LLukas22/scidocs huggingface dataset:
Costs and Consequences Associated With Misdiagnosed Lower Extremity Cellulitis.

Importance
Inflammatory dermatoses of the lower extremity are often misdiagnosed as cellulitis (aka "pseudocellulitis") and treated with antibiotics and/or hospitalization. There is limited data on the cost and complications from misdiagnosed cellulitis.


Objective
To characterize the national health care burden of misdiagnosed cellulitis in patients admitted for treatment of lower extremity cellulitis.


Design, Setting, and Participants
Cross-sectional study using patients admitted from the emergency department (ED) of a large urban hospital with a diagnosis of lower extremity cellulitis between June 2010 and December 2012. Patients who were discharged with a diagnosis of cellulitis were categorized as having cellulitis, while those who were given an alternative diagnosis during the hospital course, on discharge, or within 30 days of discharge were considered to have pseudocellulitis. A literature review was conducted for calculation of large-scale costs and complication rates. We obtained national cost figures from the Medical Expenditure Panel Survey (MEPS), provided by the Agency for Healthcare Research and Quality (AHRQ) for 2010 to calculate the hospitalization costs per year attributed to misdiagnosed lower extremity pseudocellulitis.


Exposures
The exposed group was composed of patients who presented to and were admitted from the ED with a diagnosis of lower extremity cellulitis.


Main Outcomes and Measures
Patient characteristics, hospital course, and complications during and after hospitalization were reviewed for each patient, and estimates of annual costs of misdiagnosed cellulitis in the United States.


Results
Of 259 patients, 79 (30.5%) were misdiagnosed with cellulitis, and 52 of these misdiagnosed patients were admitted primarily for the treatment of cellulitis. Forty-four of the 52 (84.6%) did not require hospitalization based on ultimate diagnosis, and 48 (92.3%) received unnecessary antibiotics. We estimate cellulitis misdiagnosis leads to 50 000 to 130 000 unnecessary hospitalizations and $195 million to $515 million in avoidable health care spending. Unnecessary antibiotics and hospitalization for misdiagnosed cellulitis are projected to cause more than 9000 nosocomial infections, 1000 to 5000 Clostridium difficile infections, and 2 to 6 cases of anaphylaxis annually.


Conclusions and Relevance
Misdiagnosis of lower extremity cellulitis is common and may lead to unnecessary patient morbidity and considerable health care spending.
Porous shape-memory NiTi-Nb with microchannel arrays

Porous NiTi-Nb containing a 3D array of orthogonally interconnected microchannels was created via a novel powder metallurgy process combining: (i) Mg ribbon scaffold construction, (ii) slip casting of NiTi þ Nb powder blend within the scaffold, (iii) Mg scaffold vacuum evaporation, and (iv) NiTi þ Nb liquid phase sintering. The later stage was achieved by creating small amounts of quasi-binary NiTi-Nb liquid eutectic, which wicked between NiTi particles and bonded them together while leaving 28 vol.% of residual pores. These hierarchical porous structures have a total porosity of 30e53%, an effective stiffness of 5e9 GPa, and a yield strength of 20e80 MPa. They exhibit the shape memory effect, with 3% strain recovery after 7% compressive deformation upon multiple load-unload cycles. Finite element modeling (FEM) is used to model the anisotropy of these structures, as well as to probe the strain distributions on a microscopic level. Mechanical anisotropy was present in FEM of all structures, though more pronounced in structures with high microchannel volume fraction. With mechanical properties between those of trabecular and cortical bone, these structures are of great interest for bone implant applications. © 2016 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.
The Relationship between Career Adaptability, Person and Situation Variables, and Career Concerns in Young Adults.

