Miracle-dz/UniFAR-FTUs huggingface dataset:
Community-acquired MRSA: a practitioner's guide

Methicillin-resistant Staphylococcus aureus (MRSA) is usually considered a hospital-acquired (HA) organism. As highlighted elsewhere in this issue of CMAJ , infections with community-acquired (CA) strains of MRSA are being noted more frequently. The molecular and antimicrobial resistance profiles of
End-of-Life Transitions and Hospice Utilization for Adolescents: Does Having a Usual Source of Care Matter?

Adolescents with life-limiting illnesses have intensive end-of-life trajectories and could benefit from initiation of hospice services. The medical home model, which includes having a usual source of primary care, may help facilitate quality outcomes at the end of life for adolescents. The purpose of this study was to determine the relationship between having a usual source of primary care on hospice utilization and end-of-life transitions among adolescents between 15 and 20 years with a life-limiting illness. A retrospective cohort design used 2007-2010 California Medicaid claims data (N = 585). Our dependent variables were hospice utilization (ie, hospice enrollment and hospice length of stay), and the independent variable was usual source of primary care. Multivariate regression techniques including least squares regression, multivariate logistic regression, and negative binomial regression were used in the analysis of the relationship between usual source of primary care and hospice utilization and end-of-life transitions. Ten percent of our sample used hospice services. Having a usual source of primary care was associated with an increase in hospice enrollment, hospice length of stay, and end-of-life transitions. Adolescents with a cancer diagnosis were more likely to enroll in hospice services. For adolescents at the end of life, having a usual source of primary care had a significant effect on hospice enrollment and length of stay. This study is among the first to demonstrate a relationship between primary care and hospice use among this vulnerable population.
Infective endocarditis in the Pacific: clinical characteristics, treatment and long-term outcomes

Introduction Data on clinical characteristics and outcomes of infective endocarditis (IE) in the Pacific are scarce. Methods Retrospective hospital-based study in New Caledonia, a high-income country, on patients aged over 18 years with definite IE according to the modified Duke criteria (2005–2010). Results 51 patients were included: 31 (60.8%) men; median age of 52.4 years (IQR 33.0–70.0). Left-sided IE accounted for 47 (92.2%) patients: native valve IE in 34 (66.7%) and prosthetic valve IE in 13 (25.5%). The main underlying heart disease included: rheumatic valve disease in 19 (37.3%), degenerative heart valve disease in 12 (23.5%) and congenital heart disease in 6 (11.8%). Significant comorbidities (Charlson's score >3) were observed in 20 (38.7%) patients. Infection was community acquired in 43 (84.3%) patients. Leading pathogens included Staphylococcus aureus in 16 (31.4%) and Streptococcus spp in 15 (29.4%) patients. Complications were noted in 33 patients (64.7%) and 24 (47.1%) were admitted to the intensive care unit. Cardiac surgery was eventually performed in 22 of 40 (55.0%) patients with a theoretical indication. None underwent emergent cardiac surgery (ie, first 24 h); 2 (3.9%) were operated within 7 days; and 20 (39.2%) beyond 7 days. 11 (21.6%) patients died in hospital and 21 (42.9%) were dead after a median follow-up of 28.8 months (IQR 4.6–51.2). Two (3.9%) were lost to follow-up. Conclusions In New Caledonia, IE afflicts relatively young patients with rheumatic heart disease, and carries high complication and mortality rates. Access to heart surgery remains relatively limited in this remote archipelago.
Gender Mainstreaming vs Positive Action

This article examines the development of a gender mainstreaming strategy in the EU by illustrating how this strategy was shaped by other than gender equality policy goals. Gender mainstreaming was originally launched in 1996 to promote gender equality in all EU policies, in the context of international and European mobilization on women’s issues. It was aimed to transform mainstream policies by introducing a gender equality perspective. However, it has been largely used as an alibi for neutralizing positive action. The successful implementation of positive action in political decision-making had challenged the gender distribution of political power over policy institutions and technical, human and financial resources. This led to policy softening and institutional weakening due to counteracting by the EU political and administrative hierarchies. The argument is based on text analyses of relevant Community acts and on direct observations of the policy process, based on personal working experiences in the European Commission.
Influence of exposure parameters and iterative reconstruction on automatic airway segmentation and analysis on MDCT—An ex vivo phantom study

