Miracle-dz/UniFAR-FTUs huggingface dataset:
Dose comparisons of clopidogrel and aspirin in acute coronary syndromes.

BACKGROUND Clopidogrel and aspirin are widely used for patients with acute coronary syndromes and those undergoing percutaneous coronary intervention (PCI). However, evidence-based guidelines for dosing have not been established for either agent. METHODS We randomly assigned, in a 2-by-2 factorial design, 25,086 patients with an acute coronary syndrome who were referred for an invasive strategy to either double-dose clopidogrel (a 600-mg loading dose on day 1, followed by 150 mg daily for 6 days and 75 mg daily thereafter) or standard-dose clopidogrel (a 300-mg loading dose and 75 mg daily thereafter) and either higher-dose aspirin (300 to 325 mg daily) or lower-dose aspirin (75 to 100 mg daily). The primary outcome was cardiovascular death, myocardial infarction, or stroke at 30 days. RESULTS The primary outcome occurred in 4.2% of patients assigned to double-dose clopidogrel as compared with 4.4% assigned to standard-dose clopidogrel (hazard ratio, 0.94; 95% confidence interval [CI], 0.83 to 1.06; P=0.30). Major bleeding occurred in 2.5% of patients in the double-dose group and in 2.0% in the standard-dose group (hazard ratio, 1.24; 95% CI, 1.05 to 1.46; P=0.01). Double-dose clopidogrel was associated with a significant reduction in the secondary outcome of stent thrombosis among the 17,263 patients who underwent PCI (1.6% vs. 2.3%; hazard ratio, 0.68; 95% CI, 0.55 to 0.85; P=0.001). There was no significant difference between higher-dose and lower-dose aspirin with respect to the primary outcome (4.2% vs. 4.4%; hazard ratio, 0.97; 95% CI, 0.86 to 1.09; P=0.61) or major bleeding (2.3% vs. 2.3%; hazard ratio, 0.99; 95% CI, 0.84 to 1.17; P=0.90). CONCLUSIONS In patients with an acute coronary syndrome who were referred for an invasive strategy, there was no significant difference between a 7-day, double-dose clopidogrel regimen and the standard-dose regimen, or between higher-dose aspirin and lower-dose aspirin, with respect to the primary outcome of cardiovascular death, myocardial infarction, or stroke. (Funded by Sanofi-Aventis and Bristol-Myers Squibb; ClinicalTrials.gov number, NCT00335452.)
Lung function in rescue workers at the World Trade Center after 7 years.

BACKGROUND The terrorist attacks on the World Trade Center on September 11, 2001, exposed thousands of Fire Department of New York City (FDNY) rescue workers to dust, leading to substantial declines in lung function in the first year. We sought to determine the longer-term effects of exposure. METHODS Using linear mixed models, we analyzed the forced expiratory volume in 1 second (FEV(1)) of both active and retired FDNY rescue workers on the basis of spirometry routinely performed at intervals of 12 to 18 months from March 12, 2000, to September 11, 2008. RESULTS Of the 13,954 FDNY workers who were present at the World Trade Center between September 11, 2001, and September 24, 2001, a total of 12,781 (91.6%) participated in this study, contributing 61,746 quality-screened spirometric measurements. The median follow-up was 6.1 years for firefighters and 6.4 years for emergency-medical-services (EMS) workers. In the first year, the mean FEV(1) decreased significantly for all workers, more for firefighters who had never smoked (a reduction of 439 ml; 95% confidence interval [CI], 408 to 471) than for EMS workers who had never smoked (a reduction of 267 ml; 95% CI, 263 to 271) (P<0.001 for both comparisons). There was little or no recovery in FEV(1) during the subsequent 6 years, with a mean annualized reduction in FEV(1) of 25 ml per year for firefighters and 40 ml per year for EMS workers. The proportion of workers who had never smoked and who had an FEV(1) below the lower limit of the normal range increased during the first year, from 3% to 18% for firefighters and from 12% to 22% for EMS workers, stabilizing at about 13% for firefighters and 22% for EMS workers during the subsequent 6 years. CONCLUSIONS Exposure to World Trade Center dust led to large declines in FEV(1) for FDNY rescue workers during the first year. Overall, these declines were persistent, without recovery over the next 6 years, leaving a substantial proportion of workers with abnormal lung function.
Hurst's the Heart

