Miracle-dz/UniFAR-FTUs huggingface dataset:
Surrogate and patient discrepancy regarding consent for critical care research

Objective:Critically ill patients frequently display impaired decision-making capacity due to their underlying illness and the use of sedating medications. Healthcare providers often rely on surrogates to make decisions for medical care and participation in clinical research. However, the accuracy of surrogate decisions for a variety of critical care research studies is poorly understood. Design:Cross-sectional observational study. Setting:Academic medical center. Patients:Medical intensive care unit patients and their designated surrogates. Intervention:Patients were asked whether they would consent to participate in hypothetical research studies of increasing complexity, and surrogates independently indicated whether they would consent to enroll the patient in the same scenarios. Results:Overall, 69 medical intensive care unit patients were enrolled into the study. The majority of surrogates were either the spouse (58%) or parent (22%) of the patient. The percentage of patients that would agree to participate in a research study and the percentage of surrogates that would agree to have the patient enrolled into a research study both declined as the risk of the study increased (p < .001 for both analyses). In addition, the overall discrepancy, the false-negative rates, and the false-positive rates between patient and surrogates were greater as the risk of the study increased (p < .001, p < .001, and p = .049, respectively). &kgr; values for all seven scenarios demonstrated less-than-moderate agreement (range 0.03–0.41). Conclusions:There are significant discrepancies in the willingness to participate in various types of clinical research proposals between critically ill patients and their surrogate decision makers. The results of this study raise concerns about the use of surrogate consent for inclusion of critically ill patients into research protocols.
Local release of ATP into the arterial inflow and venous drainage of human skeletal muscle: insight from ATP determination with the intravascular microdialysis technique

Non‐technical summary ATP has been proposed to contribute to the local regulation of skeletal muscle blood flow by inducing local vasodilatation. ATP is continuously released, degraded and taken up by cells and the physiological levels are therefore difficult to determine. In the present investigation, we used a novel technique involving microdialysis probes to determine plasma ATP levels in blood vessels supplying and draining resting and contracting human skeletal muscle and to investigate the stimuli for ATP release. The results show a local release of ATP into arterial and venous blood. In addition, we found that thigh compression is a stimulus for ATP release. Furthermore, we find that the half‐life of ATP in arterial blood is <1 s.
Lumbar spondylolysis: reactive marrow changes seen in adjacent pedicles on MR images.

OBJECTIVE In a search for ancillary MR findings for the diagnosis of spondylolysis, we performed a retrospective study to characterize changes in MR signal intensity of marrow within lumbar pedicles at the level of a spondylolytic defect. These reactive marrow changes were classified according to the anatomic-pathologic scheme developed for degenerative disk disease by Modic et al. MATERIALS AND METHODS Two neuroradiologists retrospectively reviewed MR images of 60 patients with lumbar spondylolysis confirmed by conventional radiography or CT. The MR signal of each pedicle at the level of a pars defect was compared on T1- and T2-weighted sagittal images to that at the next higher level. When both observers concurred that the signal of the involved pedicle differed significantly from that of its neighbor, this signal change was classified into one of three types (type I: hypointense on T1-weighted images, hyperintense on T2-weighted images; type II: hyperintense on T1-weighted images, isointense or hyperintense on T2-weighted images; type III: hypointense on both T1- and T2-weighted images). RESULTS Changes in MR signal intensity of pedicles adjacent to spondylolytic defects were observed in 24 (40%) of the 60 patients. Type I changes were seen in three patients, all less than 24 years old. Type II changes were seen in 17 patients with a median age of 35 years. Type III changes were seen in four patients with a median age of 51 years. The distribution of changes in signal intensity in the pedicle as a function of age was significant (p = .001). CONCLUSION Categories of changes in MR signal intensity, similar to those described adjacent to degenerating disks, can be seen in lumbar pedicles adjacent to a spondylolytic defect of the pars interarticularis and are distributed as a function of age. Awareness of this finding may aid in establishing the correct diagnosis of spondylolysis on MR imaging and prevent erroneous interpretation of abnormal signal intensity in the pedicles in these patients.
Rolling motion estimation for mobile robot by using omnidirectional image sensor HyperOmniVision

Described here is a method for estimating a rolling motion of a mobile robot from optical flows. We have proposed an image sensor with a hyperboloidal mirror for vision based navigation of the mobile robot. Its name is HyperOmniVision. This sensing system can acquire an omnidirectional view around the robot, in real-time, with use of the hyperboloidal mirror. The radial component of optical flow in HyperOmniVision has a periodic characteristic. The proposed method makes use of this characteristic to estimate robustly the rolling motion of the robot.
Actions of nizatidine, a selective histamine H2-receptor antagonist, on gastric acid secretion in dogs, rats and frogs.

