Miracle-dz/UniFAR-FTUs huggingface dataset:
The effects of problem-based learning during medical school on physician competency: a systematic review

Background: Systematic reviews on the effects of problem-based learning have been limited to knowledge competency either during medical school or postgraduate training. We conducted a systematic review of evidence of the effects that problem-based learning during medical school had on physician competencies after graduation. Methods: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Databases, and the tables of contents of 5 major medical education journals from earliest available date through Oct. 31, 2006. We included studies in our review if they met the following criteria: problem-based learning was a teaching method in medical school, physician competencies were assessed after graduation and a control group of graduates of traditional curricula was used. We developed a scoring system to assess the quality of the studies, categorized competencies into 8 thematic dimensions and used a second system to determine the level of evidence for each competency assessed. Results: Our search yielded 102 articles, of which 15 met inclusion criteria after full text review. Only 13 studies entered final systematic analysis because 2 studies reported their findings in 2 articles. According to self-assessments, 8 of 37 competencies had strong evidence in support of problem-based learning. Observed assessments had 7 competencies with strong evidence. In both groups, most of these competencies were in the social and cognitive dimensions. Only 4 competencies had moderate to strong levels of evidence in support of problem-based learning for both self-and observed assessments: coping with uncertainty (strong), appreciation of legal and ethical aspects of health care (strong), communication skills (moderate and strong respectively) and self-directed continuing learning (moderate). Interpretation: Problem-based learning during medical school has positive effects on physician competency after graduation, mainly in social and cognitive dimensions.
Clarification of issues regarding manometry for central venous catheterization.

To the Editor: Drs. Leibowitz and Rozner and Leone raise several excellent issues regarding our article on the use of manometry for internal jugular cannulation. First, the sentinel event discussed in our article was not the first occurrence of arterial cannulation in our institution. It was, however, the only occurrence resulting in a patient’s death. This adverse outcome led to the implementation of mandatory manometry for central venous catheterization. The published incidence of arterial cannulation is between 0.1% and 0.8%. Using the most conservative figure, we would have expected to see approximately 10 arterial cannulations, not one, as mentioned by Dr. Leone. We believe that going from an estimate of 10 arterial cannulations to 0 is beyond the natural variability. This is supported by the data from last year of our report: our incidence of 0.78% unrecognized arterial puncture agrees with the literature, and the possible subsequent risk of arterial cannulation was prevented in all cases by manometry. Two common risk concerns mentioned by Leone are sterility and venous air embolism. In our more than 17 yr of experience with manometry using standard precautions to prevent air entry, we have not witnessed a single instance of clinically recognizable venous air embolism. Our catheterization kits come prepackaged with sterile tubing, minimizing the possibility of a break in sterility. Again, we thank the authors for their insightful comments and criticisms. Patient safety can only be improved through these discussions, and we strongly feel that applying manometry to every central venous catheterization is a simple, userfriendly technique that eliminates arterial cannulation.
Hungry for Love: The Influence of Self-Regulation on Infidelity

ABSTRACT The current research examines the effect of self-regulation on the likelihood of committing infidelity. Thirty-two college students in exclusive romantic relationships interacted through a private chat room with an opposite-sex confederate. Prior to this interaction, a food-restriction task depleted half the participants of self-control. As predicted, depleted levels of self-regulation increased the likelihood of infidelity. Specifically, depleted participants were more likely to both accept a coffee date from and supply a personal telephone number to the confederate than non-depleted participants. Weakened self-control may be one potential cause for the levels of infidelity occurring in romantic partnerships today.
Knowledge matching in the technology outsourcing context of online innovation intermediaries

This paper focuses on innovation matchmaking by online innovation intermediaries that operate as technology outsourcing services. These services connect employers wishing to commission individuals to complete technical activities to individuals with knowledge to undertake the project. We present three new metrics based on the statistical mechanics of complex networks to assess forms of knowledge matches between the knowledge required by employers’ projects and the knowledge offered by service providers. Based upon the results, we identify several challenges open innovation intermediaries, employers, and providers face: structuring knowledge to identify providers who can provide solutions beyond the immediate exigencies of the problem, choosing a provider among many potential matches, and choosing an online innovation intermediary when several suitable alternatives exist. The metrics provide insight into potential solutions to these challenges. We conclude with recommendations to improve the service offerings of online innovation intermediaries.
Array‐based DNA methylation profiling in acute myeloid leukaemia

