Miracle-dz/UniFAR-FTUs huggingface dataset:
An unusual airway challenge in a patient with acromegaly

Sir, We report an unusual airway challenge in a 32-year-old male acromegalic planned for endoscopic trans-sphenoidal resection of a pituitary macroadenoma. Airway examination showed a large jaw and an enlarged tongue, with a Class III modified Mallampati score. Anesthesia was induced using fentanyl, propofol, and rocuronium. Laryngoscopy revealed a Cormack-Lehane Grade I view and a large laryngeal inlet. Orotracheal intubation was performed with size 8.5 mm cuffed endotracheal tube (ETT). There was an audible leak during positive pressure ventilation, and the peak airway pressure was 15 cmH2O. On further inflation of the cuff with up to 10 ml of air, the leak reduced but was persistent. The pilot balloon was distended. There was a volume loss of 150 ml during ventilation resulting in fogging of the endoscope lens. The throat was packed with ribbon gauze and the audible leak as well as fogging of the lens ceased. The rest of the procedure was uneventful, and the patient's trachea was extubated on table. After extubation, we confirmed that the cuff of the ETT was intact and inflating normally. Subsequently, the tracheal diameter was measured using the computed tomography (CT) scan of the para-nasal sinus and neck. The sagittal diameter (SD) and coronal diameter (CD) of the trachea were 25.7 mm and 19.4 mm, respectively [Figures 1 and 2], at the level where the ETT cuff rests (30 mm below the glottis). The abnormal anatomy of larynx in acromegalics may result from soft-tissue hypertrophy and bony alterations. Jackson reported four acromegalics who had laryngeal abnormality caused by overgrowth of soft tissue and cartilages. [1] Other authors[2,3] have reported laryngeal stenosis and generally thickened tissues of the upper airway. Hassan et al.[4] measured the cricoid width and anterior-posterior diameter of cords and showed for the first time that they were narrower in acromegaly patients compared to normal patients and showed the need for smaller size tubes in these patients due to airway mucosal hypertrophy. In contrast to the above studies, our patient required a larger size ETT. The mean SD of 17.4 ± 3.1 (18.1–14.8) and CD of 17.7 ± 2.6 (18.3–15.2) of the trachea measured from CT scans in adult Indian population[5] were significantly smaller than in our patient, in whom the large tracheal diameter resulted in inability to achieve a seal despite over inflating the ETT cuff. No studies have documented an air leak following use of a standard size ETT in acromegalics. Thus, knowing the tracheal diameter preoperatively will be helpful in these patients to predict the size of ETT. Anesthesiologists must be aware that though literature cautions that a smaller size ETT is required in acromegalics due to airway mucosal hypertrophy, a larger size ETT may occasionally be required. Chest X-ray tends to overestimate the tracheal diameter. [6] A CT scan if available should be examined or ultrasound performed to measure the tracheal diameter before surgery, to predict the ETT size required. In case both are unavailable, one should keep larger size ETTs ready. Letters to Editor
Suffering caused by care—elderly patients’ experiences in community care

Background Growing old involves many changes in life and implies an increased risks of illness and different forms of disabilities. Life may change in a radical way when a person gets a disease like dementia or moves to a nursing home due to disabilities or needs. In both cases, it often leads to an increased dependency on care where the patient becomes exposed and vulnerable and thereby at a higher risk for experiencing different forms of suffering. Aim The aim of this study was to elucidate and gain a deeper understanding of elderly patients’ experiences of suffering in relation to community care in nursing homes and home care services. Materials and methods A lifeworld hermeneutical approach was used. Phenomenological interviews and conversations with an open approach were conducted and analysed with a focus on meanings. Findings The findings were presented in four main themes; an absence of the other in care, an absence of dialogues, a sense of alienation and a sense of insecurity. The findings in this study revealed that persons who were cared for in nursing homes and home care services sometimes were exposed to an unnecessary suffering. The suffering sometimes was caused by various caring actions, that is, unnecessary suffering. The suffering caused by care that aroused was due to caregiver's inability to be present, to show their face, and truly meet the patient. Conclusion Suffering from care increased the elderly patients’ feelings of insecurity, loneliness, and alienation; this seemed to be the foundation for patients’ experiences of being outside a human community. There was a lack of knowledge and understanding about the patient's lifeworld.
Market Returns to Acquirers of Substantial Assets

