Miracle-dz/UniFAR-FTUs huggingface dataset:
Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database

We designed and internally validated an aggregate weighted early warning scoring system specific to the obstetric population that has the potential for use in the ward environment. Direct obstetric admissions from the Intensive Care National Audit and Research Centre's Case Mix Programme Database were randomly allocated to model development (n = 2240) or validation (n = 2200) sets. Physiological variables collected during the first 24 h of critical care admission were analysed. Logistic regression analysis for mortality in the model development set was initially used to create a statistically based early warning score. The statistical score was then modified to create a clinically acceptable early warning score. Important features of this clinical obstetric early warning score are that the variables are weighted according to their statistical importance, a surrogate for the FIO2/PaO2 relationship is included, conscious level is assessed using a simplified alert/not alert variable, and the score, trigger thresholds and response are consistent with the new non‐obstetric National Early Warning Score system. The statistical and clinical early warning scores were internally validated using the validation set. The area under the receiver operating characteristic curve was 0.995 (95% CI 0.992–0.998) for the statistical score and 0.957 (95% CI 0.923–0.991) for the clinical score. Pre‐existing empirically designed early warning scores were also validated in the same way for comparison. The area under the receiver operating characteristic curve was 0.955 (95% CI 0.922–0.988) for Swanton et al.'s Modified Early Obstetric Warning System, 0.937 (95% CI 0.884–0.991) for the obstetric early warning score suggested in the 2003–2005 Report on Confidential Enquiries into Maternal Deaths in the UK, and 0.973 (95% CI 0.957–0.989) for the non‐obstetric National Early Warning Score. This highlights that the new clinical obstetric early warning score has an excellent ability to discriminate survivors from non‐survivors in this critical care data set. Further work is needed to validate our new clinical early warning score externally in the obstetric ward environment.
Sexual harassment against nursing staff in Tanta University Hospitals, Egypt.

BACKGROUND Sexual harassment against nurses is a major workplace problem causing adverse psychological effects and may affect the occupational performance of the nurses. This study aimed to assess the magnitude of this problem, and its characteristics and consequences among the nursing staff in Tanta University Hospitals, Gharbeia Governorate, Egypt. PARTICIPANTS AND METHODS A descriptive cross-sectional study was carried out on 430 nurses at Tanta University Hospitals using a semistructured, self-administered questionnaire to collect the data concerning the exposure and characteristics of harassment situations. A representative sample of the nurses was taken randomly from the emergency, medical and surgical departments. RESULTS Overall, 70.2% of the studied nurses were ever exposed to sexual harassment at the workplace; 43.7% of the harassed nurses were working in both day and night shifts. Staring in a suggestive manner emerged as the most common form of harassment, followed by hearing sexual words and comments or jokes (70.9, 58.6 and 57.3%, respectively). The relatives of the patients were the most common perpetrators, followed by the hospital staff other than the doctors (61.9, 45.4%, respectively). During the harassment situation, astonishment and shock were the most frequent responses in 65.2% of the harassed nurses, while after its occurrence 38.4% ignored the situation. About 95% of the harassed nurses were left with psychological effects, mostly in the form of disappointment and depression (76.5 and 67.9%, respectively). CONCLUSION AND RECOMMENDATIONS The prevalence of sexual harassment among nurses at the workplace was high with relation to certain occupational factors, and it led to marked psychological effects on the victims. Hence, protective legislations and measures should be taken by the hospital management for prevention of this problem in the future.
Molecular cytogenetic characterization of doxorubicin‐resistant neuroblastoma cell lines: Evidence that acquired multidrug resistance results from a unique large amplification of the 7q21 region

