Miracle-dz/UniFAR-FTUs huggingface dataset:
Cost and Cost-effectiveness of Universal Screening for Hearing Loss in Newborns

OBJECTIVE: To estimate the cost and cost-effectiveness of universal newborn hearing screening. STUDY DESIGN AND SETTING: Decision analysis model utilizing the hospital perspective. This model evaluated 4 distinct protocols for screening a fixed and defined hypothetical cohort of newborn infants. OUTCOME MEASURES: Cost of screening and the number of infants with hearing loss identified through universal screening. RESULTS: Otoacoustic emissions testing at birth followed by repeat testing at follow up demonstrated the lowest cost ($13 per infant) and had the lowest cost-effectiveness ratio ($5100 per infant with hearing loss identified). Screening auditory brainstem evoked response testing at birth with no screening test at follow-up was the only protocol with greater effectiveness, but it also demonstrated the highest cost ($25 per infant) and highest cost-effectiveness ratio ($9500 per infant with hearing loss identified). These findings were robust to sensitivity analysis, including best-case and worst-case estimation. The prevalence of hearing loss and the fraction of infants returned for follow-up testing had a large impact on the absolute level, but not relative level of protocol cost and cost-effectiveness. CONCLUSION: The otoacoustic emissions testing protocol should be selected by screening programs concerned with cost and cost-effectiveness, although there are certain caveats to consider. SIGNIFICANCE: The most significant barriers to implementation of universal newborn hearing screening programs have been financial, and this study compares the most common protocols currently in use. This study can assist program directors not only in the decision to initiate universal screening but also in their choice of screening protocol.
The hospitalist perspective on opioid prescribing: A qualitative analysis.

BACKGROUND Pain is a frequent symptom among patients in the hospital. Pain management is a key quality indicator for hospitals, and hospitalists are encouraged to frequently assess and treat pain. Optimal opioid prescribing, described as safe, patient-centered, and informed opioid prescribing, may be at odds with the priorities of current hospital care, which focuses on patient-reported pain control rather than the potential long-term consequences of opioid use. OBJECTIVE We aimed to understand physicians' attitudes, beliefs, and practices toward opioid prescribing during hospitalization and discharge. DESIGN In-depth, semistructured interviews. SETTING Two university hospitals, a safety-net hospital, a Veterans Affairs hospital, and a private hospital located in Denver, Colorado or Charleston, South Carolina. PARTICIPANTS Hospitalists (N = 25). MEASUREMENTS We systematically analyzed transcribed interviews and identified emerging themes using a team-based mixed inductive and deductive approach. RESULTS Although hospitalists felt confident in their ability to control acute pain using opioid medications, they perceived limited success and satisfaction when managing acute exacerbations of chronic pain with opioids. Hospitalists recounted negative sentinel events that altered opioid prescribing practices in both the hospital setting and at the time of hospital discharge. Hospitalists described prescribing opioids as a pragmatic tool to facilitate hospital discharges or prevent readmissions. At times, this left them feeling conflicted about how this practice could impact the patient over the long term. CONCLUSIONS Strategies to provide adequate pain relief to hospitalized patients, which allow hospitalists to safely and optimally prescribe opioids while maintaining current standards of efficiency, are urgently needed. Journal of Hospital Medicine 2016;11:536-542. © 2016 Society of Hospital Medicine.
The growth response of ostrich (Struthio camelus var. domesticus) chicks fed on diets with three different dietary protein and amino acid concentrations

