Miracle-dz/UniFAR-FTUs huggingface dataset:
Essays in Health Economics

Opioid abuse is currently the most significant public health problem in the US. Many US states have implemented prescription drug monitoring programs (PDMPs) in response. In the rst paper, I use a new micro-level medical claims database to exploit state-level and time-series variations in PDMP implementation and shed light on the impacts of these programs. My results show that PDMPs have led to an overall 14% reduction in the odds ratio of abuse/addiction. Also, there is evidence of substantial heterogeneity in impacts, with larger impacts for females and minorities. Another nding is that at least 23% of opioid abuse is a result of drug diversion to nonmedical opioid users. PDMPs were not successful in decreasing the rate of abuse for this group, and, in fact, there is some evidence that they increased the diversion to heroin. Finally, I show that PDMPs' eectiveness varies by type of insurance and that they are more eective in reducing abuse rates in the general population as compared with Medicare Part D recipients. I use my estimates to analyze the potential eects of modifying PDMPs to include giving insurance providers access to electronic databases, providing educational programs for less-educated people, and expanding their \must access" requirement. In the second chapter, I estimate dierent models for opioid demand and compare their performance. My results suggest that the NB2 and Poisson FE models best match the data. Using these models for calculating the marginal effect of insurance characteristics provides suggestive evidence of the best insurance design to reduce the demand for opioids. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Economics This dissertation is available at ScholarlyCommons: https://repository.upenn. edu/edissertations/2874 First Advisor Petra Todd
Study and implementation of a high step-up voltage DC-DC converter using coupled-inductor and cascode techniques

A novel high efficiency high step-up DC-DC converter is proposed in this paper. The proposed converter can achieve high voltage ratio with appropriate duty cycle by using the coupled-inductor and cascode technique. In order to achieve high efficiency, a capacitor is used to recycle the leakage energy of the coupled-inductor and reduce the voltage stress on the switch. Therefore, the low-voltage rating MOSFET with low conduction resistance can be used. The operational principles and steady-state analysis of the proposed converter are discussed in detail. Finally, a prototype circuit with input voltage 24 V, output voltage 200 V and output power 250 W is implemented to verify the performances of the proposed converter. The experimental results reveals that the highest efficiency of the proposed converter is 94.6%, the full load efficiency is 92.3%, and the 10% load efficiency is 93.8%.
Effects of disease severity distribution on the performance of quantitative diagnostic methods and proposal of a novel ‘V-plot’ methodology to display accuracy values

Background Diagnostic accuracy is widely accepted by researchers and clinicians as an optimal expression of a test’s performance. The aim of this study was to evaluate the effects of disease severity distribution on values of diagnostic accuracy as well as propose a sample-independent methodology to calculate and display accuracy of diagnostic tests. Methods and findings We evaluated the diagnostic relationship between two hypothetical methods to measure serum cholesterol (Cholrapid and Cholgold) by generating samples with statistical software and (1) keeping the numerical relationship between methods unchanged and (2) changing the distribution of cholesterol values. Metrics of categorical agreement were calculated (accuracy, sensitivity and specificity). Finally, a novel methodology to display and calculate accuracy values was presented (the V-plot of accuracies). Conclusion No single value of diagnostic accuracy can be used to describe the relationship between tests, as accuracy is a metric heavily affected by the underlying sample distribution. Our novel proposed methodology, the V-plot of accuracies, can be used as a sample-independent measure of a test performance against a reference gold standard.
Acupuncture in the Treatment of a Female Patient Suffering from Chronic Schizophrenia and Sleep Disorders

