Miracle-dz/UniFAR-FTUs huggingface dataset:
A retrospective study of the changing trends of antimicrobial resistance of Klebsiella pneumoniae isolated from urine samples over last 3 years (2012-2014)

Background: In our country, the problem of antibiotic resistance is compounding because of overuse and misuse of antibiotics. There is no systematic national surveillance of antibiotic resistance and insufficient data are available to quantify the problem. Objectives: To study the changing pattern of antimicrobial resistance of Klebsiella pneumoniae isolates from patients of urinary tract infections over last 3 years. Materials and Methods: A retrospective, record-based study carried out based on the records culture sensitivity reports of indoor patients, during past 3 years (2012-2014). The type of organisms most common in urine sample was noted, and the drugs still effective for the particular organism were noted. Results: Klebsiella was the second most frequent isolate throughout the 3 years (14%) of the total isolates). Analysis of the results year wise indicated that the lowest percentage of resistance was manifested against imipenem between 11.94% (2012) and 13.75% (2014). Over the successive years, resistance to ceftriaxone tends to increase from 74.95 % (2012) to 81% (2014). Klebsiella showed very high resistance 90.78% (2012) and 95.63% (2012) to co-trimoxazole and tetracycline, respectively with increasing trend to absolute resistance to both groups over the 3 years period. On an average over the 3 years Klebsiella showed a high amount of resistances to fluoroquinolones (72.71%) and aminoglycosides (76.22%). While multi-drug resistant Klebsiella range between 65% (2012) and 67% (2014). Conclusion: The antimicrobial resistance patterns are constantly evolving and vary from region to region it has become a necessity to do constant antimicrobial sensitivity surveillance. This will help clinicians to provide safe and effective empirical therapies.
Vibration Response Imaging as a New Tool for Interventional-Bronchoscopy Outcome Assessment: A Prospective Pilot Study

Background: In many patients, the benefit of interventional bronchoscopy cannot be appropriately objectified. Objectives: We investigated a new technique, vibration response imaging (VRI), for breathing sound mapping to determine whether it could provide additional, valuable objective qualitative and quantitative information in central airway obstruction (CAO) and patient outcome following interventional bronchoscopy. Methods: VRI images from 83 patients with suspected central airway stenosis and 25 healthy volunteers were evaluated by two raters blinded to the subjects’ status. Qualitative and quantitative dynamic and static features were documented for the final assessment of images as normal or abnormal and changes after the intervention. As a secondary goal, stenosis location was also evaluated and compared to bronchoscopic findings. Treatment outcome analysis (improved vs. not improved) was performed by comparing baseline and follow-up images in 64 evaluations of interventional bronchoscopy. VRI measurements of treatment outcome were compared to standard tests, i.e. dyspnea score, pulmonary function testing (PFT, i.e. FEV1, FVC and FEV1/FVC), chest X-ray/computed tomography and bronchoscopy, the latter being considered the gold standard). Results: There was 95% (115/121) agreement between raters and clinical assessment in distinguishing between normal and abnormal images. The sensitivity and specificity of VRI were 97 and 88%, respectively. The accuracy of VRI in locating the pathology compared to bronchoscopy was 85% (17/20) for tracheal and 88% (51/58) for bronchial obstruction; overall accuracy was 83%. Correct detection of the affected side in bronchial obstructions was 88%. The overall accuracy of VRI in defining the outcome of interventional bronchoscopy was 84%. Conclusions: Obstruction location and procedure outcome were reliably identified according to specific patterns of lung images. VRI proved at least as good as standard tests in locating CAO and has the potential for becoming a valuable complementary tool in evaluating treatment outcome in patients with CAO. If our results are confirmed by further studies, VRI may replace PFT or imaging procedures in cases in which such tests cannot be performed or are not readily available at the time of the intervention.
Chinese Classical Formula Sijunzi Decoction and Chronic Atrophic Gastritis: Evidence for Treatment Approach?