Nizatidine (LY139037), a selective histamine H2-receptor antagonist, is a potent inhibitor of gastric acid secretion. It was 17.8 times as active as cimetidine on histamine (10(-5) M)-induced secretion from the isolated gastric mucosa of the bullfrog. Nizatidine was 8.9 times as active as cimetidine on basal acid secretion of the chronic gastric fistula rats after s.c. administration. Against acid secretion from the vagally innervated gastric fistula and Heidenhain pouch of dogs stimulated with submaximal doses of histamine, methacholine and gastrin, nizatidine was, respectively, 6.5, 5 and 4.7 times as active as cimetidine by i.v. administration. Nizatidine was very well absorbed from the gut and was 5 to 10 times as active as cimetidine on gastric acid secretion of dogs induced by submaximal and maximal doses of histamine when given p.o. Equal molar doses of nizatidine showed equal peak effects when given i.v. , s.c. or i.m. Pharmacological data indicate that nizatidine is safe and effective as an agent for the control of excessive gastric acid secretion.
Plant AP2/ERF transcription factors

Transcription factors (TFs) play important roles in plant development and its response to the biotic and abiotic stresses. AP2/ERF transcription factors family is unique to plants and a conserved AP2/ERF domain of about 60 amino acids characterized these transcription factors. AP2/ERF genes have been shown to regulate developmental processes and the response of plants to various types of biotic and environmental stress. Here, we summarize the current knowledge of AP2/ERF plant transcription factor family.
Phase 1b study of dulanermin (recombinant human Apo2L/TRAIL) in combination with paclitaxel, carboplatin, and bevacizumab in patients with advanced non-squamous non-small-cell lung cancer.

PURPOSE To determine the safety, pharmacokinetics (PK), and maximum-tolerated dose (MTD) up to a prespecified target dose of dulanermin in combination with paclitaxel, carboplatin, and bevacizumab (PCB) in patients with previously untreated, nonsquamous, stage IIIb (with pleural effusion)/IV or recurrent non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS In this phase 1b study, patients (n = 24) received PCB on day 1 of each 21-day cycle then dulanermin at 4 or 8 mg/kg/d for 5 consecutive days or 15 or 20 mg/kg/d for 2 consecutive days per assigned treatment cohort. Incidence of dose-limiting toxicities (DLTs), adverse events, and antidulanermin antibodies were assessed. PK parameters were recorded for each agent. Tumor response was measured by modified Response Evaluation Criteria in Solid Tumors. RESULTS Twenty-four patients received at least one dose of dulanermin plus PCB, six in each treatment cohort. There were no DLTs. An MTD was not reached, and the drug combination was well tolerated. Treatment-emergent adverse events were generally as expected for the PCB regimen. Adverse events attributed to dulanermin were grade 1/2; no significant hepatotoxicity occurred. There was minimal impact of PCB on the PK of dulanermin. There was one confirmed complete response and 13 confirmed partial responses. The overall response rate was 58% (95% CI, 37 to 78). Median progression-free survival was 7.2 months (95% CI, 4.7 to 10.3). CONCLUSION Dulanermin plus PCB was well tolerated with no occurrence of DLTs and demonstrated antitumor activity in this patient population. Dulanermin at 8 mg/kg/d for 5 days and 20 mg/kg/d for 2 days every 3 weeks in combination with PCB is being studied in a phase II trial.
Repetitive transcranial magnetic stimulation is as effective as fluoxetine in the treatment of depression in patients with Parkinson’s disease

Objective: To study the efficacy of 15 Hz repetitive transcranial magnetic stimulation (rTMS) in treating depression in patients with Parkinson’s disease. Methods: 42 patients were enrolled into two groups: group 1, active rTMS (15 Hz rTMS for 10 days) and placebo drug treatment; group 2, sham rTMS and fluoxetine 20 mg/day. A specially designed sham coil was used for sham stimulation. The unified Parkinson’s disease rating scale (UPDRS), activities of daily living (ADL), Hamilton rating scale for depression (HRSD), Beck depression inventory (BDI), and mini-mental state examination (MMSE) were assessed by a rater blinded to treatment arm. Results: HRSD and BDI were improved to the same extent in both groups after two weeks of treatment (38% and 32% for group 1, 41% and 33% for group 2, respectively). At week 8 there was a tendency for worse motor UPDRS scores in group 2 (NS). ADL showed improvement at week 8 only in group 1. MMSE improved in both groups after treatment, but faster in group 1 than in group 2. There were fewer adverse effects in group 1 than in group 2. Conclusions: rTMS has the same antidepressant efficacy as fluoxetine and may have the additional advantage of some motor improvement and earlier cognitive improvement, with fewer adverse effects.
Hypertension knowledge, awareness, and attitudes in a hypertensive population

