Miracle-dz/UniFAR-FTUs huggingface dataset:
How to ventilate patients with acute lung injury and acute respiratory distress syndrome

Purpose of review The purpose of this paper is to review the mechanisms of ventilator-induced lung injury as a basis for providing the less damaging mechanical ventilation in patients with acute respiratory failure. Recent findings In normal lungs, high tidal volume causes an immediate gene upregulation and downregulation. Although the importance of alveolar inflammatory reaction is well known, recent findings suggest the potential role of airway distension in causing ventilator-induced lung injury. The initial activation has been shown to occur in the airways, accounting for the damages induced by high peak flow. The healthier lung regions are more exposed to the injury, since they may be subjected to strain. Challenge with endotoxin enhances in a synergistic manner the pulmonary inflammation induced by mechanical ventilation. However, mechanical strain and endotoxin seem to trigger lung inflammation through two different pathways. Despite convincing experimental and clinical evidences of lung injury, the clinical implementation of low tidal volume ventilation is still limited and has not yet become part of standard clinical practice. Setting positive end-expiratory pressure remains an open problem because the ALVEOLI study did not provide any exhaustive answers, likely because of methodologic problems and, unphysiologic design. Summary Gentle lung ventilation must be standard practice. Because stress and strain are the triggers of ventilator-induced lung injury, their clinical equivalents should be measured (transpulmonary pressure and the ratio between tidal volume and end-expiratory lung volume). For a rational application of positive end-expiratory pressure, the potential for recruitment in any single patient should be estimated.
Combined Endovascular/Surgical Management of a Ruptured Para-Anastomotic Aneurysm of the Left Common Iliac Artery#

A 75-year old man presented with signs and symptoms of acute abdomen and a clinical picture of hypovolemic shock. An emergency CT scan revealed a ruptured para-anastomotic left common iliac artery aneurysm. The patient had undergone an elective abdominal aortic aneurysm repair operation and placement of an aortoiliac bifurcated graft 10 years before. Para-anastomotic aneurysms had developed in all 3 (aortic and the 2 iliac) anastomosis. As the patient was highrisk, a combined endovascular/surgical approach was undertaken. The patient was discharged 4 days later. This article discusses the applicability of endovascular procedures in emergency settings to high-risk patients.
Advances in oral macromolecular drug delivery

Introduction: Various macromolecules including polypeptides, proteins, genes and polysaccharides have been drawing attention for their therapeutic potential. The passage through intestinal epithelium is the major barrier for the oral delivery of macromolecules, by either paracellular or transcellular pathways. However, most macromolecules are poorly absorbed in oral route due to their high molecular weight and low stability in the gastrointestinal (GI) tract. Nonetheless, advancing in oral macromolecular drug delivery will be significant in expanding the clinical use of therapeutic macromolecules. Areas covered: Technologies using chemical conjugation, absorption enhancers and nano-/micro-particulate systems have been developed to improve oral bioavailability of macromolecules, and some of them are in the process of clinical trials. In this review, they are discussed in the context of their progression states, hurdles and modes of action. Expert opinion: According to the better understanding of receptor or transporter structure and transport mechanisms in the GI tract, the progress ineffective oral delivery systems for therapeutic macromolecules is anticipated over the next decades. In addition, the advent of numerous particulate systems will also speed up the development of novel drug delivery technologies. This offers an optimistic perspective on the potential clinical usage of oral macromolecular drugs.
Tumor necrosis factor inhibitors for inflammatory bowel disease.

n engl j med 369;8 nejm.org august 22, 2013 754 This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the authors’ clinical recommendations. John A. Jarcho, M.D., Editor
A new, lower value of total solar irradiance: Evidence and climate significance

