Miracle-dz/UniFAR-FTUs huggingface dataset:
Age and sex differences in general practice benzodiazepine prescription in United Kingdom

guidelines (GUI, 1993; Stanley & Doyle, 1993). Prescribing above BNF recommended maximum daily doses was of particular concern (6.5% and 50% of patients respectively). As results from these audits may not relate to the majority of psychiatric in-patients, we examined the pre scribing of antipsychotic medication in a general psychiatric hospital over a 24 hour period in 1993. A similar audit had been performed two years previously. Of 77 in-patients in general psychiatry wards, 55 received an antipsychotic medication. One patient received more than the BNF recom mended maximum daily dose and two others could have done if all prescribed PRN doses were given. Six patients received more than one antipsychotic; two by more than one route. Of 42 in-patients in old age psychiatry wards (functional mental illness), 21 received antipsychotic medication. None were given or pre scribed over BNF recommended maximum daily doses although there are often no specific guidelines for elderly people. Three patients re ceived more than one type of oral antipsychotic medication. Two years previously, 63 of 113 general and old age psychiatry in-patients received antipsychotics over a similar 24 hour period. One patient received an antipsychotic over recom mended BNF limits. Eleven received more than one antipsychotic medication; seven by more than one route. Prescription of antipsychotic medication in excess of BNF guidelines is not common in this general psychiatric hospital set ting (<1%), perhaps because of the addition of benzodiazepines for sedation or lower doses of more than one antipsychotic. Although both practices are probably safer alternatives, it is not clear how to assess the risk of using multiple neuroleptics. 'Chlorpromaztne equivalents' are often used
Alarming signs of serious infections in febrile children: Studies in primary care and hospital emergency care

__Abstract__ Children constitute a substantial part of the workload of physicians in primary care and hospital emergency care. In the Netherlands, about 70% of the 3.9 million inhabitants less than 20 years of age had one or more contacts with their general practitioner (GP) in 2011. Primary out-ofhours care is annually visited by approximately 600,000 children younger than 14 years of age and hospital emergency departments (EDs) by nearly 400,000 children in this age group. Fever is one of the most common reasons for children to consult a physician. The incidence of fever as a reason for contacting primary care is approximately 430 per 1,000 patients/year under the age of 5 years. The overall incidence rate of the diagnosis of fever (without apparent source) in primary care is 19.2 per 1,000 patients/year, with the highest rate for children less than one year (100 per 1,000 patients/year) and the lowest rate for children aged 10 to 17 years (2.7 per 1,000 patients/year). At the ED, fever is also one of the main presenting problems and accounts for about 10% to 30% of all visits by children. Most acute febrile illnesses are caused by self-limiting viral infections, which do not require antibiotic treatment, diagnostic procedures, or hospitalization. However, a minority of febrile children develop a serious infection, such as meningitis, sepsis, pneumonia or urinary tract infection, for which timely diagnosis and targeted therapy are necessary to prevent harm. In primary care, the annual incidence of serious infections is about 1%, with a peak incidence rate among the youngest children (0 to 4 years: 21.1 per 1,000 patients/year). At the hospital ED about 15% to 20% of febrile children are diagnosed with a serious infection. Serious infections are an important cause of morbidity and mortality, especially in young children. Infections accounted for about 15% to 20% of all childhood deaths by natural cause in the Netherlands and the United Kingdom.
REVIEW ON SIDDHAMANTRA WITH SPECIAL REFERENCE TO PITTAGHNA VARGA

Siddhamantra , the Nighantu of early 13 th century AD, written by Vaidyacharya Kesava is now a forgotten work among the lexicons of Indian Materia Medica. Kesava has adopted a reverse method of describing the drugs in this Nighantu . In Siddh amantra the drugs have been arranged according to effect on Dosas. Rasa, Veerya, Vipaka have to be inferred on this basis. Literary research on Siddhamantra was carried out using all available literatures in Dravyagunashastra and clarified with Vopadeva’s Prakasha commentary. Objectives of the stud y we re to establish known botanical source of the medicinal plants mentioned in Siddhamantra through profound literary research, analysing the mode of classification of the drugs in
Relationships More Important than Money? A Study of What Keeps Teachers Going When the Going Get Tough.

