Miracle-dz/UniFAR-FTUs huggingface dataset:
6-minute walk distance is an independent predictor of mortality in patients with idiopathic pulmonary fibrosis

6-min walk distance (6MWD) has recently been shown to be associated with the risk of mortality in patients with idiopathic pulmonary fibrosis (IPF); however, the independent contribution of 6MWD to the prediction of mortality risk has not been evaluated in a large, well-defined population of patients with IPF. A Cox proportional hazards model was used to characterise the relationship between risk factors of interest and all-cause mortality in IPF patients who completed a week 24 study visit in a clinical trial evaluating interferon &ggr;-1b (n=748). Risk factors of interest included the independent predictors of mortality in the previously published clinical prediction model together with 6MWD and 24-week change in 6MWD. Baseline 6MWD <250 m was associated with a two-fold increase in the risk of mortality (hazard ratio 2.12, 95% CI 1.15–3.92) and a 24-week decline in 6MWD >50 m was associated with a nearly three-fold increase in mortality risk (hazard ratio 2.73; 95% CI 1.60–4.66). Inclusion of 6MWD data improved model discrimination compared with the original model (C-statistic 0.80 (95% CI 0.76–0.85) versus 0.75 (0.71–0.79)). Both 6MWD and change in 6MWD are independent predictors of mortality in patients with IPF. The addition of 6MWD to the clinical prediction model improves model discrimination compared with the original model. 6MWD indices independently predict mortality in IPF and improve performance of previous clinical prediction model http://ow.ly/tDdmP
Global strategy for asthma management and prevention: GINA executive summary

Asthma is a serious health problem throughout the world. During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services. Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations. A comprehensive workshop report entitled “A Global Strategy for Asthma Management and Prevention”, first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines. The 2006 report contains important new themes. First, it asserts that “it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained,” and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions. The importance of the patient–care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised.
A micropower log domain FGMOS filter

In this paper, a CMOS implementation of a low voltage micropower logarithmic biquad based on floating gate MOS transistors (FGMOS) is presented. The translinear principle applied to the floating gate MOS transistor leads to an easy implementation of the state-space equations without using the source terminal in the loop. The voltage supply can be reduced and also there is no need of separate wells. The technique is proven in this low/band pass filter working at 1 V with a maximum power consumption of 2 /spl mu/W. The filter parameters can be adjusted in more than two decades, being the upper frequency around 150 kHz.
A processing element architecture for high-density focal plane analog programmable array processors

The architecture of the elementary Processing Element - PE - used in a recently designed 128/spl times/128 Focal Plane Analog Programmable Array Processor is presented. The PE architecture contains the required building blocks to implement bifurcated data flow vision algorithms based on the execution of 3/spl times/3 convolution masks. The vision chip has been implemented in a standard 0.35 /spl mu/m CMOS technology. The main PE related figures are: 180 cells/mm/sup 2/, 18 MOPS/cell, and 180 /spl mu/W/cell.
Global incidence and mortality of idiopathic pulmonary fibrosis: a systematic review

As idiopathic pulmonary fibrosis emerges as an important public health problem, there is a need to coordinate data on incidence and mortality globally. This study aims to systematically assess all available studies to investigate the global burden of disease. Medline and Embase databases were searched systematically for all population-based studies of incidence or mortality of idiopathic pulmonary fibrosis. Clinical case series and prevalence studies were excluded. The search was supplemented using the Google search engine, hand-searching of references and conference abstracts. Data were extracted independently by two authors using a pre-specified proforma, with assessment of methodological quality. 34 studies were identified, providing data from 21 countries from 1968–2012. 28 studies reported incidence data and eight reported mortality data. In studies from the year 2000 onwards, we estimated a conservative incidence range of 3–9 cases per 100 000 per year for Europe and North America. Incidence was lower in East Asia and South America. The majority of studies showed an increase in incidence over time. The incidence of idiopathic pulmonary fibrosis is increasing worldwide and rates are coming together across countries. Current data suggest incidence is similar to that of conditions such as stomach, liver, testicular and cervical cancers. Incidence of IPF varies worldwide but seems to be increasing to rates around 3–9 per 100 000 per year http://ow.ly/KSeMZ
Gender differences in patient-described pain, stress, and anxiety among patients undergoing treatment for painful conditions in the emergency department.

