Miracle-dz/UniFAR-FTUs huggingface dataset:
Influence of personal preferences for life-sustaining treatment on medical decision making among pediatric intensivists*

Objectives: Withholding and withdrawal of life-sustaining treatment by physicians is influenced by a variety of factors; the role of physicians’ personal preferences for life-sustaining treatments has not previously been explored. We sought to examine the relationship between personal preferences for life-sustaining treatment and medical decision making among pediatric intensivists. Design: Cross-sectional national anonymous mail survey. Subjects: All board-certified/eligible pediatric intensivists identified by the American Medical Association Masterfile. Interventions: None. Measurements and Main Results: A total of 471 (30%) surveys were returned. A Personal Preference Score was calculated from responses to personal-preference questions for life-sustaining treatments adapted from “Your Life, Your Choices,” by Pearlman et al. Physicians were asked to consider the “acceptability” of offering and recommending treatment options involving life-sustaining treatments in a hypothetical scenario of a 2-yr old with a high cervical spinal-cord transection. Logistic regression controlling for sociodemographic characteristics found significant relationships (p < .01) between physicians’ own preferences modeled as a one standard deviation change in their own Personal Preference Score (preference for life-sustaining treatment) and whether they offered more or less aggressive care (OR [95%CI]). Physicians who had a higher Personal Preference Score (higher preference for their own life-sustaining treatment) were more likely to recommend a tracheostomy (1.38 [1.35–1.41]) and reintubation if the patient failed extubation (1.87 [1.81–1.94]). Pediatric intensivists who had a lower Personal Preference Score (lower preference for life-sustaining treatment) were more likely to recommend that the patient not be reintubated if extubation failed (1.42 [1.39–1.46]) and to recommend Do Not Resuscitate status (1.34 [1.31–1.37]). Conclusions: Among pediatric intensivists, personal preferences for life-sustaining treatment were significantly associated with scenario-based responses to acceptability of withholding and withdrawal of life-sustaining treatment. Physicians should be aware of the potential for personal preferences to influence practice recommendations, and endeavor to elicit and respect family preferences in collaborative decision making.
The effect of the Massachusetts healthcare reform on the uninsured rate of the orthopaedic trauma population.

BACKGROUND The 2006 Massachusetts Healthcare Reform (MHR) has resulted in health coverage for 98.1% of residents in Massachusetts. The purpose of this study was to evaluate the effect of MHR on the actual rate of uninsured individuals in the orthopaedic trauma population in the largest metropolitan area of Massachusetts. We also sought to measure the change in uncompensated care following the implementation of MHR. METHODS We performed a retrospective review of all patients treated by the orthopaedic trauma services at three of the four level-I trauma centers in Boston from 2003 to 2010. The primary study cohort consisted of all uninsured patients, while the remaining patients were considered to have insurance. The study population was divided into two groups to compare the uninsured rate before and after MHR. Patients from 2006 to 2007 were excluded from the analysis to allow for an enrollment period in subsidized health insurance. RESULTS A total of 16,338 patients with extremity and pelvic fractures and dislocations were treated from 2003 to 2010. There was a significant decrease in the uninsured rate from 23.8% to 14.4% following MHR (p < 0.001). The post-MHR risk of being uninsured is approximately 0.6 times the pre-MHR risk, with a 95% confidence interval of 0.56 to 0.65. There was also a reduction in the proportion of uncompensated care from 16.7% to 11.5% after MHR. CONCLUSIONS There was an estimated 40% reduction in risk of uninsured individuals in the orthopaedic trauma population in the metropolitan Boston area following MHR. Despite a significant improvement, these results reveal a rate of uninsured individuals fivefold greater than currently reported by the state of Massachusetts and the U.S. government.
Chapter 6 Fractionation of lignocellulosic materials with ionic liquids