Objectives To evaluate the influence of exposure parameters and raw-data-based iterative reconstruction (IR) on computer-aided segmentation and quantitative analysis of the tracheobronchial tree on multidetector computed tomography (MDCT). Material and methods 10 porcine heart-lung-explants were mounted inside a dedicated chest phantom. MDCT was performed at 120kV and 80kV with 120, 60, 30 and 12 mAs each. All scans were reconstructed with filtered back projection (FBP) or IR, resulting in a total of 160 datasets. The maximum number of detected airway segments, most peripheral airway generation detected, generation-specific airway wall thickness (WT), total diameter (TD) and normalized wall thickness (pi10) were compared. Results The number of detected airway segments decreased slightly with dose (324.8±118 at 120kV/120mAs vs. 288.9±130 at 80kV/30mAs with FBP, p<0.05) and was not changed by IR. The 20th generation was constantly detected as most peripheral. WT did not change significantly with exposure parameters and reconstruction algorithm across all generations: range 1st generation 2.4–2.7mm, 5th 1.0–1.1mm, and 10th 0.7mm with FBP; 1st 2.3–2.4mm, 5th 1.0–1.1mm, and 10th 0.7–0.8mm with IR. pi10 was not affected as well (range 0.32–0.34mm). Conclusions Exposure parameters and IR had no relevant influence on measured airway parameters even for WT <1mm. Thus, no systematic errors would be expected using automatic airway analysis with low-dose MDCT and IR.
Harnessing Natural Recovery Processes to Improve Restoration Outcomes: An Experimental Assessment of Sponge-Mediated Coral Reef Restoration

Background Restoration is increasingly implemented to reestablish habitat structure and function following physical anthropogenic disturbance, but scientific knowledge of effectiveness of methods lags behind demand for guidelines. On coral reefs, recovery is largely dependent on coral reestablishment, and substratum stability is critical to the survival of coral fragments and recruits. Concrete is often used to immobilize rubble, but its ecological performance has not been rigorously evaluated, and restoration has generally fallen short of returning degraded habitat to pre-disturbance conditions. Fragments of erect branching sponges mediate reef recovery by facilitating rubble consolidation, yet such natural processes have been largely overlooked in restoring reefs. Methods On two reefs in Curacao, four treatments - coral rubble alone, rubble seeded with sponge fragments, rubble bound by concrete, and concrete “rubble” bound by concrete - were monitored over four years to investigate rubble consolidation with and without sponges and the ecological performance of treatments in terms of the number and diversity of coral recruits. Species specific rates of sponge fragment attachment to rubble, donor sponge growth and tissue replacement, and fragment survival inside rubble piles were also investigated to evaluate sponge species performance and determine rates for sustainably harvesting tissue. Findings/Significance Rubble piles seeded with sponges retained height and shape to a significantly greater degree, lost fewer replicates to water motion, and were significantly more likely to be consolidated over time than rubble alone. Significantly more corals recruited to sponge-seeded rubble than to all other treatments. Coral diversity was also greatest for rubble with sponges and it was the only treatment to which framework building corals recruited. Differences in overall sponge species performance suggest species selection is important to consider. Employing organisms that jump start successional pathways and facilitate recovery can significantly improve restoration outcomes; however, best practices require techniques be tailored to each system.
A ‘back to basics’ approach to offender supervision: Does working alliance contribute towards success of probation?

