Miracle-dz/UniFAR-FTUs huggingface dataset:
Cohort study to test the predictability of the Melbourne criteria for activation of the medical emergency team

Objective To test the predictability of the Melbourne criteria for activation of the medical emergency team (MET) to identify children at risk of developing critical illness. Design Cohort study. Setting Admissions to all paediatric wards at the University Hospital of Wales. Outcome measures Paediatric high dependency unit admission, paediatric intensive care unit admission and death. Results Data were collected on 1000 patients. A single abnormal observation determined by the Melbourne Activation Criteria (MAC) had a sensitivity of 68.3% (95% CI 57.7 to 77.3), specificity 83.2% (95% CI 83.1 to 83.2), positive predictive value (PPV) 3.6% (95% CI 3.0 to 4.0) and negative predictive value 99.7% (95% CI 99.5 to 99.8) for an adverse outcome. Seven of the 16 children (43.8%) would not have transgressed the MAC prior to the adverse outcomes. Four hundred and sixty-nine of the 984 children (47.7%) who did not have an adverse outcome would have transgressed the MAC at least once during the admission. Conclusion The MAC has a low PPV and its full implementation would result in a large number of false positive triggers. Further research is required to determine the relative contribution of the components of this complex intervention (Paediatric Early Warning System, education and MET) on patient outcome.
Cash Versus Accrual Accounting and the Availability and Cost of Small Business Debt

We examine whether the voluntary use of accrual accounting provides incremental information to capital providers above cash accounting, thereby lowering the firm’s availability and cost of debt. We investigate these issues using a large, generalizable sample of small businesses that have discretion in their choice of cash or accrual accounting. We find that small businesses using accrual accounting have significantly lower interest rates after controlling for many factors associated with cost of debt. The findings are robust to controlling for self-selection of firms that apply for debt and the endogenous choice to use accrual accounting. However, we find limited evidence that accrual accounting decreases the likelihood of loan denial. In addition, third-party credit scores appear to partially substitute for the incremental information provided through accruals. Finally, accrual accounting and credit scores are only significantly associated with lending decisions for firms without long-term relationship with their lenders. The latter result is consistent with the “soft” information obtained through ongoing banking relationships providing a superior means for reducing information asymmetries between small business borrowers and lenders. * Corresponding author: Gavin Cassar, The Wharton School, University of Pennsylvania, Steinberg Hall-Dietrich Hall (Suite 1300), 3620 Locust Walk, Philadelphia, PA 19104-6365. cassar@wharton.upenn. edu (215) 898 2023. The authors thank Jeffrey Doyle and Jennifer Blouin, seminar participants from the University of Colorado at Boulder, Ghent University, Lancaster University, University of Pennsylvania, Tilburg University, and Utah Winter Accounting Conference for their comments. The financial support of The Wharton School and Ernst & Young is greatly appreciated. Cash Versus Accrual Accounting and the Availability and Cost of Small Business Debt
Galerkin method for calculating valence-band wavefunctions in quantum-well structures using exact envelope theory

The ability to calculate accurately the valence-band structure in semiconductors is important in the design of quantum-well (QW) semiconductor devices. The Galerkin method for calculating accurate analytic approximations for multicomponent valence-band wavefunctions is computationally fast and efficient. The Galerkin method is, in fact, an improved version of an earlier Raleigh-Ritz-type variational method. In this paper, we remark that both the variational method and the more recently proposed Galerkin method are formulated such that they imply symmetrized boundary constraints at material interfaces, with the symmetrized nature of the constraints arising from neglecting the ordering of the operators. Burt's exact envelope-function theory for semiconductor microstructures has been used to demonstrate, however, that the commonly used symmetrized boundary constraints for material interfaces are unphysical. We therefore present a modified version of the Galerkin method that implicitly assumes physically reasonable, exact envelope-function boundary constraints. Simulations show that the modified Galerkin method successfully produces physical, semi-analytic results that are consistent with exact envelope theory.
An ambiguous relationship--a qualitative meta-synthesis of hospitalized somatic patients' experience of interaction with fellow patients.

