Miracle-dz/UniFAR-FTUs huggingface dataset:
Role of Long-Acting Muscarinic Antagonist/Long-Acting β2-Agonist Therapy in Chronic Obstructive Pulmonary Disease

Objective: To compare the available literature regarding the use of long-acting muscarinic antagonist (LAMA)/long-acting β2 agonists (LABA) and inhaled corticosteroid (ICS)/LABA combination inhaler therapy in chronic obstructive pulmonary disease (COPD) maintenance therapy management. Data Sources: A MEDLINE literature search from database inception to February 2017 was conducted using the search terms chronic obstructive pulmonary disease, adrenergic beta-agonist, muscarinic antagonist, and inhaled corticosteroid. References from extracted sources were further searched for any relevant, missed data sources. Study Selection and Data Extraction: All English-language randomized-controlled trials comparing LAMA/LABA and ICS/LABA combination inhaler therapy were evaluated. Data Synthesis: A total of 10 randomized controlled trials have reviewed the use of LAMA/LABA compared with ICS/LABA therapy for COPD maintenance therapy. Results of clinical trials that evaluated LAMA/LABA and ICS/LABA maintenance therapy demonstrated superior improvements in pulmonary function tests via spirometry and improved clinical outcomes with LAMA/LABA therapy, specifically reduction in COPD exacerbation rates. The safety of LAMA/LABA combination therapy also is favorable compared with ICS/LABA combination therapy because of the increased infection risk with ICS therapy. Conclusions: COPD is a disease state with significant morbidity and mortality in the United States and is the third leading cause of death. Long-acting inhalers are recommended for the majority of COPD severities, and combination therapy is typically utilized. LAMA/LABA combination therapy has demonstrated superior improvements in pulmonary function and reduction in COPD exacerbation rates compared with ICS/LABA. LAMA/LABA combination therapy will have a larger future role in COPD maintenance management.
Asymptotic Performance of Energy Detector in Fading and Diversity Reception

Missed-detection probability expressions for energy detectors often involve infinite series and do not provide quick insights into the effects of operating conditions. To overcome these limitations, we develop novel asymptotic analyses by proposing an approximate probability density function (PDF) of a random variable β, which, in general, can characterize fading channels in diverse operating conditions. The coefficients of the proposed approximate PDF of β are obtained by matching the coefficients of the approximate PDF's series expansion (or coefficients of the approximate PDF's moment generating function (MGF)) with those of the exact PDF (or MGF) of β. By using the proposed approximation, a unified closed-form asymptotic missed-detection probability is derived. Its usefulness is then demonstrated for fading channels without and with antenna diversity, for cooperative detection, and in co-channel interference. For each case, the sensing gain, which reveals the effect of the operating conditions on the detection performance, is determined explicitly. Furthermore, the asymptotic complementary area under the receiver operating characteristic curve, an alternative performance metric, is derived, and found to reveal the sensing gain. Numerical results verify the accuracy of our derived asymptotic expressions over a wider signal-to-noise ratio (SNR) range compared to the existing asymptotic solution, which is accurate only for high SNRs.
pVHL suppresses kinase activity of Akt in a proline-hydroxylation–dependent manner

Activation of the serine-threonine kinase Akt promotes the survival and proliferation of various cancers. Hypoxia promotes the resistance of tumor cells to specific therapies. We therefore explored a possible link between hypoxia and Akt activity. We found that Akt was prolyl-hydroxylated by the oxygen-dependent hydroxylase EglN1. The von Hippel–Lindau protein (pVHL) bound directly to hydroxylated Akt and inhibited Akt activity. In cells lacking oxygen or functional pVHL, Akt was activated to promote cell survival and tumorigenesis. We also identified cancer-associated Akt mutations that impair Akt hydroxylation and subsequent recognition by pVHL, thus leading to Akt hyperactivation. Our results show that microenvironmental changes, such as hypoxia, can affect tumor behaviors by altering Akt activation, which has a critical role in tumor growth and therapeutic resistance.
Monitoring of Recommended Metabolic Laboratory Parameters Among Medicaid Recipients on Second-Generation Antipsychotics in Federally Qualified Health Centers

