Miracle-dz/UniFAR-FTUs huggingface dataset:
Rural emergency department use by CTAS IV and V patients.

OBJECTIVE For a variety of reasons, many emergency department (ED) visits are classified as less- or nonurgent (Canadian Triage and Acuity Scale [CTAS] level IV and V). A recent survey in a tertiary care ED identified some of these reasons. The purpose of our study was to determine if these same reasons applied to patients presenting with problems triaged at a similar level at a low- volume rural ED. METHODS A 9-question survey tool was administered to 141 CTAS level IV and V patients who attended the South Huron Hospital ED, in Exeter, Ontario, over a 2-week period in December 2006. RESULTS Of the 141 eligible patients, 137 (97.2%) completed the study. One hundred and twenty-two patients (89.1%) reported having a family physician (FP) and 53 (38.7%) had already seen an FP before presenting to the ED. Just over one-half of all patients (51.1%) had their problem for more than 48 hours, and 42 (30.7%) stated that they were referred to the ED for care. Fifty-three (38.7%) of the respondents felt they needed treatment as soon as possible. Many patients reported coming to the ED because: 1) their FP office was closed (21.9%); 2) they could not get a timely appointment (16.8%); or 3) the walk-in clinic was closed (24.8%). Only 6 patients (4.4%) specifically stated that they came to the ED because they had no FP. One-third of patients attended the ED because they believed it offered specialized services. CONCLUSION In this rural setting, most less- or nonurgent ED patients had an FP yet they went to the ED because they did not have access to primary care, because they perceived their problem to be urgent or because they were referred for or sought specific services.
Conservative Management of Abnormally Invasive Placentation

Due to the growing number of cesarean deliveries, the frequency of abnormally invasive placentation is increasing. The optimal management of this condition remains unclear. This article reviews the efficacy and safety of conservative management of abnormally invasive placentation. We performed a MEDLINE and Embase search and reviewed all articles on conservative management of abnormally invasive placentation published from 1985 through 2006. Over the past 20 years, 48 reports have described outcomes of 60 women who were treated conservatively for abnormally invasive placentation. Twenty-six women were managed without any additional interventions. In most of these patients (19/26), the placenta had been partially removed. In 4 of these 26, conservative therapy failed. Twenty-two women received adjuvant methotrexate. In most of these women (19/22), the entire placenta was left in situ. In 5, therapy failed. Twelve women were managed with arterial embolization. In most of these (9/12), the diagnosis was made antepartum and the placenta was completely left in situ. In 3, therapy failed. Overall, 11 women experienced infection (11/60), 21 women experienced vaginal bleeding (21/60), and 4 suffered disseminated intravascular coagulopathy (4/60). Spontaneous loss of placental tissue was noted in 16 women. Subsequent pregnancies were reported in 8 women. Conservative management of abnormally invasive placentation can be effective and fertility can be preserved. It should only be considered in highly selected cases when blood loss is minimal and there is desire for fertility preservation. Whether adjuvant methotrexate or selective arterial embolization is beneficial is uncertain. Undetectable hCG values do not seem to guarantee complete resorption of retained placental tissue. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to explain that there are methods to successfully treat abnormal placentation with conservative means, but these methods must be applied only in highly selected cases and recall that no one method is superior to the other.
Proton, helium, and electron spectra during the large solar particle events of October-November 2003

The extraordinary period from late October through early November 2003 was marked by more than 40 coronal mass ejections (CME), eight X-class flares, and five large solar energetic particle (SEP) events. Using data from instruments on the ACE, SAMPEX, and GOES-11 spacecraft, the fluences of H, He, O, and electrons have been measured in these five events over the energy interval from ∼0.1 to >100 MeV/nucleon for the ions and ∼0.04 to 8 MeV for electrons. The H, He, and O spectra are found to resemble double power laws, with a break in the spectral index between ∼5 and ∼50 MeV/nucleon which appears to depend on the charge-to-mass ratio of the species. Possible interpretations of the relative location of the H and He breaks are discussed. The electron spectra can also be characterized by double power laws, but incomplete energy coverage prevents an exact determination of where and how the spectra steepen. The proton and electron fluences in the 28 October 2003 SEP event are comparable to the largest observed during the previous solar maximum, and within a factor of 2 or 3 of the largest SEP events observed during the last 50 years. The 2-week period covered by these observations accounted for ∼20% of the high-energy solar-particle fluence over the years from 1997 to 2003. By integrating over the energy spectra, the total energy content of energetic protons, He, and electrons in the interplanetary medium can be estimated. After correcting for the location of the events, it is found that the kinetic energy in energetic particles amounts to a significant fraction of the estimated CME kinetic energy, implying that shock acceleration must be relatively efficient in these events.
31 P-NMR SPECTROSCOPY OF RAT LIVER DURING SIMPLE STORAGE OR CONTINUOUS HYPOTHERMIC PERFUSION 1

