Miracle-dz/UniFAR-FTUs huggingface dataset:
Nonurgent Use of a Pediatric Emergency Department: A Preliminary Qualitative Study

Objectives: To understand patterns of decision making among families presenting to a pediatric emergency department (ED) for nonacute care and to understand pediatric ED staff responses. Methods: Cross-sectional qualitative study using in-depth interviews, direct observations, and nonidentifying demographic data. Results: Eleven percent of visits made during the study period were identified as nonacute. All were made by families from low-income areas. Three main themes emerged: (1) most families had been referred by their primary care providers; (2) the complexity of living in low-income areas makes the ED a choice of convenience for these stressed families; and (3) mistrust of primary health services was not identified by our respondents as a motivator for ED utilization, in contrast with other published data. Two themes emerged from ED staff: (1) actual nonurgent visit rates were lower than staff estimates; and (2) these visits produced frustration among staff members, although their degrees of insight and understanding of factors motivating these visits were variable. Conclusions: In this setting, nonacute visits occurred with lower than perceived frequency and caused disproportionate frustration among staff and families. These visits appear to be driven more by consequences of system design and structure than by family members' decision making. Mistrust of primary care services was not a strong family decision-making factor; the study's setting may have limited its ability to capture such data. Recommended system changes to lower barriers to primary care include expanded office hours, subsidized staffing for offices in medically underserved areas, and lowering barriers to sick care.
Caregivers' reasons for nursing home placement: clues for improving discussions with families prior to the transition.

PURPOSE This study identifies the relative importance of reasons for institutionalization endorsed by caregivers of patients with dementia; examines the relationship between caregivers' reasons for institutionalization and indicators of caregiver and patient physical and emotional functioning measured in the prior year; and compares, on these indicators, caregivers who institutionalized their care recipients with caregivers who did not. DESIGN AND METHODS Participants were 2,200 caregivers from the National Longitudinal Caregiver Study, including 580 who institutionalized their care recipient during the 3-year interval. Caregivers' reason(s) for institutionalization were examined and correlated with indicators of caregiver and patient physical and emotional functioning. These indicators were used in a proportional hazards model to determine independent predictors. RESULTS Caregivers' reasons for placement included (a) the need for more skilled care (65%); (b) the caregivers' health (49%); (c) the patients' dementia-related behaviors (46%); and (d) the need for more assistance (23%). Each of these reasons was significantly associated with indicators in the prior year's survey. This study uniquely demonstrates that caregiving task demand and a single-item measure of caregiver life satisfaction significantly predict placement. IMPLICATIONS These findings emphasize that caregivers' reasons have valid underpinnings and that institutionalization of dementia patients results from caregiver and patient factors evident in the year prior to placement. In routine office visits, caregivers should be systematically screened; accounts of low life satisfaction, dementia problem behaviors, or high task demand should cue clinicians that discussions of nursing home placement would be timely and appropriate.
Epidemiology of pelvic inflammatory disease in parous women with special reference to intrauterine device use

Summary. Up to the end of 1989, 206 parous women in the Oxford Family Planning Association contraceptive study had been referred to hospital with a first episode of pelvic inflammatory disease. Of these, 65 suffered from definite disease described as acute, 81 from definite disease not described as acute and 60 from ‘other disease’. Considering all forms of disease together, referral was less common in those aged 25–29 and in those aged 45 or more than in those aged 30–44. Referral was more common in those of low social class, in those who smoked and in those who married young. All these factors were taken into account in analyses considering the effects of contraceptive methods. In these analyses, women currently using the contraceptive pill, the diaphragm, the sheath, female sterilization or an intrauterine device (IUCD) were compared with those currently using other methods or no method of contraception. IUCD ex‐users were, however, placed in a separate category, irrespective of their current method of contraception. The relative risks obtained in these analyses, with 95% CI, were as follows: contraceptive pill 0.5 (0.2‐0.9), diaphragm 0.6 (0.3‐1.2), sheath 1.2 (0.6‐2.4), female sterilization 0.7 (0.3‐1.5), non‐medicated IUCD 3.3 (2.3‐5.0), medicated IUCD 1.8 (0.8‐4.0), IUCD ex‐users 1.3 (0.7‐2.3). These data suggest that oral contraceptives, the diaphragm and female sterilization protect against pelvic inflammatory disease and that IUCDs increase the risk. Medicated devices, however, appear to carry only about half the risk of non‐medicated devices, and the elevation of risk in IUCD ex‐users appears to be small. Special analyses examined the risk associated with use of a Dalkon Shield. Among women currently using an IUCD (of any kind), those who had used a Dalkon Shield (at any time) had nearly five times as great a risk of hospital referral for pelvic inflammatory disease as those who had never used a Dalkon Shield (relative risk 4.7, 95% CI 2.1‐9.0).
Decreased prevalence of asymptomatic choroidal metastasis in disseminated breast and lung cancer: argument against screening

