Miracle-dz/UniFAR-FTUs huggingface dataset:
Threats to biodiversity from cumulative human impacts in one of North America's last wildlife frontiers

Land‐use change is the largest proximate threat to biodiversity yet remains one of the most complex to manage. In British Columbia (BC), where large mammals roam extensive tracts of intact habitat, continued land‐use development is of global concern. Extant mammal diversity in BC is unrivalled in North America owing, in part, to its unique position at the intersection of alpine, boreal, and temperate biomes. Despite high conservation values, understanding of cumulative ecological impacts from human development is limited. Using cumulative‐effects‐assessment (CEA) methods, we assessed the current human footprint over 16 regional ecosystems and 7 large mammal species. Using historical and current range estimates of the mammals, we investigated impacts of human land use on species’ persistence. For ecosystems, we found that bunchgrass, coastal Douglas fir, and ponderosa pine have been subjected to over 50% land‐use conversion, and over 85% of their spatial extent has undergone either direct or estimated indirect impacts. Of the mammals we considered, wolves were the least affected by land conversion, yet all species had reduced ranges compared with historical estimates. We found evidence of a hard trade‐off between development and conservation, most clearly for mammals with large distributions and ecosystems with high levels of conversion. Rather than serve as a platform to monitor species decline, we strongly advocate these data be used to inform land‐use planning and to assess current conservation efforts. More generally, CEAs offer a robust tool to inform wildlife and habitat conservation at scale.
Akciğer Kanserinde F-18-FDG PET ve PET/BT'nin Rolü

Pozitron emisyon tomografi (PET), kan akimi, oksijen tuketimi ve glukoz metabolizmasi gibi vucut fonksiyonlarini goruntulemede cok degerlidir. PET goruntuleme, bilgisayarli tomografi (BT) ile birlestirildiginde dogru anatomik lokalizasyonla birlikte metabolik aktivitenin yuksek duyarlilikla tesbit edilmesini saglar. Glukoz analogu F-18- FDG ile yapilan PET/BT, kanserli hastalarin goruntulenmesinde en onemli tetkiklerden biri olmustur. F-18-FDG PET/BT, onkolojik hastaliklarin ayirici tanisinda, evrelemede ve tedavi cevabini degerlendirmede degerli bilgiler saglar. Akciger kanseri dunyada kadin ve erkeklerde en sik olume neden olan malign hastaliktir. Bu makalede, F-18-FDG PET ve F-18-FDG PET/BT'nin akciger kanserlerindeki rolu gozden gecirilecektir.
Combined modality treatment for early-stage Hodgkin’s lymphoma: the GHSG experience

The prognosis of patients has substantially improved over the last decades. Currently, approximately 80% of all patients remain disease free 5 years after treatment.1 On the basis of clinical staging and risk factors as listed in Table 1 patients with Hodgkin lymphoma (HL) are usually classified into early favourable stages (CS 1-2 without risk factors), early-unfavorable stages (CS I-II with risk factors) or advanced stages. Here, we report on the experience of the GHSG and others in the treatment of early favourable and unfavourable HL.
Lessons from Białowieża Forest on the history of protection and the world's first reintroduction of a large carnivore

Understanding how the relationships between large carnivores and humans have evolved and have been managed through centuries can provide relevant insights for wildlife conservation. The management history of many large carnivores has followed a similar pattern, from game reserved for nobility, to persecuted pests, to conservation targets. We reconstructed the history of brown bear (Ursus arctos) management in Białowieża Forest (Poland and Belarus) based on a detailed survey of historical literature and Russian archives. From the end of the Middle Ages to the end of 18th century, the brown bear was considered “animalia superiora” (i.e., game exclusively reserved for nobility and protected by law). Bears, also a source of public entertainment, were not regarded as a threat. Effective measures to prevent damages to traditional forest beekeeping were already in practice. In the beginning of 19th century, new game‐management approaches allowed most forest officials to hunt bears, which became the primary target of hunters due to their valuable pelt. This, together with an effective anticarnivore policy enhanced by bounties, led to bear extirpation in 1879. Different approaches to scientific game management appeared (planned extermination of predators and hunting levels that would maintain stable populations), as did the first initiatives to protect bears from cruel treatment in captivity. Bear reintroduction in Białowieża Forest began in 1937 and represented the world's first reintroduction of a large carnivore motivated by conservation goals. The outbreak of World War II spoiled what might have been a successful project; reproduction in the wild was documented for 8 years and bear presence for 13. Soft release of cubs born in captivity inside the forest but freely roaming with minimal human contact proved successful. Release of captive human‐habituated bears, feeding of these bears, and a lack of involvement of local communities were weaknesses of the project. Large carnivores are key components of ecosystem‐function restoration, and site‐specific histories provide important lessons in how to preserve them for the future.
Will this patient develop persistent disabling low back pain?

