Miracle-dz/UniFAR-FTUs huggingface dataset:
Comparison of pain and emotional symptoms in soldiers with polytrauma: unique aspects of blast exposure.

OBJECTIVES To compare the physical and emotional presentation and pain treatment outcomes of service members who sustained polytrauma secondary to blast with those of soldiers injured by other means. DESIGN Retrospective medical record review. SETTING AND PATIENTS One of four Veterans Affairs multidisciplinary inpatient Polytrauma Rehabilitation Centers. One hundred twenty-eight Operation Enduring Freedom and Operation Iraqi Freedom military personnel with serious polytrauma injuries and concomitant pain categorized into three groups based on type of injuries: blast injuries, combat injuries other than blast, and noncombat, nonblast injuries. INTERVENTIONS Intensive, interdisciplinary inpatient rehabilitation and pain treatment. OUTCOME MEASURES Pain intensity ratings; Functional Independence Measure scores; Rancho Los Amigos levels; and opioid analgesic doses. RESULTS Service members injured via blast demonstrated a broader spectrum of physical injuries, higher levels of admission and discharge opioid analgesic use, reduced improvement in pain intensity following treatment, and much higher rates of posttraumatic stress disorder and other psychiatric diagnoses than those injured via other means. CONCLUSIONS Blast injury may be associated with differential physical, emotional, and pain-related symptoms that pose increased challenges for successful treatment.
Self-coherent OFDM for wireless communications

In this paper, we present self-coherent OFDM, a well-known non-coherent technique in optical communications, for wireless RF communications. Self-coherent OFDM is known to have complete immunity against phase noise using a simple RF front-end receiver and to provide a significantly higher spectral efficiency than self-het OFDM, which uses at most 50% of the available spectrum for communications. We present the performance analysis of self-coherent OFDM over additive white Gaussian noise (AWGN) and frequency selective fading channels. We show by simulations that self-coherent OFDM provides not only a higher spectral efficiency but also a better bit error rate (BER) performance than self-het OFDM. Finally, we discuss the impact on the system performance of the filters design parameters used in the self-coherent OFDM receiver.
Androgen Receptor Expression in Endometrial Carcinoma

Endometrial carcinoma (ECA) is frequently hormonally driven and can be treated with endocrine-based therapy, yet hormone receptor status is not routinely assessed. In particular, little is known about the significance of androgen receptor (AR) in ECA. Androgen has antiproliferative effects in the healthy endometrium and could serve a similar role to progesterone in curbing the progression of estrogen-dependent neoplasia. There may also be a subset of ECA that benefits from androgen antagonistic therapy. We herein investigate AR expression across ECA subtypes and compare its expression to estrogen receptor (ER) and progesterone receptor (PR). Immunohistochemical staining for AR, ER, and PR was performed on an endometrial tissue microarray containing 50 ECA with a variety of morphologic subtypes as well as 20 benign and 9 atypical hyperplastic endometria. AR was expressed by 54% (27/50) of ECA including 60% of low grade endometrioid carcinomas, 70% high grade endometrioid carcinomas, 70% serous carcinomas, 50% carcinosarcomas, and 20% clear cell carcinomas. High AR expression was chiefly restricted to a subset of serous carcinomas (50%). AR expression occurred most often in concert with ER staining, although 5 high grade cancers (1 serous carcinoma, 4 carcinosarcomas) showed AR expression in the absence of ER. In summary, AR positivity is seen in over half of ECA in our study, including the majority of low grade endometrioid carcinomas, high grade endometrioid carcinomas, and serous carcinomas. High level expression is seen in half of serous carcinomas and a subset of serous carcinomas and carcinosarcomas show some degree of AR staining in the absence of ER, suggesting a possible role for androgen inhibition in treatment of these cases.
Metal-non-metal and other interfaces: the role of image interactions

The authors argue that many phenomena associated with metal/nonmetal interfaces and similar situations with a large dielectric constant mismatch can be understood in terms of the image interactions due to charges in the nonmetal. The effects are additional to the traditional interactions, and are especially significant when no reactions between the phases occur. The image-charge concept allows one to rationalise much apparently unrelated information concerning: (a) the systematics of wetting and nonwetting of oxides by liquid metals; (b) the systematics of strong metal-support interaction in catalysis; (c) the spatial variation of stoichiometry in oxides grown on metals; (d) the dependence on thickness of the observed changes in the wetting by water of oxide grown on silicon; (e) some features of radiation-enhanced adhesion; and (f) a number of correlations of behaviour with nonmetal properties in which the precise choice of metal is not critical.
Does Fibular Plating Improve Alignment After Intramedullary Nailing of Distal Metaphyseal Tibia Fractures?

