Miracle-dz/UniFAR-FTUs huggingface dataset:
The Prevalence of Obesity and Its Relation to Physical Activity and Dietary Patterns among Female High School Students of Tehran, Iran

Objective: There are many causes for obesity; inappropriate dietary patterns, inadequate physical activity, and lethargic lifestyle can be mentioned as the main and most important of these causes. Due to the increasing prevalence of obesity in society, it seems necessary to study its causes and find ways to tackle this problem. Materials and Methods: This descriptive-analytical study was conducted on 380 female high school students from district 5 of Tehran, Iran, in 2012. In this research, physical activity was measured using the International Physical Activity Questionnaire (IPAQ), and dietary pattern was measured using the Food Frequency Questionnaire (FFQ). Body mass index (BMI) was also calculated. In addition, for measurement of aerobic and anaerobic powers, the 540-meter sprint and vertical jump test (Sargent Jump Test) were applied. Gathered data was analyzed using SPSS software. Results: The findings of the present study show that 24.7% of the population was overweight and obese, 67% of normal weight (natural), and 8.2% underweight (thin). Chi-square test on breakfast and classification of weight (r = -0.285 and P = 0.002) showed a negative relationship between obesity and eating breakfast. Moreover, it showed a significant positive correlation between watching television and working on the computer, and obesity. Conclusion: According to the results of this research, there is a positive and direct relationship between obesity and lack of exercise and fast food intake (P < 0.05). There is also a positive and direct relationship between physical fitness, and amount of physical activity and fruit and vegetables intake (P < 0.05). The highest rates of overweight and obesity were observed in 17 year olds.
Do Patient Characteristics Impact Decisions by Clinicians on Hemoglobin A1c Targets?

In setting hemoglobin A1c (HbA1c) targets, physicians must consider individualized risks and benefits of tight glycemic control (1,2) by recognizing that the risk-benefit ratio may become unfavorable in certain patients, including the elderly and/or those with multiple comorbidities (3,4). Customization of treatment goals based on patient characteristics is poorly understood, partly due to insufficient data on physicians’ decisions in setting targets. We used the National Health and Nutrition Examination Survey (NHANES) to analyze patient-reported HbA1c targets set by physicians and to test whether targets are correlated with patient characteristics. Data from the NHANES waves 2005–2006, 2007–2008, 2011–2012, and 2013–2014 (the 2009–2010 wave lacked HbA1c data) comprised 2,641 individuals with self-reported diabetes, of which 1,782 responded to the question, “What does [your doctor] say [your] ‘A1C’ level should be? ” On the basis of the distribution of responses, we analyzed the following targets: <6%, <7%, and higher cutoffs (<8%, 9%, and 10%) combined. Using ordered logistic regression, we assessed the influence of age; sex; race; diabetes duration; comorbidities; BMI; variables on physical, mental, and biological health; and health care utilization. We used NHANES sample weights to calculate population rates of target HbA …
Management of Diabetic Ketoacidosis in Severe Insulin Resistance

Syndromes of severe insulin resistance (IR) include mutations of or autoantibodies to the insulin receptor and lipodystrophy (1). Diabetic ketoacidosis (DKA), although rare, can occur in these patients, even in the context of hyperinsulinemia, due to impaired insulin signaling. DKA can be extremely challenging to treat, and few clinicians are experienced or comfortable in using the high doses of insulin required. We describe aggressive management of DKA in three patients with syndromic severe IR. An 18-year-old man with compound heterozygous mutation of the insulin receptor presented with DKA. He had poorly controlled diabetes (A1C 14% [130 mmol/mol]) treated with U-500 insulin (1,500 units/day), metreleptin (recombinant human methionyl leptin as an experimental drug), and metformin (2 g/day). Two weeks prior, he underwent a root canal for an abscessed tooth but did not take the prescribed antibiotics. Antibiotics were subsequently initiated. One day after discharge, he developed abdominal pain, nausea, vomiting, and worsening jaw pain and swelling. Two days later, he developed fatigue, malaise, and Kussmaul respirations. He presented to an outside hospital with DKA with a pH of 7.08, partial pressure CO2 of 27 mmHg, and bicarbonate of 8 mmol/L. He received fluid resuscitation for an estimated 10% dehydration. In collaboration with National Institutes of Health (NIH) physicians, an insulin drip was started at 100 units/h that was gradually increased to 1,000 units/h on the first day and 2,000 units/h on the second day, without improvement of acidosis (Fig. 1 A ). Because of the lack of improvement despite massive doses of insulin (>50,000 units/day) and intravenous antibiotics, bicarbonate was given and dental extraction performed. He improved thereafter on 2,000 units/h of insulin, which …
Oral hypoglycaemic drugs and newer agents use in Type 2 diabetes mellitus

