Miracle-dz/UniFAR-FTUs huggingface dataset:
Pain management practices surrounding lumbar punctures in children: A survey of Canadian emergency physicians.

OBJECTIVES Lumbar punctures (LPs) are painful for children, and analgesia is recommended by academic societies. However, less than one-third of pediatric emergency physicians (EPs) adhere to recommendations. We assessed the willingness to provide analgesia among pediatric and general EPs and explored patient and provider-specific barriers. METHODS We surveyed physicians in the Pediatric Emergency Research Canada (PERC) or Canadian Association of Emergency Physicians (CAEP) databases from May 1 to August 1, 2016, regarding hypothetical scenarios for a 3-week-old infant, a 3-year-old child, and a 16-year-old child requiring an LP. The primary outcome was the willingness to provide analgesia. Secondary outcomes included the type of analgesia, reasons for withholding analgesia, and their perceived competence performing LPs. RESULTS For a 3-week old infant, 123/144 (85.4%) pediatric EPs and 231/262 (88.2%) general EPs reported a willingness to provide analgesia. In contrast, the willingness to provide analgesia was almost universal for a 16-year-old (144/144 [100%] of pediatric EPs and 261/262 [99.6%] of general EPs) and a 3-year-old (142/144 [98.6%] of pediatric EPs and 256/262 [97.7%] of general EPs). For an infant, the most common barrier cited by pediatric EPs was the perception that it produced additional discomfort (13/21, 61.9%). The same reason was cited by general EPs (12/31, 38.7%), along with unfamiliarity surrounding analgesic options (13/31, 41.9%). CONCLUSION Compared to a preschool child and adolescent, the willingness to provide analgesia for an LP in a young infant is suboptimal among pediatric and general EPs. Misconceptions and the lack of awareness of analgesic options should be targets for practice-changing strategies.
Macrophage Heterogeneity in the Immunopathogenesis of Tuberculosis

Macrophages play a central role in tuberculosis, as the site of primary infection, inducers and effectors of inflammation, innate and adaptive immunity, as well as mediators of tissue destruction and repair. Early descriptions by pathologists have emphasized their morphological heterogeneity in granulomas, followed by delineation of T lymphocyte-dependent activation of anti-mycobacterial resistance. More recently, powerful genetic and molecular tools have become available to describe macrophage cellular properties and their role in host-pathogen interactions. In this review we discuss aspects of macrophage heterogeneity relevant to the pathogenesis of tuberculosis and, conversely, lessons that can be learnt from mycobacterial infection, with regard to the immunobiological functions of macrophages in homeostasis and disease.
Fusion of Hyperspectral and LiDAR Data With a Novel Ensemble Classifier

Due to the development of sensors and data acquisition technology, the fusion of features from multiple sensors is a very hot topic. In this letter, the use of morphological features to fuse a hyperspectral (HS) image and a light detection and ranging (LiDAR)-derived digital surface model (DSM) is exploited via an ensemble classifier. In each iteration, we first apply morphological openings and closings with a partial reconstruction on the first few principal components (PCs) of the HS and LiDAR data sets to produce morphological features to model spatial and elevation information for HS and LiDAR data sets. Second, three groups of features (i.e., spectral and morphological features of HS and LiDAR data) are split into several disjoint subsets. Third, data transformation is applied to each subset and the features extracted in each subset are stacked as the input of a random forest classifier. Three data transformation methods, including PC analysis, linearity preserving projection, and unsupervised graph fusion, are introduced into the ensemble classification process. Finally, we integrate the classification results achieved at each step by a majority vote. Experimental results on coregistered HS and LiDAR-derived DSM demonstrate the effectiveness and potentialities of the proposed ensemble classifier.
Comparative efficacy and acceptability of antidiabetic agents for Alzheimer's disease and mild cognitive impairment: A systematic review and network meta‐analysis

