Miracle-dz/UniFAR-FTUs huggingface dataset:
Managed care, professional autonomy, and income

AbstractCONTEXT: Career satisfaction among physicians is a topic of importance to physicians in practice, physicians in training, health system administrators, physician organization executives, and consumers. The level of career satisfaction derived by physicians from their work is a basic yet essential element in the functioning of the health care system. OBJECTIVE: To examine the degree to which professional autonomy, compensation, and managed care are determinants of career satisfaction among physicians. DESIGN: Cross-sectional analysis using data from 1996–97 Community Tracking Study physician telephone survey. SETTING AND PARTICIPANTS: A nationally representative sample of 12,385 direct patient care physicians. The survey response rate was 65%. MAIN OUTCOME MEASURE: Overall career satisfaction among U.S. physicians. RESULTS: Bivariate results show that physicians with low managed care revenues are significantly more likely to be “very satisfied” than are physicians with high managed care revenue (P<.05), and that physicians with low managed care revenues are significantly more likely to report higher levels of clinical freedom than are physicians with high managed care revenue (P<.05). Multivariate analyses demonstrate that, among our measures, traditional core professional values and autonomy are the most important determinants of career satisfaction after controlling for all other factors. Relative income is also an important independent predictor. Multiple dimensions of professional autonomy hold up as strong, independent predictors of career satisfaction, while the effect of managed care does not. Managed care appears to exert its effect on satisfaction through its impact on professional autonomy, not through income reduction. CONCLUSIONS: Our results suggest that when managed care (or other influences) erode professional autonomy, the result is a highly negative impact on physician career satisfaction.
CLINICIAN ’ S CORNER CLINICAL CROSSROADS CONFERENCES WITH PATIENTS AND DOCTORS A 66-Year-Old Man With an Abdominal Aortic Aneurysm Review of Screening and Treatment

DR BURNS: Mr F is a 66-year-old man with an abdominal aortic aneurysm (AAA). He has a medical history of coronary artery disease, coronary artery bypass graft surgery in 1995, hyperlipidemia, hypertension, tobacco use, and gastroesophageal reflux disease. He has Medicare insurance with coinsurance. In November 2004, Mr F saw his primary care physician for a routine physical. At that time, he smoked 1 pack of cigarettes per day, his blood pressure was controlled (110/70 mm Hg) with lisinopril, and his cholesterol was high (lowdensity lipoprotein cholesterol [LDL-C], 168 mg/dL [4.35 mmol/L]) despite atorvastatin. He was counseled to quit smoking and his atorvastatin dosage was increased. He was seen a few months later for persistent gastroesophageal reflux symptoms that disrupted his sleep and were unresponsive to proton pump inhibitors. When upper endoscopy did not reveal a cause, he underwent chest computed tomography (CT) because of a concern about external compression of the esophagus. The CT scan revealed ectasia of the descending thoracic aorta and aneurysmal dilation of the abdominal aorta. A subsequent CT angiogram revealed heavy atheroma and mild aneurismal dilation of the descending thoracic aorta (3.8 cm at its maximum) and the infrarenal AAA (4.3 cm at its maximum). It also showed extensive thrombus at the origin of the right renal artery; the right kidney appeared diminutive. At Mr F’s next visit with his physician, his cholesterol remained above goal (LDL-C, 83 mg/dL [2.15 mmol/L]) and his atorvastatin dosage was increased to 80 mg/d. He began taking aspirin and metoprolol. Although counseled again on the importance of smoking cessation, he continued to smoke 1packperday.Hiscreatininewasslightlyelevatedat1. 3mg/dL (114.9μmol/L). WhenaCTangiogramwas repeated6months later, the thoracic and infrarenal aortic aneurysms were unchanged in size at 3.5 cm and 4.4 cm, respectively. A little more than 1 year later, Mr F had a repeat abdominal ultrasound and the infrarenal AAA was somewhat larger at 5.0 3.8 cm (FIGURE 1A). Over the next year, the aneurysm remained stable as measured by abdominal ultrasound. At this time,hewasseenbyavascularsurgeonwhorecommended continued cardiovascular risk factor reduction. Early in 2008, Mr F underwent surgery for an ulnar nerve entrapment. At that time, an anesthesiologist recommended cardiology clearance because Mr F reported chest pain with exertion. An exercise MIBI revealed a moderated fixed, inferobasilar, lateral, and apical defect, and his ejection fraction was reduced to 31%. Cardiac catheterization was performed, the right coronary artery was stented, and balloon angioplasty of a small distal right coronary vessel was executed. Mr F continued his same medication with the
Ca(2+)‐activated K+ channels in isolated type I cells of the neonatal rat carotid body.

