Miracle-dz/UniFAR-FTUs huggingface dataset:
Early lactate clearance is associated with improved outcome in severe sepsis and septic shock*

Objective:Serial lactate concentrations can be used to examine disease severity in the intensive care unit. This study examines the clinical utility of the lactate clearance before intensive care unit admission (during the most proximal period of disease presentation) as an indicator of outcome in severe sepsis and septic shock. We hypothesize that a high lactate clearance in 6 hrs is associated with decreased mortality rate. Design:Prospective observational study. Setting:An urban emergency department and intensive care unit over a 1-yr period. Patients:A convenience cohort of patients with severe sepsis or septic shock. Interventions:Therapy was initiated in the emergency department and continued in the intensive care unit, including central venous and arterial catheterization, antibiotics, fluid resuscitation, mechanical ventilation, vasopressors, and inotropes when appropriate. Measurements and Main Results:Vital signs, laboratory values, and Acute Physiology and Chronic Health Evaluation (APACHE) II score were obtained at hour 0 (emergency department presentation), hour 6, and over the first 72 hrs of hospitalization. Therapy given in the emergency department and intensive care unit was recorded. Lactate clearance was defined as the percent decrease in lactate from emergency department presentation to hour 6. Logistic regression analysis was performed to determine independent variables associated with mortality. One hundred and eleven patients were enrolled with mean age 64.9 ± 16.7 yrs, emergency department length of stay 6.3 ± 3.2 hrs, and overall in-hospital mortality rate 42.3%. Baseline APACHE II score was 20.2 ± 6.8 and lactate 6.9 ± 4.6 mmol/L. Survivors compared with nonsurvivors had a lactate clearance of 38.1 ± 34.6 vs. 12.0 ± 51.6%, respectively (p = .005). Multivariate logistic regression analysis of statistically significant univariate variables showed lactate clearance to have a significant inverse relationship with mortality (p = .04). There was an approximately 11% decrease likelihood of mortality for each 10% increase in lactate clearance. Patients with a lactate clearance ≥10%, relative to patients with a lactate clearance <10%, had a greater decrease in APACHE II score over the 72-hr study period and a lower 60-day mortality rate (p = .007). Conclusions:Lactate clearance early in the hospital course may indicate a resolution of global tissue hypoxia and is associated with decreased mortality rate. Patients with higher lactate clearance after 6 hrs of emergency department intervention have improved outcome compared with those with lower lactate clearance.
Federal Reserve Bank of San Francisco

In the July survey, modest fractions of domestic banks, on balance, continued to report having eased their lending standards across most loan types over the past three months. 2 Relatively large fractions reported stronger demand for many types of loans over that period. In contrast, lending standards at U.S. branches and agencies of foreign banks continued to tighten for commercial and industrial (C&I) loans and were unchanged for commercial real estate (CRE) loans; demand for both types of loans reportedly weakened, on net, at those institutions.
The Roles of Toll-Like Receptors in Atherosclerosis

Atherosclerosis is a chronic inflammatory disease of the arteries that is characterised by the activation of endothelial cells, the recruitment of monocytes into the vessel wall and the differentiation of recruited macrophages into cholesterol-laden foam cells. Recent evidence from a variety of experimental approaches has indicated that Toll-like receptors (TLRs), which serve to initiate inflammatory signalling in response to the detection of molecules associated with microbial infection or tissue damage, play key roles in the development of atherosclerosis. This review summarises the recent evidence implicating TLR-dependent signalling in the activation of vascular cells during atherogenesis, and the mechanisms by which TLR-signalling may promote the dysregulation of macrophage cholesterol metabolism that is a prerequisite for the formation of foam cells and lesion progressionin vivo. Particular attention is paid to the recent studies aimed at identifying potential ligands of the TLRs that may be relevant to atherogenesis, and the diverse mechanisms by which vascular tissues may become exposed to ligands of the TLRs.
Sand in the cogs? Power and public participation in the Alberta tar sands

