Miracle-dz/UniFAR-FTUs huggingface dataset:
Folate intake, alcohol consumption, cigarette smoking, and risk of colorectal adenomas.

BACKGROUND Recent evidence suggests that folic acid (and derivatives) could contribute to the protective effect of fruits and vegetables against the risk of large-bowel cancer. Other evidence indicates that alcohol drinking and cigarette smoking may impair the biologic actions of folate. We used data from an adenoma prevention trial to investigate the occurrence of colorectal adenomas (possible precursors of colorectal cancer) in association with folate intake, alcohol consumption, and cigarette smoking. METHODS Patients with at least one recent large-bowel adenoma were followed with colonoscopy 1 year and 4 years after their qualifying colon examinations. Adenomas detected after the year 1 examination were used as end points. A food-frequency questionnaire was administered at study entry and at study completion; nutrient intake at study entry was used in this analysis. All statistical tests were two-sided. RESULTS After adjustment for caloric intake, dietary folate had a significant protective association with the risk of recurrence of large-bowel adenoma (P for trend = .04). However, this inverse association was attenuated by further adjustment for intake of dietary fiber and fat. Use of folate supplements was not associated with a reduction in risk. Alcohol intake (seven or more drinks/week) was associated with increased risk (odds ratio = 2.04; 95% confidence interval = 1.28-3.26). Cigarette smoking, even smoking for long duration, was not related to adenoma recurrence. CONCLUSIONS These data provide only modest support for previous findings suggesting beneficial effects of folate on colorectal adenoma risk. We find no evidence that cigarette smoking increases risk. These findings do suggest a substantial increase in risk with alcohol consumption.
Navigating Multiple Tensions for Engaged Praxis in a Complex Social-Ecological System

Innovative, pragmatic approaches are needed to support sustainable livelihoods and landscape management in complex social-ecological systems (CSES) such as river catchments. In the Tsitsa River Catchment, South Africa, researchers and natural resource managers have come together to apply such innovative approaches. Since CSES are characterised by uncertainty and surprise, understanding and managing them requires a commitment to reflexive praxis and transdisciplinarity. Accordingly, we facilitated a collective reflection and learning process in the project team to deepen our understanding of praxis in CSES. Our findings indicate that CSES thinking created an enabling framing. However, building new linkages among diverse actors to put CSES thinking into practice is challenging, since it requires the development of novel working relationships. Existing institutional structures, power dynamics, and ways of working impose significant constraints. A deeper critical realist analysis of our findings revealed a metaphor which explains why this work is challenging. In this metaphor, the Tsitsa Project team is navigating a bumpy terrain of dialectic tensions. These are tensions for example between natural science and social science, and between science and indigenous knowledge. Based on this metaphor, we suggest an expanding role for scientists and managers, and recommend transformative social learning processes to support teams navigating such bumpy terrains.
Familial Mediterranean Fever in Children Presenting with Attacks of Fever Alone

Objective. Familial Mediterranean fever (FMF) is an inherited disease characterized by attacks of febrile polyserositis. In children, attacks of fever alone, or with headache and malaise, may precede other forms of attacks. Our objective was clinical and genetic characterization of FMF and its development in pediatric patients who first presented with attacks of fever alone. Methods. Clinical characterization and MEFV genotype of all FMF patients < 16 years of age at disease onset and first presenting with attacks of fever alone were analyzed and compared for age, sex, and disease duration with matched FMF patients presenting with serositis at the onset of the disease. Results. There were 814 patients with FMF in our registry. Fifty patients formed the study group and 234 patients the control group. In the study group, the first (febrile) attacks appeared at a younger age than in the control group (1.7 ± 1.6 yrs vs 5.0 ± 4.1 yrs, respectively; p < 0.0001), diagnosis was made earlier (4.2 ± 2.7 yrs vs 6.7 ± 4.1 yrs; p < 0.0001), despite a trend for a longer delay in diagnosis. In the study group, attacks were shorter (1.6 ± 0.8 days vs 2.1 ± 1.0 days; p = 0.023) and homozygosity to the M694V mutation was more prevalent (46% vs 31%; p = 0.03). Attack rate, colchicine dose, and the MEFV mutation carrier rates were comparable between the groups. In 40/50 (80%) of the patients with fever alone, serositis had developed over a course of 2.9 ± 2.2 years after disease onset. Conclusion. FMF in young children may begin with attacks of fever alone, but it progresses to typical FMF disease over the next 2.9 ± 2.2 years. Our study demonstrates that clinical heterogeneity at presentation is more likely to indicate a feature of a disease in development, rather than to mark distinct phenotypes of FMF.
Resources–tasks imbalance: Experiences of nurses from factors influencing workload to increase

