Miracle-dz/UniFAR-FTUs huggingface dataset:
A Matter of Urgency: Reducing Clinical Text Message Interruptions During Educational Sessions

BACKGROUND Text messaging is increasingly replacing paging as a tool to reach physicians on medical wards. However, this phenomenon has resulted in high volumes of nonurgent messages that can disrupt the learning climate. OBJECTIVE Our objective was to reduce nonurgent educational interruptions to residents on general internal medicine. DESIGN, SETTING, PARTICIPANTS This was a quality improvement project conducted at an academic hospital network. Measurements and interventions took place on eight general internal medicine inpatient teaching teams. INTERVENTION Interventions included (1) refining the clinical communication process in collaboration with nursing leadership; (2) disseminating guidelines with posters at nursing stations; (3) introducing a noninterrupting option for message senders; (4) audit and feedback of messages; (5) adding an alert for message senders advising if a message would interrupt educational sessions; and (6) training and support to nurses and residents. MEASUREMENTS Interruptions (text messages, phone calls, emails) received by institution-supplied team smartphones were tracked during educational hours using statistical process control charts. A one-month record of text message content was analyzed for urgency at baseline and following the interventions. RESULTS The interruption frequency decreased from a mean of 0.92 (95% CI, 0.88 to 0.97) to 0.59 (95% CI, 0.51 to 0.67) messages per team per educational hour from January 2014 to December 2016. The proportion of nonurgent educational interruptions decreased from 223/273 (82%) messages over one month to 123/182 (68%; P < .01). CONCLUSIONS Creation of communication guidelines and modification of text message interface with feedback from end-users were associated with a reduction in nonurgent educational interruptions. Continuous audit and feedback may be necessary to minimize nonurgent messages that disrupt educational sessions.
Intraoperative Colloid Administration Reduces Postoperative Nausea and Vomiting and Improves Postoperative Outcomes Compared with Crystalloid Administration

The debate over colloid versus crystalloid as the best solution for intraoperative fluid resuscitation is not resolved. Published studies have shown that mortality is not related to the specific fluid used for resuscitation. In addition, the quality of postoperative recovery between colloid and crystalloid has not been well investigated. In a prospective, blinded fashion, we investigated the effects of colloid and crystalloid resuscitation on nausea and vomiting and on the postoperative patient recovery profile. Patients undergoing major elective noncardiac surgery were randomized to receive 6% hetastarch in saline (HS-NS), 6% hetastarch in balanced salt (HS-BS), or lactated Ringer’s solution (LR) on the basis of a fluid administration algorithm. The anesthetic was standardized. Hemodynamic targets included maintenance of arterial blood pressure, heart rate, and urine output within a predefined range. A postoperative morbidity survey was performed at baseline and daily after surgery. Ninety patients participated in the study, with 30 patients in each group. The amounts of study fluid (mean ± sd) administered were 1301 ± 1079 mL, 1448 ± 759 mL, and 5946 ± 1909 mL for the HS-NS, HS-BS, and LR groups, respectively (P < 0.05, HS-NS and HS-BS versus LR). Both the HS-NS and HS-BS (colloid) groups had a significantly less frequent incidence of nausea and vomiting, use of rescue antiemetics, severe pain, periorbital edema, and double vision. We concluded that intraoperative fluid resuscitation with colloid, when compared with crystalloid administration, is associated with an improvement in the quality of postoperative recovery.
Multiple MDMA (Ecstasy) Overdoses at a Rave Event

Twelve patients with 3,4-methylenedioxymethamphetamine (MDMA) toxicity from a single rave event presented to multiple San Francisco Bay area hospitals with various life-threatening complications including seizures and hyperthermia. Eight required emergent endotracheal intubation and six had hypotension. Hyperkalemia, acute kidney injury, and rhabdomyolysis were present in most of the patients. In all, 2 patients died, 4 survived with permanent neurologic, musculoskeletal, and/or renal sequelae, and 6 survived without any apparent lasting deficits. Hyperthermia was present in 10 patients and was severe (40.9-43° C) in 7. Using multiple cooling methods, the average time to achieve cooling was 2.7 hours. Serum drug analysis was performed on 3 patients, demonstrating toxic MDMA concentrations without the presence of other xenobiotics. Two capsules confiscated by police at the event contained 82% and 98% MDMA, respectively, without other pharmacologically active compounds. Capsule #2 contained 270 mg MDMA, which is more than twice the amount of MDMA usually contained in 1 dose. The MDMA-induced hyperthermia significantly contributed to the morbidity and mortality in this case series. Factors contributing to the severity of the hyperthermia include ingestion of large doses of MDMA, a warm ambient environment, and physical exertion.
Interaction between interferon γ and insulin‐like growth factor‐1 in hippocampus impacts on the ability of rats to sustain long‐term potentiation