OBJECTIVES The primary objective of this study was to determine whether patient-described pain correlates with patient-described stress, anxiety, and satisfaction with ongoing treatment and if that correlation differs by gender. METHODS This was a prospective observational study at an urban, Level I trauma center conducted between June 1, 2010, and January 1, 2013. Patients reporting pain rated greater than 3 of 10 were eligible. Patients who qualified and consented for participation completed demographic and pain, anxiety, stress, and satisfaction scales at baseline, every 30 minutes, and at discharge. Data were analyzed using analysis of variance, chi-square tests, t-tests, multiple regression, and the Wilcoxon-Mann-Whitney rank test. RESULTS A total of 7,124 patients were screened for enrollment. Of those, 3,495 (49%) did not qualify at screening for various reasons, including insufficient pain levels (17.5%), elected not to participate (37.7%), did not qualify for other reasons (12.4%), and reason not captured (32.4%). A total of 3,629 (51%) screened patients were eligible and consented. Of those, 620 (16.8%) did not have any data collected past baseline, leaving 3,009 as the final sample size. The patients completing data collection had a median age of 39 years (range = 18 to 90 years), and 50% were male. The mean presenting pain visual analog scale (VAS) score was 71.5 mm. Presenting stress and anxiety VAS scores were significantly higher in females (0.61 and 0.53, respectively) than males (0.56 and 0.50, respectively), whereas presenting pain VAS (0.71 male and 0.72 female) and satisfaction VAS (0.34 male and 0.35 female) did not differ by sex. Ethnicity, education, and income were all statistically different when compared with baseline pain, stress, anxiety, and satisfaction. Male gender was associated with a significant change in pain over time from baseline (coefficient = 0.040, p = 0.037); however, when adjusting for age, ethnicity, education, and income, and for changes in stress, anxiety, and satisfaction VAS scores, changes in pain related to male gender was no longer significant (coefficient = 0.034, p = 0.11). When asked about their satisfaction with the results of the pain treatment that had been provided, patients reported a median of 2 (out of 6, 1 = satisfied, 6 = dissatisfied; interquartile range = 1 to 2). There was no significant difference between sexes (p > 0.90). CONCLUSIONS Patient-reported stress and anxiety were higher among female patients than male patients, but there was no significant difference in reported pain and satisfaction between sexes. Sex alone was not a significant predictor of change in pain for patients presenting to the emergency department with pain-related complaints. Anxiety and stress may potentially influence the pain-gender relationship.
Diets that differ in their FODMAP content alter the colonic luminal microenvironment

Objective A low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) diet reduces symptoms of IBS, but reduction of potential prebiotic and fermentative effects might adversely affect the colonic microenvironment. The effects of a low FODMAP diet with a typical Australian diet on biomarkers of colonic health were compared in a single-blinded, randomised, cross-over trial. Design Twenty-seven IBS and six healthy subjects were randomly allocated one of two 21-day provided diets, differing only in FODMAP content (mean (95% CI) low 3.05 (1.86 to 4.25) g/day vs Australian 23.7 (16.9 to 30.6) g/day), and then crossed over to the other diet with ≥21-day washout period. Faeces passed over a 5-day run-in on their habitual diet and from day 17 to day 21 of the interventional diets were pooled, and pH, short-chain fatty acid concentrations and bacterial abundance and diversity were assessed. Results Faecal indices were similar in IBS and healthy subjects during habitual diets. The low FODMAP diet was associated with higher faecal pH (7.37 (7.23 to 7.51) vs 7.16 (7.02 to 7.30); p=0.001), similar short-chain fatty acid concentrations, greater microbial diversity and reduced total bacterial abundance (9.63 (9.53 to 9.73) vs 9.83 (9.72 to 9.93) log10 copies/g; p<0.001) compared with the Australian diet. To indicate direction of change, in comparison with the habitual diet the low FODMAP diet reduced total bacterial abundance and the typical Australian diet increased relative abundance for butyrate-producing Clostridium cluster XIVa (median ratio 6.62; p<0.001) and mucus-associated Akkermansia muciniphila (19.3; p<0.001), and reduced Ruminococcus torques. Conclusions Diets differing in FODMAP content have marked effects on gut microbiota composition. The implications of long-term reduction of intake of FODMAPs require elucidation. Trial registration number ACTRN12612001185853.
Staging of idiopathic pulmonary fibrosis: past, present and future

