Miracle-dz/UniFAR-FTUs huggingface dataset:
Clinical and epidemiological features of Turkish children with 2009 pandemic influenza A (H1N1) infection: Experience from multiple tertiary paediatric centres in Turkey

Abstract Background: In April 2009 a novel strain of human influenza A, identified as H1N1 virus, rapidly spread worldwide, and in early June 2009 the World Health Organization raised the pandemic alert level to phase 6. Herein we present the largest series of children who were hospitalized due to pandemic H1N1 infection in Turkey. Methods: We conducted a retrospective multicentre analysis of case records involving children hospitalized with influenza-like illness, in whom 2009 H1N1 influenza was diagnosed by reverse-transcriptase polymerase chain reaction assay, at 17 different tertiary hospitals. Results: A total of 821 children with 2009 pandemic H1N1 were hospitalized. The majority of admitted children (56.9%) were younger than 5 y of age. Three hundred and seventy-six children (45.8%) had 1 or more pre-existing conditions. Respiratory complications including wheezing, pneumonia, pneumothorax, pneumomediastinum, and hypoxemia were seen in 272 (33.2%) children. Ninety of the patients (11.0%) were admitted or transferred to the paediatric intensive care units (PICU) and 52 (6.3%) received mechanical ventilation. Thirty-five children (4.3%) died. The mortality rate did not differ between age groups. Of the patients who died, 25.7% were healthy before the H1N1 virus infection. However, the death rate was significantly higher in patients with malignancy, chronic neurological disease, immunosuppressive therapy, at least 1 pre-existing condition, and respiratory complications. The most common causes of mortality were pneumonia and sepsis. Conclusions: In Turkey, 2009 H1N1 infection caused high mortality and PICU admission due to severe respiratory illness and complications, especially in children with an underlying condition.
Evaluating Pain Induced by Venipuncture in Pediatric Patients With Developmental Delay

Objectives:Little attention has been paid to the assessment of pain in children with developmental delay. The aim of this study was to explore several methods for assessing pain during venipuncture in this population of children, using classic and modified scales to evaluate the children’s response to simplified tools. Methods:Sixteen children with mild or moderate developmental delay were evaluated using three standard self-rating scales (Visual Analog Scale [VAS], Eland Scale, and Faces Scale) and three modified methods (Cube Test, Modified Eland Scale, and Modified Faces Scale), recording subjective self-ratings and behavioral expressions of pain during a venipuncture procedure, apart from the initial fear. The children’s pain and reaction time were assessed by an outside observer, while their pain and fear were also evaluated by the parents. Results:The VAS was used without difficulty by all the children and revealed a good consistency with the Cube Test. The parents’ and neutral observer’s indirect pain assessment was also consistent with the child’s evaluations. The Eland Scale proved difficult to use, especially for Down’s syndrome children, while its modified version was easier. Results emerging from the original and modified Faces Scales were inconsistent. Frightened children attributed higher pain scores, demonstrating that negative emotions exacerbate the experience of pain in developmentally delayed children. The patients showed a limited capacity for verbal and behavioral expression in reaction to the painful stimulus (especially the Down’s cases). Discussion:These findings support the conviction that even developmentally delayed children can use self-rating methods effectively. This sector demands further, more extensive study, including the development of simplified tools, to ensure an adequate pain assessment and optimal antalgic approach to this particular pediatric population.
Mainstreaming Innovation: Exploring Institutional Change in the Australian Water Sector