Neuroblastoma is a heterogeneous neural crest–derived embryonic childhood neoplasm that is the second most common solid tumor found in children. Despite recent advances in combined therapy, the overall survival of patients with high‐stage disease has not improved in the last decades. Treatment failure is in part attributed to multidrug resistance. To address the mechanisms involved in the development of multidrug resistance, we have generated two doxorubicin‐resistant neuroblastoma cell lines (IGRN‐91R and LAN‐1R). These cells were shown to overexpress the MDR1 gene coding for the P‐glycoprotein and were resistant to other MDR1‐ and non‐MDR1‐substrate drugs. Indeed, the MDR1 inhibitor verapamil only partially restored sensitivity to drugs, confirming that P‐glycoprotein‐mediated drug efflux was not responsible for 100% resistance. High‐resolution and array‐based comparative genomic hybridization analyses revealed the presence of an amplicon in the 7q21 region as the unique genomic alteration common to both doxorubicin‐resistant cell lines. In addition to the MDR1 locus, this large amplified region is likely to harbor additional genes potentially involved in the development of drug resistance. This study represents the first molecular cytogenetic and genomic approach to identifying genomic regions involved in the multidrug‐resistant phenotype of neuroblastoma. These results could lead to the identification of relevant target genes for the development of new therapeutic modalities. © 2006 Wiley‐Liss, Inc.
Improved Matching of Waveguide Focal Plane Arrays Using Patch Array Covers as Compared to Conventional Dielectric Sheets

This paper presents the advantages of microstrip patch array covers as matching layers for waveguide arrays, as compared with the use of conventional dielectric sheets. It will be demonstrated that both types of covers can be tuned to improve the transmission levels of uncovered arrays at either low frequencies or over a very wide band. However, at low frequencies where the radiation performance tends to be poor due to strong mutual coupling between closely separated elements, the patch array cover offers itself as a lower profile and lighter weight matching structure. This makes it highly advantageous for use in space applications and satellite communications. In addition, it is also able to provide wider matching bandwidths than dielectric sheets. Here, we present a rigorous analysis of such a patch array printed on a dielectric slab and placed over an array of sidewall loaded hard rectangular waveguides. Due to the desirable properties of its aperture field, this type of element serves as an ideal reference for conveying the properties of the two matching layers studied here. Also, to ensure the matching layer performance is independent of the array elements, optimized elements are used in all computations. The method of moments using spectral Green's functions for multilayer structures is employed. Two array operation scenarios are studied, which are the direct radiating phased arrays, and focal plane arrays (FPAs) as feeds for reflectors.
Healthcare service failure: how dissatisfied patients respond to poor service quality

Few scholars have so far explored how healthcare service quality affects patient dissatisfaction, leading to negative behavior responses when a healthcare service fails. The purpose of this paper is to examine how different service quality attributes affect patient dissatisfaction leading to a variety of asymmetric negative behavior responses. ,Following a survey of 453 dissatisfied outpatients in Korea, structural equation modeling with a series of post hoc analyses is used to test the research model. It consists of five hypotheses. ,Outcome quality is found to be the most significant variable affecting patient dissatisfaction, followed by administrative quality, interactive quality, and environmental quality. Dissatisfied patients tend to engage more in active behaviors (e.g. negative word-of-mouth, switching, and complaining) than in remaining passive in a non-linear way. Also, the mediating role of dissatisfaction is found to be significant. ,This paper has empirically identified the most significant service quality attributes that lead to dissatisfied patients and negative behaviors on their part. These findings indicate that different quality attributes of service failure lead to different actions. However, this study has suffered from a few limitations as a result of its research context and scope. ,This paper is one of the very few empirical studies examining the relationships among the output and process quality attributes, patient dissatisfaction, and actual behaviors in a healthcare service failure context.
Helicobacter pylori Disrupts STAT1-Mediated Gamma Interferon-Induced Signal Transduction in Epithelial Cells