Abstract We have reviewed the use of oral agents in the management of Type 2 diabetes, together with their pharmacological mechanisms, indications, side effects and contra-indications. The principal oral agents available for use include metformin, sulphonylureas, non-sulphonylurea secretagogues (meglitinides), thiazolidinediones, and α-glucosidase inhibitors. More recently, DPP-IV inhibitors and glucagon-like peptide-1 agents have been registered for use in the United States and in Europe. They await Medicines Control Council registration for use in South Africa. This article will discuss the various oral hypoglycaemic agents, together with the newer modes of therapy, which are soon to become available in our therapeutic armamentarium in South Africa.
Chronic folate deficiency induces glucose and lipid metabolism disorders and subsequent cognitive dysfunction in mice

Previous studies have shown that folate levels were decreased in patients with type 2 diabetes (T2D) and further lowered in T2D patients with cognitive impairment. However, whether folate deficiency could cause T2D and subsequent cognitive dysfunction is still unknown. The present study aimed to explore the effects of chronic folate deficiency (CFD) on glucose and lipid metabolism and cognitive function in mice. Seven-week-old mice were fed with either a CFD or control diet for 25 weeks. Serum folate was significantly reduced, whereas serum total homocysteine was significantly increased in the CFD group. Moreover, CFD induced obesity after a 6-week diet treatment, glucose intolerance and insulin resistance after a 16-week-diet treatment. In addition, CFD reduced the hepatic p-Akt/Akt ratio in response to acute insulin administration. Moreover, CFD increased serum triglyceride levels, upregulated hepatic Acc1 and Fasn mRNA expression, and downregulated hepatic Cd36 and ApoB mRNA expression. After a 24-week diet treatment, CFD induced anxiety-related activities and impairment of spatial learning and memory performance. This study demonstrates that folate deficiency could induce obesity, glucose and lipid metabolism disorders and subsequent cognitive dysfunction.
Contraceptive, condom and dual method use at last coitus among perinatally and horizontally HIV-infected young women in Atlanta, Georgia

Objective To evaluate factors within the social-ecological framework associated with most or moderately effective contraception, condom and dual method use at last coitus among young, HIV-infected women in Atlanta. Methods This is a cross-sectional study conducted from November, 2013 until August, 2015 at the Grady Infectious Disease Clinic in Atlanta, Georgia. We recruited perinatally and horizontally HIV-infected women of ages 14–30 years to complete an audio computer-assisted self-interview. We evaluated factors within a social-ecological framework associated with most or moderately effective contraceptive use (hormonal contraception or an IUD), condom use, and dual method use (use of condom and most or moderately effective contraceptive) at last coitus. Results Of 103 women enrolled, 74 reported a history of sexual activity. The average age was 22.1; 89% were African American, 52% were perinatally infected, 89% received combination antiretroviral therapy, and 63% had undetectable viral loads. At last coitus, 46% reported most or moderately effective contraception, 62% reported condom use and 27% reporting dual-method use. The odds of most or moderately effective contraceptive use was significantly reduced among those with detectable viral loads (versus undetectable viral loads; aOR 0.13 [0.04, 0.38]). Older age (aOR 0.85 [0.74, 0.98] and more frequent coitus (>once/week versus < = once/week; aOR 0.24 [0.08, 0.72]) was significantly associated with reduced condom use. Having a detectable viral load (versus undetectable viral loads; aOR 0.13 [0.03, 0.69]) and more frequent coitus (>once/week versus < = once/week; aOR 0.14 [0.03,0.82]), was associated with reduced dual method use, while being enrolled in school (aOR 5.63 [1.53, 20.71]) was significantly associated with increased dual method use. Conclusions Most or moderately effective contraception, condom and dual method use remained inadequate in this cohort of young HIV-infected women. Individual-level interventions are needed to increase the uptake of dual methods with user-independent contraceptives.
Patients’ adherence to optimal therapeutic, lifestyle and risk factors recommendations after myocardial infarction: Six years follow-up in primary care

