Miracle-dz/UniFAR-FTUs huggingface dataset:
Milk, chocolate and Nobel prizes

In a recent paper Dr Messerli1 reported a strong correlation between a nation's chocolate consumption with the country's prowess in winning Nobel prizes per capita (see Carphology, in this issue). Messerli speculated that flavonoids within chocolate may contribute to this link by improving cognitive function—while recognising a correlation does not establish causation. However, chocolate is not usually consumed on its own, often being combined …
Treatment of favorable, limited-stage Hodgkin's lymphoma with chemotherapy without consolidation by radiation therapy.

PURPOSE Limited-stage Hodgkin's lymphoma (HL) has been treated with radiation alone or radiation combined with chemotherapy. Although results in progression-free survival and overall survival have been excellent, the long-term, radiation-induced, toxic cardiac and secondary oncologic complications occurring in succeeding decades have compromised survival of young patients. This study examines the impact of chemotherapy alone in treatment of limited-stage, nonbulky HL, radiation therapy eliminated from primary treatment. PATIENTS AND METHODS From 1992 to May 2008, 71 patients with a median age of 29 years (range, 17-44 years) with stages I and II HL without bulky nodes were treated with six cycles of classic combination doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Two patients received six cycles of ABVD-like modification. Two patients received four cycles of ABVD. The ABVD regimen was known to be curative in more advanced disease without radiation therapy. RESULTS All patients achieved a clinical complete response (CR) or CR unconfirmed. After a median follow-up of at least 60 months (range, at least 12 to at least 204 months), six patients experienced relapse at 6, 10, 11, 16, 20, and 58 months. All relapses occurred at site of presenting disease. No patients have died. Salvage therapy was successful with second-line chemotherapy/radiation and autologous stem-cell transplantation. CONCLUSION Six cycles of ABVD is an effective and safe treatment for limited-stage, nonbulky HL and would spare young patients radiation toxicity. Interim positron emission tomography/computed tomography scans in current and future trials may identify those patients who require less than six cycles of chemotherapy.
Phase II study of sunitinib in patients with metastatic urothelial cancer.

PURPOSE No standard therapy exists for metastatic urothelial cancer (UC) that has progressed after initial chemotherapy. This trial was designed to assess the efficacy and tolerability of sunitinib in patients with advanced, previously treated UC. PATIENTS AND METHODS In this phase II trial, 77 patients received sunitinib between September 2006 and January 2009 on one of two schedules (50 mg per day for 4 weeks on and 2 weeks off [cohort A], 37.5 mg per day continuously [cohort B]), using a Simon 2 stage design in each cohort separately. RESULTS A partial response was seen in three of 45 patients (95% CI, 1% to 18%) in cohort A, and in one of 32 patients (95% CI, 0% to 16%) in cohort B. Clinical regression or stable disease was achieved in 33 of 77 patients (43%). Tumor regression lasted between 0.6 and 23.4 months with 29% of patients achieving response lasting longer than 3 months. The progression-free survival (2.4 v 2.3 months; P = .4) and overall survival (7.1 v 6.0 months; P = .4) were similar in both cohorts. There was one treatment-related death, and 47 patients (33 cohort A, 24 cohort B) experienced grade 3 or 4 toxicity. CONCLUSION Sunitinib did not achieve the predetermined threshold of >or= 20% activity defined by Response Evaluation Criteria in Solid Tumors. However, antitumor responses were observed, identifying the vascular endothelial growth factor axis as a viable pathway for UC treatment. The reported clinical benefit in previously treated patients warrants further investigation in a disease for which there is no US Food and Drug Administration-approved treatment.
Characterizing Superposition Arrival Processes in Packet Multiplexers for Voice and Data

This paper analyzes a model of a multiplexer for packetized voice and data. A major part of the analysis is devoted to characterizing the aggregate packet arrival process resulting from the superposition of separate voice streams. This is done via the index of dispersion for intervals (IDI), which describes the cumulative covariance among successive interarrival times. The IDI seems very promising as a measurement tool to characterize complex arrival processes. This paper also describes the delays experienced by voice and data packets in the multiplexer using relatively simple two-parameter approximations.
A Statistical Model for Indoor Multipath Propagation