Objective: Evaluate whether supplementary fibular fixation helped maintain axial alignment in distal metaphyseal tibia-fibula fractures treated by locked intramedullary nailing. Design: Retrospective chart and radiographic review. Setting: Three, level 1, trauma centers. Patients: Distal metaphyseal tibia-fibula fractures were separated into 2 groups based on the presence of adjunctive fibular plating. Group 1 consisted of fractures treated with small fragment plate fixation of the fibula and intramedullary (IM) nailing of the tibia, whereas group 2 consisted of fractures treated with IM nailing of the tibia without fibular fixation. Outcome Measures: Malalignment of the tibial shaft was defined as 1) >5° of varus/valgus angulation, or 2) >10° anterior/posterior angulation. Measures of angulation were obtained from radiographs taken immediately after the surgery, a second time 3 months later, and at 6-month follow-up. Leg length and rotational deformity were not examined. Results: Seventy-two fractures were studied. In 25 cases, the associated fibula fracture was stabilized, and in 47 cases the associated fibula fracture was not stabilized. Cases were more likely to have the associated fibula fracture stabilized where the tibia fracture was very distal. In multivariate adjusted analysis, plating of the fibula fracture was significantly associated with maintenance of reduction 12 weeks or later after surgery (odds ratio = 0.03; P = 0.036). The use of 2 medial-lateral distal locking bolts also was protective against loss of reduction; however, this association was not statistically significant (odds ratio = 0.29; P = 0.275). Conclusions: In this study, the proportion of fractures that lost alignment was smaller among those receiving stabilization of the fibula in conjunction with IM nailing compared with those receiving IM nailing alone. Adjunctive fibular stabilization was associated significantly with the ability to maintain fracture reduction beyond 12 weeks. At the present time, the authors recommend fibular plating whenever IM nailing is contemplated in the unstable distal tibia-fibular fracture.
Effectiveness of Local Government and Community Participation in Health Service Delivery in Rural Haryana

The recent health sector reform initiatives argue that health service delivery mechanism can be made effective through the participation of local governments and community in policy making, planning and services delivery. We believe that the gain from such initiatives to the large extent depends on how these initiatives are implemented at the ground level. In order to evaluate their effectiveness, this study first captures the degree of local agent’s participation and extent of decentralization in health, and then measures their impact on health service access and health-seeking behaviour of rural households, controlling for socio-economic, demographic and political factors, such as reservation of women/minority groups in politics. This exercise is largely based on field survey data collected from 12 villages of Haryana. The results show that the degree of community participation and women/minority groups’ reservation in politics hardly matters for promoting the equity in access to health care. This may be because dominant class/caste/male captures most of the decentralization powers in Haryana. A properly designed and implemented decentralized policy however turns effective in promoting the health care use from public facilities. The study argues that the gains from decentralization can be enhanced by devolving more health-related functions, funds, management, regulation and policy making powers to local Panchayat and community. The magnitude of Panchayat support and priorities to health and coordination between local agents and health functionaries is a value addition for materializing the greater gains from such decentralized initiatives.
A Test of Vehicle-to-Grid (V2G) for Energy Storage and Frequency Regulation in the PJM

2 ! 3 Executive Summary This report documents a practical demonstration of Vehicle-to-Grid power, providing real-time frequency regulation from an electric car. Vehicle-to-Grid (V2G) presents a mechanism to meet key requirements of the electric power system, using electric vehicles when they are parked and underutilized. While V2G is expected to have several applications, the most economic entry for this green innovation is the market for ancillary services (A/S). The highest value A/S is frequency regulation (in many ISOs, including PJM, this service is simply called " regulation " and we will use that term subsequently). In areas with deregulated electricity markets, regulation can have average values of $30-$45/MW per hour, with hourly rates fluctuating widely around that average. A second market of interest is spinning reserves, or synchronous reserves, with values in the range of $10/MW per hour, but much less frequent dispatch. The primary revenue in both of these markets is for capacity rather than energy, and both markets are well suited for batteries as a storage resource because they require quick response times yet low total energy demand. Additionally, V2G can provide distribution system support when there is a concentration of parked V2G cars, along overload elements in the distribution system. A later application, when parked V2G-capable cars are connected and aggregated in large numbers, would be to use them as dispersed energy storage for intermittent but renewable resources such as wind and solar. The results of the study show that V2G, in addition to providing valuable grid servies, could also prove to be a prominent application in the global transition to the emerging green and sustainable energy economy. A fully functional, freeway-capable electric vehicle was used in this study. Its power electronics are designed to both drive the vehicle and allow for high-power exchange with the electric grid. We modified this vehicle by adding controls and logic to make it respond to the PJM real-time signal for regulation. The data and resulting graphs show the ability of the car to provide regulation in addition to zero emission local commute driving. This is a technology proof of concept with a single vehicle. Current work is directed toward developing dispatch of about a half-dozen vehicles. To move from a technology demonstration to commercial application, the next step would be a business model development at the scale of 100 to 300 vehicles. The report is comprised of six sections. …
Index-Linked Investing—A Curse for the Stability of Financial Markets around the Globe?

