Miracle-dz/UniFAR-FTUs huggingface dataset:
Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy (Summary)

Abstract In 1997, I wrote No Easy Answers: Research Findings on Programs to Reduce Teen Pregnancy for the National Campaign to Prevent Teen Pregnancy. At that time, with only a few exceptions, most studies assessing the impact of programs to reduce teen sexual risk-taking failed either to measure or to find sustained long-term impact on behavior. Now, 4 years later, the research findings are definitely more positive, and there are at least five important reasons to be more optimistic that we can craft programs that help to reduce teen pregnancy. First, teen pregnancy, abortion, and birth rates began to decrease about 1991 and have continued to decline every year since then. Second, larger, more rigorous studies of some sex and HIV education programs have found sustained positive effects on behavior for as long as 3 years. Third, there is now good evidence that one program that combines both sexuality education and youth development (i.e., the Children's Aid Society—Carrera Program) can reduce pregnancies for as long as 3 years. Fourth, both service learning programs (i.e., voluntary community service with group discussions and reflection) and sex and HIV education programs (i.e., Reducing the Risk) have been found to reduce sexual risk-taking or pregnancy in several settings by independent research teams. Fifth, there is emerging evidence that some shorter, more modest clinic interventions involving educational materials coupled with one-on-one counseling may increase contraceptive use. Given the stronger and more consistent research findings demonstrating program effectiveness, this report has been titled Emerging Answers.
High Tibial Osteotomy Utilizing Distraction Osteogenesis

Surgical management of the malaligned arthritic knee in an active individual presents a challenge to the orthopaedic surgeon. High tibial osteotomy has become a widely accepted treatment of patients with moderately severe, primarily unicompartmental, varus degenerative arthritis of the knee. The purpose of this article is to review the indications and surgical technique for proximal tibial realignment utilizing distraction osteogenesis.
Long-term outcomes among older patients following nonmyeloablative conditioning and allogeneic hematopoietic cell transplantation for advanced hematologic malignancies.

CONTEXT A minimally toxic nonmyeloablative regimen was developed for allogeneic hematopoietic cell transplantation (HCT) to treat patients with advanced hematologic malignancies who are older or have comorbid conditions. OBJECTIVE To describe outcomes of patients 60 years or older after receiving minimally toxic nonmyeloablative allogeneic HCT. DESIGN, SETTING, AND PARTICIPANTS From 1998 to 2008, 372 patients aged 60 to 75 years were enrolled in prospective clinical HCT trials at 18 collaborating institutions using conditioning with low-dose total body irradiation alone or combined with fludarabine, 90 mg/m(2), before related (n = 184) or unrelated (n = 188) donor transplants. Postgrafting immunosuppression included mycophenolate mofetil and a calcineurin inhibitor. MAIN OUTCOME MEASURES Overall and progression-free survival were estimated by Kaplan-Meier method. Cumulative incidence estimates were calculated for acute and chronic graft-vs-host disease, toxicities, achievement of full donor chimerism, complete remission, relapse, and nonrelapse mortality. Hazard ratios (HRs) were estimated from Cox regression models. RESULTS Overall, 5-year cumulative incidences of nonrelapse mortality and relapse were 27% (95% CI, 22%-32%) and 41% (95% CI, 36%-46%), respectively, leading to 5-year overall and progression-free survival of 35% (95% CI, 30%-40%) and 32% (95% CI, 27%-37%), respectively. These outcomes were not statistically significantly different when stratified by age groups. Furthermore, increasing age was not associated with increases in acute or chronic graft-vs-host disease or organ toxicities. In multivariate models, HCT-specific comorbidity index scores of 1 to 2 (HR, 1.58 [95% CI, 1.08-2.31]) and 3 or greater (HR, 1.97 [95% CI, 1.38-2.80]) were associated with worse survival compared with an HCT-specific comorbidity index score of 0 (P = .003 overall). Similarly, standard relapse risk (HR, 1.67 [95% CI, 1.10-2.54]) and high relapse risk (HR, 2.22 [95% CI, 1.43-3.43]) were associated with worse survival compared with low relapse risk (P < .001 overall). CONCLUSION Among patients aged 60 to 75 years treated with nonmyeloablative allogeneic HCT, 5-year overall and progression-free survivals were 35% and 32%, respectively.
Detours on the road to personalized medicine: barriers to biomarker validation and implementation.

