Miracle-dz/UniFAR-FTUs huggingface dataset:
A methodological approach for determination of maximal inspiratory pressure in patients undergoing invasive mechanical ventilation.

BACKGROUND Maximal inspiratory pressure (MIP) can help to evaluate inspiratory muscle strength. However its determination in ventilated patients is cumbersome and needs special equipment. We hypothesized that MIP could be obtained by using the expiratory hold knob of the ventilator. The aim of this study was to verify whether: 1) the end expiratory occlusion technique can be used for MIP determination; and 2) if this technique provides different results compared to those obtained by the traditional method of MIP calculation. METHODS We studied 23 consecutive patients undergoing mechanical ventilation for acute respiratory failure. The MIP was determined by two different methods, both based on occluding the airway for 20 seconds. This occlusion was obtained either by pressing the expiratory hold knob of the ventilator; or by detaching the patient from the ventilator circuit and using a noiseless pneumatic shutter placed on the inspiratory line of a two-way valve that allows expiration but prevents inspiration. RESULTS The average values of MIP obtained by using either the hold knob of the ventilator or the noiseless pneumatic shutter were -46±14 cmH2O and -56±13 cmH2O, respectively. The linear regression analysis showed a significant correlation between MIPVent and MIPOcc (r2=0.95), although the Bland- Altman analysis revealed that they are not clinically comparable. CONCLUSION MIP can be easily determined at the bedside by pressing the expiratory hold knob of ventilator. However, MIPVent and MIPOcc are different in terms of absolute value probably because they were determined at diverse lung volume.
CD44 and Annexin A2 Mediate the C5a Chemotactic Cofactor Function of the Vitamin D Binding Protein1

The vitamin D binding protein (DBP) is a plasma protein that significantly enhances the chemotactic activity of C5a and C5adesArg (cochemotactic activity). The objective of this study was to investigate how DBP mediates this process using neutrophils and U937 cells transfected with the C5a receptor (U937-C5aR cells) and comparing chemotaxis to C-activated serum (DBP dependent) vs purified C5a (DBP independent). Binding to the cell surface is essential for this protein to function as a chemotactic cofactor, and DBP binds to a chondroitin sulfate proteoglycan (CSPG) on neutrophil plasma membrane preparations. To determine whether a CSPG also functions to mediate cochemotactic activity, U937-C5aR cells were grown in chlorate to inhibit CSPG sulfation or treated with chondroitinase AC. Either treatment significantly inhibited chemotaxis only to C-activated serum. CD44 is a major cell surface CSPG on leukocytes, and functions to facilitate chemotaxis. Treatment of cells with anti-CD44 blocks chemotaxis of neutrophils and U937-C5aR cells to C-activated serum but not purified C5a. DBP binds to CD44 on the cell surface as evidenced by coimmunoprecipitation, confocal microscopy, and cell binding studies. Annexin A2 associates with CD44 in lipid rafts; therefore, its potential role in mediating cochemotactic activity was investigated. Results demonstrate that anti-A2 inhibits neutrophil and U937-C5aR chemotaxis specifically to C-activated serum, blocks DBP binding to cells, and colocalizes with anti-DBP on the cell surface. These results provide clear evidence that CD44 and annexin A2 mediate the C5a chemotactic cofactor function of DBP.
Story understanding and counterfactual reasoning.

D. Kahneman and A. Tversky (1982), in a seminal study on counterfactual reasoning, claimed empirical support for a simulation heuristic wherein ease of converting unusual conditions determines their selection as causes over normal conditions. Discourse analysis of their stories revealed a confounding of explanation and normality. A connectionist simulation of online comprehension and memory access of alternative conditions without conversion accounted for their data. Normality and explanation were varied independently in 2 experiments. Explanation but not normality affected the rank ordering of counterfactual conditions after reading. Access of alternative conditions in simulation was again the best predictor of empirical findings. Comprehension and memory operate where stories communicate information for decision making such as counterfactual reasoning and hindsight bias.
Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia.

