Miracle-dz/UniFAR-FTUs huggingface dataset:
Evaluation of pediatric intensive care

A total of 294 Clinical Classification System (CCS) Classes III and IV patients in a pediatric ICU (PICU) were evaluated in terms of severity of illness and quantity of care. The group was comprised of patients from 3 services: medicine, cardiovascular surgery, and other surgery. Severity of illness was measured by the Physiologic Stability Index (PSI) and quantity of care was measured by the Therapeutic Intervention Scoring System (TISS). Comparisons were made between survivors and nonsurvivors and among the 3 services. Nonsurvivors had significantly higher (p < .01) PSI and TISS scores than survivors. Medical patients had the highest PSI scores while cardiovascular surgery patients had the highest TISS scores. Analysis of 7-day regression slopes for all survivor groups and medicine and other surgery nonsurvivor groups demonstrated slopes consistent with the expected clinical course. Cardiovascular surgery nonsurvivor slopes were unique and demonstrated increasing stability with stable amounts of care. The PSI/TISS ratio was used to relate levels of physiologic instability to the amount of therapy. Medical patients had the highest ratios and cardiovascular surgery patients had the lowest ratios. Comparisons of survivors and nonsurvivors for the PSI/TISS ratios and regression slopes demonstrated differences that were not evident through comparison of PSI and TISS scores alone.
Which rectal cancers are locally advanced?

In populations in whom there has been a focus on the important components of rectal cancer management, 5-year survival is better in rectal cancer than in colon cancer, which was not the case in the past. Total mesorectal excision (TME) is one of many important components of current management.
Exploring and influencing the knowledge and attitudes of health professionals towards extended breastfeeding.

BACKGROUND Although many U.S. professional health organizations have policy statements that support the breastfeeding of children beyond one year (extended breastfeeding), the actual attitudes of health workers towards this practice have not been explored. The purposes of this study were (1) to explore the knowledge and attitudes of various U.S. health professionals towards extended nursing and (2) to pilot an educational display for U.S. health professionals to promote their knowledge and attitudes towards extended breastfeeding. METHODS A total of 84 participants in a New York City academic medical center provided responses to a structured self-administered questionnaire given before and after an educational display. RESULTS Respondents reported negative attitudes towards extended breastfeeding at baseline, with negative attitudes increasing as the age of the breastfed child increased. After education, the percentage of participants who found breastfeeding acceptable for 1- or 2-year-old children increased from 61% to 89% (p < 0.001). Acceptability of 3- or 4-year-old children breastfeeding increased from 22% to 41% (p < 0.001). CONCLUSIONS Viewing educational media concerning older nursing children may lead to more positive attitudes towards extended breastfeeding among healthcare professionals.
Evidence for primordial water in Earth’s deep mantle

Shaking out water's dusty origin Where did Earth's water come from? Lavas erupting on Baffin Island, Canada, tap a part of Earth's mantle isolated from convective mixing. Hallis et al. studied hydrogen isotopes in the lavas that help to “fingerprint” the origin of water from what could be a primordial reservoir. The isotope ratios for the Baffin Island basalt lavas suggest a pre-solar origin of water in Earth, probably delivered by adsorption onto dust grains. Science, this issue p. 795 Baffin Island basalt hydrogen isotopes suggest a protosolar origin for Earth’s water. The hydrogen-isotope [deuterium/hydrogen (D/H)] ratio of Earth can be used to constrain the origin of its water. However, the most accessible reservoir, Earth’s oceans, may no longer represent the original (primordial) D/H ratio, owing to changes caused by water cycling between the surface and the interior. Thus, a reservoir completely isolated from surface processes is required to define Earth’s original D/H signature. Here we present data for Baffin Island and Icelandic lavas, which suggest that the deep mantle has a low D/H ratio (δD more negative than –218 per mil). Such strongly negative values indicate the existence of a component within Earth’s interior that inherited its D/H ratio directly from the protosolar nebula.
Long-term prognosis of near-fatal asthma. A 6-year follow-up study of 145 asthmatic patients who underwent mechanical ventilation for a near-fatal attack of asthma.

