Miracle-dz/UniFAR-FTUs huggingface dataset:
Safety of Outpatient Surgery for Obstructive Sleep Apnea

Objective Determine the safety experience of adult obstructive sleep apnea patients undergoing airway surgery. Study Design A retrospective cohort study. Setting The experience of members of a large Medicaid managed care organization between January 10, 2009, and June 30, 2011. Subjects and Methods Four hundred fifty-two adult Medicaid obstructive sleep apnea (OSA) patients (404 ambulatory, 48 inpatient) receiving head and neck airway surgery form the basis of this report. Four safety indicators were reported from administrative data for 30 days: emergency room visit, inpatient admission, observation day, and 3 or more primary care physician visits. The occurrence of myocardial infarction, deep venous thrombosis, stroke, pulmonary embolism, tracheostomy, or transfusion was noted. Results Ninety-four percent of the nasal, 86% of the palatal, and 79% of the nasal/palatal surgeries (89% overall) were ambulatory. The observed catastrophic complication rate among ambulatory patients was zero (95% confidence interval, 0.0%-1.1%). Emergency room visits for pain-related diagnoses were the most common adverse outcome (51%). Administrative data sets can be used to provide insight into practice safety questions. Conclusion Contrary to guidelines, most OSA patients underwent ambulatory head and neck airway surgery. The observed catastrophic complication rate was zero. Administrative data sets can be used to provide insight into practice safety questions. Further study is warranted of ambulatory surgery management of adult sleep apnea patients.
The Evolution of Racial, Ethnic, and Gender Diversity in US Otolaryngology Residency Programs

Objective To examine the evolution of racial, ethnic, and gender diversity in US otolaryngology–head and neck surgery residency programs and compare these figures with other residency programs. Design Retrospective database review. Setting US residency programs. Methods Information concerning minority and female representation in US residency programs was obtained from annually published graduate medical education reports by the Journal of the American Medical Association from 1975 to 2010. Minority representation among US population and university students was obtained from the US Census Bureau. The racial, ethnic, and gender diversity of otolaryngology residents was then compared with other medical fields (general surgery, family medicine, and internal medicine). Results Underrepresentation in otolaryngology–head and neck surgery is particularly disconcerting for African Americans (–2.3%/y, P = .09) and Native Americans (1.5%/y, P = .11) given their nonsignificant annual growth rates. Hispanic representation (17.3%/y, P < .0001) is growing in otolaryngology but is half the rate of growth of the Hispanic American population (32.8%/y, P < .0001). There is nonetheless promise for women (70.6%/y, P < .0001) and Asian Americans (63.0%/y, P < .0001), who demonstrated statistically significant growth trends Conclusion To our knowledge, this is the first study to describe the evolution of female and minority representation among US otolaryngology residents. Despite increasing gender, ethnic, and racial diversity among medical residents in general, female and certain minority group representation in US otolaryngology residency programs is lagging. These findings are in contrast to rising trends of diversity within other residency programs including general surgery.
Studies of Retinal Vascular Patterns: Part I. Normal Architecture

Flat preparations of the retina afford an unusually favorable opportunity to study blood vessel architecture (Ballantyne and Lowenstein 1 ). The retinal vessels have been visualized in the past by the following methods: 1. injection of India ink into the heart, major arteries, or directly into the retinal artery (Michaelsen, 2 Ashton, 3 Keeney and Barlow, 4 and others); 2. latex injection into the aorta (Janes 5 ); 3. benzidine-peroxidase staining of the red blood cells (Michaelsen 2 ); 4. infusion of silver nitrate with subsequent reduction of the silver to outline the reticular fibers, 6 and 5. staining of the full thickness of
Evaluation of knowledge, attitude and practice of rational use of medicines among clinicians in a tertiary care teaching hospital