Public participation in natural-resource management has been theorised as a potential means of slowing or halting the ‘treadmill of production’. We examine the institutional processes for citizen participation in bitumen development proposals in Alberta, Canada, home of the tar sands – one of the world's largest reserves of fossil fuel. Within the context of economic and ecological impacts of fossil-fuel resource development in Alberta, we chart the active treadmill forces, and examine the legal framework that enables public involvement in the province. We also provide a detailed account of the extent of public participation through the available avenues to date. We conclude, in line with the expectations of the treadmill of production, that the institutionalised processes of participation have been restricted to the point of nullifying the possibility of effective, democratic control over the expansion of the tar sands.
The Poor Stay Poor: Non-Convergence Across Countries and Regions

We study the issue of income convergence across countries and regions with a Bayesian model which allows us to use information in an efficient and flexible way. We argue that the very slow convergence rates to a common level of per-capita income found, for example, by Barro and Sala-i-Martin, is due to a 'fixed effect bias' that their cross-sectional analysis introduces in the results. Our approach permits the estimation of different convergence rates to different steady states for each cross-sectional unit. When this diversity is allowed, we find that convergence of each unit to (its own) steady-state income level is much faster than previously estimated, but that cross-sectional differences persist: inequalities will only be reduced by a small amount by the passage of time. The cross-country distribution of the steady state is largely explained by the cross-sectional distribution of initial conditions.
The spectrum of hippocampal sclerosis: A quantitative magnetic resonance imaging study

One hundred patients with intractable temporal lobe epilepsy and 22 control subjects were scanned on 1.5‐T Siemens SP63 Magnetom scanner. A combination of hippocampal T2 mapping, hippocampal volume measurement corrected for intracranial volume, and inspection of hippocampal morphology on a hippocampal volume distribution graph compared with a control graph revealed previously undetected forms of bilateral hippocampal sclerosis and four false‐positive diagnoses of hippocampal sclerosis made on visual inspection of the scans. A physiological asymmetry in the position of the hippocampi in 41% of control subjects and focal hippocampal atrophies in patients made measurement of the whole length of the hippocampus mandatory. The extent of hippocampal damage in patients with hippocampal sclerosis correlated with the number of secondary generalized seizures during a patient's lifetime. In contrast to patients with unilateral hippocampal sclerosis, patients with severe bilateral hippocampal sclerosis had no history of febrile convulsions. Twenty‐six patients with intractable temporal lobe epilepsy had normal hippocampal magnetic resonance imaging measures and as a group were significantly older at the onset of habitual epilepsy than were patiets with hippocampal sclerosis. In conclusion, a combination of quantitative magnetic resonance imaging techniques revealed a spectrum of hippocampal sclerosis and optimally defined boundaries of hippocampal normality. The spectrum of hippocampal sclerosis is related to the etiology, the number of secondary generalized seizures, and the age at onset of habitual epilepsy.
Testing separability of public consumption in household decisions

In this paper we propose a sequential strategy, based on the microeconomic approach of the demand theory, in order to test for separability between private and public consumption. The aim of the present work is to verify, using a conditional almost ideal demand system, whether the different components of public consumption exert conditioning effects on the allocative structure of private spending. The empirical estimation of the model and the separability tests are developed for both a demand system in five functional categories of private spending, and for a demand system in six categories, where the private expenditures on those goods and services which can also be offered by the public sector are enclosed in a single functional category. The results of the separability tests, obtained using UK data for the 1974–2000 period, show that public individual consumption plays an important role in modifying consumer choices, while public collective consumption does not affect private consumption behaviours. The relationships between the different components of private spending and public individual consumption are both of substitutability and complementarity; in particular, we find that public individual consumption and the corresponding private expenditures on ‘Health, education, recreation and social protection’ are complements.
The Demand for Alcohol in Ireland

