Miracle-dz/UniFAR-FTUs huggingface dataset:
How easily malaria can be missed.

The diagnosis of malaria can be missed when there is a significant time lag from exposure and negative initial tests. As clinicians we must always consider the diagnosis in the appropriate clinical setting as a missed diagnosis can potentially result in serious consequences. A 27-year-old Nigerian woman presented with a 2-day history of headaches, mild photophobia, sweats and fever. She arrived in the UK from Nigeria 8 months previously and had not been back since. On admission she was unwell with a temperature of 38.5°C, pulse 110/min but otherwise haemodynamically stable. Examination revealed a soft ejection systolic murmur and signs of meningism, but her neurological assessment was otherwise entirely normal. Her initial investigations showed a haemoglobin level of 11.8 g/dL, white cell count 3.9×109/L, lymphocytes 0.5×109/L, platelets 118×109/L, C-reactive protein 121 mg/L; urea and electrolytes and liver function tests were normal. She was commenced on ceftriaxone 2 g daily with a presumptive diagnosis of meningitis. The patient had a normal computerized tomograph of the head, which was followed by a normal lumbar puncture. Two sets of blood cultures and a mid-stream urine sample had no growth after 48 h. The initial admission pyrexic thick and thin blood film and malarial antigen test (Optimal, DiaMed) were negative. She improved initially with antibiotics and intravenous fluids. 24 h into her admission, having been reviewed by a number of senior doctors, her working diagnosis was changed to one of a viral illness and plans were made for her discharge. Malaria was felt to be unlikely given that not only was she 8 months post-exposure for malaria, her blood film and antigen test were negative. However, on the day of discharge she was found to spike a temperature of 38°C and remained thrombocytopenic (108×109/L). It was decided that in view of her country of origin and the fact that she remained thrombocytopenic, malaria still needed to be considered. Even though a thick and thin blood film and malarial antigen test (Optimal, DiaMed) were negative, we felt three negative blood films were needed before excluding malaria and labelling her as a patient with a viral illness. Interestingly, a repeat blood film showed malarial parasitaemia of 5% Plasmodium falciparum (Figure 1). Her haemoglobin dropped to 9 g/dL and platelets dropped to 93×109/L over the next 2 days, which then recovered. She was treated with intravenous quinine (10 mg/kg) for 48 h and converted to oral quinine for 7 days followed by three tablets of oral pyrimethamine with sulfadoxine (Fansidar). She was discharged home with a negative parasitaemia. Figure 1 Patients blood film showing malarial parasites (in colour online)
Bayesian Methods for Correcting Misclassification: An Example from Birth Defects Epidemiology

Background: Cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO) are common congenital malformations. Numerous epidemiologic studies have shown an increased risk for orofacial clefts among children whose mothers smoked during early pregnancy; however, there is concern that the results of these studies may have been biased because of exposure misclassification. The purpose of this study is to use previous research on the reliability of self-reported cigarette smoking to produce corrected point estimates (and associated credible intervals) of the effect of maternal smoking on children's risk of clefts. Methods: We accounted for misclassification using 4 Bayesian models that made different assumptions about the sensitivity and specificity of self-reported maternal smoking data. We used results from previous studies to specify the prior distributions for sensitivity and specificity of reporting and used Markov chain Monte Carlo algorithms to calculate the posterior distribution of the effect of maternal smoking on children's risk for CL/P and CPO. Results: After correcting for potential sources of misclassification in data from the National Birth Defects Prevention Study, we found an increased risk of CL/P among children born to mothers who smoked during early pregnancy (posterior odds ratio [OR] = 1.6, 95% credible interval = 1.1–2.2). The posterior effect of smoking on CPO provided less evidence of effect (posterior OR = 1.1, 95% credible interval = 0.7–1.7). Conclusion: Our results lend some credibility to the hypothesis that periconceptional maternal smoking increases the risk of a child being born with CL/P. The results concerning CPO provide no overall evidence of effect, although the estimates were relatively imprecise. We suggest that future research should emphasize validity studies, especially those of differential reporting, rather than replicating existing analyses of the relationship between maternal smoking and clefts. We discuss how our approach is also applicable to evaluating misclassification in a wide range of exposure-outcome scenarios.
The Sygen® Multicenter Acute Spinal Cord Injury Study

