Miracle-dz/UniFAR-FTUs huggingface dataset:
Evaluating the Value of the Respiratory Therapist: Where Is the Evidence? Focus on the Barnes-Jewish Hospital Experience

Currently, >20 million people in the United States have asthma, and approximately 15 million adults have been diagnosed with COPD, with approximately the same number not yet having been diagnosed with this condition. Moreover, the overall burden of respiratory diseases is still increasing, in part due to environmental factors, such as air pollution. At the same time, the number of patients requiring hospitalization as well as the number of individuals admitted to ICUs from emergency departments has been on the rise over the last decade. Because of the cost to the health-care system, the burden of respiratory diseases, hospitalizations, and ICU admissions also falls on society; it is paid for with tax dollars, higher health insurance rates, and lost productivity. Respiratory therapists (RTs) are in a unique position to influence health-care delivery in a number of settings that include acutely ill hospitalized patients and those with chronic conditions in ambulatory settings. Clinical studies have demonstrated the value of RTs in specific areas, including the performance of medical procedures, the development and implementation of protocols aimed at weaning patients from mechanical ventilation and providing lung-protective ventilation, optimal delivery of in-patient respiratory treatments, the application of disease management programs for COPD, and as part of rapid response teams. However, due to increasing scrutiny of health-care expenditures and limited resources, there is a growing need to document the impact of health-care providers in terms of clinical outcomes. As a profession, RTs should continue to describe the impact they have on patient outcomes and the value they bring to our health-care system. Promoting such investigative outcomes research, along with enhancing the professional aspects of the field of respiratory care, will ensure that the value of RTs does not go unappreciated.
What If Variable Annuity Policyholders with Guaranteed Lifelong Withdrawal Benefit Were Rational?

This article examines the lapse risk inherent to the guaranteed lifelong withdrawal benefit option embedded in a variable annuity product valuated from a pure derivatives perspective, that is, as a Bermudian option given to the policyholder. We assume rational behavior and quantify the potential impact of the lapse risk, defined as the difference between no lapse and optimal lapsing. We develop a sensitivity analysis that shows how the value of the product varies with the key parameters, and calculate the fair fee using Monte Carlo simulations. Empirical analyses are performed and numerical results are provided.
Control of ciliogenesis by FOR20, a novel centrosome and pericentriolar satellite protein

Cilia and flagella are evolutionary conserved organelles that generate fluid movement and locomotion, and play roles in chemosensation, mechanosensation and intracellular signalling. In complex organisms, cilia are highly diversified, which allows them to perform various functions; however, they retain a 9+0 or 9+2 microtubules structure connected to a basal body. Here, we describe FOR20 (FOP-related protein of 20 kDa), a previously uncharacterized and highly conserved protein that is required for normal formation of a primary cilium. FOR20 is found in PCM1-enriched pericentriolar satellites and centrosomes. FOR20 contains a Lis1-homology domain that promotes self-interaction and is required for its satellite localization. Inhibition of FOR20 expression in RPE1 cells decreases the percentage of ciliated cells and the length of the cilium on ciliated cells. It also modifies satellite distribution, as judged by PCM1 staining, and displaces PCM1 from a detergent-insoluble to a detergent-soluble fraction. The subcellular distribution of satellites is dependent on both microtubule integrity and molecular motor activities. Our results suggest that FOR20 could be involved in regulating the interaction of PCM1 satellites with microtubules and motors. The role of FOR20 in primary cilium formation could therefore be linked to its function in regulating pericentriolar satellites. A role for FOR20 at the basal body itself is also discussed.
Management of open fractures in pediatric patients: current teaching in Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs

The purpose of this study was to determine the method of treatment for open fractures in pediatric patients that is used and taught at academic orthopedic residency programs. A web-based survey was constructed and emailed to program directors of orthopedic residencies. Seventy programs out of a total of 140 surveyed programs responded. Data were tabulated and charts created in an Excel spreadsheet. Type I fractures were treated by most with a cephalosporin alone (97%) for less than 48 h (87%). Type II were treated by most programs with a cephalosporin alone with no aminoglycoside (84%) for less than 48 h (80%). Type IIIa were treated by most programs with a cephalosporin and an aminoglycoside (50%) for less than 48 h (60%). Type IIIb were treated by most programs with a cephalosporin and aminoglycoside (54%) for less than 48 h (53%). Type IIIc were also treated by most with a cephalosporin and an aminoglycoside (53%) for less than 48 h (51%). Wounds were closed by most responders for type I (90%), type II (86%) and type IIIa (50%) but not type IIIb (10%), and type IIIc (16%). For the programs responding to the pediatric section of the survey over half (53%) reported using a trauma room and 58% reported allowing residents to irrigate and debride wounds in the emergency room. In conclusion, for pediatric patients most orthopedic residencies use a cephalosporin alone for type I and type II open fractures with an aminoglycoside added for type III fractures. Treatment is typically for 48 h or less. Delay of 6 h seems to be accepted for type I and type II fractures but not type III fractures.
Scoping a flexible deployment framework using adversarial scenario analysis

To aid with Australian Army deployment planning we propose a flexible deployment concept developed using adversarial scenario analysis. This novel technique begins with a simple scenario and a core strategy. Iteratively, the scenario is modified to defeat the existing strategy and the strategy is altered to cope. This process results in the deployed force being structured as a set of cohesive functional teams that provide emotional support to their members, suffer stress at different rates and are able to be rotated independently of each other. An accumulator model of deployment stress is assumed and continuous time-in-theatre is minimised subject to realistic constraints. The concept is focused on stable long term commitments to small wars, insurgencies and peacekeeping operations within four time-zones of the deployment source and with forward bases near usable airfields. To plan specific deployments, the same process could be expanded upon with appropriate detail.
X-TCP: a cross layer approach for TCP uplink flows in mmwave networks

Millimeter wave frequencies will likely be part of the fifth generation of mobile networks and of the 3GPP New Radio (NR) standard. MmWave communication indeed provides a very large bandwidth, thus an increased cell throughput, but how to exploit these resources at the higher layers is still an open research question. A very relevant issue is the high variability of the channel, caused by the blockage from obstacles and the human body. This affects the design of congestion control mechanisms at the transport layer, and state-of-the-art TCP schemes such as TCP CUBIC present suboptimal performance. In this paper, we present a cross layer approach for uplink flows that adjusts the congestion window of TCP at the mobile equipment side using an estimation of the available data rate at the mmWave physical layer, based on the actual resource allocation and on the Signal to Interference plus Noise Ratio. We show that this approach reduces the latency, avoiding to fill the buffers in the cellular stack, and has a quicker recovery time after RTO events than several other TCP congestion control algorithms.
Seroprevalence and clinical characteristics of viral hepatitis in transfusion-dependent thalassemia and hemophilia patients

Background/Aims Transfusion dependent subjects are at a great risk of viral hepatitis infection. We aimed to evaluate the prevalence and factors associated with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among transfusion-dependent patients in Taiwan. Methods A total of 140 patients (67 thalassemic patients, 70 hemophilic patients, two patients with hereditary spherocytosis and one patient with von Willebrand disease) were prospectively enrolled to evaluate the prevalence and factors associated with viral hepatitis and spontaneous HCV clearance. All patients were tested for HBV and HCV serology and virology. Two consecutive serum samples, at least 1 year apart, were collected to clarify HCV seroclearance. Results The seropositivity rate of hepatitis B surface antigen (HBsAg), HCV antibody (anti-HCV), and both HBsAg/anti-HCV were 6.4%, 45.7% and 5%, respectively. Logistic regression analysis of factors associated with anti-HCV seropositivity included age (odds ratio/95% confidence interval [OR/CI]: 1.12/1.07–1.18, P<0.001), serum alanine aminotransferase (ALT) (OR/CI: 1.04/1.02–1.06, P<0.001) and platelet counts (OR/CI: 0.995/0.991–0.998, P = 0.002). Age was the only factor independently associated with HBsAg seropositivity (OR/CI: 1.08/1.02–1.14.4, P = 0.007). Compared to patients born before 1992, the seroprevalence of HCV among thalassemic patients decreased dramatically in those born after 1992 (46.0% vs. 11.8%, p = 0.012). The seroprevalence of HCV among hemophilic patients also decreased significantly when comparing patients born before 1987 to those born after 1987 (79.5% vs. 11.5%, p<0.001). Similarly, the seroprevalence of HBV decreased significantly in the post-vaccination cohort compared to its counterpart (13.1%, vs. 1.3%, p = 0.005). The spontaneous clearance of HCV was observed in 25.4% (15/59) of patients, and ALT was the only factor associated with it (OR/CI 0.98/0.96–1.00, P = 0.02). Conclusions Both HBV and HCV infections are prevalent among transfusion-dependent thalassemic and hemophilic patients in Taiwan. Nevertheless, seroprevalence decreased significantly and dramatically for HCV after universal blood screening and for HBV after implementation of a universal mass vaccination program.
Bromocriptine use and the risk of valvular heart disease