Background. The use of acupuncture in the treatment of sleep disorders in patients with chronic schizophrenia is investigated. Case Presentation. We report the case of a 44-year-old female outpatient of German origin who had been suffering from long-term schizophrenia and sleep disorders. The patient was treated with manual acupuncture weekly for 12 weeks, and a psychological assessment was performed before, immediately after, and three months after the acupuncture treatment period. In addition, actiwatch data were collected for 14 days both before and after the acupuncture treatment period. Conclusion. Acupuncture treatment led to a decrease in general psychopathology, less severe sleep problems, and markedly improved cognitive functioning (working memory) in the patient; however, the positive and the negative symptoms remained stable. The actiwatch data revealed a beneficial effect of acupuncture, showing better sleep latency, a trend towards better sleep efficiency, and a decrease in the number of minutes that the patient was awake during the night after acupuncture treatment. In sum, this study showed that acupuncture might be beneficial in the treatment of sleep disorders in patients suffering from chronic schizophrenia, but future, large, randomized (placebo), controlled, clinical trials are needed in order to replicate the present preliminary findings.
Association between Anxiety or Depressive Symptoms and Arterial Hypertension, and Their Impact on the Quality of Life

Objective: Despite all progress made in understanding and treating systemic arterial hypertension (SAH), the study of the impact of psychological disorders in SAH is still controversial and is not well understood. Our aim was to test the hypothesis that SAH can be associated with anxiety and depressive symptoms and to verify its effect on the quality of life. Method: A controlled cross-sectional study included 302 patients (152 hypertensive and 150 normotensive) outpatients at Hospital São Lucas of PUC-RS. Measurements were made in individual interviews and included data collection and application of general scales such as State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), and Medical Outcome Study Short Form, General Health Survey (SF-36). Results: Anxiety was significantly associated with SAH only after adjusted for relevant risk factors (odds ratio (OR) = 2.83, 95% confidence interval (CI) = 1.55 to 5.18). Depressive symptoms were significantly associated with SAH (OR) = 4.34 (95% CI: 2.34 to 8.06). A significant association between quality of life and SAH were also found. However, this association diminished after adjusted for BDI and STAI. This shows the effect of depressive symptoms, in particular, and anxiety, in the worsening of quality of life. Conclusions: This study suggested that anxiety, especially depressive symptoms, are significantly associated with SAH and had a significant effect on hypertensive patients' worse quality of life.
Expression of herpes simplex virus type 1 DNA polymerase gene by in vitro translation and effects of gene deletions on activity

A cloned herpes simplex virus type 1 DNA polymerase gene which is biologically functional was inserted into SP6 and T7 promoter-containing vectors for in vitro transcription-translation. pol-specific RNA synthesized in vitro will direct the synthesis of a 140-kilodalton polypeptide in rabbit reticulocyte lysates. RNAs prepared from pol templates linearized at internal restriction sites specified deleted polypeptides with sizes consistent with colinearity of the pol gene and the 140-kilodalton primary translation product. The in vitro translated pol gene product was enzymatically active, with salt resistance and sensitivity to acyclovir triphosphate, similar to the enzyme activity in crude extracts of herpes simplex virus type 1-infected Vero cells. An in-frame deletion of 78 residues (amino acids residues 881 to 959) was introduced into the expression vectors to investigate the function of a region of the polypeptide (amino acids residues 881 to 895) which is conserved in nine other DNA polymerases. In a complementation assay, this mutation abolished biological activity as well as the enzymatic activity of the in vitro translated product. A BAL31 mutation deleting the upstream open reading frame of pol had no effect on biological activity in a complementation assay but was found to increase the efficiency of in vitro translation of pol RNA. Two amino-terminal deletions of 27 and 67 residues were found to greatly enhance the enzymatic activity of the in vitro translated product, while all carboxy-terminal deletions examined (the smallest being 164 residues) abolished in vitro enzymatic activity. Expression of the 67-residue amino-terminal deleted pol gene in Escherichia coli, using a bacteriophage T7-based system, resulted in accumulation of large amounts of an insoluble fusion protein. An antiserum prepared against this fusion protein precipitated the 140-kilodalton DNA polymerase from herpes simplex virus type 1-infected cell lysates.
Health economics of treating haemophilia A with inhibitors

