Miracle-dz/UniFAR-FTUs huggingface dataset:
The relationship of interictal epileptiform discharges to clinical epilepsy severity : A study of routine EEGs and review of the literature

Purpose—EEGs are widely used to detect interictal epileptiform discharges (IEDs) in patients with a known history of seizures. However, prior studies have not found a consistent association between the presence or frequency of IEDs and clinical epilepsy severity, possibly because of differences in subject characteristics and recording techniques. We sought to investigate this relationship in a population and setting reflective of the most common clinical usage. Methods—We analyzed EEGs and clinical records of all consenting patients with a history of at least two presumed focal-onset seizures who presented for routine EEG recording over one year’s time in an academic neurophysiology laboratory (n = 129). Results—Despite adequate statistical power, we did not find an association between the presence or absence of IEDs or IED frequency and the most recently determined seizure frequency (median 4 per year). A higher IED incidence was seen in subjects with longer epilepsy duration (p = 0.04). Neither IED incidence nor frequency (median 10.0 per hour) correlated with age or antiepileptic drug use. Conclusions—Our results differ from those of some prior studies, most of which focused on more narrow subject populations, suggesting that the patient’s clinical circumstances must be taken into account before assuming the utility of IEDs on routine EEG in predicting epilepsy severity.
The Impact of Brand trust, Self-image Congruence and Usage Satisfaction toward Smartphone Repurchase Intention

The purpose of this study is to examine the subjective factors; brand trust, self-image congruence and usage satisfaction toward repeat purchase intention of smartphones among the Gen-Y consumers in Malaysia. A total of 182 respondents participated in this research. Most of the respondents purchased a smartphone within the last 12 months and a large number of the respondents are active users of text messaging and smartphone applications. Results indicate that self-image congruence is the main antecedents for repeat purchase of smartphones. This is the followed by usage satisfaction as the second predictor and lastly would be brand trust. This paper provides some discussion and recommendations for practitioners.
The Effect of Online Word-of-Mouth on Risk Assessment for an Experience Service as Price Acceptability Changes

ABSTRACT The influence of online word-of-mouth (WOM) on risk assessments for an experience good, in the presence of different price acceptability levels, was examined through 12 online experiments using potential travelers presented with realistic information settings. Online WOM was found more influential than advertised price as a cue to risk perceptions. The perceived risk level was raised when positive and negative online WOM were present compared with when WOM was either absent or positive only. The negative effect of inconsistent online WOM on consumers' risk perceptions was found in all price conditions.
Product portfolio management over horizontal and vertical portfolios

The main objective of this study is to clarify the current challenges and preconditions relating to product portfolio management (PPM) and widen the PPM framework over horizontal and vertical portfolios, including a related governance model, strategic performance management and the PPM process. This study analyses comprehensively the current PPM literature and the relevant practices of 10 case companies representing business areas such as hardware (HW), software (SW) and Services. This study approaches PPM from a more comprehensive viewpoint as all product life cycle phases and product structure levels are not covered well in this context by the earlier literature. The principal results of this study involve revealing the need for a new PPM governance model including strategic targets, KPIs and the PPM process according to vertical and horizontal portfolios. The created PPM framework clarifies the strategic role of PPM in cross-functional analysis and decision making for commercial and technical portfolios. The role and the impact of strategic PPM have been further enhanced by positioning the PPM process on the level of other business processes. The created PPM framework enhances the collaboration between business and engineering teams. The managerial implications include the potential preconditions of clarifying the dynamic and active role of PPM at the level of other business processes. The findings can aid business managers in understanding PPM as an entity that has a role in managing the entire product portfolio and its renewal based on strategic performance measures over horizontal and vertical portfolios according to cross-functional governance bodies. This highlights the criticality of managing all items both in commercial and technical portfolios. The role of other business processes should be highly operational by executing product development, marketing and sales, delivery and care activities according to PPM decisions. The primary role of PPM should be active management of the entire product portfolio over product life cycle phases and product structure levels, instead of merely focusing on new product development, to ensure product portfolio renewal.
Antibodies to myelin oligodendrocyte glycoprotein in bilateral and recurrent optic neuritis