Idiopathic pulmonary fibrosis (IPF) is traditionally staged with terms such as “mild”, “severe”, “early” and “advanced” based on pulmonary function tests. This approach allows physicians to monitor disease progression and advise patients and their families. However, it is not known if the stages of this model reflect distinct biological or clinical phenotypes and the therapeutic and prognostic value of this system is limited. Novel methods of IPF staging have recently been developed. The GAP model includes four baseline variables that were found to be predictive of outcome, as identified by logistic regression. These factors are: gender (G), age (A) and two lung physiology variables (P) (forced vital capacity and diffusing capacity of the lung for carbon monoxide). The clinical utility and accuracy of staging models may be further improved in the future by the integration of dynamic parameters that can be measured over time, as well as biological data from biomarkers which may be able to directly measure disease activity. The development of an evidence-based, multidimensional IPF staging model that builds on the current staging approaches to IPF is an important objective for improving the management of IPF.
Gastro-oesophageal reflux disease and non-asthma lung disease

Gastro-oesophageal reflux disease (GERD) is a common disorder in Western countries, and its relationship to airways disorders (e.g. asthma) has been well established. Lung diseases other than asthma have also been associated with GERD, but the nature and scope of this relationship has not been fully defined. Diseases that have been associated with GERD include bronchiolitis syndromes, idiopathic pulmonary fibrosis, scleroderma and nontubercular mycobacterial infection. Diagnostic evaluation centres upon proving both reflux and pulmonary aspiration, which may be accomplished in some cases by lung biopsy. However, in many cases a compatible clinical and radiographic picture coupled with proof of proximal reflux by combined oesophageal probe testing may suffice for a provisional diagnosis and allow institution of anti-reflux measures. Proton-pump inhibitors are the medications of choice for GERD; other interventions shown to reduce reflux are weight loss, elevation of the head of the bed and avoidance of recumbency after meals. However, acid suppression therapy does not address non-acid reflux that may be important in disease pathogenesis in select patients, and lifestyle modifications often fail. Laparoscopic fundoplication is the procedure of choice for medically refractory GERD with excellent short-term results with respect to respiratory symptoms associated with GERD; however, long-term studies document a significant percentage of patients requiring ongoing acid suppression therapy.
Sleep disorders in COPD: the forgotten dimension

Sleep in chronic obstructive pulmonary disease (COPD) is commonly associated with oxygen desaturation, which may exceed the degree of desaturation during maximum exercise, both subjectively and objectively impairing sleep quality. The mechanisms of desaturation include hypoventilation and ventilation to perfusion mismatching. The consequences of this desaturation include cardiac arrhythmias, pulmonary hypertension and nocturnal death, especially during acute exacerbations. Coexistence of COPD and obstructive sleep apnoea (OSA), referred to as overlap syndrome, has been estimated to occur in 1% of the general adult population. Overlap patients have worse sleep-related hypoxaemia and hypercapnia than patients with COPD or OSA alone. OSA has a similar prevalence in COPD as in a general population of similar age, but oxygen desaturation during sleep is more pronounced when the two conditions coexist. Management of sleep-related problems in COPD should particularly focus on minimising sleep disturbance via measures to limit cough and dyspnoea; nocturnal oxygen therapy is not generally indicated for isolated nocturnal hypoxaemia. Treatment with continuous positive airway pressure alleviates hypoxaemia, reduces hospitalisation and pulmonary hypertension, and improves survival.
Part five: Breast and bottle feeding in an inner‐city community: An assessment of perceptions and practices