The purpose of this study was to compare two large school districts to national studies on what teachers believe is good and bad about their jobs and what affects a decision to stay at or leave a position. The study consisted of five interviews of special education teachers in varying positions, backgrounds, and years of experience. Data was collected using a series of open-ended questions and then compared to researched literature. Although several common themes were found, there were several significant differences. Implications for findings were discussed. It was suggested that fostering positive relationships among teachers in a district can have a significant affect on teacher retention.
Assessment of willingness to pay for expanded carrier screening among women and couples undergoing preconception carrier screening

Background Expanded carrier screening can provide risk information for numerous conditions. Understanding how individuals undergoing preconception expanded carrier screening value this information is important. The NextGen study evaluated the use of genome sequencing for expanded carrier screening and reporting secondary findings, and we measured participants’ willingness to pay for this approach to understand how it is valued by women and couples planning a pregnancy. Methods We assessed 277 participants’ willingness to pay for genome sequencing reporting carrier results for 728 gene/condition pairs and results for 121 secondary findings. We explored the association between attitudes and demographic factors and willingness to pay for expanded carrier screening using genome sequencing and conducted interviews with 58 of these participants to probe the reasoning behind their preferences. Results Most participants were willing to pay for expanded carrier screening using genome sequencing. Willingness to pay was associated with income level and religiosity, but not risk status for a condition in the carrier panel. Participants willing to pay nothing or a small amount cited issues around financial resources, whereas those willing to pay higher amounts were motivated by “peace of mind” from carrier results. Conclusion Women and couples planning a pregnancy value genome sequencing. The potentially high out-of-pocket cost of this service could result in healthcare disparities, since maximum amounts that participants were willing to pay were higher than a typical copay and related to income.
Association of current and former smoking with body mass index: A study of smoking discordant twin pairs from 21 twin cohorts

Background Smokers tend to weigh less than never smokers, while successful quitting leads to an increase in body weight. Because smokers and non-smokers may differ in genetic and environmental family background, we analysed data from twin pairs in which the co-twins differed by their smoking behaviour to evaluate if the association between smoking and body mass index (BMI) remains after controlling for family background. Methods and findings The international CODATwins database includes information on smoking and BMI measured between 1960 and 2012 from 156,593 twin individuals 18–69 years of age. Individual-based data (230,378 measurements) and data of smoking discordant twin pairs (altogether 30,014 pairwise measurements, 36% from monozygotic [MZ] pairs) were analysed with linear fixed-effects regression models by 10-year periods. In MZ pairs, the smoking co-twin had, on average, 0.57 kg/m2 lower BMI in men (95% confidence interval (CI): 0.49, 0.70) and 0.65 kg/m2 lower BMI in women (95% CI: 0.52, 0.79) than the never smoking co-twin. Former smokers had 0.70 kg/m2 higher BMI among men (95% CI: 0.63, 0.78) and 0.62 kg/m2 higher BMI among women (95% CI: 0.51, 0.73) than their currently smoking MZ co-twins. Little difference in BMI was observed when comparing former smoking co-twins with their never smoking MZ co-twins (0.13 kg/m2, 95% CI 0.04, 0.23 among men; -0.04 kg/m2, 95% CI -0.16, 0.09 among women). The associations were similar within dizygotic pairs and when analysing twins as individuals. The observed series of cross-sectional associations were independent of sex, age, and measurement decade. Conclusions Smoking is associated with lower BMI and smoking cessation with higher BMI. However, the net effect of smoking and subsequent cessation on weight development appears to be minimal, i.e. never more than an average of 0.7 kg/m2.
Perception about HIV testing among women attending antenatal clinics at Primary Health Centres in Osogbo, Southwest, Nigeria