Study Design. Randomized, double-blind, sequential, multicenter clinical trial of two doses of Sygen®versus placebo. Objectives. To determine efficacy and safety of Sygen® in acute spinal cord injury. Summary of Background Data An earlier, single-center trial in 28 patients showed an improvement (50.0%vs. 7.1%, P = 0.034) in marked recovery with Sygen®. Methods. Standard clinical trial techniques. Results. The prospectively planned analysis at the prespecified endpoint time for all patients was negative. There was a significant effect in all patients in the primary outcome variable (the percentage of marked recovery) at week 8, the end of the dosing period. There was a significant effect in all patients in the time at which marked recovery is first achieved. Restricted to severity Group B, which has small sample size, the primary efficacy analysis showed a trend but did not reach significance. There is a large, consistent and, at some time points, significant effect in the primary outcome variable in the nonoperated patients through week 26. The American Spinal Injury Association motor, light touch, and pinprick scores showed a consistent trend in favor of Sygen®, as also did bowel function, bladder function, sacral sensation, and anal contraction. The less severely injured patients appeared to have a greater beneficial drug effect. Evidence against an effect of Sygen® was minimal and scattered. Conclusions. Although not proven in the primary efficacy analysis of this trial, Sygen® appears to be beneficial in patients with severe spinal cord injury.
Effect of Attachment Site and Routing Variations in Split Tendon Transfer of Tibialis Posterior

Spastic equinovarus is a condition that commonly affects the gait of children with cerebral palsy. Split tendon transfers of the tibialis posterior (TP) are often performed to eliminate the excessive hindfoot inversion present in equinovarus. TP muscle moment arms were computed before and after three variations of split TP tendon transfer to assess the effectiveness of each. The three surgeries tested were (1) the original split TP transfer to the distal peroneus brevis tendon routing behind the lateral malleolus; (2) an attachment variation in which the transferred tendon half was attached to the proximal peroneus brevis tendon rather than to the distal site; and (3) a routing variation in which the transferred tendon half was passed through a window in the interosseous membrane and attached to the distal peroneus brevis tendon. Tendon tension was controlled for in these experiments because improper tensioning is often cited as a reason for poor outcomes. All three surgeries significantly reduced the ability of TP to invert the hindfoot, thus eliminating a potential deforming force, but the reduction following interosseous routing was significantly less than that found for the other two transfer procedures. Routing through the interosseous membrane also reduced the ability of the TP to plantarflex the foot, but ankle actions were preserved following the other two surgeries. Routing through the interosseous membrane to an anterior attachment site resulted in a muscle with minimal potential to create or resist action about the ankle joint. Similar moment arms were measured when the attachment site on the peroneus brevis tendon was located either proximally or distally, suggesting that this choice does not appear to significantly affect the mechanical outcome.
Satisfaction with Life Scale in a Representative Sample of Spanish Adults: Validation and Normative Data

Abstract The Satisfaction with Life Scale (SWLS) is a measure widely used to assess life satisfaction. This paper aims to test its psychometric properties, factor structure, and distribution scores across age, gender, education, and employment status. For this purpose, a representative sample of the Spanish population (N = 2,964) was used. Although analyses showed no significant differences across age or gender, participants with higher education level and those who held an occupation were more satisfied with their lives. Confirmatory factor analysis revealed a unifactorial structure with significant correlations between the SWLS, and subjective happiness and social support. The internal consistency of the scale was . 88. Thus, our results indicate that the Spanish version of the SWLS is a valid and reliable measure of life satisfaction within the Spanish context.
The Role of Education In Awareness Enhancement of Takaful: A Literature Review

