Miracle-dz/UniFAR-FTUs huggingface dataset:
Gastrointestinal fistulas associated with large abdominal wall defects: Experience with 43 patients

Experience with 43 patients with gastrointestinal fistulas associated with a large abdominal wall defect is presented. The overall mortality rate was 60per cent; 37per cent in patients who underwent the primary procedure in the home unit and 74 per cent in those from elsewhere. An average of five operations per patient was performed. The abdominal wall defect developed spontaneously as a consequence of postoperative peritonitis in 24 patients (mortality rate, 71 per cent) and was created intentionally as apart of the ‘open management’ in 19 cases (mortality rate, 47per cent). Errors in management were identified in 63per cent of the patients and this adversely influenced the outcome. Patients with this condition should be referred early to tertiary care facilities where diversion of the intestinal leak away from the defect, prompt control of the associated intra‐abdominal infection and adequate handling of the defect itself can be performed.
The Cost of Screening Esophageal Varices: Traditional Endoscopy Versus Computed Tomography

Objective Under current guidelines, patients diagnosed with cirrhosis are to undergo initial and continued screening endoscopy for esophageal varices throughout the course of disease. Recent literature suggests that computed tomography (CT) of the abdomen is adequately sensitive for detecting grade 3 varices, those in need of immediate intervention. This study presents a cost comparison of traditional endoscopy versus CT of the abdomen. Methods Using TreeAge Pro software, a budget impact cost model was created for a hypothetical managed care organization covering 1 million lives over a 10-year period. Incidence figures for cirrhosis and the progression of esophageal varices were applied to the patient population. National Medicare reimbursement costs were used to compare screening with traditional endoscopy versus CT. Costs utilizing screening with combined endoscopy and CT were also examined. Results The results of comparing screening paradigms under a budget impact cost model results in an outcome measure termed “per-member, per-month” (PMPM) cost of implementing a new strategy. Computed tomography was the least expensive modality with an average 10-year cost per screened patient of $1097.30 and PMPM of $0.03. Endoscopy was the most expensive modality with an average 10-year cost per screened patient of $1464.89 and PMPM of $0.04. Conclusion Computed tomography has been shown to be sensitive in detecting esophageal varices and now less costly to implement in screening. The cost of esophageal rupture in endoscopy and the less costly risk of contrast reaction as well as radiation exposure in CT of the abdomen should be considered when developing a screening paradigm.
Robust beat detector for ambulatory cardiac monitoring

Robust beat detection under noisy conditions is required in order to obtain a correct clinical interpretation of the ECG in ambulatory settings. This paper describes the evaluation and optimization of a beat detection algorithm that is robust against high levels of noise. An evaluation protocol is defined in order to study four different characteristics of the algorithm: non-rhythmic patterns, different levels of SNR, exact peak detection and different levels of physical activity. This protocol is based on the MIT/BIH arrhythmia database and additional ECG recordings obtained under different levels of physical activity measured by 2-axis accelerometers. The optimized algorithm obtained a Se=99.65% and +P=99.79% on the MIT/BIH arrhythmia database while keeping a good performance on ECGs with high levels of activity (overall of Se=99.86%, +P=99.91%). In addition, this method was optimized to work in real time, for future implementation in a Wireless ECG sensor based on a microprocessor.
Loss-of-function EA2 mutations are associated with impaired neuromuscular transmission