Working alliance (WA) considers the bond between two people, and their ability to work collaboratively to set goals and tasks. In the present study, WA was applied to probation to assess the relationship between a probation officer and offender. Questionnaires were administered to offenders to examine the impact of offender risk and offence type upon the development of WA, and how WA predicted perceived success of probation. WA did not differ as a result of risk or offence type but was highly predictive of success of probation. Results were discussed in terms of task, bond and goals and how these are a cost-effective method of improving success of probation.
Relative Processing Fluency

The subjective ease, or fluency, that is experienced during the cognitive processing of information has a large impact on the outcome of the processing. Research on judgment in a variety of domains shows that such fluency effects depend less on the (absolute) level of experienced fluency than on the relative fluency—that is, the change in fluency or the deviation from the expected level of fluency. Changes in an internal state are often more noticeable and perhaps more relevant as a diagnostic cue regarding the environment than the absolute level of that state. Relative experience is therefore particularly informative and accounts for ease-of-retrieval effects as well as classic fluency effects such as the truth effect and the mere-exposure effect.
Distinct Balance of Excitation and Inhibition in an Interareal Feedforward and Feedback Circuit of Mouse Visual Cortex

Mouse visual cortex is subdivided into multiple distinct, hierarchically organized areas that are interconnected through feedforward (FF) and feedback (FB) pathways. The principal synaptic targets of FF and FB axons that reciprocally interconnect primary visual cortex (V1) with the higher lateromedial extrastriate area (LM) are pyramidal cells (Pyr) and parvalbumin (PV)-expressing GABAergic interneurons. Recordings in slices of mouse visual cortex have shown that layer 2/3 Pyr cells receive excitatory monosynaptic FF and FB inputs, which are opposed by disynaptic inhibition. Most notably, inhibition is stronger in the FF than FB pathway, suggesting pathway-specific organization of feedforward inhibition (FFI). To explore the hypothesis that this difference is due to diverse pathway-specific strengths of the inputs to PV neurons we have performed subcellular Channelrhodopsin-2-assisted circuit mapping in slices of mouse visual cortex. Whole-cell patch-clamp recordings were obtained from retrobead-labeled FFV1→LM- and FBLM→V1-projecting Pyr cells, as well as from tdTomato-expressing PV neurons. The results show that the FFV1→LM pathway provides on average 3.7-fold stronger depolarizing input to layer 2/3 inhibitory PV neurons than to neighboring excitatory Pyr cells. In the FBLM→V1 pathway, depolarizing inputs to layer 2/3 PV neurons and Pyr cells were balanced. Balanced inputs were also found in the FFV1→LM pathway to layer 5 PV neurons and Pyr cells, whereas FBLM→V1 inputs to layer 5 were biased toward Pyr cells. The findings indicate that FFI in FFV1→LM and FBLM→V1 circuits are organized in a pathway- and lamina-specific fashion.
Developmental Pathways of Deviance in Sexual Aggressors

The study investigated the behavioral antecedents of deviance in sexual aggressors and how they relate to sexual offending. Semistructured interviews were conducted with 553 convicted sexual aggressors to gather data on developmental history. Structural equation modeling was employed to analyze the behavioral antecedents. Results indicated the presence of three broad dimensions of deviance: internalization, externalization, and sexualization. Aggressors against children showed higher levels of internalization, whereas aggressors against adults reported higher levels of externalization. It is the dimension of sexualization and externalization, however, that appeared the most valuable in the understanding of sexual offending.
The Importance of Resistance to Peer Influence and Personality Traits in Young Drivers" Risky Driving

Risky dri ving remains the major prerequisite of young drivers' injuries and fatalities in road traffic accidents all over the world. The present study investigates how personality trait differences and resistance to peer influence of young drivers interact and correlate to their risky driving behaviour. Data from 226 drivers (127 men and 99 women) were analysed using ordinal regression analyses. The results did not support the idea that resistance to peer influence might be more important factor in young drivers' sample than personality traits. Contrary to expectations personality traits had more stable and larger contribution to risky driving behaviour, but their predictive value was different for males and females. Higher extraversion and lower agreeableness predicted more intentional driving violations among young men; lower agreeableness and lower conscientiousness predicted more intentional driving violations among young women. Thus, personality is important in understanding of risky driving among young adults and should be taken into consideration in prevention efforts.
Spotlight on valsartan–sacubitril fixed-dose combination for heart failure: the evidence to date