Summary. Haemophilia is a rare, inherited blood disorder in which blood clotting is impaired such that patients suffer from excessive internal and external bleeding. At present there is no cure for haemophilia A and patients require expensive, life‐long treatment involving clotting factor replacement therapy. Treatment costs are perceived to be higher for patients who have developed inhibitory antibodies to factor VIII, the standard therapy for haemophilia A. However, initial cost analyses suggest that clotting factor therapy with alternative haemostatic agents, such as recombinant activated factor VII or activated prothrombin complex concentrate, is no more expensive for the majority of haemophilia A patients with inhibitors than for those without inhibitors. With the availability of effective alternative haemostatic agents, orthopaedic surgery for haemophilia A patients with inhibitors is now a clinical option, and initial cost analyses suggest this may be a cost‐effective treatment strategy for patients with inhibitors whose quality of life (QoL) is severely impaired by joint arthropathy. In an era of finite healthcare resourcing it is important to determine whether new treatments justify higher unit costs compared with standard therapies and whether such higher costs are justified from an individual perspective in terms of improved QoL, and from a societal perspective in terms of improved productivity and reduced overall healthcare costs. This paper examines current data on the health economics of treating haemophilia A patients with inhibitors, focusing on the overall costs of clotting factor replacement therapy and the cost consequences of joint replacement.
Computational and experimental analysis of TMS-induced electric field vectors critical to neuronal activation

Objective. Transcranial magnetic stimulation (TMS) represents a powerful technique to noninvasively modulate cortical neurophysiology in the brain. However, the relationship between the magnetic fields created by TMS coils and neuronal activation in the cortex is still not well-understood, making predictable cortical activation by TMS difficult to achieve. Our goal in this study was to investigate the relationship between induced electric fields and cortical activation measured by blood flow response. Particularly, we sought to discover the E-field characteristics that lead to cortical activation. Approach. Subject-specific finite element models (FEMs) of the head and brain were constructed for each of six subjects using magnetic resonance image scans. Positron emission tomography (PET) measured each subject’s cortical response to image-guided robotically-positioned TMS to the primary motor cortex. FEM models that employed the given coil position, orientation, and stimulus intensity in experimental applications of TMS were used to calculate the electric field (E-field) vectors within a region of interest for each subject. TMS-induced E-fields were analyzed to better understand what vector components led to regional cerebral blood flow (CBF) responses recorded by PET. Main results. This study found that decomposing the E-field into orthogonal vector components based on the cortical surface geometry (and hence, cortical neuron directions) led to significant differences between the regions of cortex that were active and nonactive. Specifically, active regions had significantly higher E-field components in the normal inward direction (i.e., parallel to pyramidal neurons in the dendrite-to-axon orientation) and in the tangential direction (i.e., parallel to interneurons) at high gradient. In contrast, nonactive regions had higher E-field vectors in the outward normal direction suggesting inhibitory responses. Significance. These results provide critical new understanding of the factors by which TMS induces cortical activation necessary for predictive and repeatable use of this noninvasive stimulation modality.
Application of Automatic Mutation-gene Pair Extraction to Diseases

To have a better understanding of the mechanisms of disease development, knowledge of mutations and the genes on which the mutations occur is of crucial importance. Information on disease-related mutations can be accessed through public databases or biomedical literature sources. However, information retrieval from such resources can be problematic because of two reasons: manually created databases are usually incomplete and not up to date, and reading through a vast amount of publicly available biomedical documents is very time-consuming. In this paper, we describe an automated system, MuGeX (Mutation Gene eXtractor), that automatically extracts mutation-gene pairs from Medline abstracts for a disease query. Our system is tested on a corpus that consists of 231 Medline abstracts. While recall for mutation detection alone is 85.9%, precision is 95.9%. For extraction of mutation-gene pairs, we focus on Alzheimer's disease. The recall for mutation-gene pair identification is estimated at 91.3%, and precision is estimated at 88.9%. With automatic extraction techniques, MuGeX overcomes the problems of information retrieval from public resources and reduces the time required to access relevant information, while preserving the accuracy of retrieved information.
The collaborative relationship between teacher librarians and public librarians

