Miracle-dz/UniFAR-FTUs huggingface dataset:
The use of oral transmucosal fentanyl citrate for painful procedures in children.

OBJECTIVE To investigate the efficacy and safety of oral transmucosal fentanyl (OTFC) in providing analgesia and sedation for painful diagnostic procedures in children. DESIGN Randomized, placebo-controlled clinical trial. METHOD Forty-eight children referred to the University Connecticut Division of Pediatric Hematology/Oncology for bone marrow aspiration or lumbar puncture were randomized to receive either OTFC (15 to 20 micrograms/kg) or a placebo lollipop. Thirty minutes after administration, the procedure was begun. An anesthesiologist monitored the child's heart rate, blood pressure, and oxygen saturation every 10 minutes. At the conclusion of the procedure, the nurse, the child's parent, and all children over 8 years of age were asked to rate the pain associated with the procedure using a 1 to 10 visual analogue scale. Young children (less than 8) used a modified scale, the Oucher, yielding a 0 to 5 score. RESULTS Significant differences in pain ratings between the OTFC and placebo groups were noted on the pain scores of the parents (P = .005), nurses (P = .001), younger children (P = .006), and older children (P = .013), and median pain scores in the OTFC group were reduced to tolerable levels. Vomiting (P = .003) and itching (P = .001) were more common in the OTFC group, but no clinically significant vital sign deviations occurred. CONCLUSION OTFC is safe and effective for use in relieving the pain of pediatric procedures, but frequency of vomiting may restrict its clinical usefulness.
Inequality, emulation and debt: The occurrence of different growth regimes in the age of financialization in a stock-flow consistent model

ABSTRACT In the era of financialization, increasing income inequality could be observed in most developed and many developing countries. Despite similar developments in inequality, the growth performance and drivers for growth differed markedly among countries, allowing clusters of different growth regimes to be identified. Among them are 2 extreme types: the debt-led private-demand boom and the export-led mercantilist economies. Whereas the former rely mainly on credit-financed household consumption in order to compensate for the potential lack of demand (associated with the depressing effect of financialisation), the latter rely on net exports as the main driver of aggregate demand. Using a stock-flow consistent model it will be demonstrated how increasing inequality, depending on a countries institutional structure and regulatory framework, affects growth differently, explaining the occurrence of both regime types.
Safety impacts of pavement surface roughness at two-lane and multi-lane highways: accounting for heterogeneity and seemingly unrelated correlation across crash severities

ABSTRACT Highway agencies continue to show interest in measuring pavement condition effects on safety. This paper estimates univariate negative binomial (UNB) and random-parameters seemingly-unrelated negative binomial (RPSUNB) regression models. The latter account for unobserved heterogeneity and correlation in crash frequencies across the crash severity levels. The analysis was carried out for two-lane and multi-lane highways, and the results suggest that at the latter, the pavement condition generally has a far more significant safety impact compared to the former. This could be due to risk compensation effects where drivers offset the safety hazard associated with inherently less safe situations by driving more carefully. It was determined that compared to UNB, RPSUNB models have superior efficacy in addressing seemingly unrelated correlations among the crash severity levels.
Transient evoked otoacoustic emissions in the elderly: Emisiones otoacústicas evocadas transitorias en el anciano

