Miracle-dz/UniFAR-FTUs huggingface dataset:
Diagnostic Strategies in Young Patients with Ischemic Stroke in Canada

ABSTRACT: Background: A preliminary national survey of ischemic stroke in the young (15-45 years) undertaken by the Canadian Stroke Consortium indicated that in 44% of 356 patients, no cause was found. Objective: To determine the reason for this high incidence of diagnostic uncertainty in young patients with ischemic stroke. Methods: Neurologists in the ten Canadian stroke centers completed a detailed questionnaire for patients aged 15-45 years admitted to hospital between January 1993 and December 1997. Using a step-wise diagnostic algorithm incorporating clinical, neuroimaging, neurovascular and laboratory data, we divided patients into three groups: (1) those with established cause for the ischemic stroke, (2) those who remained unexplained despite adequate investigation, (3) those who remained unexplained but were, in our opinion, under-investigated. Results: In 197 patients (56%), an identified cause was established including cardioembolic sources (14%), extracranial arterial dissection (13%), lacunar infarcts (8%) atherosclerosis (6%). A miscellaneous group of 15%, included cerebral venous thrombosis, coagulopathies, vasculitis and others. In 159 patients (44%) with no apparent cause for their stroke, we considered only 81 (23%) adequately investigated, and 78 (21%) inadequately investigated. Conclusion: About one in five young patients was inadequately investigated by a stroke-oriented group of neurologists. The major problem appears to be restriction of investigations to neuroimaging alone (usually computerized cerebral tomography), without further tests such as cerebral angiography and cardiac imaging.
The effects of human CYP2C8 genotype and fluvoxamine on the pharmacokinetics of rosiglitazone in healthy subjects.

AIMS To determine the effect of CYP2C8 genotype and of fluvoxamine on the pharmacokinetics of rosiglitazone. METHODS Twenty-three healthy subjects with the following genotypes were included in a two-phase, open-label, cross-over trial: CYP2C8*3/ *3 (n = 3), CYP2C8*1/ *3 (n = 10) and CYP2C8*1/ *1 (n = 10). In Phase A, the subjects were given 4 mg rosiglitazone as a single oral dose. In Phase B, the subjects were treated with multiple oral doses of 50 mg fluvoxamine maleate for 3 days prior to the single oral administration of 4 mg rosiglitazone. Plasma concentrations of rosiglitazone and relative amounts of N-desmethylrosiglitazone were measured in both phases for 24 h after drug administration. RESULTS The pharmacokinetics of rosiglitazone and N-desmethylrosiglitazone were not significantly different between the CYP2C8 genotypic groups. Fluvoxamine caused a statistically significant (P = 0.0066) increase in the AUC(0-infinity) of rosiglitazone, with a geometric mean ratio of 1.21 [95% confidence interval (CI) 1.06-1.39]. The elimination half-life (t(1/2)) was also significantly higher (P = 0.0203) with a geometric mean ratio of 1.38 [95% CI 1.06-1.79]. The coadministration of fluvoxamine had no influence on the pharmacokinetics of N-desmethylrosiglitazone. CONCLUSION The importance of the CYP2C8*3 mutation in the in vivo metabolism of rosiglitazone could not be confirmed. Fluvoxamine increased the AUC(0-infinity) and t(1/2) of rosiglitazone moderately and hence may be a weak inhibitor of CYP2C8.
Parental tracking in the postfire wood decay ascomycete Daldinia loculata using highly variable nuclear gene loci

