Miracle-dz/UniFAR-FTUs huggingface dataset:
The Cost Effectiveness of Single-Level Instrumented Posterolateral Lumbar Fusion at 5 Years After Surgery

Study Design. Cost effectiveness analysis for single-level instrumented fusion during a 5-year postoperative interval. Objective. To determine the cost/quality-adjusted life year (QALY) gained for single-level instrumented posterolateral lumbar fusion for degenerative lumbar spine conditions during a 5-year period. Summary of Background Data. Cost/QALY has become a standard measure among healthcare economists because it is generic and can be used across medical treatments. Prior studies have reported widely variable estimates of cost/QALY for lumbar spine fusion. This variability may be related to factors including study design, sample population, baseline assumptions, and length of the observation period. Methods. To determine QALY, the Short Form 6D (SF-6D), a utility index derived from the Short Form (36) Health Survey (SF-36) was used. Cost analysis was performed based on actual reimbursements from third-party payors, including those for the index surgical procedure, treatment of complications, emergency room outpatient visits, and revision surgery. A second cost analysis using only the contemporaneous Medicare Fee schedule was also performed, in addition to a subanalysis including indirect costs from days off work. Results. The mean SF-6D health utility value showed a gradual increase throughout the follow-up period. The mean health utility value gained in each year postoperatively was 0.12, 0.14, 0.13, 0.15, and 0.15, for a cumulative 0.69 QALY improvement during the 5-year interval. Mean direct medical costs based on actual reimbursements for 5 years after surgery, including the index and revision procedures, was $22,708. The resultant cost per QALY gained at the 5-year postoperative interval was $33,018. The analogous mean direct cost based on Medicare reimbursement for 5 years was $20,669, with a resultant cost per QALY gained of $30,053. The mean total work productivity cost for 5 years was $14,377. The resultant total cost (direct and indirect) per QALY gained ranged from $53,949 to $53,914 at 5 years postoperatively. Conclusion. In the future, surgeons will need to demonstrate cost-effectiveness as well as clinical efficacy in order to justify payment for medical and surgical interventions, including lumbar spine fusion. This study indicates that at 5-year follow-up, single-level instrumented posterolateral spine fusion is both effective and durable, resulting in a favorable cost/QALY gain compared to other widely accepted healthcare interventions.
Early discharge after primary percutaneous coronary intervention for ST-elevation myocardial infarction

Background: To assess safety of early discharge following primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). Methods and results: Retrospective analysis of prospectively collected data of 2448 STEMI patients treated with PPCI surviving to hospital discharge. Post-discharge all-cause mortality was reported at 1, 7, and 30 days and long-term follow up. A total of 1542 patients (63.0%) were discharged within 2 days of admission (early discharge group) and 906 patients (37.0%) after 2 days (late discharge group). In both groups, no deaths were recorded 1 day post discharge. The early and late discharge group mortality figures for 7 days were 0 and 4 patients (0.04%) and between 7 and 30 days were 11 (0.7%) and 11 patients (1.2%), respectively. During a mean follow up of 584 days, 178 patients (7.3%) died: 67 in the early discharge group (4.3%) and 111 in the late discharge group (12.3%). Conclusions: This exploratory, observational study demonstrates that discharging low-risk STEMI patients within 2 days following PPCI is safe. For providers of health care, early discharge can help to allay the cost of providing a 24-hour PPCI service and adds to the recognized benefits arising from PPCI.
Catel-Manzke digitopalatal syndrome or Temtamy preaxial brachydactyly hyperphalangism syndrome?