The most accurate value of total solar irradiance during the 2008 solar minimum period is 1360.8 ± 0.5 W m−2 according to measurements from the Total Irradiance Monitor (TIM) on NASA's Solar Radiation and Climate Experiment (SORCE) and a series of new radiometric laboratory tests. This value is significantly lower than the canonical value of 1365.4 ± 1.3 W m−2 established in the 1990s, which energy balance calculations and climate models currently use. Scattered light is a primary cause of the higher irradiance values measured by the earlier generation of solar radiometers in which the precision aperture defining the measured solar beam is located behind a larger, view‐limiting aperture. In the TIM, the opposite order of these apertures precludes this spurious signal by limiting the light entering the instrument. We assess the accuracy and stability of irradiance measurements made since 1978 and the implications of instrument uncertainties and instabilities for climate research in comparison with the new TIM data. TIM's lower solar irradiance value is not a change in the Sun's output, whose variations it detects with stability comparable or superior to prior measurements; instead, its significance is in advancing the capability of monitoring solar irradiance variations on climate‐relevant time scales and in improving estimates of Earth energy balance, which the Sun initiates.
Price changes by firms in New Zealand - some evidence from the Quarterly Survey of Business Opinion

TIn the last decade, central banks have conducted new research enhancing their understanding of firm level price-setting behaviour. This work has revealed new information about the frequency with which firms change prices and provided explanations as to why prices are sticky. This information could potentially improve monetary policymaking and, as a result, reduce the real cost of policy changes and non-policy shocks. This article outlines the major themes and results from selected international research. It then examines price changing behaviour in New Zealand using firm-level data from the quarterly survey of business opinion (OSBO) published by new Zealand intuit of economic research (NZIER). In line with international research. We find considerable diversity in the frequency of the price changes by firms moreover; firms change prices more in response to cost changes than demand changes, and in response to falling demand than increasing demand
Children's Emotions and Moods: Developmental Theory And Measurement

1. Why Study Emotion? - Why Not Study Cognition? - 2. Emotion: An Overview. - What is Emotion? - Emotion versus Affect. - Primary versus Secondary or Derived Emotions. - Emotion, Mood, and Personality. - Individual Differences in Emotion. - 3. Approaches to the Study of Emotion. - Philosophical Inquiries into Emotion. - The Physiological Approach. - The Cognitive Approach. - The Motivational Approach. - The Cognitive-Emotional Eugue. - 4. The Structure of Emotion: The Development of Five Components. - Emotional EJicitors. - Emotional Receptors. - Emotional States. - Emotional Expressions. - Emotional Experiences. - 5. The Development of Emotion. - A Model of Emotion. - Specific Developmental Issues. - 6. The Socialization of Emotion: How and When to Express Emotions. - Issues in the Socialization of Emotion. - How to Express Emotions: The Use of Display Rules. - When to Express Emotions: Knowledge of Emotions by Situation. - 7. The Socialization of Emotion: How Emotions Are Managed, Labeled, and Interpreted. - How Emotions Are Managed: The Use of Others. - How Emotions Are Labeled: The Acquisition of an Affect Lexicon. - How Emotions Are Interpreted. - 8. The Measurement of Emotion. - Emotions as Private Acts. - The Meaning of Behavior. - Stimulus or Contextual Meaning. - 9. Construction of the Scales of Socioemotional Development. - Which Emotions Should Be Studied? - Where Should Emotions Be Studied? - Which Situations Should Be Used? - Which Behaviors Should Be Used? - The Scales of Socioemotional Development. - 10. Internal Properties of the Scales. - Method. - Internal Consistency of the Domain Scales. - Independence of the Domain Scales. - 11. Individual Differences in Emotional States. - Age and Gender Differences. - Social Milieu Differences. - Relationships among Emotional States. - Patterns of Emotional States. - 12. Profiles of Enduring Emotional States (Moods). - Constructing Individual Profiles. - Case Studies. - Concluding Remarks. - References. - Appendix A. Scales of Socioemotional Development. - Appendix B. Coding Forms for the Scales of Socioemotional Development. - Author Index.
Gram-Negative Infections in Adult Intensive Care Units of Latin America and the Caribbean

