobou (Agboville, Côte-d'Ivoire)

Une etude ethnomedicinale realisee chez les Krobou, une ethnie du Departement d’Agboville (Cote-d’Ivoire), a montre que 27 traditherapeutes utilisent 18 especes de la flore ivoirienne, pour combattre differentes pathologies. Diverses parties de la plante (ecorces de racine et de tige, feuilles, fruits, graines et tubercules) sont utilisees pour la preparation des recettes medicamenteuses. Ces recettes, monospecifiques en general, necessitent divers modes de preparation (decoction, expression, infusion, maceration, petrissage, pilage, pulverisation, ramollissement, torrefaction et trituration). On note divers modes d’administration des medicaments : ablution, application locale, badigeonnage, bain de vapeur, boisson, instillations buccales, nasales, vaginales et purges. Les tests tri phytochimiques realises sur 3 extraits (etherique, methanolique et aqueux) ont revele que les differentes drogues renferment des sterols, polyterpenes, polyphenols, flavonoides, tanins catechiques, alcaloides et des saponosides, qui leur conferent les proprietes therapeutiques diverses. An ethnomedicinal study carried out at Krobou, an ethnic group in the Department of Agboville (Cote-d’Ivoire) showed that 27 traditional doctors use 18 ivorian plants species to cure people to different pathologies. Various parts of the plant (barks of root and stem, sheets, fruits, seeds and tubers) are used to prepare the medicamentous receipts. These receipts which are generally monospecific, require different preparation modes (decoction, expression, infusion, soaking, kneading, pounding, crushing, softening, rousting and trituration). We note several administration modes of those medicines : washing, application on the skin, painting, steam bath, drinking, oral, nasal, vaginal instillations and purges. The tri phytochemical tests of three extracts (etheric, methanolic and aqueous) revealed that the different drugs contain sterols, polyterpenes, polyphenols, flavonoids, tannins, alkaloids and saponosides which give these medicines several healing properties. Keywords: Agboville, chemical Components, Cote-d’Ivoire, Ethnomedicine, Krobou, Phytochemistry
Back on Track: Confronting Post-Surgical Weight Gain

Abstract The battle against obesity is a lifelong journey. Surgery can be an effective intervention; however, many patients experience post-surgical weight regain. At a large, urban health care system in Virginia performing bariatric surgeries, it was determined that a focused intervention was needed to target this weight regain in many patients. Thus, an 8-week pilot group therapy intervention was implemented to help these patients get “Back on Track. ” Groups combined cognitive-behavioral therapy and motivational interviewing to address the specific needs of these participants. Fourteen female Roux-en-Y gastric bypass surgery patients who were at least 18 months post surgery completed the 8-week program in two separate groups. Participants reported difficulty coping with the return of food cravings and challenging eating behaviors after a period of relative relief following surgery. Participants rated peer support as a highly valuable component of group and reported significant behavioral changes, enhanc.
The proboscis lateralis--a 14-year follow-up.

: A short historical review of proboscis lateralis is given and some of the important contributions highlighted. Forster was the first to mention this abnormality. I collected 34 cases from the literature (including one of my own) and have divided them clinically into four groups. The proboscis is most commonly associated with deformities of the ipsilateral half nose, the eye, and its adnexa. The various lines of management of this problem are discussed. I recommend dilating the canal of the proboscis as a useful step when it is used for reconstructing the absent heminose. A case of a left proboscis lateralis associated with an ipsilateral heminasal aplasia, a bilateral cleft of the lip and palate, a congenital cleft ala, and microphthalmia with a coloboma of the lower eyelid is documented.
Cross‐education after high‐frequency versus low‐frequency volume‐matched handgrip training

Introduction: Cross‐education training programs cause interlimb asymmetry of strength and hypertrophy. We examined the cross‐education effects from a high‐frequency (HF) versus a low‐frequency (LF) volume‐matched handgrip training program on interlimb asymmetry. Methods: Right‐handed participants completed either HF (n = 10; 2 × 6 repetitions 10 times per week) or LF (n = 9; 5 × 8 repetitions 3 times per week) training. Testing occurred twice before and once after 4 weeks of right‐handed isometric handgrip training totaling 120 weekly repetitions. Measures were maximal isometric handgrip and wrist flexion torque, muscle thickness, and muscle activation (electromyography; EMG). Results: Grip strength was greater in both limbs posttraining, pooled across groups (P < 0.001). Trained limb muscle thickness increased in both groups (P < 0.05; untrained, P = 0.897). EMG and wrist flexion torque did not change (all P > 0.103). Discussion: Both LF and HF induced cross‐education of grip strength to the untrained limb, but HF did not reduce asymmetry. These findings have implications for injury rehabilitation. Muscle Nerve 56: 689–695, 2017
Tumour necrosis factor (TNF)α −308 G/G promoter polymorphism and TNFα levels correlate with a better response to adalimumab in patients with rheumatoid arthritis