As PMTCT services are being decentralized to primary health centres, it becomes important to understand the disposition of clients at this level to HIV counselling and testing (HCT) in order to design targeted programs. This study aimed to examine the perception about HIV testing among ante-natal clinic clients at primary health centres (PHC) in Osogbo, Southwest, Nigeria. This is a cross-sectional descriptive study. All 270 consenting pregnant women that attended antenatal booking clinic in three selected PHCs in Osogbo, between May 2009 and October 2010 were included in the study. 193 (71.5%) were aware of HCT, however, only 26.3% knew their HIV status, and the reasons for testing included; desire to know status (28, 39.4%), request by the church before wedding (11.3%), when very ill (42.3%) and other reasons (5.6%). Majority of the respondents (260, 96.3%) were willing to do the test after counselling, but only if treatment was available for positive cases (46.5%) and if anonymity is strictly maintained (16.9%). The major reason given by the respondents who were not willing to carry out the test, was that they were not at risk (7, 70.0%). Willingness to test was found to have a statistically significant relationship with specific MTCT-related knowledge (t = 2.431, p = 0.034). The level of awareness of respondents about HIV/AIDS, prevent the mother-to-child transmission of HIV (PMTCT) and HIV counselling and testing (HCT) was high among the respondents, however very few knew their HIV status. It is recommended that HIV educational activities should target special groups such as pregnant women attending PHCs and should address the challenges peculiar to these groups. Keywords: HIV/AIDS, prevent the mother-to-child transmission of HIV (PMTCT), HIV counselling and testing, pregnant women, antenatal clinic, perception.
Glucagon and Amino Acids Are Linked in a Mutual Feedback Cycle: The Liver–α-Cell Axis

Glucagon is usually viewed as an important counterregulatory hormone in glucose metabolism, with actions opposing those of insulin. Evidence exists that shows glucagon is important for minute-to-minute regulation of postprandial hepatic glucose production, although conditions of glucagon excess or deficiency do not cause changes compatible with this view. In patients with glucagon-producing tumors (glucagonomas), the most conspicuous signs are skin lesions (necrolytic migratory erythema), while in subjects with inactivating mutations of the glucagon receptor, pancreatic swelling may be the first sign; neither condition is necessarily associated with disturbed glucose metabolism. In glucagonoma patients, amino acid turnover and ureagenesis are greatly accelerated, and low plasma amino acid levels are probably at least partly responsible for the necrolytic migratory erythema, which resolves after amino acid administration. In patients with receptor mutations (and in knockout mice), pancreatic swelling is due to α-cell hyperplasia with gross hypersecretion of glucagon, which according to recent groundbreaking research may result from elevated amino acid levels. Additionally, solid evidence indicates that ureagenesis, and thereby amino acid levels, is critically controlled by glucagon. Together, this constitutes a complete endocrine system; feedback regulation involving amino acids regulates α-cell function and secretion, while glucagon, in turn, regulates amino acid turnover.
I. ANTIFIBRINOLYSIN AND ANTISTREPTOLYSIN RESPONSE

Although the immunologic response to infection with the beta hemolytic streptococcus has interested investigators for many years, they have encountered technical difficulty because of the variability of the response with different strains when determined by means of precipitation, agglutination or complement-fixation tests. The recent development of technics for the determination of the streptococcic antihemolysin titer and antifibrinolytic property of blood has made it possible to reconsider the problem by employing methods which are not seriously influenced by differences between strains of organisms in the host and in the test tube, provided the organisms are of human origin. It has long been recognized that there is a substance in the filtrates of cultures of hemolytic streptococci which causes disintegration of red blood cells.1It was subsequently observed that the hemolytic action of such filtrates could be inhibited by the blood of laboratory animals and man under certain conditions.2 Despite
Priming Effect of a Morning Meal on Hepatic Glucose Disposition Later in the Day