CONTEXT Low back pain is extremely common. Early identification of patients more likely to develop persistent disabling symptoms could help guide decisions regarding follow-up and management. OBJECTIVE To systematically review the usefulness of individual risk factors or risk prediction instruments for identifying patients more likely to develop persistent disabling low back pain. DATA SOURCES Electronic searches of MEDLINE (1966-January 2010) and EMBASE (1974-February 2010) and review of the bibliographies of retrieved articles. STUDY SELECTION Prospective studies of patients with fewer than 8 weeks of low back pain from which likelihood ratios (LRs) were calculated for prediction of persistent disabling low back pain for findings attainable during the clinical evaluation. DATA EXTRACTION Two authors independently assessed studies and extracted data to estimate LRs. DATA SYNTHESIS A total of 20 studies evaluating 10,842 patients were identified. Presence of nonorganic signs (median [range] LR, 3.0 [1.7-4.6]), high levels of maladaptive pain coping behaviors (median [range] LR, 2.5 [2.2-2.8]), high baseline functional impairment (median [range] LR, 2.1 [1.2-2.7]), presence of psychiatric comorbidities (median [range] LR, 2.2 [1.9-2.3]), and low general health status (median [range] LR, 1.8 [1.1-2.0]) were the most useful predictors of worse outcomes at 1 year. Low levels of fear avoidance (median [range] LR, 0.39 [0.38-0.40]) and low baseline functional impairment (median [range] LR, 0.40 [0.10-0.52]) were the most useful items for predicting recovery at 1 year. Results were similar for outcomes at 3 to 6 months. Variables related to the work environment, baseline pain, and presence of radiculopathy were less useful for predicting worse outcomes (median LRs approximately 1.5), and a history of prior low back pain episodes and demographic variables were not useful (median LRs approximately 1.0). Several risk prediction instruments were useful for predicting outcomes, but none were extensively validated, and some validation studies showed LRs similar to estimates for individual risk factors. CONCLUSION The most helpful components for predicting persistent disabling low back pain were maladaptive pain coping behaviors, nonorganic signs, functional impairment, general health status, and presence of psychiatric comorbidities.
Spinal cord stimulation in neuropathic pain technical aspects and effectiveness

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Thin-cap fibroatheroma and microchannel findings in optical coherence tomography correlate with subsequent progression of coronary atheromatous plaques.

AIMS Morphological characteristics of non-significant coronary plaques (NSCPs) that develop rapid progression have not been fully elucidated. The aim of this study was to clarify the morphological characteristics of NSCPs in patients with coronary artery disease (CAD) using intravascular optical coherence tomography (OCT). METHODS AND RESULTS Fifty-three consecutive CAD patients undergoing percutaneous coronary intervention were enrolled and 69 NSCPs (per cent diameter stenosis <50%) were identified on baseline angiogram. Baseline characteristics of NSCPs were evaluated by OCT, and patients were followed-up prospectively. At the second coronary angiography, the baseline OCT characteristics and plaque progression were correlated. During the 7-month follow-up period, 13 NSCPs showed angiographic progression and 56 NSCPs did not. Baseline minimum lumen diameter and diametric stenosis were similar between NSCPs with and without progression. Compared with NSCPs without progression, those with progression showed a significantly higher incidence of intimal laceration (61.5 vs. 8.9%, P < 0.01), microchannel (76.9 vs. 14.3%, P < 0.01), lipid pools (100 vs. 60.7%, P = 0.02), thin-cap fibroatheroma (TCFA) (76.9 vs. 14.3%, P < 0.01), macrophage images (61.5 vs. 14.3%, P < 0.01), and intraluminal thrombi (30.8 vs. 1.8%, P < 0.01). Univariate regression analysis showed that TCFA and microchannel images showed high correlation with subsequent luminal progression [odds ratio (OR): 20.0, P < 0.01 and OR: 20.0, P < 0.01, respectively]. CONCLUSION Optical coherence tomography-based complex characteristics of TCFA and microchannel were the potential predictors of subsequent progression of NSCPs in patients with CAD.
Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States.

