Miracle-dz/UniFAR-FTUs huggingface dataset:
Planning for Burn Disasters: What Can We Learn from One Hundred Years of History?: 1.

D. J. Barillo, MD, FACS U.S. Army Institute of Surgical Research, San Antonio, TX Introduction: The terrorist attacks of September 11 have prompted both local and national interest in developing plans to manage thousands of burn casualties. There is little, if any, actual experience in managing disasters of this size. As an alternative, lessons may be learned from the historical experiences of those who have responded to other civilian burn or fire disasters or mass casualty incidents occurring in the United States. Methods: Review of the pertinent medical, fire service and popular literature pertaining to civilian fire or burn disasters occurring within the United States between the years 1900 to 2000. Results: Since 1900, there have been less than 40 major fire or burn disasters in the US. With each disaster prompting a strengthening of fire regulations or building codes, the number of incidents and number of fatalities per incident has steadily decreased. Only 25% of the burn disasters of the last century have occurred in the last 50 years (graphic below: deaths per incident). Detailed examination of several landmark fires (Cocoanut Grove, Beverly Hills Supper Club, Our Lady of Angels School) revealed that although casualty counts were high, in practice, most of the casualties had fatal injuries, with most deaths occurring on-scene or within 24 hours. As a result, there were relatively few burn survivors requiring long-term burn care. Conclusions: Fire and burn mass casualty incidents are uncommon events. Both the number of incidents and the number of casualties per incident are decreasing over time. In most major fires, most of the injured expire on-scene or within 24 hours and most disasters produce less than 50 treatable patients. This would be a rational point to begin burn center preparations for mass casualty incidents.
Key Questions in Ventilator Management of the Burn-Injured Patient (Second of Two Parts)

While tidal volume reduction and application of end expiratory pressure are being studied and refined in contemporary ventilation strategies, alternative modes of ventilation designed to better match respiratory demand are also in development. Some of these strategies relevant to the burn-injured patient are briefly reviewed along with propagation of lung injury and fluid management physiology in the ventilated patient.
A Noninvasive Computational Method for Fluid Resuscitation Monitoring in Pediatric Burns: A Preliminary Report

The fluid resuscitation needs of children with small area burns are difficult to predict. The authors hypothesized that a novel computational algorithm called the compensatory reserve index (CRI), calculated from the photoplethysmogram waveform, would correlate with percent total body surface area (%TBSA) and fluid administration in children presenting with ⩽20% TBSA burns. The authors recorded photoplethysmogram waveforms from burn-injured children that were later processed by the CRI algorithm. A CRI of 1 represents supine normovolemia; a CRI of 0 represents the point at which a subject is predicted to experience hemodynamic decompensation. CRI values from the first 10 minutes of monitoring were compared to clinical data. Waveform data were available for 27 children with small to moderate sized burns (4–20 %TBSA). The average age was 6.3 ± 1.1 years, the average %TBSA was 10.4 ± 0.8%, and the average CRI was 0.36 ± 0.03. CRI inversely correlated with the %TBSA (P < .001). Twenty children were transferred with an average reported %TBSA of 16.5 ± 1.4%, which was significantly higher than the actual %TBSA (P < .001). CRI correlated better with actual %TBSA compared to reported %TBSA (P = .02). CRI correlated with the amount of fluid resuscitation given at the time of CRI measurement (P = .02) and was inversely related to total fluids given per 24 hours for children with adequate urine output (>0.5 ml/kg/hr) (P < .001). The CRI is decreased in children with small to moderate size burns, and correlates with %TBSA and fluid administration. This suggests that the CRI may be useful for fluid resuscitation guidance, warranting further study.
Music therapy: A nonpharmacological approach to the care of agitation and depressive symptoms for nursing home residents with dementia