The purpose of this study is to evaluate the general level of public awareness towards Takaful concept and principles, and the role of education in enhancing public awareness on Takaful concept and principles. In addition, the study also evaluates some important issues that need to be taken into consideration by Takaful stakeholders in integrating Takaful courses into academic curriculum of higher learning institutions. Using literature/library based method, which is a kind of qualitative research approach, the study finds that the global level of public awareness on Takaful concepts and principles is relatively low. Review of literature also reveals that education plays an importance role in enhancing public awareness on Takaful concepts and principles. Therefore, integrating Takaful courses into academic curriculum of higher learning institutions is important to enhance the level of public awareness. The study also finds that there is a skill mismatch issue within Islamic finance industry in general including Takaful segment. Close and intensive collaboration between regulators, Takaful companies and universities and training institutes that are currently offering or intend to offer Takaful courses is highly recommended to overcome the skill mismatch issue. This study is expected to benefit Takaful regulators, higher learning institutions offering Takaful courses and Takaful companies in terms of providing them with the inputs to enhance public awareness on Takaful concept and principles.
Effect of Crystallization Firing on Marginal Gap of CAD/CAM Fabricated Lithium Disilicate Crowns

PURPOSE To evaluate the marginal gaps of CAD/CAM (CEREC 3) produced crowns made from leucite-reinforced glass-ceramic (IPS Empress CAD) blocks (LG), and lithium-disilicate (IPS e.max CAD) blocks before (LD-B), and after (LD-A) crystallization firing. MATERIALS AND METHODS A human molar tooth (#19) was mounted with adjacent teeth on a typodont and prepared for a full-coverage ceramic crown. The typodont was assembled in the mannequin head to simulate clinical conditions. After tooth preparation 15 individual optical impressions were taken by the same operator using titanium dioxide powder and a CEREC 3 camera per manufacturer's instructions. One operator designed and machined the crowns in leucite-reinforced glass-ceramic blocks (n = 5) and lithium-disilicate blocks (n = 10) using the CEREC 3 system. The crowns were rigidly seated on the prepared tooth, and marginal gaps (μm) were measured with an optical microscope (500×) at 12 points, 3 on each of the M, B, D, and L surfaces of the leucite-reinforced glass-ceramic crowns and the lithium-disilicate crowns before and after crystallization firing. Results were analyzed by two-way ANOVA followed by a Tukey's post hoc multiple comparison test (α = 0.05). RESULTS The overall mean marginal gaps (μm) for the crowns evaluated were: LG = 49.2 ± 5.5, LD-B = 42.9 ± 12.2, and LD-A = 57.2 ± 16.0. The marginal gaps for LG and LD-B were not significantly different, but both were significantly less than for LD-A. CONCLUSIONS The type of ceramic material did not affect the marginal gap of CAD/CAM crowns. The crystallization firing process required for lithium-disilicate crowns resulted in a significant increase in marginal gap size, likely due to shrinkage of the ceramic during the crystallization process. CLINICAL RELEVANCE The marginal gap of CAD/CAM-fabricated lithium disilicate crowns increases following crystallization firing. The marginal gap still remains within clinically acceptable parameters.
International diversification and corporate social responsibility: An empirical study of Chinese contractors

Purpose – The purpose of this paper is to explore the relationship between international diversification strategy and corporate social responsibility (CSR) for firms from emerging economies. Design/methodology/approach – This paper is based on an empirical study of a sample of Chinese firms listed in Engineering News Record top contractors from 2010 to 2014. A moderated analysis is employed in order to test the hypotheses and examine how the scale and scope of international diversification affect CSR. Findings – The empirical results show that degree of internationalization (DOI), as the scale, is positively related to firms’ CSR scores. Furthermore, two scopes, geographic diversification (GD) and project diversification (PD), have different effects on CSR scores. GD negatively moderates the relationship between DOI and CSR scores, while PD has a positive direct impact on CSR scores. Research limitations/implications – This paper focusses on firms from emerging economies; therefore, the findings may not h.
A Shadow Rate Model with Time-Varying Lower Bound of Interest Rates