Urban water systems are under significant pressure in light of complex and interrelated challenges such as climate change, population growth, urbanisation and degraded water and urban environments. In response, there is increasing consensus within academia, policy and industry spheres that conventional water management approaches, typically reliant upon large-scale, centralised and highly engineered infrastructure, are ill-equipped to meet the diverse and changing needs of our cities. Urban water scholars and practitioners are therefore calling for an urgent shift towards a more integrated approach to water management in order to deliver improved sustainability, liveability and resilience outcomes. This requires transformative change in the way urban water systems are both designed and delivered. As the means through which new practices are organised, moderated and implemented, institutions are essential to this process of broader system transformation. However, there is currently limited practical or theoretical understanding of institutional change processes in the context of transformative system change. Against this backdrop, this PhD thesis aims to explain how institutional change unfolds in a sustainability transition. Drawing primarily on sustainability transitions scholarship and institutional theory, this research is focused through the overall research question of “how does a radical innovation become institutionalised within a sector? ” In answering this question, the research seeks to (1) identify patterns and dynamics of institutional change, (2) assess the type and operation of institutional change mechanisms and (3) develop a framework describing the role of institutional change mechanisms in transformative system change. For this qualitative research project, three empirical cases of contemporary transition in the Australian urban water sector were examined. The results provide insight into the dynamics and co-evolution of institutional change to support a transition, and identify a number of institutional change mechanisms that are key to a transition effort. The findings also provide insight into the pace and speed of transformative system change, demonstrating the importance of incremental institutional change and introducing a hybrid pattern of transformative change. Finally, the results of this research have led to the development of a framework of institutional change, providing a foundation for further examination of the mechanisms of institutional change operating in the context of transformative system change. As one of the first detailed studies of institutional change in the context of a sustainability transition, this research advances the scholarship in this area while also offering practical guidance that can support the strategic activities of transition advocates and decision makers in pursuit of transformations towards sustainability.
Elevated COX-2 Expression in Cervical Carcinoma: Reduced Cause-Specific Survival and Pelvic Control

The purpose of this study was to correlate the level of cyclooxygenase-2 (COX-2) expression in carcinoma of the cervix with the clinical endpoints: local control, cause-specific survival, and patterns of failure in patients treated with radiotherapy. Formalin-fixed, paraffin-embedded tumor biopsies were stained for COX-2. Clinical factors such as stage, grade, tumor size, pre- and posttreatment hemoglobin level, and radiotherapy dose were also evaluated. Actuarial local control rates and cause-specific survival were determined according to the Kaplan-Meier method. COX-2 distribution staining was the only prognostic factor that was associated with local control and cause-specific survival. High COX-2 distribution staining was associated with decreased local control and decreased cause-specific survival by log rank comparison of Kaplan-Meier survival curves. The 5-year cause-specific survival rates for tumors with low versus high COX-2 distribution values were 90% and 22%, respectively (p = 0.0003). Actuarial pelvic control at 5 years was superior in patients with low COX-2 distribution staining (92%) compared with high staining (42%, p = 0.005). COX-2 staining intensity was found to correlate positively with tumor size (p = 0.02). These findings indicate that increased expression of COX-2 yields reduced pelvic control and cause-specific survival in patients with invasive carcinoma of the cervix treated with radiotherapy. Previously, inhibition of COX-2 has been demonstrated to sensitize tumors to radiation without effect on normal tissue. Taken together, these data may support a novel therapeutic application of COX-2 inhibitors in the treatment of carcinoma of the cervix.
'To move or not to move': a national survey among professionals on beliefs and considerations about the place of end-of-life care for people with intellectual disabilities.