CONTEXT Early data on pandemic 2009 influenza A(H1N1) suggest pregnant women are at increased risk of hospitalization and death. OBJECTIVE To describe the severity of 2009 influenza A(H1N1) illness and the association with early antiviral treatment among pregnant women in the United States. DESIGN, SETTING, AND PATIENTS Surveillance of 2009 influenza A(H1N1) in pregnant women reported to the Centers for Disease Control and Prevention (CDC) with symptom onset from April through December 2009. MAIN OUTCOME MEASURES Severity of illness (hospitalizations, intensive care unit [ICU] admissions, and deaths) due to 2009 influenza A(H1N1) among pregnant women, stratified by timing of antiviral treatment and pregnancy trimester at symptom onset. RESULTS We received reports on 788 pregnant women in the United States with 2009 influenza A(H1N1) with symptom onset from April through August 2009. Among those, 30 died (5% of all reported 2009 influenza A[H1N1] influenza deaths in this period). Among 509 hospitalized women, 115 (22.6%) were admitted to an ICU. Pregnant women with treatment more than 4 days after symptom onset were more likely to be admitted to an ICU (56.9% vs 9.4%; relative risk [RR], 6.0; 95% confidence interval [CI], 3.5-10.6) than those treated within 2 days after symptom onset. Only 1 death occurred in a patient who received treatment within 2 days of symptom onset. Updating these data with the CDC's continued surveillance of ICU admissions and deaths among pregnant women with symptom onset through December 31, 2009, identified an additional 165 women for a total of 280 women who were admitted to ICUs, 56 of whom died. Among the deaths, 4 occurred in the first trimester (7.1%), 15 in the second (26.8%), and 36 in the third (64.3%); CONCLUSIONS Pregnant women had a disproportionately high risk of mortality due to 2009 influenza A(H1N1). Among pregnant women with 2009 influenza A(H1N1) influenza reported to the CDC, early antiviral treatment appeared to be associated with fewer admissions to an ICU and fewer deaths.
Toda fibrilación auricular sin cardiopatía debe ser tratada con ablación

El 10% a 30% de los pacientes portadores de fibrilación auricular (FA) no presentan cardiopatía estructural o tienen alguna comorbilidad como la hipertensión arterial. Es la arritmia más frecuente con la que lidiamos a diario y que debemos tratar en forma individual debido a la diversidad de situaciones en que se presenta. En varios estudios poblacionales se asocia con mayor morbimortalidad, genera peor calidad de vida y es la arritmia que precipita el mayor número de internaciones con un importante gasto en salud. La terapia de ablación avanza a paso constante para tratar de curar la FA. Su indicación lentamente se va expandiendo de la mano del mayor conocimiento fisiopatológico, las notables mejoras tecnológicas y los mejores resultados. En el registro español de 2007, 1 de cada 10 ablaciones era por FA y actualmente es la ablación más común en centros de referencia en los Estados Unidos. ¿Como se ha llegado a esto?
Glucose Intolerance in Subclinical Hyperthyroid Patients

Introduction: In overt hyperthyroidism, although impaired glucose tolerance has long been observed as a frequent complication, the impact of subclinical hyperthyroidism on glucose metabolism is unclear. Therefore, we compared glucose tolerance tests in patients with subclinical hyperthyroidism and a group of healthy controls. Materials and Methods: Forty- five patients with a drug history of therapy with Levothyroxine and 14 healthy controls were enrolled and T4, T3, T3RU, TSH were measured prior to and TSH again after intravenous injection of 250 µg TRH. Oral glucose tolerance test was performed after 7 to 11 days. The data obtained for patients with subclinical hyperthyroidism and euthyroid healthy controls were compared. Results: Twenty-five patients and one control had subclinical hyperthyroidism based on basal TSH. Basal glucose concentrations were not significantly different between the subclinical hyperthyroidism and euthyroidism group. Plasma glucose levels (milligrams per dl ± SEM) at 90 and 120 minutes after ingestion of glucose were significantly higher (p=0.005 and p=0.06 respectively) in the subclinical hyperthyroid (SHR) patients (162 ± 17, 146 ± 16 respectively) compared to euthyroid (EU) normal subjects(101±7 and 94±5 respectively). SHR patients showed higher postprandial glucose concentrations (area under the curve, AUC90, 120 18072±4779 and 18130±1758 mg/dlmin ± SEM respectively) versus EU normal subjects (AUC90, 120 1045±516, 13360 ± 643 mg/dl min ± SEM, P= 0.026, 0.018 respectively). Conclusion: Subclinical hyperthyroidism results in glucose intolerance despite normal fasting plasma glucose, findings that recommend oral glucose tolerance tests for SHR patients.
Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study.