AIM The aim of this study was to provide a clear view of the existing knowledge regarding patients' significance to fellow patients during hospitalization. METHOD Sandelowski and Barroso's approach to qualitative meta-synthesis was selected and systematically used for collecting and assessing findings from qualitative studies. Data consisted of seven qualitative studies published as one book, four scientific articles and two doctoral theses from Scotland, UK, Norway and Denmark. The analysis and synthesis were conducted with inspiration from both Sandelowski and Barroso and Ian Dey's approach to qualitative data analysis. RESULTS The qualitative meta-synthesis resulted in the heading An Ambiguous Relationship under which three core categories illustrate the hospitalized patients' different interaction roles. The core categories were as follows: (i) the fellow patient experienced as an enforced companion, (ii) the fellow patient experienced as an expert on illness and hospital life and (iii) the fellow patient experienced as a care provider. Each core category was elaborated through several subcategories. Social interaction among hospitalized patients embedded elements of both enforced and volunteered participation. Typically, the social interaction was experienced as giving and was referred to in positive terms but recurrently, the opposite was experienced too. The ambiguity of the relationship clearly emerged in all of the synthesized themes presented in this article. IMPLICATIONS FOR PRACTICE Hospitalized patients experienced interaction with fellow patients to be of great significance. We suggest that knowledge of patients' interaction is to be included in the nursing education and that nurses reflect on how this knowledge may be implemented as a part of caring in nursing.
Beta2-receptor polymorphisms in patients receiving salmeterol with or without fluticasone propionate.

RATIONALE Retrospective pharmacogenetic studies have questioned whether patients with asthma who are arginine homozygous at the beta(2-)adrenergic receptor (position 16) should use long-acting beta-agonists. OBJECTIVES To examine whether the response to salmeterol alone or in combination with an inhaled corticosteroid is influenced by beta- receptor polymorphisms. METHODS Subjects using only as-needed albuterol were screened and completed two sequential open-label run-in periods (8 wk on as-needed albuterol; 8 wk on as-needed ipratropium). Five hundred forty-four subjects were randomized by Arg16Gly genotype to salmeterol alone or with fluticasone propionate for 16 weeks. Change from baseline in morning peak expiratory flow was the primary endpoint. MEASUREMENTS AND MAIN RESULTS Lung function responses were sustained over treatment and no statistically significant changes from baseline between genotypes within treatments were observed. Overall mean changes in morning peak flow for salmeterol with fluticasone propionate were 32.6 L/min (Arg/Arg vs. Gly/Gly, 95% confidence interval [CI], -6.3, 22.1), 25.9 L/min (Arg/Arg vs. Arg/Gly, 95% CI, -7.1, 21.3), and 24.9 L/min (Arg/Gly vs. Gly/Gly, 95% CI, -13.0, 14.6), and for salmeterol alone were 19.4 L/min (Arg/Arg vs. Gly/Gly, 95% CI, -1.7, 21.4), 24.6 L/min (Arg/Arg vs. Arg/Gly, 95% CI, -13.0, 10.6), and 12.4 L/min (Arg/Gly vs. Gly/Gly, 95% CI, -0.2, 22.3) for Arg/Arg, Arg/Gly, and Gly/Gly genotypes, respectively. Other measures of asthma control showed similar responses. CONCLUSIONS The results showed no evidence of a pharmacogenetic effect of beta-receptor variation on salmeterol response. Clinical trial registered with www.clinicaltrials. gov (NCT 00102882).
Analysis of motor patterns in the isolated guinea‐pig large intestine by spatio‐temporal maps

We investigated and quantified the spontaneous patterns of motility in the isolated guinea‐pig proximal and distal colon taken from adult animals. During spontaneous emptying, profiles of proximal and distal colon were recorded with a video camera, and image analysis was used to construct spatio‐temporal maps of the motions of the intestinal wall. Four patterns of motility were recorded. In the proximal colon there were neurally mediated contractions that propagated in the aboral direction at 4.1 mm s–1, gently pushing the soft contents aborally; these are likely to represent spontaneous peristaltic behaviour. A second pattern, insensitive to tetrodotoxin (TTX; 0.6 μM), consisted, in both oral and aboral propagation, of shallow contractions of the circular muscle (ripples). These contractions propagated aborally at 2.8 ± 0.45 mm s–1 and orally at 2.03 ± 0.31 mm s–1 (n=10). Of these TTX‐resistant contractions, 22.5% propagated both orally and aborally from a common origin. The orally propagated component of these myogenic contractions is likely to correspond to the antiperistalsis widely described in the proximal colon. In the distal colon, two patterns of motor activity were observed. One, induced by natural or artificial pellets, consisted of peristaltic contractions that pushed the pellets aborally at 0.8 mm s–1 and expelled a pellet every 108 s. In the interval between pellet propulsion and after the distal colon had emptied all of its pellets a second, nerve‐mediated pattern of motor activity, consisting of clusters of annular circular muscle contractions separated by short dilated regions, slowly propagated aborally at 0.3 mm s–1. Both of these motor patterns were abolished by TTX (0.6 μM). A latex balloon, inserted at the oral end of the empty isolated distal colon and inflated to a size similar to faecal pellets, was propelled at 1.4 mm s–1. Epoxy resin‐covered natural pellets were propelled at a similar speed of 1.6 mm s−1.Our data revealed that myogenic and neurogenic patterns of propagated contractions in the colon occur in isolated preparations and are involved in emptying the colon.
[The effect of mycophenolic acid on activation antigen expression and in vitro T lymphocytes proliferation in peripheral blood].

