Miracle-dz/UniFAR-FTUs huggingface dataset:
National cost savings from observation unit management of syncope.

OBJECTIVES Syncope is a frequent emergency department (ED) presenting complaint and results in a disproportionate rate of hospitalization with variable management strategies. The objective was to estimate the annual national cost savings, reduction in inpatient hospitalizations, and reduction in hospital bed hours from implementation of protocolized care in an observation unit. METHODS We created a Monte Carlo simulation by building a model that reflects current clinical practice in the United States and uses inputs gathered from the most recent available peer-reviewed literature and national survey data. ED visit volume was adjusted to reflect observation unit availability and the portion of observation visits requiring subsequent inpatient care. A recent multicenter randomized controlled study informed the cost savings and length of stay reduction per observation unit visit model inputs. The study population included patients aged 50 years and older with syncope deemed at intermediate risk for serious 30-day cardiovascular outcomes. RESULTS The mean (±SD) annual cost savings was estimated to be $108 million (±$89 million) from avoiding 235,000 (±13,900) inpatient admissions, resulting in 4,297,000 (±1,242,000) fewer hospital bed hours. CONCLUSIONS The potential national cost savings for managing selected patients with syncope in a dedicated observation unit is substantial. Syncope is one of many conditions suitable for care in an observation unit as an alternative to an inpatient setting. As pressure to decrease hospital length of stay and bill short-stay hospitalizations as observation increases, syncope illustrates the value of observation unit care.
Computation and transmission requirements for a decentralized linear-quadratic-Gaussian control problem

A decentralized control problem involving K nodes is formulated. At each node are sensors and controls. The object is to share the information of each sensor, processed with a Kalman estimator, with all the other nodes so that the controllers can be computed using the best estimate of the state of the system given the information from all the sensors. The controls are determined so that the expected value of a quadratic performance index is minimized. The problem is formulated as a decentralized control problem without a central supervisor so that the system performance will degrade gracefully under structural perturbations, Therefore, the transmission of data is from each node to every other node: there are ¿i=1 K (i-1) links connecting all nodes. It is shown that if the dimension of the controls at each node l is less than both the dimension of the data at node m and the dimension of the state, then a data vector with dimension of the control at l can be transmitted from m to l. This compression of data transmission is done at the expense of propagating an additional data dependent vector at each node beyond the usual Kalman filter equations.
Production and Characterization of Melanin Pigment from Halophilic Black Yeast Hortaea werneckii

Melanin is nearly a ubiquitous pigment synthesized by living organisms in the course of hydroxylation and polymerization of organic compounds. Melanins have immense application potentials in the field of agriculture, cosmetics and pharmaceutical industries (photoprotection and mosquitocidal activity isolated from Streptomycete). In this study, the halophilic black yeast, Hortaea werneckii produced a diffusible dark pigment on potato dextrose agar. This work was designed to study the ability of the yeast for the production, characterization and optimization of the melanin pigment with different nutrient sources. Characterization of melanin was analyzed by UV spectroscopy, FT IR, SEM and antibacterial potential of melanin was also studied. The favorable condition for the high yield of melanin was found to be glucose as carbon source and peptone as nitrogen source with the optimum parameters like temperature 30oC, salinity 15‰, pH 7.0, incubation period of 168 hrs and the rice bran as a cheaper substrate, which produced 5.60g/L of melanin. It also showed inhibitory activity against potential pathogens and activity was observed in Salmonella typhi (17mm) and Vibrio parahaemolyticus (15mm). It was concluded that the melanin of Hortaea werneckii isolated from solar salterns possess a high antibacterial activity and could act as a suitable source of new antimicrobial natural products.
Establishing the Feasibility of Face Transplantation in Granulomatosis With Polyangiitis