Abstract Breast feeding is least prevalent among the urban poor, the group whose infants stand to gain the most benefit from that practice. To assess attitudes and influences contributing to this low prevalence of nursing, 141 inner‐city mothers were interviewed. One hundred and four (74 percent) bottle fed and thirty‐seven (26 percent) breast fed their younger child. Breast feeders arc generally older, better educated, and report living with a male more often than bottle feeders. Preferences of the child's father are closely correlated with the mother's feeding practice. Women who themselves were breast fed are more likely to nurse their first born, but not subsequent children. Large differences in the prevalence of nursing exist between cultural subgroups within a single community. Women most often bottle fed to avoid embarrassment associated with nursing in public; breast feeders most often nurse for nutritional benefits. Of the breast feeders, 67 percent received verbal approval of plans to nurse from.
New Wnt/β-catenin target genes promote experimental metastasis and migration of colorectal cancer cells through different signals

Objectives We have previously identified a 115-gene signature that characterises the metastatic potential of human primary colon cancers. The signature included the canonical Wnt target gene BAMBI, which promoted experimental metastasis in mice. Here, we identified three new direct Wnt target genes from the signature, and studied their functions in epithelial–mesenchymal transition (EMT), cell migration and experimental metastasis. Design We examined experimental liver metastases following injection of selected tumour cells into spleens of NOD/SCID mice. Molecular and cellular techniques were used to identify direct transcription target genes of Wnt/β-catenin signals. Microarray analyses and experiments that interfered with cell migration through inhibitors were performed to characterise downstream signalling systems. Results Three new genes from the colorectal cancer (CRC) metastasis signature, BOP1, CKS2 and NFIL3, were identified as direct transcription targets of β-catenin/TCF4. Overexpression and knocking down of these genes in CRC cells promoted and inhibited, respectively, experimental metastasis in mice, EMT and cell motility in culture. Cell migration was repressed by interfering with distinct signalling systems through inhibitors of PI3K, JNK, p38 mitogen-activated protein kinase and/or mTOR. Gene expression profiling identified a series of migration-promoting genes, which were induced by BOP1, CKS2 and NFIL3, and could be repressed by inhibitors that are specific to these pathways. Conclusions We identified new direct Wnt/β-catenin target genes, BOP1, CKS2 and NFIL3, which induced EMT, cell migration and experimental metastasis of CRC cells. These genes crosstalk with different downstream signalling systems, and activate migration-promoting genes. These pathways and downstream genes may serve as therapeutic targets in the treatment of CRC metastasis.
Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis

Objective To assess the efficacy and safety of endoscopic resection of large colorectal polyps. Design Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966–2014. Studies in which ≥20 mm colorectal neoplastic lesions were treated with endoscopic resection were included. Rates of postendoscopic resection surgery due to non-curative resection or adverse events, as well as the rates of complete endoscopic removal, invasive cancer, adverse events, recurrence and mortality, were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models. I2 statistic was used to describe the variation across studies due to heterogeneity. Meta-regression analysis was also performed. Results 50 studies including 6442 patients and 6779 large polyps were included in the analyses. Overall, 503 out of 6442 patients (pooled rate: 8%, 95% CI 7% to 10%, I2=78.6%) underwent surgery due to non-curative endoscopic resection, and 31/6442 (pooled rate: 1%, 95% CI 0.7% to 1.4%, I2=0%) to adverse events. Invasive cancer at histology, non-curative endoscopic resection, synchronous lesions and recurrence accounted for 58%, 28%, 2.2% and 5.9% of all the surgeries, respectively. Endoscopic perforation occurred in 96/6595 (1.5%, 95% CI 1.2% to 1.7%) polyps, while bleeding in 423/6474 (6.5%, 95% CI 5.9% to 7.1%). Overall, 5334 patients entered in surveillance, 502/5836 (8.6%, 95% CI 7.9% to 9.3%) being lost at follow-up. Endoscopic recurrence was detected in 735/5334 patients (13.8%, 95% CI 12.9% to 14.7%), being an invasive cancer in 14/5334 (0.3%, 95% CI 0.1% to 0.4%). Endoscopic treatment was successful in 664/735 cases (90.3%, 95% CI 88.2% to 92.5%). Mortality related with management of large polyps was reported in 5/6278 cases (0.08%, 95% CI 0.01% to 0.15%). Conclusions Endoscopic resection of large polyps appeared to be an extremely effective and safe intervention. However, an adequate endoscopic surveillance is necessary for its long-term efficacy.
Achalasia: new diagnostic tests and treatments