We used hepatic balance and tracer ([3H]glucose) techniques to examine the impact of “breakfast” on hepatic glucose metabolism later in the same day. From 0–240 min, 2 groups of conscious dogs (n = 9 dogs/group) received a duodenal infusion of glucose (GLC) or saline (SAL), then were fasted from 240–360 min. Three dogs from each group were euthanized and tissue collected at 360 min. From 360–600 min, the remaining dogs underwent a hyperinsulinemic (4× basal) hyperglycemic clamp (arterial blood glucose 146 ± 2 mg/dL) with portal GLC infusion. The total GLC infusion rate was 14% greater in dogs infused with GLC than in those receiving SAL (AUC360–600min 2,979 ± 296 vs. 2,597 ± 277 mg/kg, respectively). The rates of hepatic glucose uptake (5.8 ± 0.8 vs. 3.2 ± 0.3 mg ⋅ kg−1 ⋅ min−1) and glycogen storage (4.7 ± 0.6 vs. 2.9 ± 0.3 mg ⋅ kg−1 ⋅ min−1) during the clamp were markedly greater in dogs receiving GLC compared with those receiving SAL. Hepatic glycogen content was ∼50% greater, glycogen synthase activity was ∼50% greater, glycogen phosphorylase activity was ∼50% lower, and the amount of phosphorylated glycogen synthase was 34% lower, indicating activation of the enzyme, in dogs receiving GLC compared with those receiving SAL. Thus, morning GLC primed the liver to extract and store more glucose in the presence of hyperinsulinemic hyperglycemia later in the same day, indicating that breakfast enhances the liver’s role in glucose disposal in subsequent same-day meals.
A 12-Week Low-Calorie Diet plus Behavioral Modification Acutely Improves Glycemic Parameters in Type 2 Diabetes Mellitus

Background: This study sought to determine the effect of a 12-week low-calorie diet (LCD) and behavioral modification program on fasting plasma glucose (FPG) levels, glycated hemoglobin (GHb) levels, use of hypoglycemic agents, and change in glycemic parameters in an overweight or obese population with type 2 diabetes mellitus. Methods: This was a retrospective review of 129 participants with type 2 diabetes. Logistic regression analysis was conducted to explore predictors associated with improvement in glycemic parameters. Results: FPG decreased from 7.77 ± 2.62 mmol/l at baseline to 6.66 ± 1.93 mmol/l after 12 weeks (p=0.0013). GHb decreased from 7.34 ± 1.38% at baseline to 6.55 ± 0.95% after 12 weeks (p 7.0% to achieve optimal glycemic parameters after 12 weeks (OR 4.6, 95% CI [1.4,15.7]). Conclusions: A 12-week low-calorie diet combined with a behavioral modification program is effective in reducing FPG, GHb, and use of hypoglycemic agents and it is associated with acute improvement in glycemic parameters in obese subjects with type 2 diabetes mellitus.mechanisms controlling skeletal muscle mass to that of the lean, while reducing body mass.
Hyperlipidemia-Induced MicroRNA-155-5p Improves β-Cell Function by Targeting Mafb

A high-fat diet increases bacterial lipopolysaccharide (LPS) in the circulation and thereby stimulates glucagon-like peptide 1 (GLP-1)–mediated insulin secretion by upregulating interleukin-6 (IL-6). Although microRNA-155-5p (miR-155-5p), which increases IL-6 expression, is upregulated by LPS and hyperlipidemia and patients with familial hypercholesterolemia less frequently develop diabetes, the role of miR-155-5p in the islet stress response to hyperlipidemia is unclear. In this study, we demonstrate that hyperlipidemia-associated endotoxemia upregulates miR-155-5p in murine pancreatic β-cells, which improved glucose metabolism and the adaptation of β-cells to obesity-induced insulin resistance. This effect of miR-155-5p is because of suppression of v-maf musculoaponeurotic fibrosarcoma oncogene family, protein B, which promotes β-cell function through IL-6–induced GLP-1 production in α-cells. Moreover, reduced GLP-1 levels are associated with increased obesity progression, dyslipidemia, and atherosclerosis in hyperlipidemic Mir155 knockout mice. Hence, induction of miR-155-5p expression in β-cells by hyperlipidemia-associated endotoxemia improves the adaptation of β-cells to insulin resistance and represents a protective mechanism in the islet stress response.
The role of heart rate and the benefits of heart rate reduction in acute myocardial ischaemia