This study (registered with PROSPERO, CRD42018085967) compares the efficacy (i.e. pro‐cognitive effects) and acceptability of antidiabetic agents for Alzheimer's disease (AD) and mild cognitive impairment (MCI). Cochrane Library (CENTRAL), PubMed/MEDLINE, EMBASE and PsycINFO were searched from inception to January 15, 2018 for randomized controlled trials comparing antidiabetic agents with placebo and/or another active antidiabetic agent for the treatment of AD or MCI. Nineteen eligible studies (n = 4855) evaluating the effects of 6 different antidiabetic drugs (i.e. intranasal insulin, pioglitazone, rosiglitazone, metformin, sitagliptin and liraglutide) were included. The results of 29 pairwise comparisons indicated that cognition was significantly improved in subjects treated with antidiabetic agents compared with placebo. Pioglitazone 15 to 30 mg demonstrated the greatest efficacy compared to placebo in network meta‐analysis. No significant differences in acceptability were identified when comparing agents with each other and with placebo. The current findings indicate a pro‐cognitive class effect of antidiabetic agents in AD/MCI. Other antidiabetic agents should also be investigated in future studies.
Infantile Onset Intractable Inflammatory Bowel Disease Due to Novel Heterozygous Mutations in TNFAIP3 (A20).

Background Mutations in tumor necrosis factor alpha-induced protein 3 (TNFAIP3), a key player in the negative feedback regulation of nuclear factor-κB signaling, have recently been recognized as leading to early onset autoinflammatory and autoimmune syndrome. Here, we have reported the phenotypes of 3 infantile onset intractable inflammatory bowel disease (IBD) patients with TNFAIP3 mutations and reviewed previously reported cases to establish phenotypic features associated with TNFAIP3 monogenicity. Methods From January 1, 2015, to December 31, 2017, we recruited 58 infantile-onset IBD patients. Targeted sequencing and whole-exome sequencing were performed. Sanger sequencing confirmed the variants and determined the parental origin. We followed all the patients with TNFAIP3 mutations in our cohort and analyzed their clinical data. Results Genetic screening in all 58 patients with infantile-onset IBD revealed 44 (75.9%) cases of monogenic disorders, and 3 de novo TNFAIP3 mutations were identified, including 1 nonsense and 2 frame shift mutations. All the mutations resulted in premature stop codon. All 3 patients had multiple systemic involvements, with predominant gastrointestinal diseases. Conclusions Most infantile-onset IBD was associated with monogenetic mutation, and in addition to the 50 reported genes, other rare genetic variants need to be determined. TNFAIP3 may be an important candidate gene. The treatment of TNFAIP3-associated infantile-onset-IBD was challenging. 10.1093/ibd/izy165_video1izy165. video15789607089001.
Organ Donation After Circulatory Death: Ethical Issues and International Practices

Donation after circulatory death (DCD) is an increasingly utilized practice that can contribute to reducing the difference between the supply of organs and the demand for organs for transplantation. As the number of transplanted organs from DCD donors continues to increase, there is an essential need to address the ethical aspects of DCD in institutional DCD protocols and clinical practice. Ethical issues of respecting the end-of-life wishes of a potential donor, respecting a recipient’s wishes, and addressing potential conflicts of interest are important considerations in developing policies and procedures for DCD programs. Although there may be diversity among DCD programs in Europe, Australia, Israel, China, the United States, and Canada, addressing ethical considerations in these DCD programs is essential to respect donors and recipients during the altruistic and generous act of organ donation.
The cursed duet today: TB and HIV-coinfection

1,686 Characters with spaces included) The TB and HIV syndemic continues to rage and are a major public health concern worldwide. This deadly association raises complexity, and represent a significant barrier towards TB elimination. TB continues to be the leading cause of death amongst HIV-infected people. This paper reports the challenges that lay ahead and outlines some of the current and future strategies that may be able to address this co-epidemic efficiently. Improved diagnostics, cheaper and more effective drugs, shorter treatment regimens for both drug-sensitive and drug-resistant TB are discussed. Also, special topics on drug interactions, TB-IRIS and TB relapse are also described. Notwithstanding the defeats and meagre investments, diagnosis and management of the two diseases have seen significant and unexpected improvements of late. On the HIV side, expansion of ART coverage, development of new updated guidelines aimed at the universal treatment of those infected, and the increasing availability of newer, more efficacious and less toxic drugs are an essential element to controlling the two epidemics. On the TB side, diagnosis of MDR-TB is becoming easier and faster thanks to the new PCR-based technologies, new anti-TB drugs active against both sensitive and resistant strains (i.e. bedaquiline and delamanid) have been developed and a few more are in the pipeline, new regimens (cheaper, shorter and/or more effective) have been introduced (such as the ‘Bangladesh regimen’) or are being tested for MDR-TB and drugsensitive-TB. However, still more resources will be required to implement an integrated approach, install new diagnostic tests, and develop simpler and shorter treatment regimens.
On the Power of Hybrid Networks in Multi-Party Computation