Ionic liquids (ILs) have been recognized as a promising way to fractionate lignocellulosic biomass. During recent years, a number of publications have introduced a variety of technical developments and solvent systems based on several types of ILs to fractionate lignocellulose into individual polymeric components, after full or partial dissolution. In this chapter we briefly review the latest developments and knowledge in this field of study and introduce an alternative fractionation method based on the controlled regeneration of components from 1-allyl-3-methyl-imidazolium chloride ([amim]Cl). Norway spruce (Picea abies) and Eucalyptus grandis woods were dissolved in their fibrous state or by utilizing ball milling to improve solubility. The resulting wood solutions were precipitated gradually resulting into fractions by addition of non-solvents, such as acetonitrile and water. Further water extraction of the crude fractions resulted in better separations. By analyzing molecular weight distributions of the fractions, together with their chemical composition, we have obtained fundamental information concerning the mechanisms of wood fractionation with ILs. Fractionation efficiency is found to be highly dependent on the modification of the wood cell wall ultrastructure and the degree of
Microscopic colitis: a descriptive clinical cohort study of 795 patients with collagenous and lymphocytic colitis

Abstract Objective Microscopic colitis is a common cause of chronic diarrhoea in the Scandinavian countries. This report comprises demographic data, clinical and endoscopic features, and occurrence of coeliac and inflammatory bowel disease (IBD) in a large urban cohort of patients with lymphocytic colitis (LC) and collagenous colitis (CC). Materials and methods A total of 795 patients with microscopic colitis from two hospitals in Stockholm were included. Medical records were reviewed and clinical data, including endoscopic and histological findings, were compiled. Results Forty-three percent had CC (female:male ratio 3.7:1) and 57% had LC (female:male ratio 2.7:1). The mean age at diagnosis of CC was 63 years and of LC was 59 years (p = 0.005). Clinical features were similar in both entities, but the intensity of symptoms differed. Watery diarrhoea was reported in 55% in CC patients versus in 43% in LC patients (p = 0.0014), and nocturnal diarrhoea in 28% versus 18% (p = 0.002). Subtle endoscopic mucosal findings were reported in 37% of the CC patients and in 25% of the LC patients (p = 0.0011). Colorectal adenomatous polyps were found in 5.3% of all patients. Coeliac disease occurred in 6% and IBD occurred in 2.1% of all patients. Conclusions Clinical features of LC and CC are similar but not identical. CC seems to be a more severe type of bowel inflammation and LC tends to occur earlier in life. Both forms might indeed feature endoscopic findings despite the designation ‘microscopic’. Our study confirms the strong association with coeliac disease.
Postoperative anemia does not impede functional outcome and quality of life early after hip and knee arthroplasties

BACKGROUND: Clinicians have adopted a restrictive transfusion threshold (75‐80 g/L) after major orthopedic surgery. Anemia may be associated with a decrease in postoperative vigor. We hypothesize that, in these patients, a threshold hemoglobin (Hb) concentration exists below which functional recovery and quality of life (QoL) become difficult.
"Alien Health Game": An Embodied Exergame to Instruct in Nutrition and MyPlate.

OBJECTIVE A feasibility study was run on an immersive, embodied exergame ("Alien Health Game") designed to teach 4th-12th-grade students about nutrition and several U.S. Department of Agriculture MyPlate guidelines. This study assessed acceptability and limited efficacy. Students learned about the amount of nutrients and optimizers in common food items and practiced making rapid food choices while engaging in short cardiovascular activities. SUBJECTS AND METHODS Nineteen 4th graders played a "mixed reality" game that included both digital components (projected graphics on the floor) and tangible, physical components (hand-held motion-tracking wands). Players made food choices and experienced immediate feedback on how each item affected the Alien avatar's alertness/health state. One member of the playing dyad had to run short distances to make the game work. The final level included a digital projection of the MyPlate icon, and each food item filled the appropriate quadrant dynamically. RESULTS All students remained engaged with the game after approximately 1 hour of play. Significant learning gains were seen on a pretest and posttest that assessed nutrition knowledge (paired t18=4.13, P<0.001). In addition, significant learning gains were also seen in knowledge regarding MyPlate (paired t18=3.29, P<0.004). CONCLUSIONS Results suggest preliminary feasibility via demonstrated acceptability and improved within-group content knowledge. Future research should explore improved measures of knowledge gains, alternative mechanisms for supporting the game mechanics to increase the scalability of the system (i.e., via Kinect(®) [Microsoft(®), Redmond, WA] sensors), and the formal evaluation of the system via a randomized controlled trial.
Brain specific proteins in posthaemorrhagic ventricular dilatation

Median neurofilament and glial fibrillary acidic protein concentrations in the cerebrospinal fluid of 18 infants with posthaemorrhagic ventricular dilatation were 20–200 times higher than control values. S-100 protein in cerebrospinal fluid was four times higher than control values. Glial fibrillary acidic protein concentrations correlated with death or disability and with parenchymal lesions but not with shunt dependence.
Best practice determination of timing of spinal fracture fixation as defined by analysis of the National Trauma Data Bank.

