Miracle-dz/UniFAR-FTUs huggingface dataset:
Photo quiz. Rapidly progressive skin lesions requiring admission in a young, HIV-infected man.

Diagnosis: Disseminated Cryptococcosis With Prominent Skin Involvement The patient’s serum cryptococcal antigen was strongly positive (titer >1:1024). After 96 hours of incubation, both blood and synovial fluid grew Cryptococcus neoformans. Cerebrospinal fluid (CSF) analysis showed no pleocytosis, and CSF cultures and cryptococcal antigen were negative. Skin biopsies revealed evidence of a granulomatous inflammation (arrow) in the dermis and subcutaneous tissue (Figure 1A). Round fungal organisms (arrowheads) were seen within the cytoplasm of histiocytes and multinucleated giant cells (Figure 1A-insert). Grocott’s methenamine silver stain demonstrated abundant budding yeasts ranging in size from 5 to 15 μm in diameter (Figure 1B). The budding cells (arrowhead) had a narrow base (Figure 1B-insert). Mucicarmine stain revealed the characteristic pink-red capsule of Cryptococcus neoformans. (Figure 2) The patient was treated with amphotericin lipid complex B and flucytosine. His highly active anti-retroviral therapy (HAART) regimen and trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis were continued. He was eventually discharged in overall better condition and with improved skin lesions, with plans to complete the induction phase of antifungal therapy with oral fluconazole. The final diagnosis was disseminated cryptococcosis with fungemia, joint and prominent skin involvement, and possible pulmonary involvement, but sparing the meninges, as well as an underlying HIV (human immunodeficiency virus) infection with a low CD4 cell count. Skin lesions in the setting of human innumodeficiency virus (HIV) infection often present a diagnostic challenge, and newly found nodules and/or ulcers can be the dermal manifestation of infectious and non-infectious diseases. Among the latter, drug reactions, neoplasms (including but not limited to Kaposi’s sarcoma), and vasculitides should be considered. Potential infectious agents include viruses such as Molluscum contagiosum, bacteria that include Treponema pallidum as well as non-tuberculous mycobacteria such as Pseudomonas Figure 1. Histology of the facial skin lesions. (A) Hematoxylin and eosin stain demonstrates granulomatous inflammation (arrow); the size bar corresponds to 100 μm. Fungal bodies (insert, arrowheads) are seen in the cytoplasm of histiocytes and giant cells. (B ) Grocott’s methenamine silver stain reveals abundant, variably sized, dark-stained, spherical yeasts. A narrow-based, budding yeast is demonstrated more clearly in the insert (arrowhead). Original magnifications, ×200 for A, ×400 for the A-insert and B, ×1000 for the B-insert. Figure 2. Mucicarmine stain. This special stain highlights the capsule of Cryptococcus neoformans in pink-red. Original magnification ×1000.
Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women.

BACKGROUND Herpes simplex virus infections type 1 (HSV-1) and type 2 (HSV-2) are common, but the epidemiology of HSV disease is changing. METHODS HSV-seronegative women, aged 18-30 years, who were in the control arm of the HERPEVAC Trial for Women were followed for 20 months for primary HSV infections. RESULTS Of the 3438 evaluable participants, 183 became infected with HSV: 127 (3.7%) with HSV-1 and 56 (1.6%) with HSV-2. The rate of infection for HSV-1 (2.5 per 100 person-years) was more than twice that for HSV-2 (1.1 per 100 person-years). Most infections (74% of HSV-1 and 63% of HSV-2) occurred without recognized signs or symptoms of herpes disease. The HSV-2 infection rate was 2.6 times higher in non-Hispanic black participants than in Hispanics and 5.5 times higher than in non-Hispanic whites (P < .001), while the HSV-1 infection rate was 1.7 times higher in non-Hispanic whites than non-Hispanic blacks. Younger participants (18-22 years) were more likely to acquire HSV-1 infections and less likely to develop recognized disease than older participants. Overall, 84% of recognized disease cases were genital. No differences were noted in the clinical manifestations of genital HSV-1 vs genital HSV-2 disease. The clinicians' assessment that cases were caused by HSV was good when they assessed cases as clinically confirmed or unlikely (validated in 83% and 100% of cases, respectively). CONCLUSIONS HSV-1 is now more common than HSV-2 as a cause of oral and genital mucosal infections in young women, but there are important age and race differences.
Exhaled eicosanoid profiles in children with atopic asthma and healthy controls