We surveyed 245 first-year university students using measures of career concerns, career adaptability (career planning, career exploration, self exploration, decision-making, selfregulation), goal-orientation (learning, performance-prove, performance-avoid) and social support (family, friends, significant others), and tested: (a) whether the career adaptability variables could be represented by a second-order factor of career adaptability; (b) whether career adaptability, goal-orientation and social support were associated with fewer career concerns; and (c) whether career adaptability mediated the relationship between goal-orientation and social support and career concerns. The study demonstrated that the career adaptability variables were inter-related and could be represented by a higher-order factor. Decision-making and self-exploration were negatively associated with career concerns, and decision-making mediated the relationship between goal-orientation and career concerns. Having more of a learning orientation was associated with more decision-making and fewer career concerns, whereas holding a performance-prove orientation was associated with poorer decision-making and more career concerns.
Effect of etanercept, infliximab and methotrexate in the treatment of arthritis.

BACKGROUND
Rheumatoid arthritis a chronic inflammatory autoimmune disease with inflammation of the joint, leading to damage of bone and surrounding cartilage.


OBJECTIVES
Our study was designed to find the efficacy of etanercept, infliximab and methotrexate in effective therapeutic management against arthritis patients.


METHODS
A total of 315 patients, including both the sexes in the age group of 45-70 years with active rheumatoid arthritis attending Hospital of Academy of Military Medical Sciences, Beijing, China during the period of December 2012 to November 2013 were included in the study. 100 patients with joint pains, but not with rheumatoid arthritis were taken as a control group. All the patients were treated with infliximab, methotrexate and etanercept.


RESULTS
In our study, patients responded, 75% to infliximab and etanercept combinations than to methotrexate. The combination therapy also showed a radiological decrease in the joint damage. There is significant when combinations of these drugs were used for the therapy (P<0.001).


CONCLUSION
In our study, use of infliximab and etanercept combinations lowered the joint damage and helped in the improvement of the patient's life.
"CF asthma": what is it and what do we do about it?

The diagnosis of "CF asthma" is problematic and it is difficult to determine which patients have a combination of CF and asthma and which have asthma like symptoms caused by inflammation of the CF lung. This may not matter, however; the relevance lies in the possible approaches to treatment.
Effective Network Vulnerability Assessment through Model Abstraction

A significant challenge in evaluating network security stems from the scale of modern enterprise networks and the vast number of vulnerabilities regularly found in software applications. A common technique to deal with this complexity is attack graphs, where a tool automatically computes all possible ways a system can be broken into by analyzing the configuration of each host, the network, and the discovered vulnerabilities. Past work has proposed methodologies that post-process “raw” attack graphs so that the result can be abstracted and becomes easier for a human user to grasp. We notice that, while visualization is a major problem caused by the multitude of attack paths in an attack graph, a more severe problem is the distorted risk picture it renders to both human users and quantitative vulnerability assessment models. We propose that abstraction be done before attack graphs are computed, instead of after. This way we can prevent the distortion in quantitative vulnerability assessment metrics, at the same time improving visualization as well. We developed an abstract network model generator that, given reachability and configuration information of a network, provides an abstracted model with much more succinct information about the system than the raw model. The model is generated by grouping hosts based on their network reachability and vulnerability information, as well as grouping vulnerabilities with similar exploitability. We show that the attack graphs generated from this type of abstracted inputs are not only much smaller, but also provide more realistic quantitative vulnerability metrics for the whole system. We conducted experiments on both synthesized and production systems to demonstrate the effectiveness of our approach.
Survey study of members of the Canadian Orthopaedic Association on the natural history and treatment of anterior cruciate ligament injury.

OBJECTIVE
To describe current preferences and opinions of members of the Canadian Orthopaedic Association (COA) pertaining to anterior cruciate ligament (ACL) reconstruction.


DESIGN
Survey study.


PARTICIPANTS
All orthopedic surgeon members of the COA residing in Canada were invited to participate.


MAIN OUTCOME MEASURES
The primary measure was a survey completed via an Internet-based survey manager. It was composed of 30 questions on the natural history of ACL-injured knees, and surgical and postsurgical treatment choices.