This review summarizes recent epidemiology of Gram-negative infections in selected countries from Latin American and Caribbean adult intensive care units (ICUs). A systematic search of the biomedical literature (PubMed) was performed to identify articles published over the last decade. Where appropriate, data also were collected from the reference list of published articles, health departments of specific countries, and registries. Independent cohort data from all countries (Argentina, Brazil, Chile, Colombia, Cuba, Mexico, Trinidad and Tobago, and Venezuela) signified a high rate of ICU infections (prevalence: Argentina, 24%; Brazil, 57%). Gram-negative pathogens, predominantly Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, accounted for >50% of ICU infections, which were often complicated by the presence of multidrug-resistant strains and clonal outbreaks. Empirical use of antimicrobial agents was identified as a strong risk factor for resistance development and excessive mortality. Infection control strategies utilizing hygiene measures and antimicrobial stewardship programs reduced the rate of device-associated infections. To mitigate the poor health outcomes associated with infections by multidrug-resistant Gram-negative bacteria, urgent focus must be placed on infection control strategies and local surveillance programs.
Supervision in the Psychological Therapies

The purpose of this study was to investigate supervisors’ perceptions of the relationship between supervision and therapeutic outcomes in the psychological therapies. Research investigating the contribution of supervision to therapeutic outcomes is limited and often methodologically weak (e.g. Freitas, 2002; Inman & Ladany, 2008; Watkins, 2011b; Wheeler & Richards, 2007a, 2007b). Watkins (2011b) identified only three methodologically robust research studies in this area in a period spanning thirty years, from 1981 to 2011 and only one of the three was situated within the psychological therapies (Bambling, King, Raue, Schweitzer, & Lambert, 2006). This qualitative study used a constructivist version of Grounded Theory to analyse the data collected from individual semi-structured interviews with ten participants, and a focus group with three participants. All participants were experienced supervisors and qualified psychological therapists based in the South West of the UK. Findings suggest that supervisors perceive the relationship between supervision and therapeutic outcomes to be indirect and that enabling the supervisee to become a better therapist is how supervision is perceived to indirectly contribute to improved outcomes for the supervisee’s clients. A number of issues emerged from the findings including difficulties in finding a common language for the term ‘therapeutic outcome’ and difficulty in ascertaining supervisory responsibility for therapeutic outcome, particularly where the supervisor did not have the ‘full picture’ of the supervisee’s caseload. These findings are captured in the core connecting category, which is conceptualised as ‘making sense of paradox and inconsistency in an indirect relationship between supervision and therapeutic outcomes’. An explanatory theory of the relationship between supervision and therapeutic outcomes, together with a diagrammatic theoretical model, is presented and recommendations for supervision practice and supervisor training in the psychological therapies are proposed. The study concludes that future research investigating the efficacy of supervision and its influence on client outcomes should first take account of supervisors’ frame of reference in relation to client outcomes and its application in supervision practice.
Noninvasive estimation of FDG input function for quantification of cerebral metabolic rate of glucose: optimization and multicenter evaluation.

UNLABELLED The aims of this study were to determine whether body weight or body surface area (BSA) should be used for noninvasive measurement of the cerebral metabolic rate of glucose (CMRGlc) by FDG PET with a standardized input function (SIF) and an autoradiographic method and to validate the procedure in a large population from different PET centers. METHODS Plasma input functions measured by intermittent arterial blood sampling after intravenous injection of FDG, in 101 patients from 1 institution who were fasting for at least 4 h, were used to generate the SIF. The SIF was generated by averaging over 101 patients the input function normalized with the net injected dose and initial distribution volume (DV) of FDG estimated by the formula c x Ha x Wb, where H is body height and W is body weight. To evaluate the estimation of DV by BSA or body weight, the coefficient of variation (CV) of the ratio of Ha x Wb to the measured DV was calculated by changing a and b independently. Estimation of the CMRGlc with SIF based on the formula for DV was validated with an additional 192 subjects from 3 institutions who underwent FDG PET while fasting. The result of simulation was compared with the results of 4 previously published formulas for BSA and body weight. RESULTS The optimal set of parameters, in which a was 0.80 and b was 0.35, minimized the CV. The averaged percentage error of the CMRGlc based on the optimal set of parameters for DV estimation and SIF was 8.9% for gray matter and 10.6% for white matter. Four BSA formulas brought about a similar error, which was significantly smaller than that based on body weight (P < 0.001, ANOVA). CONCLUSION Noninvasive estimation of CMRGlc is made possible by careful measurement of the net injected dose and BSA.
Heat production from shivering.