Background: In 2004, a consensus statement outlining recommended metabolic monitoring for patients prescribed second-generation antipsychotics (SGAs) was published. More than a decade later, suboptimal adherence rates to these recommendations continue to be reported, which could lead to long-term and costly complications. Objectives: To define the prevalence of appropriately monitored Medicaid patients receiving care at federally qualified health centers (FQHCs) prescribed SGAs. Methods: This was a retrospective study examining electronic health record and Medicaid claims data to assess the rates of glucose and lipid monitoring for patients prescribed SGAs from January 2014 to August 2016 in a FQHC. Prescription and laboratory claims for patients receiving care at 4 FQHCs were reviewed. Descriptive statistics were used to evaluate the primary outcome. Results: A total of 235 patients were included in the analysis. Patients initiated on SGA therapy (n = 92) had baseline glucose and lipid monitoring rates of 50% and 23%, respectively. The 3-month monitoring rates were 37% for glucose and 26% for lipids, whereas annual rates were 71% and 40%, respectively. Patients continuing SGA therapy (n = 143) had annual glucose and lipid monitoring rates of 67% and 44%. Conclusions: Medicaid patients at FQHCs initially prescribed SGAs have low baseline and 3-month metabolic monitoring, whereas annual monitoring was comparable to previously published studies. Adults receiving chronic care at a FQHC were more likely to receive glucose monitoring. Those with type 2 diabetes mellitus and/or hyperlipidemia were more likely to receive glucose and lipid monitoring.
Sports Medicine

An estimated 10% of head and spinal cord injuries are due to sports-related activities. As the popularity of sports increases so does the incidence of sports-related injuries. In recent years, concussion has received significant media attention as high-profile athletes have come forward to share their experiences and long-term struggles with this specific type of traumatic brain injury. Public health initiatives such as the “Heads Up: Concussion in Youth Sports” program run by the Center for Disease Control and Prevention have been developed to raise awareness regarding concussion injuries. These programs target not only athletes themselves but also include coaches, medical professionals, and parents to ensure that all individuals involved in sports, be it directly or peripherally, obtain the education required to prevent, correctly diagnose, and treat concussion. They are a testament to how elementary our understanding of concussion continues to be. They also demonstrate that misinformation and lack of awareness pose a significant obstacle to proper diagnosis and treatment. In this review, the authors discuss concussion both as a medical challenge and as a public health concern. The authors examine the definition as well as diagnostic criteria that have been agreed on during the Third International Conference on Concussion in Sport in Zurich 2008. Furthermore, current options and limitations in preventing and treating concussion are reviewed. Finally, the 2 most commonly used standardized grading systems as well as guidelines for return to play are reviewed. Overall, this article will offer health care providers and members of the general public alike the current understanding of concussion.
Autonomy in Assisted Living: Employees’ Perspectives

This focused ethnography explores how employees in assisted living facilities give meaning to the term autonomy, a core value in the mission of assisted living facilities. In-depth interviews were conducted with managerial and front line staff in two assisted living facilities to understand their interpretation of the concept of autonomy and how they felt they enhance the autonomy of the residents. Four interrelated themes capturing the meaning of autonomy emerged from analysis of the interview data: (1) autonomy is synonymous with functional independence, (2) expectations of residents of assisted living are different from residents of nursing homes, (3) rehabilitation is a goal of assisted living, and (4) a tendency to intervene in the best interests of the residents. The implications of the findings are discussed in terms of their potential effect on residents.
Performance Analysis of Centralized and Partially Decentralized Co-Operative Networks

