Miracle-dz/UniFAR-FTUs huggingface dataset:
The English national screening programme for sight-threatening diabetic retinopathy.

OBJECTIVES The main objective of the national screening programme is to reduce the risk of sight loss among people with diabetes due to diabetic retinopathy (DR). METHODS Offering two-field mydriatic digital photographic screening to all people with diabetes in England over the age of 12 years. STAGE OF DEVELOPMENT The programme is in its infancy, receiving the first year's annual reports from approximately 96 screening programmes, each of which have developed to offer screening to a minimum number of 12,000 people with diabetes, which would cover a population of 350,000 people with 3.4% diabetes prevalence. The national programme has commenced the External quality assurance (QA) programme in order to achieve and sustain the highest possible standards. POTENTIAL BENEFITS England has a population of two million people with diabetes over the age of 12 and it is believed that there is a prevalence of blindness of 4200 and an annual incidence of blindness of 1280 people with diabetes. This programme has the potential to reduce the prevalence of blindness in England from 4200 people to 1000 people and a conservative estimate of reducing the annual incidence of DR blindness by one-third would save 427 people per annum from blindness. These figures are based on the UK certification of blindness but if World Health Organization (WHO) definitions are used the prevalence, incidence and potential reductions in blindness are much greater.
Exploring the validity and reliability of a questionnaire for evaluating virtual patient design with a special emphasis on fostering clinical reasoning

Abstract Background: Virtual patients (VPs) are increasingly used to train clinical reasoning. So far, no validated evaluation instruments for VP design are available. Aims: We examined the validity of an instrument for assessing the perception of VP design by learners. Methods: Three sources of validity evidence were examined: (i) Content was examined based on theory of clinical reasoning and an international VP expert team. (ii) The response process was explored in think-aloud pilot studies with medical students and in content analyses of free text questions accompanying each item of the instrument. (iii) Internal structure was assessed by exploratory factor analysis (EFA) and inter-rater reliability by generalizability analysis. Results: Content analysis was reasonably supported by the theoretical foundation and the VP expert team. The think-aloud studies and analysis of free text comments supported the validity of the instrument. In the EFA, using 2547 student evaluations of a total of 78 VPs, a three-factor model showed a reasonable fit with the data. At least 200 student responses are needed to obtain a reliable evaluation of a VP on all three factors. Conclusion: The instrument has the potential to provide valid information about VP design, provided that many responses per VP are available.
Components of Depression in HIV-1 Infection: Their Differential Relationship to Neurocognitive Performance

Both depression and neurocognitive compromise are commonly observed among persons infected with the Human Immunodeficiency Virus (HIV). To date, the majority of studies have failed to find a consistent relationship between mood and cognition among HIV-seropositive (HIV+) individuals, suggesting that these constructs are independent of one another. However, depression is a multi-dimensional syndrome and its measurement often utilizes multi-factorial instruments containing cognitive, affective, somatic, and motivational components. The degree to which various symptoms or dimensions of depression might be related to neuropsychological performance in HIV-1 infection is not typically explored and was a main objective of the current study. A sample of 247 HIV+ persons completed both a comprehensive neurocognitive battery and the Beck Depression Inventory (BDI) as part of a standard clinical evaluation at a major community hospital. To examine the dimensionality of the BDI, a principal components analysis was conducted which suggested a three-factor solution comprised of factors representing Self-Reproach (SR), Mood-Motivation Disturbance (MM), and Somatic Disturbance (SOM). The relationship between each of these three factors and neurocognitive performance was examined using both regression and analysis of variance techniques. These analyses showed the MM factor, more so than either the SR or SOM factors, to be associated with several aspects of neurocognitive performance, including verbal memory, executive functioning, and motor speed. These findings suggest that certain items on depression rating scales may be more indicative of central nervous system (CNS) involvement than others. The association between disturbance in mood and motivation and neurocognitive compromise may suggest that each are sequelae of disease specific mechanisms. This research was supported in part by grants from the National Institute of Mental Health (RO1MH58552; T32MH19535), the University of California Universitywide AIDS Research Program (F98-LA-125) and the UCLA Academic Senate. We would like to thank Marta Stefaniak for her assistance with manuscript preparation. Portions of this paper were presented at the 28th Annual Meeting of the International Neuropsychological Society in Boston, Massachusetts.
High-voltage pulsed-power sources for high-energy experimentation