BACKGROUND The aim of this article was to investigate the beliefs and considerations of professionals concerning an appropriate environment for end-of-life care for people with intellectual disabilities (ID). METHOD A survey questionnaire was composed based on a scan of relevant literature and the results of group interviews with professionals, family members and people with ID. The questionnaire focused on the respondents' general beliefs about an appropriate environment for end-of-life care and their specific considerations regarding the place of care of the last client for whom the respondent provided end-of-life care. The questionnaire was sent to 294 care staff members recruited from a nationally representative panel of nurses and social workers, 273 ID physicians recruited from the members list of the Dutch professional association of ID physicians, and 1000 general practitioners (GPs) recruited from a nationally representative sample from a national registration of GPs. RESULTS The overall response was 46%. Professionals predominantly believe that all efforts should be made to ensure that a person with ID receives end-of-life care in their own home environment, and that 24/7 care is available. Respondents indicated that most of the clients (79%) who had last received end-of-life care from an ID care service were able to stay in their own home environment. Decisions to keep the client in their own home environment were primarily based on the familiarity of the environment and the expertise of the team in end-of-life care. Insufficient expertise and a lack of adequate equipment were the main considerations in decisions to move a client. Despite the belief of care staff in particular that the wishes of the person with ID should always be leading when deciding on the place of end-of-life care, only 8% of the care staff and ID physicians explicitly mentioned that the client's wishes were taken into account in actual decision-making. CONCLUSIONS Professionals agree that end-of-life care for people with ID should preferably take place in the client's home environment, even when nursing expertise, experience and adequate equipment are not (yet) in place. Nonetheless, a lack of expertise in end-of-life care is the foremost consideration in decisions to move a client. If ID care services want to promote end-of-life care in the client's own home, we recommend formulating a policy on how to realise end-of-life care in the client's own home environment and provide sufficient training and support for staff. To involve people with ID as much as possible, we recommend that professionals integrate more collaborative principles in decision-making about the place of end-of-life care.
In the African Lungfish Met-Enkephalin and Leu-Enkephalin Are Derived from Separate Genes: Cloning of a Proenkephalin cDNA

A full-length proenkephalin cDNA (accession number: AF232670) was cloned from an African lungfish (Protopterus annectens) brain cDNA library. The 1,351-bp African lungfish proenkephalin contains an open reading frame that codes 266 amino acids and a stop codon. Within the sequence of lungfish proenkephalin there are 5 pentapeptide opioid sequences (all YGGFM), 1 octapeptide opioid sequence (YGGFMRSL) and 1 heptapeptide opioid sequence (YGGFMGY). A Leu-enkephalin sequence was conspicuously absent in lungfish proenkephalin. These results, coupled with observations on the organization of amphibian proenkephalin and mammalian proenkephalin, indicate that among the Sarcopterygii (lobed finned fish and tetrapods), the appearance of a Leu-enkephalin sequence in proenkephalin may have evolved in either the ancestral amniotes or the ancestral mammals, but not earlier in sarcopterygian evolution. Furthermore, the detection of neurons in the lungfish CNS that are only immunopositive for Met-enkephalin, coupled with earlier anatomical studies on the presence of neurons in the lungfish CNS that are only immunopositive for Leu-enkephalin, indicates that a Leu-enkephalin-coding opioid gene must be present in the CNS of the lungfish. This gene may be the lungfish form of prodynorphin. Given the phylogenetic position of the lungfish in vertebrate evolution, the putative Leu-enkephalin-coding gene must have evolved in the ancestral sarcopterygian vertebrates, or in the ancestral gnathostomes. The apparent slow rate of lungfish evolution makes these organisms interesting models for investigating the evolution of the opioid/orphanin gene family.
Do Firms Learn more from Exporting to the Developed Markets? Empirical Evidence of Indian Firms

Abstract The hypothesis of learning-by-exporting hinges largely based on the argument that the exporters are exposed to knowledge and technology to foreign markets and they learn and become more productive and innovative. However, firms from developing countries not only export to industrialized economies but also to less developed countries. The natural questions arises that what if a firm from developing countries directs its exports to a country at a similar or lower level of technological developed. Would there still be productivity gains to be made? We attempt to test the effects of destination of exports on firms’ productivity and innovation for a sample of the Indian manufacturing firms. Our findings indicate that a positive learning effect is flowing from developed countries to productivity and innovation of the Indian firms. However, in the case of exporting to developing countries including China, we find weak or negative effects. Furthermore, our results also suggest that in-house R&D and foreign technology enhances the absorption capacity of firms, which in turn help firms in learning and gaining through exporting to technologically advanced countries.
Practice patterns for surveillance of Barrett's esophagus in the united states.