OBJECTIVE To explore the effect of mycophenolic acid (MPA) on activation and proliferation of T lymphocytes in vitro. METHODS Peripheral blood mononuclear cells (PBMNC) were prepared from normal donors, and incubated with phytohemagglutinin (PHA) with or without MPA and cyclosporin A (CSA) in vitro. After incubation, the expression of T lymphocytes activation markers such as CD(69), CD(25) and CD(3) on cell surface was assayed with flow cytometry. At the same time, incorporation rate of bromodeoxyuridine (BrdU), an analog of thymidine, was detected for T lymphocytes proliferation by flow cytometry. RESULTS (1) Both MPA and CSA could significantly inhibit the expression of CD(3) on T lymphocyte surface. After 96 hours, the expression of CD(3) in MPA and CSA group was (37.60 +/- 7.89)% and (55.85 +/- 13.64)% respectively, while that of the control group was (74.20 +/- 7.51)%. (2) The expression of CD(3) was still significantly inhibited when MPA was added to PBMNC which was prior incubated with PHA for 72 hours. (3) MPA, CSA did not affect the expression of CD(69) on T lymphocyte surface after 24 hours. (4) Both MPA and CSA could significantly inhibit the expression of CD(25) on T lymphocyte surface. After 72 hours, the expression of CD(25) in MPA group and CSA group was (37.15 +/- 7.15)% and (62.47 +/- 12.50)% respectively, while that of the control group was (84.85 +/- 8.46)%. (5) MPA (10(-5) mol/L) significantly inhibited the incorporation of BrdU in PHA activated PBMNC (9.77 +/- 7.55)% VS (43.27 +/- 18.85)% in control (P = 0.046). Cell cycle analysis showed that MPA decreased especially the percentage of S phase cells, while the percentage of G(0)/G(1) phase cells was comparatively increased and that of G(2)/M phase cells was not changed. CONCLUSIONS The expression of CD(3) and CD(25) was inhibited by MPA. The expression of CD(3) could be suppressed by MPA even if MPA was added to PBMNC after PHA. It is suggested that MPA could suppress T lymphocyte activation and could also reverse T lymphocyte activation. MPA could suppress T lymphocyte proliferation by down-regulating the DNA synthesis. MPA decreased especially the percentage of S phase cells decreased and increased comparatively the percentage of G(0)/G(1) phase and G(2)/M phase cells.
Reply: Respiratory motor function in centronuclear myopathy

