Miracle-dz/UniFAR-FTUs huggingface dataset:
Rehabilitative post-acute care for stroke patients delivered by per-diem payment system in different hospitalization paths: A Taiwan pilot study

Objective To explore how post-acute care (PAC) for stroke patients delivered by per-diem payment system in varying hospitalization paths affects medical care utilization and functional status. Design, setting and patients A longitudinal prospective cohort study of 181 acute stroke patients in a southern Taiwan hospital and patients were separated into two groups: patients transferred from regional hospitals (group 1) and patients referred from medical centers (group 2). Intervention The intervention was a hospital based, function oriented, 3- to 12-weeks rehabilitative PAC intervention for patients with cerebrovascular diseases. Measurements Barthal Index, Functional Oral Intake Scale, Instrumental Activities of Daily Living Scale, EuroQoL Quality of Life Scale, and Berg Balance Scale. Results The average duration between day of stroke onset and day of admission to PAC ward was significantly (P < 0.001) shorter in group 1 (9.88 days) compared to group 2 (17.11 days). The average duration of PAC was also significantly (P < 0.01) shorter in group 1 (25.51 days) compared to group 2 (34.11 days). Finally, the average cost of PAC under per-diem payment was significantly lower (P < 0.01) in group 1 (US$2637) compared to group 2 (US$3450). Functional status significantly (P < 0.05) improved in patients who had received rehabilitative PAC. However, functional status did not significantly differ between the two groups. Conclusions The most effective way to reduce the costs of PAC for stroke patients is to minimize the duration of their hospital stay before transfer to rehabilitative PAC. Because it substantially reduces medical costs, rehabilitative PAC should be considered standard care for stroke patients.
Postoperative antibacterial prophylaxis for the prevention of infectious complications associated with tube thoracostomy in patients undergoing elective general thoracic surgery: a double-blind, placebo-controlled, randomized trial.

OBJECTIVE To determine whether extended postoperative antibacterial prophylaxis for patients undergoing elective thoracic surgery with tube thoracostomy reduces the risk of infectious complications compared with preoperative prophylaxis only. DESIGN Prospective, randomized, double-blind, placebo-controlled trial. SETTING Brigham and Women's Hospital, an 800-bed tertiary care teaching hospital in Boston, Massachusetts. PARTICIPANTS A total of 251 adult patients undergoing elective thoracic surgery requiring tube thoracostomy between April 2008 and April 2011. INTERVENTIONS Patients received preoperative antibacterial prophylaxis with cefazolin sodium (or other drug if the patient was allergic to cefazolin). Postoperatively, patients were randomly assigned (at a 1:1 ratio) using a computer-generated randomization sequence to receive extended antibacterial prophylaxis (n = 125) or placebo (n = 126) for 48 hours or until all thoracostomy tubes were removed, whichever came first. MAIN OUTCOME MEASURES The combined occurrence of surgical site infection, empyema, pneumonia, and Clostridium difficile colitis by postoperative day 28. RESULTS A total of 245 patients were included in the modified intention-to-treat analysis (121 in the intervention group and 124 in the placebo group). Thirteen patients (10.7%) in the intervention group and 8 patients (6.5%) in the placebo group had a primary end point (risk difference, -4.3% [95% CI, -11.3% to 2.7%]; P = .26). Six patients (5.0%) in the intervention group and 5 patients (4.0%) in the placebo group developed surgical site infections (risk difference, -0.93% [95% CI, -6.1% to 4.3%]; P = .77). Seven patients (5.8%) in the intervention group and 3 patients (2.4%) in the placebo group developed pneumonia (risk difference, -3.4% [95% CI, -8.3% to 1.6%]; P = .21). One patient in the intervention group developed empyema. No patients experienced C difficile colitis. CONCLUSIONS Extended postoperative antibacterial prophylaxis for patients undergoing elective thoracic surgery requiring tube thoracostomy did not reduce the number of infectious complications compared with preoperative prophylaxis only. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00818766.
Chemotherapy after portal vein embolization to protect against tumor growth during liver hypertrophy before hepatectomy.