AIMS The impact of some risk factors for stroke and bleeding, and the value of stroke and bleeding risk scores, in atrial fibrillation (AF), has been debated, as clinical trial cohorts have not adequately tested these. Our objective was to investigate risk factors for stroke and bleeding in AF, and application of the new CHA(2)DS(2)-VASc and HAS-BLED schemes for stroke and bleeding risk assessments, respectively. METHODS AND RESULTS We used the Swedish Atrial Fibrillation cohort study, a nationwide cohort study of 182 678 subjects with a diagnosis of AF at any Swedish hospital between 1 July 2005 and 31 December 2008, who were prospectively followed for an average of 1.5 years (260 000 years at risk). With the use of the National Swedish Drug Registry, all patients who used an oral anticoagulant anytime during follow-up were identified. Most of the analyses were made on a subset of 90 490 patients who never used anticoagulants. Risk factors for stroke, the composite thromboembolism endpoint (stroke, TIA, or systemic embolism), and bleeding, and the performance of published stroke and bleeding risk stratification schemes were investigated. On multivariable analysis, significant associations were found between the following 'new' risk factors and thromboembolic events; peripheral artery disease [hazard ratio (HR) 1.22 (95% CI 1.12-1.32)], 'vascular disease' [HR 1.14 (1.06-1.23)], prior myocardial infarction [HR 1.09 (1.03-1.15)], and female gender [HR 1.17 (1.11-1.22)]. Previous embolic events, intracranial haemorrhage (ICH), hypertension, diabetes, and renal failure were other independent predictors of the composite thromboembolism endpoint, while thyroid disease (or hyperthyroidism) was not an independent stroke risk factor. C-statistics for the composite thromboembolic endpoint with the CHADS(2) and CHA(2)DS(2)-VASc schemes were 0.66 (0.65-0.66) and 0.67 (0.67-0.68), respectively. On multivariable analysis, age, prior ischaemic stroke or thromboembolism, prior major bleeding events, and hypertension were significant predictors of ICH and major bleeding. Heart failure, diabetes, renal failure, liver disease, anaemia or platelet/coagulation defect, alcohol abuse, and cancer were other significant predictors for major bleeding, but not ICH. The ability for predicting ICH and major bleeding with both bleeding risk schemes (HEMORR(2)HAGES, HAS-BLED) were similar, with c-statistics of ~0.6. CONCLUSION Several independent risk factors (prior ICH, myocardial infarction, vascular disease, and renal failure) predict ischaemic stroke and/or the composite thromboembolism endpoint in AF, but thyroid disease (or hyperthyroidism) was not an independent risk factor for stroke. There is a better performance for CHA(2)DS(2)-VASc over CHADS(2) schemes for the composite thromboembolism endpoint. While both tested bleeding risk schemes have similar predictive value, the HAS-BLED score has the advantage of simplicity.
Advances in genetics show the need for extending screening strategies for autosomal dominant hypercholesterolaemia.

