Miracle-dz/UniFAR-FTUs huggingface dataset:
Medical care in long-term survivors of childhood cancer: a report from the childhood cancer survivor study.

PURPOSE To evaluate whether childhood cancer survivors receive regular medical care focused on the specific morbidities that can arise from their therapy. PATIENTS AND METHODS We conducted a cross-sectional survey of health care use in 8,522 participants in the Childhood Cancer Survivor Study, a multi-institutional cohort of childhood cancer survivors. We assessed medical visits in the preceding 2 years, whether these visits were related to the prior cancer, whether survivors received advice about how to reduce their long-term risks, and whether screening tests were discussed or ordered. Completion of echocardiograms and mammograms were assessed in patients at high risk for cardiomyopathy or breast cancer. We examined the relationship between demographics, treatment, health status, chronic medical conditions, and health care use. RESULTS Median age at cancer diagnosis was 6.8 years (range, 0 to 20.9 years) and at interview was 31.4 years (range, 17.5 to 54.1 years). Although 88.8% of survivors reported receiving some form of medical care, only 31.5% reported care that focused on their prior cancer (survivor-focused care), and 17.8% reported survivor-focused care that included advice about risk reduction or discussion or ordering of screening tests. Among survivors who received medical care, those who were black, older at interview, or uninsured were less likely to have received risk-based, survivor-focused care. Among patients at increased risk for cardiomyopathy or breast cancer, 511 (28.2%) of 1,810 and 169 (40.8%) of 414 had undergone a recommended echocardiogram or mammogram, respectively. CONCLUSION Despite a significant risk of late effects after cancer therapy, the majority of childhood cancer survivors do not receive recommended risk-based care.
Maintenance rituximab after cyclophosphamide, vincristine, and prednisone prolongs progression-free survival in advanced indolent lymphoma: results of the randomized phase III ECOG1496 Study.

PURPOSE To determine if maintenance rituximab (MR) after standard chemotherapy improves progression-free survival (PFS) in advanced-stage indolent lymphoma. PATIENTS AND METHODS Patients with stage III-IV indolent lymphoma with responding or stable disease after cyclophosphamide, vincristine, and prednisone (CVP) chemotherapy were stratified by initial tumor burden, residual disease after CVP (minimal or gross), and histology, and randomly assigned to observation (OBS) or MR 375 mg/m(2) once per week for 4 weeks every 6 months for 2 years. PFS was the primary end point. RESULTS Three hundred eleven (282 with follicular lymphoma) evaluable patients who received CVP were randomly assigned to OBS (n = 158) or MR (n = 153). Best response improved in 22% MR versus 7% OBS patients (P = .00006). Toxicity was minimal in both study arms. Three-year PFS after random assignment was 68% MR versus 33% OBS (hazard ratio [HR] = 0.4; P = 4.4 x 10(-10) [all patients]) and 64% MR v 33% OBS (HR = 0.4; P = 9.2 x 10(-8) [patients with follicular lymphoma]). There was an advantage for MR regardless of Follicular Lymphoma International Prognostic Index score, tumor burden, residual disease, or histology. In multivariate analysis of MR patients, minimal disease after CVP was a favorable prognostic factor. OS at 3 years was 92% MR versus 86% OBS (HR = 0.6; log-rank one-sided P = .05) and, among patients with follicular lymphoma, OS was 91% MR versus 86% (HR = 0.6; log-rank one-sided P = .08). A trend favoring MR was observed among patients with high tumor burden (log-rank one-sided P = .03). CONCLUSION The E1496 study provides the first phase III data in untreated indolent lymphoma that MR after chemotherapy significantly prolongs PFS.
Phase III trial comparing concurrent biochemotherapy with cisplatin, vinblastine, dacarbazine, interleukin-2, and interferon alfa-2b with cisplatin, vinblastine, and dacarbazine alone in patients with metastatic malignant melanoma (E3695): a trial coordinated by the Eastern Cooperative Oncology Grou