It has been reported that patients on pergolide and carbergoline have an increased risk of developing valvular heart disease. It is uncertain if bromocriptine, an ergot‐derived dopamine agonist (DA) with partial 5‐HT2B activity, is associated with a similar risk. We assessed the frequency of valvular heart disease in Parkinson's disease (PD) patients on bromocriptine compared to pergolide and a control group of PD patients who had not been treated on any DA. Seventy‐two PD patients on bromocriptine, 21 patients on pergolide, and 47 control PD patients were recruited. Transthoracic echocardiographic studies were performed and reviewed by a blinded cardiologist. The risk for the bromocriptine group to develop any abnormal valvular regurgitation was 3.32 (adjusted OR, 95% CI: 1.11–9.92, P = 0.03) compared to controls, whereas the risk for the pergolide group was 3.66 (adjusted OR, 95% CI: 1.22–10.97, P = 0.02). When cumulative dose of bromocriptine was analyzed by quartiles, patients with a greater exposure to bromocriptine had significantly higher risk of developing both mild and moderate‐severe regurgitations (P for trend, 0.005 and 0.019, respectively). This study demonstrated that bromocriptine use was associated with an increased risk of developing valvular heart disease, which occurred in a cumulative dose‐dependent manner. © 2008 Movement Disorder Society
Microbial Leakage of Gutta-percha and Resilon™ Root Canal Filling Material: A Comparative Study Using a new Homogeneous Assay for Sequence Detection

The sealing ability of gutta-percha/sealer root canal filling was compared to a new thermoplastic synthetic polymer-based obturation material (Resilon TM), using a microleakage model and a new sequence detection assay One Cut Event AmplificatioN (OCEANTM). Eighty-eight extracted human teeth, shaped with K-Files and the ProTaper Technique, were randomly assigned to four groups (n = 22) and obturated in the apical 5 mm. Group R were obturated with the Resilon/Epiphany technique; group GP were obturated with gutta-percha and Zinc oxide eugenoe sealer; group RCH and GPCH received calcium hydroxide intracanal medication before being obturated. Sterilized specimens were inoculated with Enterococcus faecalis and incubated in sterile medium for 47 days. DNA extracted from the specimens was amplified by PCR and then identified by the OCEAN technique. Samples obturated with Resilon root canal filling material showed a greater number of microleakage events than the other groups (p = 0.036). Calcium hydroxide medication did not have a relevant impact on the quality of the apical seal (p = 0.044).
Pharmacokinetics of centhaquin citrate in a rat model

Centhaquin citrate is a novel agent being developed for use in the treatment of haemorrhagic shock. It has decreased mortality in rat, rabbit and pig models of hypovolaemic shock compared to hypertonic saline and lactated Ringer's resuscitation. The pharmacokinetics of centhaquin citrate have not been described to date.
TREATMENT DECISION MAKING IN MATURE ADULTS: GENDER DIFFERENCES