Background The 20% observed mortality within 5 years among survivors of myocardial infarction may be explained in part by non-adherence to the recommended treatment over the long term. Main objective To investigate post-myocardial infarction patients’ adherence to the therapeutic, lifestyle and risk factor control recommendations of the French health authority over 6 years. Materials and methods A cohort of survivors of myocardial infarction established in Tours in 2009 was followed over 6 years. The general practitioner of the patients included in the first 1-year follow-up study was contacted to collect data on treatments, cardiovascular risk factors and lifestyle between January and June 2015. Data were described and compared with the recommendations and predictors of achieving all the recommended targets were determined. Results A total of 97 patients (52%) among the 185 patients who underwent a coronary angioplasty for MI were included at baseline. Treatment was adapted by the general practitioner on the advice on the cardiologist for 75% (73/97) patients, by both of them for 12% (12/97) and by the general practitioner alone for 7% (7/97) patients. Among the 97 initial patients, 62 were included in the final analysis at 6 years. Fatal events rate was 5% (5/97) at 1 year and 12% (11/91) at 6 years. Non-fatal events rate was 44% (43/97) at 6 months, 19% (17/91) at 1 year and 29% (18/62) at 6 years. Six years after the myocardial infarction, 6 (10%) patients achieved the recommended targets in terms of prescriptions of treatment, risk factors and lifestyle targets. Exposure to a cardiac rehabilitation program after a myocardial infarction was associated with long-term achievement of optimal therapeutic objectives (OR = 7.31 [95% CI 1.74; 44.88], p<0.002). Conclusion Our data show suboptimal long-term adherence to secondary prevention treatment in this high-risk population of survivors of myocardial infarction, which seems to be improved in patients exposed to a cardiac rehabilitation program.
An Overview of the Preparation and Certification of Teachers Working with Limited English Proficient (LEP) Students.

The American Association of Colleges for Teacher Education (AACTE) contributed much of the data pertaining to the preparation of mainstream and bilingual education teachers at colleges and universities throughout the country. under contract number ED-99-CO-0007. The contents of this publication do not necessarily reflect the views or policies of The Department of Education nor does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. Readers are free to duplicate and use these materials in keeping with accepted publication standards. NCBE and the ERIC Clearinghouse on Teaching and Teacher Education request that proper credit be given in the event of reproduction. Abstract This descriptive study combined wide-scale survey data with qualitative analysis to explore the preparation of teachers of English language learners (ELLs) in institutions of higher education throughout the U.S. The American Association of Colleges for Teacher Education (AACTE) disseminated a survey to its member institutions and website users designed to ascertain the breadth and depth of preparation programs for teachers of ELLs, garnering 417 usable responses. The National Clearinghouse for Bilingual Education built on this data by comparing AACTE's findings to its analysis of both state-level bilingual education teacher licensure requirements and the content of courses required by institutions of higher education for a degree and/or licensure in bilingual education. Licensure and course requirements were categorized according to areas of knowledge, and revealed that while typically emphasizing the areas of pedagogy and cultural/linguistic diversity, by contrast, the area of linguistics receives less emphasis at both state and institutional levels. At the state level, while there is great variance in the ways in which states mandate requirements for bilingual education teacher licensure, the requirements dictated by the states do impact the programming that occurs in institutions of higher education. And at the institutional level, it was found that programs vary in the depth of their coverage of areas of knowledge; in specific, bachelor's programs were found to be more likely to cover studies within an area of knowledge through a broad overview or survey course that may combine various topics or areas within a single course. Findings indicate further that only a small minority of institutions of higher education offer a program specifically to prepare bilingual education teachers, and fewer than 1/6 th of institutions studied require preparation for mainstream teachers regarding the education of ELLs.
Empagliflozin as Add-on Therapy in Patients With Type 2 Diabetes Inadequately Controlled With Linagliptin and Metformin: A 24-Week Randomized, Double-Blind, Parallel-Group Trial