ABSTRACT Infection with Helicobacter pylori is chronic despite a vigorous mucosal immune response characterized by gastric T-helper type 1 cell expansion and gamma interferon (IFN-γ) production. IFN-γ signals by activation and nuclear translocation of signal transducer and activator of transcription 1 (STAT1); however, the effect of H. pylori infection on IFN-γ-STAT1 signaling is unknown. We infected human gastric (MKN45 and AGS) and laryngeal (HEp-2) epithelial cell lines with type 1 and type 2 H. pylori strains and then stimulated them with IFN-γ. Western blotting of whole-cell protein extracts revealed that infection with live, but not heat-killed, H. pylori time-dependently decreased IFN-γ-induced STAT1 tyrosine phosphorylation. Electrophoretic mobility shift assay of nuclear protein extracts demonstrated that H. pylori infection reduced IFN-γ-induced STAT1 DNA binding. STAT1 was unable to translocate from the cytoplasm to the nucleus in H. pylori-infected HEp-2 cells examined by immunofluorescence, and reverse transcription-PCR showed that IFN-γ-induced interferon regulatory factor 1 expression was inhibited. These effects were independent of the cagA, cagE, and VacA status of the infecting H. pylori strain. Furthermore, neither H. pylori culture supernatants nor conditioned medium from H. pylori-infected MKN45 cells inhibited IFN-γ-induced STAT1 tyrosine phosphorylation, suggesting that inhibition is independent of a soluble epithelial or bacterial factor but is dependent on bacterial contact with epithelial cells. H. pylori disruption of IFN-γ-STAT1 signaling in epithelial cells may represent a mechanism by which the bacterium modifies mucosal immune responses to promote its survival in the human host.
Investigation of the Dynamic Stability of Microgrid

Microgrid is an aggregation of distributed generators (DGs) and energy storage systems (ESS) through corresponding power interface, such as synchronous generators, asynchronous generators and power electronic devices. Without the support from the public grid, the control and management of an autonomous microgrid is more complex due to its poor equivalent system inertia. To investigate microgrid dynamic stability, a small-signal model of a typical microgrid containing asynchronous generator based wind turbine, synchronous diesel generator, power electronic based energy storage and power network is proposed in this paper. The small-signal model of each of the subsystem is established respectively and then the global model is set up in a global reference axil frame. Eigenvalues distributions of the microgrid system under certain steady operating status are identified to indicate the damping of the oscillatory terms and its effect on system stability margin. Eigenvalues loci analysis is also presented which helps identifying the relationship among the dynamic stability, system configuration and operation status, such as the variation of intermittent generations and ESS with different control strategies. The results obtained from the model and eigenvalues analysis are verified through simulations and experiments on a study microgrid system.
Asymmetric Actor Critic for Image-Based Robot Learning

Deep reinforcement learning (RL) has proven a powerful technique in many sequential decision making domains. However, Robotics poses many challenges for RL, most notably training on a physical system can be expensive and dangerous, which has sparked significant interest in learning control policies using a physics simulator. While several recent works have shown promising results in transferring policies trained in simulation to the real world, they often do not fully utilize the advantage of working with a simulator. In this work, we exploit the full state observability in the simulator to train better policies which take as input only partial observations (RGBD images). We do this by employing an actor-critic training algorithm in which the critic is trained on full states while the actor (or policy) gets rendered images as input. We show experimentally on a range of simulated tasks that using these asymmetric inputs significantly improves performance. Finally, we combine this method with domain randomization and show real robot experiments for several tasks like picking, pushing, and moving a block. We achieve this simulation to real world transfer without training on any real world data.
Adaptation by a Cochlear-Implant Patient to Upward Shifts in the Frequency Representation of Speech

The purpose of this project was to assess the degree to which a patient, after 1 wk of experience, could adapt to 3.2-mm and 6.8-mm basal shifts in the representation of speech. Only small deficits in performance were found after practice after the 3.2-mm shift. After practice after the 6.9-mm shift, scores on tests that emphasized amplitude envelope cues returned to baseline levels. Scores on vowel and sentence tests that emphasized frequency-based cues remained poor. Scores for “place,” however, showed some recovery. Vowel recognition may be the limiting factor in recognizing basally shifted speech.
Sleep during Experimental Trypanosomiasis in Rabbits