BACKGROUND Endoscopic surveillance of Barrett's esophagus is recommended to detect dysplasia or cancer at an early and potentially treatable stage. However, little is known about the clinical practice patterns for endoscopic surveillance in the United States. METHODS A questionnaire regarding surveillance intervals, techniques and management approaches for patients with Barrett's esophagus was mailed to 1000 randomly selected members of the Clinical Practice Section of the American Gastroenterological Association. RESULTS The response rate was 455 of 1000 (45%). Not all respondents answered all questions. Seventy-nine percent of respondents were in community practices, and 21% were in academic practices. Nearly all (96%) performed endoscopic surveillance, but it was practiced more commonly in the community (334 of 341 [98%]) than in the academic setting (83 of 93 [89%], p < 0.001). For patients without dysplasia, endoscopic surveillance was most commonly performed every 2 years (264 of 415 [64%]). Patients with low-grade dysplasia usually had surveillance endoscopy at 6-month intervals (215 of 413 [52%]), whereas those with high-grade dysplasia most commonly had endoscopy every 3 months (201 of 404 [50%]). These surveillance patterns did not differ between the academic and community groups. Random biopsies were performed by 93 of 403 (23%), 4-quadrant biopsies by 310 (77%). Most physicians (83%) used standard capacity forceps. Brush cytology was done uncommonly (69 of 414 [17%]). The most common indications for esophagectomy were high-grade dysplasia by 82% and cancer by 83%. Ablation therapy was performed for Barrett's esophagus without dysplasia by 3.5%, Barrett's with dysplasia by 20%, and cancer by 8%. CONCLUSIONS Surveillance for Barrett's esophagus is widely practiced in the United States but there is considerable variation in interval and technique. A clearer consensus on endoscopic surveillance is warranted to optimize care of patients with Barrett's esophagus.
Wireless Mesh Infrastructure Supporting Broadband Internet with Multimedia Services

Wireless mesh infrastructure provides for attractive solutions to telecommunication services, where larger network capacity for broadband wireless Internet may be realized by spatial spectrum re-use, and lower network costs may be realized by the saving of cable/fiber backhaul on wireless stations. However, state-of-the-art technologies suffer from scalability limitations, where dataflow quality of service (QoS), e.g., throughput and end-to-end delay, can degrade fast with the number of wireless hops. In this paper, we show a novel architecture of opportunistic mesh (OPM), based on the large-scale cognitive networking technologies, which can resolve aforementioned problems. The concept is to opportunistically utilize network resources including both spectrum bandwidth and mesh station/radio availability, so as to achieve reliable QoS for real-time traffics (e.g., of multimedia services). An extensive study reports the seamless integration with Internet protocols, as well as a proof-of-concept prototype and experiment results.
Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients.

BACKGROUND Early goal-directed therapy for severe sepsis or septic shock improves outcomes but requires placement of a central venous catheter to measure central venous pressure (CVP), which may delay timely resuscitation and cause catheter-related complications. In addition, nonintensivists may not start early aggressive fluid resuscitation because of difficulty estimating CVP and concerns for inadvertent volume overload. OBJECTIVE To determine if the CVP target of 8 to 12 mm Hg can be accurately assessed using noninvasive ultrasound to measure the internal jugular vein aspect ratio (height/width). DESIGN Prospective observational study. SETTING Two academic medical centers. PARTICIPANTS Nineteen euvolemic volunteers and a convenience sample of 44 spontaneously breathing, critically ill patients. MEASUREMENTS Ultrasound imaging of internal jugular vein aspect ratio; invasive CVP measurement in critically ill patients. RESULTS For the volunteers, mean (standard deviation [SD]) aspect ratio of both the right and left internal jugular vein was 0.82 (0.07). Bland-Altman analysis indicated moderate intraobserver and interobserver agreement. Aspect ratio was similar for right and left sides and between men and women. In the critically ill patients, ultrasound accurately estimated a CVP of 8 mm Hg; area under the receiver operating characteristics curve was 0.84. For an invasively measured CVP of <8 mm Hg, the likelihood ratio for a positive ultrasound test (aspect ratio <0.83) was 3.5 and for a negative test (aspect ratio > or =0.83) was 0.30. CONCLUSIONS In this exploratory study, noninvasive ultrasound imaging of internal jugular vein aspect ratio accurately estimated a CVP of 8 mm Hg in spontaneously breathing, critically ill patients.
Etiology associated with developing posthemispherectomy hydrocephalus after resection-disconnection procedures.