Objective: We examined a cohort of adults with aquaporin-4 (AQP4) antibody–negative neuromyelitis optica/neuromyelitis optica spectrum disorder (NMO/NMOSD) for antibodies to myelin oligodendrocyte glycoprotein (MOG). Methods: We performed a flow cytometry cell-based assay using live human lentivirus–transduced cells expressing full-length surface MOG. Serum was tested in 23 AQP4 antibody–negative NMO/NMOSD patients with bilateral and/or recurrent optic neuritis (BON, n = 11), longitudinally extensive transverse myelitis (LETM, n = 10), and sequential BON and LETM (n = 2), as well as in patients with multiple sclerosis (MS, n = 76) and controls (n = 52). Results: MOG antibodies were detected in 9/23 AQP4 antibody–negative patients with NMO/NMOSD, compared to 1/76 patients with MS and 0/52 controls (p < 0.001). MOG antibodies were detected in 8/11 patients with BON, 0/10 patients with LETM, and 1/2 patients with sequential BON and LETM. Six of 9 MOG antibody–positive patients had a relapsing course. MOG antibody–positive patients had prominent optic disc swelling and were more likely to have a rapid response to steroid therapy and relapse on steroid cessation than MOG antibody–negative patients (p = 0.034 and p = 0.029, respectively). While 8/9 MOG antibody–positive patients had good follow-up visual acuity, one experienced sustained visual impairment, 3 had retinal nerve fiber layer thinning, and one had residual spinal disability. Conclusions: MOG antibodies have a strong association with BON and may be a useful clinical biomarker. MOG antibody–associated BON is a relapsing disorder that is frequently steroid responsive and often steroid dependent. Failure to recognize the disorder early and institute immunotherapy promptly may be associated with sustained impairment. Classification of evidence: This study provides Class II evidence that MOG antibodies are associated with AQP4 antibody–negative BON (sensitivity 69%, 95% confidence interval [CI] 42%–87%; specificity 99%, 95% CI 93.7%–99.8%).
Singular Stochastic Control Problems

In this paper, we study an optimal singular stochastic control problem. By using a time transformation, this problem is shown to be equivalent to an auxiliary control problem defined as a combination of an optimal stopping problem and a classical control problem. For this auxiliary control problem, the controller must choose a stopping time (optimal stopping), and the new control variables belong to a compact set. This equivalence is obtained by showing that the (discontinuous) state process governed by a singular control is given by a time transformation of an auxiliary state process governed by a classical bounded control. It is proved that the value functions for these two problems are equal. For a general form of the cost, the existence of an optimal singular control is established under certain technical hypotheses. Moreover, the problem of approximating singular optimal control by absolutely continuous controls is discussed in the same class of admissible controls.
12-lead ST-segment monitoring vs single-lead maximum ST-segment monitoring for detecting ongoing ischemia in patients with unstable coronary syndromes.

BACKGROUND 12-lead ECG monitoring of the ST segment is more sensitive than patients' symptoms for detecting ischemia after thrombolytic therapy or catheter-based interventions, but it is unclear whether monitoring of the single lead showing maximum ST deviation would be as efficacious. OBJECTIVE To determine whether monitoring all 12 ECG leads for changes in the ST segment is necessary to detect ongoing ischemia in patients with unstable coronary syndromes. METHODS Continuous 12-lead ST segment monitoring was performed in 422 patients from the onset of myocardial infarction or during balloon inflation in catheter-based interventions until the patient's discharge from the cardiac care unit. Computer-assisted techniques were used to determine (1) which lead showed the maximum ST deviation at the onset of myocardial infarction or during balloon inflation and (2) what proportion of later ischemic events were associated with ST deviation in this lead. RESULTS The lead with the maximum ST deviation could be determined in 312 patients (74%). The remaining 110 (26%) had non-Q wave infarction without ST deviation or no ST changes during balloon inflation. During 18,394 hours of 12-lead ST monitoring, 118 (28%) of the 312 patients had a total of 463 ischemic events, 80% of which were silent. Of 377 ischemic events in which a maximum ST lead was detected, 159 (42%) did not show ST deviation in this lead (sensitivity, 58%; 95% CI, 53%-63%). Routine monitoring of leads V1 and II showed ST deviation in only 152 of the 463 events (sensitivity, 33%; 95% CI, 29%-37%). CONCLUSIONS Monitoring of all 12 ECG leads for changes in the ST segment is necessary to detect ongoing ischemia in patients with unstable coronary syndromes.
The value of antibody-coated bacteria in tracheal aspirates for the diagnosis of ventilator-associated pneumonia: a case-control study