Studies have shown that women are less likely to receive several specific medical interventions, including organ transplantation, cardiac diagnostic studies, and coronary artery bypass surgery. This study investigates the hypothesis that this inequity may be explained by gender differences in treatment decisions made by older adults. A self-report questionnaire using hypothetical situations, treatment choices, and influencing factors was designed based on literature review and interviews with key informants. The questionnaire was administered to 250 nonpatient adults over the age of 50 in urban and rural settings in Ontario, Canada. Results revealed no significant gender differences in hypothetical treatment decisions made by patients nor in the factors affecting those decisions. In the absence of evidence that patient choice accounts for gender differences in utilization rates, physicians need to carefully examine their assumptions about patient preference and gender in the provision of specific interventions to male and female patients.
Changes in socio-economic and demographic composition of Greek football spectators

Abstract Contemporary changes throughout Europe have deeply influenced Greece in many fields such as the economy (agriculture, cattle-raising, industry), politics, communications, sports and particularly football, which is considered to be the most famous and most popular sport in Greece. At the same time, many changes have occurred in Greek society, based on local factors. Sport as a societal subsystem reflects all the changes which have occurred in Greek society during recent decades. The socio-economic composition and the demographic characteristics of football fans have rapidly changed. The major aim of the study was to discover how the Greek football spectators’ behavioural patterns have changed and how the main social, political and economic changes in wider Greek society have affected this process. The methods which have been used for the collection of qualitative data were in-depth interviews with media experts, managers and coaches of football teams, and analysis of documents. Quantitative data were collected through questionnaires answered by football spectators before, during and after matches of the premier league in Greece. In this article, the results related to the Greek football spectators’ major social and demographic characteristics and their opinions on the occurrence of deviancy in Greek football stadia are presented.
Effect of delayed‐onset muscle soreness on muscle recovery after a fatiguing isometric contraction

An increase to above‐baseline levels of electromyography (EMG) mean power spectral frequency (MPF) has been observed previously during muscle recovery following fatiguing contractions and has been explained by membrane hyperpolarization due to increased activation of the Na+–K+ pump. It is hypothesized that this membrane mechanism is impaired by muscle fiber damage following eccentric exercise. Thus, the aim of the study was to investigate surface EMG signal characteristics during recovery from fatigue after eccentric exercise. Ten healthy subjects performed sustained isometric knee extensions at 40% of the maximal torque (MVC) until task failure before, immediately after and 24 and 48 h after eccentric exercise. Bipolar surface EMG signals were recorded from six locations over the quadriceps during the sustained isometric contraction and during 3‐s long contractions at 40% MVC separated by 1‐min intervals for 15 min (recovery). Before the eccentric exercise, MPF of EMG signals increased to values above baseline during recovery from the fatiguing isometric contraction (P<0.001), whereas immediately after and 24 and 48 h after the eccentric task, MPF was lower than baseline during the entire recovery period (P<0.01). In conclusion, delayed‐onset muscle soreness abolished the supranormal increase in EMG MPF following recovery from fatigue.
Inflammatory Bowel Disease Promotes Venous Thrombosis Earlier in Life

Background: Patients with inflammatory bowel disease (IBD) may be at increased risk of having venous thromboembolism. Methods: Medical records from 1253 IBD patients attending hospital care during the years 1987-97 were studied. These patients were recruited from a population of 340,000 inhabitants. Patients with verified venous thrombosis were characterized clinically, and blood samples were examined for coagulopathy including analyses of antithrombin, plasminogen, protein C, protein S, factor V, and prothrombin mutations. As control groups we used 99 patients with verified venous thrombosis and no history of IBD and 288 volunteers with no history of thrombosis. Results: The incidence of venous thrombosis was 1.5/1000 IBD patients per year, which is comparable to the background population. The mean age was significantly lower in IBD patients than in non-IBD patients (53 versus 64 years, P = 0.0225). We found one patient with antithrombin deficiency but none with protein C, protein S, or plasminogen deficiency. Factor V mutation was as prevalent in IBD patients with thrombosis as in thrombotic non-IBD patients (27% versus 28%) and 3.0 times (95% confidence interval, 0.8-11.9) more frequent in IBD patients with thrombosis than in healthy controls. Prothrombin mutation was not detected in IBD patients with venous thrombosis. Conclusion: We found no increased incidence of venous thrombosis in IBD patients compared with a background population. However, IBD patients had venous thrombosis earlier in life than non-IBD patients. Although factor V mutation may contribute to thrombosis, IBD acts as a trigger through mechanisms that still remain unexplained.
Cytogenetic characteristics of therapy‐related acute nonlymphocytic leukaemia, preleukaemia and acute myeloproliferative syndrome: correlation with clinical data for 61 consecutive cases