1. Ca(2+)‐activated K+ (K+Ca) channels in neonatal rat type I carotid body cells were studied using single channel patch clamp techniques. In outside‐out patches, using symmetrical 120 mM [K+] solutions, channels were observed with a slope conductance of 190 pS and a reversal potential of 0 mV. Reducing [K+]o to 5 mM shifted the reversal potential as expected for a K(+)‐selective channel. 2. With 100 nM Ca2+ bathing the cytosolic aspect of patches, channel activity (number of active channels in a patch x open probability, NPo) increased with depolarization. NPo also increased with increasing ‘cytosolic’ [Ca2+] at a fixed membrane potential (0 mV). Using outside‐out patches, bath application of 20 or 100 nM charybdotoxin reduced NPo by > 85%. These data indicate the presence of K+Ca channels in type I cells. 3. At 0 mV, using solutions of identical composition (1 microM Ca2+ bathing the cytosolic aspect of the channels), NPo was higher in outside‐out patches than in inside‐out patches. NPo was greatest in recordings using the perforated‐vesicle technique. 4. Hypoxia and anoxia were without effect on K+Ca channels in outside‐out patches, but caused significant, reversible reductions of NPo in channels recorded in perforated vesicles. 5. The whole‐cell perforated‐patch technique was used to record membrane potential at 35‐37 degrees C. Hypoxia, anoxia and charybdotoxin all depolarized type I cells. 6. Our results suggest an important role for K+Ca channels in type I carotid body cells, and their activity in relation to a model for chemotransduction is discussed.
Comparative efficacy of granular and bagged formulations of the hemostatic agent QuikClot.

BACKGROUND QuikClot is a zeolite-based dressing approved and deployed by military for the arrest of severe combat-induced hemorrhage. A novel formulation (bagged QuikClot [ACS]) of the original granular QuikClot (QC) has been proposed to facilitate the application of the hemostatic dressings under battlefield conditions. This study compares the hemostatic efficacy of ACS and QC in controlling blood loss and improving survival in a swine model of uncontrolled hemorrhage induced by complex groin injury. METHODS After transection of the femoral vasculature, anesthetized Yorkshire pigs (n = 32) were hemorrhaged for 3 minutes and randomized into four groups: no treatment (NONE) or application of standard dressing (SD), QC, or ACS. At 15 minutes, resuscitation was initiated by infusion of 500 mL Hextend during a span of 30 minutes. Vital signs were continuously recorded throughout the 4-hour experimental period. In addition, blood loss and temperature at the dressing and tissue interface were continuously recorded. RESULTS After 3 minutes, average blood loss was 44.7% +/- 11.9% estimated blood volume (EBV) for all animals (34.1 +/- 3.2 kg). Posttreatment blood loss was significantly higher (p < 0.01) for NONE- and SD-treated animals (31.5% +/- 21.8% and 22.3% +/- 12.6% EBV, respectively) as compared with animals treated with QC and ACS (7.4% +/- 7.1% and 10.3% +/- 6.9%, respectively). All NONE animals died at approximately 60 minutes. Times until death were slightly greater for animals treated with SD (96.8 minutes) and significantly greater for animals treated with QC (188 minutes) and ACS (194 minutes). Overall survival to 4 hours for SD (1 of 8, 12.5%) was significantly lower (p < 0.02) than for QC (6 of 8, 75%) and for ACS (6 of 8, 75%) treatments. Elevated temperatures at the dressing and tissue interface were seen in animals treated with QC and ACS (average at 8 minutes was 58.1 +/- 4.5 degrees C and 58.2 +/- 5.3 degrees C, respectively) compared with SD treated animals (38.8 +/- 2.7 degrees C). Histologic examination revealed more edema in muscular tissue of animals treated with ACS as compared with in QC-treated animals. CONCLUSIONS ACS was as efficacious as original granular QC in inducing hemostasis and improving survival as compared with the efficacy of SD. Easier and more rapid application and complete removal of ACS may offer a distinct advantage in battlefield resuscitation efforts to enhance a clean wound site and eventual surgical repair.
Oncostatin M Regulation of Interleukin‐6 Expression in Astrocytes