The origin of the male and female gametes involved in fertilization events within a local population of the postfire wood decay ascomycete Daldinia loculata was investigated by genotyping the mycelia growing in the wood and the sexual ascospores, using three highly variable nuclear gene loci. The study was conducted in a geographically isolated burned forest site in southern Sweden. An intensive sampling was performed by collecting stromata containing ascospores and wood samples containing mycelia. In total, from 32 mapped burned birches, cultures of 22 haploid genets from decayed wood and six ascospores from each of 19 stromata were isolated and analysed. In 80% of the investigated burned branches, only one genet was found. From the analysis of the ascospore genotypes, we detected 30 fertilization events and 60% of them were the result of mating between conidia (clonal propagules) acting as male gametes and the genets in the branches representing the female gametes. The male parents producing the conidia were detected within the same local population as the female parents in 27% of the fertilization events and originated either from the same branch or from different trees located at 0.5–36 m away from the female parents. In 33% of the fertilization events, conidia originated from three male parents that were not found within the local population sampled. These parents could be anywhere inside or outside the sampled area. For the remaining fertilization events, we could not rule out the ascospores or the conidia as fertilizing propagules. No strong evidence for fertilization by recombinant propagules (ascospores) was detected in this study. The pyrophilous insect species associated with conidia of D. loculata are suggested to be essential vectors for the realization of the sexual cycle of this fungal species. By feeding on the conidia and flying between nearby trees inhabiting wood decay mycelia, these insects allow the transfer of conidia and therefore the opposite mating types to meet within a localized burned forest site.
Factors associated with non-adherence of HIV/AIDS patients to HAART regimen in a healthcare facility in Ikot Ekpene, Akwa Ibom State, Nigeria

Adherence to highly active antiretroviral therapy (HAART) regimen, of at least 95%, is necessary for effective therapeutic response among people living with human immunodeficiency virus (PLWHIV). This study determined the factors associated with non-adherence of PLWHIV to HAART regimen among patients attending a healthcare facility in Akwa Ibom State, Nigeria. Two hundred and fifty one patients, aged 18 to 70 years, attending a healthcare facility in Akwa Ibom State, Nigeria from 8th July to 8th August 2018, were adequately informed and their consent was obtained to enroll in the study. The enrollees were defined as non-adherent (NA), if, for any reason, they missed at least one dose of their drug within the last 30 days. These NA enrollees were purposively selected. The data was obtained using interviewer-administered semi-structured questionnaire. The data obtained was checked for completeness, coded and technique analyzed using Statistical Package for Social Science (SPSS) version 22 software. The statistical association between variables was described using logistic regression. Of the 251 PLWHIV, 100 (39.84%) were NA enrollees. Three major reasons provided by enrollees for missing medication were: (1) forgetfulness 41%, (2) travelling with incomplete medication and difficulty in the accessing drug from a new clinic, 15% and (3) not willing to take HIV/AIDS drugs with other prescribed drugs, 10%. This study has shown that a majority of PLWHIV (60.16%) complied with therapy regimen. Forgetfulness was the most common factor reported for non-adherence by the enrollees. This suggests that there is an increasing need for healthcare personnel to encourage patients to use memory aids, and to increase the awareness of the consequences of non-adherence during drug administration. Key words: Highly active antiretroviral therapy, HIV/AIDS, medication non-adherence, healthcare facility.
Improving Intrusion Detection Model Prediction by Threshold Adaptation

Network traffic exhibits a high level of variability over short periods of time. This variability impacts negatively on the accuracy of anomaly-based network intrusion detection systems (IDS) that are built using predictive models in a batch learning setup. This work investigates how adapting the discriminating threshold of model predictions, specifically to the evaluated traffic, improves the detection rates of these intrusion detection models. Specifically, this research studied the adaptability features of three well known machine learning algorithms: C5.0, Random Forest and Support Vector Machine. Each algorithm’s ability to adapt their prediction thresholds was assessed and analysed under different scenarios that simulated real world settings using the prospective sampling approach. Multiple IDS datasets were used for the analysis, including a newly generated dataset (STA2018). This research demonstrated empirically the importance of threshold adaptation in improving the accuracy of detection models when training and evaluation traffic have different statistical properties. Tests were undertaken to analyse the effects of feature selection and data balancing on model accuracy when different significant features in traffic were used. The effects of threshold adaptation on improving accuracy were statistically analysed. Of the three compared algorithms, Random Forest was the most adaptable and had the highest detection rates.
Effects of intraoperative i.v. acetaminophen vs i.m. meperidine on post-tonsillectomy pain in children.

