Miracle-dz/UniFAR-FTUs huggingface dataset:
Reduction in Clinical Variance Using Targeted Design Changes in Computerized Provider Order Entry (CPOE) Order Sets

Summary Objectives: Unwarranted variance in healthcare has been associated with prolonged length of stay, diminished health and increased cost. Practice variance in the management of asthma can be significant and few investigators have evaluated strategies to reduce this variance. We hypothesized that selective redesign of order sets using different ways to frame the order and physician decision-making in a computerized provider order entry system could increase adherence to evidence-based care and reduce population-specific variance. Patients and Methods: The study focused on the use of an evidence-based asthma exacerbation order set in the electronic health record (EHR) before and after order set redesign. In the Baseline period, the EHR was queried for frequency of use of an asthma exacerbation order set and its individual orders. Important individual orders with suboptimal use were targeted for redesign. Data from a Post-Intervention period were then analyzed. Results: In the Baseline period there were 245 patient visits in which the acute asthma exacerbation order set was selected. The utilization frequency of most orders in the order set during this period exceeded 90%. Three care items were targeted for intervention due to suboptimal utilization: admission weight, activity center use and peak flow measurements. In the Post-Intervention period there were 213 patient visits. Order set redesign using different default order content resulted in significant improvement in the utilization of orders for all 3 items: admission weight (79.2% to 94.8% utilization, p<0.001), activity center (84.1% to 95.3% utilization, p<0.001) and peak flow (18.8% to 55.9% utilization, p<0.001). Utilization of peak flow orders for children ≥8 years of age increased from 42.7% to 94.1% (p<0.001). Conclusions: Details of order set design greatly influence clinician prescribing behavior. Queries of the EHR reveal variance associated with ordering frequencies. Targeting and changing order set design elements in a CPOE system results in improved selection of evidence-based care.
Adenoma Formation and Malignancy After Restorative Proctocolectomy With or Without Mucosectomy in Patients With Familial Adenomatous Polyposis

BACKGROUND: There is controversy concerning whether or not to perform mucosectomy after IPAA in patients with familial adenomatous polyposis. Although more frequent adenoma formation at the anastomotic site in patients without a mucosectomy is documented, the interpretation of the theoretical reflections and empirical findings are ambiguous. OBJECTIVE: The aim of this study was to assess the differences in adenoma formation at the anastomotic site and in the ileal pouch among patients with familial adenomatous polyposis after IPAA with or without mucosectomy. DESIGN: Data were gathered from The Norwegian Polyposis Registry and The Cancer Registry of Norway. PATIENTS: Sixty-one patients with familial adenomatous polyposis who had IPAA were included in the Norwegian Polyposis Registry. MAIN OUTCOME MEASURES: The frequency of adenoma development in the pouch or at the anastomotic site was measured. RESULTS: Thirty-nine patients had a pelvic pouch performed with mucosectomy and 22 patients without. The observational time was 15.5 and 13.7 years. Adenoma formation at the anastomotic site was 4 in 39 and 14 in 22, and the estimated rate was 17% vs 75% (p = 0.0001). One patient without mucosectomy had a cancer (Dukes A) at the anastomotic site. There was no estimated long-term difference in adenoma formation in the ileal pouches between the 2 surgical procedures (38%) (p = 0.10). LIMITATIONS: The study is retrospective, in part, and relies on data from registries. There is a limited number of cases, and selection bias because of surgeon preference may exist. CONCLUSION: In patients with familial adenomatous polyposis who undergo IPAA, adenoma formation at the anastomotic site is significantly reduced after mucosectomy. Mucosectomy may be the preferable procedure to prevent adenomas at the anastomotic site.
Ambient RF Energy Harvesting in Urban and Semi-Urban Environments

RF harvesting circuits have been demonstrated for more than 50 years, but only a few have been able to harvest energy from freely available ambient (i.e., non-dedicated) RF sources. In this paper, our objectives were to realize harvester operation at typical ambient RF power levels found within urban and semi-urban environments. To explore the potential for ambient RF energy harvesting, a city-wide RF spectral survey was undertaken from outside all of the 270 London Underground stations at street level. Using the results from this survey, four harvesters (comprising antenna, impedance-matching network, rectifier, maximum power point tracking interface, and storage element) were designed to cover four frequency bands from the largest RF contributors (DTV, GSM900, GSM1800, and 3G) within the ultrahigh frequency (0.3-3 GHz) part of the frequency spectrum. Prototypes were designed and fabricated for each band. The overall end-to-end efficiency of the prototypes using realistic input RF power sources is measured; with our first GSM900 prototype giving an efficiency of 40%. Approximately half of the London Underground stations were found to be suitable locations for harvesting ambient RF energy using our four prototypes. Furthermore, multiband array architectures were designed and fabricated to provide a broader freedom of operation. Finally, an output dc power density comparison was made between all the ambient RF energy harvesters, as well as alternative energy harvesting technologies, and for the first time, it is shown that ambient RF harvesting can be competitive with the other technologies.
Sleep Duration in Relation to Cognitive Function among Older Adults: A Systematic Review of Observational Studies