The results of indoor multipath propagation measurements using 10 ns, 1.5 GHz, radarlike pulses are presented for a medium-size office building. The observed channel was very slowly time varying, with the delay spread extending over a range up to about 200 ns and rms values of up to about 50 ns. The attenuation varied over a 60 dB dynamic range. A simple statistical multipath model of the indoor radio channel is also presented, which fits our measurements well, and more importantly, appears to be extendable to other buildings. With this model, the received signal rays arrive in clusters. The rays have independent uniform phases, and independent Rayleigh amplitudes with variances that decay exponentially with cluster and ray delays. The clusters, and the rays within the cluster, form Poisson arrival processes with different, but fixed, rates. The clusters are formed by the building superstructure, while the individual rays are formed by objects in the vicinities of the transmitter and the receiver.
Longitudinal study of depressive symptoms in patients with metastatic gastrointestinal and lung cancer.

PURPOSE Although early intervention is increasingly advocated to prevent and relieve distress in patients with metastatic cancer, the risk factors for such symptoms and their trajectory are not well established. We therefore conducted a longitudinal study to determine the course and predictors of depressive symptoms. PATIENTS AND METHODS Patients (N = 365) with metastatic gastrointestinal or lung cancer completed measures of physical distress, self-esteem, attachment security, spiritual well-being, social support, hopelessness, and depression at baseline; physical distress, social support, hopelessness, and depression were subsequently assessed at 2-month intervals. RESULTS Of the sample, 35% reported at least mild depressive symptoms, with 16% reporting moderate to severe depressive symptoms that persisted in at least one third of such individuals. Moderate to severe depressive symptoms were almost three times more common in the final 3 months of life than > or = 1 year before death. Predictors of depressive symptoms included younger age, antidepressant use at baseline, lower self-esteem and spiritual well-being, and greater attachment anxiety, hopelessness, physical burden of illness, and proximity to death. The combination of greater physical suffering and psychosocial vulnerability put individuals at greatest risk for depression. CONCLUSION Depressive symptoms in advanced cancer patients are relatively common and may arise as a final common pathway of distress in response to psychosocial vulnerabilities, physical suffering, and proximity to death. These findings support the need for an integrated approach to address emotional and physical distress in this population and to determine whether early intervention may prevent depression at the end of life.
Assessing organisational culture for quality and safety improvement: a national survey of tools and tool use

Background: There is growing international interest in managing organisational culture as a lever for healthcare improvement. This has prompted a practical need to understand what instruments and tools exist for assessing cultures in healthcare contexts. The present study was undertaken to determine the culture assessment tools being used in the English NHS and assess their fitness for purpose. Methods: Postal questionnaire survey of clinical governance leads in 275 English NHS organisations, with a response rate of 77%. Results: A third of the organisations were currently using a culture assessment instrument to support their clinical governance activity. Although we found a high degree of satisfaction with existing instruments, in terms of ease of use and relevance, there is an immediate practical need to develop new and better bespoke culture assessment tools to bridge the gap between the cultural domains covered by extant instruments and the broader range of concerns of clinical governance managers. Conclusion: There is growing interest in understanding and shaping local cultures in healthcare, which is not yet matched by widespread use of available instruments. Even though extant tools cover many of the most important cultural attributes identified by clinical governance managers, the over-riding focus of tools in use is on safety rather than a holistic assessment of the dimensions of healthcare quality and performance.
Service management in secure and QoS-aware wireless enterprise networks

Wireless local-area networks (WLANs) based on the IEEE 802.11 technology have been widely adopted for private use over the past few years. However, several issues remain concerns for large-scale deployment in corporate environments. Enforcing security and quality-of-service (QoS) has become a fundamental challenge to managing IEEE 802.11-based enterprise networks. In order to provide corporate networks with a global management solution, we have designed a service-oriented management system that enables user-centric service provisioning, while enforcing security and QoS requirements. As enterprises may be comprised of a number of distinct networks, we have extended our system to support the roaming of users between different enterprise sites. In this paper, we describe the design, implementation, and performance evaluation of our solution.
Obese women's reasons for not attending a weight management service during pregnancy