Depression, agitation, and wandering are common behaviors associated with dementia and frequently observed among nursing home residents. Even with pharmacological treatment, behaviors often persist, hindering quality of life for elders, their family, and paid caregivers. This study examined the use of music therapy for treatment of these symptoms among 132 people with moderate to severe dementia in nursing homes. Participants were evaluated for depressive symptoms, agitation, and wandering to determine their predominate behavior. There were two assessments, two weeks apart, prior to intervention, followed by a two-week intervention, and two follow-up assessments, also two weeks apart. A repeated measures ANOVA determined that after two weeks of music therapy, symptoms of depression and agitation were significantly reduced; there was no change for wandering. Multivariate analyses confirmed a relationship between music therapy and change in neuropsychiatric symptoms associated with dementia. Results suggest widespread use of music therapy in long-term care settings may be effective in reducing symptoms of depression and agitation.
Event-Triggered Learning for Resource-Efficient Networked Control

Common event-triggered state estimation (ETSE) algorithms save communication in networked control systems by predicting agents' behavior, and transmitting updates only when the predictions deviate significantly. The effectiveness in reducing communication thus heavily depends on the quality of the dynamics models used to predict the agents' states or measurements. Event-triggered learning is proposed herein as a novel concept to further reduce communication: whenever poor communication performance is detected, an identification experiment is triggered and an improved prediction model learned from data. Effective learning triggers are obtained by comparing the actual communication rate with the one that is expected based on the current model. By analyzing statistical properties of the inter-communication times and leveraging powerful convergence results, the proposed trigger is proven to limit learning experiments to the necessary instants. Numerical and physical experiments demonstrate that event-triggered learning improves robustness toward changing environments and yields lower communication rates than common ETSE.
Outcomes and survival following heart retransplantation for cardiac allograft failure: a systematic review and meta-analysis.

Background Long-term efficacy of heart retransplantation (RTx) for end-stage cardiac allograft failure remains unclear given the limited worldwide experience and is an important question to elucidate given the shortage of donor organs. The aim of this systematic review was to examine the outcomes of RTx in patients with cardiac allograft failure. Methods Electronic search was performed to identify all studies in the English literature assessing RTx for cardiac allograft failure. All identified articles were systematically assessed for inclusion and exclusion criteria. Results Eleven studies were included for analysis, with a total of 7,791 patients. A total of 7,446 patients underwent primary heart transplantation (HTx) whereas 345 patients underwent RTx with average time from primary HTx to RTx interval of 5.03 years (95% CI: 3.13-6.94 years). There were 35.2% of patients received RTx within 30 days of primary transplant. Early mortality was significantly higher among RTx patients (RTx 28.2% vs. HTx 11.2%, P<0.001) whereas survival was significantly higher among HTx patients when compared to RTx patients at 1 year (HTx 81.8% vs. RTx 59.1%, P<0.001), 2 years (HTx 77.9% vs. RTx 53.6%, P<0.001), 3 years (HTx 76.1% vs. RTx 49.8%, P<0.001), 5 years (HTx 68.8% vs. RTx 41.4%, P<0.001) and 10 years (HTx 53.9% vs. RTx 31.7%, P<0.001). There were no significant differences between HTx and RTx in terms of freedom from rejection at 1 year (HTx 61.0% vs. RTx 53.7%, P=0.43), 2 years (HTx 63.8% vs. RTx 53.7%, P=0.26), 3 years (HTx 62.9% vs. RTx 51.9%, P=0.30) and 5 years (HTx 61.0% vs. RTx 51.9%, P=0.36). Conclusions Patients who underwent heart RTx had a significant lower survival when compared to those who only underwent primary HTx. There were no significant differences in post-transplantation freedom from rejection. Careful patient selection and perioperative care can make heart RTx a viable option for selected recipients.
Dominant forest tree mycorrhizal type mediates understory plant invasions.

