Miracle-dz/UniFAR-FTUs huggingface dataset:
Management of Severe Sepsis of Abdominal Origin

Severe sepsis is a life-threatening condition that may occur as a sequela of intra-abdominal infections (IAIs) of all types. Diagnosis of IAIs is predicated upon the combination of physical examination and imaging techniques. Diffuse peritonitis usually requires urgent surgical intervention. In the absence of diffuse peritonitis, abdominal computed tomography remains the most useful test for the diagnosis of IAIs, and is essential to both guide therapeutic interventions and evaluate suspected treatment failure in the critically ill patient. Parameters most consistently associated with poor outcomes in patients with IAIs include increased illness severity, failed source control, inadequate empiric antimicrobial therapy, and healthcare-acquired, as opposed to community-acquired infection. Whereas community-acquired IAI is characterized predominantly by enteric gram-negative bacilli and anaerobes that are susceptible to narrow-spectrum agents, healthcare-acquired IAI (e.g., anastomotic dehiscence, postoperative organ-space surgical site infection) frequently involves at least one multi-drug resistant pathogen, necessitating broad-spectrum therapy guided by both culture results and local antibiograms. The cornerstone of effective treatment for abdominal sepsis is early and adequate source control, which is supplemented by antibiotic therapy, restoration of a functional gastrointestinal tract (if possible), and support of organ dysfunction. Furthermore, mitigation of deranged immune and coagulation responses via therapy with recombinant human activated protein C may improve survival significantly in severe cases complicated by septic shock and multiple organ dysfunction syndrome.
Mental Health Service Use Among Lesbian, Gay, and Bisexual Older Adults.

OBJECTIVE Empirical efforts to measure use of mental health services among lesbian, gay, and bisexual (LGB) older adults have been notably lacking. Thus this study assessed associations between sexual orientation and mental health service use among older adults and determined the mediating role of nonspecific psychological distress, excessive alcohol use, and self-perceived poor general medical health. METHODS Data from the 2011 New York City Community Health Survey were analyzed. The analytic sample comprised 5,138 adults ages 50 and over. Logistic regression modeling was used to examine associations between sexual orientation (LGB versus heterosexual) and past-year mental health service use (counseling or medication), adjusting for sociodemographic and clinical characteristics. Mediation analyses using bootstrapping were conducted. RESULTS Among LGB older adults, 23.9% reported receiving counseling, and 23.4% reported taking psychiatric medication in the past year. LGB respondents were significantly more likely than heterosexuals to have received counseling (adjusted odds ratio [AOR]=2.16, 95% confidence interval [CI]=1.49-3.13) and psychiatric medication (AOR=1.97, CI=1.36-2.86). Psychological distress, excessive alcohol use, and self-perceived poor general medical health did not mediate the association between sexual orientation and mental health service use. CONCLUSIONS LGB older adults were more likely than heterosexuals to utilize mental health services, and this association was not explained by indicators of general medical, mental, or behavioral health.
A comparison of pregnancy and child health outcomes between teenage and adult mothers in the slums of Nairobi, Kenya

The study assessed and compared pregnancy and child health outcomes of teenage (aged less than 20 years) and adult (20-34 years of age) mothers. A total of 226 teenage and 205 adult mothers met the study criteria out of the 3,256 women in the reproductive age group (15-49 years) and 318 adolescent girls (12-14 years of age) covered by the Nairobi Cross-sectional Slums Survey (NCSS). The main comparison involved socio-demographic variables, events during pregnancy, obstetric outcome, child morbidity and mortality and care provided during an illness episode. Results showed that a significantly higher percentage of teenage mothers and their partners had lower educational achievement compared with adult mothers and their partners. They were more likely to be economically disadvantaged than the adult mothers. Teenage mothers and their parents were also less likely to have ever been married. The two groups of mothers were comparable in terms of the rate and timing of antenatal care visits, place of delivery, rate of operative deliveries, reported size of the baby at birth, child vaccination status and reported morbidity and health care practice during an illness episode. The index child was alive during the survey period for 89.4% of the teenage and 96.6% of the adult mothers (OR = 3.36; 95% CI = 1.34, 8.79; P = 0.004). Child survival rates in the two groups of mothers were found to be quite similar after controlled analysis for the influence of socio-economic factors. The study concluded that bad obstetric outcomes were not associated with maternal age. Although teenage and adult mothers were not significantly different on child health practices, children born to the former group died most frequently probably due to their poor socioeconomic achievements.
Antiplatelet effects of clopidogrel and bleeding in patients undergoing coronary stent placement