The trusted landmark cardiology resource thoroughly updated to reflect the latest clinical perspectives Includes DVD with image bank Through thirteen editions Hursts the Heart has always represented the cornerstone of current scholarship in the discipline. Cardiologists, cardiology fellows and internists from across the globe have relied on its unmatched authority breadth of coverage and clinical relevance to help optimize patient outcomes. The thirteenth edition of Hursts the Heart continues this standard-setting tradition with 19 new chapters and 59 new authors, each of whom are internationally recognized as experts in their respective content areas. Featuring an enhanced reader-friendly design the new edition covers need-to-know clinical advances as well as issues that are becoming increasingly vital to cardiologists worldwide. As in previous editions you will find the most complete overview of cardiology topics available plus a timely new focus on evidence-based medicine health outcomes and health quality. New Features: 1548 full-color illustrations and 578 tables. Companion DVD with image bank includes key figures and tables from the text.
Understandings of influenza and promoting influenza vaccination among high-risk urban dwelling Thai adults

The research aimed to explore beliefs about influenza and influenza vaccination, and the social influences on decisions whether or not to accept the influenza vaccination in a sample of urban-dwelling Thai adults. It also aimed to test the effect of a Health Action Process Approach (HAPA)-based leaflet on influenza vaccination behaviours among these high-risk individuals, and to evaluate the impact of a HAPA-based leaflet on potential mediators of behavioural change. Additional aim was to examine the predictive utility of the HAPA model in relation to both intention and subsequent vaccination behaviour in a certain high risk group. Firstly, a qualitative study was carried out. In-depth interviews were conducted among 20 high-risk individuals who were either (i) aged 65 and over, or (ii) under 65 years with chronic diseases that had clinical indications requiring influenza vaccination. Findings indicate that most participants had insufficient knowledge about influenza and influenza vaccination. Their decisions whether or not to get vaccinated against influenza were based on a number of factors, including salience of risk, influence of others, perception of the need for preventive health care, and the availability of influenza vaccine. Secondly, a controlled before and after trial was conducted. Participants in the intervention (n = 99) received a HAPA-based leaflet and asking them to form an action plan identifying where, when and how they would seek vaccination. Those in the comparison condition (n = 102) received a standard government information leaflet. The HAPA intervention resulted in greater changes on measures of risk perception, outcome expectancies, self-efficacy, and intention than the comparison condition. No significant difference in vaccination rates was observed between two groups. Influenza vaccination was directly predicted by self-efficacy and intention.
Postmarket Safety Events Among Novel Therapeutics Approved by the US Food and Drug Administration Between 2001 and 2010

Importance Postmarket safety events of novel pharmaceuticals and biologics occur when new safety risks are identified after initial regulatory approval of these therapeutics. These safety events can change how novel therapeutics are used in clinical practice and inform patient and clinician decision making. Objectives To characterize the frequency of postmarket safety events among novel therapeutics approved by the US Food and Drug Administration (FDA), and to examine whether any novel therapeutic characteristics known at the time of FDA approval were associated with increased risk. Design and Setting Cohort study of all novel therapeutics approved by the FDA between January 1, 2001, and December 31, 2010, followed up through February 28, 2017. Exposures Novel therapeutic characteristics known at the time of FDA approval, including drug class, therapeutic area, priority review, accelerated approval, orphan status, near–regulatory deadline approval, and regulatory review time. Main Outcomes and Measures A composite of (1) withdrawals due to safety concerns, (2) FDA issuance of incremental boxed warnings added in the postmarket period, and (3) FDA issuance of safety communications. Results From 2001 through 2010, the FDA approved 222 novel therapeutics (183 pharmaceuticals and 39 biologics). There were 123 new postmarket safety events (3 withdrawals, 61 boxed warnings, and 59 safety communications) during a median follow-up period of 11.7 years (interquartile range [IQR], 8.7-13.8 years), affecting 71 (32.0%) of the novel therapeutics. The median time from approval to first postmarket safety event was 4.2 years (IQR, 2.5-6.0 years), and the proportion of novel therapeutics affected by a postmarket safety event at 10 years was 30.8% (95% CI, 25.1%-37.5%). In multivariable analysis, postmarket safety events were statistically significantly more frequent among biologics (incidence rate ratio [IRR] = 1.93; 95% CI, 1.06-3.52; P = .03), therapeutics indicated for the treatment of psychiatric disease (IRR = 3.78; 95% CI, 1.77-8.06; P < .001), those receiving accelerated approval (IRR = 2.20; 95% CI, 1.15-4.21; P = .02), and those with near–regulatory deadline approval (IRR = 1.90; 95% CI, 1.19-3.05; P = .008); events were statistically significantly less frequent among those with regulatory review times less than 200 days (IRR = 0.46; 95% CI, 0.24-0.87; P = .02). Conclusions and Relevance Among 222 novel therapeutics approved by the FDA from 2001 through 2010, 32% were affected by a postmarket safety event. Biologics, psychiatric therapeutics, and accelerated and near–regulatory deadline approval were statistically significantly associated with higher rates of events, highlighting the need for continuous monitoring of the safety of novel therapeutics throughout their life cycle.
The necessary components of a staff development program to prepare teachers to teach secondary online classes: A Delphi study