Oncostatin M (OSM) is a member of the interleukin (IL)‐6 family of cytokines and has both pro‐ and anti‐inflammatory properties. Of interest, OSM has functional effects within the CNS. We have shown recently that OSM can modulate expression of the cytokine IL‐6 in astrocytes. Herein we characterize the molecular mechanisms and signaling cascades involved in this response. OSM induces IL‐6 protein expression in a dose‐ and time‐dependent manner in astrocytes. In addition, OSM can synergize with the cytokines tumor necrosis factor‐α, IL‐1β, and transforming growth factor‐β for enhanced IL‐6 expression. Using neutralizing antibodies to gp 130, the OSM receptor (OSMR), and the leukemia inhibitory factor receptor (LIFR), we document that OSM exclusively uses the OSMR/gp 130 heterodimer in signaling events, rather than the LIFR/gp 130 heterodimer. Kinetic analysis of OSM‐induced IL‐6 mRNA reveals two up‐regulatory events. The first, peaking at 1 h, is transient, does not require protein synthesis, and is regulated at the transcriptional level. The second, peaking between 6 and 8 h, is prolonged and sensitive to puromycin, suggesting a requirement for de novo protein synthesis, and also is transcriptionally regulated. OSM‐induced IL‐6 mRNA and protein expression is inhibited by the mitogen‐activated protein kinase (MAPK) inhibitors U0126 and SB202190, suggesting a requirement for the MAPKs ERK1/2 and p38 in this response. Finally, we show that the MAPKs ERK1/2 and p38 are activated by OSM in astrocytes and that this activation is reduced by the MAPK inhibitors. These data demonstrate that OSM induces IL‐6 expression in astrocytes and that the MAPKs ERK1/2 and p38 participate in this response.
Long-Term Effects of Television Advertising on Sales of Consumer Durables and Nondurables--The Case of China

It is every company's goal to gain the most from investments in advertising. Contrary to the conventional wisdom that sustained spending in advertising is needed to maintain high levels of sales, the concept of marketing persistence suggests that short-term advertising campaigns can have long-lasting impacts on sales. This study offers a first glimpse of the long-term effect of television advertising on sales in China through the use of a marketing-persistence mode. Significant marketing persistence was found in sales of consumer durables, whereas there were mixed results in sales of nondurables. Based on the findings, implications for long-term marketing resource deployment are suggested.
Collective agreements and wages in the New Earnings Survey

This article describes the incidence of collective agreements in the UK wage setting using the years 1998 through 2001 of the New Earning Survey (NES). It shows that the percentage of workers with a wage set with reference to a collective agreement is 51 per cent in the private sector, 96 per cent in the public sector, and 63 per cent in the full sample for workers aged 18 to 65. These numbers are considerably higher than the percentages of workers covered by a wage agreement found with other datasets. This is consistent with union-bargained wages having an affect not only on wages of workers directly covered by collective agreements, but also on the wages of part of the non-covered workforce. Finally, the estimated wage premium associated with having a wage set with reference to a collective agreement is around two per cent in the private sector and close to zero in the public sector. Introduction
Peroxisome Proliferator Activator Receptor-γ Ligands, 15-Deoxy-Δ12,14-Prostaglandin J2 and Ciglitazone, Reduce Systemic Inflammation in Polymicrobial Sepsis by Modulation of Signal Transduction Pathways 1