Summary. Background: In patients undergoing percutaneous coronary intervention (PCI), a link between bleeding and excess mortality has been demonstrated. A potential association of platelet response to clopidogrel and bleeding has not been well established yet. Objectives: The aim of the present study was to assess the impact of clopidogrel responsiveness on the risk of bleeding in clopidogrel‐treated patients undergoing PCI. Methods: Patients (n = 2533) undergoing PCI after pretreatment with 600 mg of clopidogrel were enrolled in this study. Blood was obtained directly before PCI. Adenosine‐diphosphate (ADP)‐induced platelet aggregation was assessed on a Multiplate analyzer. The primary endpoint was the incidence of in‐hospital Thrombolysis in Myocardial Infarction (TIMI) major bleeding and the secondary endpoint was in‐hospital TIMI minor bleeding. Receiver‐operator curve (ROC) analysis was used to derive the optimal platelet aggregation value defining enhanced clopidogrel responders for the association of measurements with major bleeding. Results: Thirty‐four (1.3%) major bleeding events and 137 (5.4%) minor bleeding events were observed. The risk of a major bleeding was significantly higher in patients (n = 975) with an enhanced response to clopidogrel as compared with the remaining patients (n = 1558) (2.2 vs. 0.8%, unadjusted odds ratio (OR) 2.6, 95% confidence interval (CI) 1.3–5.2, P = 0.005; adjusted OR 3.5, 95% CI 1.6–7.3, P = 0.001). No significant differences between both groups were observed for the occurrence of minor bleeding events (P = 0.68). Conclusions: Enhanced clopidogrel responsiveness is associated with a higher risk of major bleeding. Whether guidance of antiplatelet treatment based on platelet function testing proves useful for avoiding bleeding events warrants further investigation.
Understanding co-morbidities affecting children with epilepsy

Co-morbid conditions frequently occur in childhood epilepsy and may significantly affect epilepsy and its treatment. Similarly, epilepsy and antiepileptic drugs (AEDs) may affect these associated conditions. Co-morbidities that have a significant association with childhood epilepsy include attention-deficit/hyperactivity disorder, autism, developmental disabilities, accidental injury, migraine, and depression/anxiety. Understanding the interrelationships among co-morbidities, epilepsy, and their treatments is essential to optimal management of pediatric patients. Treatment should be individualized with consideration for specific co-morbidities and concomitant medications. Key treatment goals are to achieve seizure control and optimal physical and cognitive function using the simplest possible AED regimen. The clinician should consider whether an antiepileptic treatment can be chosen that also ameliorates the co-morbid condition. Newer AEDs, such as lamotrigine, topiramate, gabapentin, oxcarbazepine, and tiagabine, may benefit children with epilepsy and some co-morbid disorders.
Influence of Venous Return on Baroreflex Control of Heart Rate during Lumbar Epidural Anesthesia in Humans

The role of variation of venous return on baroreflex control of heart rate during lumbar epidural anesthesia was investigated in 12 unpremedicated patients. Group 1 patients (n = 6) received 8 ml of 0.5% plain bupivacaine in the epidural space (L3–4) (mean upper level of analgesia at T10). Group 2 patients (n = 6) received 8 ml of saline at the same level in the epidural space. Following the epidural injection, phenylephrine (PHE) and nitroglycerin (NTG) were employed to alter the stimulation of baroreceptor sites before and during application of lower body positive pressure (LBPP). Plasma bupivacaine, catecholamines, renin activity, and vasopressin were assayed. In contrast to saline, epidural bupivacaine induced a decrease in systolic arterial and right atrial pressures (−11 ‡ 4 and −3.2 ‡ 0.7 mmHg, respectively, mean ‡ SEM) without change in heart rate, an increase in baroreflex slopes during PHE and NTG injections (+5.9 ‡ 1.6 ms/mmHg and +2.8 ‡ 0.9 ms/mmHg, respectively), and a decrease in plasma norepinephrine (−248 ‡ 89 pg/ml). The application of LBPP restored hemodynamic and reflex variables to preepidural analgesia values, whereas plasma catecholamines decreased further. Plasma renin activity and vasopressin were not modified at any time in either groups. This study indicates that lumbar epidural anesthesia enhances cardiac vagal tone mainly through a decrease in venous return.
Long-Term Impacts of High Temperatures on Economic Productivity