There is compelling evidence to suggest that inflammation significantly contributes to neurodegenerative changes. Consistent with this is the observation that several neurodegenerative disorders are accompanied by an increase in the concentration of interleukin (IL)‐1β. IL‐1β has a negative impact on synaptic plasticity and therefore an increased concentration of IL‐1β, such as that in the hippocampus of the aged rat, is associated with a deficit in long‐term potentiation (LTP). IL‐1β is derived mainly from activated microglia but the trigger leading to this activation, specifically in the aged brain, remains to be identified. Here we examined the possiblity that interferon (IFN)γ may stimulate microglial activation and increase IL‐1β concentration, thereby inhibiting LTP. The IFNγ concentration was increased in hippocampus prepared from aged, compared with young, rats and inversely correlated with the ability of rats to sustain LTP. Intracerebroventricular injection of IFNγ inhibited LTP, and increased microglial activation was observed in both IFNγ‐injected and aged rats. The age‐related increase in IFNγ was accompanied by a decrease in the hippocampal concentration of insulin‐like growth factor (IGF)‐1. The evidence presented suggests that IGF‐1 acts to antagonize the IFNγ‐induced microglial activation, the accompanying increase in IL‐1β concentration and the consequent deficit in LTP.
Drug susceptibility in HIV infection after viral rebound in patients receiving indinavir-containing regimens.

CONTEXT Loss of viral suppression in patients infected with human immunodeficiency virus (HIV), who are receiving potent antiretroviral therapy, has been attributed to outgrowth of drug-resistant virus; however, resistance patterns are not well characterized in patients whose protease inhibitor combination therapy fails afterachieving viral suppression. OBJECTIVE To characterize drug susceptibility of virus from HIV-infected patients who are failing to sustain suppression while taking an indinavir-containing antiretroviral regimen. DESIGN AND SETTING Substudy of the AIDS Clinical Trials Group 343, a multicenter clinical research trial conducted between February 1997 and October 1998. PATIENTS Twenty-six subjects who experienced rebound (HIV RNA level > or =200 copies/mL) during indinavir monotherapy (n = 9) or triple-drug therapy (indinavir, lamivudine, and zidovudine; n = 17) after initially achieving suppression while receiving all 3 drugs, and 10 control subjects who had viral suppression while receiving triple-drug therapy. MAIN OUTCOME MEASURE Drug susceptibility, determined by a phenotypic assay and genotypic evidence of resistance assessed by nucleotide sequencing of protease and reverse transcriptase, compared among the 3 patient groups. RESULTS Indinavir resistance was not detected in the 9 subjects with viral rebound during indinavir monotherapy or in the 17 subjects with rebound during triple-drug therapy, despite plasma HIV RNA levels ranging from 10(2) to 10(5) copies/mL. In contrast, lamivudine resistance was detected by phenotypic assay in rebound isolates from 14 of 17 subjects receiving triple-drug therapy, and genotypic analyses showed changes at codon 184 of reverse transcriptase in these 14 isolates. Mean random plasma indinavir concentrations in the 2 groups with rebound were similar to those of a control group with sustained viral suppression, although levels below 50 ng/mL were more frequent in the triple-drug group than in the control group (P = .03). CONCLUSIONS Loss of viral suppression may be due to suboptimal antiviral potency, and selection of a predominantly indinavir-resistant virus population may be delayed for months even in the presence of ongoing indinavir therapy. The results suggest possible value in assessing strategies using drug components of failing regimens evaluated with resistance testing.
Sensory correlations in autism