SUMMARY The ATP content and intracellular pH (pH i )3 of isolated rat liver before, during, and after cold preservation in either UW-lactobionate (UW, n=10) or Euro-Collins (EC, n=8) solutions were monitored using phosphorus-31 nuclear magnetic resonance ( 31 P-NMR) spectroscopy. The 31 P-NMR spectra were obtained on a 4.7-Tesla system operating at 81 MHz. Fructose metabolism, liver enzyme release, O 2 consumption, and rat survival after liver transplantation were also evaluated. During simple cold storage (SCS), the ATP level declined to undetectable levels with both preservation solutions while the pH i declined to approximately 7.0. In contrast, during continuous hypothermic perfusion (CHP), hepatic ATP levels remained measurable during the 24-hour EC preservation and actually increased significantly (p>0.01) during UW preservation. After reperfusion at 37°C with Krebs-lactate, the SCS livers treated with EC differed significantly from the UW livers in terms of their ATP and pH i as well as their response to a fructose challenge. In contrast, livers undergoing CHP demonstrated similar behaviors with both solutions. These results demonstrate an increase in the hepatic ATP content during CHP which occurs with UW but is not seen with EC. On the other hand, only livers that were simply stored with UW achieved significant survival after transplant, while CHP livers were affected by vascular damage as demonstrated by fatal thrombosis after transplant. These data suggest that ATP content is not the only determinant of good liver function although a system of hypothermic perfusion might further improve liver preservation efficacy should injury to vascular endothelium be avoided.
The Major Nuclear Envelope Targeting Domain of LAP2 Coincides with Its Lamin Binding Region but Is Distinct from Its Chromatin Interaction Domain*

LAP2 is an integral protein of the inner nuclear membrane which binds lamins and chromosomes and is suggested to have an important role in nuclear envelope organization. In a previous study we identified an internal 76-amino acid region of LAP2 which is required for stable targeting of the protein to the nuclear envelope. Here, we have mapped the lamin binding region of LAP2 and demonstrate that it coincides with this nuclear envelope targeting domain. In contrast, we found that the portion of LAP2 involved in binding to chromosomes resides in a separate region of the protein near its NH2 terminus. The minimal lamin binding region of LAP2 is capable of conferring stable nuclear envelope localization when attached to the transmembrane and partial lumenal domains of a protein that shows no nuclear envelope targeting activity. This directly supports the notion that a major mechanism for localization of integral membrane proteins at the inner nuclear membrane involves binding to lamins, which would constrain diffusion through the continuous nuclear envelope/endoplasmic reticulum membrane system.
Molecular characterization of Escherichia coli isolated from different food sources

Abstract Escherichia coli and Escherichia coli O157 were identified from "selom" (Oenanthe stolonifera), "pegaga" (Centella asiatica), beef, chicken, lamb, buffalo, "ulam Raja" (Cosmos caudatus) and "tenggek burung" (Euodia redlevi). The bacteria were recovered using chromagenic agar. Isolated Escherichia coli and Escherichia coli 0157 were further characterized by plasmid profiling and enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR). The virulence genes of the isolates (VT1, VT2, LT, ST, eaeA, inV) that produces pathogenic Escherichia coli and 16S rRNA gene were screened by a multiplex PCR assay. The plasmid profiling analysis showed that out of 176 isolates, only 103 isolates contained plasmids. ERIC-PCR analysis generated amplified products in the range of ~150 bp to > 1000 bp categorizing isolates into a total of 52 different profiles. Multiplex PCR showed that 20 (32.3%) of the isolates carried eaeA gene, 6 (9.7%) isolates possessed inV genes, only 1 (1.6%) have VT2 genes and 1 (1.6%) as well carried VT1 genes, 2 (3.2%) of the isolates harboured LT genes, and only 1 (1.6%) isolate possessed ST genes. There were no correlation between plasmid, ERIC-PCR and virulence genes profiles.
Phase shifts in stochastic resonance.