ABSTRACT Objective: Ventilator-associated pneumonia (VAP) is the leading type of hospital-acquired infection in ICU patients. The diagnosis of VAP is challenging, mostly due to limitations of the diagnostic methods available. The aim of this study was to determine whether antibody-coated bacteria (ACB) evaluation can improve the specificity of endotracheal aspirate (EA) culture in VAP diagnosis. Methods: We conducted a diagnostic case-control study, enrolling 45 patients undergoing mechanical ventilation. Samples of EA were obtained from patients with and without VAP (cases and controls, respectively), and we assessed the number of bacteria coated with FITC-conjugated monoclonal antibodies (IgA, IgM, or IgG) or an FITC-conjugated polyvalent antibody. Using immunofluorescence microscopy, we determined the proportion of ACB among a fixed number of 80 bacteria. Results: The median proportions of ACB were significantly higher among the cases (n = 22) than among the controls (n = 23)-IgA (60.6% vs. 22.5%), IgM (42.5% vs. 12.5%), IgG (50.6% vs. 17.5%), and polyvalent (75.6% vs. 33.8%)-p < 0.001 for all. The accuracy of the best cut-off points for VAP diagnosis regarding monoclonal and polyvalent ACBs was greater than 95.0% and 93.3%, respectively. Conclusions: The numbers of ACB in EA samples were higher among cases than among controls. Our findings indicate that evaluating ACB in EA is a promising tool to improve the specificity of VAP diagnosis. The technique could be cost-effective and therefore useful in low-resource settings, with the advantages of minimizing false-positive results and avoiding overtreatment.
Ka-band RF MEMS phase shifters for energy starved millimetre-wave radar sensors

Low-loss millimetre-wave RF MEMS phase shifters made on quartz are assessed with respect to a Ka-band low-power multifunctional radar sensor application. A loaded line type of phase shifter circuit presents a phase shift of 22.3° and a loss of 0.4 dB at 35 GHz. A switched line phase shifter gives 187° of phase shift and 1.5 dB of loss at 30 GHz (i.e. a FoM=122°/dB). We estimate that a 5-bit loaded line/switched line MEMS phase shifter circuit can achieve a loss of 4 dB at 35 GHz which could reduce by a factor 2 the required transmit DC power level in a Ka-Band energy starved phased array radar system.
Metastatic orbital tumors in Japan: A review of the literature

A review of reports on metastatic orbital tumors published from 1903 to 1998 in Japan revealed 128 patients, 74 males, 52 females and 2 whose sex was not recorded. The average age was 44.8 years, but varied depending on the primary tumor. Since 1980, metastatic orbital tumors have increased in Japan, especially those from the lung, liver and adrenal gland, while metastasis from the stomach has decreased slightly. Metastasis from the breast is still common. Most metastatic orbital tumors were from the lung, followed, in order, by breast, liver, adrenal gland and stomach. Males had four times as many metastatic orbital tumors from lung cancer than did females; only females had metastases from breast cancer; almost 90% of metastases from hepatoma were in males; metastasis from renal carcinoma was 2–3 times more common in males than in females. Metastasis from the liver and stomach is seen more frequently in Japan than in the United States and Europe. Ocular signs due to orbital metastases from hepatoma, neuroblastoma and gastric cancer were apt to appear earlier than the signs of the primary lesion. Metastases to the orbit were frequently bilateral in patients with neuroblastoma and malignant lymphoma. Specific ocular signs such as ecchymosis and conjunctival hemorrhages were seen in orbital metastasis from neuroblastoma and seminoma, while ocular pain was characteristic of malignant lymphoma. Orbital metastasis was very rare in patients with carcinoma of the uterus, ovaries, bladder, pancreas, colon or rectum in both Japan, the United States and Europe.
Validity of self-reported alcohol consumption in the emergency room: data from the United States, Mexico and Spain.