Context: Increasing evidence suggests that circadian and sleep parameters influence cognitive function with aging. Objective: To evaluate observational studies of sleep duration and cognition in older adults. Data Sources: A systematic review of OVID Medline and PsycINFO through September 2015, and review of bibliographies from studies identified. Study Selection: English-language articles reporting observational studies of sleep duration and cognitive function in older populations. Data Extraction: Data extraction by 2 authors using predefined categories of desired information. Results: Thirty-two studies met our inclusion criteria, with nearly two-thirds published in the past 4 years. One-third of studies indicated that extreme sleep durations were associated with worse cognition in older adults. More studies favored an association with long vs. short sleep durations (35 vs. 26% of studies, respectively). Four studies found that greater changes in sleep duration over time were related to lower cognition. Study design and analytic methods were very heterogeneous across studies; therefore, meta-analysis was not undertaken. Limitations: We reviewed English-language manuscripts only, with a qualitative summary of studies identified. Conclusions and Implications of Key Findings: Observational studies of sleep duration and cognitive function in older adults have produced mixed results, with more studies suggesting that long (rather than short) sleep durations are related to worse cognition. Studies more consistently indicate that greater changes in sleep duration are associated with poor cognition. Future studies should be prospectively designed, with objective sleep assessment and longer follow-up periods; intervention studies are also needed to identify strategies for promoting cognitive health with aging.
Are long tide gauge records in the wrong place to measure global mean sea level rise?

Ocean dynamics, land motion, and changes in Earth's gravitational and rotational fields cause local sea level change to deviate from the rate of global mean sea level rise. Here we use observations and simulations of spatial structure in sea level change to estimate the likelihood that these processes cause sea level trends in the longest and highest‐quality tide gauge records to be systematically biased relative to the true global mean rate. The analyzed records have an average twentieth century rate of approximately 1.6 mm/yr, but based on the locations of these gauges, we show that the simple average underestimates the twentieth century global mean rate by 0.1 ± 0.2 mm/yr. Given the distribution of potential sampling biases, we find that <1% probability that observed trends from the longest and highest‐quality tide gauge records are consistent with global mean rates less than 1.4 mm/yr.
Variation of Functional Neurological Symptoms and Emotion Regulation with Time

Introduction The present study addressed the variation of emotion regulation in the context of functional neurological symptom disorder (FNSD) by examining changes of functional neurological symptoms (FNS), general psychological strain, alexithymia, emotion regulation strategies, and cortical correlates of emotion regulation in the context of a standard inpatient treatment program. Methods and materials Self-report data on FNS, general psychological strain, alexithymia, emotion regulation strategies, and cortical correlates of an experimentally induced emotion regulation task (participants either passively watched unpleasant and neutral pictures or regulated their emotional response to unpleasant pictures using pre-trained reappraisal, while an electroencephalogram was recorded) were compared between 19 patients with FNSD and 19 healthy comparison participants (HC) before and after a 4-week standard treatment protocol that included a combination of (individual and group) psychotherapies and functional treatments (such as physiotherapy) or a 4-week interval in HC, respectively. Results General psychological strain did not decrease significantly in FNSD patients. Changes in emotion regulation in FNSD patients were constrained to an increase in self-reported use of cognitive reappraisal strategies. Subjective symptom intensity in FNSD patients varied with alexithymia pretreatment, but did not decrease significantly. Cortical activity in the time and frequency-domain distinguished passive watching of neutral and unpleasant pictures and regulating emotional responses upon unpleasant pictures from passively watching them without difference between groups and/or time. Discussion Over the investigated time interval, augmented habitual cognitive emotion regulation suggests an alleviation of emotion processing deficits, but no significant symptom decrease. More controlled and prolonged treatment studies would be needed to determine whether and how a specific contribution of treatment-related changes of emotion regulation and FNS might be inferred.
Epimutational profile of hematologic malignancies as attractive target for new epigenetic therapies