Aim: To determine the frequency of visually asymptomatic choroidal metastases in patients with disseminated breast and lung carcinomas in order to establish optimal patient management policies. Methods: All patients with confirmed metastatic disease treated in our institution between January 2002 and December 2003 were invited to undergo a funduscopic examination and a B-scan ultrasound evaluation. Results: Of the 169 study participants, 77 had breast cancer (64 with metastases in one organ and 13 with multiple-organ involvement) and 92 had lung cancer (85 with metastases in one organ and 7 with multiple-organ involvement). No patient with metastatic breast cancer and two patients with metastatic lung disease (each with multiple-organ involvement) were found to have choroidal metastases. The choroidal metastases were detected by both the funduscopic and ultrasound examinations. Conclusions: The 2.17% incidence of choroidal metastasis in disseminated lung cancer and the 0% incidence in disseminated breast cancer speaks against the practicality of screening for early detection of choroidal metastasis among these patients, even though it would lead to early implementation of appropriate, often vision saving, therapeutic management. Its low incidence probably testifies to progress achieved by enhanced systemic oncological treatment policies that have been introduced into routine patient management over the past few years.
Long-term evaluation of clinical performance of direct-bonded brackets: an epidemiologic survey.

AIM The objective of the current epidemiologic study was to investigate characteristics associated with bracket failure in bonded brackets. MATERIALS AND METHODS A retrospective study on data of 144 patients treated during 2009 to 2012 was done. Baseline data including age, gender, malocclusion, bite type and debonding incidences per teeth were retrieved. ANOVA analysis and t-test were used to evaluate the data. RESULTS Second premolar teeth had significantly higher debonding incidences. Patients' age was negatively correlated with debonding incidences. No difference was observed for various types of malocclusion (class I, II and III), arch side (right or left) or arch location (upper or lower). However, deep bite patients had significantly higher failure incidents. CONCLUSION For a total of 144 patients with 2,524 bonded brackets, the overall failure rate was 7.8%. Deep bite was the only factor that was associated with higher bracket failure. The bracket failure incidents tend to decrease as patients age increase. CLINICAL SIGNIFICANCE Deep bite patients and also second premolar teeth seem to be especially prone to debonding incidents. Care must be taken to avoid premature contacts in deep bite patients. Also strict adherence to moisture control protocols when bonding second premolar teeth is recommended since these teeth are at increased risk for debonding.
Adjustment of antibiotic treatment according to the results of blood cultures leads to decreased antibiotic use and costs.