Context: Prescribing is a challenging task requiring knowledge of essential medicine (EM), rational use of medicines (RUM) and personal drugs (P-drug). Though the majority of clinicians recognize the importance of RUM, most of them have not been able to apply this knowledge in their medical practice. Aims: The aim of the following study is to assess knowledge, attitude and practice of clinicians about RUM, EM, P-drugs, and sources of drug information. Settings and Design: A cross-sectional, questionnaire based study . Subjects and Methods: Study was carried out in 100 respondents including faculty members and junior residents (JRs) in a tertiary-care teaching hospital. Statistical Analysis: Univariate analysis was carried out using fisher's exact test. Results: Nearly 93% respondents were aware about EM, but only 79% prescribe them. Percentage is significantly higher in respondents of age more than 30, having clinical experience P . Conclusions: It is an encouraging finding that higher percentages of clinicians were aware about EM and also prescribed it. However, level of understanding related to P-drug concept and existence of essential medicines list are much below par. Also prescribing by trade name and heavy dependency on medical representatives for drug information is the matter of concern.
Reactive Oxygen Species in Chronic Rhinosinusitis and Secondhand Smoke Exposure

Objective Reactive oxygen species (ROS) can potentiate cellular injury and inflammation. This study aimed to (1) assess the presence of reactive oxygen species in the sinus tissue of patients with chronic rhinosinusitis (CRS) and (2) assess the impact of secondhand smoke (SHS) exposure on reactive oxygen species (ROS) production. Study Design Retrospective cohort study. Setting Academic medical center. Subjects and Methods Sinus tissue samples from patients undergoing sinus surgery were analyzed using diaminobenzidine (DAB) staining to assess for ROS. Stained specimens were photographed at random by a blinded photographer and then quantified by 3 blinded graders. The patient’s SHS exposure was determined by hair nicotine levels. Results were compared between non–smoke exposed cohorts and those exposed to secondhand smoke and by diagnosis. Results Sixty-nine adults undergoing sinus surgery were included in the study. For the non-SHS-exposed cohorts, chronic rhinosinusitis with nasal polyps (CRSwNP) had the highest number of DAB+ cells/high-powered field (hpf) followed by chronic rhinosinusitis without nasal polyps (CRSsNP) and controls. When comparing the control patients to their SHS-exposed counterparts, SHS exposure yielded statistically significantly higher levels of DAB-positive cells/hpf. SHS exposure did not affect DAB staining in CRSsNP or CRSwNP patients. Conclusion ROS are differentially expressed in various subtypes of CRS. SHS exposure increases ROS in sinus tissue of control patients, but the clinical significance of this is unclear.
Synergistic Effect of Partially Fluorinated Ether and Fluoroethylene Carbonate for High-Voltage Lithium-Ion Batteries with Rapid Chargeability and Dischargeability.

The roles of a partially fluorinated ether (PFE) based on a mixture of 1,1,1,2,2,3,3,4,4-nonafluoro-4-methoxybutane and 2-(difluoro(methoxy)methyl)-1,1,1,2,3,3,3-heptafluoropropane on the oxidative durability of an electrolyte under high-voltage conditions, the rate capability of the graphite and 5 V-class LiNi0.4Mn1. 6O4 (LNMO) electrodes, and the cycling performance of graphite/LNMO full cells are examined. Our findings indicate that the use of PFE as a cosolvent in the electrolyte yields thermally stable electrolytes with self-extinguishing ability. Electrochemical tests confirm that the PFE combined with fluoroethylene carbonate (FEC) effectively alleviates the oxidative decomposition of the electrolyte at the high-voltage LNMO cathode and enables reversible electrochemical reactions of the graphite anodes and LNMO cathodes at high rates. Moreover, the combination of PFE, which mitigates electrolyte decomposition at high voltages, and FEC, which stabilizes the anode-electrolyte interface, enables the reversible cycling of high-voltage full cells (graphite/LNMO) with a capacity retention of 70.3% and a high Coulombic efficiency of 99.7% after 100 cycles at 1C rate at 30 °C.
Physician Knowledge of and Attitudes toward the Patient Protection and Affordable Care Act