Background: While nursing workload is a worldwide challenge, less attention has been given to the determining factors. Understanding these factors is important and could help nursing managers to provide suitable working environment and to manage the adverse outcomes of nursing workload. The aim of this study was to discover nurses’ experiences of determinant factors of their workload. Materials and Methods: In this qualitative study, the participants included 15 nurses working in two hospitals in Tehran, Iran. The data were collected through 26 unstructured interviews and were analyzed using conventional content analysis. The rigor has been guaranteed with prolonged engagement, maximum variance sampling, member check, and audit trail. Results: Resource–task imbalance was the main theme of nurses’ experiences. It means that there was an imbalance between necessary elements to meet patients’ needs in comparison with expectation and responsibility. Resource–task imbalance included lack of resource, assignment without preparation, assigning non-care tasks, and patients’ and families’ needs/expectations. Conclusions: A deep and comprehensive imbalance between recourses and tasks and expectations has been perceived by the participants to be the main source of work overload. Paying more attention to resource allocation, education of quality workforce, and job description by managers is necessary.
Comparing profit shares in value-added in four OECD countries: Towards more harmonised national accounts

This article gives methodological guidance on how best to compare the share of profits in value-added across countries using national accounts. Such comparisons are often based on accounts for institutional sectors such as non-financial corporations. It turns out that these are less internationally comparable than is usually assumed. The main issue is the allocation of certain types of self-employed workers to the corporations’ sector of some countries, most notably Germany and Italy. The consequence is that the measured gross operating surplus of corporations is overstated and has to be adjusted for international comparisons. If this is not feasible, it is preferable to rely on industry accounts, focus on a subset of industries and impute a labour compensation to self-employed workers for international comparisons. Profit shares in France, Germany, Italy and the United States are then much more similar than what the accounts for non-financial corporations suggest. The claim of a global increase in the profit share in the last decades is at best debatable for Germany and not backed with the evidence presented in this paper for France and Italy. It is only for the United States that we can confirm such an increase. Cet article decrit d’un point du vue methodologique comment effectuer des comparaisons internationales du partage de la valeur ajoutee en utilisant au mieux les donnees de comptabilite nationale. Ces comparaisons reposent souvent sur les comptes de secteurs institutionnels, en particulier les comptes des societes non-financieres. Or, ceux-ci sont moins comparables d’un pays a l’autre que ce que l’on pense habituellement. Le probleme principal est lie a la presence de travailleurs non-salaries dans les comptes des societes de certains pays, notamment l’Allemagne et l’Italie. Cela conduit dans ce cas a une surestimation de l’excedent brut d’exploitation et rend necessaire un ajustement du compte des societes pour les comparaisons internationales. Lorsque cet ajustement s’avere impossible a realiser, nous recommandons d’utiliser les comptes de branches, de restreindre l’analyse a certaines branches et d’imputer une remuneration du travail aux non-salaries pour les comparaisons internationales. Les taux de marge en France, en Allemagne, en Italie et aux Etats-Unis sont alors plus proches que ce que suggerent les comptes des societes non-financieres. L’hypothese d’une hausse tendancielle du taux de profit sur les dernieres decennies est au mieux contestable pour l’Allemagne et invalidee par les donnees pour la France et l’Italie. C’est uniquement pour les Etats-Unis que nous sommes en mesure de la confirmer.
Testing efficient market hypothesis in developing Eastern European countries