IMPORTANCE Portal vein embolization improves the safety of liver resection by increasing the size of residual liver, but the embolization may increase tumor growth during the waiting period before definitive hepatectomy. OBJECTIVE To determine whether the administration of chemotherapy mitigates tumor growth after portal vein embolization (PVE) performed before major hepatectomy for metastatic colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS Review of prospectively collected data at Memorial-Sloan Kettering Cancer Center was conducted. The database included patients subjected to PVE before major hepatectomy for metastatic colorectal cancer. MAIN OUTCOMES AND MEASURES Lesions in both the embolized and nonembolized lobes of the liver before and 1 month after PVE were measured and Response Evaluation Criteria in Solid Tumors were applied to assess disease status. Assessment of survival was based on receipt of post-PVE chemotherapy and then stratified by subsequent resectability. RESULTS Two hundred eight tumors were measured in 64 patients; 53 tumors were in patients undergoing post-PVE chemotherapy. Approximately one-third of the lesions progressed after PVE when no chemotherapy was administered. This did not differ significantly according to whether tumors were ipsilateral or contralateral to the PVE. When chemotherapy was administered, there was a significantly lower rate of progression (18.9%, P = .03). In long-term follow-up, treatment with post-PVE chemotherapy was also independently associated with improved survival (P < .006). CONCLUSIONS AND RELEVANCE Chemotherapy does not retard growth of the liver after PVE and may prevent cancer progression. Thus, the combination of PVE and chemotherapy may enhance both oncologic and operative safety.
The spatial distribution of soil organic carbon in tidal wetland soils of the continental United States

Tidal wetlands contain large reservoirs of carbon in their soils and can sequester carbon dioxide (CO2) at a greater rate per unit area than nearly any other ecosystem. The spatial distribution of this carbon influences climate and wetland policy. To assist with international accords such as the Paris Climate Agreement, national‐level assessments such as the United States (U.S.) National Greenhouse Gas Inventory, and regional, state, local, and project‐level evaluation of CO2 sequestration credits, we developed a geodatabase (CoBluCarb) and high‐resolution maps of soil organic carbon (SOC) distribution by linking National Wetlands Inventory data with the U.S. Soil Survey Geographic Database. For over 600,000 wetlands, the total carbon stock and organic carbon density was calculated at 5‐cm vertical resolution from 0 to 300 cm of depth. Across the continental United States, there are 1,153–1,359 Tg of SOC in the upper 0–100 cm of soils across a total of 24 945.9 km2 of tidal wetland area, twice as much carbon as the most recent national estimate. Approximately 75% of this carbon was found in estuarine emergent wetlands with freshwater tidal wetlands holding about 19%. The greatest pool of SOC was found within the Atchafalaya/Vermilion Bay complex in Louisiana, containing about 10% of the U.S. total. The average density across all tidal wetlands was 0.071 g cm−3 across 0–15 cm, 0.055 g cm−3 across 0–100 cm, and 0.040 g cm−3 at the 100 cm depth. There is inherent variability between and within individual wetlands; however, we conclude that it is possible to use standardized values at a range of 0–100 cm of the soil profile, to provide first‐order quantification and to evaluate future changes in carbon stocks in response to environmental perturbations. This Tier 2‐oriented carbon stock assessment provides a scientific method that can be copied by other nations in support of international requirements.
Range position and climate sensitivity: The structure of among‐population demographic responses to climatic variation

