Miracle-dz/UniFAR-FTUs huggingface dataset:
Comparison of Two Pain Assessment Tools, “Facial Expression” and “Critical Care Pain Observation Tool” in Intubated Patients After Cardiac Surgery

Background: Critical-care patients are at higher risk of untreated pain, because they are often unable to communicate owing to altered mental status, tracheal intubation and sedation. Objectives: This study compared two pain assessment tools on tracheal intubated critically ill patients in a cardiac post-anesthesia care unit, who were unable to communicate verbally. The studied tools were “critical-care pain observation tool (CPOT)” and “facial expression (FE)”. Patients and Methods: This was a prospective study based on diagnostic test evaluation. A sample of 91 intubated patients was selected from cardiac post-anesthesia care unit. Collected data were demographic characteristics, vital signs, FE and CPOT tools’ scale. Pain was assessed with CPOT and FE scores five times. The first assessment was performed in at least 3 hours after admission of patients to ICU. Then, the pain intensity was reassessed every 30 minutes. In addition, blood pressure, heart rate, respiratory rate and oxygen saturation were measured simultaneously. Results: At the first period, the frequency of “severe” pain intensity using the CPOT was 58.2% and with the FE tool was 67% (P = 0.001). Both tools demonstrated reduction in severity of pain on second and third assessment times. Significantly increasing level of pain and blood pressure due to nursing painful procedures (endo-tracheal suctioning, changing patient’s position, etc.), were obtained by CPOT in fourth assessment. FE was not able to detect such important findings (κ = 0.249). In the fifth step, pain intensity was reduced. The most agreement between the two tools was observed when the reported pain was “severe” (κ = 0.787, P < 0.001) and “mild” (κ = 0.851, P < 0.001). Conclusions: The sensitivity of CPOT was higher for detection and evaluation of pain in intubated postoperative patients compared with “Facial Expression”. Best agreement between these tools was observed in two extremes of pain intensity.
Cost-Effectiveness of Thrombolysis With Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke Assessed by a Model Based on UK NHS Costs

Background and Purpose— Thrombolytic therapy is licensed for use in highly selected patients with acute ischemic stroke. We aimed to model the health economic impact of limited use of thrombolytic therapy and to assess whether it was likely to be cost-effective when used more widely in the UK National Health Service (NHS). Methods— The authors formed a discussion panel to develop the decision-analysis model of acute stroke care. It consisted of Markov state-transition processes, with probabilities of different health states determined by certain key variables. The range of estimates of efficacy of recombinant tissue plasminogen activator (rt-PA) was taken from an update to a Cochrane systematic review of randomized trials of thrombolysis. Data on outcome after stroke were taken from our hospital-based stroke register, supplemented by data derived from relevant literature sources. Results— The model suggested that compared with standard care, if eligible patients were treated with rt-PA up to 6 hours, there was a 78% probability of a gain in quality-adjusted survival during the first year, at a cost of £13 581 per quality-adjusted life-year (QALY) gained. Over a lifetime, rt-PA was associated with cost-savings of £96 565 per QALY. However, the estimates were imprecise and highly susceptible to the assumptions used in the economic model; under several plausible assumptions, rt-PA was much less cost-effective than standard care, and under others, a great deal more cost-effective. Conclusions— The estimates of effectiveness and cost-effectiveness were imprecise. Although the benefits appeared promising, the data did not support the widespread use of thrombolytic therapy outside the terms of the current restricted license in routine clinical practice in the NHS. There is a case for new large-scale randomized trials comparing thrombolytic therapy with control up to 6 hours to determine more precisely the effects of rt-PA on short-term and long-term survival and its cost-effectiveness when used in a wider range of patients.
Brain size in birds is related to traffic accidents