Equilibrium and dynamic versions of Deaton and Muellbauer's AIDS model are used to estimate demand systems for Irish consumption of beer, spirits and wine using quarterly data for the period 1969-1980. The dynamic model is preferred on the grounds that it allows both homogeneity and symmetry whereas the equilibrium model does not. Estimated elasticities are used to derive tax elasticities for the change in revenue resulting from changes in excise duties. These elasticities are unambiguously positive. his paper uses a dynamic version of Deaton and Muellbauer's (1980a) A Almost Ideal Demand System (AIDS) to estimate price and expen­ diture elasticities for alcohol consumption in Ireland. The study differs from previous work on this topic in at least three important respects. First, the data set are based on quarterly observations over 1969(1) to 1980(4) dis­ aggregated into expenditures on beer, spirits and wine. Walsh and Walsh (1970) report price and income elasticities for beer and spirits but not for wine, while O'Riordan (1975) and McCarthy (1977) each report budget and price elasticities for the composite commodity alcohol using annual data. Second, the use of a flexible functional form permits systematic testing of homogeneity and symmetry restrictions implied by utility maximisation. Previous studies use either ad hoc functional forms (Walsh and Walsh) or restrictive models such as the Linear Expenditure System (McCarthy) which typically impose restrictions on the preference ordering. Third, rather than
Improving Innovation Capabilities Of Small Enterprises: Cluster Strategy As A Tool

This study focuses on innovation capabilities in small enterprises and how their development can be supported by regional strategies. The study utilizes multiple case studies. The empirical evidence is based on data from four regions in Finland. Each of them has adopted an industrial cluster approach as the basis of regional development. The study draws a common framework for assessing how regional development efforts meet the needs of innovation development in small enterprises. The findings demonstrate that most of the efforts for improving innovation capabilities of small enterprises are appropriate for innovation generation in the front-end phase. Instead, there were no significant efforts to support innovation adoption. Further, the highly conceptualised development services provided by a variety of public organizations meet the needs of large companies. However, these services match poorly with the nature of innovation development in small enterprises.
Calcium metabolism in early chronic renal failure: implications for the pathogenesis of hyperparathyroidism.

Studies in the past showed elevated immunoreactive parathyroid hormone (PTH) serum values in early renal failure, but the assays used in these studies could not discriminate between bioinactive fragments of the PTH peptide and biologically active hormone. The availability of a sensitive PTH assay, which quantitates intact hormone, now allows the analysis of biologically active PTH in renal failure. To characterise more precisely the point of onset of hyperparathyroidism in the course of chronic renal failure and its relation to 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], we measured plasma intact PTH and vitamin D metabolite serum values in 63 non-nephrotic uraemic patients (male n = 35, female n = 28, age 31-78 years) with incipient (GFR 60-90 ml/min per 1.73 m3, n = 19) mild (GFR 40-60, n = 22) and moderate (GFR 20-40, n = 22) renal failure, and in 22 age-matched healthy control subjects. Intact PTH concentrations were negatively correlated with GFR (r = -0.57, P less than 0.001). Median plasma intact PTH values (normal range 1.2-6 pmol/l) were 5.6 (range 2.2-13.0) in incipient, 8.1 (2.9-24.0) in mild, and 13.0 (5.4-59.0) in moderate renal failure. Intact PTH values in incipient renal failure were significantly greater than in 22 age-matched control subjects (P less than 0.01). The decline of GFR was paralleled by a progressive decrease in 1,25(OH)2D3 serum values (r = 0.44, P = 0.001). Median values of the hormone (normal range 35-90 pg/ml) were 32 (range 20-66) in incipient (P less than 0.01 vs. age-matched control subjects), 34 (22-74) in mild, and 26 (17-39) in moderate renal failure. In all three groups, mean serum phosphate and total calcium concentrations (corrected for serum protein) were within the normal range. (ABSTRACT TRUNCATED AT 250 WORDS)
Prevalence and risk factors of vertebral fracture in female Japanese patients with systemic lupus erythematosus