This study examined the relationship between auditory, visual, touch, and oral sensory dysfunction in autism and their relationship to multisensory dysfunction and severity of autism. The Sensory Profile was completed on 104 persons with a diagnosis of autism, 3 to 56 years of age. Analysis showed a significant correlation between the different processing modalities using total scores. Analysis also showed a significant correlation between processing modalities for both high and low thresholds, with the exception that auditory high threshold processing did not correlate with oral low threshold or touch low threshold processing. Examination of the different age groups suggests that sensory disturbance correlates with severity of autism in children, but not in adolescents and adults. Evidence from this study suggests that: all the main modalities and multisensory processing appear to be affected; sensory processing dysfunction in autism is global in nature; and sensory processing problems need to be considered part of the disorder.
Anti-opioid receptor antibody recognition of a binding site on brain and leukocyte opioid receptors.

Opioid receptors reportedly exist on neuronal tissue of central and peripheral origin as well as on cells of the immune system. Previously, an opioid receptor has been purified from the neuroblastoma x glioma hybrid cell line, NG108-15 cells. In an effort to compare these results with opioid receptors isolated from primary neuronal tissue, we employed a methodology based on the molecular recognition theory to develop a monoclonal antibody which was used to isolate and biochemically characterize murine brain opioid receptors. We herein report the purification of an opioid receptor from mouse brain with a molecular weight of 65,000 daltons (range was 62-70 kD under reducing conditions) using a monoclonal antibody to an (the) opioid receptor. In situ labeling experiments with the delta-class selective opioid receptor affinity ligand, cis-(+)-3-methylfentanylisothiocyanate (SUPERFIT) of brain membrane confirmed these observations. Moreover, SUPERFIT, when coupled to the binding site, could block the recognition of the receptor by the monoclonal antibody. However, the selective, mu-class opioid receptor affinity reagent, 2-(p-ethoxybenzyl)-1-N,N-diethylaminoethyl-5-isothiocyanatobenz imidazole was ineffective at masking the binding site from recognition by the monoclonal antibody. Likewise, opioid-like receptors were purified from murine leukocytes which migrated at a molecular weight of 58,000 daltons under nonreducing conditions and 70,000 daltons under reducing conditions. In addition, immunoaffinity-purified receptor is shown to specifically bind the delta-class-selective opioid ligand, cis-(+)-3-methylfentanylisothiocyanate as well as the endogenous opioid peptides, beta-endorphin and [Met]-enkephalin. (ABSTRACT TRUNCATED AT 250 WORDS)
Quantitative and Comparative Studies of the Vocal Fold Extracellular Matrix II: Collagen

Objectives: This study examines the collagen content and turnover in the midmembranous vocal fold laminae propriae (LPs) of humans, dogs, pigs, and ferrets. Methods: The LP collagen levels were assessed by quantifying tissue hydroxyproline. Quantitative histology allowed evaluation of the collagen content in specific LP regions. Several collagen types and Two markers of collagen turnover were examined immunohistochemically. Results: Collagen made up 43.4% ± 2.6% of human LP total protein (TP), with men having approximately 30% higher collagen content than women (p > .024). The collagen levels in pigs (52.6% ± 1.9% of TP) and ferrets (29.8% ± 3.7% of TP), but not that in dogs (45.3% ± 1.2% of TP), varied significantly from that in humans (pigs, p > .016; ferrets, p > .011). Quantitative histology indicated marked interspecies differences in total collagen distribution. Collagen types I, III, and IV were detected in the LP, and spatially complex staining patterns were observed for the Two markers of collagen turnover studied. Conclusions: The collagen content of the human LP is approximately 60% to 70% of that of human dermis. Although canine LP collagen levels are most similar to those of humans, quantitative histology indicates that the collagen distribution of the human LP is best matched by the porcine LP. Collagen types I and III seem to be the dominant LP collagens. Spatial variations in collagen turnover appear to exist that may contribute to normal LP physiology.
Early Development of the Thalamic Inhibitory Feedback Loop in the Primary Somatosensory System of the Newborn Mice