Estimates suggest that perhaps a quarter of a billion birds are killed by traffic annually across the world. This is surprising because birds have been shown to learn speed limits. Birds have also been shown to adapt to the direction of traffic and lane use, and this apparently results in reduced risks of fatal traffic accidents. Such behavioural differences suggest that individual birds that are not killed in traffic should have larger brains for their body size. We analysed the link between being killed by traffic and relative brain mass in 3521 birds belonging to 251 species brought to a taxidermist. Birds that were killed in traffic indeed had relatively smaller brains, while there was no similar difference for liver mass, heart mass or lung mass. These findings suggest that birds learn the behaviour of car drivers, and that they use their brains to adjust behaviour in an attempt to avoid mortality caused by rapidly and predictably moving objects.
Endothelial Cell Activation Is Associated with Cerebral White Matter Lesions in Patients with Cerebrovascular Disease

Abstract: Cerebral MRI scanning frequently shows white matter lesions in elderly people. They are related to cognitive impairment and may result in dementia. Although vascular risk factors are associated with the presence of white matter lesions, the exact pathogenesis remains unclear. Animal studies have indicated involvement of endothelial cells in the pathogenesis of white matter lesions and possibly dementia. We investigated the relation between endothelial cell activation and white matter lesions in individuals with cerebrovascular disease. In 29 patients with an acute stroke (n= 11) or TIAs associated with a symptomatic internal carotid artery stenosis (n= 18), markers of endothelial cell activation such as intercellular adhesion molecule‐1 (sICAM‐1), vascular cell adhesion molecule‐1 (sVCAM‐1), sE‐selectin, and sP‐selectin were measured by means of ELISA. All individuals underwent 1.5‐T MRI scanning. White matter lesions were rated for the periventricular and the subcortical region separately. Individuals with severe periventricular white matter lesions had higher levels of sP‐selectin (245.5 ng/mL vs. 172.7 ng/mL, p= 0.01) and sVCAM‐1 (547.8 ng/mL vs. 454.0 ng/mL, p= 0.04) than those without. This association was only found in individuals with a symptomatic carotid artery stenosis. No such association was found for subcortical white matter lesions. We did not detect any relation between sICAM‐1 and sE‐selectin and white matter lesions. Endothelial cell activation may play a role in the pathogenesis of white matter lesions, especially in periventricular white matter. Possibly, this activation represents the influence of vascular factors on the cerebral endothelium as a prelude to increasingly severe small vessel disease.
Computational Prediction of Neutralization Epitopes Targeted by Human Anti-V3 HIV Monoclonal Antibodies

The extreme diversity of HIV-1 strains presents a formidable challenge for HIV-1 vaccine design. Although antibodies (Abs) can neutralize HIV-1 and potentially protect against infection, antibodies that target the immunogenic viral surface protein gp120 have widely variable and poorly predictable cross-strain reactivity. Here, we developed a novel computational approach, the Method of Dynamic Epitopes, for identification of neutralization epitopes targeted by anti-HIV-1 monoclonal antibodies (mAbs). Our data demonstrate that this approach, based purely on calculated energetics and 3D structural information, accurately predicts the presence of neutralization epitopes targeted by V3-specific mAbs 2219 and 447-52D in any HIV-1 strain. The method was used to calculate the range of conservation of these specific epitopes across all circulating HIV-1 viruses. Accurately identifying an Ab-targeted neutralization epitope in a virus by computational means enables easy prediction of the breadth of reactivity of specific mAbs across the diversity of thousands of different circulating HIV-1 variants and facilitates rational design and selection of immunogens mimicking specific mAb-targeted epitopes in a multivalent HIV-1 vaccine. The defined epitopes can also be used for the purpose of epitope-specific analyses of breakthrough sequences recorded in vaccine clinical trials. Thus, our study is a prototype for a valuable tool for rational HIV-1 vaccine design.
Insulin, insulin-like growth factor-I, and risk of breast cancer in postmenopausal women.