The validity of self-reported alcohol consumption within 6 hours prior to injury based on breath-analyzer readings obtained at the time of emergency room (ER) admission is compared among probability samples of ER patients in Contra Costa County, California (n = 450), Mexico City (n = 500) and Barcelona, Spain (n = 864). The same questionnaire, study design and methods were used in all three countries to maintain comparability for comparative analyses. The analysis was restricted to those breath analyzed within 6 hours of injury occurrence who reported no drinking following the event. Validity of self-reports was high in all three samples. The proportion of those reporting not drinking prior to injury who had positive breath-analyzer readings was . 5% in the U.S., 1.5% in Spain and 3.3% in Mexico. Validity of self-reports was not associated with cause of injury in the United States. In Mexico those injured in motor vehicle accidents or by violence were most likely to deny drinking, while in Spain those injured in violent situations were most likely to report not drinking. Validity of self-reports in these studies is much higher than that found in other U.S. studies, but this may be partly due to the fact that self-reports were obtained after the patient had been breath analyzed.
Clinical digital breast tomosynthesis system: dosimetric characterization.

PURPOSE To comprehensively characterize the dosimetric properties of a clinical digital breast tomosynthesis (DBT) system for the acquisition of mammographic and tomosynthesis images. MATERIALS AND METHODS Compressible water-oil mixture phantoms were created and imaged by using the automatic exposure control (AEC) of the Selenia Dimensions system (Hologic, Bedford, Mass) in both DBT and full-field digital mammography (FFDM) mode. Empirical measurements of the x-ray tube output were performed with a dosimeter to measure the air kerma for the range of tube current-exposure time product settings and to develop models of the automatically selected x-ray spectra. A Monte Carlo simulation of the system was developed and used in conjunction with the AEC-chosen settings and spectra models to compute and compare the mean glandular dose (MGD) resulting from both imaging modalities for breasts of varying sizes and glandular compositions. RESULTS Acquisition of a single craniocaudal view resulted in an MGD ranging from 0.309 to 5.26 mGy in FFDM mode and from 0.657 to 3.52 mGy in DBT mode. For a breast with a compressed thickness of 5.0 cm and a 50% glandular fraction, a DBT acquisition resulted in an only 8% higher MGD than an FFDM acquisition (1.30 and 1.20 mGy, respectively). For a breast with a compressed thickness of 6.0 cm and a 14.3% glandular fraction, a DBT acquisition resulted in an 83% higher MGD than an FFDM acquisition (2.12 and 1.16 mGy, respectively). CONCLUSION For two-dimensional-three-dimensional fusion imaging with the Selenia Dimensions system, the MGD for a 5-cm-thick 50% glandular breast is 2.50 mGy, which is less than the Mammography Quality Standards Act limit for a two-view screening mammography study.
FACTORS AFFECTING PERFORMANCE OF HOTELS AND RESTAURANTS IN KENYA: A CASE OF KISII COUNTY

The future direction of organizations is determined by management practices and how people working in that organization interact and collaborates with each other, with customers and other stakeholders. Many former large and successful hotels in Kisii County are drastically declining in performance and even closing down at alarming rates. The study aimed at investigating factors responsible for these trend in performance and management practices that can enhance sustainable performances of hotels and restaurants in Kisii County. The nature of services offered, human resource management practices and managers‟ planning skills in hotels and restaurants were examined to determine their influence on the performance of the hotels. The target population was all employees, customers and managers of large hotels and restaurants in Kisii County. A sample of five hotels with over twenty rooms and workers was selected using the stratified random sampling technique using such characteristics as location, years of existence and general performance. A sample of over hundred respondents including managers, employees and customers were given questionnaires and others interviewed to gather the required data for analysis. Assessment of strategic plans, employee skills and knowledge and customer satisfaction levels revealed gaps in strategic management of these organizations. Organizations need to design best management practices for high sustainable performance of their organizations, the county and the country.
Thrombomodulin in Patients with Takayasu’s Arteritis