Typically a constant – or zero – lower bound for interest rates is applied in shadow rate term structure models. However, euro area yield curve data suggest that a time-varying lower bound might be appropriate for the euro area. I show that this indeed is the case, i.e. a shadow rate model with time-varying lower bound outperforms the constant lower bound model in euro area data. I argue that the time-variation in the lower bound is related to the deposit facility rate and, thus, to monetary policy. This time-variation in the lower bound gives a new channel via which monetary policy may affect the yield curve in a shadow rate model. I show that the intensity of this channel depends on how tightly the lower bound restricts the yield curve, and I argue that this channel has recently become important for the euro area.
Withdrawal of Analgesic Medication for Chronic Low-Back Pain Patients: Improvement in Outcomes of Multidisciplinary Rehabilitation Regardless of Surgical History

Crisostomo RA, Schmidt JE, Hooten WM, Kerkvliet JL, Townsend CO, Bruce BK: Withdrawal of analgesic medication for chronic low-back pain patients: improvement in outcomes of multidisciplinary rehabilitation regardless of surgical history. Am J Phys Med Rehabil 2008;87:527–536. Objective:To determine the posttreatment outcomes of multidisciplinary pain rehabilitation that incorporates analgesic medication withdrawal for chronic low-back pain patients on the basis of lumbar spine surgical history. Design:This is a retrospective analysis of 383 consecutive chronic low-back pain patients participating in a 3-wk, outpatient, intensive, multidisciplinary pain rehabilitation program. The study sample was divided into three groups based on history of spine surgery: 196 patients without previous lumbar spine surgery, 125 with history of lumbar fusion, and 62 with history of nonfusion lumbar spine surgery. Patients were assessed at admission and dismissal for medication use, pain severity and affective characteristics, physical functioning, depression, and pain catastrophizing. Results:At admission, patients in both the fusion and nonfusion surgery groups were using more opioids compared with the no-surgery group. Reported pain severity and duration was highest in the fusion group compared with the other groups. Admission to dismissal comparisons showed significant and nearly equal improvements for all groups in health and medication measures. Conclusions:Study results demonstrate that multidisciplinary pain rehabilitation treatment incorporating analgesic medication withdrawal is associated with significant clinical improvements in physical and emotional functioning, regardless of lumbar spine surgical history.
An Arabidopsis gene family encoding DRE/CRT binding proteins involved in low-temperature-responsive gene expression.

In higher plants, a cis-acting element, DRE/CRT, is involved in gene expression responsive to drought and low-temperature stress. To understand signal transduction pathways from the cold stress signal to gene expression, we characterized a gene family for DRE/CRT-binding proteins DREB1A and CBF1 in Arabidopsis thaliana. DREB1A and CBF1 were shown to be involved in low-temperature-responsive gene expression. We screened an Arabidopsis genomic DNA library with the cDNA fragment of DREB1A as a probe and isolated DREB1A and 2 related genes, DREB1B (= CBF1) and DREB1C. These were arrayed in the order B, A, C in an 8.7 kb region of Arabidopsis chromosome 4. Northern blot analysis using gene-specific probes showed that the 3 DREB1 genes are induced mainly by cold stress but not by osmotic stress in leaves, roots, and stems. Several conserved sequences were found in the promoter regions of all 3 genes. The beta-glucuronidase (GUS) reporter gene driven by the DREB1 promoters was induced at transcriptional level by low temperature in transgenic Arabidopsis plants.
Integration of High Resolution EEG and Functional Magnetic Resonance in the Study of Human Movement-Related Potentials