Heart failure is a global problem with elevated prevalence, and it is associated with substantial cardiovascular morbidity and mortality. Treating heart-failure patients has been a very challenging task. This review highlights the main pharmacological developments in the field of heart failure with reduced ejection fraction, giving emphasis to a drug that has a dual-acting inhibition of the neprilysin and renin–angiotensin–aldosterone system. Neprilysin is an enzyme that participates in the breakdown of biologically active natriuretic peptides and several other vasoactive compounds. The inhibition of neprilysin has been a therapeutic target for several drugs tested in cardiovascular disease, mainly for heart failure and/or hypertension. However, side effects and a lack of efficacy led to discontinuation of their development. LCZ696 is a first-in-class neprilysin- and angiotensin-receptor inhibitor that has been developed for use in heart failure. This drug is composed of two molecular moieties in a single crystalline complex: a neprilysin-inhibitor prodrug (sacubitril) and the angiotensin-receptor blocker (valsartan). The PARADIGM-HF trial demonstrated that this drug was superior to an angiotensin-converting enzyme inhibitor (enalapril) in reducing mortality in patients with heart failure with reduced ejection fraction. The ability to block the angiotensin receptor and augment the endogenous natriuretic peptide system provides a distinctive mechanism of action in cardiovascular disease.
The Distribution of Blood Rheological Parameters in the Microvasculature of Cat Mesentery

In vivo studies of the rheological behavior of blood in the microcirculation were conducted by direct in situ measurements in cat mesentery. Upstream to downstream pressure drops were measured in unbranched arterioles, capillaries, and venules, with diameters from 7 to 58 fim. Simultaneous measurements of red cell velocity and vessel geometry facilitated computation of bulk velocity, pressure gradient, apparent viscosity, wall shear stress, and resistance. Arteriovenous distributions of these parameters revealed the following. Maximum pressure gradient (0.015 cm H2O/;im) occurs in the true capillaries (7 μm in diameter); intravascular wall shear stress averaged 47.1 dynes/cm2 in arterioles and 29.0 dynes/cm2 in venules. Extreme values as great as 200 dynes/cm2 were observed in a few shunting arterioles. Apparent viscosity averaged 3.59 cP in arterioles, 5.15 cP in venules, and 4.22 cP overall. Intravascular resistance per unit length of microvessel varied with luminal diameter as a power law function with exponents of −4.04 for arterioles, −3.94 for venules, and −3.99 for all vessels combined. This apparent maintenance of Poiseuille's law is attributed to the opposing processes of hematocrit reduction and decreasing shear rate as blood is dispersed in successive arteriolar segments, and the converse action of these processes in the venous confluences which lessen the extent of network variations in apparent viscosity. Reductions in bulk velocity from the normal flow state to below 0.5 mm/sec resulted in increases in apparent viscosity by a factor of 2 to 10, which are attributed primarily to obstruction of the lumen by leukocyte-endothelium adhesion.
Gastrointestinal adverse events during methylphenidate treatment of children and adolescents with attention deficit hyperactivity disorder: A systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials

Objectives To study in more depth the relationship between type, dose, or duration of methylphenidate offered to children and adolescents with attention deficit hyperactivity disorder and their risks of gastrointestinal adverse events based on our Cochrane systematic review. Methods and findings We use data from our review including 185 randomised clinical trials. Randomised parallel-group trials and cross-over trials reporting gastrointestinal adverse events associated with methylphenidate were included. Data were extracted and quality assessed according to Cochrane guidelines. Data were summarised as risk ratios (RR) with 95% confidence intervals (CI) using the inverse variance method. Bias risks were assessed according to domains. Trial Sequential Analysis (TSA) was used to control random errors. Eighteen parallel group trials and 43 cross-over trials reported gastrointestinal adverse events. All trials were at high risk of bias. In parallel group trials, methylphenidate decreased appetite (RR 3.66, 95% CI 2.56 to 5.23) and weight (RR 3.89, 95% CI 1.43 to 10.59). In cross-over trials, methylphenidate increased abdominal pain (RR 1.61, 95% CI 1.27 to 2.04). We found no significant differences in the risk according to type, dose, or duration of administration. The required information size was achieved in three out of four outcomes. Conclusion Methylphenidate increases the risks of decreased appetite, weight loss, and abdominal pain in children and adolescents with attention deficit hyperactivity disorder. No differences in the risks of gastrointestinal adverse events according to type, dose, or duration of administration were found.
Homeless street boys in Nepal: their demography and lifestyle.