We consider cellular networks with co-operative clusters of neighboring base stations detecting multiple in-cluster users subject to interference from out-of-cluster users. We assume that the base stations, equipped with multiple antennas, are connected to a central processor in each cluster. For such a network, we first consider centralized processing where all the in-cluster user signals are sent to the central processor for linear minimum mean squared error (LMMSE) estimation. Next, we consider partially decentralized processing where the in-cluster user signals are locally estimated at each base station, and the local estimates are combined at the central processor. For both processing architectures, we derive new expressions for the achievable rate of an in-cluster user when the channels between the users and base stations are subject to independent Rayleigh fading and distance-dependent path loss. The solutions are based on accurate approximations we derive for the characteristic function (CF) and the probability density function (PDF) of each user's signal-to-interference-plus-noise ratios (SINRs). Numerical examples highlight the accuracy of the analysis and compare the performance of centralized and partially decentralized processing under different cluster scenarios.
Predictors of Medication Errors Among Elderly Hospitalized Patients

Medication errors are a serious safety concern and most errors are preventable. A retrospective study design was employed to describe medication errors experienced during 10187 hospitalizations of elderly patients admitted to a Midwest teaching hospital between July 1, 1998 and December 31, 2001 and to determine the factors predictive of medication errors. The model considered patient characteristics, clinical conditions, interventions, and nursing unit characteristics. The dependent variable, medication error, was measured using a voluntary incident reporting system. There were 861 medication errors; 96% may have been preventable. Most errors were omissions errors (48.8%) and the source was administration (54%) or transcription errors (38%). Variables associated with a medication error included unique number of medications (polypharmacy), patient gender and race, RN staffing changes, medical and nursing interventions, and specific pharmacological agents. Further validation of this explanatory model and focused interventions may help decrease the incidence of medication errors. (Am J Med Qual 2008; 23:115-127)
Farmwork path planning for field coverage with minimum overlapping

This paper presents a path planning algorithm for a tractor to execute specific farmwork tasks requiring the complete coverage of a field while minimizing the overlapping between successive passages. The proposed method is based on the determination of a set of characteristic points from which a graph is defined. The covering trajectory is determined by means of a greedy algorithm associated to a heuristic and a cost function minimization which is used to determine the best Hamiltonian solution in the graph.
Power Allocation in Multiuser Parallel Gaussian Broadcast Channels With Common and Confidential Messages

We consider a broadcast communication over parallel channels, where the transmitter sends K + 1 messages: one common message to all users, and K confidential messages to each user, which need to be kept secret from all unintended users. We assume partial channel state information at the transmitter, stemming from noisy channel estimation. Our main goal is to design a power allocation algorithm in order to maximize the weighted sum rate of common and confidential messages under a total power constraint. The resulting problem for joint encoding across channels is formulated as the cascade of two problems, the inner min problem being discrete, and the outer max problem being convex. Thereby, efficient algorithms for this kind of optimization program can be used as solutions to our power allocation problem. For the special case K = 2, we provide an almost closed-form solution, where only two single variables must be optimized, e.g., through dichotomic searches. To reduce computational complexity, we propose three new algorithms, maximizing the weighted sum rate achievable by two suboptimal schemes that perform per-user and per-channel encoding. By numerical results, we assess the performance of all proposed algorithms as a function of different system parameters.
An ice age recorded in the polar deposits of Mars

Evidence for ice ages on Mars Models predict that Mars should have undergone ice ages in the past, but evidence has been scant. Smith et al. used radar measurements from NASA's Mars Reconnaissance Orbiter to probe the planet's polar ice caps. Clear layers within the ice allowed them to calculate how much ice was deposited at different times. The results provide evidence for a recent ice age on Mars. Understanding the martian climate will help determine when the planet was habitable in the past, and how that changed, and may inform studies of climate change on Earth. Science, this issue p. 1075 Layers within Mars’ polar ice caps indicate previous ice ages on the planet and how its climate changed. Layered ice deposits at the poles of Mars record a detailed history of accumulation and erosion related to climate processes. Radar investigations measure these layers and provide evidence for climate changes such as ice advance and retreat. We present a detailed analysis of observational data showing that ~87,000 cubic kilometers of ice have accumulated at the poles since the end of the last ice age ~370,000 years ago; this volume is equivalent to a global layer of ~60 centimeters. The majority of the material accumulated at the north pole. These results provide both a means to understand the accumulation history of the polar deposits as related to orbital Milankovitch cycles and constraints for better determination of Mars’ past and future climates.
On Code Design for Joint Energy and Information Transfer