Evaluations of services targeting obese women's gestational weight gain often report low uptake. Thus it is important to elicit the reasons why obese pregnant women decline to participate in these services and to identify their barriers to participation. Sixteen obese pregnant and postnatal women were interviewed regarding their reasons for declining a group‐based service targeting their gestational weight gain. All interviews were recorded, transcribed verbatim and analyzed thematically. Both pragmatic and motivational barriers were identified. The most common practical reasons for not attending the service were its inconvenient location and time, and feeling unable to attend due to work commitments. Pregnancy‐specific barriers included decreased mobility and feeling unwell. Motivational barriers included lack of interest and not wanting to focus on one's weight in pregnancy. These findings highlight issues that need to be taken into consideration when designing group‐based weight management services for this population.
Satisfaction with inpatient care in a population-based Hong Kong Chinese sample

Objective To measure self-reported inpatient experience in Hong Kong. Design Data were derived from the 2005 Thematic Household Survey. Setting and participants 24 364 non-institutional and 3390 institutionalised respondents aged at least 18 years systematically drawn to represent the Hong Kong adult population, 6.9% of whom were admitted at least once as an inpatient during the previous 12 months. Data from this group was analysed. Main outcome measure Picker Patient Experience Questionnaire-15. Results Overall, respondents scored their last inpatient episode 39.6 (range=0–100, the lower the score, the better the patient experience). Patients who sought care from private hospitals reported a lower Picker Patient Experience Questionnaire-15 score than those cared for in public facilities (31.1 vs 41.8 respectively, p<0.001). We observed substantial differences between public hospital geographic clusters that were confirmed by multivariable regression. When benchmarked against the UK, Germany and the USA, Hong Kong patients tended to report a significantly higher number of problems. Conclusions We found systematic differences between the level of satisfaction and type of problems reported by Hong Kong Chinese compared to those in Euro-American settings. The observed heterogeneities among different public hospitals, between the private and public sectors, and among subgroups of inpatients should provide an evidence based on which quality improvement initiatives can be designed and evaluated.
Patient safety begins with proper planning: a quantitative method to improve hospital design

Background A quantitative methodology that enhances design of patient-safe healthcare facilities is presented. The prevailing paradigm of evaluating the design of healthcare facilities relies mainly on postconstruction criticism of design flaws; by then, design flaws may have already negatively affected patient safety. The methodology presented here utilises simulation-based testing in real-size replicas of proposed hospital designs. Other simulations to assess design solutions generated mainly qualitative data about user experience. To assess the methodology, we evaluated one patient safety variable in a proposed hospital patient room. Method Fifty-two physicians who volunteered to participate were randomly assigned to examine a standardised patient in two hospital room settings using a replica of the proposed architectural plan; the two settings differed only by the placement of the alcohol-based hand-rub dispenser. The primary outcome was the hand hygiene compliance rate. Results When the dispenser was in clear view of the physicians as they observed the patient, 53.8% sanitised their hands. When the dispenser was not in their field of view (as in the original architectural plan), 11.5% sanitised their hands (p=0.0011). Based on these results, the final architectural plans were adjusted accordingly. Conclusion The methodology is an effective and relatively inexpensive means to quantitatively evaluate proposed solutions, which can then be implemented to build patient-safe healthcare facilities. It enables actual users to proactively identify patient safety hazards before construction begins.
A comparative study of safety climate differences in healthcare and the petroleum industry