PURPOSE Phase II trials with biochemotherapy (BCT) have shown encouraging response rates in metastatic melanoma, and meta-analyses and one phase III trial have suggested a survival benefit. In an effort to determine the relative efficacy of BCT compared with chemotherapy alone, a phase III trial was performed within the United States Intergroup. PATIENTS AND METHODS Patients were randomly assigned to receive cisplatin, vinblastine, and dacarbazine (CVD) either alone or concurrent with interleukin-2 and interferon alfa-2b (BCT). Treatment cycles were repeated at 21-day intervals for a maximum of four cycles. Tumor response was assessed after cycles 2 and 4, then every 3 months. RESULTS Four hundred fifteen patients were enrolled, and 395 patients (CVD, n = 195; BCT, n = 200) were deemed eligible and assessable. The two study arms were well balanced for stratification factors and other prognostic factors. Response rate was 19.5% for BCT and 13.8% for CVD (P = .140). Median progression-free survival was significantly longer for BCT than for CVD (4.8 v 2.9 months; P = .015), although this did not translate into an advantage in either median overall survival (9.0 v 8.7 months) or the percentage of patients alive at 1 year (41% v 36.9%). More patients experienced grade 3 or worse toxic events with BCT than CVD (95% v 73%; P = .001). CONCLUSION Although BCT produced slightly higher response rates and longer median progression-free survival than CVD alone, this was not associated with either improved overall survival or durable responses. Considering the extra toxicity and complexity, this concurrent BCT regimen cannot be recommended for patients with metastatic melanoma.
The ICESat-2 Laser Altimetry Mission

Satellite and aircraft observations have revealed that remarkable changes in the Earth's polar ice cover have occurred in the last decade. The impacts of these changes, which include dramatic ice loss from ice sheets and rapid declines in Arctic sea ice, could be quite large in terms of sea level rise and global climate. NASA's Ice, Cloud and Land Elevation Satellite-2 (ICESat-2), currently planned for launch in 2015, is specifically intended to quantify the amount of change in ice sheets and sea ice and provide key insights into their behavior. It will achieve these objectives through the use of precise laser measurements of surface elevation, building on the groundbreaking capabilities of its predecessor, the Ice Cloud and Land Elevation Satellite (ICESat). In particular, ICESat-2 will measure the temporal and spatial character of ice sheet elevation change to enable assessment of ice sheet mass balance and examination of the underlying mechanisms that control it. The precision of ICESat-2's elevation measurement will also allow for accurate measurements of sea ice freeboard height, from which sea ice thickness and its temporal changes can be estimated. ICESat-2 will provide important information on other components of the Earth System as well, most notably large-scale vegetation biomass estimates through the measurement of vegetation canopy height. When combined with the original ICESat observations, ICESat-2 will provide ice change measurements across more than a 15-year time span. Its significantly improved laser system will also provide observations with much greater spatial resolution, temporal resolution, and accuracy than has ever been possible before.
Global Change Observation Mission (GCOM) for Monitoring Carbon, Water Cycles, and Climate Change

The Japan Aerospace Exploration Agency (JAXA) is pursuing the Global Change Observation Mission (GCOM) that will inherit the Advanced Earth Observing Satellite-II (ADEOS-II) mission and develop into long-term monitoring. GCOM is not the name of a single satellite, but of a mission that consists of two series of medium-size satellites, GCOM-W (Water) and GCOM-C (Climate), and three generations of each satellite series to continue the observations for 10 to 15 years. The Advanced Microwave Scanning Radiometer-2 (AMSR2) will be the single instrument on the GCOM-W1 satellite, which is the first satellite of the GCOM series. The second satellite will be GCOM-C1, which will carry the Second-generation Global Imager (SGLI). GCOM-W will mainly contribute to the observations related to global water and energy circulation, while GCOM-C will contribute to the measurements related to the carbon cycle and radiation budget. Current target launch years are calendar year 2011 for GCOM-W1 and 2014 for C1.
Prevalence of gastrointestinal zoonotic helminths in dogs of Kathmandu, Nepal