Forest mycorrhizal type mediates nutrient dynamics, which in turn can influence forest community structure and processes. Using forest inventory data, we explored how dominant forest tree mycorrhizal type affects understory plant invasions with consideration of forest structure and soil properties. We found that arbuscular mycorrhizal (AM) dominant forests, which are characterised by thin forest floors and low soil C : N ratio, were invaded to a greater extent by non-native invasive species than ectomycorrhizal (ECM) dominant forests. Understory native species cover and richness had no strong associations with AM tree dominance. We also found no difference in the mycorrhizal type composition of understory invaders between AM and ECM dominant forests. Our results indicate that dominant forest tree mycorrhizal type is closely linked with understory invasions. The increased invader abundance in AM dominant forests can further facilitate nutrient cycling, leading to the alteration of ecosystem structure and functions.
Multi-body optimization with subject-specific knee models: performance at high knee flexion angles

Abstract When estimating knee kinematics from skin markers and stereophotogrammetry, multi-body optimization (MBO) has provided promising results for reducing soft tissue artefacts (STA), but can still be improved. The goal of this study was to assess the performance of MBO with subject-specific knee models at high knee flexion angles (up to 110°) against knee joint kinematics measured by magnetic resonance imaging. Eight subjects were recruited. MBO with subject-specific knee models was more effective in compensating STA compared to no kinematic and spherical constraints, in particular for joint displacements. Moreover, it seems to be more reliable over large ranges of knee flexion angle. The ranges of root mean square errors for knee rotations/displacements were 3.0°–9.2°/1.3–3.5 mm for subject-specific knee models, 6.8°–8.7°/6.0–12.4 mm without kinematic constraint and 7.1°–9.8°/4.9–12.5 mm for spherical constraints.
Learning to Learn from Weak Supervision by Full Supervision

In this paper, we propose a method for training neural networks when we have a large set of data with weak labels and a small amount of data with true labels. In our proposed model, we train two neural networks: a target network, the learner and a confidence network, the meta-learner. The target network is optimized to perform a given task and is trained using a large set of unlabeled data that are weakly annotated. We propose to control the magnitude of the gradient updates to the target network using the scores provided by the second confidence network, which is trained on a small amount of supervised data. Thus we avoid that the weight updates computed from noisy labels harm the quality of the target network model.
Nursing home director of nursing leadership style and director of nursing-sensitive survey deficiencies

Background: Nursing homes are becoming increasingly complex clinical environments because of rising resident acuity and expansion of postacute services within a context of historically poor quality performance. Discrete quality markers have been linked to director of nursing (DON) leadership behaviors. However, the impact of DON leadership across all measured areas of DON jurisdiction has not been tested using comprehensive domains of quality deficiencies. Purpose: The aim of this study was to examine the effects of DON leadership style including behaviors that facilitate the exchange of information between diverse people on care quality domains through the lens of complexity science. Methodology: Three thousand six hundred nine DONs completed leadership and intent-to-quit surveys. Quality markers that were deemed DON sensitive included all facility survey deficiencies in the domains of resident behaviors/facility practices, quality of life, nursing services, and quality of care. Logistic regression procedures estimated associations between variables. Findings: The odds of deficiencies for all DON sensitive survey domains were lower in facilities where DONs practiced complexity leadership including more staff input and shared decisional authority. DON quit intentions were aligned with higher odds of facility deficiencies across all domains. Practice Implications: Results supported the hypotheses that DONs using complexity leadership approaches by interacting more freely with staff, discussing resident issues, and sharing decision making produced better care outcomes from every DON sensitive metric assessed by Centers for Medicare and Medicaid Services. The mechanism linking poor quality with high DON quit intentions is an area for future research. Encouraging DON use of complexity leadership approaches has the potential to improve a broad swath of quality outcomes.
Internet‐delivered eating disorder prevention: A randomized controlled trial of dissonance‐based and cognitive‐behavioral interventions