Aim The aim of this article is to compare safety climate in healthcare and the petroleum industry by collecting empirical evidence of differences between the two sectors. Methods The Hospital Survey on Patient Safety Culture (HSOPSC) is used to measure the safety climate in two organisations operating in the two different sectors: (1) a large Norwegian university hospital offering a wide range of hospital services and (2) a large Norwegian petroleum company producing oil and gas worldwide. Results and discussion Statistical analyses supported the expected hypotheses that safety climate is positively related to outcome measures and that the level on safety climate and outcome measures are generally higher in the petroleum sector. Empirical findings indicate that healthcare should learn from the petroleum industry regarding safety improvement efforts, and the implication of this is discussed in the paper.
The significance of cell type and tumor growth markers in the prognosis of unscreened cervical cancer patients

ter Harmsel B, van Muyden R, Smedts F, Hermans J, Kuijpers J, Raikhlin N, Petrov S, Lebedev A, Ramaekers F, Trimbos B. The significance of cell type and tumor growth markers in the prognosis of unscreened cervical cancer patients. Int J Gynecol Cancer 1998; 8: 336–344. The clinical significance of p53, Ki-67-Ag, and BCL-2 as markers for patient prognosis in cervical carcinoma was compared to established prognostic tumor parameters. The examined population consisted of 159 unscreened Russian women, presenting with Stage I (n= 74) and Stage II (n= 85) cervical carcinoma. Relevant clinical information was available in all cases. Thirty-five percent of cases were either adenocarcinoma or contained an adenocarcinomatous component. Lymph node status and stage of disease appeared to be statistically significant parameters for patient survival. Depth of tumor infiltration was a significant indicator of 5-year relapse risk, while tumor size and histologic classification were not predictive. When analyzed separately, p53, Ki-67-Ag, and BCL-2 were not significantly correlated with clinical parameters. However, high Ki-67-Ag combined with high BCL-2 indices predicted a shorter relapse-free interval than did low Ki-67-Ag combined with low BCL-2 index. We conclude that the relatively high incidence of cervical adenocarcinomas is merely due to an increased awareness in the histologic classification criteria of this tumor subtype. Furthermore, histologic parameters are not of value in predicting patient outcome. Although tumor stage and lymph node status are superior to individual markers of tumor growth and genomic instability in determining patient prognosis, a combination of markers for proliferation index and protection from apoptotic cell death shows a tendency to predict clinical outcome.
Injection drug use, sexual risk, violence and STI/HIV among Moscow female sex workers

Background/objectives The HIV prevalence in Eastern Europe and Central Asia continues to increase. While injection drug use (IDU) is leading factor, heterosexual transmission is on the rise. Little is known about female sex workers (FSWs) in the region despite the central role of commercial sex in heterosexual sexually transmitted infection (STI)/HIV transmission globally. The authors evaluated the prevalence of STI/HIV among Moscow-based FSWs and potential risk factors including IDU, sexual risks and violence victimisation. Methods Moscow-based FSWs (n=147) completed a clinic-based survey and STI/HIV testing over an 8-month period in 2005. Results HIV prevalence was 4.8%, and 31.3% were infected with at least one STI including HIV. Sexual behaviours significantly associated with STI/HIV included anal sex (adjusted odds ratio (AOR) 3.48), high client volume (three or more clients daily, AOR 2.71), recent subbotnik (sex demanded by police; AOR 2.50) and regularly being presented with more clients than initially agreed to (AOR 2.45). Past year experiences of physical violence from clients and threats of violence from pimps were associated with STI/HIV (AOR 3.14 and AOR 3.65, respectively). IDU was not significantly associated with STI/HIV. Anal sex and high client volume partially mediated the associations of abuse with STI/HIV. Conclusions Findings illustrate substantial potential for heterosexual STI/HIV transmission in a setting better known for IDU-related risk. Many of the STI/HIV risks observed are not modifiable by FSWs alone. STI/HIV prevention efforts for this vulnerable population will benefit from reducing coercion and abuse perpetrated by pimps and clients.
Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavorable Hodgkin's lymphoma: final analysis of the German Hodgkin Study Group HD11 trial.