High temperature anomalies have recently been shown to have adverse short-term impacts on multiple health and socio-economic outcomes. A well established literature on the impacts of early life stress on life-long human capital accumulation has led us to hypothesize that high temperature anomalies can also have long-term impacts on economic productivity. Using unique data sets on historical weather and the earnings, place and date of birth of all 1.5 million formal employees in Ecuador, we find that women who have experienced a 1°C increase in average temperature while in-utero earn 1.1%-1.7% less as adults. The results are highly robust and suggest warming may already have caused adverse long-term economic losses "in the pipeline" that have not been appreciated to date.
Influence of glutamine on cytokine production by human gut in vitro.

BACKGROUND glutamine modulates cytokine production by immune cells in vitro and protects the gut from experimental enterocolitis, but data on the effect of glutamine on cytokine production in human gut are lacking. AIM to assess the effect of glutamine pre-treatment in vivo and in vitro on cytokine production by intestinal mucosa. METHODS nine fasted volunteers received either enteral glutamine or saline over 6 h in a cross-over design. Duodenal biopsies were cultured for 24 h with or without glutamine. Cytokine content of culture media was analysed by ELISA, and the expression of cytokine mRNA in biopsies was assessed by semi-quantitative RT-PCR. RESULTS glutamine given in vivo and in vitro significantly decreased IL-6 [1.4 (0.8-8.5) vs 8.9 (1.0-43.9)] and IL-8 production [5.8 (0-51.4) vs. 53.0 (2.5-114.6), pg/mg wet tissue], median (range), both P< or =0.01, in comparison to no glutamine experiments. Glutamine did not influence IL-4 production. IL-1beta, IL-10 and TNF-alpha were not detectable in culture media. The expression of any cytokine mRNA was not influenced by glutamine. CONCLUSIONS glutamine reduces pro-inflammatory cytokine production by human intestinal mucosa, probably by a post-transcriptional pathway. Glutamine could be useful to modulate inflammatory conditions with imbalanced cytokine production.
Pharmacological and molecular characterization of muscular cholecystokinin receptors in the human lower oesophageal sphincter

In vitro cholecystokinin (CCK) contracts the human lower oesophageal sphincter by stimulating muscular receptors. The aim of this study was to characterize the muscular CCK receptor subtypes in the human lower oesophageal sphincter. Twenty‐five circular strips from six patients were studied. RNA was extracted, reverse transcribed, and cDNAs were amplified with primers for human CCK‐A and B receptors. The potency of the contraction induced by CCK‐8, desulphated CCK‐8, and gastrin‐I, and the effect of the CCK‐A (loxiglumide and SR 27897) and the CCK‐B (YM022 and L‐365 260) specific receptor antagonists were compared. Both CCK‐A and CCK‐B receptor mRNAs were found in functional lower oesophageal sphincter strips. The potency of the CCK‐8 concentration‐dependent contraction was two and three orders of magnitude higher than that of desulphated CCK‐8 and gastrin‐I, respectively. The CCK‐8‐induced contraction was blocked by the CCK‐A receptor antagonists loxiglumide (IC50 11 μmol L–1) and SR 27897 (IC50 74 nmol L–1) but not by CCK‐B receptor antagonists (1 μmol L–1). Our data suggest that, although the human lower oesophageal sphincter expresses both CCK‐A and CCK‐B receptors, the contractile effect of CCK‐8 on the circular muscle is mainly due to the activation of CCK‐A receptors.
Immunoreactivity of CD99 in invasive malignant melanoma

Background: CD99, also known as p30/32, is a glycoprotein product of the MIC2 gene. It was originally utilized in immunohistochemistry as a unique marker for Ewing sarcoma, other primitive neuroectodermal tumors, and subsequently in other tumors. Its expression in malignant melanoma (MM) has not been well documented, with just two isolated cases of MM recently reported. Recent studies have documented CD99 expression in a significant percentage of atypical fibroxanthomas (AFX), posing potential diagnostic problems in differentiating these two entities. As mistaking MM for AFX based on immunohistochemical staining pattern has significant consequences, we sought to determine the percentage of invasive MM in our archives that have this staining pattern.
The influence of alkali and alkaline earths on the working range for bioactive glasses.

