Miracle-dz/UniFAR-FTUs huggingface dataset:
Transition from paediatric to adult care. Bridging the gaps or passing the buck?

The fate of older adolescent patients in paediatric clinics is either one of transfer to adult services, long term retention in the paediatric clinic, or discharge from medical supervision, either voluntarily or by neglect. Neither simple transfer to adult doctors nor allowing adolescents to “drop out” of medical care is now acceptable quality care for young people with chronic illness. Arranging efficient and caring transfer for adolescents from paediatric to adult care is one of the great challenges facing paediatrics—and indeed the health services—in the coming century.1 Many illnesses once considered to be confined to childhood, such as cystic fibrosis and metabolic conditions, must now be thought of as diseases that begin in childhood but continue into adult life. Paediatric and adult medicine differ greatly in their approach to issues of growth, development, patient agency, and involvement of the family—differences that may become more noticeable with the recent separation of paediatricians from the Royal College of Physicians in the UK. Adolescents sit poorly between the family centred, developmentally focused, paediatric paradigm (which frequently ignores their growing independence and increasingly adult behaviour) and the adult medical culture, which acknowledges patient autonomy, reproduction, and employment issues but neglects growth, development, and family concerns.2 The simple matter of transferring care to adult physicians has been challenged in the past decade by the notion of “transition”, emphasising the need for the change to adult care to be a guided educational and therapeutic process, rather than an administrative event.3 To achieve effective transition, it must be recognised that transition in health care is but one part of the wider transition from dependent child to independent adult and that, in moving from child centred to adult health services, young people undergo a change that is systemic and cultural, as well as clinical.2 …
Parental Support, Behavioral Control, and Psychological Control Among African American Youth

Associations among three dimensions of parenting (support, behavioral control, psychological control) and measures of adolescent depression, delinquency, and academic achievement were assessed in a sample of African American youth. All data were adolescent self-reports by way of school-administered questionnaires in random samples of classrooms in southeastern U.S. metropolitan areas. Path analysis revealed several associations between parenting dimensions and youth outcomes, including negative relationships between paternal support and depression and between parental behavioral control and delinquency. Group comparisons (by youth grade level, gender, and family socioeconomic status [SES]) were also conducted, and no age or SES differences were noted.
Endoleaks following Endovascular Repair of Thoracic Aortic Aneurysm: Etiology and Outcomes

Purpose: To evaluate the incidence and natural history of endoleaks following thoracic endovascular aortic repair (TEVAR) of thoracic aortic aneurysm (TAA). Methods: A retrospective review was conducted on 200 TAA patients (122 men; mean age 69±12 years) who underwent elective TEVAR in the descending thoracic aorta between January 2001 and December 2006. The mean aneurysm diameter was 66 mm (range 50–124), and most (75%) of the aneurysms were atherosclerotic in origin. Medical records and multidetector computed tomography studies were evaluated on a 3-dimensional workstation to categorize endoleak, establish morphological characteristics, and assess outcomes. The outcomes following any secondary interventions were noted in the context of endoleak etiology and the magnitude of the intervention. Results: Over a mean follow-up of 30 months (range 12–73), 39 (19.5%) patients developed an endoleak (33 primary and 8 secondary); 3 people had 2 distinct types of endoleaks. Endoleaks were associated with the presence of a carotid-subclavian bypass (p=0.0001) and lengthy aortic coverage by the stent-graft (p=0.005). The proportion of the 170 patients with a Zenith stent-graft who had an endoleak (17%, n=39) was significantly lower (p<0.01) than the proportion of endoleaks (34%, n=10) in the 30 patients with Gore or Talent devices. Secondary interventions for endoleak were performed in 79% of type I, 24% of type II, and 57% of type III endoleaks. Conclusion: In this study, 1 in 5 TAA patients with TEVAR had endoleak. Most type I and III endoleaks required secondary intervention, while conservative treatment was most frequent for type II. Characterization of endoleak type was not always precise, and routine surveillance of all patients with endoleak is recommended.
Non-transitive information flow in Japanese noun-classifier matching