RESULTS
Two hundred eighty-three surgeons (50%) responded to the survey. One hundred forty-four performed ACL reconstruction in the past year. In terms of natural history, the only area of agreement was that hamstring and quadricep strength affects function in ACL-deficient knees (92%). A majority of surgeons indicated preference for hamstring autograft (73%), transtibial versus anteromedial portal for establishment of the femoral tunnel (70% vs 28%), and promotion of full weight bearing and range of motion immediately after surgery (72% and 75%, respectively). The most frequent surgeon-reported complication was tunnel widening (10%). A greater proportion of high-volume surgeons permitted earlier return to sport (P < 0.008).


CONCLUSIONS
In the rapidly evolving area of ACL reconstruction, no recent surveys of opinions and preferences of Canadian orthopedic surgeons have been published. In addition to providing information from a Canadian perspective, the findings from this study will allow surgeons to evaluate a range of treatment decisions based on the general opinions of their colleagues and also highlights areas of dissimilarity that can be targeted for more extensive research.
A Concept Design for the STL

This report presents a concept design for the algorithms part of the STL and outlines the design of the supporting language mechanism. Both are radical simplifications of what was proposed in the C++0x draft. In particular, this design consists of only 41 concepts (including supporting concepts), does not require concept maps, and (perhaps most importantly) does not resemble template metaprogramming.
Energy analysis of end-of-life options for personal computers: resell, upgrade, recycle

Governments, firms, and civil society are increasingly taking action to mange the end-of-life of computers. While appropriate treatment of the waste stream via recycling and other technologies is required, it is also important to address the flow upstream through reduction of final demand via improved utilization. This article evaluates endof-life options for computers via quantitative assessment of life cycle energy use in three cases: reselling to secondary markets, upgrading of key components, and recycling to recover materials. Results indicate that reselling or upgrading 10% of end-of-life computers reduces life cycle energy use by 8.6% and 5.2% respectively. In contrast, recycling 10% of computers only saves .43% of life cycle energy, suggesting that reselling and upgrading are far more effective from an environmental standpoint. The origin of this dramatic difference between reuse and recycling lies in the fact that much of the energy investment in the life cycle of a computer is in producing its complex form rather than its physical substance. Thus, the environmental payback of recycling materials is poor compared to many goods. This strongly suggests that management strategies for waste electronics should emphasize extension of life-
AN IMPLEMENTATION OF LOAD BALANCING ALGORITHM IN CLOUD ENVIRONMENT

7124 | P a g e C o u n c i l f o r I n n o v a t i v e R e s e a r c h J u l y , 2 0 1 6 w w w . c i r w o r l d . c o m AN IMPLEMENTATION OF LOAD BALANCING ALGORITHM IN CLOUD ENVIRONMENT Sheenam Kamboj , Mr. Navtej Singh Ghumman (2) (1) Research Scholar, Department of Computer Science & Engineering, SBSSTC, Ferozepur, Punjab. sheenam31.sk@gmail.com (2) Assistant Professor, Department of Computer Science & Engineering, SBSSTC, Ferozepur, Punjab. navtejghumman@yahoo.com ABSTRACT
Fluoxetine in early poststroke depression: a double-blind placebo-controlled study.

BACKGROUND AND PURPOSE
Early poststroke depression (PSD) is a frequent and specific entity that impairs the rehabilitation and functional recovery of hemiplegic patients. This trial was designed to study the efficacy and tolerance of fluoxetine (FLX) in the treatment of early PSD.


METHODS
This was a multicenter, double-blind, placebo-controlled study. Recent hemiplegic patients (<3 months) suffering from major depressive disorder (determined by International Classification of Diseases, 10th Revision, and Montgomery-Asberg Depression Rating Scale [MADRS] >19) were randomized to receive either 20 mg/d fluoxetine (FLX) or placebo for 6 weeks. Patients were evaluated by use of the Motricity Index, Mini-Mental State Examination, Functional Independence Measure, and MADRS. Statistical analysis was performed by using an intent-to-treat approach comparing the 2 groups at day 0 (baseline) and days 15, 30, and 45 (end point).