ObjectiveWe examined the prevalence and risk factors of vertebral fracture in female Japanese patients with systemic lupus erythematosus (SLE). MethodsWe performed lateral radiographs of the thoracic and lumbar spine and bone mineral density (BMD) measurements and collected demographic, lifestyle, clinical, and treatment characteristics of 52 SLE patients. Vertebral fractures were defined as a >20 % reduction of vertebral body height. Odds ratios (ORs) and their 95 % confidence intervals (CIs) were computed to assess the strength of associations between vertebral fractures and selected factors among SLE patients.ResultsAt least one vertebral fracture was detected in 50 % of SLE patients. A history of previous bone fracture was significantly associated with an increased risk of vertebral fractures among SLE patients (adjusted OR = 14.8, 95 % CI = 1.62–134; P = 0.017). Daily use of tea or coffee was marginally associated with a decreased risk of vertebral fractures among SLE patients (adjusted OR = 0.11, 95 % CI = 0.01–1.01; P = 0.051). ConclusionThe high prevalence of vertebral fracture in SLE patients (50 %) indicates that we need to assess the lateral spine radiograph in more female Japanese SLE patients regardless of BMD and use of corticosteroids, although additional studies are warranted to confirm the findings suggested in this study.
Mirror movements in amyotrophic lateral sclerosis

Abstract Amyotrophic lateral sclerosis (ALS) is a progressive motor syndrome with clinical evidence of upper and lower motor neuron dysfunction. Mirror movements (MM) in ALS have been reported and attributed to a disturbed transcallosal inhibition (TI). Hence, occurrence of MM in ALS might be explained by involvement of transcallosal projecting fibre tracts into the degenerative process of the motor system. Twenty-six consecutive ALS patients were studied by clinical investigation of MM and by transcranial magnetic stimulation testing of TI using evaluation of the ipsilateral silent period. MM were observed in 39% of ALS patients. There was a significant correlation between the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and occurrence of MM (correlation coefficient −0.315; p = 0.044). In conclusion, all MM patients had pathological TI at least in one hemisphere, which indicates involvement of transcallosally projecting output neurons in ALS patients, which in turn may be an early feature of the disease process with the potential of a diagnostic biomarker.
Oral manifestations in patients with gastro-oesophageal reflux disease: a single-center case-control study.

OBJECTIVE To assess the occurrence of oral pathological changes and symptoms in patients affected by gastro-oesophageal reflux disease (GERD). PATIENTS AND METHODS 200 patients with GERD and 100 matched healthy controls were studied. Thorough visual examination of the dental and oral mucosal tissues was performed and medical history relevant to oral symptoms was collected. The primary outcome was defined as a statistically significant difference, between the study group and controls, in the presence of the following indicators: soft/hard palate and uvula erythema, tooth wear, xerostomia, oral acid/burning sensation, subjective halitosis and dental sensitivity. Statistical analysis included chi-squared test, and crude odds ratio with 95% CI. RESULTS Univariate analysis showed that xerostomia, oral acid/burning sensation, subjective halitosis, and soft and hard palate mucosa and uvula erythema were more common in patients with GERD than matched controls (P < 0.05). CONCLUSIONS This study failed to find any significant association between GERD and dental erosions, whereas some symptoms and other objective oral mucosal changes were found to be significantly associated with GERD.
A Balanced Budget with Side Effects—A Case Study of Implementation of a Hospital Cost Savings Program in Sweden

This study examines the implementation of a hospital cost savings program in a Swedish county hospital to understand how and why a downsizing intervention works and what outcomes it produces. Data were gathered from interviews and documents. Substantial differences were found among the healthcare professionals’ perceptions of the downsizing process. These diverse perceptions likely limited the scope of staffs’ participation and innovations of new savings strategies. Our findings stress the need for impact analyses addressing both intended aims and unintended side effects. Full attention should be paid to communication processes required to establish a trustful and committed change climate.
The Nature and Design of Post-Industrial Organizations