The purpose of this study was to analyse the changes in transient evoked otoacoustic emissions (TEOAEs) with age. We studied 232 subjects above 60 years of age with a battery of audio-logical tests, including TEOAEs. Our criterion for the presence of TEOAEs was based on a cutoff at overall wave reproducibility 55% or overall response level 4 dB SPL. The prevalence of TEOAEs in left ears was 55.6%. No TEOAEs were found in subjects with a pure-lone average (PTA) above 40 dB HL. In the subgroup with TEOAEs, a significant decrease in overall wave reproducibility with age was found. We compared 45 normal-hearing elderly subjects with TEOAEs with a control group of 20 normal-hearing young adults. The elderly had significantly lower mean overall response levels and mean overall wave reproducibility. Average hearing level was significantly higher in the elderly than in controls. We conclude that the prevalence of TEOAEs decreases with age, and that the overall response level and overall reproducibility decrease with age. This decrease may not be seen in isolation from the increase in hearing threshold level. El propósito de cste estudio fue analizar los cambios en las emisiones otoacústicas evocadas por transitorios (TEOAEs) con la edad. Estudiamos 232 sujetos con edades por encima de los 60 años, con una batería de prueba audiológicas que incluían las TEOAEs. Nuestro critcrio para la presencia de las TEOAEs se basó en un corte al 55% de reproducibilidad global de la onda, o a un nivel de respuesta global de 4 dB SPL. La prevalencia de las emisiones (TEOAEs) en oídos izquierdos fue de 55.6%. No se encontraron emisiones en sujetos con promedios tonales (PTA) por encima de 40dB HL. En el sub-grupo con TEOAEs, se encontró una disminución significativa en la reproductibilidad global de la onda relacionada con la edad. Comparamos 45 ancianos con audición normal y con TEOAEs, con un grupo control de 20 adullos jóvenes normooyentes. Los ancianos mostraron niveles globales de respuesta promedio y promedios de reproducibilidad global de la onda significativamente menores. El nivel auditivo promedio fue significativamente mayor en los ancianos que en los controles. Concluimos que la prevalencia de las TEOAEs disminuye con la edad y que el nivel global de respuesta y la reproducibilidad global disminuyen también con la edad. Esta disminución de debe observarse aisladamente en relación con el deterioro en los umbrales de audición.
The Production of Cognitive and Non-Cognitive Human Capital in the Global Economy

A country’s welfare depends on its ability to accumulate cognitive and noncognitive human capital. However, we do not fully understand what makes some countries successful at producing human capital and even struggle with measurement. e.g. international test scores are informative about the cognitive dimension but neglect the non-cognitive dimension. In this paper, we develop a multi-country, open-economy general-equilibrium framework in which countries’ ability to turn resources into human capital along the cognitive and non-cognitive dimensions is revealed by the endogenous educational and occupational choices of its citizens and their subsequent performance on international exams. Our model allows us to estimate countries’ underlying productivities of cognitive and non-cognitive human capital. We find that high test scores do not necessarily imply high cognitive productivities (e.g. Switzerland, Hong Kong) and that many countries with low test scores have high non-cognitive productivities (e.g. the U.S. and U.K.). We then aggregate over these two dimensions to construct a single educational quality index, and illustrate its intuition using an iso-education-quality curve. We use our model to decompose variation in output per capita across countries into a component involving the educational quality index and another involving output TFP. This exact decomposition shows that the differences in cognitive and noncognitive productivities across countries have large implications for differences in output per worker. These results help quantify the potential payoffs of education policies and clarify their objective; e.g. excessive attention to test scores may decrease aggregate output. International trade plays an important role in our model because the gains from trade help to compensate a country for uneven productivity across human capital types. In counterfactual exercises, we show that if barriers to trade are completely eliminated, we would obtain a very different iso-education-quality curve. This implies large improvements of overall education quality, and large gains from trade, for the countries with strong comparative advantages in producing cognitive (e.g. S. Korea would gain 30.1% to 44.1% of its output) or non-cognitive human capital (e.g. the Netherlands would gain 18.8% to 55.6%).
Rethinking User Behaviour Comfort Patterns in the South of Spain—What Users Really Do