The purpose of this research study is to develop an understanding of the collaborative relationships between teacher librarians and public librarians in Cedar County, Iowa, a region that includes five public school districts, seven public town libraries, and one branch of a county library system. Additionally, this research explores the potential role of public librarians in working with students on school curriculum and/or homework assignments. In conducting research, a survey was given to a variety of participants who serve teens or young adults through either public schools or public libraries in the research study area. Participants included school librarians, public librarians, classroom teachers, and administrators. In addition to the survey, teacher librarians and public librarians were asked to voluntarily participate in a follow-up interview that included additional questions as well as the opportunity to elaborate on survey responses. The research recorded the frequency and percentages of responses, looking for and noting commonalities in the participants’ responses. The researcher discovered that a majority of the teacher librarians and public librarians surveyed are engaged in some form of professional relationship. Common current collaborative practices include mutual promotion of youth programs or events and shared resources. A disconnect emerged, however, concerning public librarians and their role in collaboration on school curriculum and student homework assignments. While all participants interviewed believe that the pursuit of collaborative relationships is worthwhile, responses differed concerning the library staff’s responsibility in helping students with homework assignments. In general, participants’ responses indicated current successful practices in collaboration as well as the potential for stronger relationships, including collaboration on school curriculum and student homework assignments, in the future. TABLE OF CONTENTS LIST OF TABLES vi LIST OF FIGURES vii CHAPTER
Multi modal multi-semantic image retrieval

viii ACKNOLWEDGEMENTS x ABBREVIATIONS xi CHAPTER 1 INTRODUCTION 1 1.1 Motivation 2 1.1.1 Representing Visual Content and Classifying Images 3 1.1.2 Ambiguity of Natural Language in Text Captions 4 1.1.3 Use of Hybrid Visual and Textual Metadata Models 5 1.2 Research Objectives 6 1.3 Structure of this Thesis 8 CHAPTER 2 FUNDAMENTALS 10 2.1 Main Processes for IMR 10 2.2 Content-Based Image Retrieval (CBIR) 13 2.2.1 Global Features 14 2.2.2 Local Features 15 2.3 Semantic-Based Image Retrieval (SBIR) 16 2.3.1 Knowledge (Ontology-based) Representation Techniques 18 2.3.2 Advantages of Using Ontologies for IR 21 2.4 MPEG-7 and Ontology-based KB 21 2.5 Summary 25 CHAPTER 3 SURVEY AND ANALYSIS OF THE STATE-OF-THE-ART FRAMEWORKS 26 3.1 Problem Analysis of the Image Retrieval Systems 26 3.2 Formal Requirements of Image Retrieval Systems 28 3.3 Survey of State of the Art Frameworks 29 3.3.1 Ontology-Based KB Frameworks for IMR 29 3.3.2 Visual Features-Based Frameworks for Visual Content Representation 34 3.4 Discussion 39 3.5 Summary 42
Energy and flux limits of cold-fusion neutrons using a deuterated liquid scintillator.

Deuterated liquid scintillator detectors (NE230), which give excellent {ital n}/{gamma} discrimination and provide a direct measure of the neutron {ital energy} spectrum, have been used to search for 2 to 3 MeV neutrons produced in {ital d}+{ital d} cold fusion. The apparatus consisted of an electrolytic cell using high-efficiency inverted-well geometry. Several samples of annealed Pd wire and a Pd casting (up to 13 g) were studied over a period of several weeks. An upper limit of {le}10{sup {minus}3} fusion ({ital n}/s g) Pd was obtained corresponding to {lt}7{times}10{sup {minus}24} fusion ({ital n}/s) {ital dd} pair in our samples which excludes most of the reported positive results. Several sources of spurious signals, which could closely mimic signals from fusion neutrons, were also observed.
Neonatal Subgaleal Hemorrhage and Its Relationship to Delivery by Vacuum Extraction