Objective This aim is to evaluate the effect of Sijunzi decoction (SJZD) treating chronic atrophic gastritis (CAG). Methods We performed searches in seven databases. The randomized controlled trials (RCTs) comparing SJZD with standard medical care or inactive intervention for CAG were enrolled. Combined therapy of SJZD plus conventional therapies compared with conventional therapies alone was also retrieved. The primary outcome included the incidence of gastric cancer and the improvement of atrophy, intestinal metaplasia, and dysplasia based on the gastroscopy and pathology. The secondary outcomes were Helicobacter pylori clearance rate, quality of life, and adverse event/adverse drug reaction. Results Six RCTs met the inclusion criteria. The research quality was low in the trials. For the overall effect rate, pooled analysis from 4 trials showed that modified SJZD plus conventional medications exhibited a significant improvement (OR = 4.86; 95% CI: 2.80 to 8.44; P < 0.00001) and without significant heterogeneity compared with the conventional medications alone. None reported the adverse effect. Conclusions Modified SJZD combined with conventional western medicines appears to have benefits for CAG. Due to the limited number and methodological flaw, the beneficial and harmful effects of SJZD for CAG could not be identified. More high-quality clinical trials are needed to confirm the results.
Clinical aspects and frequency of scorpion stings in the Riyadh region of Saudi Arabia.

OBJECTIVES To study the clinical aspects and frequency of scorpion stings in Riyadh region of Saudi Arabia. METHODS Clinical aspects and frequency of scorpion sting cases reporting to 2 referral hospitals in the Riyadh region of Saudi Arabia were analyzed during May 2006 to April 2008. Data on demographic status, date and time of sting, sting site, scorpion color, clinical manifestations, and treatment were collected. RESULTS A total of 391 cases of scorpion stings were recorded from the 2-referral hospitals, 248 (63.4%) of were men and 143 (36.6%) were women. The 21-30 years age group was the worst affected, followed by 31-40 years, 11-20 years, and <10 years age groups. Larger number of stings occurred during the summer months, at nights, and on distal limbs. Most of the patients reached the hospital within one hour of the sting. The yellow scorpions were responsible for a larger number of stings than the black scorpions. Seventy-five percent of the patients showed local signs and symptoms and 25% demonstrated systemic manifestations of poisoning. Most of the patients were treated with antivenom. CONCLUSION The high prevalence of scorpion stings largely with mild signs/symptoms and without any mortality suggests the predominance of weak venomous scorpion species in the Riyadh region. Therefore, the protocol of managing scorpion-sting patients with anti-venom irrespective of the intensity of manifestations warrants a detailed review.
Comparison of spatial aloha and CSMA using simple stochastic geometry models for 1D and 2D networks

Spatial throughput (i.e. throughput with spatial reuse) is important with new types of networks such as vehicular, sensor and military networks. The aim of this study is to compute the spatial throughput of Aloha and CSMA using tools for stochastic geometry. Our network nodes will be modeled as elements of a Poisson Point Process (PPP) of a one- or two-dimensional space. Spatial Aloha can be modeled easily, the transmitting nodes are just selected with a given transmission probability. In spatial CSMA the nodes with the smallest backoff counter in their neighborhood will be selected to transmit and thus we can use random marks to perform the selection. We use the two models we have built to compare the spatial density of successful transmissions of CSMA and Aloha. To carry out a fair comparison, we will optimize both schemes by adjusting their parameters. For spatial Aloha, we can adapt the transmission probability, whereas for spatial CSMA we have to find the suitable carrier sense threshold. The results obtained show that CSMA, when optimized, outperforms Aloha for nearly all the parameters of the network model values and we evaluate the gain of CSMA over Aloha. We also find interesting results concerning the effect of the model parameters on the performance of both Aloha and CSMA. The closed formulas we have obtained provide immediate evaluation of performance, whereas simulations may take minutes to give their results. Even if Aloha and CSMA are old protocols, this comparison of spatial performance is new and provides interesting and useful results.
Skeletal Fragility in Children with Chronic Disease