Objective: To examine the functional consequences of episodic ataxia type 2 (EA2)-causing nonsense and missense mutations in vitro and to characterize the basis of fluctuating weakness in patients with E2A. Background: Mutations in CACNA1A encoding the Cav2.1 calcium channel subunit cause EA2 through incompletely understood mechanisms. Although the Cav2.1 subunit is important for neurotransmission at the neuromuscular junction, weakness has not been considered a feature of EA2. Methods: The disease-causing mutations in three unrelated patients with EA2 and fluctuating weakness were identified by mutation screening and sequencing. Mutant constructs harboring mutations R1281X, F1406C, R1549X were transfected into COS7 cells and expressed for patch clamp studies. Single-fiber electromyography (SFEMG) was performed in patients to examine synaptic transmission at the neuromuscular junction. Results: Functional studies in COS7 cells of nonsense and missense EA2 mutants demonstrated markedly decreased current densities compared with wild type. SFEMG demonstrated jitter and blocking in these patients with EA2, compared with normal subjects and three patients with SCA-6. Conclusion: EA2-causing missense and nonsense mutations in CACNA1A produced mutant channels with diminished whole cell calcium channel activity in vitro due to loss of function. Altered biophysical properties or reduced efficiency of plasma membrane targeting of mutant channels may contribute to abnormal neuromuscular transmission, manifesting as myasthenic syndrome.
A Multi-Case Study Examining Reflection within Collaborative Teacher Inquiry

Collaborative teacher inquiry is a learning process that is often conceptualized as involving teacher teams in the investigation of their own practice. I drew from constructivist (Dewey, 1910), situated (Lave & Wegner, 1991), and transformative learning (Mezirow, 1991) theories to conduct a qualitative multi-case study that examined teacher teams across two school districts implementing a collaborative inquiry process as a means for promoting teacher learning. Specifically, this research examined whether and how enactment of collaborative inquiry and teacher conversational routines influenced reflection, while also investigating the teacher learning experiences and outcomes generated. During the course of the study, teacher teams did not engage in critical reflection, the highest level of reflection within the scope of collaborative inquiry. Certain factors related to the enactment of collaborative inquiry were found to promote or limit reflective dialogue more generally. Factors found to promote reflection included the visual representation of data across classrooms for comparison of instructional practices, the investigation of an instructional problem focused on teacher strategy, joint lesson planning, and the use of revising questions during team discussions. The utilization of protocols that guided teachers to consider past practices promoted pedagogical reflection, but was insufficient for cultivating critical reflection. Whether or how teams utilized student learning data was found to influence reflection. Reflection was limited when student learning data was not utilized or when teams used data for planning without consideration of past practice. Additionally, reflection was limited when teachers normalized a problem of practice without asking revising questions. Overall, the highest level of reflection observed within collaborative teacher inquiry was pedagogical reflection and teams that engaged in pedagogical reflection were more likely to experience transformative learning related to content and pedagogy which subsequently led to changes to instructional practices. Teacher learning and opportunities to make changes to practice were undermined when teacher reflection was limited to technical or non-reflective levels. Findings from this study suggest that the framing of collaborative inquiry and the enactment of components within the process, as well as teachers’ conversational routines, are of consequence to reflection, teacher learning, and instructional outcomes.
Synthetic Glucocorticoid Dexamethasone Inhibits Branching Morphogenesis in the Spiny Mouse Placenta1

ABSTRACT High levels of maternal glucocorticoids during pregnancy can alter the developmental trajectory of some fetal organs. These perturbations are often more profound for the male fetus and have been attributed to passage of glucocorticoids through the placenta. However, the effect of excess glucocorticoids on the placenta itself is less well understood and, particularly, whether this is affected by fetal sex. Expression of genes involved in placental patterning, apoptosis, and nutrient transfer, along with their response to maternal administration of dexamethasone (DEX), has previously been shown to be dependent on fetal sex in the spiny mouse. Here we describe the placental spatiotemporal expression of genes important for branching morphogenesis (WNT4, BMP4, GREM1, TGFB1, KDR, VEGFA). Furthermore, we report that compared to TGFB1 expression in the female labyrinth, expression of TGFB1 in the male labyrinth was higher, and earlier peaks in expression levels of VEGFA (Day 19 placenta [male] vs. Day 37 labyrinth [female]) and KDR (Day 19 placenta [male] vs. Day 20 labyrinth [female]) were observed. Administration of DEX to pregnant dams for 60 h commencing at mid-gestation caused significantly different, sex-related changes in expression of genes that were constitutively different before DEX treatment (e.g., KDR, TGFB1) and those that were not (i.e., VEGFA, WNT4). Similarly, some genes which displayed similar expression profiles across gestation for both sexes also showed similar responses to DEX (e.g., BMP4), while others did not (i.e., GREM1). These results showed that constitutive and glucocorticoid-induced changes in expression of genes involved in branching morphogenesis may be influenced by fetal/placental sex and that fundamental differences exist between a male and female placenta.
Exercise, smoking, and calcium intake during adolescence and early adulthood as determinants of peak bone mass