Methylation in the promoter region of many genes is involved in regulating gene expression patterns. Using the Illumina GoldenGate© methylation assay, we examined the methylation status of 1505 CpG‐sites from 807 genes in 32 samples from patients with acute myeloid leukaemia (AML) at diagnosis, nine at relapse and 15 normal controls and performed additional pyrosequencing and semiquantitative methylation specific polymerase chain reaction (MSP) of the GNMT promoter in 113 diagnostic AML samples. We found a gain of overall methylation in AML samples with a further increase at relapse. Regional hypermethylation as assessed by array analysis could be confirmed by both MSP and pyrosequencing. Additionally, large‐scale methylation analysis identified interesting candidate genes. Cluster analysis indicated that cytogenetic subgroups seemed to be characterized by additional distinct epigenetic modifications and that basic DNA methylation patterns remain at relapse. Therefore, promoter hypermethylation is a frequent event in AML and is accentuated at relapse. Array‐based methylation analysis determined distinct methylation profiles for non‐malignant controls and AML samples with specific chromosomal aberrations and can identify target genes for further evaluation.
Stage‐ and CA125–related survival in patients with epithelial ovarian cancer treated at a cancer center

Current accepted prognostic indicators in ovarian cancer include performance status, surgical (FIGO) staging, and residual disease after operation. Here we present data from a prospective analysis of patients with ovarian cancer treated at the Christie Hospital. We confirm the independent prognostic effects of FIGO staging, performance status, and residual disease in our group of patients and furthermore show that CA125 levels at presentation to the oncology service are of independent prognostic significance (P= 0.02). We present survival data and show that the 3-year, cancer-specific survival for stage I disease is 90%. We postulate that this good survival may in part be due to the use of computed tomography scanning at presentation to allow accurate staging. Further clinical trials are needed to test whether combinations of surgical, histologic, biochemical, and radiologic parameters can be used to identify a population with such a good prognosis that adjuvant therapy is not required.
Microbial Tailoring of Acyl Peptidic Siderophores

Marine bacteria produce an abundance of suites of acylated siderophores characterized by a unique, species-dependent headgroup that binds iron(III) and one of a series of fatty acid appendages. Marinobacter sp. DS40M6 produces a suite of seven acylated marinobactins, with fatty acids ranging from saturated and unsaturated C12–C18 fatty acids. In the present study, we report that in the late log phase of growth, the fatty acids are hydrolyzed by an amide hydrolase producing the peptidic marinobactin headgroup. Halomonas aquamarina str. DS40M3, another marine bacterium isolated originally from the same sample of open ocean water as Marinobacter sp. DS40M6, produces the acyl aquachelins, also as a suite composed of a peptidic headgroup distinct from that of the marinobactins. In contrast to the acyl marinobactins, hydrolysis of the suite of acyl aquachelins is not detected, even when H. aquamarina str. DS40M3 is grown into the stationary phase. The Marinobacter cell-free extract containing the acyl amide hydrolase is active toward exogenous acyl-peptidic siderophores (e.g., aquachelin C, loihichelin C, as well as octanoyl homoserine lactone used in quorum sensing). Further, when H. aquamarina str. DS40M3 is cultured together with Marinobacter sp. DS40M6, the fatty acids of both suites of siderophores are hydrolyzed, and the aquachelin headgroup is also produced. The present study demonstrates that coculturing bacteria leads to metabolically tailored metabolites compared to growth in a single pure culture, which is interesting given the importance of siderophore-mediated iron acquisition for bacterial growth and that Marinobacter sp. DS40M6 and H. aquamarina str. DS40M3 were isolated from the same sample of seawater.
Event-sequence Analysis of Appraisals and Coping during Trapshooting Performance

This study describes appraisal and coping patterns of Portuguese trapshooters during competition, via post-performance retrospective verbal reports. Probabilities that an event (e.g., missed target) is followed by another event (e.g., negative appraisal) were calculated and state transitional diagrams were drawn. Event-sequences during critical and non-critical performance periods were compared. Negative appraisals were most likely before and after missed targets and hits with the second shot. Positive appraisals were most likely before problem-focused coping and after emotion-focused coping. These findings support the process view of coping by illustrating that athletes cope with a variety of situations via a complex set of appraisals.
Immunological Problems of Transplantation into the Subretinal Space

The objective of retinal transplantation is to substitute destroyed or degenerated retina to improve visual function. Photoreceptors and retinal pigment epithelium cells of embryonic and nonembryonic origin have been transplanted into the subretinal space in different animal models. Recently, retinal cells have also been used for transplantation in untreated or immunosuppressed patients with retinitis pigmentosa and age-related macular degeneration. Transplants performed in animals such as the RCS rat have maintained retinal function at the transplantation site for long periods of time, although such transplantations in humans have not proved conclusively, to date, whether there is a real effect or not. One reason for this phenomenon seems to be an immune response to transplanted retinal cells at the transplantation site. The detectable rejection process shows that the posterior part of the eye is not absolutely immunologically privileged and that rejection is a serious problem in human retinal transplantation. Many questions concerning transplantation technique, graft treatment and postoperative treatment will be answered through more intensive experiments and clinical trials regarding the immunology. However, rejection of transplanted material is one of the main reasons why retinal transplantation has not yet proved successful.
Functional Module Connectivity Map (FMCM): A Framework for Searching Repurposed Drug Compounds for Systems Treatment of Cancer and an Application to Colorectal Adenocarcinoma