THE NECESSARY COMPONENTS OF A STAFF DEVELOPMENT PROGRAM TO PREPARE TEACHERS TO TEACH SECONDARY ONLINE CLASSES: A DELPHI STUDY by John Wesley Davidson Educators are faced with the rapid influx of online courses in the K-12 educational setting. The majority of research conducted to date has been in the area of higher education. Research and publications suggest that many factors control the success or failure of students enrolled in online courses. These factors include student characteristics, mentoring, and teacher/student interaction. Other factors affect the implementation of successful online courses and virtual schools. These factors include policies, funding, student support, technology, curriculum, access, equity, staff development, and administration. Currently, the absence of appropriate research suggest the need to identify the necessary components of a staff development program to prepare teachers to teach secondary online classes in a local school system. In the development of a staff development program, measures need to be undertaken to assess and address the individual needs of the teachers. This study was designed to identify the necessary components of a staff development program for the purpose of training teachers to teach secondary online courses in a local school system and collect recommendations for differentiating staff development to meet the individual needs of teachers. Using a three-round Delphi technique, panelists, representing successful secondary public and corporate online schools, developed a common consensus on the necessary components. The panelists identified the components needed for teacher training and ways in
Supplement use, vitamin C intake and breast cancer risk in UK women

Background: When analysing relationships between breast cancer risk and vitamin C intake, few prospective studies have included vitamin C intake from supplements, or excluded general supplement users in dietary only analyses. For the first time these relationships are explored in UK women, and from diary recordings. Methods: The UK Women’s Cohort Study was used in prospective breast cancer risk analyses examining exposures from: general supplement use; fruit and vegetable intake; and dietary only vitamin C intake recorded at baseline using FFQs and additional questions for 33,000 women (~1,000 cases); vitamin C contained in supplements recorded by diaries at phase 2 for 11,000 women (239 cases); and total vitamin C intake from diet and supplement recorded by diaries in pooled UK nested case-control studies (851 cases 2727 controls). Results: There was no evidence of dose-response relationships between breast cancer risk and vitamin C intake from diet, supplements or both, or from fruit and vegetable intake; risk estimates were non-significant and generally close to unity. There was some evidence that risks differed by menopausal status and supplement use. There were no significant associations for non-users of supplements or post-menopausal women by continuous estimate or intake category. Risks were raised for pre-menopausal women who were: frequent users of supplements containing low vitamin C (1-60mg/d) (HR=2.37; 95% CI: 1.32, 4.27; p=0.004); daily multivitamin users (HR=1.51; 95% CI: 0.90, 2.54); or general supplement users (HR=1.14; 95% CI: 0.91, 1.43), compared to non-users of these supplements. Women with a history of breast cancer were significantly more likely to be high dose vitamin C users (≥1000mg/d). Conclusion: There was no evidence of significant associations between vitamin C intake per se and breast cancer incidence, even at high doses. The increased risk for pre-menopausal women taking supplements containing low dose vitamin C may be due to other ingredients.
Closure or medical therapy for cryptogenic stroke with patent foramen ovale.