BACKGROUND To examine the efficacy of early versus late spinal fracture fixation, we reviewed National Trauma Data Bank (NTDB) records to identify the breakpoint in reported timing of operative fixation. Using this breakpoint we then analyzed outcome for those treated early versus late, hypothesizing that the early group would experience better outcome as reflected by resource utilization and complications. METHODS The NTDB was queried for patients with any level spinal fracture that required surgical stabilization. Histogram analysis of the postinjury day of initial operative fixation was used to determine the point at which the majority of operative procedures had been performed, thereby defining early (E) and late (L) groups. Patients in E were matched to a cohort from L with similar age, Injury Severity Score, and Glasgow Coma Scale. Outcome data included hospital length of stay, intensive care unit length of stay, ventilator days, charges, incidence of complications, and mortality. The groups were compared using Student's t test for continuous variables and Fisher's exact test for categorical variables, accepting p < or = 0.05 as significant. RESULTS Of 16,812 patients who underwent operative fixation, 59% were completed within 3 days of injury and formed E. The 374 L patients whose dataset was complete enough to allow analysis were matched to 497 E patients. There was no significant difference in the presence of spinal cord injury between E and L (51 vs. 48%; p = 0.3735). Complications were significantly higher in L (30% vs. 17.5%; p < 0.0001) yet mortality was similar in both groups (2.0% vs.1.9%; p > 0.05). CONCLUSIONS NTDB records indicate that the majority of patients with spinal fractures undergo operative fixation within 3 days, and that these patients had less complications and required less resources. Use of a national data bank to compare groups with similar injury severity and presenting physiology can validate best practice and define opportunities for improvement in care.
Biogeography and phylogenomics of New World Bambusoideae (Poaceae), revisited.

UNLABELLED • PREMISE OF THE STUDY New World Bambusoideae have only recently been studied in a phylogenomic context. Plastome sequences were determined and analyzed from Arundinaria appalachiana, A. tecta, and Olyra latifolia, to refine our knowledge of their evolution and historical biogeography. A correction is noted regarding an error in an earlier report on the biogeography of Cryptochloa• METHODS Single-end DNA libraries were prepared and sequenced on the Illumina platform. Complete plastomes were assembled and analyzed with 13 other Poaceae. • KEY RESULTS Complete sampling in Arundinaria and an additional species of Olyreae gave a more detailed picture of their evolution/historical biogeography. Phylogenomic analyses indicated that the first major divergence in Arundinaria occurred around 2.3 to 3.2 mya and that Arundinaria tecta and A appalachiana diverged from their common ancestor around 0.57 to 0.82 mya. Estimates of the divergence of Olyra latifolia from Cryptochloa strictiflora ranged from 14.6 to 20.7 mya. The age of the stem node of Olyreae ranged from an estimated 26.9 to 38.2 mya. • CONCLUSIONS Estimates of divergences in Arundinaria can be correlated with paleoclimatic events including an early Pliocene warming, subsequent cooling, and North American glaciations. Discriminating between alternate evolutionary/biogeographic scenarios in Olyreae is challenging.
FGFR-4, a new member of the fibroblast growth factor receptor family, expressed in the definitive endoderm and skeletal muscle lineages of the mouse.

We have used the polymerase chain reaction to clone from fetal cerebellar RNA a novel member of the fibroblast growth factor receptor family, FGFR-4. cDNAs encoding a full-length receptor were isolated and RNA expression examined in adult and fetal tissues by RNA blot analysis. Transcripts were detected in adult lung, liver and kidney and in fetal RNAs from 11.5 to 16.5 days post coitum (p.c.). In situ hybridization was performed to examine developmental expression. FGFR-4 RNA was expressed in definitive endoderm of the developing gut and extraembryonic endoderm of the yolk-sac from 8.5 to 14.5 days p.c. At early somite stages, FGFR-4 was also expressed in the myotomal component of the somite, and by 14.5 days p.c. in the myotomally derived skeletal muscle. No expression was seen at any stage in cardiac muscle. Several endodermal derivatives, the liver, lung and pancreas, expressed FGFR-4 at 14.5 days p.c. In addition, FGFR-4 RNA was detected in the adrenal cortex, collecting tubules of the kidney and condensing cartilage at this time. These results suggest that FGFR-4 is likely to have diverse roles in development, which may include regulation of definitive endoderm and skeletal muscle lineages.
CARBON BALANCE AND VEGETATION DYNAMICS IN AN OLD-GROWTH AMAZONIAN FOREST