Although energy analysis techniques can contribute to substantial energy savings in housing stock retrofitting operations, the outcomes often deviate significantly from the predicted results, which tend to overestimate potential savings by overestimating the starting energy baselines, particularly in southern Europe. This deviation can be largely attributed to occupant practice relating to the use of air conditioning facilities and the temperatures at which occupants feel comfortable. The patterns observed differed widely from standard values. In this study environmental variables, primarily indoor air temperature both with and without HVAC, were monitored in occupied dwellings for a full year. The data gathered were supplemented with surveys on occupants’ temperature-related behaviour to define comfort patterns. The findings show that the standards in place are not consistent with actual comfort-accepted patterns in medium- to low-income housing in southern Spain, where energy consumption was observed to be lower than expected, mostly because occupants endure unsuitable, even unhealthy, conditions over long periods of time. A new user profile, better adjusted to practice in southern Europe, particularly in social housing, is proposed to reflect the current situation.
Percentage of REM sleep is associated with overnight change in leptin

Sleep contributes importantly to energy homeostasis, and may impact hormones regulating appetite, such as leptin, an adipocyte‐derived hormone. There is increasing evidence that sleep duration, and reduced rapid eye movement sleep, are linked to obesity. Leptin has central neural effects beyond modulation of appetite alone. As sleep is not a unifrom process, interactions between leptin and sleep stages including rapid eye movement sleep may play a role in the relationship between sleep and obesity. This study examined the relationship between serum leptin and rapid eye movement sleep in a sample of healthy adults. Participants were 58 healthy adults who underwent polysomnography. Leptin was measured before and after sleep. It was hypothesized that a lower percentage of rapid eye movement sleep would be related to lower leptin levels during sleep. The relationship between percentage of rapid eye movement sleep and leptin was analysed using hierarchical linear regression. An increased percentage of rapid eye movement sleep was related to a greater reduction in leptin during sleep even when controlling for age, gender, percent body fat and total sleep time. A greater percentage of rapid eye movement sleep was accompanied by more marked reductions in leptin. Studies examining the effects of selective rapid eye movement sleep deprivation on leptin levels, and hence on energy homeostasis in humans, are needed.
MICROVASCULAR COMPLICATIONS-NEUROPATHY ( D ZIEGLER , SECTION EDITOR ) Neurovascular Function and Sudorimetry in Health and Disease

In this review of thermoregulatory function in health and disease, we review the basic mechanisms controlling skin blood flow of the hairy and glabrous skin and illustrate the major differences in blood flow to glabrous skin, which is, in essence, sympathetically mediated, while hairy skin is dependent upon neuropeptidergic signals, nitric oxide, and prostaglandin, among others. Laser Doppler methods of quantification of blood flow—in response to iontophoresis of acetylcholine or heat—and nociceptor-mediated blood flow have relatively uniformly demonstrated an impaired capacity to increase blood flow to the skin in diabetes and in its forerunners, prediabetes and the metabolic syndrome. This reduced capacity is likely to be a significant contributor to the development of foot ulcerations and amputations in diabetes, and means of increasing blood flow are clearly needed. Understanding the pathogenic mechanisms is likely to provide a means of identifying a valuable therapeutic target. Thermoregulatory control of sweating is intimately linked to the autonomic nervous system via sympathetic C fibers, and sweat glands are richly endowed with a neuropeptidergic innervation. Sweating disturbances are prevalent in diabetes and its precursors, and quantification of sweating may be useful as an index of diagnosis of somatic and, probably, autonomic dysfunction. Moreover, quantifying this disturbance in sweating by various methods may be useful in identifying the risk of progression from prediabetes to diabetes, as well as responses to therapeutic intervention. We now have the technological power to take advantage of this physiological arrangement to better understand, monitor, and treat disorders of small nerve fibers and the somatic and autonomic nervous system (ANS). Newer methods of sudomotor function testing are rapid, noninvasive, not technically demanding, and accessible to the outpatient clinic. Whether the potential applications are screening for diabetes, following poorly controlled diabetes subjects during alteration of their treatment regimen, or simply monitoring somatic and autonomic function throughout the course of treatment, sudorimetry can be an invaluable tool for today’s clinicians.
MOD* Lite: An Incremental Path Planning Algorithm Taking Care of Multiple Objectives