In Japanese, as in other classifier languages like Chinese and Malay, numerals do not directly quantize nouns, but first combine with a classifier to form a measure phrase (MP; cf. Aikhenvald 2000). From the perspective of constraint-based approaches to syntax/semantics, the mutual selective restriction between classifiers and nouns can be stated in terms of information-sharing and featural identity, to some extent parallel to the treatment of gender/number agreement (between determiner and noun, for instance) (cf. Pollard and Sag 1994; Kathol 1999). There are, however, data that challenge this line of approach to noun-classifier matching. We demonstrate in this paper that it is possible that a single noun is associated with different types of classifier, and show why they are problematic for unification-based approaches, similar to the situation with case syncretism in European languages (Ingria 1990 and others). Later in the paper, we argue that information-sharing between noun, predicate and classifier is not completely transitive, and present a formal analysis which models multiple selectional requirements with sets.
Thyroid Allostasis–Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming

The hypothalamus–pituitary–thyroid feedback control is a dynamic, adaptive system. In situations of illness and deprivation of energy representing type 1 allostasis, the stress response operates to alter both its set point and peripheral transfer parameters. In contrast, type 2 allostatic load, typically effective in psychosocial stress, pregnancy, metabolic syndrome, and adaptation to cold, produces a nearly opposite phenotype of predictive plasticity. The non-thyroidal illness syndrome (NTIS) or thyroid allostasis in critical illness, tumors, uremia, and starvation (TACITUS), commonly observed in hospitalized patients, displays a historically well-studied pattern of allostatic thyroid response. This is characterized by decreased total and free thyroid hormone concentrations and varying levels of thyroid-stimulating hormone (TSH) ranging from decreased (in severe cases) to normal or even elevated (mainly in the recovery phase) TSH concentrations. An acute versus chronic stage (wasting syndrome) of TACITUS can be discerned. The two types differ in molecular mechanisms and prognosis. The acute adaptation of thyroid hormone metabolism to critical illness may prove beneficial to the organism, whereas the far more complex molecular alterations associated with chronic illness frequently lead to allostatic overload. The latter is associated with poor outcome, independently of the underlying disease. Adaptive responses of thyroid homeostasis extend to alterations in thyroid hormone concentrations during fetal life, periods of weight gain or loss, thermoregulation, physical exercise, and psychiatric diseases. The various forms of thyroid allostasis pose serious problems in differential diagnosis of thyroid disease. This review article provides an overview of physiological mechanisms as well as major diagnostic and therapeutic implications of thyroid allostasis under a variety of developmental and straining conditions.
The effect of Massachusetts health reform on 30 day hospital readmissions: retrospective analysis of hospital episode statistics

Objectives To analyse changes in overall readmission rates and disparities in such rates, among patients aged 18-64 (those most likely to have been affected by reform), using all payer inpatient discharge databases (hospital episode statistics) from Massachusetts and two control states (New York and New Jersey). Design Difference in differences analysis to identify the post-reform change, adjusted for secular changes unrelated to reform. Setting US hospitals in Massachusetts, New York, and New Jersey. Participants Adults aged 18-64 admitted for any cause, excluding obstetrical. Main outcome measure Readmissions at 30 days after an index admission. Results After adjustment for known confounders, including age, sex, comorbidity, hospital ownership, teaching hospital status, and nurse to census ratio, the odds of all cause readmission in Massachusetts was slightly increased compared with control states post-reform (odds ratio 1.02, 95% confidence interval 1.01 to 1.04, P<0.05). Racial and ethnic disparities in all cause readmission rates did not change in Massachusetts compared with control states. In analyses limited to Massachusetts only, there were minimal overall differences in changes in readmission rates between counties with differing baseline uninsurance rates, but black people in counties with the highest uninsurance rates had decreased odds of readmission (0.91, 0.84 to 1.00) compared with black people in counties with lower uninsurance rates. Similarly, white people in counties with the highest uninsurance rates had decreased odds of readmission (0.96, 0.94 to 0.99) compared with white people in counties with lower uninsurance rates. Conclusions In the United States, and in Massachusetts in particular, extending health insurance coverage alone seems insufficient to improve readmission rates. Additional efforts are needed to reduce hospital readmissions and disparities in this outcome.
Drosophila Lipid Storage Droplet 2 gene (Lsd‐2) is expressed and controls lipid storage in wing imaginal discs