Species’ distributions will respond to climate change based on the relationship between local demographic processes and climate and how this relationship varies based on range position. A rarely tested demographic prediction is that populations at the extremes of a species’ climate envelope (e.g., populations in areas with the highest mean annual temperature) will be most sensitive to local shifts in climate (i.e., warming). We tested this prediction using a dynamic species distribution model linking demographic rates to variation in temperature and precipitation for wood frogs (Lithobates sylvaticus) in North America. Using long‐term monitoring data from 746 populations in 27 study areas, we determined how climatic variation affected population growth rates and how these relationships varied with respect to long‐term climate. Some models supported the predicted pattern, with negative effects of extreme summer temperatures in hotter areas and positive effects on recruitment for summer water availability in drier areas. We also found evidence of interacting temperature and precipitation influencing population size, such as extreme heat having less of a negative effect in wetter areas. Other results were contrary to predictions, such as positive effects of summer water availability in wetter parts of the range and positive responses to winter warming especially in milder areas. In general, we found wood frogs were more sensitive to changes in temperature or temperature interacting with precipitation than to changes in precipitation alone. Our results suggest that sensitivity to changes in climate cannot be predicted simply by knowing locations within the species’ climate envelope. Many climate processes did not affect population growth rates in the predicted direction based on range position. Processes such as species‐interactions, local adaptation, and interactions with the physical landscape likely affect the responses we observed. Our work highlights the need to measure demographic responses to changing climate.
Improving predictions of tropical forest response to climate change through integration of field studies and ecosystem modeling

Tropical forests play a critical role in carbon and water cycles at a global scale. Rapid climate change is anticipated in tropical regions over the coming decades and, under a warmer and drier climate, tropical forests are likely to be net sources of carbon rather than sinks. However, our understanding of tropical forest response and feedback to climate change is very limited. Efforts to model climate change impacts on carbon fluxes in tropical forests have not reached a consensus. Here, we use the Ecosystem Demography model (ED2) to predict carbon fluxes of a Puerto Rican tropical forest under realistic climate change scenarios. We parameterized ED2 with species‐specific tree physiological data using the Predictive Ecosystem Analyzer workflow and projected the fate of this ecosystem under five future climate scenarios. The model successfully captured interannual variability in the dynamics of this tropical forest. Model predictions closely followed observed values across a wide range of metrics including aboveground biomass, tree diameter growth, tree size class distributions, and leaf area index. Under a future warming and drying climate scenario, the model predicted reductions in carbon storage and tree growth, together with large shifts in forest community composition and structure. Such rapid changes in climate led the forest to transition from a sink to a source of carbon. Growth respiration and root allocation parameters were responsible for the highest fraction of predictive uncertainty in modeled biomass, highlighting the need to target these processes in future data collection. Our study is the first effort to rely on Bayesian model calibration and synthesis to elucidate the key physiological parameters that drive uncertainty in tropical forests responses to climatic change. We propose a new path forward for model‐data synthesis that can substantially reduce uncertainty in our ability to model tropical forest responses to future climate.
Negative emissions from stopping deforestation and forest degradation, globally

Forest growth provides negative emissions of carbon that could help keep the earth's surface temperature from exceeding 2°C, but the global potential is uncertain. Here we use land‐use information from the FAO and a bookkeeping model to calculate the potential negative emissions that would result from allowing secondary forests to recover. We find the current gross carbon sink in forests recovering from harvests and abandoned agriculture to be −4.4 PgC/year, globally. The sink represents the potential for negative emissions if positive emissions from deforestation and wood harvest were eliminated. However, the sink is largely offset by emissions from wood products built up over the last century. Accounting for these committed emissions, we estimate that stopping deforestation and allowing secondary forests to grow would yield cumulative negative emissions between 2016 and 2100 of about 120 PgC, globally. Extending the lifetimes of wood products could potentially remove another 10 PgC from the atmosphere, for a total of approximately 130 PgC, or about 13 years of fossil fuel use at today's rate. As an upper limit, the estimate is conservative. It is based largely on past and current practices. But if greater negative emissions are to be realized, they will require an expansion of forest area, greater efficiencies in converting harvested wood to long‐lasting products and sources of energy, and novel approaches for sequestering carbon in soils. That is, they will require current management practices to change.
Climate change and Saharan dust drive recent cladoceran and primary production changes in remote alpine lakes of Sierra Nevada, Spain