Does poor post-acquisition performance characterise firms that make non-M&A acquisitions? We investigate the wealth effects of substantial asset acquisitions (i.e. acquisitions that cost over $10 million) on acquiring firms' shareholders. We find significant abnormal positive market reaction to asset acquisition announcements and contrary to findings for firms undertaking M&As, the acquiring firms perform exceptionally well post-acquisition. Our findings are robust to the research method weaknesses common to many studies of long-term performance and we control for free-cash-flow as well. Our results contradict the hubris hypothesis of acquisitions and lend weight to the argument that the auction-style process that characterizes corporate takeover bids contributes to overpayment.
Making regulatory T cells with defined antigen specificity: role in autoimmunity and cancer

Summary: There is increasing evidence that agonist ligand presentation either intrathymically or extrathymically plays a crucial if not essential role in the generation of regulatory T cells (Tregs). Thus, it is possible to induce Tregs of any desired specificity in vivo. The same goal can be achieved in vitro by expanding antigen‐specific CD4+ T cells and retrovirally transducing them. In contrast, in vitro expansion of Tregs is limited to antigens that have resulted in Treg generation in vivo. Antigen‐specific Tregs can be used in cellular therapy with the goal to prevent autoimmune disease or even to interfere with established autoimmunity. The latter requires that the Tregs can suppress effector cells that have already caused harm, which is possible because of the antigen‐dependent homing properties of Tregs, i.e. these cells can accumulate in antigen‐draining lymph nodes and exit into inflamed tissue. Generally, the in vivo interference is dependent on cytokines such as transforming growth factor‐β and interleukin‐10 that were dispensable in in vivo analysis of immunosuppression. The precise mechanisms of suppression remain enigmatic, however, but may be further elucidated by the molecular analysis of suppressed versus non‐suppressed T cells.
Testing the endogenous growth model: public expenditure, taxation, and growth over the long run

Endogenous growth models, such as Barro (1990), predict that government expenditure and taxation will have both temporary and permanent effects on growth. We test this prediction using panels of annual and period-averaged data for OECD countries during 1970-95, isolating long-run from short-run fiscal effects. Our results strongly support the endogenous growth model and suggest that long-run fiscal effects are not fully captured by period averaging and static panel methods. Unlike previous investigations, our estimates are free from biases associated with incomplete specification of the government budget constraint and do not appear to result from endogeneity of fiscal or investment variables.
The Determinants of Job Satisfaction among Federal, State, and Local Government Employees

Winter 1997 7 TODAY, AT ALL LEVELS of government, public managers are increasingly concerned with promoting job satisfaction among employees. In part, this concern stems from the widespread perception that public employees are not satisfied with their jobs and that this dissatisfaction results in lower productivity and higher turnover; however, the link between these factors has never been established definitively (Jayaratne 1993). This study contributes to our understanding of the public workplace by comparing degree of job satisfaction among federal, state, and local employees. Our findings suggest that public managers can effectively promote job satisfaction—without necessarily increasing public expenditures—but that their efforts should focus on the needs of their particular level of government. Public employees at all levels are likely to confront similar political, economic, and administrative environments and, thus, may be said to be similar to each other in many respects. For example, current fiscal conditions demand that governmental agencies survive The Determinants of Job Satisfaction among Federal, State, and Local Government Employees
Activated protein C therapy in a rat heat stroke model*