Smith et al. reported 13 people with centronuclear myopathy (CNM) who “required full-time, invasive mechanical ventilation. ” However, we find that virtually all such patients can use continuous noninvasive ventilatory support (CNVS) as an alternative to invasive tracheostomy mechanical ventilation (TMV). Even when intercurrent episodes of acute on chronic respiratory failure result in intubation, these patients can always be extubated back to CNVS and use mechanical insufflation-exsufflation (MIE) to expulse airway secretions rather than require tracheotomy. The bulbar weakness of CNM patients as reported by the authors does not exclude these patients from using CNVS any more than it does our spinal muscular atrophy type 1A (type 0) patients who have now been CNVS dependent for over 20 years, beginning as early as age 4 months. The authors sought to better understand CNM patient reliance on mechanical ventilation and yet, 13 of their 14 were full-time TMV users. While it is true that monitoring vital capacity (VC) and maximum insufflation capacity (MIC) allows for preemptive care and better anticipatory guidance for patients, the authors should recognize that guidance is best used to avert episodes of acute respiratory failure and need for invasive mechanical ventilation. The latter causes ventilatorinduced diaphragm dysfunction (VIDD) in as little as 18 h of mechanical ventilation. Such disuse atrophy has never been reported for CNVS users using oral or nasal interfaces. Thus, the authors’ assessment of respiratory function of only CNM patients who were using TMV fails to consider ventilator dependent patients using noninvasive means. Indeed, before requiring CNVS, our patients use nocturnal NVS at full ventilatory support settings to more fully rest their muscles during sleep to better normalize daytime blood gases. While the authors recognize that longitudinal examination of respiratory motor function is important, they are not using the simple parameters that are important for CNVS dependent patients that include end-tidal CO2, spirometry for MIC, and manually assisted cough flow. In summary, with few exceptions, most patients can benefit from the combination of CNVS and MIE to avoid the hazards of invasive mechanical ventilation. It is our contention, based on the over 300 CNVS dependent patients we have treated, that no patients with CNM nor any other congenital myopathy or muscular dystrophy should ever require an indwelling tracheostomy tube.
Hypomelanosis of Ito. Neurological Complications in 34 Cases

ABSTRACT: We studied 34 Spanish children with hypomelanosis of Ito. This disease has an incidence of 1 per 1000 new patients consulting a paediatric neurological service, or 1 per 8000-10,000 unselected patients in a children's hospital. About 94% of our patients show noncutaneous abnormalities. Mental retardation (IQ below 70) was present in 64.7%; another 14.7% had an IQ between 70 and 90, usually associated with poor school performance. Four children exhibited autistic behaviour. Seizures of various types were present in 53% of cases. Other skin alterations in addition to the typical hypomelanosis were observed in 38% of our cases: caf6-au-lait spots, angiomatous nevi, nevus marmorata, nevus of Ota, Mongolian blue spot, heterochromia of the iris or hair, and other nonspecific pigmentations. Other associated disorders occur inconsistently and include macrocephaly, microcephaly, h6mihypertrophy, kyphoscoliosis, coarse facial features, genital anomalies, inguinal hernia, congenital heart disease, hypertelorism, and abnormalities of the teeth, feet and eyes. Autosomal dominant inheritance is demonstrated in some but not all cases.
Virus particles and viral antigens in chicken tissues free of infectious avian leukosis virus.

12 Robinson, H. L. , personal communication. 13 Vogt, P. K. , J. Virol. , in press. 14 Rubin, H. , these PROCEEDINGS, 46, 1105-1119 (1960). 15 Vogt, P. K. , and R. Ishizaki, Virology, 26, 664-672 (1965). 16 Hanafusa, H. , and T. Hanafusa, these PROCEEDINGS, 55, 532-538 (1966). 17 Vogt, P. K. , and R. Ishizaki, Viruses Inducing Cancer, ed. W. J. Burdette (Salt Lake City, Utah: University of Utah Press, 1966), pp. 71-90. 18 Vogt, P. K. , R. Ishizaki, and R. Duff, in Subviral Carcinogenesis, ed. Y. Ito (International Symposium on Tumor Viruses, Nagoya, Japan, 1966), in press. 19 Vogt, P. K. , in Virus-Directed Host Response, ed. M. Pollard (New York: Academic Press, 1967), pp. 199-228. 20 Vogt, P. K. , and R. Ishizaki, Virology, 30, 368-374 (1966).
Predicting Customer Value Using Clumpiness: From RFM to RFMC

In recent years, customer lifetime value CLV has gained increasing importance in both academia and practice. Although many advanced techniques have been proposed, the recency/frequency/monetary value RFM segmentation framework, and its related probability models, remain a CLV mainstay. In this article, we demonstrate the deficiency in RFM as a basis for summarizing customer history data compression, and extend the framework to include clumpiness C by a metric-based approach. Our main empirical finding is that C adds to the predictive power, above and beyond RFM and firm marketing action, of both the churn, incidence, and monetary value parts of CLV. Hence, we recommend a significant implementation change: from RFM to RFMC. This work is also motivated by noting that although statistical models based on RFM summaries can fit well in aggregate, their use can lead to significant micro-level e.g., ranking of customers prediction errors unless C is captured. A set of detailed empirical studies using data from a large North American retailer, in addition to six companies that vary in their business model: two traditional e.g., CDNow.com and four Internet e.g., Hulu.com, demonstrate that the "clumpiness phenomena" is widely prevalent, and that companies with "bingeable content" have both high potential and high risk segments, previously unseen, but now uncovered because of the new framework: RFM to RFMC.
High-sensitivity C-reactive protein concentration in patients with myocardial infarction-environmental factors, and polymorphisms in interleukin-10 and CD14 genes