Peroxisome proliferator activator receptor-γ (PPARγ) is a nuclear receptor that controls the expression of several genes involved in metabolic homeostasis. We investigated the role of PPARγ during the inflammatory response in sepsis by the use of the PPARγ ligands, 15-deoxy-Δ12,14-PGJ2 (15d-PGJ2) and ciglitazone. Polymicrobial sepsis was induced by cecal ligation and puncture in rats and was associated with hypotension, multiple organ failure, and 50% mortality. PPARγ expression was markedly reduced in lung and thoracic aorta after sepsis. Immunohistochemistry showed positive staining for nitrotyrosine and poly(ADP-ribose) synthetase in thoracic aortas. Plasma levels of TNF-α, IL-6, and IL-10 were increased. Elevated activity of myeloperoxidase was found in lung, colon, and liver, indicating a massive infiltration of neutrophils. These events were preceded by degradation of inhibitor κBα (IκBα), activation of IκB kinase complex, and c-Jun NH2-terminal kinase and, subsequently, activation of NF-κB and AP-1 in the lung. In vivo treatment with ciglitazone or 15d-PGJ2 ameliorated hypotension and survival, blunted cytokine production, and reduced neutrophil infiltration in lung, colon, and liver. These beneficial effects of the PPARγ ligands were associated with the reduction of IκB kinase complex and c-Jun NH2-terminal kinase activation and the reduction of NF-κB and AP-1 DNA binding in the lung. Furthermore, treatment with ciglitazone or 15d-PGJ2 up-regulated the expression of PPARγ in lung and thoracic aorta and abolished nitrotyrosine formation and poly(ADP-ribose) expression in aorta. Our data suggest that PPARγ ligands attenuate the inflammatory response in sepsis through regulation of the NF-κB and AP-1 pathways.
Customer retention management: a reflection of theory and practice

Customer retention is increasingly being seen as an important managerial issue, especially in the context of saturated market or lower growth of the number of new customers. It has also been acknowledged as a key objective of relationship marketing, primarily because of its potential in delivering superior relationship economics, i.e. it costs less to retain than to acquire new customers. This paper reports an investigation, through case studies, that is concerned with testing whether or not a theoretical position relating to strategies for retaining customers reflects practices in four firms. The assumption is that generalised theories, which imply universal applicability, tend to overlook the distinctive impact of contextualised business conditions on effective customer retention strategies. The paper recommends that both theoreticians and managers should consider “business context” in developing and implementing customer retention strategies.
Why Does Corporate Governance Explain Credit Spreads?

This study explores a number of alternative explanations for the relation between credit spreads and governance. These include the overinvestment story in Li (2007), the information quality story of Duffie and Lando (2001) and an information asymmetry hypothesis based on the findings in Ferreira and Laux (2007). First, we find an economically weak negative relation between overinvestment and CDS spreads. This is consistent with Li (2007). Second, we find that credit spreads are increasing in information imprecision, as measured by analyst forecast errors. This is consistent with the notion that poor governance increases firms' disclosure quality and thus decreases credit spreads by the channel suggested in Duffie and Lando (2001). However, neither overinvestment nor information quality appear to explain the relation between governance and credit spreads. Finally, we find that proxies for liquidity in the CDS market are strongly related to CDS spreads. More significantly, we find that in the presence of our CDS market liquidity variables, the G-index has neither an economically nor statistically significant relation to CDS spreads. We argue, based on the findings in Ferreira and Laux (2007), that this consistent with the notion that the increased information production associated with low G-index firms makes bond dealers reluctant to post quotes for these firms, thereby reducing the liquidity of the CDS market and raising the level of the CDS spreads.
Dietary exposure to aluminium of the Hong Kong population

A total of 256 individual food samples were collected in Hong Kong for aluminium testing. Most of food samples were analysed in ready-to-eat form. High aluminium levels were found in steamed bread/bun/cake (mean: 100–320 mg kg−1), some bakery products such as muffin, pancake/waffle, coconut tart and cake (mean: 250, 160, 120 and 91 mg kg−1, respectively), and jellyfish (ready-to-eat form) (mean: 1200 mg kg−1). The results demonstrated that aluminium-containing food additives have been widely used in these food products. The average dietary exposure to aluminium for a 60 kg adult was estimated to be 0.60 mg kg−1 bw week−1, which amounted to 60% of the new PTWI established by JECFA. The main dietary source was “steamed bread/bun/cake”, which contributed to 60% of the total exposure, followed by “bakery products” and “jellyfish”, which contributed to 23 and 10% of the total exposure, respectively. However, the estimation did not include the intake of aluminium from natural food sources, food contact materials or other sources (e.g. drinking water). Although the results indicated that aluminium it is unlikely to cause adverse health effect for the general population, the risk to some populations who regularly consume foods with aluminium-containing food additives cannot be ruled out.
Variation in oral sensation: implications for diet and health