Objective:To evaluate the therapeutic effects of activated protein C in an animal model of heat stroke. Design:Laboratory investigation. Setting:Chi-Mei Medical Center research laboratory. Subjects:Male Sprague-Dawley rats weighing 252–304 g. Interventions:Anesthetized animals were subjected to heat stress (40°C) to induce heat stroke. A bolus injection of normal saline or recombinant human activated protein C (drotrecogin alfa, activated) was conducted via femoral catheters immediately after the onset of heat stroke. Blood sampling was done before initiation of heat stress and 0 and 40 mins after the onset of heat stroke. Measurements and Main Results:When the vehicle-treated rats underwent heat exposure, their survival time values were found to be 56–64 mins (n = 16). Resuscitation with activated protein C significantly and dose-dependently improved survival during heat stroke (108–246 mins for doses of 0.5–20 mg of activated protein C per kilogram of body weight) (n = 32). All heat-stressed animals displayed systemic inflammation and activated coagulation, evidenced by increased tumor necrosis factor-&agr;, prothrombin time, activated partial thromboplastin time, and D-dimer and decreased platelet count and protein C. Biochemical markers evidenced by cellular ischemia and injury/dysfunction included increased plasma levels of blood urea nitrogen, creatinine, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and alkaline phosphatase; increased striatal levels of glutamate, glycerol, and lactate/pyruvate ratio; and decreased striatal levels of partial pressure of oxygen and local cerebral blood flow, which were all observed during heat stroke. These heat stroke reactions were all significantly suppressed by resuscitation with activated protein C but not vehicle solution. Conclusions:The results indicate that systemic delivery of human recombinant activated protein C at the time point of onset of heat stroke may improve survival by ameliorating systemic inflammation, hypercoagulable state, and tissue ischemia and injury in multiple organs.
Applications of Meta-Analysis for Marketing and Public Policy: A Review

The author examines the relevance of meta-analysis for research on marketing and public policy. He presents an overview of the history, benefits, and criticisms of meta-analysis; reviews and suggests meta-analysis applications; gives a nontechnical description of how to perform a meta-analysis; and concludes with implications of a “meta-analysis mindset” in the conduct and reporting of primary research studies.
Normal pressure hydrocephalus and cerebral blood flow: a review

Normal pressure hydrocephalus is a neurological disease which poses both diagnostic and therapeutic problems for the clinician. The measurement and characterisation of cerebral blood flow has been proposed as a tool for resolving such problems as well as elucidating its pathophysiology. We review the results of studies in which this tool has been applied to normal pressure hydrocephalus patients and consider the merits of the techniques that have been utilised. Finally, consideration is given to feasible future studies and the methods that could be employed in the study of cerebral blood flow and metabolism in patients with normal pressure hydrocephalus.
Teaching Grantsmanship in a Nonprofit Leadership Class

Proposal-writing skills are critical for employees in a wide range of organizations, particularly in challenging economic times which demand diverse funding sources. This paper describes an innovative and multifaceted approach to teaching proposal writing to students enrolled in a nonprofit leadership course at a large, metropolitan university. The approach included a hands-on, field component in nonprofit organizations, in-depth organizational analyses involving interviews with nonprofit leaders, guest speakers including a grant professional and a foundation officer, grantsmanship textbooks loaned to all students for the semester, and review of students’ completed proposals by a grant professional and the course instructor. Students presented their proposals to the class at the end of the semester and voted for the best presentations and proposal ideas. A celebration occurred at the end of the semester involving students and nonprofit partners. The service aspect of this course is part of the university’s service learning faculty fellowship program. Additionally, in collaboration with students, during the semester the instructor modeled the application preparation process by writing and submitting a winning grant proposal to the university for funds to enhance the course. The paper adds to the existing literature on teaching grantsmanship to college students through experiential learning. It describes the various strategies used to introduce students to grant proposal writing and discusses challenges and lessons learned.
THE POOR POLITICAL REPRESENTATION OF THE POOR IN A COMPARATIVE PERSPECTIVE