RESULTS
Of 121 patients screened, 31 were included in the study, 16 in the FLX group and 15 in the placebo group. There were no significant differences in baseline characteristics among the 2 groups. The FLX-treated patients compared with placebo-treated patients demonstrated significant improvement in mean MADRS scores at end point (11.8+/-6. 7 [mean+/-SD] versus 18.7+/-10.0, respectively; P=0.05). FLX-treated patients compared with placebo-treated patients also demonstrated greater response rate (62.5% versus 33.3%, respectively) and greater mean decrease of MADRS (16.6 versus 8.4, respectively; P=0.02). There were no differences in motor, cognitive, or functional improvement and no significant side effects after FLX treatment, except for a patient with a moderate and transient increase of transaminases.


CONCLUSIONS
FLX is an efficacious and well-tolerated treatment for early PSD. Further research is needed to evaluate the efficacy and safety of long-term treatment in this population.
A New and Improved Paradigm for Hybrid Encryption Secure Against Chosen-Ciphertext Attack

We present a new encryption scheme which is secure against adaptive chosen-ciphertext attack (or CCA2-secure) in the standard model (i.e., without the use of random oracle). Our scheme is a hybrid one: it first uses a public-key step (the Key Encapsulation Module or KEM) to encrypt a random key, which is then used to encrypt the actual message using a symmetric encryption algorithm (the Data Encapsulation Module or DEM). Our scheme is a modification of the hybrid scheme presented by Shoup in (Euro-Crypt’97, Springer LNCS, vol. 1233, pp. 256–266, 1997) (based on the Cramer–Shoup scheme in CRYPTO’98, Springer LNCS, vol. 1462, pp. 13–25, 1998). Its major practical advantage is that it saves the computation of one exponentiation and produces shorter ciphertexts. This efficiency improvement is the result of a surprising observation: previous hybrid schemes were proven secure by proving that both the KEM and the DEM were CCA2-secure. On the other hand, our KEM is not CCA2-secure, yet the whole scheme is, assuming the Decisional Diffie–Hellman (DDH) Assumption. Finally we generalize our new scheme in two ways: (i) we show that security holds also if we use projective hash families (as the original Cramer–Shoup), and (ii) we show that in the random oracle model we can prove security under the weaker Computational Diffie–Hellman (CDH) Assumption.
BARD: Better Automated Redistricting

BARD is the first (and currently only) open source software package for redistricting and redistricting analysis. BARD provides methods to create, display, compare, edit, automatically refine, evaluate, and profile political districting plans. BARD aims to provide a fraimwork for scientific analysis of redistricting plans and as a step toward facilitating wider participation in the creation of new plans BARD facilitates map creation and refinement through command-line, gui, and automatic methods. Since redistricting is a computationally complex partitioning problem not amenable to an exact optimization solution, BARD makes use of a variety of selectable metaheuristics, including genetic algorithms, GRASP, and simulated annealing, that can be use to refine existing or randomly-generated redistricting plans based on user-determined criteria. Furthermore, BARD supports the ability to randomly generate redistricting plans, and to generate profiles of plans for different scoring weights. This functionality can be used both to explore trade-offs among criteria and to make inferences regarding the intent behind existing redistricting plans. Because of the computational intensity of these methods, performance is an important criterion in the design and implementation of BARD. The program implements performance enhancements such as evaluation caching, explicit memory management, and distributed computing across snow clusters.
Does integration of HIV and SRH services achieve economies of scale and scope in practice? A cost function analysis of the Integra Initiative

OBJECTIVE
Policy-makers have long argued about the potential efficiency gains and cost savings from integrating HIV and sexual reproductive health (SRH) services, particularly in resource-constrained settings with generalised HIV epidemics. However, until now, little empirical evidence exists on whether the hypothesised efficiency gains associated with such integration can be achieved in practice.


METHODS
We estimated a quadratic cost function using data obtained from 40 health facilities, over a 2-year-period, in Kenya and Swaziland. The quadratic specification enables us to determine the existence of economies of scale and scope.