IMPORTANCE The Centers for Medicare & Medicaid Services publicly reports hospital 30-day, all-cause, risk-standardized mortality rates (RSMRs) and 30-day, all-cause, risk-standardized readmission rates (RSRRs) for acute myocardial infarction, heart failure, and pneumonia. The evaluation of hospital performance as measured by RSMRs and RSRRs has not been well characterized. OBJECTIVE To determine the relationship between hospital RSMRs and RSRRs overall and within subgroups defined by hospital characteristics. DESIGN, SETTING, AND PARTICIPANTS We studied Medicare fee-for-service beneficiaries discharged with acute myocardial infarction, heart failure, or pneumonia between July 1, 2005, and June 30, 2008 (4506 hospitals for acute myocardial infarction, 4767 hospitals for heart failure, and 4811 hospitals for pneumonia). We quantified the correlation between hospital RSMRs and RSRRs using weighted linear correlation; evaluated correlations in groups defined by hospital characteristics; and determined the proportion of hospitals with better and worse performance on both measures. MAIN OUTCOME MEASURES Hospital 30-day RSMRs and RSRRs. RESULTS Mean RSMRs and RSRRs, respectively, were 16.60% and 19.94% for acute myocardial infarction, 11.17% and 24.56% for heart failure, and 11.64% and 18.22% for pneumonia. The correlations between RSMRs and RSRRs were 0.03 (95% CI, -0.002 to 0.06) for acute myocardial infarction, -0.17 (95% CI, -0.20 to -0.14) for heart failure, and 0.002 (95% CI, -0.03 to 0.03) for pneumonia. The results were similar for subgroups defined by hospital characteristics. Although there was a significant negative linear relationship between RSMRs and RSRRs for heart failure, the shared variance between them was only 2.9% (r2 = 0.029), with the correlation most prominent for hospitals with RSMR <11%. CONCLUSION AND RELEVANCE Risk-standardized mortality rates and readmission rates were not associated for patients admitted with an acute myocardial infarction or pneumonia and were only weakly associated, within a certain range, for patients admitted with heart failure.
Fixation of pelvic floor fractures in cats

Summary Objectives: To retrospectively evaluate the outcome of internal fixation of trauma-related pelvic floor fractures using a ventral abdominal approach in cats. Methods: Clinical examination and radio-graphic findings at presentation, after surgery, and at follow-up were assessed. Information gathered included concurrent injuries, surgical technique used, lameness and pain scores, and radiographic signs of implant stability. Results: Ten European shorthair cats were included in the study. Pelvic floor fractures were stabilised using locking plates in nine cats, and symphyseal separation was fixated using hemicerclage wire in one cat. Additional procedures included reduction of sacroiliac luxation in nine cats with positional screws placed in six cats, and plate stabilization of sacral fractures in one cat. All cats were able to walk within five days of surgery. No orthopaedic or neurological deficits were observed in seven cats at follow-up. Neurological deficits were observed in one cat. Signs of pain at implant sites due to inadequate surgical technique were noted in two cats. Anatomical reduction of the pelvic floor was achieved in eight cats. Clinical significance: Stabilization of the pelvic floor and repair of sacroiliac luxation and other injuries by a ventral abdominal approach in cats led to an overall successful outcome. Fixation of the pelvic floor in cats with intact acetabular and ilial bones should be considered in patients with multiple pelvic fractures in combination with sacroiliac joint luxation or sacral fracture, pelvic canal narrowing, traumatic abdominal hernia, and other abdominal injuries.
2-D tracking doppler: a new method to limit spectral broadening in pulsed wave doppler