INTRODUCTION To avoid the use of unnecessary broad-spectrum antibiotics, empirical therapy of bacteraemia should be adjusted according to the results of blood cultures. OBJECTIVES To investigate whether the results of blood cultures led to changes in antibiotic use and costs in a tertiary-care university hospital in Norway. METHODS Medical records from all patients with positive blood cultures in 2001 were analysed retrospectively. Factors predisposing to infections, results of blood cultures, antibiotic use and outcome were recorded. The influence of blood culture results on antibiotic treatment and costs were analysed. RESULTS The antibiotic use in 226 episodes of bacteraemia in 214 patients was analysed. According to the guidelines empirical antibiotic treatment should be adjusted in 166 episodes. Antibiotic use was adjusted in 146 (88%) of these 166 episodes, which led to a narrowing of therapy in 118 (80%) episodes. Compared with empirical therapy there was a 22% reduction in the number of antibiotics. Adjustment of therapy was more often performed in Gram-negative bacteraemia and polymicrobial cultures than in Gram-positive bacteraemia. In bacteraemia caused by ampicillin-resistant Escherichia coli, ampicillin was mostly replaced by ciprofloxacin. The cost for 7 days adjusted therapy in 146 episodes was euro19,800 (23%) less than for 7 days of empirical therapy. CONCLUSIONS Adjustment of antibiotic therapy according to the results of blood cultures led to a reduction in the number of antibiotics and a narrowing of antibiotic therapy. The costs for antibiotics decreased.
Role of Physics Lecture Demonstrations in Conceptual Learning.

Previous research suggests that students’ prior knowledge can interfere with how they observe and remember lecture demonstrations. We measured students’ prior knowledge in introductory mechanics and electricity and magnetism at two large universities. Students were then asked to predict the outcome of lecture demonstrations. We compare students’ predictions before having seen the demonstration to what they report having seen both right after the demonstration and several weeks later. We report four main findings. First, roughly one out of every five observations of a demonstration is inconsistent with the actual outcome. Second, students who understand the underlying concepts before observing the demonstration are more likely to observe it and remember it correctly. Third, students are roughly 20% (23%) more likely to observe a demonstration correctly if they predict the outcome first, regardless of whether the prediction is correct or not. Last, conceptual learning is contingent on the student making a correct observation. This study represents an initial step towards understanding the disconnect reported between demonstrations and student learning.
The Order of the Dorian Phylai

A CONSTANT feature of the Greek polis was the organization of the citizen population by systems of phylai, or tribes, and various constituent subdivisions. Collectively termed the "tribal organization," these units functioned as the apparatus for participation in civic affairs. Through the phylai, responsibilities and privileges could be distributed in such a way that, theoretically at least, no one individual or group might receive more or less than its share. Procedurally, however, the matter could not rest here, since, given the involvement of the several phylai, there still remained the question of precedence. In what order would the phylai stand in the phalanx? Be named in a list? Hold a magistracy? Preside over the Council? Where adequate documentation is available, it is clear that such questions were sometimes resolved by reference to an official tribal order. Whether the phylai participated simultaneously as a group, or serially over a period of time, the official order made for a regular and equitable procedure. It is the purpose of the present article to show that a tribal order, unique in form but comparable in principle to attested instances, was generally applied to the traditional tribal organization of Dorian states: Dymanes, Hylleis, and Pamphyloi.
Growth Factor Receptor‐Bound Protein 10‐Mediated Negative Regulation of the Insulin‐Like Growth Factor‐1 Receptor‐Activated Signalling Pathway Results in Cognitive Disorder in Diabetic Rats

Growth factor receptor‐bound protein 10 (Grb10) is a Src homology 2 domain‐containing protein and one of the binding partners for several transmembrane tyrosine kinase receptors, including insulin receptor (IR) and insulin‐like growth factor‐1 receptor (IGF1‐R). The hippocampus, which is critical for cognitive functions, is one of the main distribution areas of Grb10 in the central nervous system. In recent years, diabetic encephalopathy has been defined as a third type of diabetes and the IGF1‐IR pathway was shown to be critical for the neuropathogenic process of cognitive disorder in diabetes. However, the role of endogenous Grb10 in regulating the IGF1‐IR pathway and neurobehavioural changes is not explicit. The present study aimed to determine the in vivo function of endogenous Grb10 in diabetic encephalopathy and the underlying mechanisms. Using stereotaxic surgical techniques and lentiviral vectors expressing specific short hairpin RNA, we could steadily knockdown Grb10 expression in the hippocampus. More importantly, we demonstrated that hippocampus‐specific modulation of Grb10 protein levels led to a prominent remission of cognitive disorder, including improvements in both ultrastructural pathology and abnormal neurobehavioural changes. Our findings indicate that endogenous overexpression of Grb10 functions as a suppressor of the IGF1‐IR pathway, which may represent an important mechanism for regulating cognitive disorder in diabetes.
Changes in the prevalence of hypothyroidism: the HUNT Study in Norway.