OBJECT The authors sought to determine if clinical epilepsy variables, maximum daily temperature (Tmax), and blood and CSF findings were associated with the risk of developing hydrocephalus after first-time resection-disconnection hemispherectomy. METHODS Patients who underwent cerebral hemispherectomy in whom a standardized perioperative protocol was used, including the use of ventriculostomies (n = 79), were classified into those who developed and those who did not develop hydrocephalus requiring CSF shunts. The authors compared these 2 groups for clinical variables, Tmax, and blood and CSF studies through postoperative Day 12. RESULTS In this cohort, 30% of the patients required CSF shunts, of which 8% developed late hydrocephalus up to 3 years posthemispherectomy. Multivariate analysis found that etiology was associated with developing posthemispherectomy hydrocephalus. Higher shunt rates were observed for patients with hemimegalencephaly (40%; n = 15) and a history of CNS infection (100%; n = 4) compared with cortical dysplasia (17%; n = 23) and Rasmussen encephalitis (17%; n = 12). In univariate analysis, other factors associated with developing hydrocephalus were elevated maximum daily temperatures, elevated white blood cell counts, decreased CSF protein, and increased CSF red blood cell counts. CONCLUSIONS The findings of the study indicate that etiology was the factor most strongly associated with developing posthemispherectomy hydrocephalus. These findings suggest that there are variable mechanisms for developing hydrocephalus after cerebral hemispherectomy depending on the procedure, and in resection-disconnection operations the mechanism may involve changes in CSF bulk flow that varies by histopathology.
The heart in polymyositis: A prospective evaluation of 26 patients

Although cardiac abnormalities have been reported in patients with idiopathic polymyositis‐dermatomyositis (PM), the nature and extent of these abnormalities have varied. The purpose of this study was to determine the prevalence and to obtain a better description of the spectrum of cardiac abnormalities in a cohort of patients with PM by use of a thorough noninvasive cardiac evaluation. Accordingly, we studied 26 patients with a history of PM and clinically inactive myositis (22 polymyositis, 4 dermatomyositis) between June 1984 and June 1991. Examination included history, physical examination, 12‐lead electrocardiography, 24‐h ambulatory electrocardiographic monitoring, chest radiography, transthoracic echocardiography, and radionuclide ventriculography. Of the patients studied, 77% were taking corticosteroid medications at a mean dose of 39 ± 27 mg at the time of their evaluation. All 26 patients were identified as having two or more cardiac abnormalities. Cardiac symptoms and signs were common (62 and 81%, respectively), but were generally nonspecific. Electrocardiographic findings were most common (in 85% of cases), followed by findings on ambulatory monitoring (77%), echocardiography (42%), and radionuclide ventriculography (15%). The prevalence of mitral valve prolapse (8%) and hyperkinetic left ventricular contraction (12%) was significantly lower than previously reported. A secondary aim of this study was to determine associations between demographic variables including age, disease duration, cardiovascular symptoms, immunosuppressive therapy, autoantibody status, and creatinine phosphokinase level, and the presence of cardiac abnormalities. Of these patient variables, only increasing patient age was associated with an increased likelihood of cardiac abnormalities on noninvasive testing. In conclusion, abnormalities on noninvasive cardiac testing, many of which are minor and nonspecific, are prevalent in patients with PM. Our findings differ from previous reports in the demonstration of a low prevalence of mitral valve prolapse and hyperkinetic left ventricular contraction. In this population of patients with stable PM, only increased patient age was associated with a greater likelihood of abnormal cardiac findings.