This paper analyzes financial markets in four developing countries (Croatia, Serbia, Slovenia, Slovakia) using daily returns of their respective stock market indices from January 1, 2006 till December 31, 2016, timeframe which was rarely analyzed. Analysis was conducted by various statistical tests, more precisely serial correlation test, runs test, Augmented Dickey-Fuller test, unit root test, variance ratio test and test of January effect. Results suggest that all analyzed indices, except BelexLine (Serbia), confirm weak form of efficient market hypothesis, while the results on the index BelexLine are mixed and it can be concluded that it does not follow weak form of efficient market hypothesis. Given these results, it can be said that not only passive approach to portfolio management is more appropriate on all indices, except BelexLine, but also additional test and more complex models are necessary in order to confirm this conclusion.
Contribution of cortisol to glucose counterregulation in humans.

To test the hypothesis that cortisol secretion plays a counterregulatory role in hypoglycemia in humans, four studies were performed in eight normal subjects. In all studies, insulin (15 mU.m-2.min-1) was infused subcutaneously (plasma insulin 27 +/- 1 microU/ml). In study 1, plasma glucose concentration and glucose fluxes [( 3-3H]glucose), substrate, and counterregulatory hormone concentrations were simply monitored, and plasma glucose decreased from 89 +/- 2 to 52 +/- 2 mg/dl for 12 h. In study 2, (pituitary-adrenal-pancreatic clamp), insulin and counterregulatory hormone secretion (except for catecholamines) was prevented by somatostatin (0.5 mg/h, iv) and metyrapone (0.5 g/4 h, per os), and glucagon, cortisol, and growth hormone were infused to reproduce the concentrations of study 1. In study 3 (lack of cortisol increase), the pituitary-adrenal-pancreatic clamp was performed with maintenance of plasma cortisol at basal levels, and glucose was infused, whenever needed, to reproduce plasma glucose concentration of study 2. Study 4 was identical to study 3, but exogenous glucose was not infused. Isolated lack of cortisol increase caused a approximately 22% decrease in hepatic glucose production (P less than 0.01) and a approximately 15% increase in peripheral glucose utilization (P less than 0.01), which resulted in greater hypoglycemia (37 +/- 2 vs. 52 +/- 2 mg/dl, P less than 0.01) despite compensatory increases in plasma epinephrine. Lack of cortisol response also reduced plasma free fatty acid, beta-hydroxybutyrate, and glycerol concentrations approximately 50%. We conclude that cortisol normally plays an important counterregulatory role during hypoglycemia by augmenting glucose production, decreasing glucose utilization, and accelerating lipolysis.
EXPOSURE TO TRAUMA: THE LONG-TERM EFFECTS OF SUPPRESSING EMOTIONAL REACTIONS

A cross-sectional study of 437 ambulance officers in a large state of Australia examined the long-term effects of suppressing emotion reactions to exposure to trauma. Results indicate that the use of emotion-suppressing defenses (e.g., withdrawal or acting out) have a highly significant positive relationship with physical and psychological stress symptoms. Alexithymia scores were also positively associated with stress symptoms. In addition, there was a positive association between years of ambulance service and stress symptoms. Implications of the findings are discussed for recovery from exposure to trauma of emergency services personnel and more generally to the experience of survivors of trauma.
Epidemiology of Hodgkin's disease in the young

Many features of Hodgkin's disease (HD) among adolescents and young adults suggest that it has an infectious etiology. However, the proposal that HD is a contagious disease which can be transmitted by patients or their close contacts has not been substantiated. An alternative infectious disease model is suggested by analogy with paralytic poliomyelitis (PP). For both diseases, the peak age of incidence is delayed as living conditions improve. For both, increased risk is associated with higher social class and small family size. Like PP, HD may be a rare manifestation of a common infection with the probability of disease development increasing as age at infection is delayed. This analogy is supported by the report that the risk of HD is higher for persons who had a low frequency of childhood infectious diseases. If this model is valid, HD patients represent no hazard to their contacts. However, the incidence of HD among young adults may increase in the coming decade because of the current high standard of living and small family size.
The Art and Science of Immunosuppression: The Fifth Annual American Society of Transplant Surgeon's State‐of‐the‐Art Winter Symposium