Recent anthropogenic climate change and the exponential increase over the past few decades of Saharan dust deposition, containing ecologically important inputs of phosphorus (P) and calcium (Ca), are potentially affecting remote aquatic ecosystems. In this study, we examine changes in cladoceran assemblage composition and chlorophyll‐a concentrations over the past ~150 years from high‐resolution, well‐dated sediment cores retrieved from six remote high mountain lakes in the Sierra Nevada Mountains of Southern Spain, a region affected by Saharan dust deposition. In each lake, marked shifts in cladoceran assemblages and chlorophyll‐a concentrations in recent decades indicate a regional‐scale response to climate and Saharan dust deposition. Chlorophyll‐a concentrations have increased since the 1970s, consistent with a response to rising air temperatures and the intensification of atmospheric deposition of Saharan P. Similar shifts in cladoceran taxa across lakes began over a century ago, but have intensified over the past ~50 years, concurrent with trends in regional air temperature, precipitation, and increased Saharan dust deposition. An abrupt increase in the relative abundance of the benthic cladoceran Alona quadrangularis at the expense of Chydorus sphaericus, and a significant increase in Daphnia pulex gr. was a common trend in these softwater lakes. Differences in the magnitude and timing of these changes are likely due to catchment and lake‐specific differences. In contrast with other alpine lakes that are often affected by acid deposition, atmospheric Ca deposition appears to be a significant explanatory factor, among others, for the changes in the lake biota of Sierra Nevada that has not been previously considered. The effects observed in Sierra Nevada are likely occurring in other Mediterranean lake districts, especially in softwater, oligotrophic lakes. The predicted increases in global temperature and Saharan dust deposition in the future will further impact the ecological condition of these ecosystems.
Long‐term ecological changes in marine mammals driven by recent warming in northwestern Alaska

Carbon and nitrogen isotopes analyses were performed on marine mammal bone collagen from three archaeological sites (ad 1170–1813) on Cape Espenberg (Kotzebue Sound, northwestern Alaska) as well as modern animals harvested from the same area to examine long‐term trends in foraging ecology and sea ice productivity. We observed significant and dramatic changes in ringed seal stable isotope values between the early 19th and early 21st centuries, likely due to changing sea ice productivity and reduced delivery of organic matter to the benthos driven by recent warming in the Arctic. These data highlight the importance of the archaeological record for providing a long‐term perspective on environmental variation and interpreting recent changes driven by anthropogenic processes.
Pointing and Selecting with Facial Activity

Theaimofthispaperwastoevaluatetheuseofthreefacialactions(i.e.frowning,raisingtheeyebrows, andsmiling)inselectingobjectsonacomputerscreenwhengazewasusedforpointing.Dwelltime isthemostcommonlyusedselectiontechniqueingaze-basedinteraction,andthus,adwelltime of400mswasusedasareferenceselectiontechnique.Awireless,head-mountedprototypedevice thatcarriedouteyetrackingandcontactless,capacitivemeasurementoffacialactionswasusedfor theinteractiontask.Participants( N = 16) performed point-and-select tasks with three pointing distances (i.e. 60, 120 and 240mm) and three target sizes (i.e. 25, 30 and 40mm). Task completion times, pointing errors and throughput values based on Fitts’ law were used to compare the selection techniques. The participants also rated the techniques with subjective ratings scales. The results showed that the different techniques performed equally well in many respects. However, throughput values varied from 8.38bits / s (raising the eyebrows) to 15.33bits / s (smiling) and were comparable to or, in the case of smiling, better than in earlier research with similar interaction techniques.The dwell time was found to be the least accurate selection technique in terms of the magnitudes of point-and-select errors. Smiling technique was rated as more accurate to use than the frowning or the raising techniques. The results give further support for methods that combine facial behavior to eye tracking when interacting with technology.
Developing Design Guidelines for a Visual Vocabulary of Electronic Medical Information to Improve Health Literacy