Amazon forests could be globally significant sinks or sources for atmospheric carbon dioxide, but carbon balance of these forests remains poorly quantified. We surveyed 19.75 ha along four 1-km transects of well-drained old-growth upland forest in the Tapajos National Forest near Santarem, Para ´, Brazil (2 8519 S, 548589 W) in order to assess carbon pool sizes, fluxes, and climatic controls on carbon balance. In 1999 there were, on average, 470 live trees per hectare with diameter at breast height (dbh) $10 cm. The mean (and 95% CI) aboveground live biomass was 143.7 6 5.4 Mg C/ha, with an additional 48.0 6 5.2 Mg C/ha of coarse woody debris (CWD). The increase of live wood biomass after two years was 1.40 6 0.62 Mg C·ha 21 ·yr 21 , the net result of growth (3.18 6 0.20 Mg C·ha 21 ·yr 21 from mean bole increment of 0.36 cm/yr), recruitment of new trees (0.63 6 0.09 Mg C·ha 21 ·yr 21 , reflecting a notably high stem recruitment rate of 4.8 6 0.9%), and mortality (22.41 6 0.53 Mg C·ha 21 ·yr 21 from stem death of 1.7% yr 21 ). The gain in live wood biomass was exceeded by respiration losses from CWD, resulting in an overall estimated net loss from total aboveground biomass of 1.9 6 1.0 Mg C·ha 21 ·yr 21 . The presence of large CWD pools, high recruitment rate, and net accumulation of small-tree biomass, suggest that a period of high mortality preceded the initiation of this study, possibly triggered by the strong El Nino Southern Oscillation events of the 1990s. Transfer of carbon between live and dead biomass pools appears to have led to substantial increases in the pool of CWD, causing the observed net carbon release. The data show that biometric studies of tropical forests neglecting CWD are unlikely to accurately determine carbon balance. Fur- thermore, the hypothesized sequestration flux from CO 2 fertilization (,0.5 Mg C·ha 21 ·yr 21 ) would be comparatively small and masked for considerable periods by climate-driven shifts in forest structure and associated carbon balance in tropical forests.
Fatty Acid Composition of Unicellular Strains of Blue-Green Algae

The fatty acids of 34 strains of unicellular blue-green algae provisionally assigned to the genera Synechococcus, Aphanocapsa, Gloeocapsa, Microcystis, and Chlorogloea by Stanier et al. have been chemically characterized. The strains analyzed can be divided into a series of compositional groups based upon the highest degree of unsaturation of the major cellular fatty acids. Twenty strains fall into the group characterized by one trienoic fatty acid isomer (α-linolenic acid), and seven strains fall into a group characterized by another trienoic acid isomer (γ-linolenic acid). These groups in many cases correlate well with groupings based upon other phenotypic characters of the strains, e.g., deoxyribonucleic acid base composition. The assignment of a strain to a compositional group is not altered when the strain is grown under a variety of different culture conditions. All strains contain glycolipids with the properties of mono- and digalactosyldiglycerides.
Effects of Low Doses of Bisphenol A on the Metabolome of Perinatally Exposed CD1 Mice