Perfectly-secure verifiable secret sharing (VSS) and multi-party computation (MPC) protocols in asynchronous network tolerate only at most one-fourth of corruption, while their counterparts in synchronous network sustain against at most one-third corruption. Moreover property-wise, synchronous protocols provide much stronger guarantees than the asynchronous counterparts. Taking note of the fact that asynchronous network is more realistic on one hand and on the other, synchrony of a network has positive impact on several aspects of distributed protocols including properties and fault-tolerance, we explore the power of hybrid networks that combines best of both the worlds by supporting a few synchronous rounds at the onset of a protocol execution, before turning to asynchronous mode. In hybrid networks, we investigate various feasibility questions pertaining to protocols giving guarantees attainable in synchronous and asynchronous networks. For the asynchronous protocols in hybrid networks, we hope to leverage the initial synchronous rounds to bridge the gap in the fault-tolerance with the synchronous protocols under minimal synchrony assumption. We ask the following fundamental question of both theoretical and practical importance: What is the minimum number of initial synchronous rounds necessary and sufficient in a hybrid network to construct asynchronous perfectly-secure VSS and MPC protocols with the fault-tolerance of synchronous protocols? On the positive note, we show that the answer is one for VSS which is clearly optimal. Notably no broadcast oracle is invoked in the synchronous round of our proposed VSS protocol. On the negative side, we prove that one synchronous round is not enough for MPC, putting MPC on a higher pedestal than VSS in terms of difficulty. For synchronous protocols in hybrid networks, we hope to save on the synchronous rounds leveraging conveniently the available asynchronous phase. We settle the question for VSS in the negative showing that three rounds that are known to be necessary (and sufficient) for VSS in synchronous networks, are also required in hybrid networks. VSS being a special case of MPC, the lower bound holds true for MPC. We match the lower bound with a three-round protocol. Notably, synchronous MPC with cryptographic security is known to be achievable in hybrid networks with one synchronous round.
Minimal Surfaces for 3D Shape Matching: A Linear Programming Solution

We propose a novel method for computing a spatially dense matching between two 3D shapes. It is based on finding a minimal surface in the high-dimensional space representing the product of two shape surfaces. Computationally, the proposed approach leads to a binary linear program whose relaxed version can be solved efficiently in a globally optimal manner. We consider two cost functions for matching. The first one aims at computing a matching which minimizes a thin-shell energy measuring the physical energy necessary to deform one shape into the other. The second one additionally imposes that corresponding elements on either surface should have a similar local feature descriptor. Experimental results demonstrate that the proposed LP relaxation allows to compute high-quality matchings which reliably put into correspondence articulated 3D shapes.
Association of Plasma Lipids and Polar Metabolites with Low Bone Mineral Density in Singaporean-Chinese Menopausal Women: A Pilot Study

The diagnosis of osteoporosis is mainly based on clinical examination and bone mineral density assessments. The present pilot study compares the plasma lipid and polar metabolite profiles in blood plasma of 95 Singaporean-Chinese (SC) menopausal women with normal and low bone mineral density (BMD) using an untargeted metabolomic approach. The primary finding of this study was the association between lipids and femoral neck BMD in SC menopausal women. Twelve lipids were identified to be associated with low BMD by the orthogonal partial least squares (OPLS) model. Plasma concentrations of eight glycerophospholipid, glycerolipid, and sphingolipid species were significantly lower in menopausal women with low BMD but higher in two glycerophospholipid species (phosphatidylinositol and phosphatidic acid). Further, this study found no significant differences in plasma amino acid metabolites. However, trends for lower 4-aminobutyric acid, turanose, proline, aminopropionitrile, threonine, and methionine were found in women with low BMD. This pilot study identified associations between lipid metabolism and femoral neck BMD in SC women. Further studies are required on larger populations for evaluating the bone health effect of these compounds and their usefulness as clinical biomarkers for osteoporosis prediction in women.
Volume ? ?-Thermal and Compositional Evolution of the Core