HE SEQUENCING OF THE HUMAN GENOME, THE ABILitytoperformgenome-wideassociationstudies,and thedevelopmentofhigh-throughputnucleotidesequencing support the goals of personalized medicine. “Next generation” sequencing platforms now providemuchhigherresolutionofDNAthanwaspossiblewith microarray-based–single nucleotide polymorphism (SNP) detection.Otherbreakthroughtechnologiessuchastheability to sequence DNA from single cells, targeted mRNA molecules,andmethylatedregionsofDNA;DNAfragmentlength analysis; isolation of circulating tumor cells; and the ability to use paraffin-embedded tissue for mRNA sequencing will make genotyping faster, easier, less expensive, better, and ultimately more readily available. The explosion in biomarker discovery now taking place in academic and biotech communities has exposed a new obstacle on the road to personalized medicine—neither the research nor the health care ecosystems have evolved capabilities for high-volume validation of potentially useful biomarkers in large populations of patients. The limitationsoftheexistingecosystemaredescribedintermsofbiomarker complexity, clinical research infrastructure, and reimbursement issues.
The Association of Valproic Acid and Incident Breast Cancer in a Managed Care Cohort

Abstract : The possible role of histone deacetylase inhibitors (HDACi) in breast cancer treatment is an area of active investigation. However, its potential as a preventive agent has not been studied . Valproic acid (VPA) is an HDACi which has been used for many decades to safely treat neurological disorders. The rationale for the use of HDACi in breast cancer prevention is a previously unexplored area of research that is based on compelling preclinical data. Epidemiologic studies showing an association between HDACi use and breast cancer incidence would be important evidence to support future prospective clinical trials of HDACi in cancer prevention. We sought to ascertain whether the risk of incident breast cancer is reduced in patients with a history of VPA use, and if so, to determine whether this effect is proportional to the duration of VPA use and whether all breast cancer subtypes are impacted similarly. We developed a database using de-identified data from the Kaiser Permanente of Northern California (KPNC) clinical and pharmacy records of members of the KPNC Healthplan between 1997 and 2007. 20,864 breast cancer cases and 208,640 controls matched for birth year and duration of KNPC pharmacy coverage were identified. 68 incident breast cancers were seen among women with history of VPA use; 486 were in women without history of VPA use. Mean age at diagnosis of the cohort was 61 . 8 years; mean years of prescription drug coverage was 7.4 years. Among cases, 73% of the cohort was non-hispanic white, 7.6% were African American, and 10.5% were Asian/Pacific Islander. When compared to never users, patients with at least 2 years of VPA use had an increased odds of a breast cancer diagnosis (OR 1.37; 95% Cl 1.06-1.76). This effect was only significant for HR-positive incident tumors, although the numbers of HR-negative cases was small (n=12). These findings support that VPA use is not associated with reduction of breast cancer incidence.
Epidemiology: A Very Short Introduction

1. What is epidemiology? 2. Measuring health and disease 3. Searching for the causes of diseases 4. Establishing the causes of a disease 5. Testing how to control a disease 6. Following-up people's health 7. Enquiring back into people's lives 8. Mapping health and disease 9. From epidemiology to medicine, prevention, and public health 10. Epidemiology between ethics and politics
Secondary hypertension caused by primary hyperaldosteronism: a case report

Primary hyperaldosteronism is the most common cause of hypertension of endocrine origin. Aldosterone excess is associated with elevated blood pressure, hypokalemia, hyperglycemia and ventricular hypertrophy. The presence of arterial hypertension and low potassium levels in the blood alert the clinician to search for a secondary cause of arterial hypertension. We present the case of a 39 year old with Conn’s syndrome (primary aldosteronism by adrenal adenoma), with biochemical and imagiological confirmation and subsequent successful surgery (unilateral adrenalectomy). We present the approach to patients with suspected hyperaldosteronism, interpretation of current tests in our environment and its prognosis. (Acta Med Colomb 2013; 38: 86-90).
The effect of date palm fruit (Phoenix dactylifera L.) on the hormone 17-ß-estradiol in 7,12-dimethylbenz(a)anthracene-induced mammary cancer in rats