OBJECTIVE Untreated hypothyroidism is common in iodine-replete areas. Frequent thyroid function testing and use of levothyroxine treatment for subclinical hypothyroidism suggest that the prevalence may have decreased. Therefore, in this study, we examined changes in the prevalence of hypothyroidism in a Norwegian county from 1995-1997 to 2006-2008. DESIGN Population surveys of 33,917 individuals in 1995-1997 and 49,180 individuals in 2006-2008 were carried out. METHODS We compared the prevalence of untreated overt, untreated subclinical, and treated hypothyroidism between 1995-1997 and 2006-2008. RESULTS The prevalence of untreated overt hypothyroidism among women decreased by 84% from 1995-1997 (0.75%) to 2006-2008 (0.12%) (prevalence ratio (PR) 0.16; 95% CI 0.10-0.26). The corresponding decrease among men was 43% from 0.21 to 0.12% (PR 0.57; 95% CI 0.28-1.16). The prevalence of untreated subclinical hypothyroidism decreased by 64% from 3.0 to 1.1% in women (PR 0.36; 95% CI 0.31-0.42) and decreased by 54% from 2.1 to 1.0% in men (PR 0.46; 95% CI 0.38-0.56). Conversely, the prevalence of treated hypothyroidism among women increased by 60% from 5.0 to 8.0% (PR 1.60, 95% CI 1.50-1.71), and the corresponding prevalence in men doubled from 1.0 to 2.0% (PR 1.96; 95% CI 1.59-2.41). The prevalence of any form of hypothyroidism remained essentially similar at 9% in women and 3% in men. CONCLUSIONS The prevalence of untreated hypothyroidism in this Norwegian county decreased strongly from 1995-1997 to 2006-2008. The findings suggest that the prevalence of untreated hypothyroidism in populations with easy access to thyroid function testing and levothyroxine treatment may now be low.
Prolonged cold preservation augments vascular injury independent of renal transplant immunogenicity and function.

BACKGROUND While prolonged cold ischemia has detrimental effects on graft survival, the mechanisms remain unclear. We tested whether or not cold preservation enhances intragraft inflammatory responses and vascular injury. METHODS Rat renal grafts were cold preserved in University of Wisconsin solution for 2, 4, 6, 12, 24, and 48 hours, and then transplanted into syngeneic recipients and harvested after 24 hours. Frozen sections were examined histologically and stained for vascular cellular adhesion molecule-1 (VCAM-1), platelet-endothelial cell adhesion molecule-1 (PECAM-1), major histocompatibility complex (MHC) class II, tissue factor, leukocyte function associated molecule-1 (LFA-1), very late antigen-4 (VLA-4), as well as for inflammatory cells. RESULTS Function did not differ between isografts preserved for shorter (2 to 6 hours) or longer times (12 to 24 hours). Neutrophil influx and that of LFA-1-positive cells showed similar increases in all groups. Compared with short preservation groups, the long preserved grafts had more VLA-4-positive ED-1+ monocytic infiltrates adjacent to vessels expressing VCAM-1 (P < or = 0.001). Increased preservation duration had no effect on infiltration with recipient ED-2+ macrophages, MHC class II-positive cells, or dendritic cells. Decreased color intensity and continuity of PECAM-1 staining indicated loss of endothelial integrity in grafts preserved for longer than six hours. Intensity in VCAM-1 staining increased progressively in grafts preserved for more than six hours and was localized predominantly on the endothelium of elastic vessels. Endothelial cells, vascular smooth muscle cells, and monocytes expressed increasingly more tissue factor in grafts preserved for more than six hours, revealing enhanced intragraft procoagulant capacity. Furthermore, grafts with preservation times of more than six hours developed more severe vascular endothelial injury and worse tubular necrosis scores (P < or = 0.001) compared with grafts with shorter preservation times. CONCLUSIONS Because of the prominent vascular injury, strategies for endothelial protection should be attempted in grafts with long preservation times in clinical renal transplantation.
Three dimensional musculoskeletal modelling of the seated biceps curl resistance training exercise