Granulomatosis with polyangiitis (GPA; formerly Wegener's granulomatosis) is a rare vasculitis that commonly starts in the craniofacial region. We report a case that was masked by prior facial trauma and associated with pyoderma gangrenosum (PG). Disease progression and aggressive debridements led to severe facial tissue loss. The decision to perform a face transplant was controversial because of the risk of disease relapse on the facial allograft. We reviewed renal transplant outcomes in GPA for possible relevance. A PubMed search retrieved 29 studies. Patient and graft survival, relapse, morbidity, mortality, rejection and immunosuppression were assessed. Ten‐year patient survival and graft survival were 84.4% and 72.6%, respectively. GPA relapse occurred in 31.5%, and upper airway/ocular relapse occurred in 17.8% (resolved in 76.9%). Mortality was 12.3%. Acute and chronic rejection rates were 14.9% and 6.8%, respectively. Traditional posttransplant immunosuppression was effective. Our review suggests that GPA renal transplant outcomes are comparable to general renal transplant cohorts. Furthermore, transplanted GPA patients exhibit lower disease relapse secondary to lifelong immunosuppression. This supported our decision to perform a face transplant in this patient, which has been successful up to the present time (1‐year posttransplantation). Untreated GPA and PG are potential causes of worse surgical outcomes in the craniofacial region.
Prevalence of heparin‐induced antibodies in patients with chronic renal failure undergoing hemodialysis

Heparin‐induced thrombocytopenia (HIT) type II is a serious complication of heparin therapy. It presents initially as thrombocytopenia, and is associated with thrombosis in 20–50% of the cases. HIT is related to the presence of heparin‐induced antibodies (HIA), which show specificity for the PF4‐heparin (PF4‐H) complex. The FcγRIIa receptor has been suggested to participate in the pathogenic mechanism of HIA. Since patients undergoing chronic hemodialysis (HD) are exposed repeatedly to heparin, we studied the prevalence of HIA and their eventual relationship with thrombocytopenia and/or thrombosis, and the possible participation of the FcγRIIa polymorphism. We studied 207 patients with chronic renal failure (CRF) undergoing HD. As a control we included 130 blood donors and 28 patients with CRF without HD. The HIA patients were studied with the use of a PF4‐H ELISA. Additionally, in some positive cases for the previous test, a 14C‐ serotonin release assay (14C‐SRA) was performed. The polymorphism FcγRIIa H/R131 was studied by polymerase chain reaction (PCR) with allele‐specific primers. Thirty‐seven patients (17.9%) undergoing HD presented with HIA. The majority of these antibodies were IgG, IgM, and IgA. The HIA investigated presented specificity against the PF4‐H complex, but not against PF4 alone (P<0.001). Twelve out of 22 (54.5%) PF4‐H antibodies were positive when tested with the 14C‐SRA. The distribution of the FcγRIIa polymorphism in patients and healthy controls was 42.6% and 41.6% for H/H131, 41% and 48.9% for the H/R131 isoform, and 16.4% and 9.5% for the R/R131 isoform, respectively. No statistically significant difference in the FcγRIIa isoform distribution was found. Twenty‐nine out of 156 patients (18.5%) presented thrombocytopenia, and 21/207 (12.4%) had thrombosis of the native vein arterio‐venous fistula (AVF). We did not find any statistically significant between HIA and thrombocytopenia or thrombosis. An important proportion of patients with CRF undergoing HD developed HIA, but these cases were not associated with thrombocytopenia or thrombosis of AVF. The frequency of the FcγRIIa polymorphism did not statistically differ between HIT type II and normal controls. J. Clin. Lab. Anal. 19:189–195, 2005. © 2005 Wiley‐Liss, Inc.
Angiotensinogen Variants among Resistant Hypertensive Patients