Abstract 1. Feeding costs are the largest expense in an ostrich production system, and protein is one of the more expensive components of the diet. This study evaluated the growth response of ostrich chicks on diets containing different concentrations of protein (amino acids). The diets were formulated to contain three concentrations of protein (one diet with 20% less protein than the conventional concentration, L; one diet with the conventional concentration of protein, M and one diet with 20% more protein than the conventional concentration, H) for each of the phase diets. The phase diets were pre-starter, starter, grower and finisher. 2. This study includes the analysis of ostrich body weight (BW) by modelling growth with linear polynomial and non-linear functions for all the data not separated for treatments. In total, 3378 BW recordings of 90 animals were collected weekly from hatch (d 0) to 287 d (41 weeks) of age. 3. Seven non-linear growth models and three linear polynomial models were fitted to the data. The growth functions were compared by using Akaike’s information criterion (AIC). For the non-linear models, the Bridges and Janoschek models had the lowest AIC values for the H treatment, while the Richards curve had the lowest value for M and the von Bertalanffy for the L treatment. 4. For the linear polynomial models, the linear polynomial of the third degree had the lowest AIC values for all three treatments, thus making it the most suitable model for the data; therefore, the predictions of this model were used to interpret the growth data. Significant differences were found between treatments for growth data. 5. The results from this study can aid in describing the growth of ostriches subjected to optimum feeding conditions. This information can also be used in research when modelling the nutrient requirements of growing birds.
Impaired Plasmacytoid Dendritic Cell (PDC)-NK Cell Activity in Viremic Human Immunodeficiency Virus Infection Attributable to Impairments in both PDC and NK Cell Function

ABSTRACT Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections impair plasmacytoid dendritic cell (PDC) and natural killer (NK) cell subset numbers and functions, though little is known about PDC-NK cell interactions during these infections. We evaluated PDC-dependent NK cell killing and gamma interferon (IFN-γ) and granzyme B production, using peripheral blood mononuclear cell (PBMC)-based and purified cell assays of samples from HCV- and HIV-infected subjects. CpG-enhanced PBMC killing and IFN-γ and granzyme B activity (dependent on PDC and NK cells) were impaired in viremic HIV infection. In purified PDC-NK cell culture experiments, CpG-enhanced, PDC-dependent NK cell activity was cell contact and IFN-α dependent, and this activity was impaired in viremic HIV infection but not in HCV infection. In heterologous PDC-NK cell assays, impaired PDC-NK cell killing activity was largely attributable to an NK cell defect, while impaired PDC-NK cell IFN-γ-producing activity was attributable to both PDC and NK cell defects. Additionally, the response of NK cells to direct IFN-α stimulation was defective in viremic HIV infection, and this defect was not attributable to diminished IFN-α receptor expression, though IFN-α receptor and NKP30 expression was closely associated with killer activity in viremic HIV infection but not in healthy controls. These data indicate that during uncontrolled HIV infection, PDC-dependent NK cell function is impaired, which is in large part attributable to defective IFN-α-induced NK cell activity and not to altered IFN-α receptor, NKP30, NKP44, NKP46, or NKG2D expression.
Acute and delayed toxicity of gemcitabine administered during isolated lung perfusion: a preclinical dose-escalation study in pigs.

OBJECTIVES Colorectal cancer is the third most commonly diagnosed cancer worldwide, with up to 25% of patients presenting with metastases at the time of diagnosis. Despite pulmonary metastasectomy many patients go on to develop pulmonary recurrence, which might be linked to the presence of lung micrometastases. In this setting, the adjuvant administration of high-dose chemotherapy by isolated lung perfusion (ILP) has shown encouraging results. However, the tolerance to and efficacy of modern gemcitabine (GEM)-based chemotherapy regimens during adjuvant ILP remain unknown. We conducted a dose-escalating preclinical study to evaluate the immediate and delayed toxicity of GEM in a pig model to define dose-limiting toxicity (DLT) and maximum tolerated concentration. METHODS Twenty-three pigs were given increasing concentrations of GEM during ILP, and were awakened at the end of the procedure. The concentrations of GEM were 40, 80, 160, 320, 640 and 1280 µg/ml. Serum and lung samples were taken to measure GEM concentrations. Pulmonary damage was evaluated by histological examination and cleaved caspase-3 detection. Immediate and delayed (1 month) toxicity were recorded. RESULTS All of the animals underwent successful ILP with GEM. No systemic leak was observed. The three pigs that received a concentration of GEM of 1280 µg/ml died of hypoxia after lung recirculation at the end of the procedure. Eleven pigs survived for 1 month. Major lung toxicity was observed for the concentration of GEM of 640 µg/ml, both at the end of the procedure and after 1 month. DLT was defined at the concentration of 640 µg/ml and the maximum tolerated dose (MTD) was defined at the concentration of 320 µg/ml. CONCLUSIONS ILP with GEM is a safe and reproducible technique in this large-animal model, which includes 1 month of survival. The MTD in this pig model was a concentration of GEM of 320 µg/ml.
A novel method for infecting Drosophila adult flies with insect pathogenic nematodes