The response of an overdamped bistable system to a periodic force is investigated using linear-response theory and by analog electronic experiment. It is shown, both theoretically and experimentally that a phase lag phi exists between the force and the response, and that |phi| passes through a maximum when the noise intensity is tuned through the range where stochastic resonance occurs. These results clarify the interrelation between stochastic resonance a vonventional resonance phenomena, and confirm that stochastic resonance can usefully be treated by linear-response theory.
Rebound effect after stopping beta-blockers.

With cryptogenic disease it is impossible to be certain of the prognosis for these infants if they had not had surgery, but such deaths are exceptional and some component of the laparotomy or cholangiography may have contributed. These infants avoided a more immediate hazard of laparotomy-namely, in those with severe liver disease and markedly reduced bile flow, the removal of narrow but patent bile ducts because of a mistaken diagnosis of biliary atresia.7 Further, Thaler and Gellis8 have shown that infants with hepatitis submitted to laparotomy and operative cholangiography are more likely to develop cirrhosis than those with a condition of similar severity who are spared these investigations. I therefore submit that laparotomy and operative cholangiography are not simple procedures in infants with hepatobiliary disease and can safely be avoided in the vast majority. It would be a pity if the improved survival with a good quality of life for some infants with extrahepatic biliary atresia were to be counteracted by unnecessary morbidity and mortality from laparotomies in infants with hepatitis. While the lure of "new and exotic liver function tests" may contribute to the delay in surgical treatment, more important factors appear to be the failure of parents, health visitors, and some family doctors to appreciate that hyperbilirubinaemia with dark urine is always pathological and requires investigation, and persisting and understandable doubts among some paediatricians about the longterm prognosis in biliary atresia even if satisfactory bile drainage is achieved following portoenterostomy.
Entorhinal cortex of the rat: Topographic organization of the cells of origin of the perforant path projection to the dentate gyrus

By using three‐dimensional computer reconstruction techniques and the production of two‐dimensional unfolded maps, we analyzed the topographic organization of projections from the entorhinal cortex of the rat to the dentate gyrus. The retrograde tracers, Fast blue and Diamidino yellow, were injected at all septotemporal levels of the dentate gyrus, and the distribution of retrogradely labeled layer II cells in the entorhinal cortex was plotted by using computer‐aided microscopy systems. Discrete injections of fluorescent dyes into the dentate gyrus labeled bands of layer II neurons in the entorhinal cortex that covered approximately 45% of its surface area. Injections confined to the septal half of the dentate gyrus resulted in a band that occupied the most lateral and caudomedial portions of the entorhinal cortex. Although there were subtle changes in the density of labeled cells in this region, essentially the same region of cells was labeled after any injection into the septal half of the dentate gyrus. Injections into mid‐septotemporal levels of the dentate gyrus (50–75% of the distance from the septal pole) led to a distinctly different pattern of retrograde labeling. A more medial portion of the lateral entorhinal cortex and a more rostral portion of the medial entorhinal area were labeled in these cases. Another change in entorhinal labeling occurred when the injection involved the most temporal quarter of the dentate gyrus. Injections into this area led to a constrained region of entorhinal labeling that included the most medial portion of the lateral entorhinal area and the most rostral portion of the medial entorhinal area. Although the domains of cells projecting to septal, mid‐septotemporal, and temporal levels of the dentate gyrus were not entirely segregated, there was relatively little overlap of the three populations of neurons. These data raise the possibility that different portions of the entorhinal‐hippocampal circuit are capable of semiautonomous information processing, at least at the stage of input to the dentate gyrus. J. Comp. Neurol. 398:25–48, 1998. © 1998 Wiley‐Liss, Inc.
Rpl22 Loss Impairs the Development of B Lymphocytes by Activating a p53-Dependent Checkpoint