Objective: To investigate the influence of −308 tumour necrosis factor‐α (TNFα) promoter polymorphism and circulating TNFα levels in the clinical response to adalimumab treatment in patients with rheumatoid arthritis (RA). Methods: Eighty‐one patients with active RA were genotyped for the −308 TNFα polymorphism by polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP) analysis and subdivided into two groups for each polymorphism (G/A and G/G genotype). All received 40 mg of adalimumab subcutaneously every other week. We compared the groups' clinical responses to adalimumab at 8, 16, and 24 weeks using the Disease Activity Score in 28 joints (DAS28). Results: Both groups showed a significant improvement from baseline. A significant difference between groups was found at week 24. We found that 88.2% of G/G versus 68.4% of G/A for the −308 polymorphism were DAS28 responders (p = 0.05). The score improvement at week 24 was 2.5±1.3 in the G/G group and 1.8±1.3 in the G/A group for the −308 polymorphism (p = 0.04). The median of serum TNFα levels of the G/A group were lower than those of the G/G group, and statistically different at weeks 8 and 24 (p<0.039 and p<0.043). When comparing baseline levels to those achieved at 8, 16, and 24 weeks for the whole group, only responder patients showed a statistically significant overall increase in TNFα over time (p<0.000001). Conclusion: A relationship between DAS28 improvement, the −308 G/G polymorphism, and increased circulating TNFα levels was found in Chilean RA patients treated with adalimumab.
A three‐tiered approach to the rehabilitation of incarcerated sex offenders

A description is provided of a program for dealing with convicted sex offenders. This program includes: incarceration and treatment of high risk offenders in maximum and medium security institutions; movement of successfully treated offenders and lower risk offenders to a less extensive treatment program in a minimum security jail; and then release to the community where offenders are reassessed and treated, while they begin supervised implementation of a relapse prevention plan. The evidence suggests that this overall approach is not only effective in reducing recidivism, but also cost-effective in reducing the expense to society of dealing with reoffenders. Language: en
Modem treatment of menorrhagia(Commentary)

Modem treatment of menorrhagia (Commentary) Dear Sir, Although the commentary by Russell Macdonald [Br J Obstet Gynaecol (1990) 97, 3-71 gave a well-rounded review of current treatment for menorrhagia, certain points relating to endometrial fibrinolysis and the use of antifibrinolytics in menorrhagia were somewhat misleading. The commentary states that no clear difference in uterine fibrinolysis has been demonstrated between women with normal menstrual blood loss (MBL) and those with demonstrable MBL of >80ml. To the contrary, investigations of endometrial biopsy specimens taken at various points throughout the cycle demonstrate quite clearly that endometrial fibrinolytic activity increases dramatically just before menstruation (in normal and menorrhagic women) and that women with objectively measured MBL of >80 ml per period have significantly higher fibrinolytic activity at the onset of menstruation than those with blood loss of <80ml per period (Rybo 1966). To state that the mode of action of tranexamic acid is unclear is also unfounded. It is well established that tranexamic acid competes for the lysine binding sites of the plasminogen molecule which are essential for it binding to fibrin. This prevents activation of plasminogen by plasminogen activators at the fibrin surface (Thorsen 1975, Hoylaerts et a1 1981). Fibrinolytic activity in menstrual blood is reduced to normal levels in women complaining of menorrhagia treated with tranexamic acid (Bonnar et al. 3983). Finally, about Mr Macdonald’s statement that the long-term use of tranexamic is restricted by the risk of inducing thrombosis, again I can find no evidence to substantiatc this. Indeed a retrospective review of the use of tranexamic acid for menorrhagia over a 19-year period in Sweden showed the calculated incidence of thromboembolic episodes in an estimated 238 000 patientyears of treatment to be no greater than the spontaneous incidence of thrombosis in fertile women (S. Ekman and B Karlmark, Kabi Internal Report 1988). Lars Birgerson Associate Director, Medical Department Richard Bright-Paul Product Manager Pharmaceutical Division KabiVitrum Ltd 3 Dukes Meadow Milbourne Road Bourne End Bucks SL8 5XF
Screening for alcohol misuse in elderly primary care patients: a systematic literature review

ABSTRACT Background: Alcohol problems in the elderly are common and frequently undetected, and therefore a potential target for a screening program. Method: Using Medline, Psychinfo and reference lists from relevant publications, articles were identified testing pen-and-paper screens in the primary care population aged over 60 years. Results: Using standard definitions of alcohol problems, conventional screens adapted for use in the elderly have performances similar to screens in the younger primary care population. However, it can be argued that special screens perform better for the elderly. Conclusions: The Alcohol Use Disorders Identification Test is a useful screen for detecting harmful and hazardous drinking in the elderly while the CAGE is valuable when screening for dependence. In the future, the Alcohol-Related Problems Survey, a computer-based screen, may prove to be superior if practical implementation problems can be overcome.
Women's experiences of nurse case management on a gynaecological oncology unit in a Swiss tertiary hospital. A thematic analysis