Abstract Trypanosoma brucel subspecies cause the human condition known as “sleeping sickness. ” in rabbits, these organisms induce a chronic and ultimately fatal disease characterized by periodic parasitemia. To characterize sleep alterations during a chronic infectious condition and to determine how immune stimulation of the host, as reflected by cyclic parasitemia, is related to altered somnolence, we monitored sleep and other clinical indices in rabbits inoculated subcutaneously with Trypanosoma brucel brucel. Within four days, infected rabbits developed fever, reduced food intake, and other signs of infectious illness concurrent with the onset of parasitemia were evident. The initial febrile episodes were transient, recurring in temporal correlation with parasitemia. Time spent in slow-wave sleep and delta-wave amplitude during slow-wave sleep increased significantly in association with the onset of febrile episodes, despite an overall trend toward decreases in these parameters. Because each episode of parasitemia presents an immune stimulus to the infected host, the periodic enhancement of sleep observed in this model is consistent with the hypothesis that immune stimulation is correlated with increased somnolence. The data further indicate that sleep alterations occur not only during acute infections, as previously reported, but during chronic infections as well [P.S. E.B. M. 1994, Vol 205]
INCIDENCE OF MALARIA/TYPHOID CO-INFECTION AMONG ADULT POPULATION IN UNWANA COMMUNITY, AFIKPO NORTH LOCAL GOVERNMENT AREA, EBONYI STATE, SOUTHEASTERN NIGERIA

Background: Malaria and typhoid fever are two leading infections of poverty with serious health and socioeconomic impacts, and due to their geographical overlap, co-infections are very common. Their mimicking symptomatology often present with gross misdiagnosis and mistreatment. This study was carried out to determine the incidence of malaria and typhoid co-infections among adult population in Unwana Community, Afikpo-North Local Government Area of Ebonyi State. Materials and Methods: Three hundred and fifty (350) individuals were examined, their blood samples subjected to microscopic examination and widal agglutination tests, for identification of Plasmodium parasites and antibodies to Salmonella enterica serovar typhi respectively. Questionnaire was administered to obtain information on malaria/typhoid management practices. Results: Out of the 350 blood samples analysed, 190 (54.2%) were positive for malaria, 173 (49.4%) were positive for Salmonella enterica serovar typhi, while 127(36.2%) were positive for both typhoid and malaria. However, prevalence of malaria parasite was statistically significant in relation to sex (p<0.05), as males had 50% prevalence and females, 58%. For Salmonella enterica serovar typhi, the prevalence was not statistically significant in relation to sex (p>0.05); while males had 57% prevalence for Salmonella enteric serovar typhi, females had 42%. Sex was statistically significant (p<0.05) concerning prevalence rate of malaria/typhoid co-infection; males had 35% co-infection rate while females had 37%. The management practices studied revealed that over 80% of the respondents preferred environmental sanitation as the best prevention/control method. In the case of treatment, buying medicine from pharmacy shops was common (48%). This was followed by the use of herbal remedies (31%), while appreciable number adopted self-treatment method (18%). Conclusion: Both malaria and typhoid were prevalent among the studied population with high rate of co-infection. Co-infection was higher in females than males and use of herbal medicine for treatment was common. Efforts should be made to improve on the living conditions of the people of Unwana and also, there should be public enlightenment on the preventive and control measures of the two diseases. Since both diseases have similar symptomatology, treatment should be based on adequate laboratory diagnosis. Also, personal hygiene is hereby encouraged among the populace.
Remifentanil Induces Systemic Arterial Vasodilation in Humans with a Total Artificial Heart