The authors analyze the development of various risk commonalities in Europe and the United States, as well as in emerging markets, and find a substantial increase in the co-movements in trading patterns, price returns, and liquidity risk within equity markets. They test the hypothesis that index-linked investing is a major driver for the increase in risk commonality. By aggregating the data in a cross-regional perspective, the authors capitalize on the different levels of indexation in the markets and find statistically significant and economically relevant evidence that the growth in index-linked investing is related to the increased co-movement within equity markets. The results suggest a significant increase in market fragility around the globe, leading to an increased danger of more severe reactions to unanticipated events going forward. Portfolio managers are well-advised to account for the increased proportion of index-linked investing within their risk management tools, diversification approaches, and active management strategies.
Incentive Programs for Reducing Readmissions When Patient Care is Co-Produced

To reduce preventable readmissions, many healthcare systems are transitioning from Fee-for-Service (FFS) to other reimbursement schemes such as Pay-for-Performance (P4P) or Bundled Payment (BP) so that the funder of a healthcare system can transfer to the hospital some of the financial risks associated with patient re-hospitalizations. To examine the effectiveness of different schemes (FFS, P4P, and BP), we develop a "health co-production" model in which the patient's readmissions can be "jointly controlled" by the efforts exerted by both the hospital and the patient. Our analysis of the equilibrium outcomes reveals that FFS cannot entice the hospital and the patient to exert readmission-reduction efforts. Relative to BP, we find that P4P is more "robust" in the sense that it can induce readmission-reduction efforts under milder conditions. However, BP can induce greater efforts compared to P4P. More importantly, we characterize the conditions under which BP (or P4P) is the dominant scheme from the funder's perspective. Finally, we find that patient cost-sharing can generate two benefits: (a) it provides incentive for patients to exert efforts; and (b) if not excessive, it can reduce the readmission rate.
Perceptions of Unprofessional Social Media Behavior Among Emergency Medicine Physicians.

BACKGROUND Use of social media (SM) by physicians has exposed issues of privacy and professionalism. While guidelines have been created for SM use, details regarding specific SM behaviors that could lead to disciplinary action presently do not exist. OBJECTIVE To compare State Medical Board (SMB) directors' perceptions of investigation for specific SM behaviors with those of emergency medicine (EM) physicians. METHODS A multicenter anonymous survey was administered to physicians at 3 academic EM residency programs. Surveys consisted of case vignettes, asking, "If the SMB were informed of the content, how likely would they be to initiate an investigation, possibly leading to disciplinary action? " (1, very unlikely, to 4, very likely). Results were compared to published probabilities using exact binomial testing. RESULTS Of 205 eligible physicians, 119 (58%) completed the survey. Compared to SMB directors, EM physicians indicated similar probabilities of investigation for themes involving identifying patient images, inappropriate communication, and discriminatory speech. Participants indicated lower probabilities of investigation for themes including derogatory speech (32%, 95% confidence interval [CI] 24-41 versus 46%, P < .05); alcohol intoxication (41%, 95% CI 32-51 versus 73%, P < .05); and holding alcohol without intoxication (7%, 95% CI 3-13 versus 40%, P < .05). There were no significant associations with position, hospital site, years since medical school, or prior SM professionalism training. CONCLUSIONS Physicians reported a lower likelihood of investigation for themes that intersect with social identity, compared to SMB directors, particularly for images of alcohol and derogatory speech.
Offenders with intellectual disability: the size of the problem and therapeutic outcomes.

BACKGROUND People with intellectual disability (ID) who offend may be subject to a variety of dispositions within the criminal justice system, or via diversion to health and social services in inpatient units or in community ID teams. Offenders with ID are a group with complex needs who may pose a recurrent risk to the public. Despite the significant number of offenders with ID, there is limited evidence on treatment effectiveness and outcomes. METHODS A literature search of all electronic databases was undertaken, and journals were hand-searched for clinical trials or case studies of interventions for offenders with ID. The main outcome was recidivism rates. RESULTS There were no published clinical trials of offenders with ID. A series of small-scale group cognitive-behavioural treatments for sex offenders offers the most persuasive evidence of success in reducing recidivism. CONCLUSION Offenders with ID often receive inadequate services as a result of poor identification through the criminal justice system and research into effective treatments is rudimentary. Further studies are necessary in order to improve treatment efficacy and service provision for a complex group of individuals.
Characterization of Fusarium species associated with apple decline in Tunisian nurseries