OBJECTIVE The current study evaluated two web-based programs for eating disorder prevention in high-risk, predominantly ethnic minority women. METHOD Two hundred and seventy-one women with elevated weight concerns were randomized to Internet dissonance-based intervention (DBI-I), Internet cognitive-behavioral intervention (CBI-I), or no intervention (NI). Both interventions consisted of four weekly online sessions. Participants were assessed at pre- and post intervention. Outcome measures included eating pathology, body dissatisfaction, dieting, thin-ideal internalization, and depression. RESULTS At postintervention, DBI-I and CBI-I led to greater reductions in body dissatisfaction, thin-ideal internalization, and depression than NI. In addition, CBI-I was effective at reducing dieting and composite eating pathology relative to NI. No outcome differences were found between the active conditions. Moderation analyses suggested that both active conditions were more effective for ethnic minorities than Whites relative to NI. DISCUSSION Results suggest that both DBI-I and CBI-I are effective at reducing eating disorder risk factors in a high-risk, predominantly minority population relative to no intervention.
Intake of whole grains, refined grains, and cereal fiber measured with 7-d diet records and associations with risk factors for chronic disease.

BACKGROUND Research studies examining foods are important, because they account for biological interactions that might otherwise be lost in the analysis of individual nutrients. Single-nutrient studies are also needed to explore the mechanisms by which foods may be protective. OBJECTIVE Our objective was to examine associations between whole grains, refined grains, and cereal fiber and chronic disease risk factors. DESIGN In a cross-sectional analysis of participants in the Baltimore Longitudinal Study of Aging, associations between dietary intakes and risk factors were examined with multivariate linear regression analysis. Dietary intakes were assessed with 7-d dietary records and quantified in g/d. RESULTS Compared with subjects in the lowest quintile (Q1) of whole-grain intake, subjects in the highest quintile (Q5) had lower body mass index (BMI; in kg/m(2); Q1: 25.5; Q5: 24.8; P for trend <0.0001) and weight (Q1: 75.0 kg; Q5: 72.4 kg; P for trend = 0.004) and smaller waist circumference (Q1: 87.4 cm; Q5: 85.0 cm; P for trend = 0.002). Whole grains were also inversely associated with total cholesterol (P for trend = 0.02), LDL cholesterol (P for trend = 0.04), and 2-h glucose (P for trend = 0.0006). Associations between cereal fiber and anthropometrics and plasma lipids were similar. In subgroup analyses, refined grains were positively associated with fasting insulin among women (P for trend = 0.002). CONCLUSIONS Similar associations of whole grains and cereal fiber with weight, BMI, waist circumference, plasma cholesterol, and 2-h glucose were observed, suggesting that cereal fiber and its constituents may in part mediate these relations. Refined grains were associated with fasting insulin among women but not men. Additional research should explore potential interaction effects with BMI, sex, age, and genes.
Young microglia restore amyloid plaque clearance of aged microglia

Alzheimer′s disease (AD) is characterized by deposition of amyloid plaques, neurofibrillary tangles, and neuroinflammation. In order to study microglial contribution to amyloid plaque phagocytosis, we developed a novel ex vivo model by co‐culturing organotypic brain slices from up to 20‐month‐old, amyloid‐bearing AD mouse model (APPPS1) and young, neonatal wild‐type (WT) mice. Surprisingly, co‐culturing resulted in proliferation, recruitment, and clustering of old microglial cells around amyloid plaques and clearance of the plaque halo. Depletion of either old or young microglial cells prevented amyloid plaque clearance, indicating a synergistic effect of both populations. Exposing old microglial cells to conditioned media of young microglia or addition of granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) was sufficient to induce microglial proliferation and reduce amyloid plaque size. Our data suggest that microglial dysfunction in AD may be reversible and their phagocytic ability can be modulated to limit amyloid accumulation. This novel ex vivo model provides a valuable system for identification, screening, and testing of compounds aimed to therapeutically reinforce microglial phagocytosis.
Better Open Than Intellectual: The Benefits of Investment Personality Traits for Learning

The investment theory of adult intelligence posits that individual differences in knowledge attainment result from people’s differences in cognitive ability and their propensity to apply and invest that ability, which is referred to as investment personality traits. Here, we differentiated intellectual (i.e., intellectual curiosity) and nonintellectual investment (i.e., openness to experience), and we tested their respective predictive validity for knowledge attainment in four independent lab-based studies (overall N = 649). Openness to experience was positively associated with knowledge attainment across all four studies, and this effect was by and large independent of cognitive ability. By contrast, intellectual curiosity was not related to knowledge attainment. The findings suggest that openness to experience, rather than intellectual curiosity, is the investment personality trait that broadly benefits learning and adult intelligence.
Meaningful Use of Electronic Health Records and Medicare Expenditures: Evidence from a Panel Data Analysis of U.S. Health Care Markets, 2010–2013