Purpose of reviewImportant advances in our understanding of how taste, smell and somatosensation contribute to oral sensation are reviewed and the nutritional and health implications associated with variation in oral sensation are discussed. Recent findingsOral sensation is a central integration of taste (salty, sweet, sour, bitter, umami), retronasal olfaction (i.e. smelling through the mouth), and somatosensation (touch, temperature, pain) by the orbitofrontal cortex. There is normal variation in oral sensation across individuals, ranging from those living in a neon orosensory world to those living in a pastel world. Historically, study of this variation revolved around genetically mediated bitterness of phenylthiocarbamide or propylthiouracil, but now it encompasses additional phenotypes (e.g. fungiform papillae number, bitterness of quinine) and emerging receptor genotypes. Aging and exposure to pathogens interact with genetics to further influence oral sensation. Orosensory variation is associated with differences in preference for high-fat foods, sweets, vegetables, and alcoholic beverages. Emerging data suggest this variation influences intake of these foods/beverages and thus diet-related chronic diseases (cardiovascular diseases, certain cancers, obesity). SummaryOral sensation varies with genetics and gene–environment interactions. As this variation explains some of the differences in what we like/dislike to eat, attempts to reduce disease risk through diet should consider food/beverage preference to promote health and food enjoyment.
The Effect of Electronic Word of Mouth on Brand Image and Purchase Intention: An Application Concerning Cell Phone Brands for Youth Consumers in Turkey

This study aims to explain the effect of Word of mouth on purchase intention through brand image. The focus on cell phone brands specifically. The sample of this study consisted of university students residing in Turkey. Data were obtained with a questionnaire and the face to face method after briefing the participants. The results of the study showed that there is a significant positive relationship between the electronic word of mouth on brand image and purchase intention.
Analysis of Facial Asymmetry

Facial symmetry is an important component of attractiveness. However, functional symmetry is favorable to aesthetic symmetry. In addition, fluctuating asymmetry is more natural and common, even if patients find such asymmetry to be noticeable. However, fluctuating asymmetry remains difficult to define. Several studies have shown that a certain level of asymmetry could generate an unfavorable image. A natural profile is favorable to perfect mirror-image profile, and images with canting and differences less than 3°-4° and 3-4 mm, respectively, are generally not recognized as asymmetry. In this study, a questionnaire survey among 434 medical students was used to evaluate photos of Asian women. The students preferred original images over mirror images. Facial asymmetry was noticed when the canting and difference were more than 3° and 3 mm, respectively. When a certain level of asymmetry is recognizable, correcting it can help to improve social life and human relationships. Prior to any operation, the anatomical component for noticeable asymmetry should be understood, which can be divided into hard tissues and soft tissue. For diagnosis, two-and three-dimensional (3D) photogrammetry and radiometry are used, including photography, laser scanner, cephalometry, and 3D computed tomography.
Impact of a real-time controlled wastewater subsurface drip disposal system on the selected chemical properties of a vertisol

The operation of onsite septic effluent disposal without considering seasonal moisture changes in drain field conditions can be a major cause of the failure of conventional septic systems. This study addressed this issue from a soil hydraulic perspective by using real-time drain field soil moisture levels to limit septic effluent disposal in a vertisol via subsurface drip irrigation. A prototype system was field-tested in a Houston clay soil and results describe the subsequent impact on selected soil chemical properties. After one year of hydraulic dosing with a synthetic wastewater, soil total carbon and nitrogen concentrations increased, but no increase in soil total phosphorus concentration was observed. Soil NO3-N leaching potential was noted, but soil NH4-N concentrations decreased, which could be ascribed to NH4-N nitrification, fixation within clay sheets and NH3 volatilization. Soil K+, Mg2+ and Na+ concentrations increased in soil layers above the drip lines, but decreased in soil layers below drip lines. Soil electrical conductivity accordingly increased in soil layers above drip lines, but the range was significantly lower than the threshold for soil salinity. Although the moisture-controlled effluent disposal strategy successfully avoided hydraulic dosing during unfavourable wet drain field conditions and prevented accumulation of soil salts in the soil profile beneath the drip lines, soil salts tended to accumulate in top soil layers. These adverse effects warrant system corrections before large-scale implementation of subsurface drip irrigation of effluent in similar vertisols.