OBJECTIVE To evaluate the efficacy and safety of empagliflozin versus placebo as add-on therapy in patients with type 2 diabetes and inadequate glycemic control with linagliptin and metformin. RESEARCH DESIGN AND METHODS Patients with HbA1c ≥8.0% and ≤10.5% (≥64 and ≤91 mmol/mol) while receiving stable-dose metformin received open-label linagliptin 5 mg (n = 606) for 16 weeks. Subsequently, those with HbA1c ≥7.0 and ≤10.5% (≥53 and ≤91 mmol/mol) were randomized to receive double-blind, double-dummy treatment with empagliflozin 10 mg (n = 112), empagliflozin 25 mg (n = 111), or placebo (n = 110) for 24 weeks; all patients continued treatment with metformin and linagliptin 5 mg. The primary end point was the change from baseline in HbA1c after 24 weeks of double-blind treatment. RESULTS At week 24, empagliflozin significantly reduced HbA1c (mean baseline 7.96–7.97% [63–64 mmol/mol]) versus placebo; the adjusted mean differences in the change from baseline with empagliflozin 10 and 25 mg versus placebo were −0.79% (95% CI ‒1.02, ‒0.55) (−8.63 mmol/mol [‒11.20, ‒6.07 mmol/mol]) and −0.70% (95% CI ‒0.93, ‒0.46) (−7.61 mmol/mol [‒10.18, ‒5.05 mmol/mol]), respectively (both P < 0.001). Fasting plasma glucose and weight were significantly reduced in both empagliflozin groups versus placebo (P < 0.001 for all comparisons). More patients receiving placebo than empagliflozin 10 and 25 mg reported adverse events during double-blind treatment (68.2%, 55.4%, and 51.8%, respectively). CONCLUSIONS Empagliflozin treatment for 24 weeks improved glycemic control and weight versus placebo as an add-on to linagliptin 5 mg and metformin and was well tolerated.
Where in the world is my tweet: Detecting irregular removal patterns on Twitter

Twitter data are becoming an important part of modern political science research, but key aspects of the inner workings of Twitter streams as well as self-censorship on the platform require further research. A particularly important research agenda is to understand removal rates of politically charged tweets. In this article, I provide a strategy to understand removal rates on Twitter, particularly on politically charged topics. First, the technical properties of Twitter’s API that may distort the analyses of removal rates are tested. Results show that the forward stream does not capture every possible tweet –between 2 and 5 percent of tweets are lost on average, even when the volume of tweets is low and the firehose not needed. Second, data from Twitter’s streams are collected on contentious topics such as terrorism or political leaders and non-contentious topics such as types of food. The statistical technique used to detect uncommon removal rate patterns is multilevel analysis. Results show significant differences in the removal of tweets between different topic groups. This article provides the first systematic comparison of information loss and removal on Twitter as well as a strategy to collect valid removal samples of tweets.
High-Sensitivity Cardiac Troponin T (hs-cTnT) as a Predictor of Incident Diabetes in the Atherosclerosis Risk in Communities Study