The recently published paper entitled “Genetic and adverse health outcome associations with treatment resistant hypertension in GenHAT” by Lynch et al. [1] evaluated the association between 78 candidate gene polymorphisms and treatment resistant hypertension (TRH). Interestingly, the main finding was the association of two genetic variants in the angiotensinogen (AGT) gene, the M allele of rs699 and the G allele of rs5051, and TRH in white but not in African-American subjects. Previous Brazilian studies [2, 3] found the association with this SNP but at an opposite direction; carriers of the AGT M235T T allele, not Met allele, were at increased risk for resistant hypertension. The divergence among those studies might be explained by the differences between the genetic structure of the studied populations. The high degree of miscegenation among Brazilians, including Africans, Europeans, and Ameridian ancestral roots, is well known [4, 5]. Admixed populations have a distinct pattern of linkage disequilibrium that affects haplotype blocks and might explain those apparent divergent findings. Also, it is important to note that AGT M235T polymorphism reported in those studies might not be the causal variant, and the causation cannot be drawn. Moreover, the present clinical study showed evidence of a significant interaction by race in the association of AGT M235T rs699 with TRH, the Met allele being less frequent among African-American than white participants, highlighting the importance of the race in resistant hypertension susceptibility. Undoubtedly, the present study has great contribution in the genetic background of resistant hypertension and contributes to improvement of the knowledge in such condition.
An objective comparison of the pediatric interviewing skills of freshman and senior medical students.

The use of videotapes to observe senior medical students as they interviewed mothers of children has demonstrated a deficit in their ability to communicate with these parents. Seniors often fail to obtain the vital information pertaining to the child as an individual within a family unit. This study was performed to test the hypotheses that freshmen would obtain (1) more interpersonal and (2) less factual information from mothers of ill children than would seniors. Randomly selected freshmen and seniors videotaped interviews of three simulators who were programmed to portray mothers of a child with a serious organic illness with related psychosocial problems. The use of the programmed "mother" permitted each student to obtain a standardized interviewing experience. The students were given identical information about these children and informed that the mothers were simulators. Objective measurements were made by five trained observers who rated each videotape using a modified interaction analysis technique and an objective checklist of facts obtained. An interrater reliability coefficient for each group of ratings was high, rarely falling below 0.80. The results clearly demonstrated that freshmen obtained significantly more interpersonal information (i.e., the affect of the illness upon the child and his family) and asked fewer leading questions than did seniors (p < 0.01). Seniors obtained more factual information (p < 0.001). The ramifications of these data are far reaching. It would appear that, as medical students move through their training, a certain degree of their innate ability communicate with mothers of ill children seems to have been altered by their desire to obtain factual information. This alteration may well limit their effectiveness as the child's physician.
Effect of Hypoxia/Ischemia and Hypoxic Preconditioning/Reperfusion on Expression of Some Amyloid‐Degrading Enzymes

Abstract: Alzheimer's disease (AD) is linked to certain common brain pathologies (e.g., ischemia, stroke, and trauma) believed to facilitate its development and progression. One of the logical approaches to this problem is to study the effects of ischemia and hypoxia on the metabolism of amyloid precursor protein, which plays one of the key roles in the pathogenesis of AD. This involves an analysis of (1) proteases, which participate in proteolysis of amyloid precursor protein either by the nonamyloidogenic route (α‐secretase) or the amyloidogenic pathway and lead to formation of toxic β‐amyloid peptides (β‐ and γ‐secretases) and (2) several metallopeptidases that might play a role in degradation of β‐amyloid peptide (Aβ). The study of the effects of prenatal hypoxia and acute hypoxia in adult animals allowed us to conclude that oxygen deprivation results not only in an increase of amyloid precursor protein expression in the brain but also in a decrease in the activity of α‐secretase. In some brain structures involved in AD pathology (the cortex and striatum), we also observed a decrease in the expression of two of the Aβ degrading enzymes, neprilysin and endothelin‐converting enzyme, after hypoxia. A decrease in expression of these metalloproteases was also observed in the model of four‐vessel occlusion ischemia in rats with their restoration to the control levels after reperfusion. Preconditioning to mild hypoxia both in the prenatal period and in adults appeared to have a neuroprotective effect restoring, in particular, the levels of amyloid precursor protein, activity of a‐secretase, and expression of neprilysin and endothelin‐converting enzyme to their control values.
Insights into organohalide respiration and the versatile catabolism of Sulfurospirillum multivorans gained from comparative genomics and physiological studies.