Spontaneous neuronal activity plays an important role during the final development of the brain circuits and the formation of the primary sensory maps. In young rats, spindle bursts have been recorded in the primary somatosensory cortex. They are correlated with spontaneous muscle twitches and occur before active whisking. They bear similarities with the spindles recorded in adult brain that occur during early stages of sleep and rely on a thalamic feedback loop between the glutamatergic nucleus ventroposterior medialis (nVPM) and the GABAergic nucleus reticularis thalami (nRT). However, whether a functional nVPM–nRT loop exists in newborn rodents is unknown. We studied the reciprocal synaptic connections between nVPM and nRT in thalamic acute slices from mice from birth [postnatal day 0 (P0)] until P9. We first demonstrated that nVPM-to-nRT EPSCs could be distinguished from corticothalamic EPSCs by their inhibition by 5-HT attributable to the transient expression of functional presynaptic serotonin 1B receptors. The nVPM-to-nRT EPSCs and nRT-to-nVPM IPSCs were both detected the first day after birth; their amplitude near 2 nS was relatively stable until P5. At P6–P7, there was a rapid and simultaneous increase of both nVPM-to-nRT EPSCs and nRT-to-nVPM IPSCs that reached 8 and 9 nS, respectively. Our results show that the thalamic synapses implicated in spindle activity are functional shortly after birth, suggesting that they could already generate spindles during the first postnatal week. Our results also suggest an inhibitory action of 5-HT on the spindle bursts of the newborn mice.
Review Lecture: Neural mechanisms of learning: an analysis of imprinting in the domestic chick

Learning is a complex set of processes involving the acquisition and storage of information. Imprinting in the domestic chick was studied to analyse the neural basis of storage. The recently hatched chick learns the characteristics of a visually conspicuous object by being exposed to it. When a chick is trained in this way, biochemical changes can be detected in the dorsal part of the forebrain. Through a series of experiments it was shown that these changes are unlikely to be non-specific consequences of training, but more probably reflect some aspect of the storage process. By using a radioautographic technique to localize the brain region more precisely, part of the hyperstriatum ventrale was implicated in this process. Bilateral destruction of the region before imprinting prevented acquisition, and bilateral destruction after imprinting impaired retention. After exposure for 140 min to an imprinting stimulus there was an increase in the area of contact between presynaptic and postsynaptic elements in the region. This effect was found on the left side only. Sequential lesions to left and right sides confirmed that there is a hemispheric asymmetry in the role of the region in the storage of information. The area receives input from the visual pathways and possibly from other sensory pathways, and projects to regions that are thought to be involved in the control of locomotor and viscero-endocrine functions. The results afford an opportunity for the further analysis both of storage and of the whole set of neural processes that underlie imprinting in the domestic chick.
Investigation of random walks knee cartilage segmentation model using inter-observer reproducibility: Data from the osteoarthritis initiative.

BACKGROUND Existing knee cartilage segmentation methods have reported several technical drawbacks. In essence, graph cuts remains highly susceptible to image noise despite extended research interest; active shape model is often constraint by the selection of training data while shortest path have demonstrated shortcut problem in the presence of weak boundary, which is a common problem in medical images. OBJECTIVES The aims of this study is to investigate the capability of random walks as knee cartilage segmentation method. METHODS Experts would scribble on knee cartilage image to initialize random walks segmentation. Then, reproducibility of the method is assessed against manual segmentation by using Dice Similarity Index. The evaluation consists of normal cartilage and diseased cartilage sections which is divided into whole and single cartilage categories. RESULTS A total of 15 normal images and 10 osteoarthritic images were included. The results showed that random walks method has demonstrated high reproducibility in both normal cartilage (observer 1: 0.83±0.028 and observer 2: 0.82±0.026) and osteoarthritic cartilage (observer 1: 0.80±0.069 and observer 2: 0.83±0.029). Besides, results from both experts were found to be consistent with each other, suggesting the inter-observer variation is insignificant (Normal: P=0.21; Diseased: P=0.15). CONCLUSION The proposed segmentation model has overcame technical problems reported by existing semi-automated techniques and demonstrated highly reproducible and consistent results against manual segmentation method.
Cigarette smoking, fish consumption, omega-3 fatty acid intake, and associations with age-related macular degeneration: the US Twin Study of Age-Related Macular Degeneration.