This chapter examines the thermal and compositional evolution of the Earth’s core, from its formation to the present day. Late-stage planetary accretion involved collisions between comparably-sized objects which were already differentiated and probably partially molten. The final collisions experienced by the Earth were sufficiently energetic to assure formation of one or several magma oceans, with highly uncertain lifetimes. On impact, the impactor cores were likely emulsified to ∼cm-sized droplets as they sank through the magma ocean. This emulsification permitted equilibration between the iron droplets and the mantle just above the base of the magma ocean, and overprinted any previously-acquired chemical signatures. Siderophile element abundances suggest equilibration happened at 500-1000 km depth and 2000-3000 K; equilibration between core and mantle material is also suggested by Hf-W isotopes. The Hf-W isotope data also imply that core formation was complete by ≈30-50 Myr after solar system formation, roughly consistent with the accretion timescales obtained by N-body simulations. Delivery of iron from the base of the magma ocean to the core was probably rapid, likely involving diapirism, and occurred without further equilibration. The rapid descent of core material liberated significant amounts of gravitational energy, and the resulting initial core temperature was probably at least 5500 K. Uncertainties remain, notably the behaviour of large impactors as they traverse the target’s mantle, the time evolution of the core and mantle chemistry (e.g. oxidation state), and the light-element composition of the core. The present-day core geodynamo is maintained primarily by compositional convection as the inner core solidifies. The CMB heat flux is estimated at 10±4 TW and is sufficient to drive a dynamo dissipating 1-5 TW. The evolution of the core to its present-day state involved two events of importance: the initiation of the geodynamo; and the onset of inner core formation. Geodynamo activity started at 3.5 Gyr B.P. at the latest, and could have been sustained without an inner core being present. Theoretical estimates suggest that the inner core probably formed at ∼1 Gyr B.P., unless either significant quantities of potassium were present in the core, or both the ohmic dissipation (<0.25 TW) and the core-mantle boundary heat flow (<4 TW) were very low. The Re-Os isotopic system has been used to infer that inner core solidification started by 3.5 Gyr B.P., but this hypothesis remains controversial. For a moderately dissipative dynamo, the change in core temperature over 4 Gyr was probably 200-800 K, implying an early lower mantle that was extensively molten. The CMB heat flux probably evolved in two stages: an early, high heat flux stage, due to the melting of the lower mantle, and potentially generating very strong magnetic fields; and a later, lower heat flux stage.
Computing the thickness of the ventricular heart wall from 3D MRI images

A method for measuring the thickness of the ventricular heart wall from 3D MRI images is presented. The quantification of thickness could be useful clinically to measure the health of the heart muscle. The method involves extending a Laplace-equation-based definition of thickness between two surfaces to the ventricular heart wall geometry. Based on the functional organization of the heart, it is proposed that the heart be segmented into two volumes, the left ventricular wall which completely encloses the left ventricle and the right ventricular wall which attaches to the left ventricular wall to enclose the right ventricle, and that the thickness of these two volumes be calculated separately. An algorithm for performing this segmentation automatically is presented. The results of the automatic segmentation algorithm were compared to the results of manual segmentations of both normal and failing hearts and an average of 99.28% of ventricular wall voxels were assigned the same label in both the automatic and the manual segmentations. The thickness of eleven hearts, seven normal and four failing was measured.
CDPBC: A Software Application for Estimation of Concentration Dependent Plasma Binding Capacity of Small Molecule

