Miracle-dz/UniFAR-FTUs huggingface dataset:
Child understandings of the causation of childhood burn injuries: Child activity, parental domestic demands, and impoverished settings

BACKGROUND Burns are a global public health problem. In South Africa, the rate of paediatric burn deaths is 5 times higher than other upper middle-income countries, with concentrations in impoverished settings. Globally, the majority of research focuses on expert and caregiver descriptions of burn occurrence, causation, and prevention, with limited consideration of children's perspectives. This study investigated children's understanding of the causation and prevention of childhood burns. METHODS Data were collected from eighteen 10- to 11-year-old children living in selected impoverished, fire-affected neighbourhoods in Cape Town, through 3 isiXhosa focus groups. All focus groups were transcribed, coded, and analysed for emerging themes through thematic analysis. RESULTS Themes regarding burn causation and risks centred around 4 themes: (a) developmental limits in context; (b) domestic chores, child capacity, and inability to say "no"; (c) inadequate supervision and compromised caregiving; and (d) unsafe structures. Child accounts of prevention pertained to (e) burn injury prevention activities in comprised environments and emphasized child agency, and upgrading the physical environment. CONCLUSION The children in this study ascribed burn injuries as the consequence of their developmental limits in the context of poverty, constraints on parental supervision, and unsafe environments. The children recommended safety education and upgrading their physical environments as part of burns injury prevention. The child accounts offer useful insights to inform safety interventions in impoverished settings.
Body mass index and motor coordination: Non‐linear relationships in children 6–10 years

BACKGROUND Given the concern for health-related consequences of an elevated body mass index (BMI; obesity), the potential consequences of a low BMI in children are often overlooked. The purpose was to evaluate the relationship between the BMI across its entire spectrum and motor coordination (MC) in children 6-10 years. METHODS Height, weight, and MC (Körperkoordinationstest für Kinder, KTK test battery) were measured in 1,912 boys and 1,826 girls of 6-10 years of age. BMI (kg/m2 ) was calculated. KTK scores for each of the four tests were also converted to a motor quotient (MQ). One-way ANOVA was used to test differences in the BMI, individual test items, and MQ among boys and girls within age groups. Sex-specific quadratic regressions of individual KTK items and the MQ on the BMI were calculated. Girls and boys were also classified into four weight status groups using International Obesity Task Force criteria: thin, normal, overweight, and obese. Differences in specific test items and MQ between weight status groups were evaluated by age group in each sex. RESULTS Thirty-one percent of the sample was overweight or obese, whereas 5% was thin. On average, normal weight children had the highest MQ in both sexes across the age range with few exceptions. Overweight/obese children had a lower MQ than normal weight and thin children. The quadratic regression lines generally presented an inverted parabolic relationship between the BMI and MC and suggested a decrease in MC with an increase in the BMI. CONCLUSION In general, BMI shows a curvilinear, inverted parabolic relationship with MC in children 6-10 years.
Relapse in herpes simplex virus encephalitis

Herpes simplex virus type 1 (HSV) causes approximately 10% of encephalitis cases among humans worldwide, corresponding to an incidence of 1 per 500,000 persons.1 Prior to the development of effective antiviral therapy, which consisted first of vidarabine and later the more effective drug acyclovir, as many as 70% of individuals with HSV encephalitis (HSE) died, and the vast majority of survivors had severe neurologic sequelae. As greater numbers of patients survived HSE, astute clinicians recognized that some survivors, as many as 10%–25%, experienced relapses or recrudescence of neurologic symptoms despite appropriate antiviral treatment. Numerous cases have been reported during the past 3 decades.2,3 Common to most cases has been an inability to detect replicating virus in brain tissue or viral DNA in CSF, observations that led many authors to speculate that immune-mediated mechanisms accounted for the recurrences of neurologic symptoms.2 Some authors suggested that relapse among children with HSE may mimic acute disseminated encephalomyelitis, a potential complication of many different viral infections of childhood, and suggested that corticosteroids be used, in addition to acyclovir, when such relapses occurred.4 Within the past 4 years, immunoglobulin G antibodies against the GluN1 subunit NMDA receptor (NMDAR) have been detected in patients with HSE and have been implicated as a key factor in the pathogenesis of neurologic symptoms following recovery from the initial episode of HSE.5,6
Reduction of MS-related scotomata by a new class of potassium channel blockers from Ruta graveolens