Skeletal fragility associated with underlying childhood chronic disease is a systemic disorder of poor bone growth and reduction in bone turnover which can lead to abnormal bone mass, geometry and microarchitecture. Due to the growth potential unique to children, remarkable bone recovery following a transient threat to the bone can occur if there is concurrent growth. Addressing bone health in these children should focus on improvement in growth, puberty and removing the primary insult. In conditions where there is a little scope for bone recovery and limited residual growth, bone-targeted therapy may need to be considered, even though there is currently limited evidence. The importance of early detection of signs of bone fragility, by active screening for vertebral fracture using newer imaging techniques such as dual-energy X-ray absorptiometry lateral vertebral morphometry, may now be possible. There is currently, a paucity of evidence to support prophylactic use of anti-resorptive therapy. Where poor growth and low bone turnover are seen, the use of growth-promoting therapies and anabolic bone-protective agents may be more physiological and should be evaluated in well-designed trials. Collaborative studies on long-term fracture outcome and well-designed trials of bone-protective therapies are needed and to be encouraged.
CD69 expression reliably predicts the anti-CD3-induced proliferative response of lymphocytes from human immunodeficiency virus type 1-infected patients

Published studies suggest that mitogenic responses of lymphocytes can be reliably assessed by monitoring the expression of lymphocyte surface CD69 after 24 h of culture with the stimulant. We tested this hypothesis by determining the ability of lymphocyte CD69 expression to predict the outcome (normal or abnormal) of lymphocyte proliferative responses to anti-CD3 in a group of human immunodeficiency virus type 1 (HIV-1)-infected patients (n = 47). Cutoff values for defining normal and abnormal CD69 expression and proliferative ([3H]thymidine incorporation) responses were established with lymphocytes from healthy uninfected controls (n = 20). Lymphocytes from 29 HIV-infected patients exhibited an abnormal proliferative response, and those from 25 of the 29 also exhibited abnormal CD69 expression (sensitivity, 86.2%). Similarly, lymphocytes from 18 HIV-infected patients exhibited a normal proliferative response, and those from 16 of the 18 also exhibited normal CD69 expression (specificity, 88.9%). The predictive value of a normal CD69 result was 80%, and the predictive value of an abnormal CD69 result was 92.6%. These findings demonstrate that HIV-1-associated impairments in lymphocyte activation can be reliably detected by the rapid and nonradioactive CD69 expression assay.
Targeting Persisters for Tuberculosis Control

ABSTRACT Mycobacterial persisters, the survivors from antibiotic exposure, necessitate the lengthy treatment of tuberculosis (TB) and pose a significant challenge for our control of the disease. We suggest that persisters in TB are heterogeneous in nature and comprise various proportions of the population depending on the circumstances; the mechanisms of their formation are complex and may be related to those required for persistence in chronic infection. Results from recent studies implicate multiple pathways for persister formation, including energy production, the stringent response, global regulators, the trans-translation pathway, proteasomal protein degradation, toxin-antitoxin modules, and transporter or efflux mechanisms. A combination of specifically persister-targeted approaches, such as catching them when active and susceptible either by stimulating them to “wake up” or by intermittent drug dosing, the development of new drugs, the use of appropriate drug combinations, and combined chemotherapy and immunotherapy, may be needed for more effective elimination of persisters and better treatment of TB. Variations in levels of persister formation and in host genetics can play a role in the outcome of clinical treatment, and thus, these may entail personalized treatment regimens.
Economics of myocardial perfusion imaging in Europe--the EMPIRE Study.