Drosophila has been established as an excellent genetic and genomic model to investigate host-pathogen interactions and innate immune defense mechanisms. To date, most information on the Drosophila immune response derives from studies that involve bacterial, fungal or viral pathogens. However, immune reactions to insect parasitic nematodes are still not well characterized. The nematodes Heterorhabditis bacteriophora live in symbiosis with the entomopathogenic bacteria Photorhabdus luminescens, and they are able to invade and kill insects. Interestingly, Heterorhabditis nematodes are viable in the absence of Photorhabdus. Techniques for infecting Drosophila larvae with these nematodes have been previously reported. Here, we have developed a method for infecting Drosophila adult flies with Heterorhabditis nematodes carrying (symbiotic worms) or lacking (axenic worms) their associated bacteria. The protocol we present can be readily adapted for studying parasitic strategies of other insect nematodes using Drosophila as the host infection model.
Control of VOC emissions from crude oil tankers

The paper presents results from a preliminary study on some concepts for the prevention of VOC emission from crude oil tankers, with special reference to shuttle tankers and floating production units. The evaporation rate of the individual volatile hydrocarbon components as well as gas volume flow and gas composition during loading and discharging of crude oil cargo are modelled and computed by means of a comprehensive simulation program. Emission is controlled through a series of optional combinations of control techniques, including depression of evaporation at the outset through sequential transfer of tank atmosphere (STTA), condensation of oil vapour and absorption of oil vapour in the cargo oil.
Water distribution patterns inside bovine articular cartilage as visualized by 1H magnetic resonance imaging.

OBJECTIVE To develop a magnetic resonance imaging (MRI) technique to non-invasively map water volume fraction (WVF) in articular cartilage. Special emphasis was placed on spatial resolution and temporal considerations, aimed at creating a procedure feasible for eventual human studies. DESIGN Absolute proton density MR images of intact, ex vivo bovine patellae were calculated from fully T(1) relaxed, short echo time images. This was accomplished through compensation for T(2) decay with calculated T(2) maps. Calibration of the signal intensity in the image was accomplished with the use of H2O:D2O phantoms, where the WVF was varied from 0.95 to 0.75. Application of the calibration curve to the entire image yielded images that represent WVF on a pixel by pixel basis. Calculations of water content by weight were performed by considering the density of the solid content. RESULTS Using four echo time points, experiments comparing MR images from single-echo and multi-echo spin echo sequences yielded similar results. T(2) decreased with depth through the cartilage, with a maximum at the articular surface of approx 100 ms, and a approximately 50 ms minimum at the bone/cartilage interface. The WVF through the depth of the cartilage showed a similar trend, decreasing from 0.9 at the surface, to 0.7 at the bone/cartilage interface. Translation to a weight percent yielded approximately 86% weight at the surface, trending down to approximately 63% at the bone/cartilage interface, with an average of 74.5% for five patellae. These MRI derived values were compared to the measured weight of water in excised cartilage plugs from the same patellae and showed remarkably close agreement. CONCLUSION We have demonstrated that MRI can non-invasively map WVF in cartilage in a pixel by pixel manner. This was accomplished in a time span that was clinically feasible, allowing the routine use of this method in a clinical setting. Moreover, this procedure employed standard MRI equipment and pulse sequences, avoiding the need for hardware modifications and using simple post processing methods. However, baseline studies need to be performed prior to incorporation into a standard radiological evaluation. Implications in the diagnosis of osteoarthritis (OA) are discussed.
Carcinoid Tumours in the Gastrointestinal Tract — A Population-Based Study from Western Norway