Abstract: Cortical sources of human movement-related potentials (i.e. unilateral finger extension) were modeled using functional magnetic resonance imaging (fMR) data as a constraint of a linear inverse source estimation from highly sampled (128 channels) EEG data. Remarkably, this estimation was performed within realistic subject’s MR-constructed head models by boundary element techniques. An appropriate figure of merit served to set the optimal amount of fMR constraints. With respect to standard linear inverse source estimates, fMR-constrained ones presented increased spatial detail and provided a more reliable timing of activation in bilateral sensorimotor cortical regions of interest.
Precession of the Earth as the Cause of Geomagnetism

I have proposed that the precessional torques acting on the earth can sustain a turbulent hydromagnetic flow in the molten core. A gross balance of the Coriolis force, the Lorentz force, and the precessional force in the core fluid provided estimates of the fluid velocity and the interior magnetic field characteristic of such flow. Then these numbers and a balance of the processes responsible for the decay and regeneration of the magnetic field provided an estimate of the magnetic field external to the core. This external field is in keeping with the observations, but its value is dependent upon the speculative value for the electrical conductivity of core material. The proposal that turbulent flow due to precession can occur in the core was tested in a study of nonmagnetic laboratory flows induced by the steady precession of fluid-filled rotating spheroids. It was found that these flows exhibit both small wavelike instabilities and violent finite-amplitude instability to turbulent motion above critical values of the precession rate. The observed critical parameters indicate that a laminar flow in the core, due to the earth's precession, would have weak hydrodynamic instabilities at most, but that finite-amplitude hydromagnetic instability could lead to fully turbulent flow.
Explanation Theory and Models of Migration

viduals make. " It is a dialogue between ideas concerning form and process in which a theory of explanation provides the rules for structuring information and making interpretive inferences. It is of critical importance, then, to know not only what these rules are, but also why they are effective for answering specific classes of questions. As Ulam [113] has recently pointed out, diagrammatic (or mapped) representations of residential patterns can be generated by simple sets of rules, these rules constituting an explanation of the form, so to speak. At the same time, however, given only the pattern, there is in general no unique means for making inferences about the specific behaviors that gave rise to it, that is, to explain the process of migration. To do this, movement behavior must be considered as a sequence of individual decisions and the explanation given in terms of the association between residential choices and changes in social and economic conditions.
Urogenital Chlamydia trachomatis infections in general practice: diagnosis, treatment, follow-up and contact tracing.

BACKGROUND Patients with urogenital Chlamydia trachomatis infection are frequently seen in general practice. It is, therefore, important to assess GPs' management of these patients in order to ensure adequate control of the disease. OBJECTIVE We aimed to evaluate the GPs' routines in diagnosis, medical treatment, follow-up and contact tracing according to knowledge/attitude (criteria) and actual performance. METHODS The study comprised the 388 GPs in the County of Aarhus. Two questionnaires were used. The first questionnaire was mailed to each of 252 GPs who had attended a patient with urogenital C. trachomatis infection 4 weeks previously. Each GP was asked about his/her actual performance for that particular patient. In order to elucidate the GPs' criteria, the second questionnaire was mailed to each of the 388 GPs in the County of Aarhus, asking about their usual intended routines (criteria) for managing urogenital C. trachomatis infections. The questionnaires covered the same topics. RESULTS Great variations among the GPs' management of urogenital C. trachomatis infection according to sampling-site, medical treatment, follow-up and contact tracing were found. Furthermore, a discrepancy between criteria and actual performance for obtaining an urethral swab-sample in women and for contact tracing of previous partners were demonstrated. The GPs stated that they had intended to obtain more urethral swab-samples and do more contact tracing than they actually did. CONCLUSIONS We conclude that increasing the collection of urethral samples from women combined with greater emphasis on contact tracing procedures might limit the prevalence of the infection. In order to achieve this, continuous medical education and auditing procedures on urogenital chlamydial infections may be helpful.