Healthy young men were exposed, nearly nude, for 2 hours or less to various environmental conditions (dry-bulb temperature, 90°–20°F; windspeed, μ1, 5, 10 mph). Oxygen consumption was recorded at intervals during exposure. The results show that even under conditions where no visible shivering was observed, there was an increase in heat production. Exposure to very low temperatures (20°F) with low winds did not evoke the largest increases in heat production. The greatest mean heat production (370 Cal/hr.) was associated with the highest windspeed (10 mph), and this value approached the maximum heat production which can be attained by shivering (mean value about 425 Cal/hr.). Thus, increasing the windspeed had a relatively greater impact on heat production than decreasing the dry-bulb temperature. The relationships between heat production and windspeed and heat production and dry-bulb temperature were nonlinear. Submitted on February 8, 1960
Screening of Subtelomeric Rearrangements in 100 Korean Pediatric Patients with Unexplained Mental Retardation and Anomalies Using Subtelomeric FISH (Fluorescence In Situ Hybridization)

Rearrangements of the subtelomeric regions of chromosomes account for a significant proportion of the underlying genetic defects in both idiopathic mental retardation (MR) and multiple congenital anomalies. To detect the rearrangements, a set of subtelomeric fluorescence in situ hybridization (FISH) probes has been developed. The aim of this study was to reveal the frequency of subtelomeric rearrangements in Korean patients with MR or multiple anomalies. We performed a FISH study using a commercially available subtelomeric FISH probes on a series of unrelated Korean pediatric patients with MR or multiple anomalies without identifiable causes. We used a checklist to evaluate the developmental delay and/or MR. Patients who were shown to have chromosome abnormalities, metabolic disorders, or recognizable dysmorphic syndromes by clinical and laboratory findings were excluded. As a result, 100 patients were eligible for the Subtelomeric FISH study, and a total of 29 patients (29%) were suspected to have subtelomeric rearrangements on initial screening by the multiprobe FISH kit. Among theses, confirmatory FISH studies by using single locus-specific FISH probes were performed in 24 patients. One patient (a 10-yr-old girl) was confirmed to have rearrangement, deletion of the telomeric portion of the short arm of chromosome 4 (4p). Her clinical manifestation was compatible with Wolf-Hirschhorn syndrome, which is known to be caused by 4p deletion. The frequency of subtelomeric rearrangements in this study was 1.1% (1/95), lower than those previously reported (0.5-16.3%). We suggest that subtelomeric FISH test is a useful screening tool for patients with idiopathic MR and/or dysmorphism regardless of its false positive value.
Inflammation in Diabetic Nephropathy