BACKGROUND: Bisphenol A (BPA) is a well­known endocrine disruptor used to manufacture polycarbonate plastics and epoxy resins. Exposure of pregnant rodents to low doses of BPA results in pleiotropic effects in their offspring. Metabolomics, a method used to reveal metabolic changes in response to nutritional, pharmacological, or toxic stimuli is used here to examine effects of BPA exposure. OBJECTIVES: We report the use of metabolomics to identify metabolic shifts induced in vivo by perinatal exposure to low doses of BPA in CD­1 mice. METHODS: Male offspring born to pregnant CD­1 mice that were exposed to vehicle, 0.025! g, 0.25! g or 25μg BPA/kg BW/day, from gestational day 8 through day 16 of lactation, were examined on PND2 or PND 21. Aqueous extracts of newborns (PND2, whole animal), and of livers, brains, and serum samples from PND21 pups were submitted to 1 H NMR spectroscopy. Data were analyzed using Partial Least Squares Discriminant Analysis (PLS­DA). RESULTS: Examination of endogenous metabolic fingerprints revealed remarkable discrimination in the four PND2 newborn groups (whole extracts) strongly suggesting changes in the global metabolism. Furthermore, at PND 21, statistical analyses also successfully discriminated among treatment groups for liver, serum, and brain samples. Variations in glucose, pyruvate, some amino­acids, and neurotransmitters (GABA and Glutamate) were identified. CONCLUSIONS: Low doses of BPA disrupt global metabolism, including energy metabolism and brain function in perinatally exposed CD­1 mouse pups. Metabolomics can be used to highlight the effects of low doses of endocrine disruptors by linking perinatal exposure to changes in global metabolism.
The Beneficial Effect of Spinal Cord Stimulation in a Patient With Severe Cerebral Ischemia and Upper Extremity Ischemic Pain

Abstract: Spinal cord stimulation (SCS) is used in the treatment of chronic pain, ischemia because of obstructive arterial disease, and anginal pain. Recently, a number of studies have described the effects of the high cervical SCS, including increased cerebral blood flow, although the underlying mechanisms are unknown.
The Internet as a "virtual cultural region": are extant cultural classification schemes appropriate?

This paper examines the concept of the Internet as a virtual cultural region with its own demographics and psychographics. Longitudinal studies of the changing make up of Internet users have been running for much of the 1990s and market intelligence companies have been applying their proprietary segmentation models to this data and also creating new models specifically for the Internet. At a more sociological level, what are the cultural norms and cutoms of the population of the Internet cultural region? This paper complements the market intelligence research by an investigation into the applicability of cultural classification schemes as exemplified by Hofstede with a view to information extant and prospective Internet involvement. Finally, practical recommendations are made in order to reduce the risk of activities likely to cause irritation of and non‐response from this burgeoning new market.
Computed Tomography Colonography: Automated Diameter and Volume Measurement of Colonic Polyps Compared With a Manual Technique-In Vitro Study

Objective: To investigate inter- and intraobserver agreement of automated measurement of polyp diameter in vitro. Methods: Two phantoms (“QRM” and “Whiting”) containing simulated polyps of known diameter and volume were scanned using 16-detector row computed tomography. Two observers estimated polyp diameter using 3 methods: software calipers (“manual”), freehand boundary identification (“semiautomatic”), and automated software segmentation (“fully automatic”). Results: Intraobserver 95% limits of agreement for diameter were narrowest for the fully automatic method (QRM span: 0.39 mm, 0.48 mm; Whiting span: 0.24 mm, 0 mm). Manual estimates were approximately 10 times wider (QRM span: 3.57 mm, 3.21 mm; Whiting span: 3.2 mm, 2.02 mm). Volume estimates were narrowest for the fully automatic method (span: 24.2 mm3, 24.1 mm3 vs. 97.9 mm3, 102.9 mm3 for semiautomatic measurement). Interobserver agreement for diameter was narrowest for the fully automatic method (QRM span: 0.12 mm, Whiting span: 0.16 mm), with the manual method approximately 18 times wider (QRM span: 2.87 mm, Whiting span: 2.18 mm). Conclusion: Fully automated measurement of polyp diameter and volume is technically feasible and results in superior inter- and intraobserver agreement.
A beef-associated outbreak of Salmonella Typhimurium DT104 in The Netherlands with implications for national and international policy

SUMMARY A ten-fold increase in Salmonella Typhimurium DT104 cases in The Netherlands during September–November 2005 prompted an outbreak investigation. A population-based matched case-control study included 56 cases and 100 controls. Risk factors for infection were consumption of a pre-processed raw beef product (odds ratio 4·2, 95% confidence interval 1·5–12·0) and of food from mobile caterers (odds ratio 4·9, 95% confidence interval 1·1–22·1). Bacterial molecular typing established a link with another DT104 outbreak in Denmark caused by beef from a third European country. The incriminated beef was traced in The Netherlands and sampling yielded DT104 of the outbreak-associated molecular type. We concluded that this outbreak was caused by imported contaminated beef. Consumers should be informed about presence of raw meat in pre-processed food products. Optimal utilization of international networks and testing and traceability of foodstuffs has the potential to prevent foodborne infections.