Clarkson et al. (2004) reported a female infant whom they thought had Catel–Manzke syndrome with previously unreported features, mainly hyperphalangism at the bases of the proximal phalanges of the index, middle, ring and little fingers bilaterally and bony abnormalities in both feet. Their proband was the first child of healthy first cousin parents from Pakistan. She was reported to have had normal developmental milestones. Sensorineural hearing loss was noted on follow up.
Cardiac complications and diabetes in thalassaemia major: a large historical multicentre study

The relationship between diabetes mellitus (DM) and cardiac complications has never been systematically studied in thalassaemia major (TM). We evaluated a large retrospective historical cohort of TM to determine whether DM is associated with a higher risk of heart complications. We compared 86 TM patients affected by DM with 709 TM patients without DM consecutively included in the Myocardial Iron Overload in Thalassaemia database where clinical/instrumental data are recorded from birth to the first cardiovascular magnetic resonance (CMR) exam. All of the cardiac events considered were developed after the DM diagnosis. In DM patients versus non‐DM patients we found a significantly higher frequency of cardiac complications (46·5% vs. 16·9%, P < 0·0001), heart failure (HF) (30·2% vs. 11·7%, P < 0·0001), hyperkinetic arrhythmias (18·6% vs. 5·5%, P < 0·0001) and myocardial fibrosis assessed by late gadolinium enhancement (29·9% vs. 18·4%, P = 0·008). TM patients with DM had a significantly higher risk of cardiac complications [odds ratio (OR) 2·84, P < 0·0001], HF (OR 2·32, P = 0·003), hyperkinetic arrhythmias (OR 2·21, P = 0·023) and myocardial fibrosis (OR 1·91, P = 0·021), also adjusting for the absence of myocardial iron overload assessed by T2* CMR and for the covariates (age and/or endocrine co‐morbidity). In conclusion, DM significantly increases the risk for cardiac complications, HF, hyperkinetic arrhythmias and myocardial fibrosis in TM patients.
Cell-Type-Specific Cytokinin Distribution within the Arabidopsis Primary Root Apex[OPEN]

A cytokinin gradient was detected within the Arabidopsis root tip, with a concentration maximum in the lateral root cap, columella, columella initials, and quiescent center cells. Cytokinins (CKs) play a crucial role in many physiological and developmental processes at the levels of individual plant components (cells, tissues, and organs) and by coordinating activities across these parts. High-resolution measurements of intracellular CKs in different plant tissues can therefore provide insights into their metabolism and mode of action. Here, we applied fluorescence-activated cell sorting of green fluorescent protein (GFP)-marked cell types, combined with solid-phase microextraction and an ultra-high-sensitivity mass spectrometry (MS) method for analysis of CK biosynthesis and homeostasis at cellular resolution. This method was validated by series of control experiments, establishing that protoplast isolation and cell sorting procedures did not greatly alter endogenous CK levels. The MS-based method facilitated the quantification of all the well known CK isoprenoid metabolites in four different transgenic Arabidopsis thaliana lines expressing GFP in specific cell populations within the primary root apex. Our results revealed the presence of a CK gradient within the Arabidopsis root tip, with a concentration maximum in the lateral root cap, columella, columella initials, and quiescent center cells. This distribution, when compared with previously published auxin gradients, implies that the well known antagonistic interactions between the two hormone groups are cell type specific.
Closing the Gap: Eternal Domination on 3 x n Grids

The domination number for grid graphs has been a long studied problem; the first results appeared over thirty years ago [Jacobson 1984] and the final results appeared in 2013 [Goncalves 2013]. Grid graphs are a natural class of graphs to consider for the eternal dominating set problem as the domination number forms a lower bound for the eternal domination number. The 3 x n grid has been considered in several papers, and the difference between the upper and lower bounds for the eternal domination number in the all-guards move model has been reduced to a linear function of n. In this short paper, we provide an upper bound for the eternal domination number which exceeds the lower bound by at most 3.
Measurement of Symptom Withdrawal Severity in a 24-Hour Period After the Anesthesia-Assisted Rapid Opiate Detoxification Procedure

This study examined the Anesthesia-Assisted Rapid Detoxification (AAROD) procedure and the measurement of withdrawal symptom severity within a 24-hour period. The Clinical Opiate Withdrawal Scale (COWS) was utilized at various time intervals, post detoxification. This study demonstrated that all of the patients who underwent the AAROD procedure had withdrawal symptoms post detoxification in the mild range of severity, unlike like traditional detoxification procedures. Further studies are needed to measure withdrawal symptoms longer than one-day post detoxification and to compare the differences between various detoxification protocols.
Control of oscillations in PFC power supplies by Time Delay Feedback