BACKGROUND Physicians use myocardial perfusion imaging to a variable extent in patients presenting with possible coronary artery disease. There are few clinical data on the most cost-effective strategy although computer models predict that routine use of myocardial perfusion imaging is cost-effective. OBJECTIVES To measure the cost-effectiveness of four diagnostic strategies in patients newly presenting with possible coronary artery disease, and to compare cost-effectiveness in centres that routinely use myocardial perfusion imaging with those that do not. METHODS We have studied 396 patients presenting to eight hospitals for the diagnosis of coronary artery disease. The hospitals were regular users or non-users of myocardial perfusion imaging with one of each in four countries (France, Germany, Italy, United Kingdom). Information was gathered retrospectively on presentation, investigations, complications, and clinical management, and patients were followed-up for 2 years in order to assess outcome. Pre- and post-test probabilities of coronary artery disease were computed for diagnostic tests and each test was also assigned as diagnostic or part of management. Diagnostic strategies defined were: 1: Exercise electrocardiogram/coronary angiography, 2: exercise electrocardiogram/myocardial perfusion imaging/coronary angiography, 3: myocardial perfusion imaging/coronary angiography, 4: coronary angiography. Primary outcome measures were the cost and accuracy of diagnosis, the cost of subsequent management, and clinical outcome. Secondary measures included prognostic power, normal angiography rate, and rate of angiography not followed by revascularization. RESULTS Mean diagnostic costs per patient were: strategy 1: 490 Pounds, 2: 409 Pounds, 3: 460 Pounds, 4: 1253 Pounds (P < 0.0001). Myocardial perfusion imaging users: 529 Pounds, non-users 667 Pounds (P = 0.006). Mean probability of the presence of coronary artery disease when the final clinical diagnosis was coronary artery disease present were, strategy 1: 0.85, 2: 0.82, 3: 0.97, 4: 1.0 (P < 0.0001), users 0.93, non-users 0.88 (P = 0.02), and when coronary artery disease was absent, 1: 0.26, 2: 0.22, 3: 0.16, 4: 0.0 (P < 0.0001), users 0.21, non-users 0.20 (P = ns). Total 2-year costs (coronary artery disease present/absent) were: strategy 1: 4453 Pounds/710 Pounds, 2: 3842 Pounds/478 Pounds, 3: 3768 Pounds/574 Pounds, 4: 5599 Pounds/1475 Pounds (P < 0.05/0.0001), users: 5563 Pounds/623 Pounds, non-users: 5428 Pounds/916 Pounds (P = ns/0.001). Prognostic power at diagnosis was higher (P < 0.0001) and normal coronary angiography rate lower (P = 0.07) in the scintigraphic centres and strategies. Numbers of soft and hard cardiac events over 2 years and final symptomatic status did not differ between strategy or centre. CONCLUSION Investigative strategies using myocardial perfusion imaging are cheaper and equally effective when compared with strategies that do not use myocardial perfusion imaging, both for cost of diagnosis and for overall 2 year management costs. Two year patient outcome is the same.
Long short-term memory networks and laglasso for bond yield forecasting: Peeping inside the black box

Modern decision-making in fixed income asset management benefits from intelligent systems, which involve the use of state-of-the-art machine learning models and appropriate methodologies. We conduct the first study of bond yield forecasting using long short-term memory (LSTM) networks, validating its potential and identifying its memory advantage. Specifically, we model the 10-year bond yield using univariate LSTMs with three input sequences and five forecasting horizons. We compare those with multilayer perceptrons (MLP), univariate and with the most relevant features. To demystify the notion of black box associated with LSTMs, we conduct the first internal study of the model. To this end, we calculate the LSTM signals through time, at selected locations in the memory cell, using sequence-to-sequence architectures, uni and multivariate. We then proceed to explain the states' signals using exogenous information, for what we develop the LSTM-LagLasso methodology. The results show that the univariate LSTM model with additional memory is capable of achieving similar results as the multivariate MLP using macroeconomic and market information. Furthermore, shorter forecasting horizons require smaller input sequences and vice-versa. The most remarkable property found consistently in the LSTM signals, is the activation/deactivation of units through time, and the specialisation of units by yield range or feature. Those signals are complex but can be explained by exogenous variables. Additionally, some of the relevant features identified via LSTM-LagLasso are not commonly used in forecasting models. In conclusion, our work validates the potential of LSTMs and methodologies for bonds, providing additional tools for financial practitioners.
Meeting the Challenge of Assessing Clinical Competence of Occupational Therapists within a Program Management Environment