Objective: To evaluate the contribution to peak bone mass of exercise, smoking, and calcium intake in adolescents and young adults. Design: Prospective cohort study with end point measurement (bone mineral density) after 11 years'20follow up for lifestyle. Setting: Five university hospital clinics. Subjects: 264 (153 females, 111 males) subjects aged 9 to 18 years at the beginning of the follow up20and 20 to 29 years at the time of measurement of bone mineral density. Main outcome measure: Bone mineral density of lumbar spine and femoral neck by dual energy x ray absorptiometry; measures of physical activity and20smoking and estimates of calcium intake repeated three times during follow up. Results: In the groups with the lowest and highest20levels of exercise the femoral bone mineral densities (adjusted for age and weight) were 0.918 and 0.988 g/cm2 for women (P=0.015), analysis of covariance) and 0.943 and 1.042 g/cm2 for men (P=0.005), respectively; at the lumbar spine the respective20values were 1.045 and 1.131 (P=0.005) for men. In men the femoral bone mineral densities (adjusted for age, weight, and exercise) were 1.022 and 0.923 g/cm2 for the groups with the lowest and highest values of smoking index (P=0.054, analysis of covariance). In women the adjusted femoral bone mineral density increased by 4.7% together with increasing calcium intake (P=0.089, analysis of covariance). In multiple regression analysis on bone mineral density of the femoral neck, weight, exercise, age, and smoking were independent predictors for men; with weight, exercise, and age for women. These predictors together explained 38% of the variance in bone mineral density in women and 46% in men. At the lumbar spine, weight, smoking, and exercise were predictors for men; and only weight for women. Conclusions: Regular exercise and not smoking is important in achieving maximal peak bone mass in adolescents and young adults.
Optimal No-Regret Learning in General Games: Bounded Regret with Unbounded Step-Sizes via Clairvoyant MWU

In this paper we solve the problem of no-regret learning in general games. Speciﬁcally, we provide a simple and practical algorithm that achieves constant regret with ﬁxed step-sizes. The cumulative regret of our algorithm provably decreases linearly as the step-size increases. Our ﬁndings depart from the prevailing paradigm that vanishing step-sizes are a prerequisite for low regret as championed by all state-of-the-art methods to date [8, 29, 33, 9, 10, 1, 11]. We shift away from this paradigm by deﬁning a novel algorithm that we call Clairvoyant Multiplicative Weights Updates (CMWU). CMWU is Multiplicative Weights Updates (MWU) equipped with a mental model (jointly shared across all agents) about the state of the system in its next period. Each agent records its mixed strategy, i.e., its belief about what it expects to play in the next period, in this shared mental model which is internally updated using MWU without any changes to the real-world behavior up until it equilibrates, thus marking its consistency with the next day’s real-world outcome. It is then and only then that agents take action in the real-world, eﬀectively doing so with the “full knowledge” of the state of the system on the next day, i.e., they are clairvoyant . CMWU eﬀectively acts as MWU with one day look-ahead, achieving bounded regret. At a technical level, we establish that self-consistent mental models exist for any choice of step-sizes and provide bounds on the step-size under which their uniqueness and linear-time computation are guaranteed via contraction mapping arguments. Our arguments extend well beyond normal-form games with little eﬀort.
Television time and continuous metabolic risk in physically active adults.