Diabetic nephropathy is the leading cause of end-stage kidney disease worldwide but current treatments remain suboptimal. This review examines the evidence for inflammation in the development and progression of diabetic nephropathy in both experimental and human diabetes, and provides an update on recent novel experimental approaches targeting inflammation and the lessons we have learned from these approaches. We highlight the important role of inflammatory cells in the kidney, particularly infiltrating macrophages, T-lymphocytes and the subpopulation of regulatory T cells. The possible link between immune deposition and diabetic nephropathy is explored, along with the recently described immune complexes of anti-oxidized low-density lipoproteins. We also briefly discuss some of the major inflammatory cytokines involved in the pathogenesis of diabetic nephropathy, including the role of adipokines. Lastly, we present the latest data on the pathogenic role of the stress-activated protein kinases in diabetic nephropathy, from studies on the p38 mitogen activated protein kinase and the c-Jun amino terminal kinase cell signalling pathways. The genetic and pharmacological approaches which reduce inflammation in diabetic nephropathy have not only enhanced our understanding of the pathophysiology of the disease but shown promise as potential therapeutic strategies.
Exploring Microbial Diversity and Taxonomy Using SSU rRNA Hypervariable Tag Sequencing

Massively parallel pyrosequencing of hypervariable regions from small subunit ribosomal RNA (SSU rRNA) genes can sample a microbial community two or three orders of magnitude more deeply per dollar and per hour than capillary sequencing of full-length SSU rRNA. As with full-length rRNA surveys, each sequence read is a tag surrogate for a single microbe. However, rather than assigning taxonomy by creating gene trees de novo that include all experimental sequences and certain reference taxa, we compare the hypervariable region tags to an extensive database of rRNA sequences and assign taxonomy based on the best match in a Global Alignment for Sequence Taxonomy (GAST) process. The resulting taxonomic census provides information on both composition and diversity of the microbial community. To determine the effectiveness of using only hypervariable region tags for assessing microbial community membership, we compared the taxonomy assigned to the V3 and V6 hypervariable regions with the taxonomy assigned to full-length SSU rRNA sequences isolated from both the human gut and a deep-sea hydrothermal vent. The hypervariable region tags and full-length rRNA sequences provided equivalent taxonomy and measures of relative abundance of microbial communities, even for tags up to 15% divergent from their nearest reference match. The greater sampling depth per dollar afforded by massively parallel pyrosequencing reveals many more members of the “rare biosphere” than does capillary sequencing of the full-length gene. In addition, tag sequencing eliminates cloning bias and the sequences are short enough to be completely sequenced in a single read, maximizing the number of organisms sampled in a run while minimizing chimera formation. This technique allows the cost-effective exploration of changes in microbial community structure, including the rare biosphere, over space and time and can be applied immediately to initiatives, such as the Human Microbiome Project.
Reducing the bias of probing depth and attachment level estimates using random partial-mouth recording.

OBJECTIVES To evaluate the bias and precision of probing depth (PD) and clinical attachment level (CAL) estimates of random and fixed partial examination methods compared with full-mouth examinations. METHODS PD and CAL were calculated on six sites for up to 28 teeth (considered to be the gold standard with no bias) and three fixed-site selection methods (FSSMs) that resulted in a partial examination of sites: the Ramfjord method, and the NIDCR methods used in NHANES I, and NHANES 2000. Finally, seven random-site selection methods (RSSMs) were created by sampling the following number of sites: 84, 42, 36, 28, 20, 15, 10 and 6. To compare bias and precision of the methods we calculated percent relative bias and relative error. RESULTS Estimates of means, standard deviations (SD), relative bias and relative error for RSSMs were almost identical to the full-mouth examination, but SDs increase slightly when fewer than 28 sites were sampled and relative bias and error increase for methods sampling fewer than 20 sites. The FSSMs had very low relative error, but much higher relative bias indicating underestimation. The FSSM with the smallest bias and error was the Ramfjord method, but the Random 36 method had less bias and less relative error. The NHANES 2000 method was the FSSM with the lowest bias and relative error for estimates of Extent Scores (percent of sites > or =3, 4, 5, or 5 mm PD or CAL) but random methods sampling fewer sites performed just as well. Both FSSMs and RSSMs underestimated prevalence, especially prevalence of less frequently occurring conditions, but most RSSMs were less likely to underestimate prevalence than the FSSMs. CONCLUSION The promise of reducing bias and increasing precision of the estimates support the continued development and examination of RSSMs.