A high-energy pulsed-power source based on a 30 kJ capacitor bank has recently been developed at Loughborough University. An H-bridge circuit configuration is used, with one pair of the diagonally opposite arms comprising a high-voltage ballast inductor and the other pair an exploding wire array capable of generating voltages up to 250 kV. The two centre points of the H-configuration provide the output to a high-power resistive load, which is coupled through a high-voltage self-breakdown spark gap. A resistive load of 80 Ω is provided with a 300 kV impulse with a rise time of about 140 ns and a peak power of about 1 GW. Following the successful testing of the power source under indoor laboratory conditions, a similar transportable source was constructed. This is presently housed in a metal container, with the load fed through a pair of 25 m long high-voltage cables. Due to improvements in the exploding wire arrays arrangement, each now generating about 300 kV, the source is capable of delivering a power of 1.7 GW to a 45 Ω load. The Joule energy deposited of about 3 kJ represents 10% of the energy initially stored in the capacitors. The design of a more powerful transportable source, presently under construction and based on a 400 kJ capacitor bank will also be presented. This source, using an exploding wire array in the primary circuit of a high-voltage transformer, is predicted to be capable of generating in resistive loads an electrical power in excess of 4 GW.
University Students' Attitudes toward E-Tests

Nowadays, university students are evaluated using paper-and-pencil tests in addition to e-tests. A hundred university graduate and undergraduate students in a private university in Lebanon were surveyed to study their attitudes towards taking e-tests in comparison to taking paper-and-pencil tests. The results of this case study showed that the majority of the students felt less anxious while taking e-tests, preferred e-tests over paper-and-pencil tests, and thought e-tests were easier than paper-and-pencil tests. Many students, however, reported that they faced problems while taking e-tests which made them hesitant when it came to taking e-tests in all their university courses.
Comprehensive analysis of the contribution of germline MYH variation to early‐onset colorectal cancer

Mutations in the base excision repair gene MYH have recently been shown to confer recessive susceptibility to colorectal adenomas and carcinomas. To evaluate the contribution of germline MYH mutations to early‐onset colorectal cancer, we screened a series of 358 unselected early‐onset cases for germline changes in the coding sequence of the gene. Two cases harbored biallelic germline mutations (0.6%; 95% CI = 0.06–2.0) and 8 single MYH mutations (2.2%; 95% CI = 0.9–4.4). Both cases harboring biallelic MYH mutations had multiple polyps but not profuse polyposis. All cases had distally sited tumors. No biallelic mutations were detected among 354 controls. These results confirm that biallelic MYH mutations confer susceptibility to colorectal cancer but are unlikely to account for more than 3% of early‐onset colorectal cancer. © 2004 Wiley‐Liss, Inc.
Simulation-based policy improvement for power management in buildings

The technology advances in distributed power generation, co-generation of cooling, heat and power, storage devices and micro grid provide the opportunity to better manage the power in buildings in order to save power, and to reduce the CO2 emission. Due to the complexity of such a multi-energy system, simulation is usually the only faithful way to accurately describe the system dynamics and for performance evaluation. However, simulation is usually time-consuming and provides only noisy observations. Thus finding the optimal power management policy is nontrivial. In this paper, a joint schedule problem is considered to schedule solar power, wind power, combined cooling, heating, and power generation (CCHP), battery, and high temperature chiller in order to satisfy the load on electricity, sensible heat load, and latent heat load in buildings with the minimal average cost. The rollout method is applied to improve from given base policies through simulations. Numerical results show that the method obtains policies better than the base policies.
Autonomous arecanut tree climbing and pruning robot