Sulfurospirillum multivorans, a free-living ε-proteobacterium, is among the best studied organisms capable of organohalide respiration. It is able to use several halogenated ethenes as terminal electron acceptor. In this report, the complete genome sequence of S. multivorans including a comparison with genome sequences of two related non-dehalogenating species, Sulfurospirillum deleyianum and Sulfurospirillum barnesii, is described. The 3.2 Mbp genome of S. multivorans revealed a ∼ 50 kbp gene region encoding proteins required for organohalide respiration and corrinoid cofactor biosynthesis. This region includes genes for components not detected before in organohalide-respiring organisms. A transcript analysis of genes coding for some of these proteins indicates the involvement of a putative quinol dehydrogenase in organohalide respiration. The presence of genes encoding a variety of oxidoreductases reflects the organism's metabolic versatility. This was confirmed by growth studies with different electron acceptors including perchlorate and several sulfur-containing compounds. A comparison with other ε-proteobacteria indicates horizontal acquisition of many genes in the S. multivorans genome, which might be the basis of the bacterium's catabolic flexibility.
Agreement between preoperative core needle biopsy and postoperative invasive breast cancer histopathology is not dependent on the amount of clinical material obtained

Aims: To establish the relation between the amount of breast core needle biopsy (CNB) material examined and agreement between preoperative and postoperative histopathology parameters in invasive breast cancer. Methods: The CNB and surgical specimen histopathology reports of 113 patients with invasive breast carcinoma were reviewed and the total amount of CNB material examined for each case was determined. Agreement was calculated for tumour type, grade, mitoses, nuclear pleomorphism, and tubule formation. Associations between the amount of CNB material and histopathology agreement before and after surgery were explored using binary logistic regression. Results: Tumour type and grade agreed in 65.4% and 61.6% of cases, respectively. The components used to calculate grade—nuclear pleomorphism (57.4%), mitoses (59.4%), and tubule formation (55.6%)—agreed slightly less frequently. The proportion of cases with preoperative and postoperative assessments that agreed did not depend on the number of cores collected or the total amount of material examined. Conclusion: Neither tumour type and grade, nor the individual components used to calculate grade agreed consistently between the CNB and surgical specimen. The number of cores collected and the total amount of material reviewed by the pathologist does not influence the likelihood of agreement between preoperative and postoperative histopathology reports.
Let's talk about death: data collection for verbal autopsies in a demographic and health surveillance site in Malaysia

Background Verbal autopsies have gained considerable ground as an acceptable alternative to medically determined cause of death. Unlike with clinical or more administrative settings for data collection, verbal autopsies require significant involvement of families and communities, which introduces important social and cultural considerations. However, there is very little clear guidance about the methodological issues in data collection. The objectives of this case study were: to explore the range of bereavement rituals within the multi-ethnic, multi-faith population of the district; to investigate the preparedness of communities to talk about death; to describe the verbal autopsy process; to assess the effects of collecting verbal autopsy data on data collectors; and to determine the most accurate sources of information about deaths in the community. Methods A case study approach was used, using focus group discussions, indepth interviews and field notes. Thematic analyses were undertaken using NVivo. Results Consideration of cultural bereavement practices is importance to acceptance and response rates to verbal autopsies. They are also important to the timing of verbal autopsy interviews. Well trained data collectors, regardless of health qualifications are able to collect good quality data, but debriefing is important to their health and well being. This article contributes to guidance on the data collection procedures for verbal autopsies within community settings.
[Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis].

OBJECTIVE To compare the efficacy of early total enteral nutrition (TEN) vs. total parenteral nutrition (TPN) in patients with severe acute pancreatitis (SAP). METHODS A total of 22 consecutive patients with SAP were randomized to receive TPN (group I) or TEN (group II). SAP was defined applying APACHE II score, C-reactive protein (CRP) measurements and/or Balthazar CT scan score. Acute inflammatory response (CRP, TNF-a, IL-6), visceral proteins (pre-albumin, albumin), complications (systemic inflammatory response syndrome, multiorgan failure, infections), surgical interventions, length of hospital stay and mortality were evaluated. RESULTS No significant differences were found between the two groups in the APACHE II score, in CRP, TNF-a and IL-6 concentrations or in pre-albumin and albumin levels over the first 10 days. Seven patients in group I and 4 in group II suffered severe complications. Three patients in group I required surgical intervention. Length of hospital stay was alike in the two groups. Two patients from group I died in the course of the hospitalization. CONCLUSIONS SAP patients with TEN feeding showed a tendency towards a better outcome than patients receiving TPN.
Simulation of motion on the skin. V. Effect of stimulus temporal frequency on the representation of moving bar patterns in primary somatosensory cortex of monkeys.