Introduction: The past several years have seen exciting breakthroughs leading to a better understanding of the pathogenesis of achalasia, classifying the disease more accurately by high-resolution manometry (HRM), defining better predictors of achalasia treatment success and to the introduction of exciting new treatments. Areas covered: PubMed and the Cochrane library were searched with no date limits for ‘achalasia’ and appropriate treatment modalities. This review summarizes the current state-of-the-art treatment and technology in achalasia. Emphasis is placed on the role of HRM with detailed assessment of lower esophageal sphincter function and peristalsis making it possible to classify achalasia into three subsets. These subsets seem to predict treatment success: type II achalasia does best with any form of treatment, whereas type III may respond better to surgery. The multicenter, randomized controlled European Achalasia Trial now gives us confidence that either pneumatic dilation or surgical myotomy are equivalent treatments for achalasia over a 2-year period. Finally, the novel endoscopic technique of peroral endoscopic myotomy is a promising new incision-less treatment for achalasia, although troubling acid reflux is a potential drawback. Expert opinion: These are exciting times in the diagnosis and treatment of achalasia, which will definitely improve patient treatment outcomes. However, achalasia is never cured, re-treatment may be required over time and there is a slight risk of developing esophageal squamous cancer, particularly in those patients with megaesophagus.
Trust, disruption and responsibility in accounts of injecting equipment sharing and hepatitis C risk

Accounts of health-related risk behaviour are generated in a social context of risk acceptability and moral responsibility. Drawing upon qualitative semi-structured interviews with injecting drug users (IDUs) in Belgrade, Serbia (n = 67) and Podgorica and Bar, Montenegro (n = 32), we explore drug injectors' accounts of sharing injecting equipment, and ‘discriminative’ and ‘exceptional’ sharing specifically, alongside accounts of hepatitis C risk. We find that accounts emphasize discriminative and exceptional sharing as acceptable given the circumstances, with normative syringe sharing presented as unacceptable and irresponsible. Two key themes emerged in descriptions of discriminative and exceptional sharing: ‘trust’ based in social relations, ensuring that sharing took place under ‘reduced risk’ conditions; and ‘disruptions’ to safety routine brought about by accidents, unexpected events, drug withdrawal and the environment. In accounts of environmental disruption, a lack of trust (and blame) was identified in relation to pharmacies and police. Whereas trust accounts justified sharing as reduced risk, disruption accounts accepted risk opportunity but appealed to a denial of agency. In addition, accounts portrayed a general context of risk and uncertainty in relation to hepatitis C, characterized by a lack of trust in knowledge about others' disclosed antibody status, a lack of faith in expert helping systems and confusion about HCV transmission.
Constant-g/sub m/ constant-slew-rate high-bandwidth low-voltage rail-to-rail CMOS input stage for VLSI cell libraries

This paper introduces a general-purpose low-voltage rail-to-rail input stage suitable for analog and mixed-signal applications. The proposed scheme provides, simultaneously, constant small-signal and large-signal behaviors over the entire input common-mode voltage range, whilst imposing no appreciable constraint for high-frequency operation. In addition, the technique does not rely on any strict matching condition between complementary differential pairs, and is compatible with deep submicron CMOS devices, where the familiar voltage-to-current square-law in saturation is not completely satisfied. Experimental results on integrated prototypes are provided.