OBJECTIVE: Improved recognition of the importance of systolic blood pressure (SBP) has been identified as one of the major public health and medical challenges in the prevention and treatment of hypertension (HTN). SBP is a strong independent risk factor for cardiovascular disease but no information is available on whether patients understand the importance of their SBP level. The purpose of this study was to assess HTN knowledge, awareness, and attitudes, especially related to SBP in a hypertensive population.DESIGN/SETTING/PATIENTS: We identified patients with HTN (N=2,264) in the primary care setting of a large midwestern health system using automated claims data (International Classification of Diseases, Ninth Revision [ICD-9] codes 401.0–401.9). We randomly selected 1,250 patients and, after excluding ineligible patients, report the results on 826 completed patient telephone interviews (72% response rate [826/1,151]). MAIN RESULTS: Ninety percent of hypertensive patients knew that lowering blood pressure (BP) would improve health and 91% reported that a health care provider had told them that they have HTN or high BP. However, 41% of patients did not know their BP level. Eighty-two percent of all patients correctly identified the meaning of HTN as “high blood pressure. ” Thirty-four percent of patients correctly identified SBP as the “top” number of their reading; 32% correctly identified diastolic blood pressure (DBP) as the “bottom” number; and, overall, only 30% of patients were able to correctly identify both systolic and diastolic BP measures. Twenty-seven percent of patients with elevated SBP and DBP (as indicated by their medical records) perceived that their BP was high. Twenty-four percent of patients did not know the optimal level for either SBP or DBP. When asked whether the DBP or SBP level was more important in the control and prevention of disease, 41% reported DBP, 13% reported SBP, 30% reported that both were important, and 17% did not know.CONCLUSIONS: These results suggest that, although general knowledge and awareness of HTN is adequate, patients do not have a comprehensive understanding of this condition. For instance, patients do not recognize the importance of elevated SBP levels or the current status of their BP control. An opportunity exists to focus patient education programs and interventions on the cardiovascular risk associated with uncontrolled HTN, particularly elevated SBP levels.
Robotic resection of giant left ventricular myxoma causing outflow tract obstruction

We report a 38‐year‐old female, who presented with progressive dyspnea and fatigue. Echocardiography revealed a giant and freely mobile left ventricular myxoma causing left ventricular outflow tract (LVOT) obstruction. The patient underwent totally endoscopic robotic excision of a giant left ventricular myxoma. The tumor was completely removed through the mitral valve orifice with a left atriotomy incision.
Diffusion Tensor Imaging in Late Posttraumatic Epilepsy

Summary: Purpose: The main objective of this study was to use diffusion tensor imaging (DTI) to search and quantify the extent of abnormality beyond the obvious lesions seen on the T2 and fluid‐attenuation inversion recovery (FLAIR) magnetic resonance images in patients with chronic traumatic brain injury (TBI) with and without epilepsy.
The family study: a model for integrating the individual and community perspective in medical education

Summary. The principles of and experience with a family study and survey undertaken by first‐year medical students are reported. The family study is based on the observations made by pairs of students on a selected family, which includes a pregnant mother, in the Newcastle upon Tyne area. These observations include the family context, the pregnancy, the early development of the new‐born baby, and the use of health and other services. The family survey records and analyses relevant data on the collective group of selected families. The family study acts as a preparation for clinical understanding by emphasizing the individual or family view. In addition, students learn that the collective epidemiological approach provided by the survey can guide the clinical impression gained from the observational study, yet each individual and family remains unique. An early opportunity is therefore provided for students to explore and integrate these two approaches.
Purification and Characterization of the Small Subunit of Phage T4 Terminase, gp16, Required for DNA Packaging*

Phage T4 terminase is an enzyme that binds to the portal protein of proheads and cuts and packages concatemeric DNA. The T4 terminase is composed of two subunits, gene products (gp) 16 and 17. The role of the small subunit, gp16, in T4 DNA packaging is not well characterized. We developed a new purification procedure to obtain large quantities of purified gp16 from an overexpression vector. The pure protein is found in two molecular weight forms, due to specific C-terminal truncation, displays in vitro packaging activity, and binds but does not hydrolyze ATP. gp16 forms specific oligomers, rings, and side-by-side double rings, as judged by native polyacrylamide gel electrophoresis and scanning transmission electron microscopy measurements. The single ring contains about eight monomers, and the rings have a diameter of about 8 nm with a central hole of about 2 nm. A DNA-binding helix-turn-helix motif close to the N terminus of gp16 is predicted. The oligomers do not bind to DNA, but following denaturation and renaturation in the presence of DNA, binding can be demonstrated by gel shift and filter binding assays. gp16 binds to double-stranded DNA but not single-stranded DNA, and appears to bind preferentially to a gene 16-containing DNA sequence.
A novel role for the peritrophic matrix in protecting Leishmania from the hydrolytic activities of the sand fly midgut