INTRODUCTION: Considering the close association of dog and human beings and increasing trend of pet rearing, it is important to know the status of zoonotic helminths of pet and stray dogs and awareness of owners about this in Kathmandu, Nepal. This study was carried out to determine the prevalence of gastrointestinal zoonotic helminth parasites in dogs and to assess the awareness about canine helminth zoonoses in pet owners. MATERIALS AND METHODS: This cross-sectional study was conducted from September- 2012 to December- 2013. A total of 210 fecal samples (105 each from pet and stray dogs) were collected perrectally and examined by using Formalin-Ether Concentration method. Questionnaire survey was carried out among dog owners. RESULTS: The prevalence of gastrointestinal helminths was 46.7% (98/210). Out of 98 positive samples five different parasite species observed were Ancylostoma spp. 52.0% (51/98), Toxocara canis 41.8% (41/98), Taenia/Echinococcus spp. 15/98 (15.3%), Dipylidium caninum, 9.2% (9/98), and Trichuris vulpis, 5.1% (5/98). Prevalence was higher in stray dogs (56.2% vs. 37.1%) (p 0.05); in younger dogs up to 2 years of age (56.3% vs. 35.7%) (p<0.05); in non-dewormed dogs (72.7% vs. 33.0%) (p<0.05) and in dogs sharing rooms with owner (46.1% vs. 13.8%) (p<0.05). Only 11.4% of the owners surveyed were aware about canine helminth zoonoses. CONCLUSIONS: Due to potential risk of zoonotic helminths to human beings and low level of zoonoses awareness in pet owners, there is need of generating awareness to pet owners regarding periodic anthelminthic treatment of pet dogs and other prevention and control measures. DOI: http://dx.doi. org/10.3126/ijim.v2i3. 8211 Int J Infect Microbiol 2013;2(3):91-94
Evidence based practice: the practicalities of keeping abreast of clinical evidence while in training

This paper gives a practical account of why and how to learn to practise evidence based medicine while still in clinical training. It highlights practical benefits to learning the skills (such as passing exams, coping with information overload and helping patients), and explains how to manage each of the four essential steps (asking questions, acquiring information, appraising evidence, and applying the results). Key resources to give the trainee rapid access to evidence based answers are highlighted, as are efficient ways of keeping up to date with the emerging literature.
Follicular lymphoma in the United States: first report of the national LymphoCare study.

PURPOSE Optimal therapy of follicular lymphoma (FL) is not defined. We analyzed a large prospective cohort study to identify current demographics and patterns of care of FL in the United States. PATIENTS AND METHODS The National LymphoCare Study is a multicenter, longitudinal, observational study designed to collect information on treatment regimens and outcomes for patients with newly diagnosed FL in the United States. Patients were enrolled between 2004 and 2007. There is no study-specific prescribed treatment regimen or intervention. RESULTS Two thousand seven hundred twenty-eight subjects were enrolled at 265 sites, including the 80% of patients enrolled from nonacademic sites. Using the Follicular Lymphoma International Prognostic Index (FLIPI), three distinct groups independent of histologic grade could be defined. Initial therapeutic strategy was: observation, 17.7%; rituximab monotherapy, 13.9%; clinical trial 6.1%; radiation therapy, 5.6%; chemotherapy only, 3.2%; chemotherapy plus rituximab, 51.9%. Chemotherapy plus rituximab regimens were: rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone, 55.0%; rituximab plus cyclophosphamide, vincristine, and prednisone, 23.1%; rituximab plus fludarabine based, 15.5%; other, 6.4%. The choice to initiate therapy rather than observe was associated with age, FLIPI, stage, and grade (P < .01). Significant differences in treatment (P < .01) across regions of the United States were noted. Contrary to practice guidelines, treatment of stage I FL frequently omits radiation therapy. CONCLUSION Widely disparate therapeutic approaches are utilized for FL. Initial therapy is deferred in a small subset of patients. There is no single standard of care for the treatment of de novo FL, although antibody use is ubiquitous when therapy is initiated. These disparate approaches to the initial care of patients with FL render a heterogeneous group of patients at relapse.
Care pathways to in‐patient alcohol detoxification and their effects on predictors of treatment completion

Aims: This study aimed to (i) test the hypothesis that stable housing, older age, gate‐kept admission route and female gender are predictive of completion of in‐patient detoxification treatment, and (ii) compare two care pathways into treatment. Methods: Multiple logistic regression of 6,745 cases of admission to an independent sector in‐patient detoxification service between January 1995 and March 2003. Findings: Factors predictive of treatment completion were found to be older age, female gender, employment and undergoing a process of gate‐keeping for admission. A comparison of treatment completers between gate‐kept and non‐gate‐kept admissions indicated that while gate‐keeping is sensitive to potential completers by favouring people with stable housing it may also be excluding a proportion of clients among younger males with unstable housing who would otherwise benefit from admission. Conclusions: In developing care pathways that ensure effective and appropriate use of services careful consideration must be given to the impacts upon some client groups who may be disadvantaged by the process.
Multigate Communication Network for Smart Grid