The need for determining a path from an initial location to a target one is a crucial task in many applications, such as virtual simulations, robotics, and computer games. Almost all of the existing algorithms are designed to find optimal or suboptimal solutions considering only a single objective, namely path length. However, in many real life application path length is not the sole criteria for optimization, there are more than one criteria to be optimized that cannot be transformed to each other. In this paper, we introduce a novel multiobjective incremental algorithm, multiobjective D* lite (MOD* lite) built upon a well-known path planning algorithm, D* lite. A number of experiments are designed to compare the solution quality and execution time requirements of MOD* lite with the multiobjective A* algorithm, an alternative genetic algorithm we developed multiobjective genetic path planning and the strength Pareto evolutionary algorithm.
Use of diagnostic tests by dermatologists, podiatrists and family practitioners in the United States: pilot data from a cross‐sectional survey

Before treating onychomycosis, it is important to exclude other conditions such as lichen planus and psoriasis. The purpose of this study was to evaluate physician preferences and uses of diagnostic tests for toenail onychomycosis (TO) by surveying dermatologists (D), podiatrists (P) and family practitioners (FP) in the United States. Surveys were mailed to approximately 1000 randomly sampled physicians from each of the three specialities. The questionnaire consisted of 15 items regarding physician and practice characteristics, number of patients with TO seen and treated, tests used to diagnose TO and reasons for using the tests. Results were analysed using several statistical methods. Response rates were low (D33.7%; P16.6%; FP28.4%). Ds and Ps (75.2%) and FPs (43.4%) reported feeling ‘very confident’ at diagnosing onychomycosis. KOH was the preferred diagnostic test for all three specialities. More Ds (75.4%) felt ‘very confident’ interpreting potassium hydroxide (KOH) exams than Ps (24.9%) and FPs (18.5%). Use of KOH exams was statistically associated with confidence interpreting exams (P P = 0.04092; D & FP P < 0.0001). Some FPs (46.6%) and Ps (21.6%) did not obtain a confirmatory diagnostic test prior to the treatment of onychomycosis while 63.6% of Ds ‘almost always/always’ did. While limited by low‐response rate, this study provides pilot information on the diagnostic preferences for TO by American D, P and FP.
Omega‐3 supplementation in mild to moderate Alzheimer's disease: effects on neuropsychiatric symptoms

Epidemiological and animal studies have suggested that dietary fish or fish oil rich in omega‐3 fatty acids (ω3), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), may have effects in psychiatric and behavioral symptoms in Alzheimer's disease (AD). An association with APOEω4 carriers and neuropsychiatric symptoms in AD has also been suggested.
Locating the barnacle settlement pheromone: spatial and ontogenetic expression of the settlement-inducing protein complex of Balanus amphitrite

Barnacles are prominent members of hard substratum benthic communities and their study has been important to advances in experimental ecology and contemporary ecological theory. Having recently characterized the cue to gregarious settlement of Balanus amphitrite, the settlement-inducing protein complex (SIPC), we use two polyclonal antibodies to examine the tissue distribution and ontogenetic expression of this glycoprotein. These antibodies were raised against two separate peptides located near the N- and C-termini of the SIPC and were used to detect the glycoprotein by western blotting and immunohistochemistry. By in situ hybridization we also show that the SIPC mRNA co-occurs with the expressed glycoprotein in the cuticles of both nauplius and cypris larval stages and the adult. In the larvae, the SIPC is expressed most strongly in the mouthparts and the hindgut of the stage 2 nauplius and in the thoracopods, antennules and bivalved carapace of the cyprid. In adult B. amphitrite, the expressed SIPC is present in protein extracts of the shell and in all organs that are lined by cuticular tissues. We suggest that the SIPC is produced by the epidermal cells that secrete the cuticle and discuss these observations with regard to earlier studies and the role of the SIPC as a contact pheromone.
Use of Age and Milk Production Data to Improve the Ability of Enzyme-Linked Immunosorbent Assay Test Results to Predict Mycobacterium Avium ssp. Paratuberculosis Fecal Culture Status