The effects of the medicinal plant rue (Ruta graveolens L.) on MS-related visual-field defects was tested. In five of nine patients the scotomata were reduced by a single dose of an aqueous extract of 3 g of the drug; the effect was reversible, appearing after only about two hours and lasting for one to two days. There was no detectable action in four patients. In no case were undesirable side effects observed.The problems associated with generalizing and evaluating both clinical findings in MS and the efficacy of treatment are discussed. The observed action of Ruta graveolens is ascribed to the potassium channel blockers the plant contains. The authors have identified these substances as methoxy-substituted psoralens.
Chorea in a patient with cryopyrin-associated periodic syndrome

Objective: To describe a patient with cryopyrin-associated periodic syndrome (CAPS) with an uncommon neurologic phenotype and a rare underlying genetic mutation. Results: Our patient had CAPS with a rare NLPR3 missense mutation (p.Tyr859Cys) in exon 6 with chorea as the major symptom. Clinical symptoms were associated with persistent inflammatory changes of the CSF and serum and included elevated anticardiolipin immunoglobulin G; MRI showed prolonged gadolinium enhancement of 2 chronic inflammatory lesions. Conventional immunosuppressive treatment with prednisolone and hydroxychloroquine was insufficient. Neurologic symptoms, laboratory/chemical measures, and MRI abnormalities almost completely normalized following interleukin (IL)–1β blockade with anakinra. Conclusions: This case is unique for its uncommon neurologic phenotype, the rare underlying genetic mutation, and the long course of the disease as well as almost complete recovery following appropriate therapy. In addition, the chronic inflammatory white matter lesions observed on brain MRI and the responsiveness to IL-1β blockade with anakinra are unusual.
Better verbal memory in women than men in MCI despite similar levels of hippocampal atrophy

Objective: To examine sex differences in the relationship between clinical symptoms related to Alzheimer disease (AD) (verbal memory deficits) and neurodegeneration (hippocampal volume/intracranial volume ratio [HpVR]) across AD stages. Methods: The sample included 379 healthy participants, 694 participants with amnestic mild cognitive impairment (aMCI), and 235 participants with AD and dementia from the Alzheimer's Disease Neuroimaging Initiative who completed the Rey Auditory Verbal Learning Test (RAVLT). Cross-sectional analyses were conducted using linear regression to examine the interaction between sex and HpVR on RAVLT across and within diagnostic groups adjusting for age, education, and APOE ε4 status. Results: Across groups, there were significant sex × HpVR interactions for immediate and delayed recall (p < 0.01). Women outperformed men among individuals with moderate to larger HpVR, but not among individuals with smaller HpVR. In diagnosis-stratified analyses, the HpVR × sex interaction was significant in the aMCI group, but not in the control or AD dementia groups, for immediate and delayed recall (p < 0.01). Among controls, women outperformed men on both outcomes irrespective of HpVR (p < 0.001). In AD dementia, better RAVLT performance was independently associated with female sex (immediate, p = 0.04) and larger HpVR (delayed, p = 0.001). Conclusion: Women showed an advantage in verbal memory despite evidence of moderate hippocampal atrophy. This advantage may represent a sex-specific form of cognitive reserve delaying verbal memory decline until more advanced disease stages.
C-Reactive Protein and Procalcitonin as Markers of Infection, Inflammatory Response, and Sepsis

Diagnosing sepsis and differentiating bacterial infections from other causes of inflammation constitute a challenge for clinical practice, especially in the intensive care unit. Many laboratory markers have been evaluated as diagnostic tests of bacterial infections and sepsis, but C-reactive protein (CRP) and procalcitonin (PCT) are at present the most studied and used indicators. The chief objective of this review is to appraise the role of CRP and PCT as diagnostic tests (biomarkers) of infections (especially pneumonia) and sepsis, by reviewing results from published studies. The diagnostic performance is not optimal because overall results of diagnostic studies on CRP and PCT as indicators of bacteria infections and sepsis have shown to be variable with wide ranges of sensitivity and specificity. Moreover, many of these diagnostic studies had methodological limitations that make it difficult to generalize their results. PCT tests appear to have somewhat higher overall diagnostic accuracy than that of the varied CRP tests, particularly in some clinical conditions. PCT also demonstrated to be a better severity indicator than CRP. Nevertheless, because of CRP kinetics, serial determinations of CRP can be useful for monitoring inflammatory activity and patient responses to antibiotic and sepsis therapies. Some novel markers could demonstrate to be more accurate for diagnosing severe infections and sepsis in the near future.
An Assignment-Based Local Search Method for Solving Vehicle Routing Problems