It is envisioned that one of the most important issues in smart grid will be to design a network architecture that is capable of providing secure and reliable two-way communication from meters to other Smart Grid domains. While networking technologies and systems have been greatly enhanced, in wireless communication environments the smart grid faces new challenges in terms of reliability and efficiency. In this paper we present a multigate mesh network architecture to handle real-time traffic for the last mile communication. The paper consists of three parts; multigate routing, real-time traffic scheduling, and multichannel (MC) aided wireless mesh routing. The multigate routing is based on a flexible mesh network architecture that expands on the hybrid tree routing of the IEEE 802.11s. The network is specifically designed to operate in a multi gateway structure in order to meet the smart grid requirements in terms of reliability, self-healing, and throughput performance. This includes developing a timer-based multiple-path diversity scheme that takes advantage of the multi gateway network structure. With respect to packet scheduling, we introduce a novel and efficient scheme that is capable of balancing the traffic load among multiple gateways. The proposed scheme, which is based on the backpressure concept due to its simplicity, is suitable for practical implementation. We also present an MC aided wireless mesh routing protocol which is specifically designed for multigate smart grid networks. The results indicate that a combination of multipath routing and the backpressure-based packet-scheduling scheme can show a significant improvement in the network reliability, latency, and throughput performance. We also show an improvement in the order of magnitude can be achieved via the proposed multichannel aided routing protocol.
Carcinoma of the lower uterine segment: a newly described association with Lynch syndrome.

PURPOSE Endometrial carcinoma in the lower uterine segment (LUS) is a poorly described cancer that can be clinically confused with endocervical carcinoma. We performed a case-comparison study to document the clinicopathologic characteristics of LUS tumors and their association with risk factors for endometrial cancer. PATIENTS AND METHODS The clinical records and pathology reports from women who underwent hysterectomy at our institution for endometrial or endocervical adenocarcinoma over an 11-year interval were reviewed. The LUS group consisted of women with endometrial tumors that clearly originated between the lower uterine corpus and the upper endocervix. Immunohistochemistry and microsatellite instability and MLH1 methylation assays were performed. RESULTS Thirty-five (3.5%) of 1,009 women had endometrial carcinoma of the LUS. Compared with patients with corpus tumors, LUS patients were younger, had higher stage tumors, and had more invasive tumors. Preoperative diagnosis of the LUS tumors more frequently included the possibility of endocervical adenocarcinoma. Seventy-three percent of the LUS tumors had an immunohistochemical expression pattern typical of conventional endometrioid adenocarcinoma. Ten (29%) of 35 women with LUS tumors were confirmed to have Lynch syndrome or were strongly suspected to have Lynch syndrome on the basis of tissue-based molecular assays. CONCLUSION The prevalence of Lynch syndrome in patients with LUS endometrial carcinoma (29%) is much greater than that of the general endometrial cancer patient population (1.8%) or in endometrial cancer patients younger than age 50 years (8% to 9%). On the basis of our results, the possibility of Lynch syndrome should be considered in women with LUS tumors.
Risk-stratified therapy and the intensive use of cytarabine improves the outcome in childhood acute myeloid leukemia: the AML99 trial from the Japanese Childhood AML Cooperative Study Group.

PURPOSE To improve the prognosis in children with newly diagnosed acute myeloid leukemia (AML) by introducing a dose-dense intensive chemotherapy regimen and an appropriate risk stratification system. PATIENTS AND METHODS Two hundred forty children with de novo AML were treated with continuous cytarabine-based induction therapy and stratified to three risk groups based on the initial treatment response, age, and WBC at diagnosis and cytogenetics. All of the patients were treated with intensive consolidation chemotherapy including three or four courses of high-dose cytarabine. Allogeneic hematopoietic stem-cell transplantation (HSCT) was indicated for only the intermediate-risk patients with matched related donors and for all the high-risk subsets. RESULTS Two hundred twenty-seven children (94.6%) achieved a complete remission (CR). Four children demonstrated induction death. The median follow-up of the live patients was 55 months (range, 37 to 73 months). The 5-year overall survival of all 240 children was 75.6% (95% CI, 70.3% to 81.4%) and event-free survival was 61.6% (95% CI, 55.8% to 68.1%). The 5-year disease-free survival in each risk group were 71.3% (95% CI, 63.4% to 80.2%) in the low-risk group (n = 112), 59.8% (95% CI, 50.6% to 70.7%) in the intermediate-risk group (n = 92), and 56.5% (95% CI, 39.5% to 80.9%) in the high-risk group (n = 23). Eight children died during the first CR, including four after HSCT. CONCLUSION A high survival rate, 75.6% at 5 years, was achieved for childhood with de novo AML in the AML99 trial. The treatment strategy was well tolerated with only 1.7% induction death rate and 3.5% remission death rate. Low-risk children were successfully treated with chemotherapy alone.
A practical guide to the differential diagnosis of tremor