Transit time broadening is a major limitation in pulsed wave (PW) Doppler, especially when the angle between the flow direction and the ultrasound beam is large. The associated loss in frequency resolution may give severe overestimation of blood velocities, and finer details in the spectral display are lost. By using plane wave transmissions and parallel receive beamforming, multiple PW Doppler signals can be acquired simultaneously in a 2-D region. This enables tracking of the moving blood scatterers over a longer spatial distance to limit transit time broadening. In this work, the new method was tested using in vitro ultrasound recordings from a flow phantom, and in vivo recordings from a human carotid artery. The resulting 2-D tracking Doppler spectra showed significantly reduced spectral broadening compared with Doppler spectra generated by Welch's method. The reduction in spectral broadening was 4-fold when the velocity was 0.82 m/s and the beam-to-flow angle was 62°. A signal model was derived and the expected Doppler power spectra were calculated, showing good agreement with experimental data. Improved spectral resolution was shown for beam-to-flow angles between 40° and 82°.
D4F alleviates macrophage-derived foam cell apoptosis by inhibiting CD36 expression and ER stress-CHOP pathway[S]

This study was designed to explore the protective effect of D4F, an apoA-I mimetic peptide, on oxidized LDL (ox-LDL)-induced endoplasmic reticulum (ER) stress-CCAAT/enhancer-binding protein (C/EBP) homologous protein (CHOP) pathway-mediated apoptosis in macrophages. Our results showed that treating apoE knockout mice with D4F decreased the serum ox-LDL level and apoptosis in atherosclerotic lesions with concomitant downregulation of cluster of differentiation 36 (CD36) and inhibition of ER stress. In vitro, D4F inhibited macrophage-derived foam cell formation. Furthermore, like ER stress inhibitor 4-phenylbutyric acid (PBA), D4F inhibited ox-LDL- or tunicamycin (TM, an ER stress inducer)-induced reduction in cell viability and increase in lactate dehydrogenase leakage, caspase-3 activation, and apoptosis. Additionally, like PBA, D4F inhibited ox-LDL- or TM-induced activation of ER stress response as assessed by the reduced nuclear translocation of activating transcription factor 6 and the decreased phosphorylation of protein kinase-like ER kinase and eukaryotic translation initiation factor 2α, as well as the downregulation of glucose-regulated protein 78 and CHOP. Moreover, D4F mitigated ox-LDL uptake by macrophages and CD36 upregulation induced by ox-LDL or TM. These data indicate that D4F can alleviate the formation and apoptosis of macrophage-derived foam cells by suppressing CD36-mediated ox-LDL uptake and subsequent activation of the ER stress-CHOP pathway.
Immigrant students’ mathematics learning experiences in Canadian schools

Because of global mobility of populations, mathematics classrooms in many parts of the world are becoming linguistically and ethnically diverse. In the school district in which we conducted the research reported here, more than 25% of students are considered to be English language learners. Previous studies have found that teachers tend to assume that mathematics learning is universal, while immigrant students and parents can bring different expectations and norms (e.g., Gorgorio & Abreu, 2009). In order to better understand immigrant students’ trajectories of mathematics learning, we examine their lived experiences of learning mathematics as revealed through autobiographical interviews and artistic renderings. The broader study of which this is a part investigates students’ experiences of learning mathematics in Canadian schools, and the ways that these experiences contribute to students’ images of mathematics and their mathematical identities. To date, 94 autobiographical interviews have been conducted with Kindergarten to Grade 9 students. This project also utilized drawings in order to reveal students’ experiences that cannot necessarily be verbalized. In this poster, we focus only on students who had prior schooling in countries other than Canada. To interpret this element of our data, we draw from sociocultural theory, which seeks to understand how cultural practices and artifacts mediate human learning (Cole, 1996). Our results indicate that the majority of immigrant students in our study described differences in mathematics learning experiences between Canadian schools and schools in other countries. Differences were commonly identified in the following areas: practices of homework, individual learning and group work, the way teachers reward “good mathematics students,” and support and help from teachers. These differences tended to contribute to some immigrant students’ confusions, struggles, and frustrations in school mathematics learning in Canada. For example, some students reported how they were negotiating multiple norms regarding group work. Another significant common thread was pressure from parents to succeed in mathematics. Many immigrant students in our study were learning additional mathematics at home with their parents or supplementing school learning by afterschool mathematics learning programs. Some of the student drawings and narratives revealed how students conceptualized mathematics as a competitive, performance-oriented discipline, an orientation that seemed to be at odds with the educational cultures of the Canadian schools in which they found themselves. Despite the common teacher belief that mathematics learning is universal, our study unveils ways in which immigrant students are navigating different norms and practices of mathematics learning. Our research implies that language learning is not the only support needed, but negotiation of meaning attached to school mathematics practices is also necessary to better support immigrant students.
The spirometric efficacy of once-daily dosing with tiotropium in stable COPD: a 13-week multicenter trial. The US Tiotropium Study Group.