Background. Program management models have raised concerns among occupational therapists about professional standards related to clinical competence, performance review procedures, and quality improvement initiatives. Purpose. This paper describes how a chart-stimulated recall (CSR) peer-review process and interview tool was revised, implemented, and evaluated as a pilot project to assess the clinical competence of occupational therapy staff at a large urban health centre in southern Ontario. Methods. Fourteen pairs (n=28) of occupational therapists representing various practice areas participated in this project. Half served as peer assessors and half as interviewees. Peer assessors conducted an independent chart review followed by a one-hour personal interview with a peer partner to discuss clinical management issues related to the client cases. Each interviewer rated his or her partner's clinical competence in eight areas of performance using a 7-point Likert scale. Findings. Results indicated that the CSR tool could discriminate among occupational therapists in terms of overall levels of clinical competence and also identify specific areas of concern that could be targeted for professional development. Feedback from participants was positive. Conclusions. The CSR tool was found to be useful for assessing clinical competence of occupational therapists in this large health centre as a quality improvement initiative within that discipline group. Further research is needed to establish the reliability and validity of the CSR tool.
A cross-linguistic perspective on the development of temporal systems

ABSTRACT The purpose of this research was to evaluate the development of temporal location within a cross-linguistic experimental design. The research focused on the transition from a temporal system based on absolute temporal relations involving speech time and event time to a more complex system involving relative temporal relationships and reference time. A comprehension test was constructed with problems which were diagnostic of two salient distinctions within each of three temporal systems. The procedure was based on a two-choice sentence–picture matching task. The children who participated were from Poland, the USA and Finland, and there were 12 children at each of the following age levels: 2;6, 3;6, 4;6, 5;6, and 6;6. The Polish and American children solved problems requiring absolute temporal location at 2;6, and the older children eventually solved most of the problems requiring relative location. The Finnish children followed a different pattern taking longer to comprehend both types of problems. A second experiment confirmed the Finnish pattern of development. The results of the comprehension test were compared to observations of conversational and narrative discourse which were the product of two elicitation procedures. The research demonstrates the way in which conceptual development places a universal constraint on the developmental process and how the specific properties of individual languages also have an effect.
Epithelial and Stromal Cells of Bovine Endometrium Have Roles in Innate Immunity and Initiate Inflammatory Responses to Bacterial Lipopeptides In Vitro via Toll-Like Receptors TLR2, TLR1, and TLR6

Bacteria often infect the endometrium of cattle to cause endometritis, uterine disease, and infertility. Lipopeptides are commonly found among bacteria and are detected by the Toll-like receptor (TLR) cell surface receptor TLR2 on immune cells. Heterodimers of TLR2 with TLR1 or TLR6 activate MAPK and nuclear factor-κB intracellular signaling pathways to stimulate inflammatory responses. In the endometrium, epithelial and stromal cells are the first to encounter invading bacteria, so the present study explored whether endometrial cells can also mount inflammatory responses to bacterial lipopeptides via TLRs. The supernatants of pure populations of primary bovine endometrial epithelial and stromal cells accumulated the cytokine IL-6 and the chemokine IL-8 in response to triacylated or diacylated bacterial lipopeptides. The accumulation of IL-6 and IL-8 in response to triacylated lipopeptides was reduced by small interfering RNA targeting TLR2 or TLR1 but not TLR6, whereas cellular responses to diacylated lipopeptide were reduced by small interfering RNA targeting TLR2, TLR1, or TLR6. Both lipopeptides induced rapid phosphorylation of ERK1/2, p38, and nuclear factor-κB in endometrial cells, and inhibitors of ERK1/2 or p38 limited the accumulation of IL-6. The ovarian steroids estradiol and progesterone had little impact on inflammatory responses to lipopeptides. The endometrial epithelial and stromal cell responses to lipopeptides via TLR2, TLR1, and TLR6 provide a mechanism linking a wide range of bacterial infections to inflammation of the endometrium.
Variations in gastric cancer care

Race is associated with patterns of presentation and survival outcomes of gastric cancer in the United States. However, the impact of race on the receipt of guideline‐recommended care is not well characterized. By using current recommendations, the authors examined the association between race and guideline‐recommended treatments and identified factors that are predictive of variations in gastric cancer care.