In myocardial ischaemia, detailed analyses of experimental data show that regional myocardial blood flow and contractile function are reduced proportionately—this being contrary to the common notion that the underlying pathological mechanism is a supply/ demand imbalance. Such perfusion–contraction matching is maintained at an increased heart rate. In the normal myocardium, metabolic regulation prevails and tachycardia results in an increased coronary blood flow. In post-stenotic myocardium that has an exhausted dilator reserve, a reduction in diastolic duration prevails, and coronary blood flow is decreased with tachycardia. In the presence of collaterals, both metabolic vasodilation of the normal microcirculation and reduced diastolic duration act in concert to decrease collateral perfusion pressure and collateral flow into the post-stenotic coronary microcirculation. Tachycardia results from sympathetic activation and activation of beta-adrenoceptors. Accordingly, beta-adrenergic blockers have been used to treat patients with stress-induced myocardial ischaemia. The benefits of heart rate reduction by beta-blockade are in part counterbalanced by unmasked alpha-adrenergic coronary vasoconstriction. Selective heart rate-reducing agents can decrease heart rate without unmasking alpha-adrenergic coronary vasoconstriction. They improve the blood flow distribution into the ischaemic myocardium and, as a consequence, improve regional myocardial function. Ivabradine is the only clinically available selective heart rate-reducing agent, and it exerts anti-ischaemic actions in patients with chronic stable angina.
Diagnosis and treatment of essential tremor

SUMMARY Essential tremor (ET) is one of the most prevalent movement disorders in the world, affecting millions of people. Medications that are commonly used to treat ET include antiepileptic or antihypertensive medications. Primidone and propranolol are considered effective, first-line agents for treating ET, while atenolol, alprazolam and topiramate are considered second-line agents. Gabapentin appears to improve ET when used as a monotherapy, although not as an adjunct therapy. Alternatives to pharmacologic treatment for refractory ET include botulinum toxin A injections, deep-brain stimulation of the ventral intermediate nucleus of the thalamus and thalamotomy. Future developments in the treatment of ET will depend on valid animal models and a greater understanding of its pathophysiology.
EFFECTS OF THE CALCIUM CHANNEL BLOCKER BENIDIPINE ON MEMBRANE FLUIDITY OF ERYTHROCYTES IN SUBJECTS WITH ESSENTIAL HYPERTENSION: AN ELECTRON PARAMAGNETIC RESONANCE STUDY

1 In the present study, the effects of benidipine, a long‐acting Ca channel blocker, on the membrane fluidity of erythrocytes in subjects with essential hypertension were examined using an electron paramagnetic resonance (EPR) and spin‐labelling method. 2 Erythrocyte membrane fluidity was significantly lower in hypertensive than normotensive subjects. 3 Benidipine increased the membrane fluidity of erythrocytes from both hypertensive and normotensive subjects in a dose‐dependent manner. The effect of benidipine was more pronounced in hypertensive subjects than in normotensive subjects. 4 The results of the present study suggest that benidipine may have a beneficial effect on the rheological behaviour and the improvement of the microcirculation in hypertension.
Nuclear Factor-κB Induction by Visfatin in Human Vascular Endothelial Cells

OBJECTIVE—Visfatin is elevated in obesity and type 2 diabetes and is thought to be an inflammatory mediator within atherosclerotic lesions and to induce gelatinase activity. We investigated the activation of nuclear factor-κB (NF-κB), a well-known proinflammatory transcription factor, by visfatin in endothelial cells. RESEARCH DESIGN AND METHODS—Human endothelial cells were transfected with pNF-κB-Luc plasmid. Using quantitative PCR, Western blot analysis, and gelatin zymography, we studied NF-κB signaling in gelatinase-mediated vascular inflammation by visfatin using the NF-κB inhibitor BAY 11-7085. RESULTS—Visfatin significantly increased NF-κB transcriptional activity (P < 0.001). We also found a significant inhibition of tumor necrosis factor-α (TNF-α)-induced NF-κB activity by visfatin (P < 0.001). Furthermore, the NF-κB inhibitor significantly negated visfatin-induced matrix metalloproteinase (MMP)-2/9 mRNA expression, protein levels, and gelatinolytic activity (P < 0.001). CONCLUSIONS—Visfatin-induced NF-κB signaling in human endothelial cells affects the activation of gelatinases MMP-2 and -9, suggesting an important role of visfatin in the pathogenesis of vascular inflammation in obesity and type 2 diabetes.