In this paper, we propose an assignment-based local search method for solving vehicle routing problems. This method is a multi-route improvement algorithm that can operate on several routes at a time. To evaluate the performance of the proposed method, extensive computational experiments on the proposed method applied to a set of benchmark problems are carried out. The results show that the proposed method, when coupled with metaheuristics such as simulated annealing, is comparable with other efficient heuristic methods proposed in the literature.
Familial concordance of metabolic syndrome in Korean population — Korean National Health and Nutrition Examination Survey 2005

Aims: To investigate the familial concordance of metabolic syndrome and its components in a nationally representative survey in Korean. Methods: We used data from the Korean National Health and Nutrition Examination Survey (KNHANES), a nationwide survey examining the general health and nutritional status of the Korean people. We enrolled 1641 married couples and 1527 parents–1342 offspring. Results: Prevalence of the metabolic syndrome was 17.1% for husbands, 11.7% for wives, 14.3% for parents, and 7.2% for offspring. After adjustment for age, there were strong positive correlations between family members for the metabolic variables. Compared with husbands whose wives did not have metabolic syndrome, adjusted odds ratio in husbands whose wives had metabolic syndrome was 1.43 (95% CI: 1.10–1.87) for the risk of having metabolic syndrome. Similarly, wives whose husbands had metabolic syndrome had 1.41 (95% CI: 1.08–1.84) times higher risk of having metabolic syndrome. Compared with children whose parents did not have metabolic syndrome, adjusted odds ratio in children with at least one parent with the metabolic syndrome was 2.56 (95% CI: 1.09–5.98) for the metabolic syndrome. Conclusions: Our study revealed that there is significant familial concordance for metabolic syndrome and its components in Korean families. # 2011 Elsevier Ireland Ltd. All rights reserved. C o n t e n t s l i s t s a v a i l a b l e a t S c i e n c e D i r e c t Diabetes Research and Clinical Practice journal homepage: www.elsevier . com/locate/diabres
Contribution of the symptomatic lesion in establishing MS diagnosis and prognosis

Objective: To study the contribution of the symptomatic lesion in establishing multiple sclerosis (MS) diagnosis and prognosis. Methods: We performed an observational study based on a prospective clinically isolated syndrome (CIS) cohort of 1,107 patients recruited for clinical and brain MRI follow-up from 1995 to 2014. Eligible patients (n = 954) were divided into 4 groups according to baseline MRI: patients with a normal MRI (n = 290); patients with a single asymptomatic lesion (n = 18); patients with a single cord/brainstem symptomatic lesion (n = 35); and patients with more than 1 lesion (n = 611). For each group, we studied the risk of second attack, with 2005 McDonald MS and Expanded Disability Status Scale 3.0, using univariable and multivariable regression models adjusted by age, sex, oligoclonal bands, and disease-modifying treatments. We tested the diagnostic performance of a modified dissemination in space (DIS) criterion that includes symptomatic lesions in the total count and compared it to the DIS criteria (at least 1 asymptomatic lesion in at least 2 of the 4 MS characteristic MS locations) for all patients and for the subgroup of patients with brainstem or spinal cord topography. Results: Patients with a cord/brainstem single symptomatic lesion have a higher risk of second attack and disability accumulation than patients with 0 lesions but have a similar risk compared to patients with 1 asymptomatic lesion. Diagnostic properties are reasonably maintained when the symptomatic lesion qualifies for DIS. Conclusions: Despite the recommendations of the 2010 McDonald criteria, symptomatic lesions should be taken into account when considering the diagnosis and prognosis of patients with CIS.
Pricing and Calibration of a Chooser Flexible CAP