This study compares the lifestyles of street children in Kathmandu in Nepal with three control groups: rural villagers urban squatters and privileged students. Contact was established through Child Workers in Nepal (CWIN) a local group that provides safe houses. The sample which had a range of contact with CWIN included 329 boys aged 6-14 years: 130 were homeless 54 were from rural areas 62 were squatter children and 83 were students. Data were obtained from short and long interviews and home visits during July-December 1993. The homeless tended to be older. About 50% of homeless boys and 66% of students belonged to the Indo-Aryan high caste. Over 50% of squatters were low-caste members; all villagers were Tibeto-Burman. Over 50% of homeless boys had both parents at home under 10% were orphans and 23% had stepparents. Family structure age and ethnicity explained about 30% of the variance. 82% left home before the age of 12 years. The average time since leaving home was 3.0 years. 35% left for economic reasons; 42% left due to family problems; and 23% desired independence. Only 16% came from Kathmandu. Travel time to home ranged from 5-7 to 24 hours. 25% never returned home 50% visited annually and 25% made more visits. Children from single-parent families had the most contact. Children from two-parent families visited annually. There was more limited contact if at all with stepfamilies. 66% were rag pickers; 20% were beggars. Higher earners tended to be older. Beggars were younger than rag pickers. Income was significantly related to age. Over 40% of homeless boys had insufficient income to meet food needs. The homeless were less stunted than squatter or rural controls. The children had well developed peer social networks that provided material and emotional support. Most denied being a thief but reported that stealing was common. More in-depth analysis is planned for examining controversial behaviors.
Modeling and System Integration for a Thin Pneumatic Rubber 3-DOF Actuator

Recently, soft actuators have been getting increased attention within various fields. The actuators are composed of flexible materials and driven by pneumatic pressure. A thin pneumatic rubber actuator generating 3 degrees of freedom motion, called 3-DOF micro-hand, has small diameter McKibben artificial muscles which generate a contraction force in the axial direction. By this structure, the micro-hand contracts in the longitudinal direction and bends in any direction by changing the applied air pressure pattern to the artificial muscles. The input–output relation of the micro-hand, however, is complicated and has not been modeled. In this paper, modeling for 3-DOF micro-hand is proposed. Moreover, the experimental system is built for the micro-hand and the proposed model is evaluated by using the experimental results.
Language, memory, and aging: Geriatric psycholinguistics: Syntactic limitations of oral and written language

Geriatric psycholinguistics has largely neglected to examine the basic psycholinguistic abilities of adults. Although rarely made explicit, traditional models of language acquisition assume that linguistic skills, once acquired, do not vary across the lifespan (cf. Clark & Clark, 1977; Menyuk, 1977; Owens, 1984; Slobin, 1981). Obler (1985) has emphasized the expansion of vocabulary and acquisition of pragmatic skills as central characteristics of adult language development. The expanded pragmatic skills of adults include the acquisition of multiple speech registers or stylistic shifts in phonology and syntax reflecting differences in audience, context, or topic. Nevertheless, age-related declines in basic linguistic skills have been found in normative studies of the many standardized tests of adult language (Albert, 1981; Borod, Goodglass, & Kaplan, 1980; Duffy, Keith, Shane, & Podraza, 1976; Emery, this volume; Gleason et al., 1980; Schuell, 1965). These norms indicate that linguistic skills deteriorate in old age in otherwise healthy and active adults. Obler and her colleagues (1980, 1985; Obler & Albert, 1985; Gleason et al., 1980) reported that young and elderly adults responded differently when asked to tell a story about a picture; she concluded that elderly adults are more loquacious than middle-aged adults and that elderly adults' speech is more “elaborate” in that their speech is characterized by more repetition and redundancy, metalinguistic comments, and personalizations. Other studies by Walker, Hardiman, Hedrick, and Holbrook (1981) and Emery (1985, 1986, this volume) support the conclusion that elderly adults' language skills are impaired relative to those of young adults.