Although ribosomal proteins facilitate the ribosome’s core function of translation, emerging evidence suggests that some ribosomal proteins are also capable of performing tissue-restricted functions either from within specialized ribosomes or from outside of the ribosome. In particular, we have previously demonstrated that germline ablation of the gene encoding ribosomal protein Rpl22 causes a selective and p53-dependent arrest of αβ T cell progenitors at the β-selection checkpoint. We have now identified a crucial role for Rpl22 during early B cell development. Germline ablation of Rpl22 results in a reduction in the absolute number of B-lineage progenitors in the bone marrow beginning at the pro–B cell stage. Although Rpl22-deficient pro–B cells are hyporesponsive to IL-7, a key cytokine required for early B cell development, the arrest of B cell development does not result from disrupted IL-7 signaling. Instead, p53 induction appears to be responsible for the developmental defects, as Rpl22 deficiency causes increased expression of p53 and activation of downstream p53 target genes, and p53 deficiency rescues the defect in B cell development in Rpl22-deficient mice. Interestingly, the requirement for Rpl22 in the B cell lineage appears to be developmentally restricted, because Rpl22-deficient splenic B cells proliferate normally in response to Ag receptor and Toll receptor stimuli and undergo normal class-switch recombination. These results indicate that Rpl22 performs a critical, developmentally restricted role in supporting early B cell development by preventing p53 induction.
Diagnostic delay among pulmonary tuberculosis patients in Sarawak, Malaysia: a cross-sectional study.

INTRODUCTION Delayed diagnosis of tuberculosis (TB) can lead to an increased period of infectivity in the community, a delay in treatment and a severe form of the disease. The objective of this study was to determine the length of delay, and factors linking the delay from the onset of symptoms of pulmonary tuberculosis (PTB) until the commencement of treatment in Sarawak, Malaysia. METHODS An institution based cross-sectional study was conducted in 10 TB clinics in randomly selected divisions in Sarawak from June 2003 to May 2004. Delay was analyzed from two perspectives: (1) period between the onset of TB symptoms to any first medical consultation (patients' delay); and (2) period between the first medical consultation to the diagnosis of TB (diagnosis delay). Patients were interviewed on diagnosis or within the admission period using a semi-structured questionnaire. RESULTS A total of 316 new smear-positive PTB patients participated in the study. The median patient interval was 30 days. Gender was found to be significantly associated with patient delay. The median diagnosis interval was 22 days. Respondents' incomes, health-care professional first consulted and actions taken by the health-care providers during the first consultation were significantly associated with diagnosis delay. The medium treatment interval was 0 days. CONCLUSION Both patients and health providers played a role in delaying TB diagnosis. Females appeared to have longer delay. Respondents living above the poverty line had diagnosis delay as they made more visits to GPs or different government clinics without proper investigations for TB. A mechanism is needed to increase all health-care providers' suspicion of TB so that proper investigations can be done during first consultation.
Perceptions and myths regarding oral health care amongst strata of low socio economic community in Karachi, Pakistan.

OBJECTIVES To determine the prevalence of dental myths and perceived knowledge regarding oral healthcare practices and its associations with levels of education amongst low socioeconomic strata in Karachi, Pakistan. METHODS The cross-sectional study was conducted in January 2011. Two-staged random sampling was conducted to achieve a sample size of 576 participants from 8 union councils of Gadap Town, Karachi, Pakistan. An interview-based questionnaire was used to determine the participants' perceptions towards oral health and hygiene practices as well as the prevalence of common dental myths. The subjects were interviewed through a formulated questionnaire that was cross-translated into Urdu language. RESULTS Response rate from the participants was 550 (95.48%). Of the total, 270 (47%) respondents believed in the myth of tooth extraction affecting the eye vision. This was significantly associated with the socio-demography of the respondents. Besides, 421 (73%) thought that tooth extraction is not the ultimate remedy for pain relief and it was statistically significant with age and educational status of the participants. Those who considered bleeding while brushing to be normal were 144 (25%), and it was significantly associated with age and education level. Impact of oral health on general health was positively responded by 392 (68%), while 418 (72.5%) respondents did not think that the retention of baby teeth is important. Both these perceptions were significantly associated with age and level of education. CONCLUSION Pakistani population has considerable belief in myths and false perceptions regarding oral health issues. Various stakeholders should be involved to develop policies towards healthy attitudes and beliefs within the community towards their oral healthcare.
Diurnal variation of serum and urine biomarkers in patients with radiographic knee osteoarthritis.

