Miracle-dz/UniFAR-FTUs huggingface dataset:
The impact of national guidelines on the assessment and management of acute paediatric asthma presenting at a tertiary children's emergency department

Background Recent Scottish Intercollegiate Guidelines Network/British Thoracic Society guidelines have highlighted best practice for asthma management. This study examines asthma management in a paediatric emergency setting before and after the publication of these guidelines. Objectives To assess the impact of Scottish Intercollegiate Guidelines Network/British Thoracic Society guidelines on asthma management. Methods Retrospective review of patient notes over two equivalent 2-month periods in 2002 and 2003. Main outcomes were documentation of clinical history, examination, investigation, treatment and discharge; and also the use of various treatment modalities in each case. Results One hundred and sixty-four children presented with asthma, 100 in 2002 and 64 in 2003. Documentation was adequate throughout, though better when nursing staff were responsible. Completeness of documentation was not related to seniority or discipline of medical staff. Measurement of peak flow was poor in both years. The ‘doubling up’ of inhaled steroid dose for acute episodes was the only aspect of management affected by publication of the guidelines, with significantly fewer patients receiving this in 2003 (P<0.0001). Conclusions Documentation within the centre is good but has potential for improvement. Guidelines have not impacted on this except when explicit statements are made regarding treatment.
Discrete Versus Continuous State Switching Models for Portfolio Credit Risk

Dynamic models for credit rating transitions are important ingredients for dynamic credit risk analyses. We compare the properties of two such models that have recently been put forward. The models mainly differ in their treatment of systematic risk, which can be modeled either using discrete states (e.g., expansion versus recession) or continous states. It turns out that the implied asset correlations for discrete state switching models are implausibly low compared to correlation estimates in the literature. Given these limited correlations, we conclude that care has to be taken when discrete state regime switching models are employed for dynamic credit risk management. As a side result of our analysis, we obtain indirect evidence that default correlations may change over the business cycle.
Analysis of the distributed computing approach applied to the folding of a small β peptide

In the recently proposed distributed computing approach to protein folding a very large number of short independent simulations is performed. Using this method, folding events on a time scale orders of magnitude shorter than the experimental one have been reported. However, it has also been observed that the folding process is not an elementary kinetic step and that the presence of initial lag phases can bias short simulations toward atypical pathways. We study here a 20-residue three-stranded antiparallel β-sheet peptide whose equilibrium properties can be characterized by atomistic molecular dynamics simulations. We found that the folding rate of this peptide is estimated correctly by the distributed computing approach when trajectories >≈1/100 of the equilibrium folding time are considered. We also found that the fastest folding events occur through high-energy pathways, which are unlikely under equilibrium conditions. These very fast folding pathways do not relax within the equilibrium denatured state that is stabilized by the transient presence of both native and nonnative interactions, and they are characterized by the nearly simultaneous formation of the two β-hairpins and a very small number of non-native contacts.
Yersiniabactin Is a Virulence Factor for Klebsiella pneumoniae during Pulmonary Infection

ABSTRACT Iron acquisition systems are essential for the in vivo growth of bacterial pathogens. Despite the epidemiological importance of Klebsiella pneumoniae, few experiments have examined the importance of siderophores in the pathogenesis of this species. A previously reported signature-tagged mutagenesis screen identified an attenuated strain that featured an insertional disruption in ybtQ, which encodes a transporter for the siderophore yersiniabactin. We used this finding as a starting point to evaluate the importance of siderophores in the physiology and pathogenesis of K. pneumoniae. Isogenic strains carrying in-frame deletions in genes required for the synthesis of either enterobactin or yersiniabactin were constructed, and the growth of these mutants was examined both in vitro and in vivo using an intranasal infection model. The results suggest divergent functions for each siderophore in different environments, with enterobactin being more important for growth in vitro under iron limitation than in vivo and the reverse being true for the yersiniabactin locus. These observations represent the first examination of isogenic mutants in iron acquisition systems for K. pneumoniae and may indicate that the acquisition of nonenterobactin siderophores is an important step in the evolution of virulent enterobacterial strains.
Haemodynamic adaptation at rest and during exercise to long-term antihypertensive treatment with combined alpha- and beta-adrenoreceptor blockade by labetalol.