Drug repurposing has become an increasingly attractive approach to drug development owing to the ever-growing cost of new drug discovery and frequent withdrawal of successful drugs caused by side effect issues. Here, we devised Functional Module Connectivity Map (FMCM) for the discovery of repurposed drug compounds for systems treatment of complex diseases, and applied it to colorectal adenocarcinoma. FMCM used multiple functional gene modules to query the Connectivity Map (CMap). The functional modules were built around hub genes identified, through a gene selection by trend-of-disease-progression (GSToP) procedure, from condition-specific gene-gene interaction networks constructed from sets of cohort gene expression microarrays. The candidate drug compounds were restricted to drugs exhibiting predicted minimal intracellular harmful side effects. We tested FMCM against the common practice of selecting drugs using a genomic signature represented by a single set of individual genes to query CMap (IGCM), and found FMCM to have higher robustness, accuracy, specificity, and reproducibility in identifying known anti-cancer agents. Among the 46 drug candidates selected by FMCM for colorectal adenocarcinoma treatment, 65% had literature support for association with anti-cancer activities, and 60% of the drugs predicted to have harmful effects on cancer had been reported to be associated with carcinogens/immune suppressors. Compounds were formed from the selected drug candidates where in each compound the component drugs collectively were beneficial to all the functional modules while no single component drug was harmful to any of the modules. In cell viability tests, we identified four candidate drugs: GW-8510, etacrynic acid, ginkgolide A, and 6-azathymine, as having high inhibitory activities against cancer cells. Through microarray experiments we confirmed the novel functional links predicted for three candidate drugs: phenoxybenzamine (broad effects), GW-8510 (cell cycle), and imipenem (immune system). We believe FMCM can be usefully applied to repurposed drug discovery for systems treatment of other types of cancer and other complex diseases.
A Fast Nearest-Neighbor Algorithm Based on a Principal Axis Search Tree

A new fast nearest-neighbor algorithm is described that uses principal component analysis to build an efficient search tree. At each node in the tree, the data set is partitioned along the direction of maximum variance. The search algorithm efficiently uses a depth-first search and a new elimination criterion. The new algorithm was compared to 16 other fast nearest-neighbor algorithms on three types of common benchmark data sets including problems from time series prediction and image vector quantization. This comparative study illustrates the strengths and weaknesses of all of the leading algorithms. The new algorithm performed very well on all of the data sets and was consistently ranked among the top three algorithms.
A dual neural network for bi-criteria kinematic control of redundant manipulators

A dual neural network is presented for the bi-criteria kinematic control of redundant manipulators. To diminish the discontinuity of minimum infinity-norm solutions, the kinematic-control problem is formulated in the bi-criteria of the infinity and Euclidean norms. Physical constraints such as joint limits and joint velocity limits are also incorporated simultaneously into the proposed kinematic control scheme. The single-layer dual neural network model with a simple structure is developed for bi-criteria redundant resolution of redundant manipulators subject to robot physical constraints. The dual neural network is shown to be globally convergent to optimal solutions in the bi-criteria sense, and is demonstrated to be effective in controlling the PA10 robot manipulator.
Function Approximation With Continuous-Valued ActivationFunctions in

CMAC (Albus, 1975b) is well known as a good function approximator with local generalization abilities. Depending on the smoothness of the function to be approximated, the resolution as the smallest distinguishable part of the input domain, plays a crucial role. If the usually used binary quantizing functions are dropped in favor of more general, continuous-valued functions, this drawback can be remedied. We introduce such a model, using gaussians instead of binary functions. We apply the method to approximate functions. It outperforms the traditional approach with respect to training time, approximation accuracy, parameter insensitivity and memory consumption.
Alternating Multi-bit Quantization for Recurrent Neural Networks

Recurrent neural networks have achieved excellent performance in many applications. However, on portable devices with limited resources, the models are often too large to deploy. For applications on the server with large scale concurrent requests, the latency during inference can also be very critical for costly computing resources. In this work, we address these problems by quantizing the network, both weights and activations, into multiple binary codes {-1,+1}. We formulate the quantization as an optimization problem. Under the key observation that once the quantization coefficients are fixed the binary codes can be derived efficiently by binary search tree, alternating minimization is then applied. We test the quantization for two well-known RNNs, i.e., long short term memory (LSTM) and gated recurrent unit (GRU), on the language models. Compared with the full-precision counter part, by 2-bit quantization we can achieve ~16x memory saving and ~6x real inference acceleration on CPUs, with only a reasonable loss in the accuracy. By 3-bit quantization, we can achieve almost no loss in the accuracy or even surpass the original model, with ~10.5x memory saving and ~3x real inference acceleration. Both results beat the exiting quantization works with large margins. We extend our alternating quantization to image classification tasks. In both RNNs and feedforward neural networks, the method also achieves excellent performance.
Attitude of Italian physicians toward pertussis diagnosis