BACKGROUND The prevalence of patent foramen ovale among patients with cryptogenic stroke is higher than that in the general population. Closure with a percutaneous device is often recommended in such patients, but it is not known whether this intervention reduces the risk of recurrent stroke. METHODS We conducted a multicenter, randomized, open-label trial of closure with a percutaneous device, as compared with medical therapy alone, in patients between 18 and 60 years of age who presented with a cryptogenic stroke or transient ischemic attack (TIA) and had a patent foramen ovale. The primary end point was a composite of stroke or transient ischemic attack during 2 years of follow-up, death from any cause during the first 30 days, or death from neurologic causes between 31 days and 2 years. RESULTS A total of 909 patients were enrolled in the trial. The cumulative incidence (Kaplan-Meier estimate) of the primary end point was 5.5% in the closure group (447 patients) as compared with 6.8% in the medical-therapy group (462 patients) (adjusted hazard ratio, 0.78; 95% confidence interval, 0.45 to 1.35; P=0.37). The respective rates were 2.9% and 3.1% for stroke (P=0.79) and 3.1% and 4.1% for TIA (P=0.44). No deaths occurred by 30 days in either group, and there were no deaths from neurologic causes during the 2-year follow-up period. A cause other than paradoxical embolism was usually apparent in patients with recurrent neurologic events. CONCLUSIONS In patients with cryptogenic stroke or TIA who had a patent foramen ovale, closure with a device did not offer a greater benefit than medical therapy alone for the prevention of recurrent stroke or TIA. (Funded by NMT Medical; ClinicalTrials.gov number, NCT00201461.).
Functional disability 5 years after acute respiratory distress syndrome.

BACKGROUND There have been few detailed, in-person interviews and examinations to obtain follow-up data on 5-year outcomes among survivors of the acute respiratory distress syndrome (ARDS). METHODS We evaluated 109 survivors of ARDS at 3, 6, and 12 months and at 2, 3, 4, and 5 years after discharge from the intensive care unit. At each visit, patients were interviewed and examined; underwent pulmonary-function tests, the 6-minute walk test, resting and exercise oximetry, chest imaging, and a quality-of-life evaluation; and reported their use of health care services. RESULTS At 5 years, the median 6-minute walk distance was 436 m (76% of predicted distance) and the Physical Component Score on the Medical Outcomes Study 36-Item Short-Form Health Survey was 41 (mean norm score matched for age and sex, 50). With respect to this score, younger patients had a greater rate of recovery than older patients, but neither group returned to normal predicted levels of physical function at 5 years. Pulmonary function was normal to near-normal. A constellation of other physical and psychological problems developed or persisted in patients and family caregivers for up to 5 years. Patients with more coexisting illnesses incurred greater 5-year costs. CONCLUSIONS Exercise limitation, physical and psychological sequelae, decreased physical quality of life, and increased costs and use of health care services are important legacies of severe lung injury.
Öğretim Elemanlarının Geleneksel ve Çağdaş Ölçme Değerlendirme Yaklaşımlarının İncelenmesi

The purpose of this research is to investigate the views of teaching staff at higher education about traditional and alternative measurement and evaluation approaches with regard to faculty variable and whether the instructor has attended any education about measurement and evaluation. The participants comprised 200 academicians from four different universities. The data were collected using the Measurement and Evaluation Approaches Scale, developed by the researchers. The data were analyzed using descriptive statistics (means and standard deviation), one-way ANOVA, two-way ANOVA, and Bonferroni tests. The analysis revealed that the instructors embrace both traditional and alternative measurement and evaluation approaches at a moderate level, with the latter having arithmetic means slightly more than that of the former. The casual-comparative analysis proved that the instructors from non-education faculties who had not attended any training about measurement and evaluation embraced traditional measurement and evaluation approaches significantly more than other groups. No significant differences, however, were observed between the views on alternative measurement and evaluation approaches either with regard to faculty variable or previous training experience, or their interaction.
Carotid-wall intima-media thickness and cardiovascular events.