Cytogenetic studies were performed on a new series of 23 patients with therapy‐related acute non‐lymphocytic leukaemia, preleukaemia or an acute myeloproliferative syndrome. In our total series of now 61 cases studied by chromosome banding techniques, at least one of the abnormalities – 7, 5q –, 7q– or – 5 or some related unbalanced translocations, primarily – 7, +t(1q7p), was observed in 40 patients. The critical region for the deletions of chromosome no. 5 comprises bands 5q22 to 5q33 and of chromosome no. 7 bands distal to 7q22. The third most frequently involved chromosome was no. 21, rearranged at band 21q22 in the three patients with 21q + and in one patient with 21q –. An i(21q) was observed in two patients, a –21 in four patients and a –22, + t(21q22q) and a –5. –21, + t(5p21q) in one patient each. Other characteristic abnormalities included total loss or rearrangements of the short arm of chromosome no. 17, observed in nine patients. One patient had a –12, three others had rearrangements resulting in a partial or total loss of the short arm of chromosome no. 12. A 19q + with translocation to band 19q13 was observed in three cases, a – 18 in three cases and a 3p– in four cases. Thirty‐one patients with multiple chromosome aberrations experienced a significantly shorter survival as compared to 13 patients with a normal karyotype (P= 0·02) and 17 patients with one single chromosome aberration (P<0·01).
Introduction: crisis and renewal of contemporary urban planning

ABSTRACT Since 2008, cities in the Western world have been under stress due to pressures that have been labelled as the 'crisis' and its 'consequences'. Despite the fact that several years have passed, international planning debates have not fully highlighted what we have learned from this challenging phase. How and to what extent have these stresses and changes affected planning activities and knowledge? How are current reforms of national and local planning systems influenced by the crisis beyond its discursive appearance? How can we cultivate critical approaches and how can we pragmatically translate critical knowledge into practice during and after a time of crisis? This article outlines the broad questions that were addressed, under different perspectives, by the authors in the theme issue. The article serves as an introduction by, first, briefly reviewing relevant positions in the planning and urban studies debates and explaining the relationships between urban planning and the crisis; second, by presenting the papers in the issue and highlighting planners’ roles, responsibilities and relevance in the crisis and in subsequent phases; and third, by calling for closer attention to the current signals of crisis in planning theory and practice, as well as by considering new responses derived from research.
Transcatheter left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation: results from the Belgian registry.

AIMS This study aimed to assess the safety and efficacy at midterm follow-up of left atrial appendage occlusion (LAAO) using different devices, in real life in Belgium. METHODS AND RESULTS Between June 2009 and November 2016, 457 consecutive patients (63% male, 75±12 yrs, CHA2DS2-VASc 4±0.6, HAS-BLED 3.5±0.7) undergoing LAAO were included. Technical success was 97.1%. There were 19 periprocedural major adverse events (4.1%) including three deaths (0.6%), nine tamponades (1.9%), four major bleedings (0.8%) and two device embolisations (0.4%). Among patients successfully implanted having a complete follow-up (672 patient-years, median follow-up 370 days), the actual annual stroke rate was 1.2%, lower than the expected stroke risk of 4% (70% reduction). The observed bleeding rate was 2%, while the calculated risk was 3.7% (46% reduction). Kaplan-Meier analysis showed a similar overall survival (93±2% and 87±3% versus 91±3% and 87±4%; p=0.35) and event-free survival (92±2% and 84±3% versus 88±3% and 80±5%; p=0.17) at one and two years, for the ACP/Amulet versus the WATCHMAN groups of patients, respectively. CONCLUSIONS The data from the Belgian left atrial appendage occlusion registry suggest that the procedure is effective and relatively safe in a real-world setting, using either the WATCHMAN or the ACP/Amulet device.