Objective To assess otolaryngology physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act (PPACA) and compare the association of bias toward the PPACA with knowledge of the provisions of the PPACA. Study Design Cross-sectional survey. Setting Nationwide assessment. Subjects Members of the American Academy of Otolaryngology—Head and Neck Surgery. Methods Otolaryngology physicians answered 10 true/false questions about major provisions of the PPACA. They also indicated their level of agreement with 9 statements about health care and the PPACA. Basic demographic information was collected. Results Email solicitation was sent to 9972 otolaryngologists and 647 responses were obtained (6.5% response rate). Overall correct response rate was 74%. Fewer than 60% of physicians correctly answered questions on whether small businesses receive tax credits for providing health insurance, the effect of the PPACA on Medicare benefits, and whether a government-run health insurance plan was created. Academic center practice setting, bias toward the PPACA, and Democratic Party affiliation were associated with significantly more correct responses. Conclusion Overall physician knowledge of the PPACA is assessed as fair, although better than the general public in 2010. There are several areas where knowledge of physicians regarding the PPACA is poor, and this knowledge deficit is more pronounced within certain subgroups. These knowledge issues should be addressed by individual physicians and medical societies.
A new two-dimensional fast cosine transform algorithm

The discrete cosine transform (2-D DCT) is based on a one-dimensional fast cosine transform (1-D FCT) algorithm. Instead of computing the 2-D transform using the row-column method, the 1-D algorithm is extended by means of the vector-radix approach. Derivation based on both the sequence splitting and Kronecker matrix product method are discussed. The sequence splitting approach has the advantage that all the underlying operations are shown clearly, while the matrix product representations are more compact and readily generalized to higher dimensions. The bit reversal operations are placed before the recursive additions so that the recursive operations can be performed in a very regular manner. This greatly simplifies the indexing problem in the software implementation of the algorithms. The vector-radix algorithm saves 25% multiplications as compared with the row-column method. >
Dexamethasone and Risk of Bleeding in Children Undergoing Tonsillectomy

Objective To determine whether dexamethasone use in children undergoing tonsillectomy is associated with increased risk of postoperative bleeding. Study Design Retrospective cohort study using a multihospital administrative database. Setting Thirty-six US children’s hospitals. Subjects Children undergoing same-day tonsillectomy between the years 2004 and 2010. Methods We used discrete time failure models to estimate the daily hazards of revisits for bleeding (emergency department or hospital admission) up to 30 days after surgery as a function of dexamethasone use. Revisits were standardized for patient characteristics, antibiotic use, year of surgery, and hospital. Results Of 139,715 children who underwent same-day tonsillectomy, 97,242 (69.6%) received dexamethasone and 4182 (3.0%) had a 30-day revisit for bleeding. The 30-day cumulative standardized risk of revisits for bleeding was greater with dexamethasone use (3.11% vs 2.71%; standardized difference 0.40% [95% confidence interval, 0.13%-0.67%]; P = .003), and the increased risk was observed across all age strata. Dexamethasone use was associated with a higher standardized rate of revisits for bleeding in the postdischarge time periods of days 1 through 5 but not during the peak period for secondary bleeding, days 6 and 7. Conclusions In a real-world practice setting, dexamethasone use was associated with a small absolute increased risk of revisits for bleeding. However, the upper bound of this risk increase does not cross published thresholds for a minimal clinically important difference. Given the benefits of dexamethasone in reducing postoperative nausea and vomiting and the larger body of evidence from trials, these results support guideline recommendations for the routine use of dexamethasone.
Comparison of Long-term Quality-of-Life Outcomes in Vestibular Schwannoma Patients