BACKGROUND Enteral acetaminophen, when used alone, is not very effective for postoperative analgesia because of delayed absorption and sub-therapeutic plasma concentrations. In contrast, i.v. acetaminophen is devoid of these shortcomings and could potentially provide adequate postoperative analgesia as a single agent. This randomized double-blind study compared the analgesic effects of i.v. acetaminophen and i.m. meperidine in paediatric patients undergoing tonsillectomy. METHODS Eighty children undergoing tonsillectomy were randomized to receive either acetaminophen 15 mg kg(-1) i.v. (acetaminophen group) or meperidine 1 mg kg(-1) i.m. (meperidine group), intraoperatively. Anaesthesia was induced with either sevoflurane inhalation or propofol, and was maintained with sevoflurane. After operation, the objective pain scale (OPS), Ramsay sedation score and Aldrete score were recorded every 5 min, and nurses' satisfaction was determined on a 7-point scale (1-7). RESULTS On admission to the recovery room, OPS scores were 3.1 (sem 0.3) for the acetaminophen group and 2.1 (sem 0.3) for the meperidine group (P=0.147); however, Ramsay sedation scores were 3 (sem 0.2) and 4 (sem 0.3) for the acetaminophen and meperidine groups, respectively (P<0.05). Patients in the meperidine group continued to be more sedated 5 min after arrival in recovery (P<0.05). Acetaminophen group patients achieved an Aldrete score of 10 min sooner than those in the meperidine group [median (IQR) time: 15 (0-20) min vs 25 (15-30) min, respectively, P=0.005]. Adjusted nurse satisfaction scores were similar in both groups [6.1 (sem 0.2) vs 5.7 (sem 0.2) min, P=0.311]. CONCLUSION Compared with i.m. meperidine, i.v. acetaminophen provided adequate analgesia, less sedation and earlier readiness for recovery room discharge among paediatric patients undergoing tonsillectomy.
A randomized open‐label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection

Polylactic acid (PLA, New‐Fill®; Medifill, London, UK and Dermic Labs, a division of Eventis, Strasbourg, France) injections into the deep dermis increase fibroblast numbers and collagen production. The substance is widely used in medical applications including cosmetic procedures.
Characterization of Natural Suppressor Cells in Human Bone Marrow

Natural suppressor (NS) cells, which exert nonspecific suppressive activity in an unprimed manner, have been found in mouse, rabbit and monkey bone marrow (BM). In the present study, we characterize NS cells in human BM. NS activity was found in a fraction of low density (1.055‐1.065 g/ml) BM cells that had been depleted of T cells, B cells, and monocytes. The NS activity was significantly decreased by the depletion of CD34+ or CD33+ cells but not CD56+ cells. The NS activity was indeed detected in isolated CD34+ cells and further enriched in CD34+CD33+ cells. Hematopoietic progenitor cells committed to the myeloid lineage were also enriched in the CD34+CD33+ cells, which significantly correlated to the NS activity. From these findings, it is strongly suggested that NS activity in human BM is exerted by the myeloid hematopoietic progenitors. Since cell‐to‐cell contact was not necessary for the action, NS cells seemed to secrete soluble mediator(s). Transforming growth factor‐β1 and leukemia inhibitory factor were, however, not the candidates, based on experiments using neutralizing antibodies.
Evaluation of the efficacy of desflurane with or without labetalol for hypotensive anesthesia in middle ear microsurgery