FINDINGS
The empirical results reveal that at the current output levels, only HIV counselling and testing services are characterised by service-specific economies of scale. However, no overall economies of scale exist as all outputs are increased. The results also indicate cost complementarities between cervical cancer screening and HIV care; post-natal care and HIV care and family planning and sexually transmitted infection treatment combinations only.


CONCLUSIONS
The results from this analysis reveal that contrary to expectation, efficiency gains from the integration of HIV and SRH services, if any, are likely to be modest. Efficiency gains are likely to be most achievable in settings that are currently delivering HIV and SRH services at a low scale with high levels of fixed costs. The presence of cost complementarities for only three service combinations implies that careful consideration of setting-specific clinical practices and the extent to which they can be combined should be made when deciding which services to integrate.


TRIAL REGISTRATION NUMBER
NCT01694862.
Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia: a prospective cohort study

BACKGROUND
Initial management of chemotherapy-induced febrile neutropaenia (FN) comprises empirical therapy with a broad-spectrum antimicrobial. Currently, there is sufficient evidence to indicate which antibiotic regimen should be administered initially. However, no randomized trial has evaluated whether adherence to an antimicrobial stewardship program (ASP) results in lower rates of mortality in this setting. The present study sought to assess the association between adherence to an ASP and mortality among hospitalised cancer patients with FN.


METHODS
We conducted a prospective cohort study in a single tertiary hospital from October 2009 to August 2011. All adult patients who were admitted to the haematology ward with cancer and FN were followed up for 28 days. ASP adherence to the initial antimicrobial prescription was determined. The mortality rates of patients who were treated with antibiotics according to the ASP protocol were compared with those of patients treated with other antibiotic regimens. The multivariate Cox proportional hazards model and propensity score were used to estimate 28-day mortality risk.


RESULTS
A total of 307 FN episodes in 169 subjects were evaluated. The rate of adherence to the ASP was 53%. In a Cox regression analysis, adjusted for propensity scores and other potential confounding factors, ASP adherence was independently associated with lower mortality (hazard ratio, 0.36; 95% confidence interval, 0.14-0.92).


CONCLUSIONS
Antimicrobial selection is important for the initial management of patients with FN, and adherence to the ASP, which calls for the rational use of antibiotics, was associated with lower mortality rates in this setting.
Reference pricing , competition , and pharmaceutical expenditures : theory and evidence from a natural experiment

We study the impact of regulation on competition between brand-names and generics and pharmaceutical expenditures using a unique policy experiment in Norway, where reference pricing (RP) replaced price cap regulation in 2003 for a sub-sample of o¤-patent products. First, we construct a vertical di¤erentiation model to analyze the impact of regulation on prices and market shares of brand-names and generics. Then, we exploit a detailed panel data set at product level covering several o¤-patent molecules before and after the policy reform. O¤-patent drugs not subject to RP serve as our control group. We nd that RP signicantly reduces both brand-name and generic prices, and results in signicantly lower brand-name market shares. Finally, we show that RP has a strong negative e¤ect on average molecule prices, suggesting signicant cost-savings, and that patients copayments decrease despite the extra surcharges under RP. Key words: Pharmaceuticals; Regulation; Generic Competition JEL Classications: I11; I18; L13; L65 We thank David Bardey, Øivind Anti Nilsen, Frode Steen, and two anonymous referees for valuable comments and suggestions. We also thank the Norwegian Research Council, Health Economics Bergen (HEB) for nancial support. Corresponding author. Department of Economics and Health Economics Bergen, Norwegian School of Economics and Business Administration, Helleveien 30, N-5045 Bergen, Norway. E-mail: kurt.brekke@nhh.no. Uni Rokkan Centre, Health Economics Bergen, Nygårdsgaten 5, N-5015 Bergen, Norway. E-mail: tor.holmas@uni.no. Department of Economics/NIPE, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; and University of Bergen (Economics), Norway. E-mail: o.r.straume@eeg.uminho.pt.