Objective To compare long-term quality-of-life outcomes in vestibular schwannoma patients managed with observation, microsurgery, or stereotactic radiation. Study Design ross-sectional survey with retrospective chart review. Setting Tertiary care center. Subjects and Methods The Penn Acoustic Neuroma Quality of Life (PANQOL) survey was mailed to 600 patients treated for vestibular schwannoma. Patients were separated by treatment and subsequently subdivided by years of follow-up (0-5, 6-10, and >10 years). Composite quality-of-life (cQOL) scores and subscores for hearing, balance, facial nerve, pain, anxiety, energy, and general health were calculated. Scores were compared among treatment groups as a whole, among treatment groups at each time interval, and within treatment groups over time using a 2-tailed analysis of variance and paired t test. Results The survey return rate was 49%, and the mean follow-up was 7.9 years. The only significant difference in cQOL occurred at 0 to 5 years, where stereotactic radiation scores were better than both microsurgery and observation (P = .009). No significant differences were detected in cQOL after 5 years. Within the radiation group, cQOL was significantly lower at 6 to 10 years than at 0 to 5 years (P = .013). At no point was cQOL for stereotactic radiation less than that for observation or microsurgery. Conclusions Long-term (>5 years) quality-of-life outcomes measured by the PANQOL in vestibular schwannoma patients show no significant differences between stereotactic radiation, observation, and microsurgical intervention. Studies are needed to fully evaluate very-long-term QOL for patients with vestibular schwannoma.
Intrusion-aware trust model for vehicular ad hoc networks

In vehicular ad hoc networks, peers make decisions on the basis of the information provided by the other peers. If the received information is fake, then the result could be catastrophic, such as road accidents. Therefore, many researchers use the concept of trust to evaluate the trustworthiness of the received data. However, existing trust management schemes proposed so far for the vehicular networks are suffered from various limitations. For example, some schemes measure trust on the basis of the history of interactions, which is infeasible for vehicular networks due to its ephemeral nature. Also, none of the existing schemes operate in an identity anonymous environment. In order to overcome these limitations, we propose a novel trust management scheme for identity anonymous vehicular ad hoc networks. The proposed method is simple and completely decentralized that makes it easy to implement in the vehicular networks. Also, we prove that the proposed method is not only robust, but it also detects false location and time information. Furthermore, it introduces linear time complexity, which makes it suitable to use in real time. Copyright © 2013 John Wiley & Sons, Ltd.
STUDIES ON COMMERCIAL BACTERIOPHAGE PRODUCTS

Bacteriophage therapy is now being widely used for many types of bacterial infection. In the United States at the present time there are three well known pharmaceutic companies manufacturing bacteriophage and offering it to the medical profession. The present impartial study was undertaken to test these preparations in vitro to ascertain whether they contained genuine potent bacteriophages. It may serve as a guide to physicians who use such preparations and aid them in interpreting clinical results. Should a commercial product prove to contain a bacteriophage only feebly potent or one not capable of producing any lytic action, failure in therapy need not reflect on or injure the reputation of genuine bacteriophage. The first company 1 markets a jelly described in the labels on tube and carton as an antigen containing lysed proteins of staphylococcus. In the accompanying literature, however, appears the definite statement that bacteriophage is present. There are also
Profile of brentuximab vedotin and its potential in the treatment of relapsed or refractory Hodgkin lymphoma

: Treatment of primary refractory and relapsed classical Hodgkin lymphoma remains challenging, with disappointing results overall and only a minority of patients enjoying a long-term cure. Until recently, antibody therapy has not played any role in the management of this form of Hodgkin lymphoma. The CD30 antigen was first identified in the Hodgkin Reed– Sternberg malignant cell of Hodgkin lymphoma and emerged as a promising potential target for antibody treatment. The first-generation monoclonal anti-CD30 antibodies proved disap-pointing with little clinical efficacy. More recently, a novel class of antibody-drug conjugates has emerged. Antibody-drug conjugates offer the potential to target tumor tissue more specifically and deliver potent drug therapies with minimal or less systemic toxicity. Brentuximab vedotin (SGN-35) is one such drug of this class and combines an anti-CD30 monoclonal antibody and the antitubulin agent, monomethyl auristatin E. Initial Phase I studies of brentuximab vedotin showed a promising 52% overall response rate in relapsed Hodgkin lymphoma, with minimal toxicity. More recently, the pivotal Phase II study in 102 patients demonstrated an overall response rate of 75% and a complete response rate of 34%. The median duration of response was 6.7 months, but this was extended to 20.5 months in those who achieved a complete response. This review outlines the development of the antibody-drug conjugate, brentuximab vedotin, for relapsed or refractory classical Hodgkin lymphoma.
Detection of transients in 1/f noise with the undecimated discrete wavelet transform