OBJECTIVE To evaluate diurnal variation of biomarkers in subjects with osteoarthritis (OA) of the knee. METHODS Twenty subjects with radiographic knee OA were admitted to the General Clinical Research Center of Duke University for an overnight stay to undergo serial blood and urine sampling. Biomarkers measured included serum hyaluronan (HA), cartilage oligomeric matrix protein (COMP), keratan sulfate (KS-5D4), aggrecan neoepitope (CS846), high-sensitivity C-reactive protein (hsCRP), osteocalcin, transforming growth factor beta1 (TGFbeta1), and type II collagen (CII)-related epitopes (neoepitope from cleavage of CII [C2C], carboxy-terminus of three-quarter peptide from cleavage of CI and CII [C1,2C], and type II procollagen carboxy-propeptide [CPII] in serum, and C-terminal telopeptides of CII [CTX-II] and C2C in urine). RESULTS Levels of serum HA, COMP, KS-5D4, and TGFbeta1 increased significantly from T0 (before arising from bed) to T1 (1 hour after arising). More diurnal variation in HA was observed in patients with higher daily mean HA concentrations. CPII increased significantly from T0 to T2 (4 hours after arising). Urinary concentrations of CTX-II were also found to vary with morning activity, decreasing significantly from T0 to T2. Urinary C2C concentrations increased significantly from T0 until T3 (early evening). No diurnal variations in CS846, hsCRP, osteocalcin, serum C2C, or C1,2C were observed. Six biomarkers (serum C2C, C1,2C, COMP, KS-5D4, TGFbeta1, and urinary CTX-II) were associated with radiographic knee OA (expressed as the sum of Kellgren/Lawrence radiographic severity grades), with the strongest correlations observed with measurements obtained at later time points (either T2 or T3). CONCLUSION Our study results suggest that serum and urine sampling for HA, COMP, KS-5D4, TGFbeta1, CPII, urinary CTX-II, and urinary C2C should be standardized in future OA clinical trials. Serum and urine sampling at late midday time points may be the optimal approach for OA studies, although this result should be validated in a larger cohort.
Urban-rural and regional variability in the prevalence of food insecurity: the survey of the health of Wisconsin.

BACKGROUND Food insecurity is a public health concern estimated to affect 18 million American households nationally, which can result in chronic nutritional deficiencies and other health risks. The relationships between food insecurity and specific demographic and geographic factors in Wisconsin are not well documented. The goals of this paper are to investigate sociodemographic and geographic features associated with food insecurity in a representative sample of Wisconsin adults. METHODS This study used data from the Survey of the Health of Wisconsin (SHOW). SHOW annually collects health-related data on a representative sample of Wisconsin residents. Between 2008-2012, 2,947 participants were enrolled in the SHOW study. The presence of food insecurity was defined based on the participant's affirmative answer to the question "In the last 12 months, have you been concerned about having enough food for you or your family? " RESULTS After adjustment for age, race, and gender, 13.2% (95% CI, 10.8%-15.1%) of participants reported food insecurity, 56.7% (95% CI, 50.6%-62.7%) of whom were female. Food insecurity did not statistically differ by region (P = 0.30). The adjusted prevalence of food insecurity in the urban core, other urban, and rural areas was 14.1%, 6.5%, and 10.5%, respectively. These differences were not statistically significant (P = 0.13) and, for urban core and rural areas, persisted even when accounting for level of economic hardship in the community. CONCLUSIONS The prevalence of food insecurity is substantial, affecting an estimated 740,000 or more Wisconsin residents. The prevalence was similarly high in all urbanicity levels and across all state public health regions in Wisconsin. Food insecurity is a common problem with potentially serious health consequences affecting populations across the entire state.