Background and Aims: Hypotensive anesthesia technique is used to reduce intraoperative bleeding and to improve the visibility of the operative field. The aim was to evaluate the efficacy of desflurane with and without labetalol for producing hypotensive anesthesia. Material and Methods: Sixty adult patients undergoing elective middle ear surgery were administered general anesthesia and randomly divided into two groups – Group D and Group L. The target mean arterial pressure (MAP) was 55–65 mmHg during hypotensive period. Group D patients received an increasing concentration of desflurane alone. Group L patients received 3% desflurane plus labetalol (loading dose 0.3 mg/kg intravenously, followed by 10 mg increments every 10 min). Student's t-test and paired t-test were used to compare the hemodynamic parameters. Visibility of the operative field, anesthetic and rescue drug requirement, partial pressure of oxygen in arterial blood, time taken for induction and reversal of hypotension and recovery characteristics were noted. Results: Target MAP was achieved in both the groups. Group D was associated with a higher mean heart rate compared with Group L (77.3 ± 11.0/min vs. 70.5 ± 2.5/min, respectively; P < 0.001) during the hypotensive period, along with a higher requirement for desflurane (P = 0.000) and metoprolol (P = 0.01). Time taken to achieve target MAP was lesser in Group L compared with Group D (33.7 ± 7.1 vs. 39.8 ± 6.2 min, respectively; P = 0.000). Time taken to return to baseline MAP was faster in Group D (P = 0.03). Emergence time was longer with desflurane alone (P = 0.000) resulting in greater sedation (P = 0.000) in the immediate postoperative period. Conclusion: Although desflurane is effective for inducing deliberate hypotension in middle ear microsurgery, the combination of desflurane with labetalol is associated with decreased requirement of desflurane, absence of reflex tachycardia, faster induction of hypotension, faster recovery from anesthesia, and less postoperative sedation.
From strategy to action: how top managers' support increases middle managers' commitment to innovation implementation in health care organizations.

BACKGROUND Evidence suggests that top managers' support influences middle managers' commitment to innovation implementation. What remains unclear is how top managers' support influences middle managers' commitment. Results may be used to improve dismal rates of innovation implementation. METHODS We used a mixed-method sequential design. We surveyed (n = 120) and interviewed (n = 16) middle managers implementing an innovation intended to reduce health disparities in 120 U.S. health centers to assess whether top managers' support directly influences middle managers' commitment; by allocating implementation policies and practices; or by moderating the influence of implementation policies and practices on middle managers' commitment. For quantitative analyses, multivariable regression assessed direct and moderated effects; a mediation model assessed mediating effects. We used template analysis to assess qualitative data. FINDINGS We found support for each hypothesized relationship: Results suggest that top managers increase middle managers' commitment by directly conveying to middle managers that innovation implementation is an organizational priority (β = 0.37, p = .09); allocating implementation policies and practices including performance reviews, human resources, training, and funding (bootstrapped estimate for performance reviews = 0.09; 95% confidence interval [0.03, 0.17]); and encouraging middle managers to leverage performance reviews and human resources to achieve innovation implementation. PRACTICE IMPLICATIONS Top managers can demonstrate their support directly by conveying to middle managers that an initiative is an organizational priority, allocating implementation policies and practices such as human resources and funding to facilitate innovation implementation, and convincing middle managers that innovation implementation is possible using available implementation policies and practices. Middle managers may maximize the influence of top managers' support on their commitment by communicating with top managers about what kind of support would be most effective in increasing their commitment to innovation implementation.
Condensation of Semiconductor Microcavity Exciton Polaritons

A phase transition from a classical thermal mixed state to a quantum-mechanical pure state of exciton polaritons is observed in a GaAs multiple quantum-well microcavity from the decrease of the second-order coherence function. Supporting evidence is obtained from the observation of a nonlinear threshold behavior in the pump-intensity dependence of the emission, a polariton-like dispersion relation above threshold, and a decrease of the relaxation time into the lower polariton state. The condensation of microcavity exciton polaritons is confirmed.
[Spanish physicians point of view on irritable bowel syndrome (IBS). Results of a Delphi survey].

INTRODUCTION lack of evidence in most clinical situations regarding irritable bowel syndrome (IBS) enhances the importance of an expert s opinion, which will guide management and even the concept underlying the disease. OBJECTIVE to delve into the knowledge and degree of agreement on main clinical skills for this syndrome among physicians involved in its management. MATERIAL AND METHOD two rounds of a Delphi survey were conducted on 100 physicians: general practitioners (GPs) and gastroenterologists. The questionnaire evaluated agreement among participants in some aspects regarding the definition, diagnosis, and treatment of IBS. RESULTS fifty-five percent of participants completed the two-round survey. Agreement was achieved regarding the definition of typical symptoms and red flags characterizing IBS. Although there was no consensus regarding the appropriate management of patients without alarm symptoms, the performance of a colonoscopy on any patient presenting red flags was suggested. Patients were thought to require a wider examination when older than 40. A well defined line of IBS treatment was not found, albeit most physicians tended to choose it depending on the main complaint. CONCLUSION interviewed physicians showed adequate theoretical knowledge of IBS, but lack of uniformity on diagnosis and treatment approach reflects the controversial day-by-day management of this syndrome.
Can't play, won't play: longitudinal changes in perceived barriers to participation in sports clubs across the child–adolescent transition