This paper describes the nature and design of post-industrial organizations. It begins with an assessment of the popular literature on post-industrial society, and finds that this literature is an inappropriate basis for inferring the nature of post-industrial organizations. Partly as a consequence of this finding, the paper turns to systems theory as a basis for determining both the nature of post-industrial society and the nature of the increased demands that this environment would impose on post-industrial organizations. The middle three sections of the paper describe design features that post-industrial organizations will employ to deal with these demands. In particular they examine designs for making more effective three processes that will exhibit increased importance in post-industrial organizations: 1 decision-making, 2 innovation, and 3 information acquisition and distribution. In addition to its conclusions concerning the design features that post-industrial organizations will possess, the paper sets forth three general conclusions. One of these is that, even though the aggregate of the demands on post-industrial organizations will be qualitatively greater than that experienced by previous organizations, there are design features that organizations can adopt that will enable them to cope with even worst-case loadings of these demands. A second conclusion is that the nature of the post-industrial environment will cause decision-making, innovation, and information acquisition and distribution to take on added importance in post-industrial organizations, and that one result of this will be that organizations will attempt to ensure routine effectiveness of these processes through increased formalization. In some cases this formalization will have as its purpose ensuring the existence of informal or at least unstructured activities, such as experimentation by "self-designing" organizations or acquisition of "soft" information by top managers. The third conclusion set forth is that during the current transition period between the industrial and post-industrial societies we can expect many organizations to fail, or to flee to less than wholly desirable niches, because they are ignorant of the post-industrial technologies, structures, and processes that would enable them to successfully engage the post-industrial environment and to become viable post-industrial organizations. It appears that an important task of organizational and management scientists during this period will be to aid in the development, transfer, and implementation of post-industrial design features and in this way help reduce the possibility of unnecessary failure or flight.
LBS Research Online

This paper combines experimental and ﬁeld data to examine how authorities with discretion over how rules are enforced penalize transgressors when the social context of the transgression elicits expectations of leniency. Speciﬁcally, we test how transgressors are punished when it is their birthday: a day that triggers expectations of lenient treatment. First, in three scenario studies we explore individuals’ intuitions about how they would behave and expect to be treated if they transgressed on their birthdays, as well as how they would imagine penalizing a birthday transgressor. Second, using more than 134,000 arrest records for drunk driving in Washington State, we establish that police ofﬁcers penalize drivers more harshly when it is their birthday. Then, in a lab experiment in which we grant participants discretion over enforcing the rules of an essay-writing contest, we test psychological reactance toward transgressors who make their birthday salient, even subtly, as the mechanism behind this increased stringency. We rule out several alternative explanations for this effect, including public safety concerns, negative affect and overcompensation for bias. We conclude with a discussion of the theoretical and practical implications of our ﬁndings for the literatures on punishment, rule-breaking, and legal transgressions.
Regulated Flexibility – Flexible Working Time Patterns in Germany and the Role of Works Councils

This article deals with some recent trends in the patterns of working time in Germany as well as in industrial relations. Flexible forms of working time, particularly working time accounts, are gaining ground. At the same time, their introduction promotes a decentralization of collective bargaining. The industrial relations system typical of Germany has become far more elastic: the company level is gaining regulatory powers, without the protective framework of collective agreements being completely abandoned. The example of working time accounts illustrates how the interplay between the two levels of regulation can fulfil the ever more disparate requirements of companies and employees. Companies can cast off the straitjacket of uniform contractual working time standards, while regulated flexibility prevents employees from being placed at the mercy of flexible working time arrangements decided arbitrarily by the employer. This changed working time model can be described as ‘regulated flexibility’. Time management has become a new area of negotiation for workplace representation bodies.