1. To assess the mechanisms used by cortical neurons to sense motion across the skin, we applied pulsatile stimuli to a series of adjacent positions on the glabrous skin of the hand using a computer-controlled OPTACON stimulator. We describe responses of 129 single neurons in primary somatosensory cortex of alert monkeys to a horizontal bar pattern that was displaced proximally or distally in 1.2-mm steps at 10-, 20-, and 40-ms intervals (100, 50, and 25 Hz, respectively). These frequencies span the range in which apparent motion is transformed perceptually in humans from a smooth uninterrupted sweep into a series of distinct pulses that are resolved as separate events. The experiments are thus designed to decipher the neural correlates distinguishing continuous motion from discrete taps. 2. Cortical receptive fields mapped with moving bar patterns spanned 5-24 rows on the tactile array (16.2 +/- 5.4, mean +/- SD). Over 40% of the fields encompassed 18 or more rows (greater than or equal to 21.6 mm), allowing these neurons to integrate spatial information from an entire image displayed on the OPTACON. Cortical receptive fields are considerably larger than those of mechanoreceptors mapped with the same moving bar patterns (4.2 +/- 2.3 rows, mean +/- SD), reflecting convergent inputs in subcortical and cortical relays. Responses were either relatively uniform across the field or strongest at the initial point of entry, depending on the frequency of stimulation. A sharply defined field center was absent from most of the cells recorded in this study. 3. Temporal frequency of stimulation appears to be a major determinant of cortical firing patterns. Low-frequency stimuli are more effective in activating cortical neurons, producing more spikes per sweep and greater phase-locking to individual stimuli than do high frequencies. The total spike output of cortical neurons is proportional to the pulse interval over the range 10-40 ms, increasing linearly by an average of 5.9 spikes/10-ms increase in pulse period. Peak firing rates and modulation amplitude are also highest when pulses are presented at long intervals, falling significantly as the stimulation frequency rises. The reduction in firing at high pulse rates is apparently due to central mechanisms, as both rapidly adapting and Pacinian corpuscle afferents display nearly constant spike outputs and uniform sensitivity within the field when tested with identical bar patterns. Central networks thus behave as low-pass filters, reducing cortical responses to rapidly applied sequential stimuli. (ABSTRACT TRUNCATED AT 400 WORDS)
Title Relationship between fractional pancreatic beta cell area and fasting plasma glucose concentration in monkeys Permalink

Aims/hypothesis We sought to establish the relationship between fasting plasma glucose concentrations and pancreatic fractional beta cell area in adult cynomolgus monkeys (Macaca fascicularis). Methods Fasting plasma glucose and pancreatic fractional beta cell area were measured in 18 control and 17 streptozotocin-treated adult primates (17.0±1.2 vs 15.4± 1.2 years old). Results Fasting plasma glucose was increased (12.0±2.0 vs 3.4±0.1 mmol/l, p<0.01) and fractional beta cell area was decreased (0.62±0.13% vs 2.49±0.35%, p<0.01) in streptozotocin-treated monkeys. The relationship between fasting plasma glucose and pancreatic fractional beta cell area was described by a wide range of beta cell areas in controls. In streptozotocin-treated monkeys there was an inflection of fasting blood glucose at ∼50% of the mean beta cell area in controls with a steep increase in blood glucose for each further decrement in beta cell area. Conclusions/interpretation In adult non-human primates a decrement in fractional beta cell area of ∼50% or more leads to loss of glycaemic control.