In recent years, recurrent somatic mutations in epigenetic regulators have been identified in patients with hematological malignancies. Furthermore, chromosomal translocations in which the fusion protein partners are themselves epigenetic regulators or where epigenetic regulators are recruited/targeted by oncogenic fusion proteins have also been described. Evidence has accumulated showing that “epigenetic drugs” are likely to provide clinical benefits in several hematological malignancies, granting their approval for the treatment of myelodysplastic syndromes and cutaneous T-cell lymphomas. A large number of pre-clinical and clinical trials evaluating epigenetic drugs alone or in combination therapies are ongoing. The aim of this review is to provide a comprehensive summary of known epigenetic alterations and of the current use of epigenetic drugs for the treatment of hematological malignancies.
Scalability and Design of a Submerged Membrane Bioreactor for Municipal Wastewater Treatment

Jennifer Pawloski Advisor: University of Guelph, 2016 Dr. Hongde Zhou The topic of membrane performance and fouling in a membrane bioreactor system (MBR) has been extensively researched. Many approaches have been employed to explore the mechanisms behind fouling and how to control it. While a very well-studied topic, the vast majority of published results are based on lab-scale or small pilot-scale systems using synthetic wastewater. Very few studies have looked at the ability to scale the results of these studies to apply at fullscale. Use of real wastewater and testing at larger scales has been extremely limited. In an effort to close this fundamental research gap, a multi-year study on the impact system scale has on the short term membrane performance and fouling in MBR systems was conducted. Four systems of increasing size from a lab-scale system to a full-scale 3.0 million gallon/day plant were used to conduct the study. All four systems operated with municipal wastewater and used the same hollow fibre membrane. The applicability of scaling the results of small systems was explored by introducing a new evaluation approach using the difference in the ratio of solid mass flux (SMF) handled by the membranes to the amount of air mass flux (AMF) introduced to control membrane fouling. Recommendations on how to use small system data were proposed based on the findings. The impact key membrane module operational and design parameters have on fouling were also examined. The novel SMF to AMF analysis was applied to allow for comparison of results and helped determine which changes could lead to the best performance optimization. Finally, an Excel® based model capable of predicting lifecycle costs for MBR systems was developed. The model was found to be useful in predicting costs for up to six membrane products simultaneously. The impact of membrane design and operational parameters on lifecycle costs was explored using three similar products. The analysis included the impact of key operational and design parameters over a wide range of plant flow capacities. Results show that product properties and operational parameters can have a larger than expected impact on the lifecycle costs of a system.
Endoscopic treatment of native lung hyperinflation using endobronchial valves in single‐lung transplant patients: a multinational experience

Hyperinflation of the native lung (NLH) is a known complication to single‐lung transplantation for emphysema. The hyperinflation can lead to compression of the graft and cause respiratory failure. Endobronchial valves have been used to block airflow in specific parts of the native lung, reducing the native lung volume and relieving the graft.
Accuracy and Reliability of the Self-inflating Bulb to Verify Tracheal Intubation in Out-of-hospital Cardiac Arrest Patients

BackgroundTo determine the sensitivity and specificity of the self-inflating bulb (SIB) to verify tracheal intubation in out-of-hospital cardiac arrest patients. MethodsSixty-five consecutive adult patients with out-of-hospital cardiac arrest were enrolled. Patients were provided chest compression and ventilation by either bag–valve–mask or the esophageal tracheal double-lumen airway by ambulance crews when they arrived at the authors’ department. Immediately after intubation in the emergency department, the endotracheal tube position was tested by the SIB and end-tidal carbon dioxide (ETco2) monitor using an infrared carbon dioxide analyzer. We observed the SIB reinflating for 10 s, and full reinflation within 4 s was defined as a positive result (tracheal intubation). ResultsFive esophageal intubations occurred, and the SIB correctly identified all esophageal intubations. Of the 65 tracheal intubations, the SIB correctly identified 47 tubes placed in the trachea (72.3%). Delayed but full reinflation occurred in one tracheal intubation during the 10-s observation period. Fifteen tracheal intubations had incomplete reinflation during the observation period, and two tracheal intubations did not achieve any reinflation. Thirty-nine tracheal intubations were identified by ETco2 (60%). When the SIB test is combined with the ETco2 detection, 59 tracheal intubations were identified with a 90.8% sensitivity. ConclusionsThe authors found a high incidence of false-negative results of the SIB in out-of-hospital cardiac arrest patients. Because no single test for verifying endotracheal tube position is reliable, all available modalities should be tested and used in conjunction with proper clinical judgment to verify tracheal intubation in cases of out-of-hospital cardiac arrest.
When lithography meets self-assembly: a review of recent advances in the directed assembly of complex metal nanostructures on planar and textured surfaces