Drug‐plasma binding (DPB) is an important aspect during pharmacokinetics (PK) studies. DPB of small molecule cannot be evaluated through computational means. Here we present CDPBC; a standalone application for evaluation of small molecule for its capacity (concentration dependent) of binding with plasma proteins. This application is freely available at URL (https://github.com/undwive di/CDPBC.git). The application is enriched with evaluation of five major proteins of plasma. Input for application is a docked complex against the suggested PDBs of plasma proteins. As part of the analysis, software compares interaction of query compound with control compound. Main output comes as plot as well as table displaying percentage of binding in reference of concentration gradient of small molecule used in docking. The application is an advanced add‐on component to ADME analysis of small molecules as well as lead optimization.
Microbial activity during a coastal phytoplankton bloom on the Western Antarctic Peninsula in late summer

Phytoplankton biomass during the austral summer is influenced by freezing and melting cycles as well as oceanographic processes that enable nutrient redistribution in the West Antarctic Peninsula (WAP). Microbial functional capabilities, metagenomic and metatranscriptomic activities as well as inorganic 13C- and 15N-assimilation rates were studied in the surface waters of Chile Bay during two contrasting summer periods in 2014. Concentrations of Chlorophyll a (Chla) varied from 0.3 mg m-3 in February to a maximum of 2.5 mg m-3 in March, together with a decrease in nutrients; however, nutrients were never depleted. The microbial community composition remained similar throughout both sampling periods; however, microbial abundance and activity changed with Chla levels. An increased biomass of Bacillariophyta, Haptophyceae and Cryptophyceae was observed along with night-grazing activity of Dinophyceae and ciliates (Alveolates). During high Chla conditions, HCO3- uptake rates during daytime incubations increased 5-fold (>2516 nmol C L-1 d-1), and increased photosynthetic transcript numbers that were mainly associated with cryptophytes; meanwhile night time NO3- (>706 nmol N L-1 d-1) and NH4+ (41.7 nmol N L-1 d-1) uptake rates were 2- and 3-fold higher, respectively, due to activity from Alpha-/Gammaproteobacteria and Bacteroidetes (Flavobacteriia). Due to a projected acceleration in climate change in the WAP, this information is valuable for predicting the composition and functional changes in Antarctic microbial communities.
Perioperative noninvasive cardiac output monitoring in parturients with singleton and twin pregnancies undergoing cesarean section under spinal anesthesia with prophylactic phenylephrine drip: a prospective observational cohort study

Abstract Purpose: Spinal anesthesia is considered the gold standard anesthetic technique for cesarean deliveries (CDs) but is associated with a high rate of hypotension. The recent international consensus recommends continuous prophylactic phenylephrine infusion (PPI) administered throughout CD to prevent hypotension. However, little information is available on the hemodynamic profiles of women with twin pregnancies as compared to singleton pregnancies perioperatively. Therefore, in this study, we aim to compare maternal hemodynamic changes both intraoperatively and postoperatively with the use of the NICAS bioimpendence monitor in healthy singleton versus twin parturients undergoing CD deliveries with spinal anesthesia with PPI. Materials and methods: After IRB approval and signed informed consent, healthy term women with either twin or singleton pregnancies undergoing spinal anesthesia for uncomplicated CD were enrolled. The following data were collected – cardiac output (CO), stroke volume (SV), mean arterial pressure (MAP), and total peripheral resistance (TPR). Measurements were measured at five time points: (1) before arrival in OR, (2) after spinal anesthesia with PPI, (3) after beginning of oxytocin infusion, (4) in post anesthesia care room, (5) 24 hours postoperatively, and (6) 48 hours postoperatively. All parturients received standardized spinal solution consisting of 12 mg hyperbaric bupivacaine, 20 µg fentanyl and 100-µg preservative-free morphine. PPI administered was titrated to preserve blood pressure to 20% of baseline blood pressure and stopped at the end of surgery. Oxytocin was administered as a continuous infusion (20-units/1000 cm3 Ringer’s lactate) at a rate of 100 cm3/h. Results: One hundred and thirty seven parturients with singleton pregnancies and 27 parturients with twin pregnancies completed the study. There were no significant differences between groups in age or BMI. Intraoperatively, there was no difference in any hemodynamic parameter. However, postoperatively at all three times women with twin pregnancies had higher MAP, lower CO and higher TPR compared with parturients with singleton pregnancies. Conclusions: There were significant hemodynamic changes postoperatively but not intraoperatively in parturients with twin pregnancies compared to women with singleton pregnancies. These changes need to be further investigated.