PURPOSE Among Australian adults who met the public health guideline for the minimum health-enhancing levels of physical activity, we examined the dose-response associations of television-viewing time with continuous metabolic risk variables. METHODS Data were analyzed on 2031 men and 2033 women aged > or = 25 yr from the 1999-2000 Australian Diabetes, Obesity and Lifestyle study without clinically diagnosed diabetes or heart disease, who reported at least 2.5 h.wk of moderate- to vigorous-intensity physical activity. Waist circumference, resting blood pressure, and fasting and 2-h plasma glucose, triglycerides, and high-density-lipoprotein cholesterol (HDL-C) were measured. The cross-sectional associations of these metabolic variables with quartiles and hours per day of self-reported television-viewing time were examined separately for men and for women. Analyses were adjusted for age, education, income, smoking, diet quality, alcohol intake, parental history of diabetes, and total physical activity time, as well as menopausal status and current use of postmenopausal hormones for women. RESULTS Significant, detrimental dose-response associations of television-viewing time were observed with waist circumference, systolic blood pressure, and 2-h plasma glucose in men and women, and with fasting plasma glucose, triglycerides, and HDL-C in women. The associations were stronger in women than in men, with significant gender interactions observed for triglycerides and HDL-C. Though waist circumference attenuated the associations, they remained statistically significant for 2-h plasma glucose in men and women, and for triglycerides and HDL-C in women. CONCLUSIONS In a population of healthy Australian adults who met the public health guideline for physical activity, television-viewing time was positively associated with a number of metabolic risk variables. These findings support the case for a concurrent sedentary behavior and health guideline for adults, which is in addition to the public health guideline on physical activity.
Breast carcinoma in young women aged 30 or less in Northern Pakistan - the Armed Forces Institute of Pathology experience.

OBJECTIVE The study was carried out to document the occurrence of early onset breast cancer in our population and to assess prognostic variables. METHODS Records of a total of 1,644 female patients diagnosed with breast carcinoma during the last four years (Jan 2005 - Dec 2008) at the Histopathology Department, Armed Forces Institute of Pathology (AFIP) were retrieved from the AFIP tumour registry. All cases of breast carcinoma diagnosed in young females, 30 years of age or less, were selected and assessed for the type of specimen, tumour type, size and grade, presence or absence of lymph node metastasis, number of lymph nodes recovered and number of lymph nodes involved. Data were entered into SPSS version 11 to calculate mean, median, mode and standard deviation for quantitative variables and frequencies and percentages for qualitative variables. RESULTS The mean age was 28+/-2.7 years and the mean tumour size was 3.7+/-2.9 cm. Most frequent age group was 26-30 years (78.6%). The most common histological tumour type was invasive ductal carcinoma (88.7%), followed by invasive lobular carcinoma (5.4%). Seven out of 168 (4.2%) tumours were less than 2 cm in size, 69(41.1%) were between 2-5 cm and 39 (23.2%) were greater than 5 cm. Grade 2 (57.1%), followed by grade 3 (29.8%) were the most frequent. Out of 68 cases in which lymph nodes were included, lymph node metastasis was seen in 55(80.8%). CONCLUSION Breast cancer is much commoner in young women in Pakistan as compared to the rest of the world. It is important to keep this in mind when evaluating even very young females with breast lumps.
Prevention of Basement Membrane Thickening in Retinal Capillaries by a Novel Inhibitor of Aldose Reductase, Tolrestat