The objective of the present study was to investigate the long-term prognosis of near-fatal asthma. A retrospective cohort study design was used. Cases were defined as any asthmatic individual requiring mechanical ventilation for the first time for an asthma exacerbation between January 1, 1983 and December 31, 1988. The consecutive sample of patients was drawn from four study sites, specifically four intensive care units (ICU), based in a large urban area (1 million inhabitants). These four ICU total approximately 5,000 admissions per year and are the referral centers for more than 95% of patients requiring respiratory intensive care in the area. Data collection was obtained by questionnaires addressed to the patients and to their attending physicians and was completed by telephone calls if necessary. A total of 147 patients entered the study. The long-term outcome could be evaluated in all but two patients. The follow-up period ranged from 1 to 75 months. In-hospital mortality was 16.5%. Among the 121 patients discharged from the ICU, 18 subsequently died, 17 of whom died from a new attack of asthma. Post-hospitalization mortality was 10.1% (95% CI, 5.9 to 16.8%) after 1 yr, 14.4% (CI, 9 to 22.3%) after 3 yr, and 22.6% (CI, 12.7 to 36.8%) after 6 yr. Nearly two-thirds (61.5%) of these secondary deaths occurred within the year following discharge from the ICU. Smoking was associated with a higher in-hospital mortality, as well as with a higher posthospitalization mortality. Age was also independently associated with a higher posthospitalization mortality. It is noteworthy that the secondary deaths were mostly observed in patients over 40 yr of age. (ABSTRACT TRUNCATED AT 250 WORDS)
Older people and ill fitting shoes

Background: Foot health is an important issue in older people. Inappropriate shoes increase the risk of callous and ulcer formation, as well as increasing the risk of falls. There are no data defining the size of this problem. Objective: The aim of the study was to investigate the proportion of elderly people on a general rehabilitation ward wearing incorrectly sized shoes and to look for the presence of complications. Methods: Sixty five consecutive patients (mental state questionnaire score >6) admitted to a rehabilitation ward had their foot length and width measured, and the size of their current footwear recorded. Sensation was tested with a standard 10 g monofilament. The presence of ulceration was noted. Foot pain was recorded by the patient on a visual analogue scale. Any history of diabetes mellitus, peripheral vascular disease, or peripheral neuropathy was noted. Results: The median age of the subjects was 82 (range 64–93). Six (9%) had a history of diabetes, seven (11%) had symptomatic peripheral vascular disease, and 17 (26%) had sensory impairment. Ten patients (15%) had foot ulceration present, and 47 patients (72%) had ill fitting shoes (a discrepancy in length of more than half a British shoe size fitting or more than one British width fitting, 7 mm). Incorrect shoe length was significantly associated with the presence of ulceration (odds ratio (OR) = 10.04, p = 0.016). Presence of ulceration was significantly associated with a history of peripheral vascular disease (OR = 11.56, p = 0.008). Pain was significantly associated with incorrect shoe length (p = 0.0238) and with sensory impairment (p = 0.0314). Conclusion: Most older people on a rehabilitation ward wore ill fitting shoes. An association was found between ill fitting shoes and self reported pain, and between ill fitting shoes and ulcer formation. A straightforward assessment of footwear in older people could improve comfort and avoid preventable foot disorders.
UPBEAT: The Impact of a Psychogeriatric Intervention in VA Medical Centers

Background.The Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) program provides individualized interdisciplinary mental health treatment and care coordination to elderly veterans whose comorbid depression, anxiety, or alcohol abuse may result in overuse of inpatient services and underuse of outpatient services. Objectives.To determine whether proactive screening of hospitalized patients can identify unrecognized comorbid psychiatric conditions and whether comprehensive assessment and psychogeriatric intervention can improve care while reducing inpatient use. Design.Randomized trial. Subjects.Veterans aged 60 and older hospitalized for nonpsychiatric medical or surgical treatment in 9 VA sites (UPBEAT, 814; usual care, 873). Measures.The Mental Health Inventory (MHI) anxiety and depression subscales, the Alcohol Use Disorder Identification Test (AUDIT) scores, RAND 36-Item Health Survey Short Form (SF-36), inpatient days and costs, ambulatory care clinic stops and costs, and mortality and readmission rates. Results.Mental health and general health status scores improved equally from baseline to 12-month follow-up in both groups. UPBEAT increased outpatient costs by $1,171 (P <0.001) per patient, but lowered inpatient costs by $3,027 (P = 0.017), for an overall savings of $1,856 (P = 0.156). Inpatient savings were attributable to fewer bed days of care (3.30 days;P = 0.016) rather than fewer admissions. Patients with 1 or more pre-enrollment and postenrollment hospitalizations had the greatest overall savings ($6,015;P = 0.069). Conclusions.UPBEAT appears to accelerate the transition from inpatient to outpatient care for acute nonpsychiatric admissions. Care coordination and increased access to ambulatory psychiatric services produces similar improvement in mental health and general health status as usual care.
The P450 enzyme Shade mediates the hydroxylation of ecdysone to 20‐hydroxyecdysone in the Colorado potato beetle, Leptinotarsa decemlineata