STUDY OBJECTIVE To compare the bronchodilator efficacy and safety of tiotropium and placebo. DESIGN A 3-month, randomized, double-blind, placebo-controlled, multicenter trial. SETTING Outpatient. PATIENTS Four hundred seventy patients with stable COPD (mean FEV(1) = 38.6% predicted). INTERVENTIONS Tiotropium 18 microg (N = 279) or placebo (N = 191) given once daily via a lactose-based dry-powder inhaler device. MEASUREMENTS AND RESULTS Spirometry was evaluated on days 1, 8, 50, and 92. Data were expressed as the mean trough (ie, before morning dose; 23 to 24 h after previous dose) and average response observed in the 3 h after the dose was received. Tiotropium produced significant improvement in trough FEV(1) and FVC, averaging 12% greater than baseline on day 8; these improvements were maintained on days 50 and 92. The average postdose FEV(1) was 16% greater than baseline on day 1 and 20% greater than baseline on day 92; FVC was 17% greater than baseline on day 1 and 19% greater than baseline on day 92. Tiotropium was significantly more effective than placebo in both trough and average FEV(1) and FVC response (p < 0.001). These spirometric effects were corroborated by significant improvements in daily morning and evening peak expiratory flow rate, as well as a reduction in "as-needed" albuterol use. Symptoms of wheezing and shortness of breath were significantly less in patients receiving tiotropium, and the physician global assessment noted overall improvements with those treated with tiotropium relative to placebo. The most common reported adverse event after tiotropium was dry mouth (9.3% vs 1.6% relative to placebo; p < 0.05). CONCLUSIONS These data demonstrate that tiotropium is a safe and effective once-daily anticholinergic bronchodilator and should prove useful as first-line maintenance therapy in COPD.
Infectious outcomes assessment for health system strengthening in low-resource settings: the novel use of a trauma registry in Rwanda.

BACKGROUND More than 90% of injury deaths occur in low-income countries where a shortage of personnel, infrastructure, and materials challenge health system strengthening efforts. Trauma registries developed regionally have been used previously for injury surveillance in resource-limited settings, but scant outcomes data exist. METHODS A 31-item, two-page registry form was developed for use in Rwanda, East Africa. Data were collected over a one-year period from April 2011 to April 2012 at two university referral hospitals. Inpatient 30-d follow up data were abstracted from patient charts, ward reports, and operating room logs. Complications tracked included surgical site infection (SSI), pneumonia, urinary tract infection (UTI), decubitus ulcers, transfusion, cardiac arrest, respiratory failure, and blood thromboses. Univariate analysis with chi-square and the Fisher exact test was performed to determine the association between complications and hospital stay and complications and mortality. Multivariable logistic regression was used to control for age, gender, hospital, mechanism of injury (penetrating versus blunt), and Glasgow Coma scale score (GCS). RESULTS A total of 2,227 patients were recorded prospectively. One thousand five hundred nineteen patients were admitted for inpatient care (69%) with a 4% (n=67) 30-d mortality. One hundred thirteen patients developed a hospital-acquired infection (88 SSI, 15 UTI, 12 pneumonia). For admitted patients, 25% (n=387) were still in-hospital at 30-d. Whereas the development of any complication was associated with an increased mortality (p<0.0001, unadjusted OR 3.2, 95% CI 1.8-5.7), there was no association between the development of an infection and mortality (p=0.6). Hospital-acquired infection was associated with an increased length of stay (p<0.0001, adjusted odds ratio (OR) 7.3, 95% confidence interval (CI) 4.7-11.2). Surgical site infection and UTI were individually associated with an increased length of stay. CONCLUSIONS The development of hospital-acquired infections is associated with an increased hospital stay in the trauma population in Rwanda. This has important implications in improving a health system already strained by limited infrastructure, personnel, and finances.
In search of a novel antifungal agent: probing molecular interactions of fluconazole and its analogues with model membranes by NMR and DSC techniques