Due to diverging levels of political influence of various income groups, political institutions likely reflect the policy preferences of certain groups of citizens better than others, independently of their numerical weight. This runs counter the egalitarian principle of ‘one citizen, one vote’. The present article documents a general trend of underrepresentation of the preferences of relatively poor citizens both by parties and by governments across Western democracies, although important cross-national differences exist.
Production of Lipopeptide Biosurfactant by a Marine Nesterenkonia sp. and Its Application in Food Industry

Biosurfactants are smart biomolecules which have wide spread application in medicines, processed foods, cosmetics as well as in bioremediation. In food industry, biosurfactants are used as emulsion stabilizing agents, antiadhesives, and antimicrobial/antibiofilm agents. Nowadays biosurfactant demands in industries has increased tremendously and therefore new bacterial strains are being explored for large scale production of biosurfactants. In this study, an actinobacterial strain MSA31 was isolated from a marine sponge Fasciospongia cavernosa which showed high activity in biosurfactant screening assays such as drop collapsing, oil displacement, lipase and emulsification. Lipopeptide produced by MSA31 was found to be thermostable which was evident in differential scanning calorimetry analysis. The spectral data obtained in the Fourier transform infrared spectroscopy showed the presence of aliphatic groups combined with peptide moiety which is a characteristic feature of lipopeptides. The stability index of lipopeptide MSA31 revealed “halo-alkali and thermal tolerant biosurfactant” which can be used in the food industry. Microtiter plate assay showed 125 μg/ml of lipopeptide was effective in reducing the biofilm formation activity of pathogenic multidrug resistant Staphylococcus aureus. The confocal laser scanning microscopic images provided further evidences that lipopeptide MSA31 was an effective antibiofilm agent. The antioxidant activity of lipopeptide MSA31 may be due to the presence of unsaturated fatty acid present in the molecule. The brine shrimp cytotoxicity assay showed lipopeptide MSA31 was non-toxic and can be used as food additives. Incorporation of lipopeptide MSA31 in muffin showed improved organoleptic qualities compared to positive and negative control. This study provides a valuable input for this lipopeptide to be used in food industry as an effective emulsifier, with good antioxidant activity and as a protective agent against S. aureus.
Macrophages from tolerant rabbits as mediators of a specific immunological response in vitro.

An attempt has been made to evaluate the role of macrophages from rabbits rendered tolerant in neonatal life to BGG in the immune response. The results show that macrophages from a tolerant rabbit took up the antigen to which it was tolerant and stimulated a specific response in the rate of DNA synthesis by spleen cells from an immunized animal. Whatever the role macrophages play in the immune response, no obvious defect of recognition of the antigenic molecules was demonstrated and this would agree with in vivo experiments using rats and a bacterial antigen (Nossal and Ada, 1964), where tolerant animals were able to recognize antigen in a manner characteristic of immune animals.
The Relationship between Political Factors and the Development of E–Participatory Government

This article examines the determinants of the development of the e–participatory government in 189 countries selected by the United Nations for the e-Government Survey 2008. It examines the effect that the political system—features of the ruling party, interparty competition, voters, and interest groups—has on the development of e–participatory government. The authors' analysis indicates that given that politicians have the most say in the development of e–participatory government, and at the same time they are the ones most averse to its development, except for those with a conservative ideology, the style of administration and the pressure exerted by interest groups are the key factors for the development of e–participatory government.
Mental health patients in criminal justice populations: needs, treatment and criminal behaviour.