This paper presents the design and development of a versatile autonomous tree climbing & pruning robot for arecanut farming. The robot has a linear frictional force based non-linear self-regulatory system with 9 DOF that adapts itself to changing trunk diameter. The robot chassis is made rigid and light-weight. An on-board battery is the power source. The motion is provided by two DC motors fitted to spiked wheels. A 5 DOF PUMA arm is mounted on the robot for cutting and pruning purpose. The intelligence is based on Digital Image Processing using Object Recognition techniques. Machine vision is through a guiding camera mounted over the Robotic Arm that feeds the OMAP 32bit Micro-controller made of ARM CORTEX-M3 and Da Vinci processor which has Wavelet based JPEG compression and noise elimination module. A manual override with a display screen allows user to view and control the robot when necessary.
Diabetes, Diabetic Retinopathy, and Retinal Vascular Alterations: A Systematic Review

AbstractThe aim of this review is to summarize the available findings from previous research that has focused on retinal vascular caliber characteristics in diabetes and diabetic retinopathy and identify any gaps that exist in the current literature. A systematic Medline, EMBASE, and PubMed search of relevant articles was conducted with coverage up to the 30th of September, 2012. The search was not restricted by language but was limited to studies conducted in humans. The majority of articles conducted on children and adolescents with type 1 diabetes have reported that arterioles with larger caliber were present in the early stages of diabetic retinopathy (n = 5). Only a few studies conducted on older individuals with type 1 diabetes (n = 2) suggest that smaller retinal arteriolar caliber is associated with increased severity of diabetic retinopathy. Much stronger trends have been identified between venular caliber and older individuals with diabetes, with the vast majority of studies reporting that retinal venular dilation represents a later sign of severe diabetic retinopathy (n = 6), with only 1 study highlighting associations with incident diabetes (n = 1). Significant developments have occurred to better understand the relationship between retinal vascular caliber and the onset and progression of diabetes and diabetic retinopathy. Recent evidence suggests that retinal arteriolar dilation may be a possible risk factor in the early development diabetic retinopathy and retinal venules are dilated in persons with severe diabetic retinopathy. Despite this, the clinical significance of these findings requires further evaluation.
Provider type and management of common visits in primary care.

OBJECTIVES Debate continues on whether nurse practitioners (NPs) and physician assistants (PAs) are more likely to order ancillary services, or order more costly services among alternatives, than primary care physicians (PCPs). We compared prescription medication and diagnostic service orders associated with NP/PA versus PCP visits for management of neck or back (N/B) pain or acute respiratory infection (ARI). STUDY DESIGN Retrospective, observational study of visits from January 2006 through March 2008 in the adult primary care practice of Kaiser Permanente in Atlanta, Georgia. METHODS Data were obtained from electronic health records. NP/PA and PCP visits for N/B pain or ARI were propensity score matched on patient age, gender, and comorbidities. RESULTS On propensity score-matched N/B pain visits (n = 6724), NP/PAs were less likely than PCPs to order a computed tomography (CT)/magnetic resonance image (MRI) scan (2.1% vs 3.3%, respectively) or narcotic analgesic (26.9% vs 28.5%) and more likely to order a nonnarcotic analgesic (13.5% vs 8.5%) or muscle relaxant (45.8% vs 42.5%) (all P ≤.05). On propensity score-matched ARI visits (n = 24,190), NP/PAs were more likely than PCPs to order any antibiotic medication (73.7% vs 65.8%), but less likely to order an x-ray (6.3% vs 8.6%), broad-spectrum antibiotic (41.5% vs 42.5%), or rapid strep test (6.3% vs 9.7%) (all P ≤.05). CONCLUSIONS In the multidisciplinary primary care practice of this health maintenance organization, NP/PAs attending visits for N/B pain or ARI were less likely than PCPs to order advanced diagnostic radiology imaging services, to prescribe narcotic analgesics, and/or to prescribe broad-spectrum antibiotics.
Cysteine mutants of human apolipoprotein A-I: a study of secondary structural and functional properties Published, JLR Papers in Press, April 1, 2005. DOI 10.1194/jlr.M400401-JLR200