Subgaleal hemorrhage is a rare condition of the neonate often associated with instrumental delivery. It is a potentially fatal condition that is often underreported and underdiagnosed. The vacuum extractor is being advocated as the instrument of first choice for assisted vaginal delivery, but appears to be associated with an increased incidence of subgaleal hemorrhage. It is widely believed that the vacuum cup will dislodge before causing serious fetal trauma. Because of the ease of application, vacuum extractors could be used potentially in circumstances in which forceps would not be attempted, allowing an operator of average experience to perform rotational deliveries. The worrisome increase in the incidence of subgaleal hemorrhage associated with vacuum extraction leads to the issuance of warnings from governmental authorities in Canada and the United States. This review discusses the anatomy of this lesion, etiology, clinical presentation, management, and possible prevention. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to describe the clinical features of a subgaleal hemorrhage, to list the risk factors associated with a subgaleal hemorrhage, and to outline the differential diagnosis of a subgaleal hemorrhage.
Validation of a model of gross motor function for children with cerebral palsy.

BACKGROUND AND PURPOSE Development of gross motor function in children with cerebral palsy (CP) has not been documented. The purposes of this study were to examine a model of gross motor function in children with CP and to apply the model to construct gross motor function curves for each of the 5 levels of the Gross Motor Function Classification System (GMFCS). SUBJECTS A stratified sample of 586 children with CP, 1 to 12 years of age, who reside in Ontario, Canada, and are known to rehabilitation centers participated. METHODS Subjects were classified using the GMFCS, and gross motor function was measured with the Gross Motor Function Measure (GMFM). Four models were examined to construct curves that described the nonlinear relationship between age and gross motor function. RESULTS The model in which both the limit parameter (maximum GMFM score) and the rate parameter (rate at which the maximum GMFM score is approached) vary for each GMFCS level explained 83% of the variation in GMFM scores. The predicted maximum GMFM scores differed among the 5 curves (level I=96.8, level II=89.3, level III=61.3, level IV=36.1, and level V=12.9). The rate at which children at level II approached their maximum GMFM score was slower than the rates for levels I and III. The correlation between GMFCS levels and GMFM scores was (. 91. Logistic regression, used to estimate the probability that children with CP are able to achieve gross motor milestones based on their GMFM total scores, suggests that distinctions between GMFCS levels are clinically meaningful. CONCLUSION AND DISCUSSION Classification of children with CP based on functional abilities and limitations is predictive of gross motor function, whereas age alone is a poor predictor. Evaluation of gross motor function of children with CP by comparison with children of the same age and GMFCS level has implications for decision making and interpretation of intervention outcomes.
Long-term central cholinergic hypofunction induced in mice by ethylcholine aziridinium ion (AF64A) in vivo.

Ethylcholine mustard aziridinium ion (AF64A), a neurotoxic choline analog, was evaluated for its interactions with the cholinergic system in mice. Parenterally administered AF64A was lethal (LD50 = 32.6 mumol/kg i.v.) and the lethality could be antagonized even at 8 LD50 doses by pretreatment with choline (714 mumol/kg i.p.) 2 min earlier. Mice that were protected by choline slowly developed neurological motor disturbances such as ataxia and hypokinesia, and lost weight. Intracerebroventricular administration of 65 nmol of AF64A was not acutely lethal, but produced similar delayed behavioral effects similar to those found after parenteral administration of AF64A. Seven days after a single injection of 65 nmol of AF64A i.c. v. , there was a significant decrease in acetylcholine content in the cortex, striatum and hippocampus, but no change in choline levels. Acetylcholine content was still significantly reduced in the hippocampus at 3 weeks after this treatment. The reduction in activity of choline acetyltransferase and high-affinity choline transport paralleled the reduction in acetylcholine measured at 7 days post AF64A treatment, whereas muscarinic receptors in all three brain areas were unchanged. These combined data indicate that AF64A is a presynaptic chemical neurotoxin, capable of inducing a persistent deficiency in central cholinergic transmission.