suMMARY The effects on systemic and pulmonary haemodynamics of treatment with the alpha-and beta-adrenoceptor blocker labetalol for 20 months were studied in 9 hypertensive men aged 49 to 57 years, at rest in the supine and upright position and during exercise in the sitting position at 62 and 124 Watts. Pressures were recorded by means of catheters inserted percutaneously into the pulmonary and brachial artery, and cardiac output was determined by the Fick method. Systemic systolic, diastolic, and mean pressures were considerably reduced by labetalol under all conditions. Pulmonary mean pressure was slightly higher during exercise, and left ventricular (pulmonary artery) diastolic pressure was virtually unchanged. Systemic blood pressure was lowered by reduction of systemic vascular resistance alone. Though heart rate was significantly reduced under all conditions, cardiac output was unchanged because of a considerable rise in stroke volume which entirely counterbalanced the reduction in pulse rate. Compared with the haemodynamic pattern induced by intravenous labetalol, prolonged treatment resulted in a greater increase in stroke volume and a further decrease of heart rate, particularly at rest. Systemic vascular resistance showed a further tendency towards lower values. Postural hypotension which occurred frequently after intravenous labetalol was not observed after long-term treatment. Plasma renin activity and arterial lactate were consistently reduced. No serious side-effects were observed, nor were there any significant changes in haematological and biochemical variables.
Cross-Monotonic Multicast

In the routing and cost sharing of multicast towards a group of potential receivers, cross-monotonicity is a property that states a user's payment can only be smaller when serviced in a larger set. Being cross-monotonic has been shown to be the key in achieving group-strategyproofness. We study multicast schemes that target optimal flow routing, cross-monotonic cost sharing, and budget balance. We show that no multicast scheme can satisfy these three properties simultaneously, and resort to approximate budget balance instead. We derive both positive and negative results that complement each other for directed and undirected networks. We show that in directed networks, no cross-monotonic scheme can recover a constant fraction of optimal multicast cost. We provide a simple scheme that does achieve 1/k-budget-balance, where k is the number of receivers. Using a probabilistic method rooted in random graph theory, we prove an upper-bound of 2/radic(k) for the budget balance ratio. For undirected networks, we derive a constant upper-bound of 1/2 instead. We further apply a smooth dual growing technique to design a cross- monotonic scheme that recovers k+1/2kzeta of optimal multicast cost in undirected networks, where zeta is a network-dependent parameter close to 1. This is almost tight against the upper-bound |. We finally present a two-stage linear optimization model that pursues maximum budget balance in any given specific network, with trade-off in complexity. Optimization results in various network configurations confirm the theoretically established bounds.
Evaluating wireless multi-hop networks using a combination of simulation, emulation, and real world experiments

Mobile ad hoc networks suffer from complex interactions between protocols on different levels. To identify and explain anomalies found in real world experiments we propose to combine real world testing with simulation and emulation. By inspecting the differences in the results obtained using the three evaluation methods we can efficiently identify when anomalies occur and get a hint about where to further investigate. Our approach has proved to be valuable in an extensive comparison of the routing protocols AODV, DSR, and OLSR. The study resulted in two gigabytes of log data that required an efficient and structured method to isolate important time regions for further manual analysis. We discuss our approach and present some key findings.
Opioid purchases and expenditure in nine western European countries: ‘Are we killing off morphine?’

Background: In clinical practice the major role of opioid drugs is the management of malignant and nonmalignant pain. The primary aim of this study is to evaluate the trend in sales of four opioid analgesic drugs (codeine, tramadol, morphine, fentanyl), from wholesalers to community pharmacies, as an indicator of opioid consumption in nine European countries in 2001, 2002 and 2003. Secondary aims are to compare: (a) the amount of each drug purchased by different countries in 2003; (b) the average price for each drug in the different countries in 2003; and (c) the total expenditure for each opioid from 2001 to 2003. Methods: Data from the Statistical Report on drugs purchased by pharmacies was supplied by IMS Health, an internationally accepted information provider for the pharmaceutical and health care industries. Finding: In the period 2001-2003, while the percentage increase of purchases of fentanyl and tramadol was considerable, that of morphine was the lowest in most of the nine countries. The largest consumer of codeine was the UK and of tramadol was Belgium. The consumption of morphine was the lowest reported in all the countries together and was three times lower than that of transdermal fentanyl. There was a high variability in the costs of the opioids among the different countries. In 2003, the total expenditure on fentanyl reached the total expenditure on tramadol, followed by codeine. Morphine presents the lowest expenditure in all nine countries and over all three years. Interpretation: These results open up many questions. What factors influence opioid purchasing and costs in these European countries? It would be interesting to have the answers from those people who know the actual situation in the individual countries.
Perceived Frequency and Impact of Missing Information at Pediatric Emergency and General Ambulatory Encounters