Apolipoprotein A-IMilano (A-IM) (R173C), a natural mutant of human apolipoprotein A-I (apoA-I), and five other cysteine variants of apoA-I at residues 52 (S52C), 74 (N74C), 107 (K107C), 129 (G129C), and 195 (K195C) were generated. Cysteine residues were incorporated in each of the various helices at the same helical wheel position as for the substitution in A-IM. The secondary structural properties of the monomeric mutants, their abilities to bind lipid and to promote cholesterol efflux from THP-1 macrophages, and the possibility of antiperoxidation were investigated. Results showed that the α helical contents of all of the cysteine mutants were similar to that of wild-type apoA-I (wtapoA-I). The cysteine variant of A-IM at residue 173 [A-IM(R173C)] exhibited weakened structural stability, whereas A-I(G129C) a more stable structure than wtapoA-I. A-I(G129C) and A-I(K195C) exhibited significantly impaired capabilities to bind lipid compared with wtapoA-I. A-I(K107C) possessed a higher capacity to promote cholesterol efflux from macrophages than wtapoA-I, and A-IM(R173C) and A-I(K195C) exhibited an impaired efflux capability. Neither A-IM(R173C) nor any other cysteine mutant could resist oxidation against lipoxygenase. In summary, in spite of the similar mutant position on the helix, these variants exhibited different structural features or biological activities, suggesting the potential influence of the local environment of mutations on the whole polypeptide chain.
Lack of Agreement on How to Use Antegrade Enemas in Children

Objectives: The aim of the present study was to provide an overview of the existing literature regarding the outcomes of the antegrade continence enema (ACE) procedure and to assess the present practices of physicians worldwide regarding the use of the ACE. Methods: A search of the MEDLINE database was performed using the following criteria: having a clear definition of “successful outcome,” published in full manuscript form, sample size >20 patients, age <25 years. We then conducted a survey among 23 pediatric gastroenterologists and surgeons worldwide who were known to use the ACE using an 18-item questionnaire. Results: A total of 21 articles met the inclusion criteria. Successful outcomes were reported in 15% to 100%. Thirteen studies classified the outcome as full continence (success) or incontinence (failure), with a mean successful outcome of 75.6%. The 23 physicians who completed the questionnaire differed in their opinions about indications and mandatory preoperative testing. Constipation with (78%) or without (91%) fecal incontinence, anorectal malformations (96%), and spinal abnormalities (100%) were considered suitable indications for the ACE by the majority. There was less agreement regarding the required preoperative diagnostic workup. Most physicians (70%) start infusions using saline solutions and do not add a stimulant laxative to the cleansing solution. Discussion: There is a wide variation in the reported outcome of the ACE procedure and in the way success is defined. The survey identifies important differences among physicians using the ACE. Consensus on optimal use of the ACE could improve outcome of this treatment option.
Cytoplasmic dynein regulates its attachment to microtubules via nucleotide state-switched mechanosensing at multiple AAA domains