In this paper, we deal with no-arbitrage pricing problems of a chooser flexible cap written on an underlying LIBOR. The chooser flexible cap allows a right for a buyer to exercise a limited and pre-determined number of the interim period caplets in a multiple-period cap agreement. Assuming a common diffusion short rate dynamics, e.g., Hull–White model, we propose a dynamic programming approach for their risk neutral evaluation. This framework is suited to a calibration from an observed initial yield curve and market price data of discount bonds, caplets, and floorlets.
The Use of Ammonia Inhalants Among Athletes

AMMONIA INHALANTS (AI) ARE COMMONLY USED BY ATHLETES AS POSSIBLE ERGOGENIC AIDS DURING TRAINING OR COMPETITION. VIRTUALLY, NO RESEARCH EXISTS THAT HAS EXAMINED AI EFFECTIVENESS, SAFETY, OR PREVALENCE AMONG ATHLETES. ANECDOTALLY, AI USE IS WIDESPREAD, WITH SOME ADVERSE REACTIONS HAVING BEEN REPORTED. THE PRESENT ARTICLE SERVES AS AN INTRODUCTION TO THE USE OF AIS AND EXAMINES THE ANECDOTAL USE OF AIS AMONG THE ATHLETIC POPULATION, AS WELL AS THEIR EFFECTIVENESS, PRACTICES, AND SAFETY. STRENGTH AND CONDITIONING PROFESSIONALS, COACHES, AND SPORTS MEDICINE PERSONNEL SHOULD BE FAMILIAR WITH THEIR USE AND CONTRAINDICATIONS BECAUSE ADVERSE REACTIONS HAVE BEEN REPORTED.
Pathophysiology and Risk Factors for Obstructive Sleep Apnea

This chapter reviews the pathophysiology and risk factors for obstructive sleep apnea (OSA). Important risk factors for this disorder include obesity, male gender, and postmenopausal state. There is also an association between OSA and certain heritable factors, along with the endocrine disorders, acromegaly, and hypothyroidism. The pathogenesis of OSA is related to upper airway obstruction. Both neural and structural mechanisms may account for the development of pharyngeal obstruction during sleep. Neural factors influencing upper airway patency include neuromuscular reflexes, central nervous system (CNS) depressants, and neuromodulators; airway structures that both elongate and dilate the pharynx influence pharyngeal collapsibility. Based on our current understanding of the pathogenic mechanisms of upper airway obstruction, we outline the major principles for therapy of this disorder.
Sphingosine 1-phosphate lyase deficiency causes Charcot-Marie-Tooth neuropathy

Objective: To identify the unknown genetic cause in a nuclear family with an axonal form of peripheral neuropathy and atypical disease course. Methods: Detailed neurologic, electrophysiologic, and neuropathologic examinations of the patients were performed. Whole exome sequencing of both affected individuals was done. The effect of the identified sequence variations was investigated at cDNA and protein level in patient-derived lymphoblasts. The plasma sphingoid base profile was analyzed. Functional consequences of neuron-specific downregulation of the gene were studied in Drosophila. Results: Both patients present an atypical form of axonal peripheral neuropathy, characterized by acute or subacute onset and episodes of recurrent mononeuropathy. We identified compound heterozygous mutations cosegregating with disease and absent in controls in the SGPL1 gene, encoding sphingosine 1-phosphate lyase (SPL). The p.Ser361* mutation triggers nonsense-mediated mRNA decay. The missense p.Ile184Thr mutation causes partial protein degradation. The plasma levels of sphingosine 1-phosphate and sphingosine/sphinganine ratio were increased in the patients. Neuron-specific downregulation of the Drosophila orthologue impaired the morphology of the neuromuscular junction and caused progressive degeneration of the chemosensory neurons innervating the wing margin bristles. Conclusions: We suggest SPL deficiency as a cause of a distinct form of Charcot-Marie-Tooth disease in humans, thus extending the currently recognized clinical and genetic spectrum of inherited peripheral neuropathies. Our data emphasize the importance of sphingolipid metabolism for neuronal function.
Author response: Why are acute ischemic stroke patients not receiving IV tPA? Results from a national registry