PURPOSE Combined-modality treatment consisting of four to six cycles of chemotherapy followed by involved-field radiotherapy (IFRT) is the standard of care for patients with early unfavorable Hodgkin's lymphoma (HL). It is unclear whether treatment results can be improved with more intensive chemotherapy and which radiation dose needs to be applied. PATIENTS AND METHODS Patients age 16 to 75 years with newly diagnosed early unfavorable HL were randomly assigned in a 2 × 2 factorial design to one of the following treatment arms: four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) + 30 Gy of IFRT; four cycles of ABVD + 20 Gy of IFRT; four cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP(baseline)) + 30 Gy of IFRT; or four cycles of BEACOPP(baseline) + 20 Gy of IFRT. RESULTS With a total of 1,395 patients included, the freedom from treatment failure (FFTF) at 5 years was 85.0%, overall survival was 94.5%, and progression-free survival was 86.0%. BEACOPP(baseline) was more effective than ABVD when followed by 20 Gy of IFRT (5-year FFTF difference, 5.7%; 95% CI, 0.1% to 11.3%). However, there was no difference between BEACOPP(baseline) and ABVD when followed by 30 Gy of IFRT (5-year FFTF difference, 1.6%; 95% CI, -3.6% to 6.9%). Similar results were observed for the radiotherapy question; after four cycles of BEACOPP(baseline), 20 Gy was not inferior to 30 Gy (5-year FFTF difference, -0.8%; 95% CI, -5.8% to 4.2%), whereas inferiority of 20 Gy cannot be excluded after four cycles of ABVD (5-year FFTF difference, -4.7%; 95% CI, -10.3% to 0.8%). Treatment-related toxicity occurred more often in the arms with more intensive therapy. CONCLUSION Moderate dose escalation using BEACOPP(baseline) did not significantly improve outcome in early unfavorable HL. Four cycles of ABVD should be followed by 30 Gy of IFRT.
A Scalable Multicast Source Routing Architecture for Data Center Networks

This paper introduces a new scalable, efficient and stateless source routing scheme to ensure that unified unicast and multicast packets can be delivered in the Data Center Networks (DCNs). This scheme, called Code-Oriented eXplicit multicast (COXcast), is based on unicast and eXplicit multicast (Xcast). It constructs the unicast path and multicast tree by encoding the corresponding output port bitmap of each intermediate node. Using a common identifier and a node-specific key, so packets can be self-routed to multiple receivers without requiring header modification. In addition, intermediate switches/routers on the path/tree can be stateless. Compared to traditional source-based unicasting and explicit-based multicasting schemes, COXcast has lowered the processing cost, protocol overhead and delivery latency, while simplifying the deployment and management of a large number of medium-scale multicast groups, especially when applied to large-scale DCNs.
Quality cancer care for adolescents and young adults: a position statement.

PURPOSE This consensus-based position statement on behalf of the LIVESTRONG Young Adult Alliance (Alliance) offers recommendations to enhance oncologic care of adolescent and young adult (AYA) patients with cancer. BACKGROUND In 2005 to 2006, the National Cancer Institute and the Lance Armstrong Foundation jointly sponsored the Adolescent and Young Adult Oncology Progress Review Group (PRG). The PRG report included the directive to develop standards of care for AYA patients with cancer and to disseminate these guidelines to the community. To this end, the Alliance convened a meeting of experts (clinicians, researchers, and advocates) in June 2009 and derived this position statement. RESULTS Quality care for AYAs depends on four critical elements: timely detection; efficient processes for diagnosis, initiation of treatment, and promotion of adherence; access to health care professionals who possess knowledge specific to the biomedical and psychosocial needs of this population; and research that will ultimately derive objective criteria for the development of AYA oncology care guidelines. Achieving quality care for AYAs will require assistance with management of disease and treatment effects; cognizance of the unique psychosocial context for AYA growth and development; assessment of and attention to cognitive, psychiatric, and psychosocial issues; facilitated transition to treatment care; and referral to age-appropriate information and support services. CONCLUSION Dissemination of recommendations stated here will raise awareness of the need for AYA-specific care guidelines and assist providers in the delivery of care that is responsive to the distinct needs of AYAs with cancer.