Objectives In search of a novel antifungal agent with high susceptibility and increased antifungal potency it is necessary to increase the overall lipophilicity of these agents. In view of that, we have synthesized different carboxylic acid ester analogues of fluconazole, such as fluconazole‐benzoate, fluconazole‐p‐nitrobenzoate, fluconazole‐p‐methoxybenzoate and fluconazole‐toluate, with varying degrees of lipophilicity. In order to probe molecular level interactions of these molecules with biomembrane, lipid bilayers prepared from l‐α‐dipalmitoyl phosphatidyl choline (DPPC) as the model membrane were used.
Effects of exercise on resting blood pressure in obese children: a meta‐analysis of randomized controlled trials

The purpose of this meta‐analysis was to examine the evidence for the effectiveness of exercise interventions on the resting blood pressure (systolic and diastolic) of obese children. A computerized search was made of seven databases using keywords. Effect sizes (ES) and 95% confidence intervals were calculated, and the heterogeneity of the studies was estimated using Cochran's Q‐statistic applied to the effect size means. Nine randomized controlled trial (RCT) studies were selected for review as satisfying the inclusion criteria (n = 205 exercise, 205 control). The main cumulative evidence indicates that the exercise programmes with a frequency of three sessions weekly lasting longer than 60 min had a moderate effect on systolic blood pressure (ES = −0.46, I2 = 27%), and programmes of under 12 weeks with more than three sessions weekly were beneficial in terms of reduction of diastolic blood pressure (ES = −0.35, I2 = 78%).
Preradiation chemotherapy for pediatric patients with high‐grade glioma

To evaluate the feasibility and efficacy of intensive chemotherapy given prior to irradiation in pediatric patients with malignant glioma, the Society of Pediatric Oncology in Germany started a randomized trial in 1991. The high‐grade glioma strata had to be closed because of insufficient patient accrual. The follow‐up data from these patients are reported.
Effect of Excessive Green Tea Versus Fluoride and Caffeine on Body Weight and Serum Thyroid Hormones in Male Mice

Green tea is a worldwide used beverage rich in fluoride and caffeine. To study the effect of excessive green tea intake versus fluoride and caffeine on body weight and serum thyroid hormones in male mice. Also, to confirm the effect of excessive green tea intake on thyroid gland was due to its fluoride and caffeine content or not. Thirty Male albino mice 25-30 gm weight were divided into five groups. Control (C) group (6 mice) receiving distilled water. Green tea (GT) treated group; 6 mice were given a 5 gm% tea hot water extract as their sole water supply. Fluoride (FL) treated group, 6 mice were given fluorine excess solution as their only water supply. Caffeine (Caf) treated group, 6 mice were treated with caffeine (6.25 mg/kg ip). Propylthiouracil (PTU) treated group, 6 mice were treated with PTU (10 mg/kg ip). Each of the five groups is treated with the corresponding substance for 30 days, then sacrificed under ether anesthesia, blood was collected to study serum levels of T3 and T4. There was a significant decrease in serum T3 in PTU treated group (0.72±0.03), GT treated group (0.96±0.04), FL treated group (0.93±0.04) and Caf treated group (1.46±0.08) in comparison to the C group (1.71±0.05). Also, there was a significant decrease in serum T4 in PTU treated group (15.71±1.26), GT treated group (30.07±2.29) and FL treated group (22.03±1.95)in comparison to the C group (51.1±3.15). But, there was an insignificant change in serum T4 in Caf treated group (45.55±2.73) in comparison to the C group (51.1±3.15). Green tea unfractionated aqueous extract decreased serum T3 and T4 and at the same time, increased final total body weight without a significant effect on the relative thyroid weight in comparison to the control group and this may be at least partly due to its content of fluoride and caffeine. Further work should be done on green tea free fluoride and caffeine to confirm this result.