We thank Hu et al. for the interest in our article.1 We agree that there are numerous and varied obstacles worldwide that impede tPA use in patients with AIS. Hu et al. articulately outlined many of the issues patients and doctors face in China. Importantly, the development and evolution of systems of care in China have resulted in improved care of stroke.2 We remain optimistic that increased use of thrombolysis will follow.
Decrease in Aβ42 predicts dopa-resistant gait progression in early Parkinson disease

Objective: This prospective observational study investigates the role of CSF biomarkers in predicting progression of dopa-resistant gait impairments in Parkinson disease (PD) in the first 36 months from diagnosis. Methods: Quantitative gait analysis was carried out longitudinally using an instrumented walkway (GAITRite) in 108 people with PD and 130 age-matched controls. A subgroup of 44 people with PD underwent lumbar puncture from which a battery of CSF biomarkers was measured: β-amyloid 1–42 and 1–40 (Aβ42 and Aβ40), total and phosphorylated tau protein (t-tau/p-tau181), and α-synuclein (αSyn). Linear mixed models examined the association between CSF and dopa-resistant gait characteristics (defined as substantial progression despite optimal medication). Results: Low baseline CSF Aβ42, and to a lesser extend Aβ40, predicted decline in gait characteristics in the first 3 years following diagnosis, independently explaining up to 12% of progression of step time variability (single task) and step length variability (dual-task). Interestingly, these findings were independent of age and cognition. Conclusions: These findings implicate underlying amyloid pathology in neural networks involved in locomotor control. Results suggest that disturbed Aβ metabolism may be a biomarker for dopa-resistant gait impairments in early PD. Our findings raise interesting questions regarding therapeutic interventions such as compounds or molecules aimed at reducing amyloid burden to mitigate gait disturbance in early PD and potentially falls risk. Finally, progression of discrete gait characteristics suggests they may have potential as clinical biomarkers of pathology and disease progression.
Psychiatric Disability, the Use of Financial Leverage, and Perceived Coercion in Mental Health Services

Although the use of representative payees has proliferated in the past decade, little is known about whether clinicians or family members of people with mental illness use their control of clients' money to leverage treatment adherence or whether persons with psychiatric disabilities perceive that if they are noncompliant, their money will be withheld. The purpose of this study was to examine clinical and demographic variables associated with perceived financial coercion and warnings involving control of money in the context of mental health services. 258 involuntarily admitted inpatients with severe mental illness were followed for one year and interviewed, as were their clinicians and family members. Results showed that nearly 30% of participants perceived financial coercion whereas a smaller fraction of participants' clinicians and family members reported giving money warnings. However, some factors, including ethnicity and being subject to other legal mechanisms, predicted both—actual warnings and perceived coercion. Implications of these findings are discussed in terms of gaining understanding of the ways which financial arrangements facilitate or thwart delivery of effective mental health services.
Increased connectivity of hub networks and cognitive impairment in multiple sclerosis

Objective: To investigate default-mode network (DMN) and frontoparietal network (FPN) dysfunction in cognitively impaired (CI) patients with multiple sclerosis (MS) because these networks strongly relate to cognition and contain most of the hubs of the brain. Methods: Resting-state fMRI and neuropsychological assessments were performed in 322 patients with MS and 96 healthy controls (HCs). Patients with MS were classified as CI (z score < −2.0 on at least 2 tests; n = 87), mildly cognitively impaired (z score < −1.5 on at least 2 tests and not CI; n = 65), and cognitively preserved (CP; n = 180). Within-network connectivity, connectivity with the rest of the brain, and between-network connectivity were calculated and compared between groups. Connectivity values were normalized for individual means and SDs. Results: Only in CI, both the DMN and FPN showed increased connectivity with the rest of the brain compared to HCs and CP, with no change in within- or between-network connectivity. Regionally, this increased connectivity was driven by the inferior parietal, posterior cingulate, and angular gyri. Increased connectivity with the rest of the brain correlated with worse cognitive performance, namely attention for the FPN as well as information processing speed and working memory for both networks. Conclusions: In CI patients with MS, the DMN and FPN showed increased connectivity with the rest of the brain, while normal within- and between-network connectivity levels were maintained. These findings indicate that cognitive impairment in MS features disturbed communication of hub-rich networks, but only with the more peripheral (i.e., nonhub) regions of the brain.