The effect of date palm fruit feeding (to female Sprague-Dawley rats with 7,12-dimethylbenz( )anthracene–induced mammary cancer) on the hormone 17-estradiol concentration was compared to that of feeding soybean seeds and injection with two drugs (one preventive against and the other curative for 7,12-dimethylbenz( )anthracene-induced mammary cancer i,e. tamoxifen and the hormone 17-estradiol). The date palm fruit raised the hormone concentration significantly (p < 0.05). The hormone concentration was positively correlated with the palpable tumor latency, and negatively correlated with tumor incidence rate and multiplicity. It is concluded that the preventive effect of the date palm fruit against 7,12dimethylbenz( )anthraceneinduced mammary cancer is related to the effect on the hormone 17-estradiol.
Metabolomic Profiling of Prostate Cancer Progression During Active Surveillance

Abstract : This report covers the fourth year of this project. At the conclusion of the original period of performance a no cost extension (NCE) was requested to allow samples to be analyzed by our industry collaborator, Metabolon, Inc. This request was delayed while issues raised by the Office of Research Protection Human Research Protection Office (HRPO) were addressed, and a protocol specific to this study was submitted to, and approved by the Johns Hopkins School of Medicine IRB. With the IRB approval, the issues raised by HRPO were resolved and the study was approved to continue. The NCE was granted, extending the period of performance to October 29, 2017, and authorizing use of previously unspent funds. The samples needed for analysis were identified from an IRB-approved bank of existing samples from men on active surveillance and the samples have been aliquotted and shipped to Metabolon, Inc. for analysis. The study is now on track to complete laboratory analyses in April 2017, biostatistical and bioinformatics analyses completed by the end of June2017, and a manuscript submitted by the end of the period of performance in October 2017.
Predicting pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a systematic review

Approximately 20% of patients treated with neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer achieve a pathological complete response (pCR) while the remainder derive the benefit of improved local control and downstaging and a small proportion show a minimal response. The ability to predict which patients will benefit would allow for improved patient stratification directing therapy to those who are likely to achieve a good response, thereby avoiding ineffective treatment in those unlikely to benefit.
Rivaroxaban vs. vitamin K antagonists for cardioversion in atrial fibrillation.

AIMS X-VeRT is the first prospective randomized trial of a novel oral anticoagulant in patients with atrial fibrillation undergoing elective cardioversion. METHODS AND RESULTS We assigned 1504 patients to rivaroxaban (20 mg once daily, 15 mg if creatinine clearance was between 30 and 49 mL/min) or dose-adjusted vitamin K antagonists (VKAs) in a 2:1 ratio. Investigators selected either an early (target period of 1-5 days after randomization) or delayed (3-8 weeks) cardioversion strategy. The primary efficacy outcome was the composite of stroke, transient ischaemic attack, peripheral embolism, myocardial infarction, and cardiovascular death. The primary safety outcome was major bleeding. The primary efficacy outcome occurred in 5 (two strokes) of 978 patients (0.51%) in the rivaroxaban group and in 5 (two strokes) of 492 patients (1.02%) in the VKA group [risk ratio 0.50; 95% confidence interval (CI) 0.15-1.73]. In the rivaroxaban group, four patients experienced primary efficacy events following early cardioversion (0.71%) and one following delayed cardioversion (0.24%). In the VKA group, three patients had primary efficacy events following early cardioversion (1.08%) and two following delayed cardioversion (0.93%). Rivaroxaban was associated with a significantly shorter time to cardioversion compared with VKAs (P < 0.001). Major bleeding occurred in six patients (0.6%) in the rivaroxaban group and four patients (0.8%) in the VKA group (risk ratio 0.76; 95% CI 0.21-2.67). CONCLUSION Oral rivaroxaban appears to be an effective and safe alternative to VKAs and may allow prompt cardioversion. NAME OF THE TRIAL REGISTRY Clinicaltrials.gov; TRIAL REGISTRATION NUMBER NCT01674647.
Musculoskeletal Disorders in the Workplace: Principles and Practice