Ecdysone 20‐monooxygenase (E20MO), a cytochrome P450 monooxygenase (CYP314A1), catalyses the conversion of ecdysone (E) to 20‐hydroxyecdysone (20E). We report here the cloning and characterization of the Halloween gene Shade (Shd) encoding E20MO in the Colorado potato beetle, Leptinotarsa decemlineata. LdSHD has five conserved motifs typical of insect P450s, ie the Helix‐C, Helix‐I, Helix‐K, PxxFxPE/DRF (PERF) and heme‐binding motifs. LdShd was expressed in developing eggs, the first to fourth instars, wandering larvae, pupae and adults, with statistically significant fluctuations. Its mRNA was ubiquitously distributed in the head, thorax and abdomen. The recombinant LdSHD protein expressed in Spodoptera frugiperda 9 (Sf9) cells catalysed the conversion of E to 20E. Dietary introduction of double‐stranded RNA (dsRNA) of LdShd into the second instar larvae successfully knocked down the LdShd expression level, decreased the mRNA level of the ecdysone receptor (LdEcR) gene, caused larval lethality, delayed development and affected pupation. Moreover, ingestion of LdShd‐dsRNA by the fourth instars also down‐regulated LdShd and LdEcR expression, reduced the 20E titre, and negatively influenced pupation. Introduction of 20E and a nonsteroidal ecdysteroid agonist halofenozide into the LdShd‐dsRNA‐ingested second instars, and of halofenozide into the LdShd‐dsRNA‐ingested fourth instars almost completely relieved the negative effects on larval performance. Thus, LdSHD functions to regulate metamorphotic processes by converting E to 20E in a coleopteran insect species Le. decemlineata.
Reliability Study in Solder Joint under Electromigration and Thermal-Mechanical Load

This paper presents a numerical study of electronic migration in solder joint under the interaction of high current density, thermal load and mechanical load. Three dimensional finite element model of a flip chip solder joint structure is developed and tested through numerical experiment. An improved algorithm of void formation and propagation in solder joints has been developed with consideration of electro-migration, thermo-migration and stress-migration. The improved algorithm is based on direct couple analysis that includes electrical, thermal and structural fields. The time to failure life predictions due to mass migration have been simulated based on the voids, current density, temperature and mechanical stress distribution. Numerical simulation has shown that the failure life of the electronic migration under the interaction of high direct current density, thermal loads and mechanical loads is far smaller than that of the electric-thermal coupling migration without considering stress-migration
A Dual Role for Receptor-interacting Protein Kinase 2 (RIP2) Kinase Activity in Nucleotide-binding Oligomerization Domain 2 (NOD2)-dependent Autophagy*