OBJECTIVE To evaluate modifiable risk and protective factors for age-related macular degeneration (AMD) among elderly twins. METHODS The US Twin Study of Age-Related Macular Degeneration comprises elderly male twins from the National Academy of Sciences-National Research Council World War II Veteran Twin Registry. To determine genetic and environmental risk factors for AMD, twins were surveyed for a prior diagnosis of AMD and underwent an eye examination, fundus photography, and food frequency and risk factor questionnaires. This environmental component of the study includes 681 twins: 222 twins with AMD (intermediate or late stages) and 459 twins with no maculopathy or early signs. Risk for AMD according to cigarette smoking and dietary fat intake was estimated using logistic regression analyses. RESULTS Current smokers had a 1.9-fold increased risk (95% confidence interval, 0.99-3.68, P = .06) of AMD while past smokers had about a 1.7-fold increased risk (95% confidence interval, 1.2-2.6, P = .009). Increased intake of fish reduced risk of AMD, particularly for 2 or more servings per week (P trend = .04). Dietary omega-3 fatty intake was inversely associated with AMD (odds ratio, 0.55; 95% confidence interval, 0.32-0.95) comparing the highest vs lowest quartile. Reduction in risk of AMD with higher intake of omega-3 fatty acids was seen primarily among subjects with low levels (below median) of linoleic acid intake, an omega-6 fatty acid (P trend<.001). The attributable risk percentage was 32% for smoking and the preventive fraction was 22% for higher omega-3 intake. CONCLUSIONS This study of twins provides further evidence that cigarette smoking increases risk while fish consumption and omega-3 fatty acid intake reduce risk of AMD.
Slow-Wave Substrate Integrated Groove Gap Waveguide

A slow-wave substrate integrated groove gap waveguide (SW-SIGGW) is presented for the first time in this letter. The developed SW-SIGGW consists of three stacked substrate layers with different thickness, in which asymmetric half-height mushroom-type electromagnetic bandgap (EBG) structures are utilized for the convenience of tuning the heights of each layer. The slow-wave effect is achieved by loading periodical metallic via holes inside the groove gap waveguide in the bottom layer separating the magnetic and electric fields. In both lateral and longitudinal dimensions, 41% reductions are achieved through this new topology of SW-SIGGW, since the guided wavelength decreases significantly compared to the normal SIGGW of same width and height. A prototype of the SW-SIGGW is designed, manufactured, and measured. The simulated and measured results are in good agreement, proving the validity and feasibility of the design.
The Inhibitory Function in Human Progesterone Receptor N Termini Binds SUMO-1 Protein to Regulate Autoinhibition and Transrepression*

Although most studies of progesterone receptors (PR) and their two isoforms, PR-A and PR-B, focus on transcriptional stimulation, the receptors exhibit important inhibitory properties.Autoinhibition refers to an inhibitory function located in the PR N terminus, whose deletion increases transcriptional activity at least 6–10-fold. Transrepression refers to the ability of PR-A to suppress the transcriptional activity of PR-B and other nuclear receptors, including estrogen receptors.Self-squelching refers to the observation in transient transfection assays that increasing receptor concentrations paradoxically decrease transcriptional activity. Using a series of N-terminal deletion mutants constructed in both PR isoforms, we have mapped their autoinhibitory and transrepressor activities to a small ubiquitin-like modifier (SUMO-1) protein consensus-binding motif,387IKEE, located in the N terminus upstream of AF1. Self-squelching does not involve this site. SUMO-1 binds PR covalently at 387IKEE, but only if the C-terminal, liganded, hormone-binding domain is also present. A single point K388R mutation within the 387IKEE motif in either PR-A or PR-B leads to a loss of autoinhibitory and transrepressor functions of the liganded, full-length receptors. We conclude that autoinhibition and transrepression involve N-terminal sumoylation combined with intramolecular N/C-terminal communication.
Discovery of new antagonists aimed at discriminating UII and URP‐mediated biological activities: insight into UII and URP receptor activation

Recent evidence suggested that urotensin II (UII) and its paralog peptide UII‐related peptide (URP) might exert common but also divergent physiological actions. Unfortunately, none of the existing antagonists were designed to discriminate specific UII‐ or URP‐associated actions, and our understanding, on how these two endogenous peptides can trigger different, but also common responses, is limited.