Takayasu’s arteritis is a chronic inflammatory process of unknown etiology affecting the aorta and its primary branches, and frequently the pulmonary arteries. The vascular lesions point to the role of endothelial cell damage in this disorder. Thrombomodulin (TM), an anticoagulant proteoglycan of the endothelial cell membrane, exists in soluble form in plasma and has been described as a marker of endothelial damage (1). Surprisingly, in a recent study, plasma levels of TM in Takayasu patients were not increased but significantly decreased compared with those in normal control subjects (2). We measured plasma TM antigen by using an enzyme-linked immunosorbent assay (ELISA) (Asserachrom thrombomodulin, Diagnostica Stago, Asnières, France) in 42 patients (40 women and 2 men) with Takayasu’s arteritis, aged from 21 to 87 years, 5 of whom had pulmonary hypertension assessed by echocardiography, and in 398 healthy subjects aged from 20 to 60 years recruited from a health care center to which they had been referred for a routine check-up. Plasma levels of TM in patients with Takayasu’s disease (26.3 ± 2 ng/ml) (means ± SEM) were significantly lower than those in normal control subjects (38.3 ± 0.6 ng/ml) (p <0.0001) when compared by Student’s t test with adjustment for age and sex (SAS statistical software, SAS Institute Inc., Cary, NC). The distribution of plasma TM concentrations in patients with Takayasu’s disease is presented in Fig. 1. There was no difference in plasma TM levels between patients with and without pulmonary hypertension (p = 0.48, Wilcoxon rank-sum test). 15 patients had steroid treatment, but plasma TM levels were not significantly different between patients with and without steroids (25 ± 7 ng/ml versus 20 ± 6 ng/ml, respectively, p = 0.66, Wilcoxon rank-sum test). Plasma level of TM was not significantly correlated to erythrocyte sedimentation rate (ESR) (r 2 = 0.0018) nor with fibrinogen or CRP levels (r 2 = 0.004 and 0.003, respectively). Our results therefore agree with those of Akazawa et al. (2, 3). As plasma TM levels were decreased in patients with pulmonary hypertension (4), Akazawa speculated that the decrease in TM levels in patients with Takayasu’s arteritis could be due to the complicated pulmonary lesions. Our results do not support this hypothesis. Hypoxia, frequently related to vascular system disorders, has been described to lower the synthesis and expression of TM in cultured endothelial cells (5). Takayasu’s arteritis is an inflammatory disease and inflammatory mediators like endotoxin (6), tumor necrosis factor (7) and interleukin-1 (8) are known to down-regulate TM in cultured cells by mechanisms involving cytoplasmic TM mRNA levels and internalization/degradation of TM molecules (9). Quantification of these mediators in the patients’ plasma might yield interesting results. Recent results suggest that soluble TM plays a role in the regulation of blood coagulation and particularly in fibrinolysis inhibition (10). Therefore, there may be an association between occlusive events in Takayasu’s arteritis and the fall in TM.
Body mass index throughout the life-course and blood pressure in mid-adult life: a birth cohort study

Background The contribution of body mass index (BMI) at different life stages to adult blood pressure (BP) is not well known. We investigated whether changes in BMI across childhood and adulthood, and birthweight, influence BP in mid-adulthood. Methods and results In 9297 participants in the 1958 British birth cohort, we analysed BMI measures at several ages (7, 11, 16, 33 and 45 years) and BP at 45 years. Positive BMI/BP associations strengthened with age; at 45 years a standard deviation (SD) increase in concurrent BMI was associated with an increase in systolic blood pressure (SBP) of 3.9 mmHg [95% confidence interval (CI) 3.6–4.2] and an elevated risk of hypertension (odds ratio 1.68; 95% CI 1.60–1.76). The effect of concurrent BMI on BP strengthened with decreasing childhood BMI; among the thinnest 10% at 11 years, SBP increased by 5.5 mmHg per SD increase in concurrent BMI; among the heaviest 10% the increase was 3.3 mmHg. Excessive BMI gain, especially recently, was associated with raised BP; allowing for BMI at 33 years, a SD increase in BMI between 33 and 45 years was associated with an SBP increase of 4.1 mmHg (95% CI 3.6–4.6). Birthweight was inversely associated with BP; SBP reduced by 1.3 mmHg (95% CI 0.9–1.7) per SD increase in birthweight, independently of BMI. Conclusion High BMI and excessive BMI gain at any life stage, particularly recently, is associated with increased adult BP. Relatively thin children were vulnerable to BMI gain and increased BP in adulthood. Elevated BP associated with low birthweight was not caused by ‘catch-up’ growth.