Harvesting energy from radio frequency signals along with transmitting data through them is appealing for different wireless communication scenarios, such as radio frequency identification (RFID) systems and implantable devices. In this paper, we propose a technique to design nonlinear codes for the use in such systems taking into account both energy transmission and error rate requirements. In particular, we propose using concatenation of a nonlinear trellis code (NLTC) with an outer low-density parity-check (LDPC) code. We design the NLTC based on maximization of its free distance. We give necessary and sufficient conditions for its catastrophicity; in order to avoid catastrophic codes, we connect each designed NLTC to a corresponding linear convolutional code allowing for the use of simpler conditions for verification. Furthermore, we use EXIT charts to design the outer LDPC code while fixing the inner NLTC. Via examples, we demonstrate that our designed codes operate at ~0.8 dB away from the information theoretic limits, and they outperform both regular LDPC codes and optimized irregular LDPC codes for additive white Gaussian noise (AWGN) channels. In addition, we show that the proposed scheme outperforms the reference schemes of concatenating LDPC codes with nonlinear memoryless mappers and using classical linear block codes in a time switching mode.
Exploring the advocacy needs of older people with mental health problems in the West Midlands

Advocacy has long been identified as a valuable mechanism for providing support to individuals who experience difficulties in accessing services and whose voices often remain unheard in decisions relating to meeting their individual needs. However, the advocacy needs of older people age 65 and over with mental health problems remains a relatively under‐researched area.This paper presents findings from a small study undertaken in partnership with Sandwell Advocacy, a voluntary sector organisation, and researchers from Coventry University in one local authority area in the West Midlands. The aims of the study were to explore the advocacy needs of people aged 65 years and over with mental health problems and to determine the current level of demand or need for advocacy among this user group. A key motivation for this study was to explore the ways in which advocacy could provide a ‘voice’ to those whose needs are often marginalised in both social care service provision and wider society.
Europe’s forest management did not mitigate climate warming

Europe's managed forests contribute to warming For most of the past 250 years, surprisingly it seems that Europe's managed forests have been a net source of carbon, contributing to climate warming rather than mitigating it. Naudts et al. reconstructed the history of forest management in Europe in the context of a land-atmosphere model. The release of carbon otherwise stored in litter, dead wood, and soil carbon pools in managed forests was one key factor contributing to climate warming. Second, the conversion of broadleaved forests to coniferous forests has changed the albedo and evapotranspiration of those forests, also leading to warming. Thus, climate change mitigation policies in Europe and elsewhere may need to consider changes in forest management. Science, this issue p. 597 Reconstruction of 250 years of forest management history shows that Europe’s managed forests have contributed to climate warming. Afforestation and forest management are considered to be key instruments in mitigating climate change. Here we show that since 1750, in spite of considerable afforestation, wood extraction has led to Europe’s forests accumulating a carbon debt of 3.1 petagrams of carbon. We found that afforestation is responsible for an increase of 0.12 watts per square meter in the radiative imbalance at the top of the atmosphere, whereas an increase of 0.12 kelvin in summertime atmospheric boundary layer temperature was mainly caused by species conversion. Thus, two and a half centuries of forest management in Europe have not cooled the climate. The political imperative to mitigate climate change through afforestation and forest management therefore risks failure, unless it is recognized that not all forestry contributes to climate change mitigation.
Integrating Psychiatric Nursing into a Baccalaureate Nursing Curriculum