Viscosity-temperature dependence has been investigated for glasses in a system where bioactive compositions are found. A glass is called bioactive when living bone can bond to it. In this work, high-temperature microscopy was used to determine viscosity-temperature behaviour for 40 glasses in the system Na2O-K2O-MgO-CaO-B2O3-P2O5-SiO2. The silica content in the glasses was 39-70 wt% % All glasses containing < 54 mol % SiO2 devitrified during the viscosity measurements. Generally, glasses that devitrified contained more alkali but less alkaline earths than glasses with a large working range. A working range is the temperature interval at which forming of a glass can take place. This temperature interval can, for bioactive glasses, be enlarged by decreasing the amount of alkali, especially Na2O, in the glass and by increasing the amount of alkaline earths, especially MgO. Optionally, B2O3 and P2O5 can be added to the glass. An enlarged working range is a prerequisite for an expanded medical use of bioactive glasses as e.g., sintered and blown products, and fibers.
Stuttering as "false alarm" responding.

SummaryIt is hypothesised that a stutter is a false alarm, or superfluous correction response to speech feedback signals, such that the overt behavioural response is the repetition of a speech unit. The experiment attempts to elicit stuttering in normals by setting up two conditions, anxiety and divided attention, in which false alarms in any perceptual-motor task would be predicted. The divided attention condition does increase stutters. The anxiety condition does not increase stutters, but increases the probability of a speech error being corrected, indicating that anxiety directs attention to speech feedback. Auditory masking reduces stutters in all conditions, demonstrating the crucial role of auditory feedback in normal as well as in pathological speech disfluencies. The distribution of elicited stutters is analogous to the distribution of false alarms in orthodox signal detection experiments.
A Standard Protocol for the Colposcopy Exam.

A t the end of the 2016 ASCCP meeting in New Orleans, Drs Huh and Wentzensen cochaired a session that focused on the current status of colposcopy with a goal of initiating the process of setting colposcopy standards. Some of the session was focused on risk-based management, but beyond that discussion, the relatively poor ability of colposcopic-directed biopsy to exclude CIN 3 and cervical cancer (CIN 3+) must be recognized. In 1997, the authors designed a colposcopy protocol in which a colposcopic impression (negative, HPV, CIN 2 or CIN 3, or cancer) in each quadrant of the cervix was made. Then, biopsies in each quadrant of the cervix (even “random” biopsies at the squamocolumnar junction in quadrants with normal impressions) were obtained. After the cervical biopsies, an endocervical curettage (ECC) was performed. The purpose of this protocol was to avoid verification bias without performing loop electrocautery excision procedures on all patients. This colposcopy protocol has been applied to multiple other studies and generated thousands of matched quadrantbased colposcopy impressions and biopsies. Using these matched quadrant-based impressions and biopsies, we found that the sensitivity of colposcopically directed biopsy for CIN 2, CIN 3, or cancer (CIN 2 +) was 57.1% (208/364), and that for CIN 3+ was 63.5% (141/222). The sensitivity of colposcopic-directed biopsy has been further documented by others with different designs for assessment. Although there is variation in the sensitivity of colposcopy by practitioner, the sensitivity of colposcopic-directed biopsy for CIN 3+ is between 50% and 65%. During multiple presentations of these data often in debate format, in Europe, Asia, and the United States, the data suggesting that the sensitivity of colposcopicdirected biopsy for CIN 3+ was 50 to 65% were countered by colposcopists who were convinced we had no idea how to do colposcopy. We countered that we knew that there was variation in the sensitivity of colposcopy by practitioner but that there were multiple studies with multiple colposcopists showing a relatively low sensitivity of colposcopic-directed biopsy for CIN 3+. As the CIN 3+ diagnosed by
Cooperative Equilibria in Differential Games