Significance Cytoplasmic dynein is the primary minus-end–directed microtubule (MT) motor. It is unclear how dynein coordinates ATP hydrolysis and MT attachment within and between its two motor domains, each containing four AAA+ ATPases (AAA: ATPase associated with various cellular activities), AAA1–4. We characterize how mechanical tension and nucleotide states of AAA1 and AAA3 regulate dynein–MT binding. Dynein binds MTs tighter when subjected to tension opposite its normal motility. ADP binding to AAA3 unexpectedly weakens MT-binding strength and reduces the bond strength anisotropy. Finally, AAA3 “gates” the activity of AAA1: ATP binding to AAA1 induces MT release only if AAA3 contains nucleotide. This work expands understanding of the role of force in dynein mechanochemistry and identifies regulatory functions of AAA3. Cytoplasmic dynein is a homodimeric microtubule (MT) motor protein responsible for most MT minus-end–directed motility. Dynein contains four AAA+ ATPases (AAA: ATPase associated with various cellular activities) per motor domain (AAA1–4). The main site of ATP hydrolysis, AAA1, is the only site considered by most dynein motility models. However, it remains unclear how ATPase activity and MT binding are coordinated within and between dynein’s motor domains. Using optical tweezers, we characterize the MT-binding strength of recombinant dynein monomers as a function of mechanical tension and nucleotide state. Dynein responds anisotropically to tension, binding tighter to MTs when pulled toward the MT plus end. We provide evidence that this behavior results from an asymmetrical bond that acts as a slip bond under forward tension and a slip-ideal bond under backward tension. ATP weakens MT binding and reduces bond strength anisotropy, and unexpectedly, so does ADP. Using nucleotide binding and hydrolysis mutants, we show that, although ATP exerts its effects via binding AAA1, ADP effects are mediated by AAA3. Finally, we demonstrate “gating” of AAA1 function by AAA3. When tension is absent or applied via dynein’s C terminus, ATP binding to AAA1 induces MT release only if AAA3 is in the posthydrolysis state. However, when tension is applied to the linker, ATP binding to AAA3 is sufficient to “open” the gate. These results elucidate the mechanisms of dynein–MT interactions, identify regulatory roles for AAA3, and help define the interplay between mechanical tension and nucleotide state in regulating dynein motility.
The Prefrontal Cortex Regulates the Basal Release of Dopamine in the Limbic Striatum: An Effect Mediated by Ventral Tegmental Area

Abstract: The present study examined whether the prefrontal cortex (PFC) exerts a tonic control over the basal release of dopamine in the limbic striatum and whether this control is mediated by glutamatergic afferents to the dopamine cell body or terminal regions. Using intracerebral microdialysis in freely moving rats, it was demonstrated that application of tetrodotoxin in the contralateral PFC significantly decreased the release of dopamine in the medial striatum. Conversely, blockade of the tonic inhibitory GABAergic input in the PFC with bicuculline increased the release of dopamine in the medial striatum. Application of excitatory amino acid receptor antagonists into the striatum, while bicuculline was perfused in the PFC, did not affect the bicuculline‐evoked dopamine increase in the striatum. However, infusion of tetrodotoxin or excitatory amino acid receptor antagonists into the ventral tegmental area, a region containing dopamine cell bodies that project to the medial striatum, blocked the stimulation of striatal dopamine release induced by infusion of bicuculline into the PFC. These data demonstrate that the basal output of dopamine terminals in the medial striatum is under a tonic excitatory control of the PFC. Furthermore, this control occurs primarily through glutamatergic projections to the dopamine cell body area rather than the terminal regions.
Sentence-Level Movements in Parkinson's Disease: Loud, Clear, and Slow Speech.

Purpose To further understand the effect of Parkinson's disease (PD) on articulatory movements in speech and to expand our knowledge of therapeutic treatment strategies, this study examined movements of the jaw, tongue blade, and tongue dorsum during sentence production with respect to speech intelligibility and compared the effect of varying speaking styles on these articulatory movements. Method Twenty-one speakers with PD and 20 healthy controls produced 3 sentences under normal, loud, clear, and slow speaking conditions. Speech intelligibility was rated for each speaker. A 3-dimensional electromagnetic articulograph tracked movements of the articulators. Measures included articulatory working spaces, ranges along the first principal component, average speeds, and sentence durations. Results Speakers with PD demonstrated significantly smaller jaw movements as well as shorter than normal sentence durations. Between-speaker variation in movement size of the jaw, tongue blade, and tongue dorsum was associated with speech intelligibility. Analysis of speaking conditions revealed similar patterns of change in movement measures across groups and articulators: larger than normal movement sizes and faster speeds for loud speech, increased movement sizes for clear speech, and larger than normal movement sizes and slower speeds for slow speech. Conclusions Sentence-level measures of articulatory movements are sensitive to both disease-related changes in PD and speaking-style manipulations.