Aims Autosomal dominant hypercholesterolaemia (ADH) is a major risk factor for coronary artery disease. This disorder is caused by mutations in the genes coding for the low-density lipoprotein receptor (LDLR), apolipoprotein B (APOB), and proprotein convertase subtilisin/kexin 9 (PCSK9). However, in 41% of the cases, we cannot find mutations in these genes. In this study, new genetic approaches were used for the identification and validation of new variants that cause ADH. Methods and results Using exome sequencing, we unexpectedly identified a novel APOB mutation, p.R3059C, in a small-sized ADH family. Since this mutation was located outside the regularly screened APOB region, we extended our routine sequencing strategy and identified another novel APOB mutation (p.K3394N) in a second family. In vitro analyses show that both mutations attenuate binding to the LDLR significantly. Despite this, both mutations were not always associated with ADH in both families, which prompted us to validate causality through using a novel genetic approach. Conclusion This study shows that advances in genetics help increasing our understanding of the causes of ADH. We identified two novel functional APOB mutations located outside the routinely analysed APOB region, suggesting that screening for mutations causing ADH should encompass the entire APOB coding sequence involved in LDL binding to help identifying and treating patients at increased cardiovascular risk.
Identyfikacja potrzeb szkoleniowych jako istotny obszar działań w zarządzaniu personelem

Inwestycja pracodawcy w szkolenia przynosi ogromne korzyści calej orga nizacji. Przyczynia sie do budowania pozytywnego wizerunku i pozycji na wymagającym wspolczesnym rynku. Zwieksza tez wartośc pracownika na rynku pracy, sprzyjając wzrostowi motywacji i podnosząc wynik samooceny. Jednakze szkolenia są mozliwe tylko dzieki sprawnej i skutecznej realizacji dzialan poprze dzających je, ktorymi to dzialaniami jest wlaśnie identyfikacja potrzeb szkoleniowych. Bez tych dzialan nie jest i nie bedzie mozliwe realizowanie procedury szkolenia i doskonalenia zawodowego pracownikow we wlaściwy sposob i w pel nym tego slowa znaczeniu.
Improving health and health care for persons with serious mental illness: the window for US federal policy change.

IN 1928, BENJAMIN MALZBERG, A YOUNG EPIDEMIOLOgist in New York State’s Division of Mental Hygiene, began a groundbreaking study examining causes of mortality in New York State’s mental hospitals. During the ensuing 3 years, Malzberg reviewed every death that occurred throughout the state’s psychiatric hospital system; his findings were both surprising and troubling. Patients in these hospitals died an average of 15 years younger than the general population of New York State. Malzberg speculated that these excess deaths were likely due to a complex combination of factors:
Balancing hypoglycemia and glycemic control: a public health approach for insulin safety.

The Veterans Administration Diabetes Trial (VADT) study reported rates of hypoglycemic episodes of 432 per 100 patient-years in the standard treatment group and 1566 in the intensive treatment group; episodes with impaired or loss of consciousness were 4 and 12 per 100 patient-years, respectively. Moreover, symptomatic, severe hypoglycemia in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was associated with an increased risk of death in both the standard and intensive treatment groups; however, the adjusted hazard rates (HRs) were lower in the intensive group (HR, 1.41; 95% confidence interval [CI], 1.03-1.93) than in the standard group (HR, 2.30; 95% CI, 1.46-3.65). Overall, the highest mortality rates were seen in patients with 3 or more hypoglycemic events. In a trial comparing basal, biphasic, and prandial insulin regimens added to oral agents, Holman et al reported that the median number of hypoglycemic events was 1.7 in the basal group, 3.0 in the biphasic group, and 5.7 in the prandial group; few events required third-party assistance. Although it was not specified as an outcome, cardiovascular mortality, but not overall mortality, significantly differed among the treatment groups after 3 years and was highest in the prandial group and lowest in the basal group. These studies included only carefully screened volunteers who met study inclusion criteria. The absence of proven causality between hypoglycemia and mortality notwithstanding, the risk and consequences of hypoglycemia are significant in practice. Insulin is the second most common medication associated with serious adverse drug reports to the Food and Drug Administration. From 1998 to 2005, there was a slightly greater than 4-fold increase in reported adverse events. Based on national databases of emergency department visits by persons 65 years and older, 33.3% (95% CI, 27.8%-38.7%) of visits were for adverse events from potentially appropriate medications (warfarin, 17.3%; insulin, 13.0%; and digoxin, 3.2%). An observational study reported that adjusted odds ratios for 1-day mortality for glucose values of less than 50, 50 to 59, and 60 to 69 mg/dL, respectively, vs glucose at or above 70 mg/dL in the outpatient setting were 6.84, 3.28, and 3.98 for patients with chronic kidney disease.