Objective: To analyze population-based incidence, anatomic distribution and patient characteristics of gastrointestinal carcinoid tumours. Background: Neuroendocrine carcinomas (NE, carcinoid tumours) arise from neuroendocrine cells and are most commonly found in gastrointestinal tract and lungs. Previous studies on carcinoids report varying incidence rates, location of tumours and patient survival rates. Methods: Retrospective study.88 patients were diagnosed with carcinoids located in the gastrointestinal tract in the period 1983–2003 in the Norwegian counties Hordaland and Sogn og Fjordane. Patient and tumour characteristics, treatment and survival were analyzed in a sub-group of 51 patients treated at Haukeland University Hospital. Results: Incidence of carcinoids was 0.8 when analyzed from the counties Hordaland and Sogn og Fjordane as well as when analyzed from Haukeland University Hospital. There were 26 men and 25 women. Median age at surgery was 61 years (range 17–87 years). The tumours were located in the small bowel in 53%, appendix 18%, colon 4%, rectum 4%, stomach 8% and duodenum 10%. Five-year survival rate was 50% in stomach, 80% in duodenum, 43% in the small bowel, 100% for tumours in appendix, 40% in colon and 100% in rectum. Conclusion: Carcinoid tumours are relatively uncommon neoplasms and most of them are found in the small bowel. Carcinoids in the ileum tend to be more aggressive and carry a poorer prognosis than carcinoids at other locations. Tumours in the appendix are found at lower age and in an early stage. They rarely metastasize and have an excellent prognosis.
Rhythm generation in monkey motor cortex explored using pyramidal tract stimulation

We investigated whether stimulation of the pyramidal tract (PT) could reset the phase of 15‐30 Hz beta oscillations observed in the macaque motor cortex. We recorded local field potentials (LFPs) and multiple single‐unit activity from two conscious macaque monkeys performing a precision grip task. EMG activity was also recorded from the second animal. Single PT stimuli were delivered during the hold period of the task, when oscillations in the LFP were most prominent. Stimulus‐triggered averaging of the LFP showed a phase‐locked oscillatory response to PT stimulation. Frequency domain analysis revealed two components within the response: a 15‐30 Hz component, which represented resetting of on‐going beta rhythms, and a lower frequency 10 Hz response. Only the higher frequency could be observed in the EMG activity, at stronger stimulus intensities than were required for resetting the cortical rhythm. Stimulation of the PT during movement elicited a greatly reduced oscillatory response. Analysis of single‐unit discharge confirmed that PT stimulation was capable of resetting periodic activity in motor cortex. The firing patterns of pyramidal tract neurones (PTNs) and unidentified neurones exhibited successive cycles of suppression and facilitation, time locked to the stimulus. We conclude that PTN activity directly influences the generation of the 15‐30 Hz rhythm. These PTNs facilitate EMG activity in upper limb muscles, contributing to corticomuscular coherence at this same frequency. Since the earliest oscillatory effect observed following stimulation was a suppression of firing, we speculate that inhibitory feedback may be the key mechanism generating such oscillations in the motor cortex.
Amelioration of microvascular myocardial ischemia by gene transfer of vascular endothelial growth factor in rabbits.

OBJECTIVES Restoration of coronary blood flow by angiogenesis may offer a new approach to intractable ischemic heart disease. In the present study, we investigated the angiogenic effects of gene transfer of vascular endothelial growth factor 165 on microvascular myocardial ischemia. METHODS A rabbit model of microvascular myocardial ischemia was created by plugging coronary microvessels with microspheres (15 microm in diameter, 2.8 x 10(5)/kg, n = 29). Gene transfer was performed by semi-selective intracoronary injection of recombinant adenovirus expressing vascular endothelial growth factor 165 forty minutes after microsphere injection (n = 9). RESULTS Microsphere injection reduced myocardial perfusion (78% +/- 9% of baseline tissue flow) and diminished myocardial contraction (61% +/- 12% of the baseline ejection fraction) and cardiac performance (elevated left ventricular end-diastolic pressure and decreased systemic flow) in the acute phase. At 17 +/- 3 days, gene transfer of vascular endothelial growth factor 165 had had the following effects: (1) promoted coronary angiogenesis as evidenced by myocardial flow above the baseline (121% +/- 24%), (2) increased vascular density revealed by synchrotron radiation microangiography and histologic analysis, (3) ameliorated the degree of myocardial ischemia as evidenced by myocardial lactate content and the extent of histologic necrosis, and (4) restored heart function as evidenced by increased ejection fraction (95% +/- 10%), reduced left ventricular end-diastolic pressure, and restored body weight. CONCLUSIONS In vivo vascular endothelial growth factor 165 gene transfer promoted angiogenesis and was an effective approach to treating microvascular myocardial ischemia.
Hearing preservation in conservation surgery for vestibular schwannoma.