This paper deals with a class of equilibria for differential games where memory strategies are allowed. This class permits the inclusion of a threat in a cooperative strategy. The threat will be used as soon as one player is not controlling the system according to the agreed upon cooperative control. We characterize the set of such equilibria.
Towards performance prediction of multicore software routers

Rapid advances in network function virtualization technologies have led to the emergence of flexible and scalable embedded data plane processing functions, eg, packet forwarding, on commodity hardware. However, performance prediction of softwarized network functions on such shared resources is challenging but very important for obtaining the full benefits of network function virtualization. This paper addresses the problem of performance prediction for multicore software routers and reveals a key technique to achieve high accuracy. Motivated by observations, we first analyze how many CPU cycles are spent for forwarding a packet in multicore processing systems. Our prediction model of the CPU usage based on cache contention can capture its nonlinear dilation scaled by the number of CPU cores–called dilated CPU consumption (DCC). We validate the accuracy of the DCC model with measured data. On the basis of the DCC model, we develop 2 performance prediction algorithms to predict the maximum throughput of the packet‐forwarding function corresponding to the assigned resources. The first algorithm includes CPU utilization statistics (called DCC‐u), while its simplified version (called sDCC) does not require CPU utilization statistics. We validate the proposed models through the exhaustive set of experiments under various amounts of assigned resources (ie, CPU speeds and the number of CPU cores) and different traffic loads (ie, a large and small number of traffic flows). The results show that DCC‐u and sDCC achieve high accuracy under various amounts of resources and traffic conditions. Remarkably, they improve the precision of estimation from that of the existing techniques by up to 105% to 163%.
Applicability of a monoclonal antibody‐based dipstick in diagnosis of urinary schistosomiasis in the Central Region of Ghana

We tested a rapid visually read monoclonal antibody (MoAb) based dipstick assay for specific diagnosis of urinary schistosomiasis against microscopy and the use of haematuria and proteinuria in a schistosomiasis haematobia endemic area in the Central Region of Ghana. The study group consisted of 141 school children (83 males, 58 females) aged 8–19 years. A total of 129 of 141 (91.5%) submitted stool samples, and 7.8% had Schistosoma mansoni, 55% had hookworms and 6.2% had tapeworms. The presence of S. mansoni and intestinal parasites did not appear to influence the results of the MoAb‐dipstick assay. The urinary schistosomiasis prevalence by MoAb‐dipstick (78%) was higher (P < 0.05) than the estimate by microscopy (60.3%), microhaematuria (27%) and proteinuria (30.5%). The MoAb‐dipstick correctly identified 98.8% of microscopically confirmed cases and missed one (1.3%). The dipstick was also positive for 26 of 56 (46.4%) egg‐negative individuals, thereby giving a sensitivity of 98.8% and a specificity of 53.6%. On the other hand, microhaematuria and proteinuria were 38.8% and 30.6% sensitive, and 91.1% and 69.6% specific, respectively. Microhaematuria and proteinuria were less sensitive (P < 0.05) than both microscopy and MoAb‐dipstick.
Subcortical Structural Changes in ECT-Induced Delirium

A prolonged (interictal) delirium was induced by electroconvulsive therapy (ECT) in 6/36 (17%) elderly depressed patients. Brain magnetic resonance imaging or brain computerized axial tomography revealed structural changes in the basal ganglia and white matter in all six patients who developed delirium. These findings are consistent with our previous work and with several lines of data that have implicated the basal ganglia and subcortical white matter in the development of delirium from other causes. These results suggest that lesions in these areas may predispose one to developing an interictal delirium during a course of ECT. (J Geriatr Psychiatry Neurol 1990;3:172-176).
Explosive percolation with cluster aggregation model

How clusters is aggregated have great effect on the function and dynamic of complex network. A percolation transition model is introduced in this paper which can be described with the clusters aggregated probability p(C<sub>i</sub>)~1-C<sub>i</sub> / (C<sub>max</sub> + α), where C<sub>i</sub> is the size of the cluster, C<sub>max</sub> is the size of the largest cluster and α is disturbance parameter. This model respectively introduce weakly and strongly discontinuous percolation transition underlying the different α and reveal the strongly impact of clusters' aggregated probability.