Summary Objective: To document the perceived frequency, type, and impact of unavailable (“missing”) clinical information during pediatric emergency and general ambulatory encounters. Methods: This prospective cohort set in the Emergency Department and General Ambulatory Pediatric Clinic at The Children’s Hospital, Aurora, CO, assessed pediatric attending physician perceptions regarding missing information at emergency and general ambulatory encounters. The main outcome measures were the frequency of perceived missing information; its presumed location; time spent seeking; and the perceived effects on resource utilization and overall quality of care. Results: Pediatric physicians reported missing information for 2% of emergency and 22% of general ambulatory encounters. Types of missing information at general ambulatory visits included immunization (34% of types), general past medical (29%), and disease or visit specific histories (13%). Missing information at ambulatory visits was sought 20% of the time, obtained 4% of the time, and rated “somewhat or very important for today’s care” (73% of the time) and “somewhat or very important for future care” (84% of the time). For encounters with unattained missing information, physicians reported adverse affects on the efficiency of the visit (64%), physician’s confidence in care (33%), patient/family satisfaction (17%), disposition decisions (8%), and recommended additional treatment (38%), laboratory studies (16%), and imaging (12%). For 57% of encounters with missing information, physicians perceived an adverse effect on overall quality of care. Missing information was associated with not having a primary care visit at TCH within 12 months of the encounter, (OR 2.8; 95% CI, 1.7, 4.5). Conclusion: Pediatric physicians more commonly experience missing information at general ambulatory visits than emergency visits and report that missing information adversely impacts quality, efficiency, their confidence in care, patient and family satisfaction, and leads to potentially redundant resource utilization.
A randomized trial of multivitamin supplements and HIV disease progression and mortality.

BACKGROUND Results from observational studies suggest that micronutrient status is a determinant of the progression of human immunodeficiency virus (HIV) disease. METHODS We enrolled 1078 pregnant women infected with HIV in a double-blind, placebo-controlled trial in Dar es Salaam, Tanzania, to examine the effects of daily supplements of vitamin A (preformed vitamin A and beta carotene), multivitamins (vitamins B, C, and E), or both on progression of HIV disease, using survival models. The median follow-up with respect to survival was 71 months (interquartile range, 46 to 80). RESULTS Of 271 women who received multivitamins, 67 had progression to World Health Organization (WHO) stage 4 disease or died--the primary outcome--as compared with 83 of 267 women who received placebo (24.7 percent vs. 31.1 percent; relative risk, 0.71; 95 percent confidence interval, 0.51 to 0.98; P=0.04). This regimen was also associated with reductions in the relative risk of death related to the acquired immunodeficiency syndrome (0.73; 95 percent confidence interval, 0.51 to 1.04; P=0.09), progression to WHO stage 4 (0.50; 95 percent confidence interval, 0.28 to 0.90; P=0.02), or progression to stage 3 or higher (0.72; 95 percent confidence interval, 0.58 to 0.90; P=0.003). Multivitamins also resulted in significantly higher CD4+ and CD8+ cell counts and significantly lower viral loads. The effects of receiving vitamin A alone were smaller and for the most part not significantly different from those produced by placebo. Adding vitamin A to the multivitamin regimen reduced the benefit with regard to some of the end points examined. CONCLUSIONS Multivitamin supplements delay the progression of HIV disease and provide an effective, low-cost means of delaying the initiation of antiretroviral therapy in HIV-infected women.
A Protein Kinase A-Dependent Mechanism by Which Rotavirus Affects the Distribution and mRNA Level of the Functional Tight Junction-Associated Protein, Occludin, in Human Differentiated Intestinal Caco-2 Cells

ABSTRACT We found that at the tight junctions (TJs) of Caco-2 cell monolayers, rhesus monkey rotavirus (RRV) infection induced the disappearance of occludin. Confocal laser scanning microscopy showed the disappearance of occludin from the cell-cell boundaries without modifying the expression of the other TJ-associated proteins, ZO-1 and ZO-3. Western immunoblot analysis of RRV-infected cells showed a significant fall in the levels of the nonphosphorylated form of occludin in both Triton X-100-insoluble and Triton X-100-soluble fractions, without any change in the levels of the phosphorylated form of occludin. Quantitative reverse transcription-PCRs revealed that the level of transcription of the gene that encodes occludin was significantly reduced in RRV-infected cells. Treatment of RRV-infected cells with Rp-cyclic AMP and protein kinase A inhibitors H89 and KT5720 during the time course of the infection restored the distribution of occludin and a normal level of transcription of the gene that encodes occludin.
Introduction: Williams syndrome

In the nearly 50 years since the description of Williams syndrome by [Williams et al. (1961); Circulation 24:1311–1318], the focus of scientific inquiry has shifted from identification, definition, and description of the syndrome in small series to genotype–phenotype correlation, pathophysiologic investigation in both humans and in animal models, and therapeutic outcomes in large cohorts. Study of this rare syndrome has provided insight into the structure and function of the extracellular matrix, has contributed to understanding of genomic structure and rearrangement, and is beginning to elucidate genetic underpinnings of learning, language, and behavior. The results of current research not only recommend interventions that can be implemented now, but also identify areas requiring additional investigation, and suggest future therapeutic approaches. © 2010 Wiley‐Liss, Inc.
Cognit ive-Behavioral Treatment for Chronic Nightmares in Trauma-Exposed Persons : Assessing Physiological Reactions to Nightmare-Related Fear m