BACKGROUND The positive association between obesity and postmenopausal breast cancer has been attributed, in part, to the fact that estrogen, a risk factor for breast cancer, is synthesized in adipose tissue. Obesity is also associated with high levels of insulin, a known mitogen. However, no prospective studies have directly assessed associations between circulating levels of insulin and/or insulin-like growth factor (IGF)-I, a related hormone, and the risk of breast cancer independent of estrogen level. METHODS We conducted a case-cohort study of incident breast cancer among nondiabetic women who were enrolled in the Women's Health Initiative Observational Study (WHI-OS), a prospective cohort of 93,676 postmenopausal women. Fasting serum samples obtained at study entry from 835 incident breast cancer case subjects and from a subcohort of 816 randomly chosen WHI-OS subjects were tested for levels of insulin, glucose, total IGF-I, free IGF-I, insulin-like growth factor binding protein-3, and estradiol. Multivariable Cox proportional hazards models were used to estimate associations between levels of the serologic factors and baseline characteristics (including body mass index [BMI]) and the risk of breast cancer. All statistical tests were two-sided. Results Insulin levels were positively associated with the risk of breast cancer (hazard ratio [HR] for highest vs lowest quartile of insulin level = 1.46, 95% confidence interval [CI] = 1.00 to 2.13, P(trend) = . 02); however, the association with insulin level varied by hormone therapy (HT) use (P(interaction) = . 01). In a model that controlled for multiple breast cancer risk factors including estradiol, insulin level was associated with breast cancer only among nonusers of HT (HR for highest vs lowest quartile of insulin level = 2.40, 95% CI = 1.30 to 4.41, P(trend) < . 001). Obesity (BMI >or=30 kg/m(2)) was also associated with the risk of breast cancer among nonusers of HT (HR for BMI >or=30 kg/m(2) vs 18.5 to <25 kg/m(2) = 2.12, 95% CI = 1.26 to 3.58, P(trend) = . 003); however, this association was attenuated by adjustment for insulin (P(trend) = . 40). CONCLUSION These data suggest that hyperinsulinemia is an independent risk factor for breast cancer and may have a substantial role in explaining the obesity-breast cancer relationship.
Neurokinin receptors differentially mediate endogenous acetylcholine release evoked by tachykinins in the neostriatum

The regulation of neostriatal cholinergic function by tachykinins (TKs) has been studied by measuring endogenous ACh released from rat neostriatal slices. Septide (SEP; a highly selective substance P analog), neurokinin A (NKA), and neurokinin B (NKB) elicited endogenous ACh release in a concentration-dependent manner. The rank order in potency was the following: NKB (EC50 approximately 0.5 nM) greater than NKA (EC50 approximately 7 nM) greater than SEP (EC50 approximately 12 nM). Spantide (SPA) was less effective (39% inhibition) than [D-Arg6, D- Trp7,9, N-Methyl-Phe8]-substance P fragment 6–11 (53% inhibition) at antagonizing ACh release evoked by SEP and NKA. Smaller doses of the antagonists inhibited the effects of SEP compared to NKA, and the effects of NKB could only be antagonized by SPA. These findings suggest the involvement of the three neurokinin (NK) receptors in ACh release evoked by TKs with the following rank order: NK3 greater than NK2 greater than NK1. 6-Hydroxydopamine lesions of nigrostriatal neurons and tetrodotoxin (TTX) intoxication of striatal tissue revealed two different patterns of regulation of cholinergic function by TKs. On the one hand, SEP and NKA evoked ACh release, independently of the nigrostriatal dopaminergic system, by acting on NK1 and NK2 receptors that are probably localized on the somatodendritic field of cholinergic neurons receiving substance P terminals. On the other hand, dopaminergic terminals seem to regulate NKB neurons that modulate cholinergic neurons, because NKB-evoked ACh release decreased by 24% in the denervated striata. In addition, TTX partially blocked (50%) ACh release evoked by NKB, suggesting that NKB acts on NK3 receptors at both the nerve terminals and the somatodendritic field of cholinergic neurons.
Warming effects on marine microbial food web processes: how far can we go when it comes to predictions?