One of the foremost challenges in nanofabrication is the establishment of a processing science that integrates wafer-based materials, techniques, and devices with the extraordinary physicochemical properties accessible when materials are reduced to nanoscale dimensions. Such a merger would allow for exacting controls on nanostructure positioning, promote cooperative phenomenon between adjacent nanostructures and/or substrate materials, and allow for electrical contact to individual or groups of nanostructures. With neither self-assembly nor top-down lithographic processes being able to adequately meet this challenge, advancements have often relied on a hybrid strategy that utilizes lithographically-defined features to direct the assembly of nanostructures into organized patterns. While these so-called directed assembly techniques have proven viable, much of this effort has focused on the assembly of periodic arrays of spherical or near-spherical nanostructures comprised of a single element. Work directed toward the fabrication of more complex nanostructures, while still at a nascent stage, has nevertheless demonstrated the possibility of forming arrays of nanocubes, nanorods, nanoprisms, nanoshells, nanocages, nanoframes, core–shell structures, Janus structures, and various alloys on the substrate surface. In this topical review, we describe the progress made in the directed assembly of periodic arrays of these complex metal nanostructures on planar and textured substrates. The review is divided into three broad strategies reliant on: (i) the deterministic positioning of colloidal structures, (ii) the reorganization of deposited metal films at elevated temperatures, and (iii) liquid-phase chemistry practiced directly on the substrate surface. These strategies collectively utilize a broad range of techniques including capillary assembly, microcontact printing, chemical surface modulation, templated dewetting, nanoimprint lithography, and dip-pen nanolithography and employ a wide scope of chemical processes including redox reactions, alloying, dealloying, phase separation, galvanic replacement, preferential etching, template-mediated reactions, and facet-selective capping agents. Taken together, they highlight the diverse toolset available when fabricating organized surfaces of substrate-supported nanostructures.
What is nursing home quality and how is it measured?

PURPOSE In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality. DESIGN AND METHODS A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Donabedian's structure, process, and outcome (SPO) model is used to frame the discussion. Current quality indicators and quality initiatives are discussed, including those included in the Facility Quality Indicator Profile Report, Nursing Home Compare, deficiency citations included as part of Medicare/Medicaid certification, and the Advancing Excellence Campaign. RESULTS Current quality indicators are presented as a mix of structural, process, and outcome measures, each of which has noted advantages and disadvantages. We speculate on steps that need to be taken in the future to address and potentially improve the quality of care provided by nursing homes, including report cards, pay for performance, market-based incentives, and policy developments in the certification process. Areas for future research are identified throughout the review. IMPLICATIONS We conclude that improvements in nursing home quality have likely occurred, but improvements are still needed.
Camera system considerations for geomorphic applications of SfM photogrammetry

The availability of high‐resolution, multi‐temporal, remotely sensed topographic data is revolutionizing geomorphic analysis. Three‐dimensional topographic point measurements acquired from structure‐from‐motion (SfM) photogrammetry have been shown to be highly accurate and cost‐effective compared to laser‐based alternatives in some environments. Use of consumer‐grade digital cameras to generate terrain models and derivatives is becoming prevalent within the geomorphic community despite the details of these instruments being largely overlooked in current SfM literature.
Pervasive microstructural abnormalities in autism: a DTI study.

BACKGROUND Recent studies have reported abnormal functional connectivity patterns in the brains of people with autism that may be accompanied by decreases in white matter integrity. Since autism is a developmental disorder, we aim to investigate the nature and location of decreases in white and grey matter integrity in an adolescent sample while accounting for age. METHODS We used structural (T1) imaging to study brain volumetrics and diffusion tensor imaging (DTI) to investigate white and grey matter integrity in people with autism. We obtained magnetic resonance images for adolescents aged 12-18 years with high-functioning autism and from matched controls. Fractional anisotropy and mean diffusivity, as well as grey and white matter volumetrics were analyzed. RESULTS There were 17 participants with autism and 25 matched controls included in this study. Participants with autism had lower fractional anisotropy in the left and right superior and inferior longitudinal fasciculus, but this effect was not significant after adjusting for age and intelligence quotient (IQ). The kurtosis of the white matter fractional anisotropy probability distribution was higher in this participant group, with and without adjustment for age and IQ. Most notably, however, the mean diffusivity levels were markedly increased in the autism group throughout the brain, and the mean diffusivity probability distributions of both grey and white matter were shifted toward a higher value, particularly with age and IQ adjustment. No volumetric differences in grey and white matter were found. LIMITATIONS We corrected for age and IQ using a linear model. The study was also limited by its sample size, investigated age range and cross-sectional design. CONCLUSION The findings suggest that autism is characterized by a generalized reduction of white matter integrity that is associated with an increase of interstitial space. The generalized manifestation of the white matter abnormalities provides an important new perspective on autism as a connectivity disorder.