OBJECTIVE To determine if recent growth in hospital and physician electronic health record (EHR) adoption and use is correlated with decreases in expenditures for elderly Medicare beneficiaries. DATA SOURCES American Hospital Association (AHA) General Survey and Information Technology Supplement, Health Information Management Systems Society (HIMSS) Analytics survey, SK&A Information Services, and the Centers for Medicare & Medicaid Services (CMS) Chronic Conditions Data Warehouse Geographic Variation Database for 2010 through 2013. STUDY DESIGN Fixed effects model comparing associations between hospital referral region (HRR) level measures of hospital and physician EHR penetration and annual Medicare expenditures for beneficiaries with one of four chronic conditions. Calculated hospital penetration rates as the percentage of Medicare discharges from hospitals that satisfied criteria analogous to Meaningful Use (MU) Stage 1 requirements and physician rates as the percentage of physicians using ambulatory care EHRs. PRINCIPAL FINDINGS An increase in the hospital penetration rate was associated with a small but statistically significant decrease in total Medicare and Medicare Part A acute care expenditures per beneficiary. An increase in physician EHR penetration was also associated with a significant decrease in total Medicare and Medicare Part A acute care expenditures per beneficiary as well as a decrease in Medicare Part B expenditures per beneficiary. For the study population, we estimate approximately $3.8 billion in savings related to hospital and physician EHR adoption during 2010-2013. We also found that an increase in physician EHR penetration was associated with an increase in lab test expenses. CONCLUSIONS Health care markets that had steeper increases in EHR penetration during 2010-2013 also had steeper decreases in total Medicare and acute care expenditures per beneficiary. Markets with greater increases in physician EHR had greater declines in Medicare Part B expenditures per beneficiary.
Influence of Intravesical Prostatic Protrusion on Preoperative Lower Urinary Tract Symptoms and Outcomes after 120 W High Performance System Laser Treatment in Men with Benign Prostatic Hyperplasia

Purpose To evaluate the efficacy of photoselective vaporization of the prostate (PVP) with the 120 W Greenlight high performance system (HPS) laser for the treatment of benign prostatic hyperplasia (BPH) with intravesical prostatic protrusion (IPP). Materials and Methods This study was conducted on 389 BPH patients who underwent PVP with the 120 W HPS laser from April 2009 to August 2011. The patients were divided into groups according to IPP: group I was defined as IPP of 0 to 5 mm (n=216), group II as IPP of 5 to 10 mm (n=135), and group III as IPP above 10 mm (n=38). Prostate volume, prostate-specific antigen, International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), and postvoid residual volume (PVR) were assessed and checked at postoperative 1, 3, 6, and 12 months. Results There was a significant difference in the mean prostate size in each group (p<0.05). The preoperative total IPSS score, IPSS voiding symptom score, and quality of life score were not significantly different. However, the IPSS storage symptom score was significantly different between groups 1 and 2 and group 3. IPSS scores, Qmax, and PVR at postoperative 1, 3, 6, and 12 months showed significant improvement compared with preoperative values. Conclusions The degree of IPP can affect storage symptoms. However, there is no significant correlation between the degree of IPP and postoperative results. Also, the degree of IPP does not affect short- and long-term PVP results. Proper elimination of bladder outlet obstruction is important for symptomatic relief.
Horizontal Transmission of Chronic Wasting Disease in Reindeer

We challenged reindeer by the intracranial route with the agent of chronic wasting disease sourced from white-tailed deer, mule deer, or elk and tested for horizontal transmission to naive reindeer. Reindeer were susceptible to chronic wasting disease regardless of source species. Horizontal transmission occurred through direct contact or indirectly through the environment.