Lipid droplets are the major neutral lipid storage organelles in higher eukaryotes. The PAT domain proteins (Perilipin, ADRP [adipose differentiation related protein], and TIP47 [tail‐interacting 47‐kDa protein]) are associated with these structures. Perilipin and ADRP are involved in the regulation of lipid storage and metabolism in mammals. Two genes encoding PAT proteins, Drosophila Lipid Storage Droplet 2 Gene (Lsd‐2) and Lsd‐2, have been identified in Drosophila. Lsd‐2 is expressed in fat bodies and in the female germ line and is involved in lipid storage in these tissues. We showed that Lsd‐2 is expressed in third‐instar wing imaginal discs in Drosophila, with higher levels in the wing pouch, which corresponds to the presumptive wing region of the wing disc. This specific expression pattern is correlated with a high level of neutral lipid accumulation. We also showed that neutral lipid deposition in the wing disc is severely reduced in an Lsd‐2 mutant and is increased with Lsd‐2 overexpression. Finally, we showed that overexpression of the vestigial (vg) pro‐wing gene induces Lsd‐2 expression, suggesting that Lsd‐2 mediates a vg role during wing formation. Our results suggest that Lsd‐2 function is not restricted to tissues directly involved in lipid storage and could play additional roles during development. Developmental Dynamics 232:725–732, 2005. © 2005 Wiley‐Liss, Inc.
FİBER İLE GÜÇLENDİRİLMİŞ REZİN TUTUCULU KÖPRÜ RESTORASYONU

Tek dis eksikliklerinde, eksik dis boslugunun protetik rehabilitasyonu; konvansiyonel sabit bolumlu protez, metal destekli resin tutuculu kopru (Maryland), hareketli parsiyel protez veya implant ustu protez ile saglanabilmektedir. Fiber ile guclendirilmis kompozit kopruler, konvansiyonel metal destekli koprulere karsi alternatif bir tedavi haline gelmistir. Bu tip kopruler; periodontal acidan problemli destek dislerin varliginda, travma nedeniyle olusan dis kayiplarinda ve implant tedavisinde yukleme oncesi gecici restorasyon yapiminda uygulanmaktadir. Fiber ile guclendirilmis rezin tutuculu kopru restorasyonlari estetik uygulamalardir, ayni zamanda konservatif yaklasimlardir. Ayrica konvansiyonel koprulere gore zaman kazanimi, dusuk maliyet, uygulama kolayligi, metal alerjisinin gelismemesi diger avantajlaridir. Adeziv teknolojisindeki yapisabilir fiberlerin ve guclu kompozit materyallerin gelisimiyle konservatif ve estetik protetik uygulamalar kolaylikla yapilabilmektedir. Ataturk Universitesi Dis hekimligi Fakultesi Protetik Dis Tedavisi Klinigine basvuran 41 yasindaki erkek hastanin ust sag lateral dis eksikligi ve alveol krette kemik kaybi vardi. Bu eksikliklerin giderilmesinde konservatif bir yaklasim sekli olarak fiberle guclendirilmis rezin tutuculu kopru restorasyonu dusunulmustur. Hastanin olcusu irreversibl hidrokolloid olcu maddesi ile alinip, modelleri elde edilmis, indirekt yontemle uygun boyutta lateral dis hazirlanmistir. Daha sonra hasta agzinda fiberle guclendirilmis rezin ile komsu santral ve kanin dislerin palatinal bolgelerine adeziv uygulama yapilmistir
Stability in designer gravity

We study the stability of designer gravity theories, in which one considers gravity coupled to a tachyonic scalar with anti-de Sitter (AdS) boundary conditions defined by a smooth function W. We construct Hamiltonian generators of the asymptotic symmetries using the covariant phase space method of Wald et al and find that they differ from the spinor charges except when W = 0. The positivity of the spinor charge is used to establish a lower bound on the conserved energy of any solution that satisfies boundary conditions for which W has a global minimum. A large class of designer gravity theories therefore have a stable ground state, which the AdS/CFT correspondence indicates should be the lowest energy soliton. We make progress towards proving this by showing that minimum energy solutions are static. The generalization of our results to designer gravity theories in higher dimensions involving several tachyonic scalars is discussed.
Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy

Background In previous studies, Propionibacterium acnes was cultured from intervertebral disc tissue of ~25% of patients undergoing microdiscectomy, suggesting a possible link between chronic bacterial infection and disc degeneration. However, given the prominence of P. acnes as a skin commensal, such analyses often struggled to exclude the alternate possibility that these organisms represent perioperative microbiologic contamination. This investigation seeks to validate P. acnes prevalence in resected disc cultures, while providing microscopic evidence of P. acnes biofilm in the intervertebral discs. Methods Specimens from 368 patients undergoing microdiscectomy for disc herniation were divided into several fragments, one being homogenized, subjected to quantitative anaerobic culture, and assessed for bacterial growth, and a second fragment frozen for additional analyses. Colonies were identified by MALDI-TOF mass spectrometry and P. acnes phylotyping was conducted by multiplex PCR. For a sub-set of specimens, bacteria localization within the disc was assessed by microscopy using confocal laser scanning and FISH. Results Bacteria were cultured from 162 discs (44%), including 119 cases (32.3%) with P. acnes. In 89 cases, P. acnes was cultured exclusively; in 30 cases, it was isolated in combination with other bacteria (primarily coagulase-negative Staphylococcus spp.) Among positive specimens, the median P. acnes bacterial burden was 350 CFU/g (12 - ~20,000 CFU/g). Thirty-eight P. acnes isolates were subjected to molecular sub-typing, identifying 4 of 6 defined phylogroups: IA1, IB, IC, and II. Eight culture-positive specimens were evaluated by fluorescence microscopy and revealed P. acnes in situ. Notably, these bacteria demonstrated a biofilm distribution within the disc matrix. P. acnes bacteria were more prevalent in males than females (39% vs. 23%, p = 0.0013). Conclusions This study confirms that P. acnes is prevalent in herniated disc tissue. Moreover, it provides the first visual evidence of P. acnes biofilms within such specimens, consistent with infection rather than microbiologic contamination.
Hierarchical Space-Time Block Code Recognition Using Correlation Matrices

The blind recognition of communication parameters is a key research issue for commercial and military communication systems. The results of numerous investigations about symbol timing estimation, modulation recognition as well as identification of the number of transmitters have been reported in the literature. But, to our knowledge, none of them have dealt with the recognition of the Space-Time Block Codes (STBC) used in multiple transmitter communications. In order to blindly recognize the STBC of a wireless communication, this paper proposes a method based on the space-time correlations of the received signals. Under perfect timing synchronization and under ideal conditions (full rank channel and a number of receivers greater or equal to the number of transmitters), it shows that the Frobenius norms of these statistics present non-null values whose positions only depend on the STBC at the transmitter side. A classifier for the space-time code recognition of 5 linear STBC (Spatial Multiplexing, Alamouti Coding, and 3 Orthogonal STBC using 3 antennas) is presented. Simulations show that the proposed method performs well even at low signal-to-noise ratios.
A Combination of Melphalan, Prednisone, and 50 mg Thalidomide Treatment in Non-Transplant-Candidate Patients with Newly Diagnosed Multiple Myeloma

Background/Aims The clinical efficacy and safety of a three-drug combination of melphalan, prednisone, and thalidomide were assessed in patients with multiple myeloma who were not candidates for high-dose therapy as a first-line treatment. Because the side effects of thalidomide at a dose of ≥ 100 mg daily can be a barrier to effective treatment for these patients, we evaluated the efficacy and safety of a reduced dose of thalidomide, 50 mg, for non-transplant candidates. Methods Twenty-one patients were treated in 4-week cycles, receiving 4 mg/m2 melphalan and 40 mg/m2 prednisone on days 1-7 and 50 mg thalidomide daily. The primary efficacy outcome was the overall response rate. Aspirin (100 mg daily) was also provided as prophylactic treatment for thromboembolism. Results The overall response rate was 57.1%; a complete response was seen in 23.8% of patients, a partial response in 33.3%, and stable disease in 9.5%. After a median follow-up time of 16.1 months, the median time to progression was 11.4 months (95% confidence interval, 2.1 to 20.6); the median overall survival was not reached. Grades 3 and 4 adverse events included infection (10%), peripheral neuropathy (5%), diarrhea (5%), thrombosis (10%), and loss of consciousness (10%). Two patients discontinued treatment due to loss of consciousness and neuropathy. Conclusions Low-dose thalidomide (50 mg) plus melphalan and prednisone is an effective combination drug therapy option for newly diagnosed myeloma patients who are ineligible for high-dose chemotherapy.
Camptothecin poly[n-(2-hydroxypropyl) methacrylamide] copolymers in antitopoisomerase-I tumor therapy: intratumor release and antitumor efficacy.