A diabetic-like thickening of retinal capillary basement membranes induced in rats fed for 207 consecutive days a diet containing 50% galactose was prevented by the addition to the diet of tolrestat, a potent, structurally novel inhibitor of aldose reductase. Analysis of electron micrographs (× 25,000) of capillaries from the outer plexiform layer of the retina by computer planimetry showed that the basement membranes were approximately twofold thicker in rats fed galactose than in those fed either a standard diet or a diet containing galactose and tolrestat in doses of 43 or 57 mg/kg/day. The thickening of basement membranes in galactosefed rats was accompanied by other ultrastructural alterations mimicking changes typical of diabetic microangiopathy, such as multilamination and the formation of vacuoles and dense inclusions. Therefore, the galactosemic rat represents a useful model for studying basement membrane-related complications of diabetes and their possible prevention by aldose reductase inhibitors.
Measuring Informal Housing Production in California Cities

Problem, research strategy, and findings: Planning scholars and practitioners once assumed informal housing was largely absent in the developed world; today they increasingly acknowledge its role in the United States. Recent evidence suggests that informal housing, or non-permitted construction, is a significant phenomenon inside incorporated cities, despite widespread regulations and code enforcement. Informal housing is a de facto source of otherwise scarce affordable housing in many locations, but also compromises health and safety and strains municipal infrastructure and fiscal health. Planners lack a means of measuring informal construction at the scale of individual cities. We propose such a method, and apply it to incorporated cities in California. Data limitations prevent us from precisely estimating the magnitude of non-permitted construction, but our findings suggest that informal channels are an important source of housing production, especially in the places where permitted construction is constrained. Takeaway for practice: We urge planners to engage with informal housing issues, given the considerable importance of this hidden yet vital portion of the housing market as a means of providing living spaces amid tight housing market conditions. Our method for calculating the rate of informal housing addition is a useful tool for planners to gather basic facts about the informal housing market in their communities, a prerequisite for policy interventions.
Strengthening SMEs’ innovation culture through collaborations with public research organizations. Do all firms benefit equally?

ABSTRACT The purpose of this paper is to explore whether collaborating with public research organizations (PROs) contributes to strengthening the innovation culture of small and medium sized enterprises (SMEs). We examine to what extent their innovation culture is reinforced by collaborations with research organizations and investigate the type of organizational strategies that enhance this effect of collaboration. The empirical study is based on a survey of firms that collaborate with the largest Spanish PRO, Spanish National Research Council (CSIC). Our results indicate that SMEs differ greatly in their capacity to strengthen their innovation culture through collaboration with research organizations. We show also that firms with formal innovation plans that develop internal and external search strategies are more likely to improve their innovation culture as a result of collaboration with PROs. These findings provide managers with new insights into how to strengthen their firms’ innovation culture through collaboration with research organizations.
Saccharomyces cerevisiae Msh2p and Msh6p ATPase Activities Are Both Required during Mismatch Repair

ABSTRACT In the Saccharomyces cerevisiae Msh2p-Msh6p complex, mutations that were predicted to disrupt ATP binding, ATP hydrolysis, or both activities in each subunit were created. Mutations in either subunit resulted in a mismatch repair defect, and overexpression of either mutant subunit in a wild-type strain resulted in a dominant negative phenotype. Msh2p-Msh6p complexes bearing one or both mutant subunits were analyzed for binding to DNA containing base pair mismatches. None of the mutant complexes displayed a significant defect in mismatch binding; however, unlike wild-type protein, all mutant combinations continued to display mismatch binding specificity in the presence of ATP and did not display ATP-dependent conformational changes as measured by limited trypsin protease digestion. Both wild-type complex and complexes defective in the Msh2p ATPase displayed ATPase activities that were modulated by mismatch and homoduplex DNA substrates. Complexes defective in the Msh6p ATPase, however, displayed weak ATPase activities that were unaffected by the presence of DNA substrate. The results from these studies suggest that the Msh2p and Msh6p subunits of the Msh2p-Msh6p complex play important and coordinated roles in postmismatch recognition steps that involve ATP hydrolysis. Furthermore, our data support a model whereby Msh6p uses its ATP binding or hydrolysis activity to coordinate mismatch binding with additional mismatch repair components.