The 2005 American Society of Transplant Surgeons (ASTS) Winter Symposium entitled ‘The Art and Science of Immunosuppression’ explored ways to maximize existing immunosuppressive protocols and to develop new strategies incorporating novel agents and emerging diagnostic technologies to customize immunosuppression and reduce side effects. Several presentations evaluated steroid withdrawal or avoidance protocols reflecting the significant difficulties of bone loss, glucose control and growth retardation in children associated with long‐term steroid use. Calcineurin‐inhibitor related renal dysfunction of both native and transplanted kidneys was identified as significant, but no consensus was reached concerning effective prevention. Similarly, recurrence of Hepatitis C following liver transplantation was identified as problematic without identifying a preferred immunosuppressive regimen in this setting. Control of T‐cell mediated rejection was found to be excellent, but recognition and treatment of non‐T cell causes of allograft damage (i.e. B‐ or NK‐cell mediated) was identified as an area of current interest. Immunosuppressive agents under development, such as those blocking co‐stimulation or cytokine signals, and JAK‐3 inhibitors were discussed. Finally, the available technologies for molecular and genetic diagnostics and the clinical correlation in the post‐transplant setting were discussed.
[Digital morphometric and stereologic analysis of small intestinal mucosa in well-nourished and malnourished children with persistent diarrhea].

OBJECTIVE To test the hypothesis that the proximal small intestines of children with persistent diarrhea present morphometric and stereologic changes proportional to their nutritional status, using microscope images stored in a computer. METHODS Cross-sectional study with 65 pediatric patients, whose ages ranged from 4 months to 5 years, with persistent diarrhea for over 14 days. The nutritional assessment was performed according to the z-scores for weight/age (W/A), weight/height (W/H) and height/age (H/A) ratios, divided into: well-nourished = z > or =2SD and malnourished = z<2SD; well-nourished = z > or =2SD, nutritional risk = z<1SD and malnourished = z<-2SD; and continuously, in descending order, using the NCHS charts. After obtaining the computer images using the software Scion Image, villous height, crypt depth, mucosal thickness, total mucosal thickness, and villous/crypt ratio were measured in the fragments of the small intestinal mucosa, enlarged 100 times. When images were enlarged 500 times, enterocyte height, nuclear height and brush-border height were measured. Stereologic analysis was performed using cycloid arcs. RESULTS For W/A, W/H and H/A z-scores, divided into two nutritional status categories, no statistically significant difference was observed in regard to villous height, crypt depth, mucosal thickness, total mucosal thickness and villous/crypt ratio. Enterocyte height presented the most significant difference between well-nourished and malnourished groups, for W/A and W/H ratios, with a 500x enlargement, although this difference was not statistically significant. When z-scores were subdivided into three nutritional status categories, a digital morphometric analysis showed a statistically significant difference for villous/crypt ratio between the well-nourished and slightly malnourished group and the well-nourished and mild to severe malnourished group (p=0.048). The villous/crypt ratio was higher among well-nourished children. Using the Spearman coefficient, the variables enterocyte height, height of enterocyte nucleus and brush-border height presented a clear association with the W/A ratio (r=0.25; p=0.038), W/H ratio (r=0.029; p=0.019). The height of the enterocyte and the brush-border height were associated with W/H ratio. CONCLUSION The observed associations between nutritional status and the analyzed small intestinal mucosa variables showed a positive correlation with patients' weight. Although these associations were of a slight to moderate magnitude, we observed a tendency of enterocyte size reduction, as well as a reduction in the size of its nucleus and brush-border, as the level of malnutrition increases.
Review article: gastrointestinal sensory and motor disturbances in inflammatory bowel disease – clinical relevance and pathophysiological mechanisms

Background It is well known that inflammation has a profound impact on the neuromuscular apparatus of the gastrointestinal tract during the inflammatory insult and in periods of remission, at the site of inflammation and at distance from this site. The importance of this interaction is illustrated by the higher prevalence of functional gut disorders in patients with inflammatory bowel disease.
Increased levels of the pro-inflammatory prostaglandin PGE2 in CSF from ALS patients