Background Participation in sports is associated with numerous physical and psychosocial health benefits, however, participation declines with age, and knowledge of perceived barriers to participation in children is lacking. This longitudinal study of children and adolescents aimed to use the ecological model of physical activity to assess changes in barriers to participation in sports clubs to identify age-specific and weight-specific targets for intervention. Methods Longitudinal study—Perceived barriers to sports participation were collected from a birth cohort, the Gateshead Millennium Study (n>500) at ages 9 and 12 years. The open-ended question ‘Do you find it hard to take part in sports clubs for any reason? ’ was completed with free text and analysed using content analysis, and the social–ecological model of physical activity. Results Barriers from across the social-ecological model were reported. Barriers at 9 years were predominantly of a physical environmental nature, and required high parental involvement (for transport, money, permission), or were associated with a lack of suitable clubs. At 12 years, perceived barriers were predominantly classed as intrapersonal (‘they're boring’) or social environmental (‘my friends don't go’). Perceived barriers were not associated with weight status. Conclusions Perceived barriers to sports participation change rapidly in childhood and adolescence. Future interventions aiming to increase sports participation in children and adolescents should target specific age groups, should consider the rapid changes which occur in adolescence, and aim to address prominent barriers from across the socioecological model. Perceived barriers may be unrelated to current weight status, allowing for more inclusive solutions.
A Brief Review of Tests for Normality

In statistics it is conventional to assume that the observations are normal. The entire statistical framework is grounded on this assumption and if this assumption is violated the inference breaks down. For this reason it is essential to check or test this assumption before any statistical analysis of data. In this paper we provide a brief review of commonly used tests for normality. We present both graphical and analytical tests here. Normality tests in regression and experimental design suffer from supernormality. We also address this issue in this paper and present some tests which can successfully handle this problem.
Glucose-dependent Insulinotropic Polypeptide (GIP) Stimulation of Pancreatic β-Cell Survival Is Dependent upon Phosphatidylinositol 3-Kinase (PI3K)/Protein Kinase B (PKB) Signaling, Inactivation of the Forkhead Transcription Factor Foxo1, and Down-regulation of bax Expression*

The hormone glucose-dependent insulinotropic polypeptide (GIP) potently stimulates insulin secretion and promotes β-cell proliferation and cell survival. In the present study we identified Forkhead (Foxo1)-mediated suppression of the bax gene as a critical component of the effects of GIP on cell survival. Treatment of INS-1(832/13) β-cells with GIP resulted in concentration-dependent activation of the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (PKB)/Foxo1 signaling module. In parallel studies, GIP decreased bax promoter activity. Serial deletion analysis of the bax promoter demonstrated that the region -682 to -320, containing FHRE-II (5AAAACAAACA), was responsible for GIP-mediated effects. Foxo1 bound to FHRE-II in gel mobility shift assays, and Foxo1-FHRE-II interactions conferred GIP responsiveness to the bax promoter. INS-1 cells incubated under proapoptotic and glucolipotoxic conditions demonstrated increased nuclear localization of Foxo1 and bax promoter activity and decreased cytoplasmic phospho-PKB/Foxo1. GIP partially restored expression PKB/Foxo1 and bax promoter activity. Similar protective effects were found with dispersed islet cells from C57BL/6 mice, but not with those from GIP receptor knock-out (GIPR-/-) mice. GIP treatment reduced glucolipotoxicity-induced cell death in C57 BL/6 and Bax-/- islets, but not GIPR-/- mouse islets. Chronic treatment of Vancouver diabetic fatty Zucker rats with GIP resulted in down-regulation of Bax and up-regulation of Bcl-2 in pancreatic β-cells. The results show that PI3K/PKB/Foxo1 signaling mediates GIP suppression of bax gene expression and that this module is a key pathway by which GIP regulates β-cell apoptosis in vivo.