PART I: INTRODUCTION Chapter 1: Introduction to Epidemiological Concepts in Musculoskeletal Disorders Chapter 2: Models for Treating Musculoskeletal Disorders: Non-Medical Factors Contributing to Chronicity PART II: MUSCULOSKELETAL DISORDERS Section A: The Spine Chapter 3: Neck 3a. Epidemiology: Incidence, Prevalence, Risk Factors 3b. Biomechanics of the Cervical & Thoracic Spine 3c. Evaluation 3d. Treatment Options 3e. Workplace Adaptations with Case Studies Chapter 4: Lower Back 4a. Epidemiology. Incidence, Prevalence, Risk Factors 4b. Biomechanics of the Lumbar Spine 4c. Evaluation 4d. Treatment Options 4e. Workplace Adaptations with Case Studies Section B: The Upper Extremity Chapter 5: Shoulder and Elbow 5a. Epidemiology. Incidence, Prevalence, Risk Factors 5b. Biomechanics of the Shoulder Complex and Elbow 5c. Evaluation 5d. Treatment Options 5e. Workplace Adaptations with Case Studies Chapter 6: Wrist and Hand 6a. Epidemiology. Incidence, Prevalence, Risk Factors 6b. Biomechanics of the Wrist and Hand 6c Evaluation 6d. Treatment Options 6e. Workplace Adaptations with Case Studies Section C: The Lower Extremity Chapter 7: Hip and Knee 7a. Epidemiology. Incidence, Prevalence, Risk Factors 7b. Biomechanics of the Lower Extremity 7c. Evaluation 7d. Treatment Options 7e. Workplace Adaptations with Case Studies Chapter 8: Ankle and Foot 8a. Epidemiology. Incidence, Prevalence, Risk Factors 8b. Biomechanics of the Ankle and Foot 8c. Evaluation 8d. Treatment Options 8e. Workplace Adaptations with Case Studies PART 3: ABILITY EVALUATION Chapter 9: Functional Capacity Testing Chapter 10: Disability Evaluation
Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis.

CONTEXT Clinical practice guidelines on the management of mineral and bone disorders due to chronic kidney disease recommend specific treatment target levels for serum phosphorus, parathyroid hormone, and calcium. OBJECTIVE To assess the quality of evidence for the association between levels of serum phosphorus, parathyroid hormone, and calcium and risks of death, cardiovascular mortality, and nonfatal cardiovascular events in individuals with chronic kidney disease. DATA SOURCES The databases of MEDLINE (1948 to December 2010) and EMBASE (1947 to December 2010) were searched without language restriction. Hand searches also were conducted of the reference lists of primary studies, review articles, and clinical guidelines along with full-text review of any citation that appeared relevant. STUDY SELECTION Of 8380 citations identified in the original search, 47 cohort studies (N = 327,644 patients) met the inclusion criteria. DATA EXTRACTION The characteristics of study design, participants, exposures, and covariates together with the outcomes of all-cause mortality, cardiovascular mortality, and nonfatal cardiovascular events at different levels of serum phosphorus, parathyroid hormone, and calcium were analyzed within studies. Data were summarized across studies (when possible) using random-effects meta-regression. DATA SYNTHESIS The risk of death increased 18% for every 1-mg/dL increase in serum phosphorus (relative risk [RR], 1.18 [95% confidence interval {CI}, 1.12-1.25]). There was no significant association between all-cause mortality and serum level of parathyroid hormone (RR per 100-pg/mL increase, 1.01 [95% CI, 1.00-1.02]) or serum level of calcium (RR per 1-mg/dL increase, 1.08 [95% CI, 1.00-1.16]). Data for the association between serum level of phosphorus, parathyroid hormone, and calcium and cardiovascular death were each available in only 1 adequately adjusted cohort study. Lack of adjustment for confounding variables was not a major limitation of the available studies. CONCLUSIONS The evidentiary basis for a strong, consistent, and independent association between serum levels of calcium and parathyroid hormone and the risk of death and cardiovascular events in chronic kidney disease is poor. There appears to be an association between higher serum levels of phosphorus and mortality in this population.
Heart failure: the epidemic of the new century.