BackgroundTo assess intrinsic vascular effects of remifentanil, increased concentrations were infused in critically ill patients with a total artificial heart. MethodsIn the early postoperative period after implantation of a total artificial heart, nine ventilated patients requiring short general anesthesia were included in this study. After anesthesia was induced with 0.3 mg/kg intravenous etomidate, the artificial heart settings were modified to render cardiac output “preload-independent. ” While maintenance of anesthesia was ensured by a continuous infusion of etomidate, increased concentrations of remifentanil (from 0.1 to 1 &mgr;g · kg−1 · min−1) were infused in steps of 5 min under hemodynamic monitoring, including left and right atrial pressures, systemic and pulmonary arterial pressures, and left and right cardiac indices. The invasive procedure was started under the highest concentration of remifentanil tolerated by the patient. Infusion of remifentanil was stopped at the end of the invasive procedure, while etomidate infusion was maintained. New hemodynamic measurements were performed at the end of the 12-min recovery period. ResultsRemifentanil produced a dose-dependent and significant decrease in systemic arterial pressure and vascular resistances (n = 9) from a concentration of 0.25 &mgr;g · kg−1 · min−1. No significant changes were observed on pulmonary vascular resistances (n = 6). Neither right (n = 9) nor left (n = 6) atrial pressures were affected by remifentanil infusion. Hemodynamic variables returned to baseline value over the 12-min recovery period. ConclusionsIn humans with a total artificial heart, remifentanil induces a systemic arterial vasodilation without significant effect on the capacitance vessels.
Food Intake Changes Across the Menstrual Cycle in Taiwanese Women

Background: Studies in Western countries have suggested that there are relationships among sex hormones, the neuropeptide leptin, women’s food intake, and body weight changes across the menstrual cycle. However, data on this question are needed from other cultural groups. Objectives: To compare total food and macronutrient intake and serum estrogen, progesterone, and leptin levels in Taiwanese women of varying body size during three menstrual cycle phases. Method: A cross-sectional survey was conducted using a sample of 39 healthy Taiwanese women (aged 20—40 years) with regular menstrual cycles. Food journals covering 3 days, body weight, height, waist and hip circumferences, and serum samples for estrogen, progesterone, and leptin were collected at three time points during one menstrual cycle. Data were analyzed using the paired t test, mixed-model analysis, and Pearson’s correlations. Results: Regardless of body weight, women consumed more total calories (+160 kcal/day, p < .05) and more grams of protein (+6—8 g/day, p = .01) during the luteal phase and ovulation compared with the follicular phase. A higher percentage of energy was consumed as carbohydrates (CHOs) during the follicular phase (+5% of total energy intake, p < .01). No correlations were noted among serum sex hormone levels, serum leptin levels, food intake, and body weight. Discussion: The findings support the hypothesis that Taiwanese women, as previously reported in women from mixed or Western cultural groups, experience menstrual-related variations in food intake. These changes, however, were not directly linked with serum sex hormone or leptin levels.
Finding The “Self” in Self-Regulation: The Identity-Value Model

ABSTRACT Many psychological theories suggest a link between self-regulation and identity, but, until now, a mechanistic account that suggests ways to improve self-regulation has not been put forth. The identity-value model (IVM) connects the idea from social psychology that aspects of identity such as core values and group affiliations hold positive subjective value to the process-focused account from decision making and behavioral economics that self-regulation is driven by a dynamic value integration across a range of choice attributes. Together, these ideas imply that goal-directed behaviors that are identity relevant are more likely to be enacted because they have greater subjective value than identity-irrelevant behaviors. A central hypothesis, therefore, is that interventions that increase the degree to which a target behavior is perceived as self-relevant will improve self-regulation. In addition, identity-based changes in self-regulation are expected to be mediated by changes in subjective value and its underlying neural systems. In this article we define the key constructs relevant to the IVM, explicate the model and delineate its boundary conditions, and describe how it fits with related theories. We also review disparate results in the research literature that might share identity-related value as a common underlying mechanism of action. We close by discussing questions about the model, the answers to which could advance the study of self-regulation.