Resurgence of pertussis has been observed in several countries whereas Italy continues to be a low incidence country. We hypothesize that the low reported incidence of pertussis in Italy could be biased by the attitude of physicians to suspect and diagnose pertussis in different age groups. We investigated the attitude of Italian physicians toward pertussis diagnosis through clinical scenarios. A cross-sectional study was conducted in June 2012 sending online questionnaires to pediatricians and general practitioners (GPs) involved in ambulatory primary care. The questionnaire included five clinical scenarios of patients of different ages (45 d, 5 y, 11 y, 24 y, 58 y) with prolonged cough of at least 2 weeks. Respondents were asked to choose a diagnosis among a list of 14. We observed a decreasing trend of suspected pertussis diagnosis with increasing age of the patient (from 46% at 45 d to 0 at 58 y). In Italy pertussis is seldom suspected in the differential diagnosis of cough particularly in adults. This may cause a significant under-notification of pertussis, with a higher impact in older age groups. Educational programs should be reinforced to consider the differential diagnosis of pertussis in individuals with atypical presentation and in older age groups.
Amlodipine poisioning complicated with acute non-cardiogenic pulmonary oedema

Amlodipine poisoning is an uncommon presentation with potentially life threatening complications. As there are few cases of severe poisoning documented, management guidelines are limited. The authors present the case of a 22-year-old female who presented to hospital 6 h after ingesting 280 mg of amlodipine. She was treated with aggressive fluid resuscitation and calcium gluconate infusion. She went on to develop acute non-cardiogenic pulmonary odema for which she needed a frusemide infusion. She stayed in hospital for 5 days and was discharged after a psychiatric review with no long-term complications. The authors discuss the other management options available for patients presenting with amlodipine overdose.
Spotlight on Affect: Affect and Affective Forecasting in Impulse Control

The authors propose an alternative conceptualization to the Strack, Werth and Deutsch (2006) model. Their conceptualization considers how the forecasting of emotional outcomes linked to controlling or failing to control impulses impacts self-regulatory behavior. A set of future research questions is identified based on this conceptualization. The proposed model differs from that by Strack et al. (2006) by its focus on (a) affect, (b) impulse control (versus buying) and (c) deliberative processing linked to impulse control (or lack thereof).
Code decay analysis of legacy software through successive releases

Prediction of problematic software components is an important activity today for many organizations as they manage their legacy systems and the maintenance problems they cause. This means that there is a need for methods and models to identify troublesome components. We apply a model for classification of software components as green, yellow and red according to the number of times they required corrective maintenance over successive releases. Further, we apply a principal component and box plot analysis to investigate the causes for the code decay and try to characterize the releases. The case study includes eight releases and 130 software components. The outcome indicates a large number of healthy components as well as a small set of troublesome components requiring extensive repair repeatedly. The analysis characterizes the releases and indicates that it is the relationship between components that causes many of the problems.
Ferric Enterobactin Binding and Utilization byNeisseria gonorrhoeae

ABSTRACT FetA, formerly designated FrpB, an iron-regulated, 76-kDa neisserial outer membrane protein, shows sequence homology to the TonB-dependent family of receptors that transport iron into gram-negative bacteria. Although FetA is commonly expressed by most neisserial strains and is a potential vaccine candidate for bothNeisseria gonorrhoeae and Neisseria meningitidis, its function in cell physiology was previously undefined. We now report that FetA functions as an enterobactin receptor. N. gonorrhoeae FA1090 utilized ferric enterobactin as the sole iron source when supplied with ferric enterobactin at approximately 10 μM, but growth stimulation was abolished when an omega (Ω) cassette was inserted withinfetA or when tonB was insertionally interrupted. FA1090 FetA specifically bound59Fe-enterobactin, with a Kd of approximately 5 μM. Monoclonal antibodies raised against theEscherichia coli enterobactin receptor, FepA, recognized FetA in Western blots, and amino acid sequence comparisons revealed that residues previously implicated in ferric enterobactin binding by FepA were partially conserved in FetA. An open reading frame downstream of fetA, designated fetB, predicted a protein with sequence similarity to the family of periplasmic binding proteins necessary for transporting siderophores through the periplasmic space of gram-negative bacteria. An Ω insertion withinfetB abolished ferric enterobactin utilization without causing a loss of ferric enterobactin binding. These data show that FetA is a functional homolog of FepA that binds ferric enterobactin and may be part of a system responsible for transporting the siderophore into the cell.