In this paper, Time Delay Feedback Control (TDFC) is applied to stabilize a two-stage Power factor converter when it exhibits instabilities at the line period under traditional controllers. The TDFC introduces many advantages to the most and widely used Average Current Mode (ACM) control through widening the stability domain of the PFC converter. A Harmonic Balance (HB) approach is used for studying the dynamics of the system under the new scheme of control and to obtain the stabilization domain. By appropriately selecting the time delay feedback gain and the time delay period, the system can be stabilized.
Limits to Impedance Relaying

The paper reviews the role of impedance relaying in modern transmission line protection systems. The speed and reach of the first zone of an impedance relay are identified as being the most important attributes of a relay. The paper develops a mathematical model of the relaying process in the presence of transient phenomena which accompany faults. It is shown that there is an uncertainty associated with the impedance estimated by a relay and this uncertainty depends upon the speed with which these estimates are made. A quantitative relationship between the relay speed and its reach is obtained.
The Rise and Fall of Consumption in the '00s

The major portion of U.S. gross domestic product (GDP) is accounted for by consumer spending, which significantly affects the business cycle. Consumer demand has been extremely volatile since 2000, especially given the booms and busts in housing values and in subprime mortgage lending. While it is well-established that housing net worth, credit availability, and household debt levels help to explain changes in consumer spending, the roles played by other potential determinants of consumption are not well identified or understood. This paper uses county-level data and a multiple-regression framework to explore how fluctuations in consumption between 2000 and 2012 are correlated with these macroeconomic variables: income, unemployment, debt, income inequality, consumer expectations, housing wealth, credit access, cash-out refinancings, and foreclosures. Four subperiods are considered: the "dot-com" recession (2001-2003), the "subprime boom" (2004-2006), the Great Recession (2007-2009), and the "tepid recovery" (2010-2012).
Fee-Scheduleincreasesincanada: Implication for Service Volumes among Family and Specialist Physicians

Physician spending has substantially increased over the last few years in Canada to reach $27.4 billion in 2010. Total clinical payment to physicians has grown at an average annual rate of 7.6% from 2004 to 2010. The key policy question is whether or not this additional money has bought more physician services. So, the purpose of this study is to understand if we are paying more for the same amount of medical services in Canada or we are getting more bangs for our buck. At the same time, the paper attempts to find out whether or not there is a productivity difference between family physician services and surgical procedures. Using the Baumol theory and data from the National Physician Database for the period 2004–2010, the paper breaks down growth in physician remuneration into growth in unit cost and number of services, both from the physician and the payer perspectives. After removing general inflation and population growth from the 7.6% growth in total clinical payment, we found that real payment per service and volume of services per capita grew at an average annual rate of 3.2% and 1.4% respectively, suggesting that payment per service was the main cost driver of physician remuneration at the national level. Taking the payer perspective, it was found that, for the fee-for-service (FFS) scheme, volume of services per physician decreased at an average annual rate of -0.6%, which is a crude indicator that labour productivity of physicians on FFS has fallen during the period. However, the situation differs for the surgical procedures. Results also vary by province. Overall, our finding is consistent with the Baumol theory, which hypothesizes higher productivity growth in technology-driven sectors.
The role of wild grasses in subsistence and sedentism: new evidence from the northern Fertile Crescent

Abstract Sedentism is usually regarded as a pre-condition for the development of crop husbandry in Southwest Asia and, consequently, sedentary pre-agrarian sites are an important focus of research on the origins of agriculture. It is often assumed that wild grasses were as important for hunter-gatherers as domesticated cereals were for early farmers, and that wild grass exploitation may therefore have had a critical role in enabling sedentism. Results from the analysis of archaeobotanical assemblages from Hallan Çemi, Demirköy, Qermez Dere and M'lefaat, and comparison with those of other sedentary pre-agrarian sites in Southwest Asia, challenge the role often attributed to the exploitation of grasses at this time. Archaeobotanical and ethnographical evidence instead suggests that hunter-gatherers took an opportunistic approach to the resources available and their subsistence strategies were not necessarily centred on grasses and ‘wild cereals’.
Coronary risk and dyslipidemia in type 2 diabetic patients.