Background: Autophagy is triggered by NOD2 as an anti-bacterial response. Results: NOD2-stimulated autophagy requires RIP2-dependent activation of p38 MAPK and repression of the PP2A phosphatase in intestinal epithelial cell lines. Conclusion: RIP2 kinase activity is necessary for anti-bacterial autophagy induction by NOD2. Significance: These findings provide novel molecular targets for modulation of autophagy as an anti-bacterial response. Autophagy is triggered by the intracellular bacterial sensor NOD2 (nucleotide-binding, oligomerization domain 2) as an anti-bacterial response. Defects in autophagy have been implicated in Crohn's disease susceptibility. The molecular mechanisms of activation and regulation of this process by NOD2 are not well understood, with recent studies reporting conflicting requirements for RIP2 (receptor-interacting protein kinase 2) in autophagy induction. We examined the requirement of NOD2 signaling mediated by RIP2 for anti-bacterial autophagy induction and clearance of Salmonella typhimurium in the intestinal epithelial cell line HCT116. Our data demonstrate that NOD2 stimulates autophagy in a process dependent on RIP2 tyrosine kinase activity. Autophagy induction requires the activity of the mitogen-activated protein kinases MEKK4 and p38 but is independent of NFκB signaling. Activation of autophagy was inhibited by a PP2A phosphatase complex, which interacts with both NOD2 and RIP2. PP2A phosphatase activity inhibited NOD2-dependent autophagy but not activation of NFκB or p38. Upon stimulation of NOD2, the phosphatase activity of the PP2A complex is inhibited through tyrosine phosphorylation of the catalytic subunit in a process dependent on RIP2 activity. These findings demonstrate that RIP2 tyrosine kinase activity is not only required for NOD2-dependent autophagy but plays a dual role in this process. RIP2 both sends a positive autophagy signal through activation of p38 MAPK and relieves repression of autophagy mediated by the phosphatase PP2A.
Evidence for an essential role for calcium in excitation-contraction coupling in skeletal muscle

The events and processes that link the electrical events which occur at the surface of a muscle fibre with the contractile process that takes place within the fibre, have been a continuing source of interest. Recently attention has been concentrated on the role played by calcium ions in linking these two events. As often happens in physiological investigations, the idea that calcium ions play an essential role in excitation-contraction coupling is not new. As long ago as 1883 Ringer demonstrated that the frog heart fails to contract and remains relaxed when calcium ions are absent from its perfusion fluid. Later it was shown that under this condition the rhythmic spontaneous action potentials of this preparation are still present in an only slightly modified form (Mines 1913). It was known at that time that the depolarization of the muscle fibre membrane is the electrical event responsible for initiating the mechanical response (Biedermann 1896) and although this point has been disputed from time to time, the evidence presently available makes it obvious that this is the case. One explanation of these observations is that the action potential or depolarization permits or promotes the movement of calcium ions from the surface to the interior of the muscle fibre and that these ions then initiate the mechanical response. A working hypothesis of this type was proposed by Sandow (1952). However, until fairly recently the only direct evidence supporting such an hypothesis was the demonstration by Heilbrunn & Wiercinski (1947) that calcium was the only physiologically occurring cation which would cause shortening when injected into bits of skeletal muscle fibres in low concentrations. This effect was later confirmed under more physiological conditions by Niedergerke (1955). Although there is considerable evidence of recent origin showing that calcium ions play an essential role in coupling in smooth and cardiac muscles, for the sake of brevity attention will be concentrated on skeletal muscle in the present discussion.
The ethnobotany ofFagraea Thunb. (Gentianaceae): The timber of malesia and the scent of polynesia

The genusFagraea comprises a diverse group of woody gentians that are renowned for having hard wood and fragrant, showy flowers. This diverse assemblage of approximately 70 species is distributed from Southeast Asia, Malesia, to the archipelagos of the Pacific Ocean.Fagraea species occupy important niches in forest ecosystems. These fast growing, pioneer species are an important component in natural succession after forest disturbance and provide food and shelter for many other forest species. The plants have played an important role in the lives of humans and have made their way into the legends of Polynesia.Fagraea plants are utilized by the Asian, Australian, Malesian, Melanesian, Micronesian, and Polynesian cultures for timber, weapons, crafts, medicine, and adornment. This paper is a comprehensive survey of the past and present uses of the species by these cultures and identifies the need for future scientific research onFagraea.
An Enquiry into the Main Determinants of Public Debt in Jordan: An Econometric Studyxxx

The high public debt in Jordan, along with its servicing burden, is clearly hindering the government's efforts to achieve higher and sustained economic growth rates. Both central government domestic debt (DD) and the outstanding balance of external public debt (ED) have increased dramatically during the period 1980-2005 in spite of the government debt management policies and privatization. The determinants of public debt should be analyzed in order to determine the key players in public debt accumulation. In this study, the chronic government budget deficit, the savings gap, the size of foreign aids, and the real exchange rate are examined for their role on debt accumulation. The results are in harmony with expectations. The government budget deficit, savings gap and real exchange rate significantly affect ED, but real exchange rate is the most effective. These factors, don’t only decrease the government's ability to repay the debt service of the outstanding balance of public debt but also create an additional demand for new domestic public loans. Motivating domestic savings and controlling the fiscal position may help to slow down debt accumulation and debt burden. Finally, stability of the value of the Jordanian Dinar is a must if the government intends to break the unplanned growth in public debt.
Surface flux and ocean heat transport convergence contributions to seasonal and interannual variations of ocean heat content