Considerable losses of apple trees seedling were observed in many nurseries in Tunisia. From November 2012 to December 2013, surveys were conducted in 10 apples nurseries, and samples of roots were collected from apple seedlings showing decline symptoms. The isolation and the morphological and molecular identification (using ITS1 and ITS4) of obtained isolates revealed the presence of Fusarium oxysporum (111 isolates), Fusarium solani (55 isolates), Fusarium equiseti (4 isolates) and one isolate of F. proliferatum. F. oxysporum and F. solani were isolated from roots from all the surveyed nurseries. F. equiseti were isolated from roots from nurseries in Zaghouan 1 and Sbiba. F. proliferatum was recovered from roots in Zaghouan 1 nursery. The highest percent of isolation was found in Chbika 1 and Chbika for F. oxysporum (100%) and from Manzel nour for F. solani (40%). However, the lowest isolation percent was found in Oued mliz nursery. This investigation showed that there is no relationship between the Fusarium isolation percent and the plant vigors. The pathogenicity of Fusarium oxysporum and Fusarium solani was evaluated using Golden delicious apple variety grafted onto the MM106 rootstock planted in inoculated soil and revealed that some isolates of these two Fusarium species were virulent.
Smithornis broadbills produce loud wing song by aeroelastic flutter of medial primary wing feathers

ABSTRACT Broadbills in the genus Smithornis produce a loud brreeeeet during a distinctive flight display. It has been posited that this klaxon-like sound is generated non-vocally with the outer wing feathers (P9, P10), but no scientific studies have previously addressed this hypothesis. Although most birds that make non-vocal communication sounds have feathers with a shape distinctively modified for sound production, Smithornis broadbills do not. We investigated whether this song is produced vocally or with the wings in rufous-sided broadbill (S. rufolateralis) and African broadbill (S. capensis). In support of the wing song hypothesis, synchronized high-speed video and sound recordings of displays demonstrated that sound pulses were produced during the downstroke, subtle gaps sometimes appeared between the outer primary feathers P6–P10, and wingtip speed reached 16 m s−1. Tests of a spread wing in a wind tunnel demonstrated that at a specific orientation, P6 and P7 flutter and produce sound. Wind tunnel tests on individual feathers P5–P10 from a male of each species revealed that while all of these feathers can produce sound via aeroelastic flutter, P6 and P7 produce the loudest sounds, which are similar in frequency to the wing song, at airspeeds achievable by the wing tip during display flight. Consistent with the wind tunnel experiments, field manipulations of P6, P7 and P8 changed the timbre of the wing song, and reduced its tonality, demonstrating that P6 and P7 are together the sound source, and not P9 or P10. The resultant wing song appears to have functionally replaced vocal song. Highlighted Article: Smithornis broadbills produce a loud klaxon-like wing song by aeroelastic flutter of wing feathers P6 and P7, and not the outer primaries P9/P10.
Modeling complex flow dynamics of fluvial floods exacerbated by sea level rise in the Ganges–Brahmaputra–Meghna Delta

Global warming is likely to exacerbate future fluvial floods in the world’s mega-delta regions due to both changing climate and rising sea levels. However, the effects of sea level rise (SLR) on fluvial floods in such regions have not been taken into account in current global assessments of future flood risk, due to the difficulties in modeling channel bifurcation and the backwater effect. We used a state-of-the-art global river routing model to demonstrate how these complexities contribute to future flood hazard associated with changing climate and SLR in the world’s largest mega-delta region, the Ganges-Brahmaputra-Meghna Delta. The model demonstrated that flood water in the main channels flows into tributaries through bifurcation channels, which resulted in an increase in inundation depth in deltaic regions. We found that there were large areas that experienced an increase in inundation depth and period not directly from the SLR itself but from the backwater effect of SLR, and the effect propagated upstream to locations far from the river mouth. Projections under future climate scenarios as well as SLR indicated that exposure to fluvial floods will increase in the last part of the 21st century, and both SLR and channel bifurcation make meaningful contributions.
Effectiveness of OER Use in First-Year Higher Education Students’ Mathematical Course Performance

This article examines the effect of two Open Educational Resources (OER) - Khan Academy Collection and a teacher-authored open textbook - on mathematical course performance and attendance amongst first-year higher education Chilean students. It also aims to find out about teachers’ and students’ views on the use of OER in order to understand how these resources are used and valued. To this end, quantitative and qualitative methods were employed. Findings indicate that students in face-to-face classes who used Khan Academy resources obtained better examination grades than students who used the open textbook or relied on traditional proprietary textbooks. Moreover, it was also found that students who used both types of OER had significantly lower attendance levels than students who relied on traditional proprietary textbooks. Finally, it was observed that teachers and students had very positive opinions on the use of both the Khan Academy Collection and open textbook resources.