BACKGROUND Intima-media thickness of the walls of the common carotid artery and internal carotid artery may add to the Framingham risk score for predicting cardiovascular events. METHODS We measured the mean intima-media thickness of the common carotid artery and the maximum intima-media thickness of the internal carotid artery in 2965 members of the Framingham Offspring Study cohort. Cardiovascular-disease outcomes were evaluated for an average follow-up of 7.2 years. Multivariable Cox proportional-hazards models were generated for intima-media thickness and risk factors. We evaluated the reclassification of cardiovascular disease on the basis of the 8-year Framingham risk score category (low, intermediate, or high) after adding intima-media thickness values. RESULTS A total of 296 participants had a cardiovascular event. The risk factors of the Framingham risk score predicted these events, with a C statistic of 0.748 (95% confidence interval [CI], 0.719 to 0.776). The adjusted hazard ratio for cardiovascular disease with a 1-SD increase in the mean intima-media thickness of the common carotid artery was 1.13 (95% CI, 1.02 to 1.24), with a nonsignificant change in the C statistic of 0.003 (95% CI, 0.000 to 0.007); the corresponding hazard ratio for the maximum intima-media thickness of the internal carotid artery was 1.21 (95% CI, 1.13 to 1.29), with a modest increase in the C statistic of 0.009 (95% CI, 0.003 to 0.016). The net reclassification index increased significantly after addition of intima-media thickness of the internal carotid artery (7.6%, P<0.001) but not intima-media thickness of the common carotid artery (0.0%, P=0.99). With the presence of plaque, defined as intima-media thickness of the internal carotid artery of more than 1.5 mm, the net reclassification index was 7.3% (P=0.01), with an increase in the C statistic of 0.014 (95% CI, 0.003 to 0.025). CONCLUSIONS The maximum internal and mean common carotid-artery intima-media thicknesses both predict cardiovascular outcomes, but only the maximum intima-media thickness of (and presence of plaque in) the internal carotid artery significantly (albeit modestly) improves the classification of risk of cardiovascular disease in the Framingham Offspring Study cohort. (Funded by the National Heart, Lung, and Blood Institute.).
Dalteparin versus unfractionated heparin in critically ill patients.

BACKGROUND The effects of thromboprophylaxis with low-molecular-weight heparin, as compared with unfractionated heparin, on venous thromboembolism, bleeding, and other outcomes are uncertain in critically ill patients. METHODS In this multicenter trial, we tested the superiority of dalteparin over unfractionated heparin by randomly assigning 3764 patients to receive either subcutaneous dalteparin (at a dose of 5000 IU once daily) plus placebo once daily (for parallel-group twice-daily injections) or unfractionated heparin (at a dose of 5000 IU twice daily) while they were in the intensive care unit. The primary outcome, proximal leg deep-vein thrombosis, was diagnosed on compression ultrasonography performed within 2 days after admission, twice weekly, and as clinically indicated. Additional testing for venous thromboembolism was performed as clinically indicated. Data were analyzed according to the intention-to-treat principle. RESULTS There was no significant between-group difference in the rate of proximal leg deep-vein thrombosis, which occurred in 96 of 1873 patients (5.1%) receiving dalteparin versus 109 of 1873 patients (5.8%) receiving unfractionated heparin (hazard ratio in the dalteparin group, 0.92; 95% confidence interval [CI], 0.68 to 1.23; P=0.57). The proportion of patients with pulmonary emboli was significantly lower with dalteparin (24 patients, 1.3%) than with unfractionated heparin (43 patients, 2.3%) (hazard ratio, 0.51; 95% CI, 0.30 to 0.88; P=0.01). There was no significant between-group difference in the rates of major bleeding (hazard ratio, 1.00; 95% CI, 0.75 to 1.34; P=0.98) or death in the hospital (hazard ratio, 0.92; 95% CI, 0.80 to 1.05; P=0.21). In prespecified per-protocol analyses, the results were similar to those of the main analyses, but fewer patients receiving dalteparin had heparin-induced thrombocytopenia (hazard ratio, 0.27; 95% CI, 0.08 to 0.98; P=0.046). CONCLUSIONS Among critically ill patients, dalteparin was not superior to unfractionated heparin in decreasing the incidence of proximal deep-vein thrombosis. (Funded by the Canadian Institutes of Health Research and others; PROTECT ClinicalTrials.gov number, NCT00182143.).