Previsions of a warmer ocean as a consequence of climatic change point to a 2–6°C temperature rise during this century in surface oceanic waters. Heterotrophic bacteria occupy the central position of the marine microbial food web, and their metabolic activity and interactions with other compartments within the web are regulated by temperature. In particular, key ecosystem processes like bacterial production (BP), respiration (BR), growth efficiency and bacterial–grazer trophic interactions are likely to change in a warmer ocean. Different approaches can be used to predict these changes. Here we combine evidence of the effects of temperature on these processes and interactions coming from laboratory experiments, space-for-time substitutions, long-term data from microbial observatories and theoretical predictions. Some of the evidence we gathered shows opposite trends to warming depending on the spatio-temporal scale of observation, and the complexity of the system under study. In particular, we show that warming (i) increases BR, (ii) increases bacterial losses to their grazers, and thus bacterial–grazer biomass flux within the microbial food web, (iii) increases BP if enough resources are available (as labile organic matter derived from phytoplankton excretion or lysis), and (iv) increases bacterial losses to grazing at lower rates than BP, and hence decreasing the proportion of production removed by grazers. As a consequence, bacterial abundance would also increase and reinforce the already dominant role of microbes in the carbon cycle of a warmer ocean.
Centromere mitotic recombination in mammalian cells

Centromeres are special structures of eukaryotic chromosomes that hold sister chromatid together and ensure proper chromosome segregation during cell division. Centromeres consist of repeated sequences, which have hindered the study of centromere mitotic recombination and its consequences for centromeric function. We use a chromosome orientation fluorescence in situ hybridization technique to visualize and quantify recombination events at mouse centromeres. We show that centromere mitotic recombination occurs in normal cells to a higher frequency than telomere recombination and to a much higher frequency than chromosome-arm recombination. Furthermore, we show that centromere mitotic recombination is increased in cells lacking the Dnmt3a and Dnmt3b DNA methyltransferases, suggesting that the epigenetic state of centromeric heterochromatin controls recombination events at these regions. Increased centromere recombination in Dnmt3a,3b-deficient cells is accompanied by changes in the length of centromere repeats, suggesting that prevention of illicit centromere recombination is important to maintain centromere integrity in the mouse.
The Energy Endoscope: Real-Time Detailed Energy Accounting for Wireless Sensor Nodes

This paper describes a new embedded networked sensor platform architecture that combines hardware and software tools providing detailed, fine-grained real-time energy usage information. We introduce the LEAP2 platform, a qualitative step forward over the previously developed LEAP and other similar platforms. LEAP2 is based on anew low power ASIC system and generally applicable supporting architecture that provides unprecedented capabilities for directly observing energy usage of multiple subsystems in real-time. Real-time observation with microsecond-scale time resolution enables direct accounting of energy dissipation for each computing task as well as for each hardware subsystem. The new hardware architecture is exploited with our new software tools, etop and endoscope. A series of experimental investigations provide high-resolution power information in networking, storage, memory and processing for primary embedded networked sensing applications. Using results obtained in real-time we show that for a large class of wireless sensor network nodes, there exist several interdependencies in energy consumption between different subsystems. Through the use of our measurement tools we demonstrate that by carefully selecting the system operating points, energy savings of over 60% can be achieved while retaining system performance.
An axiomatic approach of the discrete Sugeno integral as a tool to aggregate interacting criteria in a qualitative framework

We present a model allowing us to aggregate decision criteria when the available information is of a qualitative nature. The use of the Sugeno integral as an aggregation function is justified by an axiomatic approach. It is also shown that the mutual preferential independence of criteria reduces the Sugeno integral to a dictatorial aggregation.
Chlamydia trachomatis Cervicitis in Gynecologic Outpatients