OBJECTIVES A prospective study was carried out to find out the percentage of dyslipidemia in type 2 diabetics, to study the pattern of dyslipidemia, categorize the levels of LDL, HDL and triglycerides into higher, borderline and lower risk of developing coronary heart disease in type 2 diabetics and to compare the lipid profile with non-diabetics. MATERIAL AND METHODS Five hundred patients of type 2 diabetes mellitus and 150 age, sex and BMI matched non-diabetic healthy individuals were studied. The labelling of dyslipidemia and the categorization of risk for developing coronary heart disease (CHD) was done according to the guidelines of American Diabetes Association (ADA, 1998). RESULTS Dyslpidemia was present in 89% of diabetic patients with LDL hyperlipoproteinemia (LDL > 100 mg%) in 76%, HDL dyslipidemia (HDL < 35 mg%) in 58%, hypertriglyceridemia (TG > 200 mg%) in 22% patients. On analysing CHD risk based on lipid profile, it was revealed that in LDL moiety 48% fell in higher risk of CHD (LDL > 130 mg%), 28% in borderline risk (LDL 100-130 mg%) and 24% (LDL < 100 mg%) in lower risk. For HDL 18.5% fell in higher risk (HDL < 35 mg%) and TG only 0.5% fell in higher risk (TG > 400 mg%). The lipid profile was significantly altered in diabetic patients as compared to non diabetics. CONCLUSIONS The major concern which our study highlights is the high percentage of LDL dyslipidemia majority of whom fell in higher risk of developing CHD. Triglyceride and HDL levels were of lesser significance when newer ADA (1998) criteria for dyslipidemia were applied.
Combined Use of Cultivation-Dependent and Cultivation-Independent Methods Indicates that Members of Most Haloarchaeal Groups in an Australian Crystallizer Pond Are Cultivable

ABSTRACT Haloarchaea are the dominant microbial flora in hypersaline waters with near-saturating salt levels. The haloarchaeal diversity of an Australian saltern crystallizer pond was examined by use of a library of PCR-amplified 16S rRNA genes and by cultivation. High viable counts (106 CFU/ml) were obtained on solid media. Long incubation times (≥8 weeks) appeared to be more important than the medium composition for maximizing viable counts and diversity. Of 66 isolates examined, all belonged to the family Halobacteriaceae, including members related to species of the genera Haloferax, Halorubrum, and Natronomonas. In addition, isolates belonging to a novel group (the ADL group), previously detected only as 16S rRNA genes in an Antarctic hypersaline lake (Deep Lake), were cultivated for the first time. The 16S rRNA gene library identified the following five main groups: Halorubrum groups 1 and 2 (49%), the SHOW (square haloarchaea of Walsby) group (33%), the ADL group (16%), and the Natronomonas group (2%). There were two significant differences between the organisms detected in cultivation and 16S rRNA sequence results. Firstly, Haloferax spp. were frequently isolated on plates (15% of all isolates) but were not detected in the 16S rRNA sequences. Control experiments indicated that a bias against Haloferax sequences in the generation of the 16S rRNA gene library was unlikely, suggesting that Haloferax spp. readily form colonies, even though they were not a dominant group. Secondly, while the 16S rRNA gene library identified the SHOW group as a major component of the microbial community, no isolates of this group were obtained. This inability to culture members of the SHOW group remains an outstanding problem in studying the ecology of hypersaline environments.
Regulation of Fibronectin EDA Exon Alternative Splicing: Possible Role of RNA Secondary Structure for Enhancer Display

ABSTRACT The fibronectin primary transcript undergoes alternative splicing in three noncoordinated sites: the cassette-type EDA and EDB exons and the more complex IIICS region. We have shown previously that an 81-nucleotide region within the EDA exon is necessary for exon recognition and that this region contains at least two splicing-regulatory elements: a polypurinic enhancer (exonic splicing enhancer [ESE]) and a nearby silencer element (exonic splicing silencer [ESS]). Here, we have analyzed the function of both elements in different cell types. We have mapped the ESS to the nucleotide level, showing that a single base change is sufficient to abolish its function. Testing of the ESE and ESS elements in heterologous exons, individually or as part of the complete EDA regulatory region, showed that only the ESE element is active in different contexts. Functional studies coupled to secondary-structure enzymatic analysis of the EDA exon sequence variants suggest that the role of the ESS element may be exclusively to ensure the proper RNA conformation and raise the possibility that the display of the ESE element in a loop position may represent a significant feature of the exon splicing-regulatory region.
Effect of tamoxifen on GH and IGF-1 serum level in stage I-II breast cancer patients.