OBJECTIVE Many individuals with prediabetes have evidence of subclinical myocardial damage and are at an increased risk of cardiovascular disease (CVD). If subclinical myocardial damage is independently associated with incident diabetes, this may contribute to the understanding of the association between diabetes and CVD. This study was conducted to determine whether high-sensitivity cardiac troponin T (hs-cTnT) is associated with incident diabetes. RESEARCH DESIGN AND METHODS Using Kaplan-Meier curves and Cox models, we prospectively analyzed 8,153 participants without known diabetes or CVD. We used the Harrell C statistic to investigate whether hs-cTnT added incremental prognostic information for diabetes prediction. RESULTS During a median of 13 years of follow-up, there were 1,830 incident cases of diagnosed diabetes. After adjustment for demographics and traditional risk factors, participants with a baseline hs-cTnT of 9–13 ng/L or ≥14 ng/L had a significantly increased risk for diabetes compared to those with an hs-cTnT of ≤5 ng/L, with hazard ratios of 1.14 (95% CI 0.99–1.33) and 1.25 (95% CI 1.03–1.53), respectively (P = 0.018 for trend). Linear spline modeling that included adjustment for baseline fasting glucose suggested an increased risk of incident diabetes for participants with hs-cTnT levels >8 ng/L. Furthermore, the addition of hs-cTnT to fully adjusted models that included glucose significantly improved the prediction of incident diabetes from 0.7636 to 0.7644 (P = 0.023). CONCLUSIONS Participants with elevated hs-cTnT levels at baseline had an increased risk of incident diabetes, suggesting that the measurement of hs-cTnT may incorporate an underlying pathophysiologic overlap between diabetes and CVD not captured by other traditional risk factors. Measurement of hs-cTnT may be useful to identify individuals at an increased risk for incident diabetes and CVD in order to provide early and more intensive risk factor modification.
Personalized medicine: Implications for research and policy

Since the Human Genome Project was completed and published in 2003, personalized (or precision) medicine has gradually been moving forward to improve health care. The cost of sequencing the human genome has dropped considerably from millions to thousands of pounds through rapid technical advancements. This means that the cost has dropped to a point where people will soon be able to possess their own genetic information on a ‘smart card’ or memory stick. It is thought that the future patient will be able to walk into their clinician’s office and present their genetic information so that the right treatment can be given at the correct dose for a condition with few adverse drug reactions or lessened possibility of treatment failure. A recent announcement by the UK government has put the future patient into the present reality by providing programme funding to the NHS to map the genetic makeup of 100,000 people in England. Patients with cancer and certain rare disease will voluntarily have their DNA mapped to identify key genetic components that will aid in medical treatment.
Association of Cardiovascular Risk Factors and Myocardial Fibrosis With Early Cardiac Dysfunction in Type 1 Diabetes: The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

OBJECTIVE We investigated the association of cardiovascular risk factors and myocardial fibrosis with early cardiac dysfunction in type 1 diabetes. RESEARCH DESIGN AND METHODS Participants with type 1 diabetes aged 13–39 years without a known history of cardiovascular disease (CVD) (n = 1,441) were recruited into the Diabetes Control and Complications Trial (1983–1993) and subsequently followed in the Epidemiology of Diabetes Interventions and Complications study (1994 to present). Seven hundred fourteen participants underwent cardiac magnetic resonance (CMR) imaging (2007–2009) with late gadolinium enhancement sequences to assess ischemic and nonischemic scars and tagging sequences to evaluate circumferential strain. CMR-derived T1 mapping also was used to assess interstitial fibrosis. The influence of cardiovascular risk factors and myocardial scar on circumferential strain was assessed using linear regression. RESULTS Circumferential dysfunction was consistently associated with older age, male sex, smoking history, obesity, higher blood pressure, lower HDL cholesterol, and higher mean HbA1c. Participants with nonischemic scars (n = 16) had the worst circumferential function compared with those without scars (β ± SE 1.32 ± 0.60; P = 0.03). In sex-adjusted models, the correlation between T1 times and circumferential strain was not significant. In the fully adjusted models, a trend toward circumferential dysfunction in participants with nonischemic scars was found. Left ventricular ejection fraction was not associated with risk factors but was significantly lower if a myocardial scar was present. CONCLUSIONS Traditional CVD risk factors and elevated HbA1c levels are major factors related to early cardiac dysfunction in type 1 diabetes. Nonischemic myocardial scar, possibly as a marker of chronic exposure to known risk factors, may predict early cardiac dysfunction mediated by diffuse myocardial fibrosis as seen in diabetic cardiomyopathy.