We present an observation-based heat budget analysis for seasonal and interannual variations of ocean heat content (H) in the mixed layer (Hmld) and full-depth ocean (Htot). Surface heat flux and ocean heat content estimates are combined using a novel Kalman smoother-based method. Regional contributions from ocean heat transport convergences are inferred as a residual and the dominant drivers of Hmld and Htot are quantified for seasonal and interannual time scales. We find that non-Ekman ocean heat transport processes dominate Hmld variations in the equatorial oceans and regions of strong ocean currents and substantial eddy activity. In these locations, surface temperature anomalies generated by ocean dynamics result in turbulent flux anomalies that drive the overlying atmosphere. In addition, we find large regions of the Atlantic and Pacific oceans where heat transports combine with local air-sea fluxes to generate mixed layer temperature anomalies. In all locations, except regions of deep convection and water mass transformation, interannual variations in Htot are dominated by the internal rearrangement of heat by ocean dynamics rather than the loss or addition of heat at the surface. Our analysis suggests that, even in extratropical latitudes, initialization of ocean dynamical processes could be an important source of skill for interannual predictability of Hmld and Htot. Furthermore, we expect variations in Htot (and thus thermosteric sea level) to be more predictable than near surface temperature anomalies due to the increased importance of ocean heat transport processes for full-depth heat budgets.
Long-term outcome after mesenteric artery reconstruction: a 37-year experience.

PURPOSE The purpose of this study was the definition of the late results and determining factors after mesenteric artery reconstruction (MAR) for atherosclerotic mesenteric ischemia. METHODS A retrospective review identified 48 consecutive patients (66 arteries) who underwent MAR for acute mesenteric ischemia (AMI) of nonembolic origin (n = 23; 12 with and 11 without prior symptoms) and chronic mesenteric ischemia (CMI; n = 25) from 1963 to 2000 in a tertiary care referral center. The 29 women (60%) and the 19 men (40%) had a mean age of 64 years (range, 40 to 87 years). The operative procedures consisted of bypass grafting in 36 arteries (AMI, 12; CMI, 24), local endarterectomy (LEA) in 16 arteries (AMI, 9; CMI 7), and transaortic endarterectomy (TAE) in 14 arteries (AMI, 4; CMI, 10). The follow-up of the 34 survivors was complete in all but four patients and averaged 5.3 years (range, 30 days to 36 years). Radiographic documentation of vessel/graft patency was obtained in 33 of 34 survivors. RESULTS Single-vessel revascularization was performed more frequently in the AMI group than in the CMI group (91% versus 48%; P =.001). The perioperative (<30 days) mortality rate in the AMI group was 52% (12 of 23 cases) as compared with 0 of 25 cases in the CMI group (P <.001). Bowel infarction was the cause of nine deaths. Major complications occurred in 60% of the cases. Fifteen late graft failures occurred, for a cumulative patency rate of 57% at 5 years and 46% at 10 years. TAE was associated with improved patency rates as compared with LEA (TAE versus LEA; P =.002). Symptomatic recurrences developed in eight patients, all involving superior mesenteric artery thrombosis (P <.001). The freedom-from-recurrence rates in the survivors were 79% at 5 years and 59% at 10 years. The late survival rates were 54% and 20% at 5 and 10 years, respectively. With the exclusion of perioperative deaths, the probability of long-term survival was 77% at 5 years and 29% at 10 years and did not differ between AMI and CMI. CONCLUSION Although MAR for CMI carries a low mortality rate, AMI remains a lethal and frequently unheralded problem. Long-term patency and symptom-free survival can be expected after successful MAR for AMI and is comparable with those rates achieved after MAR for CMI. The patency of the SMA is important in the prevention of symptomatic recurrences. Elective MAR is indicated in patients with CMI and warrants long-term surveillance.