Abstract Background: It has been shown that high-sensitivity C-reactive protein (hsCRP) concentrations are associated with elevated risk of myocardial infarction, but the mechanisms regulating hsCRP concentration are not completely elucidated yet. In our study, association of interleukin-10 (IL-10) and CD14 polymorphisms and environmental factors with the risk of myocardial infarction was studied. Methods: The study group consisted of 284 male patients aged below 65 years, admitted to hospital for myocardial infarction. The controls were age-matched individuals selected from a 1% representative population sample of adult men. Results: While there was no difference in body mass index (BMI), the patients more frequently had abdominal-type obesity. hsCRP concentration was higher in patients (2.12±2.31 mg/L) than in controls (1.40±1.56 mg/L; p=0.001), in spite of statin treatment in most of the patients. No significant difference in lipoprotein concentrations was found. There was no difference in IL-10 and CD14 genotype distributions between the patients and controls. In smoking patients carrying the CD14 C allele, hsCRP concentration was significantly higher (p=0.0012) than in a non-smoking patients with the same allele. According to linear regression analysis, statin treatment was the only variable with an influence that reached statistical significance in the patient group, while in the control group, age, smoking, education and BMI significantly influenced hsCRP concentration. Conclusions: There was no association between IL-10 and CD14 polymorphisms and myocardial infarction occurrence. Gene-environment interaction may play an important role in influencing hsCRP concentration. Clin Chem Lab Med 2007;45:855–61.
Neuromuscular Electrical Stimulation Efficacy in Acute Stroke Feeding Tube–Dependent Dysphagia During Inpatient Rehabilitation

ObjectiveThe aim of this study was to compare the efficacy of neuromuscular electrical stimulation (NMES) in addition to traditional dysphagia therapy (TDT) including progressive resistance training (PRT) with that of TDT/PRT alone during inpatient rehabilitation for treatment of feeding tube–dependent dysphagia in patients who have had an acute stroke. DesignThis study is an inpatient rehabilitation case-control study involving 92 patients who have had an acute stroke with initial Functional Oral Intake Scale (FOIS) scores of 3 or lower and profound to severe feeding tube–dependent dysphagia. Sixty-five patients, the NMES group, received NMES with TDT/PRT, and 27 patients, the case-control group, received only TDT/PRT. Treatment occurred in hourly sessions daily for a mean ± SD of 18 ± 3 days. &khgr;2 Analyses/t tests revealed no significant statistical differences between the groups for age (t = −0.85; P = 0.40), sex (&khgr;2 = 0.05; P = 0.94), and stroke location (&khgr;2 = 4.2; P = 0.24). A Mann-Whitney U test revealed a statistically significant difference between the groups for the initial FOIS score (z = −2.4; P = 0.015), with the NMES group having worse initial scores with a mean rank of 42.64 and the case-control TDT/PRT group having a mean rank of 55.8. The main outcome measure was the comparison of the FOIS scores after treatment. ResultsThe mean ± SD FOIS score after NMES with TDT/PRT treatment was 5.1 ± 1.8 compared with 3.3 ± 2.2 in the case-control TDT/PRT group. The mean gain for the NMES group was 4.4 points; and for the case-control group, 2.4 points. Significant improvement in swallowing performance was found for the NMES group compared with the TDT/PRT group (z = 3.64; P < 0.001). Within the NMES group, 46% (30 of 65) of the patients had minimal or no swallowing restrictions (FOIS score of 5–7) after treatment, whereas 26% (7 of 27) of those in the case-control group improved to FOIS scores of 5–7, a statistically significant difference (&khgr;2 = 6.0; P = 0.01). ConclusionsThis study suggests that NMES with TDT/PRT is significantly more effective than TDT/PRT alone during inpatient rehabilitation in reducing feeding tube–dependent dysphagia in patients who have had an acute stroke.