Poor health literacy, or the ability to interpret and make judgments about one’s health, affects the effectiveness of healthcare services and people’s quality of life. We explored design principles on how to design visually salient, legible and interpretable medical graphics to promote comprehension and recall of electronic medical diagnostic information, an essential component of personal health records, for populations with limited health literacy. We first conducted a two-stage investigation to confirm that people can comprehend pictorial representations of medical conditions and treatments and improve their health literacy. We then designed a set of medical diagnostics graphics, based on the principles of information design derived from a large set of information graphics in various domains. Evaluated in a lab study, our medical diagnostic graphics were found to be capable of improving people’s perceived comprehension and recall, and were considered easy to understand and very useful for individuals with limited health literacy. RESEARCH HIGHLIGHTS • Medical graphics in electronic personal health records can improve people’s comprehension and recall of diagnostic information, and enhance their health literacy. • People are good at recognizing simple symptoms and actions from medical graphics, but have difficulty in integrating pieces of information to make differentiation and judgment. • Photo-realistic illustrations provide the most details to support interpretation, but can be disturbing; animations better depict procedure and change of status, but require patience in viewing; while clipart type of representations make good use of visual cues to convey details and process, and are quick to perceive. • It is important to properly design visual features that highlight important facts, reveal details, demonstrate cause–effects, elicit terminology and measurements, e.g. color, line, symbols, text and numbers, frames, view and perspective, change of scale, style, as well as the presence and design of human character.
PCR-Múltiple para el diagnóstico de Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum y Ureaplasma urealyticum

Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum are species related with some pathologies of the urogenital tract, and particularly with non gonococal urethritis (NGU) in men. The culture of these microorganisms is very dificult, that’s why the molecular techniques, mainly the polymerase chain reaction, have become in the main detection method of this organisms. Objectives: To improve a molecular method based in technology of genes for the diagnosis of this four genital micoplasma species, applying the same in clinical samples from patients with NGU. Materials and methods: The conditions were created for a Multiplex-PCR for identify this species, using as sample reference DNA, the pairs of primer complementary to the adhesion protein gene of M. genitalium (MgPa), the rRNA 16S of M. hominis, an specific region between rRNA 16S and rRNA 23S genes of U. parvum, and the adjacent region to the urease gene specific for U. urealyticum, being a specific and sensitive method. Results: When analyzing 34 urethral sawbs samples, 27 corresponded to the Mollicutes Class, being 14,8% positive to M. genitalium, 18,5% to M. hominis, 11,1% to U. urealyticum and 3,7% to U. parvum. It was realized for fist time the diagnosis of M. genitalium, M. hominis, U. parvum and U. urealyticum in urethral samples from Cuban patients. Conclusion: It is recommended to include the diagnosis of these species in other Cuban patients with urethral symptoms, to validate the proposed method and to know the relation of these microorganisms with the NGU.
Exploring Women's Everyday Mobile Phone Experiences in Nairobi, Kenya

This article focuses on a range of Kenyan women, and their everyday experiences with mobile phones. We use our qualitative findings to broaden understanding of affordability, mobility and ease of use—design themes which underlie the motives for developing mobile phone applications in Human Computer Interaction (HCI) and Information and Communications Technology for Development (ICT4D). We find that studying women’s routine interactions with their mobile devices is useful for re-examining these themes, and for discovering new ones, including the importance of trust within mobile communication and the emotional significance women attribute to mobile devices. We then discuss the practical implications of our research, and argue that technologists should develop interventions that target Kenyan women’s everyday technology problems, rather than (as is traditional) focusing on interventions meant to improve their socioeconomic conditions. We also comment on the role of feminist theory in the design of these interventions.