The aim of this study was to evaluate the benefits and limitations of using three dimensional (3D) musculoskeletal modelling (LifeModeler™) in assessing the safety and efficacy of exercising on a seated biceps curl resistance training machine. Three anthropometric cases were studied, representing a 5th percentile female, 50th percentile and 95th percentile male. Results indicated that the LifeModeler™ default model was not adequate to solve the forward dynamics simulations. Therefore adjustments had to be made to the default model to successfully complete the forward dynamics simulations. The software was able to sufficiently highlight the shortcomings of the biceps curl machine's engineered adjustability in relation to the anthropometric dimensions of the studied cases, as the 5th percentile female could not be accommodated suitably on the machine. High lumbar spine anterior/posterior shear forces for all anthropometric cases and maximum muscle tensions for the female and 50th percentile male indicate that the seated biceps curl exercise may pose risks for injuries. To conclude, it appears that 3D musculoskeletal modelling can be used to evaluate resistance training equipment such as the seated biceps curl machine. However the limitations as indicated by this study must be taken into consideration, especially when using the default LifeModeler™ model.
Plastid Phylogenomics Resolve Deep Relationships among Eupolypod II Ferns with Rapid Radiation and Rate Heterogeneity

Abstract The eupolypods II ferns represent a classic case of evolutionary radiation and, simultaneously, exhibit high substitution rate heterogeneity. These factors have been proposed to contribute to the contentious resolutions among clades within this fern group in multilocus phylogenetic studies. We investigated the deep phylogenetic relationships of eupolypod II ferns by sampling all major families and using 40 plastid genomes, or plastomes, of which 33 were newly sequenced with next-generation sequencing technology. We performed model-based analyses to evaluate the diversity of molecular evolutionary rates for these ferns. Our plastome data, with more than 26,000 informative characters, yielded good resolution for deep relationships within eupolypods II and unambiguously clarified the position of Rhachidosoraceae and the monophyly of Athyriaceae. Results of rate heterogeneity analysis revealed approximately 33 significant rate shifts in eupolypod II ferns, with the most heterogeneous rates (both accelerations and decelerations) occurring in two phylogenetically difficult lineages, that is, the Rhachidosoraceae–Aspleniaceae and Athyriaceae clades. These observations support the hypothesis that rate heterogeneity has previously constrained the deep phylogenetic resolution in eupolypods II. According to the plastome data, we propose that 14 chloroplast markers are particularly phylogenetically informative for eupolypods II both at the familial and generic levels. Our study demonstrates the power of a character-rich plastome data set and high-throughput sequencing for resolving the recalcitrant lineages, which have undergone rapid evolutionary radiation and dramatic changes in substitution rates.
The Decapod Crustacean Circulatory System: A Case That Is neither Open nor Closed

Historically, the decapod crustacean circulatory system has been classed as open. However, recent work on the blue crab, Callinectes sapidus, suggests the circulatory system may be more complex than previously described. Corrosion casting techniques were refined and used to map the circulatory system of a variety of crab species (order: Decapoda; family: Cancridae) to determine if the complexity observed in the blue crab was present in other species. Seven arteries arose from the single chambered heart. The anterior aorta, the paired anterolateral arteries, and the paired hepatic arteries exited from the anterior aspect of the heart. The small-diameter posterior aorta exited posteriorly from the heart. Exiting from the ventral surface of the heart, the sternal artery branched to supply the legs and mouthparts of the crab. These arteries were more complex than previously described, with arterioles perfusing all areas of the body. The arterioles split into fine capillary-like vessels. Most of these capillaries were blind ending. However, in several areas (antennal gland, supraesophageal ganglion) complete capillary beds were present. After passing through the capillary-like vessels, blood drained into a series of sinuses. However, rather than being arbitrary spaces as previously described, scanning electron micrographs showed the sinuses to be distinct units. Most of the sinuses formed a series of flattened membrane-bound lacunae. This complexity may qualify the decapod crustacean circulatory system as one that is “partially closed” rather than open.