The role of the peritrophic matrix (PM) in the development of Leishmania major infections in a natural vector, Phlebotomus papatasi, was investigated by addition of exogenous chitinase to the bloodmeal, which completely blocked PM formation. Surprisingly, the absence of the PM was associated with the loss of midgut infections. The chitinase was not directly toxic to the parasite, nor were midgut infections lost due to premature expulsion of the bloodmeal. Most parasites were killed in chitinase-treated flies within the first 4 h after feeding. Substantial early killing was also observed in control flies, suggesting that the lack of PM exacerbates lethal conditions which normally exist in the blood-fed midgut. Early parasite mortality was reversed by soybean trypsin inhibitor. Allosamadin, a specific inhibitor of chitinase, led to a thickening of the PM, and also prevented the early parasite mortality seen in infected flies. Susceptibility to gut proteases was extremely high in transitional-stage parasites, while amastigotes and fully transformed promastigotes were relatively resistant. A novel role for the PM in promoting parasite survival is suggested, in which the PM creates a barrier to the rapid diffusion of digestive enzymes, and limits the exposure of parasites to these enzymes during the time when they are especially vulnerable to proteolytic damage.
A novel planar PBG structure for size reduction

A novel planar photonic band-gap (PBG) scheme is presented for size reduction, the proposed structure can be considered as a kind of distorted uniplanar compact-PBG (DUC-PBG) while being even more compact in size. Its design is detailed in this letter, and several experimental results are presented, the properties of the proposed DUC-PBG are examined, as compared with that of the conventional UC-PBG.
Recombinant p21 Protein Inhibits Lymphocyte Proliferation and Transcription Factors

Cellular proliferation determines the events leading to the initiation and development of inflammation, immune activation, cancer, atherogenesis, and other disorders associated with aberrant cell proliferation. Cyclin inhibitor p21 plays a unique role in limiting cell cycle progression. However, its effectiveness can only be demonstrated with direct in vitro and in vivo delivery to control aberrant proliferation. We demonstrate that using a protein-transducing domain p21 protein a) localizes within the nuclear compartments of cells, b) interacts with transcription factors, NF-κB, and NFATs (NFATc and NFATp), and c) inhibits lymphocyte proliferation and expression of proinflammatory cytokines. This study using lymphocyte proliferation as a model suggests that the recombinant p21 protein can directly be delivered as a therapeutic protein to provide a novel, viable, and powerful strategy to limit proliferation, inflammation, alloimmune activation, cancer, and vascular proliferative disorders such as atherosclerosis.
Total variation regularization and fast algorithms based on alternating direction method

Total variation regularization is popular in image reconstruction due to its edge-preserving property. We propose an linearized alternating direction method to solving problems in image reconstruction with total variation regularization. The algorithm effectively combines an alternating direction technique to minimize the augmented Lagrangian function at each iteration. When the resulting subproblems do not have closed-form solutions, we propose to linearize these subproblems such that closed-form solutions of these linearized subproblems can be easily derived. Numerical results on image inpainting and image debluring show that the proposed algorithm is fast and efficient.
The Industrial Organization of Health Care Markets

The US health care sector is large and growing - health care spending in 2011 amounted to $2.7 trillion and 18% of GDP. Approximately half of health care output is allocated via markets. In this paper, we analyze the industrial organization literature on health care markets focusing on the impact of competition on price, quality and treatment decisions for health care providers and health insurers. We conclude with a discussion of research opportunities for industrial organization economists, including opportunities created by the US Patient Protection and Affordable Care Act.
Implications of Meal Library & Meal Detection to Glycemic Control of Type 1 Diabetes Mellitus through MPC Control

Abstract Recent technological progress in insulin pumps and continuous glucose monitors (CGM) are enabling development of an artificial β-cell that will allow superior glycemic control for patients with type 1 diabetes mellitus (T1DM). A control algorithm that is implemented in such system will need to regulate basal insulin as well as to reject unmeasured disturbances, such as meals. A traditional approach is to combine feed-forward control as a means to overcome meal disturbances, where the user informs the controller on a meal and estimates the size of that together with PID control or Model Predictive Control (MPC) to address the regulation problem. This approach fails with T1DM adolescents and children because they often forget to give a pre-meal bolus and are poor at estimating meal sizes. A novel approach to overcome this problem is suggested in this paper by the combination of a meal library and a meal detection algorithm in the framework of Model Predictive Control (MPC). In this work, the challenging problem of an unannounced mixed meal is being addressed using this novel combination.