RATIONALE Women with gynaecological cancer face various physical, social and emotional challenges concerning their health. Existing research shows that case management can improve patient satisfaction and reduce readmission rates. Although nurse case management was introduced on a gynaecological oncology unit in a Swiss university hospital in 2013, little is known about the experiences of female patients on a unit that uses this model of care. AIMS The aims were to explore women's experiences and to gain deeper understanding about hospital-based nurse case management on a gynaecological oncology unit and to qualitatively evaluate the concept of nurse case management. METHODS Sound research knowledge suggests that experiences are best explored with a qualitative research design. Ten participant interviews were conducted and inductively analysed between September 2014 and May 2015 as described by the thematic analysis method. Ethical approval was obtained, and the women signed a consent form. RESULTS The first theme was named continuous relationship, with the nurse case manager as contact person and trusted partner. Study participants explained that friendliness and being present were essential qualities of nurse case management. Secondly, an essential support for women dealing with the situation of gynaecological cancer was described in the theme sharing information. The organisation of rehabilitation and other services by the nurse case management defined the third theme coordinating care. CONCLUSIONS AND LIMITATIONS Trust was seen as the basis of the continuous relationship, marked by friendliness and presence of the nurse case manager. The helpful approach of persons practicing nurse case management made dealing with the situation of illness easier for women with gynaecological cancer. Coordination of information between the nurse case management and other healthcare services could be improved. Further evaluation is suggested to explore effects of the concept on family members.
Changes in the perception of dementia in Japan

In parallel with the aging of Japanese society, the number of older Japanese with dementia has been steadily increasing. In response to this trend, the Japanese government has established long-term care insurance and an adult guardianship system. At the same time, national and local governments, medical associations, the Alzheimer's Association and pharmaceutical companies have tried to promulgate knowledge regarding dementia. It is therefore important to assess whether these social movements are having an impact on the perception of dementia among the general population in Japan.
Caring behaviours directly and indirectly affect nursing students' critical thinking

OBJECTIVES The purpose of this study was to determine the effect of caring behaviours on critical thinking and to examine whether self-reflection mediates the effect of caring on critical thinking. We also tested whether caring behaviours moderated the relationship between self-reflection and critical thinking. METHODS For this descriptive, correlational, cross-sectional study, we recruited 293 fifth-year nursing students from a junior college in southern Taiwan. Data were collected in 2014 on critical thinking, caring behaviours and self-reflection with insight using the Taiwan Critical Thinking Disposition Inventory, a Chinese version of the Caring Assessment Report Evaluation Q-sort, and a Chinese version of the Self-Reflection and Insight Scale, respectively. Relationships among variables were analysed by structural equation modelling, with the partial least squares method and Sobel test. RESULTS The results showed that caring behaviours significantly positively affected critical thinking (β = 0.56, t = 12.37, p < 0.001) and self-reflection with insight (β = 0.54, t = 11.99, p < 0.001). Self-reflection and insight significantly positively affected critical thinking (β = 0.34, t = 6.48, p < 0.001). Further, self-reflection and insight mediated the relationship between caring behaviours and critical thinking. Caring behaviours did not, however, moderate the relationship between self-reflection (β = 0.001, t = 0.021, p > 0.05) and critical thinking. CONCLUSION Caring behaviours directly affect self-reflection with insight and critical thinking. In addition, caring behaviours also indirectly affect critical thinking through self-reflection and insight.
Premorbid personality traits are associated with post-stroke behavioral and psychological symptoms: a three-month follow-up study in Perth, Western Australia

ABSTRACT Background: Previous research has found an association between post-stroke depressive symptoms and premorbid personality. This study sought to investigate further the relationship between premorbid personality and a number of common post-stroke behavioral and psychological symptoms in a three-month follow-up study. Methods: This prospective study was conducted between May 2003 and January 2005 in a Perth metropolitan teaching hospital. The pre-stroke personality of stroke survivors was assessed by interviewing a close family member (informant) within four weeks of the index stroke using the NEO Personality Inventory-Revised. Three months after the stroke, patients were followed up and assessed with the Cambridge Cognitive examination and Hospital Anxiety and Depression Scale, and their informants completed the Neuropsychiatric Inventory-carer distress version (NPI) and instrumental activities of daily living scale. Results: Depressive symptoms were the most commonly reported post-stroke symptom (45.1%). Spearman's correlations showed that high neuroticism was positively correlated with NPI total scores (ρ = 0.37, p = 0.007), NPI total distress scores (ρ = 0.47, p = 0.001), and specifically with agitation and irritability NPI composite scores. Agreeableness was inversely correlated with agitation (ρ = −0.40, p = 0.004) and irritability (ρ = −0.37, p = 0.007) composite scores. Conclusions: Premorbid personality traits of high neuroticism and low agreeableness are associated with the presence of post-stroke agitation, irritability, and carer distress. This knowledge may contribute to the development of strategies designed to identify patients and families who require more intense supervision and support during post-stroke rehabilitation.
Pathophysiology of acute kidney injury

This series of four articles explores the pathophysiology and treatment of chronic kidney disease (CKD) and acute kidney injury (AKI). We review the causes of CKD and AKI, the treatment options and possible secondary complications. CKD and AKI are both relatively common in general practice, and early identification and appropriate management may improve the outcome of patients with these conditions. This third article focuses on the pathophysiology of AKI.