Cognitive-behavioral treatments (CBTs) that target nightmares are efficacious for ameliorating self-reported sleep problems and psychological distress. However, it is important to determine whether these treatments influence objective markers of nightmare-related fear, because fear and concomitant physiological responses could promote nightmare chronicity and sleep disturbance. This randomized, controlled study (N 5 40) assessed physiological (skin conductance, heart rate, facial electromyogram) and subjective (displeasure, fear, anger, sadness, arousal) reactions to personally relevant nightmare imagery intended to evoke nightmare-related fear. Physiological assessments were conducted at pretreatment as well as 1-week, 3-months, and 6-months posttreatment. Results of mixed effects analysis of variance models suggested treatment reduced physiological and subjective reactions to nightmare imagery, gains that were generally maintained at the 6-month follow-up. Potential implications are discussed. & 2010 Wiley Periodicals, Inc. J Clin Psychol 66: 1–18, 2010.
Extreme intra-seasonal anomalies in the Amundsen and Bellingshausen sea-ice area, Antarctica, during the austral winter

We examine the role of the propagation of atmospheric mid-latitudes wave trains in modulating the Amundsen and Bellingshausen sea-ice area (SIA), Antarctica, on intra-seasonal timescales (20-100 days). Spectral analysis of passive microwave estimates of SIA in the Amundsen and Bellings- hausen Seas for 1979-2004 shows significant peaks on intra-seasonal timescales. Previous studies have suggested that variations in SIA are linked to disturbances in atmospheric circulation and sea surface temperature. We show that extreme SIA anomalies on intra-seasonal timescales lag the propagation of subtropical wave trains in the Southern Hemisphere by approximately 10-15 days. The sign of the SIA anomaly depends on the phase of the wave. We present evidence that the number of disturbances that cause extreme anomalies of SIA on intra-seasonal timescales has increased in the last 14 years.
Quantitative Exfoliative Cytology of Normal Oral Squames: An Age, Site and Sex-Related Survey

This study describes the development of quantitative cytological techniques and their application to oral smears. Nuclear and cell size has been measured and matched with age, sex and site in an attempt to produce a baseline for comparison with identical measurements carried out on pathological smears. The results displayed a significant variation in nuclear and cytoplasmic area between different sites. Nuclear size varied significantly with advancing age; however, this was not the case for cytoplasmic area. There was no significant variation in either criterion between males and females.
Difference in Plumage Color Used in Species Recognition between Incipient Species Is Linked to a Single Amino Acid Substitution in the Melanocortin‐1 Receptor

Many studies demonstrate that differences in mating signals are used by incipient species in recognizing potential mates or sexual competitors (i.e., species recognition). Little is known, however, about the genetic changes responsible for these differences in mating signals. Populations of the Monarcha castaneiventris flycatcher vary in plumage color across the Solomon Islands, with a subspecies on Makira Island having chestnut bellies and blue‐black upper parts (Monarcha castaneiventris megarhynchus) and a subspecies on neighboring satellite islands being entirely blue‐black (melanic; Monarcha castaneiventris ugiensis). Here we show that a single nonsynonymous point mutation in the melanocortin‐1 receptor (MC1R) gene is present in all melanic birds from one island (Santa Ana) but absent in all chestnut‐bellied birds from Makira Island, implicating this mutation in causing melanism. Birds from a second satellite island (Ugi) do not show the same perfect association between this MC1R variant and plumage color, suggesting an alternative mechanism for melanism on this island. Finally, taxidermic mount presentation experiments in Makira (chestnut) and Santa Ana (melanic) suggest that the plumage difference mediates species recognition. Assuming that the signals used in species recognition are also used in mutual mate choice, our results indicate that a single amino acid substitution contributes to speciation.
Improved Recommender for Location Privacy Preferences

Location-based services are one of the fastest growing technologies. Millions of users are using these services and sharing their locations using their smart devices. The popularity of using such applications, while enabling others to access user’s location, brings with it many privacy issues. The user has the ability to set his location privacy preferences manually. Many users face difficulties in order to set their preferences in the proper way. One solution is to use machine learning based methods to predict location privacy preferences automatically. These models suffer from degraded performance when there is no sufficient training data. Another solution is to make the decision for the intended user, depending on the collected opinions from similar users. User-User Collaborative Filtering (CF) is an example within this category. In this paper, we will introduce an improved machine learning based predictor. The results show significant improvements in the performance. The accuracy was improved from 75.30% up to 84.82%, while the privacy leak was reduced from 11.75% up to 7.65%. We also introduced an integrated model which combines both machine learning based methods and collaborative filtering based methods in order to get the advantages from both of them.