BACKGROUND Government policy requires that health and social care agencies work more closely together and in partnership with the criminal justice system. There is a well-established relationship between crime and mental disorder. METHOD The Tracking Project provides for the first time in England the means of collating and analysing data on mental disorder (defined as receiving secondary care as patients of a Mental Health Trust) and crime (defined as all those charged with an offence). Data were collected over a three-year period for all individuals who had contact with the criminal justice system and mental health services in an English county. RESULTS In a county population of 800,400, some 30,329 were offenders. More than a third had used a health or social care service during the three-year period; 8.0% were mentally disordered. Those offenders aged 25-64 and who contacted the police more than once were significantly more likely to be mentally disordered. Type of offence was also a relevant variable. The probation service showed broadly similar results. DISCUSSION The research has provided for the first time substantive quantitative evidence of the relationship between crime and mental disorder. The results can be used as the basis for further work to target assessment and risk reduction measures at those most at risk.
A single institution experience with the new bethesda system for reporting thyroid cytopathology: Correlation with existing cytologic, clinical, and histological data

Our goal was to evaluate the Bethesda system (TBS) in comparison to the previously used system at our institution. One hundred consecutive thyroid fine needle aspirations (FNAs) and 45 consecutive indeterminate FNAs were reviewed by two cytopathology‐boarded pathologists, diagnosed based on TBS and correlated with management and follow‐up. Re‐evaluation led to a diagnosis change in 48% of cases. Thirty‐nine percent of benign cases were unsatisfactory under TBS. For malignant diagnoses the positive predictive value (PPV) was unchanged, while the negative predictive value (NPV) was slightly improved using TBS. Both the PPV and NPV were improved for actionable diagnoses. Inter‐observer variability across all categories was in moderate agreement. Clinical management of both follicular lesion (FL) and indeterminate cases ranged from none to immediate surgery. Repeat FNA resolved the diagnosis in 50% of indeterminate cases. Indeterminate cases had an overall malignancy rate of 27%; higher in pre‐ (46%) than post‐TBS cases (8%). Inter‐observer variability between the reviewing pathologists and the original pathologists for indeterminate cases was fair, and between the two reviewing pathologists was moderate. Using TBS criteria increased the unsatisfactory rate and led to improved prediction of malignancy and actionable diagnoses. The pre‐Bethesda diagnosis of FL at our institution led to inconsistent clinical management. Clinical management of patients with indeterminate diagnoses was essentially unchanged following adoption of TBS. The moderate inter‐observer agreement between the reviewing pathologists may be related to level of cytology experience, strict adherence to TBS, and the exclusive use of cytomorphology for diagnosis. Diagn. Cytopathol. 2014;42:564–569. © 2014 Wiley Periodicals, Inc.
Enhancing customer brand experience and loyalty through enterprise microblogs: Empirical evidence from a communication framework perspective

As the social media platform becomes an ever more important communication channel between company and customer, companies are learning how they can best utilize social media to better communicate their brands with customers. The purpose of this paper is to explore the communication tactics adopted by the enterprise microblogs using a communication framework. Further, the authors hope to find out how these communication tactics influence customer brand experience (BE) and subsequently brand loyalty. ,First, to identify the communication tactics used by enterprise microblogs, the authors recruited six active microblog users and listed all possible characteristics of enterprise microblogs that could increase customers’ fondness for the brand. Second, based on the listed 19 characteristics and existing theories, the authors pre-classified and conceptualized the content and style tactics categories. The authors also followed a sorting procedure to verify our classification. Finally, based on the sorted characteristics and previous research, the authors designed a questionnaire and 459 sets of valid data were collected from enterprise microblog users. ,The communication tactics are classified into two dimensions, namely content tactics and style tactics. The content tactics include content diversity, content accuracy and content timeliness, and the style tactics include impression enhancement style and interactivity enhancement style. The results reveal that the communication content and style tactics significantly enhance overall customer BE and further brand loyalty. The study results also show that style tactics exert more influence on BE than content tactics. ,This paper highlights the company’s important role in company-customer communication on social media, and categorizes the effective communication tactics used by the enterprise microblog within a communication framework. Companies could build brand loyalty by enhancing users’ BE using effective communication. The communication perspective and measures of the communication tactics in this study provide an ideal background for future research on IT-based company-customer interaction.