Tremor is, by definition, a rhythmic oscillation of a body part. It is the most prevalent movement disorder in clinical medicine, so doctors working in many specialities and in general practice can expect to encounter it. Most tremors can be classified on the basis of four observable clinical characteristics: anatomical pattern; the relative prominence of the tremor at rest, on maintaining a posture, and with action; tremor frequency; and tremor amplitude. A resting tremor suggests Parkinson's disease, and the diagnosis then depends on a judgement about whether the patient has other signs of parkinsonism. The most common causes of postural tremor are physiological tremor, essential tremor and drug-induced tremor. The differential diagnosis may also include dystonic tremor and psychogenic tremor, while metabolic tremor caused by thyrotoxicosis should be considered in any recent-onset postural tremor. Wilson's disease and fragile X-associated tremor/ataxia syndrome are rarer conditions that may present with tremor and are very important to identify. There is a small but genuine diagnostic grey zone between Parkinson's disease and more benign tremor disorders such as essential tremor and dystonic tremor, in which resting and postural tremor coexist with mild or equivocal non-tremor parkinsonian signs. The authors review clinical features and investigational techniques that may help to discriminate this group of hard-to-classify tremors.
Pharmacogenetic analyses of a phase III trial in metastatic gastroesophageal adenocarcinoma with fluorouracil and leucovorin plus either oxaliplatin or cisplatin: a study of the arbeitsgemeinschaft internistische onkologie.

PURPOSE To evaluate the association of germ-line polymorphisms of genes that may impact treatment outcome of platinum and fluorouracil combination chemotherapy in advanced gastric cancer (AGC). PATIENTS AND METHODS Blood samples of 156 patients enrolled onto a phase III study comparing fluorouracil, leucovorin, and oxaliplatin with fluorouracil, leucovorin, and cisplatin were collected. Polymorphisms within genes of TS, MTHFR, MTR, OPRT, XPD, ERCC1, XRCC1, XPA, GSTP1, GSTT1, and GSTM1 were genotyped using polymerase chain reaction-based techniques. RESULTS Median overall survival (OS) was 11.8 months (95% CI, 9.75 to 13.79 months) and median progression-free survival (PFS) was 5.8 months (95% CI, 4.99 to 6.61 months). The TS-3R/+6 haplotype (P = .004), the GSTT1 deletion polymorphism (P = .015), and genotypes of OPRT-Gly213Ala (P = .003) and XRCC1-Arg399Gln (P = .023) could be identified as independent predictors of OS. For PFS analyses, the TS-3R/+6 haplotye (P = .003) and MTR-A2756G (P = .01) were identified as independent positive predictors. The association between the GSTT1 deletion polymorphism and PFS showed only borderline significance (P = .053). Treatment related hematotoxicity in terms of grade 3/4 leukopenia was lowest among TS-3R/+6 haplotype carriers (P = .037). Grade 3/4 neutropenia was directly associated with the MTR-2756G/G genotype (P = .011), GSTP1-105Ile/Ile genotype (P = .02), and with the ERCC1-118T/8092C-haplotype (P = .042). In addition, significant associations between GSTP1-105Ile/Ile genotype and neurotoxicity and between the XPD-Asn312/751Gln haplotype and nephrotoxicity could be identified (P = .028 and P = .005, respectively). CONCLUSION These findings underline the hypothesis that germ-line polymorphisms may play an important role in individualizing chemotherapy in AGC and deserve further prospective evaluation in AGC patients.