Symptoms suggestive of a lower genital tract infection (LGTI) are common complaints in women who consult gynecologists. Sexually transmitted microorganisms, such as Chlamydia traclwtnalis, Neisseria gonorrlweae, and Trichomonas vaginalix, are responsible for a substantial proportion of LGTI. This study was performed to establish the frequency of LGTI caused by C trachomaiis in women attending a gynecologic outpatient clinic. Of 170 women with LGTI,32.9% harbored one or more of these organisms: C trachomatis was found in 19.3%, N gonorrhoeae in 4.7%, and T vaginalis in 25.9%. The results of the isolation studies were correlated with clinical signs and symptoms. In women under 25 years of age, chlamydial cervicitis was found significantly more often in users of oral contraceptives than in nonusers. In women not taking such drugs, cervical erosion was found more often in Chlamydia-positive than Chlaimydia-negative women. Since clinical examination failed to reveal any characteristic signs in cases of chlamydial infection, it was not possible to distinguish a chlamydial from a gonococcal infection. This study also reports the successful treatment of 15 women affected by chlamydial cervicitis with doxycycline or trimethoprim sulphamcthoxazole.
Peripheral Inflammation Exacerbates Damage After Global Ischemia Independently of Temperature and Acute Brain Inflammation

Background and Purpose— Concomitant infection can exacerbate damage caused by cerebral ischemia. However, the interaction between and relative importance of the febrile and inflammatory components of the immune response is still unknown. Methods— Male Sprague-Dawley rats were subjected to a 2-vessel occlusion with hypotension, immediately followed by intraperitoneal injection of lipopolysaccharide or pyrogen-free saline. Results— Inflammation immediately after 2-vessel occlusion exacerbated hippocampal cell loss at 3 days and enhanced anxiety-related behaviors in the elevated plus maze and open field. These effects were not associated with differences in body temperature changes or with hippocampal pro-inflammatory cytokine production or hippocampal microglial activation. Conclusion— We show a previously undocumented dissociation between lipopolysaccharide-exacerbated damage after global ischemia in the rat and the temperature and acute brain immune response, indicating that the mechanism for enhanced lipopolysaccharide damage is hippocampal cytokine and temperature independent in this case.
Neisseria gonorrhoeae Infection Induces Altered Amphiregulin Processing and Release

Adhesion of the human pathogen Neisseria gonorrhoeae has established effects on the host cell and evokes a variety of cellular events including growth factor activation. In the present study we report that infection with N. gonorrhoeae causes altered amphiregulin processing and release in human epithelial cells. Amphiregulin is a well-studied growth factor with functions in various cell processes and is upregulated in different forms cancer and proliferative diseases. The protein is prototypically cleaved on the cell surface in response to external stimuli. We demonstrate that upon infection, a massive upregulation of amphiregulin mRNA is seen. The protein changes its subcellular distribution and is also alternatively cleaved at the plasma membrane, which results in augmented release of an infection-specific 36 kDa amphiregulin product from the surface of human cervical epithelial cells. Further, using antibodies directed against different domains of the protein we could determine the impact of infection on pro-peptide processing. In summary, we present data showing that the infection of N. gonorrhoeae causes an alternative amphiregulin processing, subcellular distribution and release in human epithelial cervical cells that likely contribute to the predisposition cellular abnormalities and anti-apoptotic features of N. gonorrhoeae infections.
Implementation of clinical guidelines on physical therapy for patients with low back pain: randomized trial comparing patient outcomes after a standard and active implementation strategy.

BACKGROUND AND PURPOSE An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain. The effect of this strategy on patients' physical functioning, coping strategy, and beliefs regarding their low back pain was studied. SUBJECTS One hundred thirteen primary care physical therapists treated a total of 500 patients. METHODS The physical therapists were randomly assigned to 1 of 2 groups. The control group received the guidelines by mail (standard passive method of dissemination). The intervention group, in contrast, received an additional active training strategy consisting of 2 sessions with education, group discussion, role playing, feedback, and reminders. Patients with low back pain, treated by the participating therapists, completed questionnaires on physical functioning, pain, sick leave, coping, and beliefs. RESULTS Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks. Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up. DISCUSSION AND CONCLUSION The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain. Active implementation strategies are not recommended if patient outcomes are to be improved.