OBJECTIVE Tamoxifen suppresses insulin-like growth factor-1 (IGF-1) plasma levels in early and advanced breast cancer patients. Relationships between tamoxifen (GH) and IGF-1 are complex and not completely described yet. The present investigation was performed to evaluate the effect of acute and chronic tamoxifen administration on GH response to growth hormone-releasing hormone (GHRH), as well as on IGF-1 serum levels. MATERIALS AND METHODS Evaluation of GH after administration of GHRH was performed (a) at baseline, (b) 3 hours after 20 mg oral administration of tamoxifen and (c) after 12 weeks of 20 mg a day oral tamoxifen treatment, in fifteen postmenopausal stage I-II breast cancer patients. IGF-I was measured at baseline and after chronic tamoxifen administration. RESULTS The GH response to GHRH was significantly reduced after 12 weeks of tamoxifen 10 mg administered twice a day orally (mean peak 3.2 +/- 0.2 micrograms/l, mean AUC 261.3 +/- 18.2 micrograms/minute p < 0.01 versus basal AUC). A concomitant significant reduction of IGF-1 was observed after 3 months of tamoxifen treatment. Basal pretreatment levels of 113.2 +/- 15.5 micrograms/l were suppressed to 70 +/- 7.9 micrograms/l (p < 0.01). CONCLUSION Our study confirm the inhibitory effect of tamoxifen on IGF-I and suggested, as shown in previous in vitro data, that its suppression could be directly related to GH reduction in response to GHRH stimulation.
Metastatic breast cancer with HER2/neu-positive cells tends to have a morbid prognosis.

BACKGROUND Clinically, human epidermal growth factor receptor 2 (HER2) overexpression is associated with a faster rate of tumor growth and an increased rate of metastasis, and a patient who is HER2 strongly positive tends to have a poor prognosis and a decreased disease-free survival and overall survival (OS) time. METHODS We analyzed data on 526 Japanese adult women with breast cancer with respect to the relationship between the status of HER2/neu receptor expression and the recurrent state and survival from detection of the first recurrence. All these women were treated from 1982 to 2000 in the Department of Surgery, National Beppu Hospital, Kyushu, Japan. In 95 patients with metastatic breast cancer after curative resection, the expression of HER2/neu status was examined by using immunohistochemical staining methods (HercepTest). Scores of 0, 1+, 2+, and 3+ were given according to the HercepTest data. Only scores of 2+ and 3+ were assessed as an overexpression of HER2/neu protein and HER2-positive patients. Between the HER2-positive and HER2-negative patients, the survival after surgical intervention, the disease-free survival time, and the survival time after the initial recurrence were compared. RESULTS An overexpression of HER2/neu receptor protein occurred at a rate of 23.7% (23/97) in the 97 women with metastatic breast cancer. There was no difference in age, tumor size, TN staging system, and the number of lymph node metastases between HER2-positive and HER2-negative patients. Almost all HER2-positive patients had a negative estrogen receptor status (14/15 [93.3%]). The initial sites of recurrence were classified as (1) soft tissue, bone, and viscera or (2) soft tissue, bone, lung-pleura, liver, and brain. For the HER2-positive patient, viscera, especially the liver and lung, were predominant initial sites of recurrence. Survival rates, OS, disease-free survival time, and time after first recurrence were all analyzed. Although there was no difference in disease-free survival time, there were significant differences between the HER2-positive and HER2-negative groups in OS and the time after initial recurrence. CONCLUSIONS Metastatic breast cancer with overexpression of HER2/neu tends toward a poor prognosis, especially after the first recurrence. For such patients with metastatic breast cancer, a high-dose anthracycline-containing regimen might be needed.