A method based on pattern matching in the undecimated discrete wavelet transform domain is introduced for the detection of a known transient with unknown parameters in the presence of 1/f noise. Maxima tracking techniques are used to reduce the computational complexity of the matching procedure by an order of magnitude, with minimal performance impact.
Strategic management of a healthcare organization: engagement, behavioural indicators, and clinical performance

Healthcare organizations today are facing a series of problems due to two main factors: increasing difficulty in satisfying a progressively more ‘aware’ and demanding user, and the need to change their internal organization to keep pace with the very rapid changes taking place in technology and approach. A continuous increase of complexity and the capacity of physicians will not ensure the fundamental requirement of any business: to really deliver what its customers need. Hence, it is time for a revolutionary strategy focused on: (i) maximizing value for patients by obtaining the best outcomes at lowest cost and (ii) moving from a physician-centred organization to an ‘organization-driven’ care process. However, complex systems are typically conservative and rather resistant to change, and the healthcare system is no exception to this rule. The challenge is that doctors have to be central players in the healthcare revolution and any strategy that they do not embrace will fail. Certainly, a piecemeal approach will not work. Engaging doctors in transforming the system requires focusing on shared goals, by using motivational tools: shared purpose, peer pressure, measuring performance, and enhancing a patient-centred approach. GVM Care & Research is a holding operating in the health, pharmaceutical, spa-well-being, research, biomedical industry, company-aimed services, real estate, and financial areas. The core business is the network of highly multi-specialized hospitals and day-hospital outpatient clinics: this complex system, involving specialized facilities and highly qualified professional expertise, is present in numerous Italian regions and extends also to France, Albania, and Poland. GVM is one of the key players in Italy in cardiac surgery (responsible for ∼15% of all cardiac interventions in Italy) and interventional cardiology, with documented excellent outcomes (cf. the Italian National Healthcare Agency and Italian Ministry of Health). The first step in any strategic transformation is to clarify the institutional mission, …
New polynomial transform algorithm for multidimensional DCT

A new algorithm for the type-II multidimensional discrete cosine transform (MD-DCT) is proposed. Based on the polynomial transform, the rD-DCT with size N/sub 1//spl times/N/sub 2//spl times//spl middot//spl middot//spl middot//spl times/N/sub r/, where N/sub i/ is a power of 2, can be converted into a series of one dimensional (1-D) discrete cosine transforms (DCTs). The algorithm achieves considerable savings on the number of operations compared with the row-column method. For example, the number of multiplications for computing an r-dimensional DCT is only 1/r times that needed by the row-column method, and the number of additions is also reduced. Compared with other known polynomial transform algorithms for MD-DCT and the most recently presented algorithm for MD-DCT, the proposed one uses about the same number of operations. However, advantages such as better computational structure and flexibility in the choice of dimensional sizes can be achieved.
Key splitting: making random key distribution schemes resistant against node capture

A large number of random key pre-distribution RKD schemes have been proposed in the literature to secure wireless sensor network applications, relying on symmetric key cryptography. However, sensor nodes are exposed to physical compromise by adversaries, who target the symmetric keys stored at each node. With the stolen keys in their possession, the adversaries are then able to compromise communication links between benign nodes. Here, the big challenge arises: how to increase resilience of RKD schemes for wireless sensor networks to node capture, while maintaining the flexibility and low-cost features of RKD? We propose the idea of key splitting to address this problem, without the need of any special-purpose hardware. Our key splitting scheme neither increases per-node storage nor introduces additional computation and communication overheads. Nevertheless, it can achieve better connectivity. More importantly, it significantly increases resilience to node compromise, when the adversary does not have overwhelming computational power. Copyright © 2014 John Wiley & Sons, Ltd.