Soluble copolymers of camptothecin (CPT), based on poly[N-(2-hydroxypropyl) methacrylamide] (pHPMA), were obtained by conjugation through the degradable spacers -Gly-Phe-Leu-Gly- or -Gly-6-aminohexanoyl-Gly-. We investigated to what extent passive accumulation and retention of hydroxypropyl methacrylamide copolymer of CPT (pHPMA-CPT) in tumors and modulation of the drug release influence efficacy. Release of CPT in vivo was detected by time-resolved phase-shift fluorescence imaging on tumor specimens, based on the evidence that free and bound drug had different fluorescence lifetimes in solution. HT-29 murine specimens, obtained at several times after treatment with (3)H-labeled free CPT, pHPMA-Gly-Phe-Leu-Gly-CPT, or pHPMA-Gly-6-aminohexanoyl-Gly-CPT, were either imaged for time-resolved phase-shift fluorescence or subjected to autoradiography. Phase shifts of CPT conjugates were equal or longer than those of free CPT, indicating the presence of both free and polymer-bound drug in the tumor, in agreement with autoradiograms. pHPMA-Gly-Phe-Leu-Gly-CPT underwent relevant intratumor hydrolysis during the first 24 h, whereas the hydrolysis of pHPMA-Gly-6-aminohexanoyl-Gly-CPT was slow. The latter showed antitumor activity at doses from 10 to 22.5 mg/kg/day against s.c. HT-29, A2780, M14, and A549 s.c. xenografts. Moreover, inhibition of tumor growth lasted for up to 73-88 days, and cures were observed on mice with orthotopic implanted HT-29; pHPMA-Gly-Phe-Leu-Gly-CPT was 2-fold more potent than pHPMA-Gly-6-aminohexanoyl-Gly-CPT but less tolerated. Our data suggest that the efficacy of pHPMA-CPT copolymers is related to their intratumor accumulation, and in vivo properties of releasing CPT by esterolytic and proteolytic degradation.
Robust $H_{\infty}$ Fuzzy Control Approach for a Class of Markovian Jump Nonlinear Systems

This paper addresses the problem of stabilizing a class of nonlinear systems subject to Markovian jump parameters using a robust stochastic fuzzy controller with Hinfin performance. The class of jump nonlinear systems considered is described by a fuzzy model composed of two levels: A crisp level which represents the jumps and a fuzzy level which represents the system nonlinearities. Considering the approximation error between the fuzzy model and the jump nonlinear system as norm-bounded uncertainties, we develop a systematic technique based on a coupled Lyapunov function to obtain a robust stochastic fuzzy controller which guarantees the L2 gain of the closed-loop system in respect to external inputs to be equal to or less than a prescribed value. A simulation example on an industrial power plant operating in a cogeneration scheme is presented to illustrate the effectiveness of the proposed stabilizing controller in reducing oscillations as well as maintaining a desired operation condition in the presence of fluctuations in the local load
The behaviour of single lap joints under bending loading

Four-point bend tests were performed on single lap joints with hard steel adherends and a structural epoxy adhesive. The effect of the overlap, the adherend thickness and the adhesive thickness was studied. It was found that the length of the overlap has no significant effect on the strength of the joints. This is because the load transfer is occurring in a very localised area around the edges of the overlap, being the failure governed by peel mechanisms. The thickness of the adherends strongly affects the strength of the joints. The thicker the adherend, the stronger is the joint. The experimental results are compared with a finite element model and reinforce the fact that the failure takes place due to local strains at the ends of the overlap in tension. An analytical model is also given to predict in a simple but effective way the joint strength and its dependence on the adherend thickness.