[Graphic][1] The incidence and prevalence of heart failure has increased importantly over the last decades.1 Major reasons are the ageing population in Western countries, an increasing survival rate after myocardial infarction with remodelling of the left ventricle thereafter, and the increasing incidence and prevalence of hypertension with often suboptimal blood pressure control.2 Over the last years, the current editorial team of the European Heart Journal 3 has devoted several Focus Issues to heart failure, its diagnosis and management, and has published several guidelines related to the aetiology of the condition4–6 and its management.7,8 Due to its importance, the editors of the European Heart Journal will devote the last issue of 2014 again to heart failure. The current state-of-the-art of the work-up of heart failure patients is reviewed in a CURRENT OPINION article entitled ‘ Non-invasive cardiac imaging evaluation of patients with heart failure: a report from the European Association of Cardiovascular Imaging ’9 led by Pasquale Perrone-Filardi from the Federico II University of Naples in Italy. Non-invasive cardiac imaging provides diagnostic, prognostic, and therapeutic information and assists decision-making in patients with heart failure. However, the cost-effectiveness of imaging modalities remains uncertain. The current consensus paper thus provides an … [1]: /embed/inline-graphic-1.gif
Effects of Smoking on ADPKD: Frequency of Vascular Events and Concentrations of Soluble CD40 Ligand

Background: Cardiovascular disease is the leading cause of death among patients with autosomal dominant polycystic kidney disease (ADPKD). Smoking increases inflammation and contributes to cardiovascular disease in the general population. The purpose of this study was to determine the effects of smoking on health outcomes in patients with ADPKD. Methods: The study population included 350 smoking and 371 non-smoking ADPKD patients who participated in studies at the University of Colorado between 1985 and 2001. In addition, outcome data collected between 2011 and 2012 by survey from 159 smoking and 259 non-smoking ADPKD patients was analyzed. The frequency of cardiovascular or cerebrovascular events, age at onset of end stage renal disease, and serum and urine chemistries where available were compared in smoking and non-smoking patients. Serum levels of soluble CD40 ligand measured by ELISA were analyzed in a sub-set of 40 patients matched by age, sex, and renal function. Results: ADPKD smokers from the University of Colorado study cohort had more cardiovascular events and higher urinary protein excretion than ADPKD non-smokers. The ADPKD survey respondents had a higher rate of cerebrovascular events in patients who smoked. Smoking years were associated with increased odds of having a cerebrovascular event. Serum soluble CD40 ligand level was higher in ADPKD patients who smoked compared to non-smoking patients (5293 ± 3168 vs. 3285 ± 2169 pg/mL, P=0.025) indicative of increased inflammation. Conclusions: ADPKD patients who smoke have a higher hazard for cardiovascular and cerebrovascular events and evidence for increased inflammation.
Body mass index and health among the working population- Epidemiologic data from Belgium

Background: The objective of the study was to investigate the distribution of body mass index (BMI; kg/m2) among the working population in Flanders and the Brussels region of Belgium and the association of BMI with gender, age, occupation, smoking, blood pressure and, more specifically, with sick leave. Methods: Routine data on body height and weight were registered in 1994 in a cross-sectional way at periodical medical examination of employees in various industrial sectors. Results for 59,081 male and 47,414 female workers, aged 18–64 years, were registered on an optical form and stored into a database. Results: Descriptive statistics (mean ± SD) for BMI among males were 25.27 ± 3.92 (median = 24.86) and among females 24.03 ± 4.37 (median = 23.13). BMI was ≧25 in 48.5%, ≧30 in 11.1% and ≧40 in 0.3% of the males. Among females a BMI ≧25 was observed in 31.7%, ≧30 in 9.4% and ≧40 among 0.7%. Significant associations were found with age, occupation, smoking, hypertension and sick leave. In both sexes younger persons, clerical workers, smokers and persons with normal systolic or diastolic blood pressure had the lowest BMIs. More prominent in females, a trend of increasing year prevalence of sick leave with increasing BMI group was found. This association was not confounded by age, occupation or other variables in a logistic regression analysis. Conclusions: The high prevalence of a BMI ≧30, more pronounced in male than in female employees, needs further investigation. In addition, the cross-sectional association with sick leave needs confirmation in prospective studies.