OBJECTIVE To evaluate preservation of hearing in the resection of vestibular schwannomas. STUDY DESIGN A retrospective case review. SETTING Tertiary-care medical center. PATIENTS Forty-seven patients (25 men, 22 women) were studied; mean age was 46 years, mean tumor diameter 9.8 mm (range 3-30 mm.) INTERVENTIONS All patients underwent resection of vestibular schwannomas by the middle cranial fossa (MCF) or the retrosigmoid (RS) approach. MAIN OUTCOME MEASURES Hearing preservation was classified by the criteria outlined by the American Academy of Otolaryngology-Head Neck Surgery. Hearing was assessed preoperatively and postoperatively at 1 month and 1 year. Facial function was graded according to the House-Brackmann scale. Minimum follow-up was 18 months. RESULTS Hearing was preserved in 69% of patients who underwent the MCF approach but in only 33% of patients for whom the RS approach was used. The RS approach was used for larger tumors (mean diameter 15 mm) and the MCF procedure for smaller tumors (mean diameter 9 mm). One hundred percent of patients had facial function H/B grade II or better, regardless of approach. CONCLUSION Hearing function can be reliably preserved in a high percentage of selected patients undergoing resection of vestibular schwannoma.
Anemia management for hemodialysis patients: Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines and Dialysis Outcomes and Practice Patterns Study (DOPPS) findings.

BACKGROUND After recombinant human erythropoietin was introduced into routine nephrologic practice, specific clinical guidelines were developed to optimize the quality of anemia management for patients with chronic kidney disease. METHODS The Dialysis Outcomes and Practice Patterns Study (DOPPS), an international investigation providing patient- and facility-level data on hemodialysis practice, was developed to provide information on various aspects of current practices in hemodialysis management, including treatment of renal anemia. RESULTS Hemoglobin concentration is strongly associated with both morbidity and mortality in hemodialysis patients. Although some improvements can be documented in anemia management practices in the years after the publication of international guidelines, wide variations in anemia management are still observed among countries. CONCLUSION Many efforts are still needed to allow a greater proportion of patients to reach the recommended hemoglobin concentrations. Significantly improved outcomes may therefore be expected by a more widespread reaching of the recommended hemoglobin levels. The results of the DOPPS point to the difficulties in implementing clinical guidelines in the everyday management of individual patients. In specific circumstances, a well-designed observational study may offer credible information and serve as a basic instrument for monitoring the implementation of clinical guidelines in typical clinical practice.
Reference distributions for the negative acute‐phase proteins, albumin, transferrin, and transthyretin: A comparison of a large cohort to the world's literature

Clinical interpretation of the acute‐phase proteins—albumin, transferrin, and transthyretin—has been hampered by the lack of accurate and precise methods for quantifying the levels and a stable and respected reference material. Now that these issues have been addressed, the community is faced with the need for credible age‐ and gender‐specific reference values. The number of publications that address this issue, even for an analyte as familiar as albumin, is small and, in most cases, such publications lack the relevant data that would allow a combined experience to be created. We have identified 40 studies that meet our criteria: a description of the study participants' health status, of the statistical methodology, and of the laboratory technique and/or reference material used. Few of these studies reported values stratified by gender. A summary of the published median levels by age is presented for the three analytes, along with our own age‐ and gender‐specific medians based on a large cohort. Ten of the studies presented a 95 percent reference range, in close agreement with ours where selection was based upon reported diagnosis rather than upon determination of individual health status. This meta‐analysis provides support for the reliability of our recently published methodology and reference data for the clinical interpretation of individual albumin, transferrin, and transthyretin values. As with most laboratory measurements, clinical interpretation requires that other laboratory and clinical factors be considered. J. Clin. Lab. Anal. 13:280–286, 1999. © 1999 Wiley‐Liss, Inc.