Abstract—Levels of the potent pro-inflammatory prostaglandin E2 (PGE2) are elevated in postmortem spinal cords from patients with ALS, and inhibition of a key PGE2-synthesizing enzyme, cylcooxygenase-2, is neuroprotective in an in vitro model of ALS. The authors report that 82% of the patients with ALS studied had 2 to 10 times higher PGE2 levels in CSF compared with normal control subjects. That affected areas of the CNS are inflamed in ALS supports this. CSF PGE2 measurement may be useful in monitoring treatment for ALS.
Human Capital and Macro-Economic Development: A Review of the Evidence

The role of human capital in facilitating macroeconomic development is at the center of both academic and policy debates. Through the lens of a simple aggregate production function, human capital might increase output per capita by directly entering in the production process, incentivizing the accumulation of complementary inputs, and facilitating the adoption of new technologies. This paper discusses the advantages and limitations of three approaches that have been used to evaluate the empirical importance of these channels: cross-country regressions, development accounting, and quantitative models. The key findings in the literature are reviewed and some of them are replicated using updated data. The bulk of the evidence suggests that human capital is an important determinant of cross-country income gaps, especially when its measurement is broadened to go beyond simple proxies of educational attainment. The paper concludes by highlighting policy implications and promising avenues for future work.
Evaluation and outcomes of women with a breast lump and a normal mammogram result

AbstractBACKGROUND: Many women experience a breast lump. Clinical guidelines suggest that a normal mammogram result alone is not adequate to exclude a diagnosis of cancer. OBJECTIVE: To examine the characteristics of women with a breast lump and a normal mammogram that were associated with receiving further evaluation, and to examine cancer outcomes. DESIGN: Observational cohort. PARTICIPANTS: Women aged 35 to 70 years who participated in a population-based mammography registry and who did not have a history of breast cancer noted at the time of their mammogram that they had a breast lump, and had a “normal” (Breast Imaging Reporting and Data System 1 or 2) mammogram result (n=771). MEASUREMENTS: Telephone survey performed 6 months after the mammogram to ascertain information about evaluation. Cancer outcomes within 12 months of the index mammogram were confirmed through linkage with a cancer registry. RESULTS: Only 56.9% of women reported receiving an adequate evaluation for their breast lump, including a subsequent clinical breast exam, a visit to a breast specialist, an ultrasound, a biopsy, or aspiration. Latinas were less likely than white women to have received adequate evaluation, as were obese women compared with normal-weight women, and uninsured women compared with women with insurance. Among women with at least 12 months of follow-up, 1.4% were diagnosed with cancer. CONCLUSIONS: Many women do not receive adequate evaluation for a recent breast lump. Interventions should be designed to improve the follow-up of women with this common clinical problem.
Primary care provider concerns about management of chronic pain in community clinic populations

BACKGROUND: Chronic pain is a common patient complaint in primary care, yet providers and patients are often dissatisfied with treatment processes and outcomes. OBJECTIVE: To assess provider satisfaction with their training for and current management of chronic pain in community clinic settings. To identify perceived problems with delivering chronic pain treatment and issues with opioid prescribing for chronic pain. DESIGN: Mailed survey to primary care providers (PCPs) at 8 community clinics. RESULTS: Respondents (N=111) included attendings, residents, and nurse practioners (NPs)/physician assistants (PAs). They reported 37.5% of adult appointments in a typical week involved patients with chronic pain complaints. They attributed problems with pain care and opioid prescribing more often to patient-related factors such as lack of self-management, and potential for abuse of medication than to provider or practice system factors. Nevertheless, respondents reported inadequate training for, and low satisfaction with, delivering chronic pain treatment. CONCLUSIONS: A substantial proportion of adult primary care appointments involve patients with chronic pain complains. Dissatisfaction with training and substantial concerns about patient self-management and about opioid prescribing suggest areas for improving medical education and postgraduate training. Emphasis on patient-centered approaches to chronic pain management, including skills for assessing risk of opioid abuse and addiction, is required.