Cows from 2 California dairies were tested for paratuberculosis at the end of lactation by using fecal culture and a commercially available serum enzyme-linked immunosorbent assay (ELISA) test kit. Individual cow characteristics and production variables were evaluated along with ELISA testing results as predictors of fecal culture status. In multivariable logistic regression analysis, age and a herd-standardized version of 305-day mature equivalent (305 ME) milk production were significant predictors of fecal culture status after adjusting for herd, quarter of the study year, and ELISA sample-to-positive (S/P) ratio. The area under a nonparametric receiver operating characteristic curve was significantly greater for a multivariable model that included age and the level of milk production when compared with a model without these covariates. In conclusion, consideration of cow-level covariates was useful as an aid in predicting Mycobacterium avium ssp. paratuberculosis (MAP) fecal culture status. For a given ELISA S/P ratio, older cows and those with lower 305 ME milk production relative to other cows in the herd were significantly more likely to be shedding MAP in their feces at the end of lactation.
Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24,061 consecutive cases.

AIMS Several studies have reported circadian and seasonal variations in acute cardiovascular disease. In addition, a weekly variation has been observed in acute myocardial infarction. The aim of our study was to determine the circadian weekly, and seasonal variations of sudden death utilizing population-based data. METHODS AND RESULTS We analysed the emergency medical system data of Berlin (West) from 1987-1991 with respect to all consecutive sudden deaths in subjects >18 years (n=24 061). There was a marked circadian variation of sudden death, with a minimum between 0 and 6 h and a maximum between 6 and 12 h (P<0.0001) for every day of the week. A minimum of events occurred on Sundays (n=3143), and a maximum on Mondays (n=3721), corresponding to a relative increase of 18.3% (P<0.0001). The increase was more pronounced (23.6%) in patients < or =65 than in patients >65 (15.7%). In addition, we found a significant seasonal variation (P<0.0001) in events, with a maximum during winter (December to February, n=6493), and a minimum during summer (June to August, n=5472), corresponding to a relative difference of 18.7%. The seasonal variation was more pronounced in patients >65 years. CONCLUSION The present analyses demonstrate marked variations in the occurrence of sudden death with peaks during morning hours, on Mondays, and during winter months. The findings suggest that the onset of sudden death may be associated with endogenous rhythms and external factors including climatic conditions.
Antiarrhythmic and Nonantiarrhythmic Drugs for Sudden Cardiac Death Prevention

Life-threatening ventricular arrhythmias such as sustained ventricular tachycardia and ventricular fibrillation are responsible for two thirds of sudden cardiac deaths annually in the United States. Implantable cardioverter-defibrillator (ICD) therapy prevents mortality from arrhythmic death but is expensive and has some associated morbidity from proarrhythmia and mechanical malfunction. Furthermore, ICDs treat ventricular arrhythmias but do not prevent them. Antiarrhythmic drugs (AADs) can be used for acute or chronic therapy to prevent ventricular arrhythmias and sudden cardiac deaths. AADS are often used in patients with an ICD who have recurrent ICD shocks resulting from ventricular arrhythmias. Class I AADs are contraindicated in patients with structural heart disease. Other than amiodarone, all Class III drugs have either a neutral or deleterious effect on mortality. Dronedarone, a new Class III drug, may reduce mortality, but more information is needed to be sure. A class of drugs that do not qualify as an AAD can modify cardiovascular remodeling processes and have a delayed and indirect antiarrhythmic effect. These so-called “nonantiarrhythmic drugs” such as drugs acting on the renin-angiotensin-aldosterone system, fish oil, and statins can reduce the likelihood of future ventricular tachycardia/ventricular fibrillation in patients with coronary artery disease or congestive heart failure. The role of AADs for chronic therapy for primary and secondary prevention of sudden cardiac death is problematic because of proarrhythmia and adverse side effects. Because these nonantiarrhythmic drugs are well tolerated and have no proarrhythmic actions, their benefits should outweigh risks.