Integrated nursing curricula are believed to carry the risk of diluting psychiatric nursing content and limiting nursing students’ opportunities to gain skills in providing care for patients with psychiatric disorders, especially patients with severe mental illnesses. Also, there is fear that integrating psychiatric nursing into more broad nursing content will reduce students’ interest in graduate psychiatric nursing study and thus endanger the specialty of psychiatric nursing. This report of a restructured baccalaureate nursing program that adopted the premise of holism—mental and physical health as united—presents a different view. Psychiatric nursing content was incorporated into classroom instruction over four semesters and, with the nursing theory of modeling and role-modeling as a guide, clinical experiences were planned for all students in primary, rehabilitative, or acute care settings. Psychiatric nursing did not disappear, as had been feared. It emerged less stigmatized, more accepted by the nonpsychiatric faculty, and enthusiastically received by the students.
Mass-dependent and -independent signature of Fe isotopes in magnetotactic bacteria

An isotope record of magnetic bacteria Microorganisms have shaped Earth's oceans and atmosphere over billions of years. Ancient microbes left very little direct morphological evidence of their existence in the rock record, thereby requiring geochemical clues for evidence of their activity. Amor et al. show that magnetotactic bacteria impart a distinct isotopic signature to their internal iron nanoparticles. Cultures of a modern magnetic bacterium fractionated 57Fe isotopes independent of their mass, in contrast to fractionation patterns often observed for other isotopes. Because this signature is not produced abiotically or by other iron-metabolizing bacteria, it could serve as a reliable biomarker of this ancient magnetic microbial lifestyle. Science, this issue p. 705 The iron isotope fractionation patterns of magnetotactic bacteria hint at a reliable biomarker of ancient microbes. Magnetotactic bacteria perform biomineralization of intracellular magnetite (Fe3O4) nanoparticles. Although they may be among the earliest microorganisms capable of biomineralization on Earth, identifying their activity in ancient sedimentary rocks remains challenging because of the lack of a reliable biosignature. We determined Fe isotope fractionations by the magnetotactic bacterium Magnetospirillum magneticum AMB-1. The AMB-1 strain produced magnetite strongly depleted in heavy Fe isotopes, by 1.5 to 2.5 per mil relative to the initial growth medium. Moreover, we observed mass-independent isotope fractionations in 57Fe during magnetite biomineralization but not in even Fe isotopes (54Fe, 56Fe, and 58Fe), highlighting a magnetic isotope effect. This Fe isotope anomaly provides a potential biosignature for the identification of magnetite produced by magnetotactic bacteria in the geological record.
Pulmonary neuroendocrine cells function as airway sensors to control lung immune response

Neuroendocrine cells as air sensors Liters of air pass through the lung every minute. Signals in the atmospheric environment are processed into physiological outputs, including the immune response. Branchfield et al. show that rare airway cells called pulmonary neuroendocrine cells (PNECs) sense and respond to airborne cues (see the Perspective by Whitsett and Morrisey). Inactivating Roundabout genes in mouse PNECs prevents normal PNEC clustering and causes an increase in the production of neuropeptides, which in turn trigger a heightened immune response. Thus PNECs, despite their rarity, are sensitive and effective rheostats on the airway wall that receive, interpret, and respond to environmental stimuli. Science, this issue p. 707; see also p. 662 Pulmonary neuroendocrine cells aggregate to form airway sensors and control the lung’s immune response. [Also see Perspective by Whitsett and Morrisey] The lung is constantly exposed to environmental atmospheric cues. How it senses and responds to these cues is poorly defined. Here, we show that Roundabout receptor (Robo) genes are expressed in pulmonary neuroendocrine cells (PNECs), a rare, innervated epithelial population. Robo inactivation in mouse lung results in an inability of PNECs to cluster into sensory organoids and triggers increased neuropeptide production upon exposure to air. Excess neuropeptides lead to an increase in immune infiltrates, which in turn remodel the matrix and irreversibly simplify the alveoli. We demonstrate in vivo that PNECs act as precise airway sensors that elicit immune responses via neuropeptides. These findings suggest that the PNEC and neuropeptide abnormalities documented in a wide array of pulmonary diseases may profoundly affect symptoms and progression.