Chronic endobronchial inflammation is a hallmark of pediatric asthma and involves the arachidonic acid pathway. Its non‐volatile metabolites can be quantified in the exhaled breath condensate (EBC), and single substances have been studied as non‐invasive biomarkers for the diagnosis and monitoring of children with asthma. The aim of this study was to compare the content and profile of a wider range of eicosanoids in the EBC between patients and a control group.
TRUST: The 5 Rights of the Second Victim

H istorically, we have referred to ‘‘The Five Rights’’ when we consider medication safety. We deliver treatment to the right patient, with the right drug, at the right time, with the right dose, and use the right route. The purpose of this article is to propose 5 rights of our caregiversV5 human rights that our health care leaders must consider as an integral part of a fair and just culture when patients are harmed during the process of care. They may be remembered by the acronym, TRUST (Treatment that is just, Respect, Understanding and compassion, Supportive Care, and Transparency and the opportunity to contribute to learning). Not only must we bear in mind the sacred trust of our patients but we also must honor the sacred trust of our caregivers who serve in our hospitals and health care organizations. Unintentional human error and systems failures account for most preventable harm to patients.2Y13 Intentional negligence and harm because of malice is extremely rare; however, we treat our caregivers who are involved in human error and system failures with blame, shame, and, what may be most harmful, abandonment.3,6,9,12Y32 We will explore systems issues of caregiver fatigue, technology adoption without proper validation in the clinical setting, and unintentional impact of workflow reengineering that can contribute to systems vulnerability, thus increasing the risk of human error. We address the impact on caregivers of unintentional human error and systems failures that result in patient harm, an impact that can cause a very real medical emergency for the caregiverVthe second victim. If the first victims are the patients and their families who are harmed, then second victims are the caregivers and staff who sustain psychological harm when they have been involved in harming patients while trying to help them. Furthermore, we submit that a third victim is our health care organization that sustains a wound that can be worsened or lessoned by the behavior of our leaders.
Mammalian prestin is a weak Cl−/HCO3− electrogenic antiporter

• Outer hair cells of the mammalian cochlea are cells which amplify the incoming sound using mechanisms based on prestin, a molecular actuator related to a family of chloride–bicarbonate exchangers. • It has not been clear so far whether prestin has any bicarbonate–chloride exchange properties, often being described as an ‘incomplete transporter’. • Here we show, using a pH probe linked to prestin in an expression system, that prestin can transport bicarbonate at low rates and acts as an electrogenic transporter for chloride. • The high expression level of prestin in mammalian outer hair cells thus accounts for a number of previous observations of the cells’ internal pH regulation, and may indicate an additional role for prestin in homeostatic regulation of cochlear amplification.
Access control for agent-based computing: a distributed approach

The mobile software agent paradigm provides a generic, customisable foundation for the development of high performance distriubuted applications. An efficient, general‐purpose access control mechanism is required to support the development of a wide range of applications. This is achievable if the design of the access control system is based on the principles of simplicity, programmability (customisation) and reusability. However, existing mobile agent architectures either neglect this issue, or offer centralised schemes that do not support adaptive access control on a per‐agent basis and do not address the issues of secure knowledge sharing and reusing. In this paper a simple, distributed access control architecture is presented, based on the concept of distributed, active authorisation entities (lock cells), any combination of which can be referenced by an agent to provide input and/or output access control. It is demonstrated how these lock cells can be used to implement security domains and how they can be combined to create composite lock cells.
A generic Grid security policy reconciliation framework

Purpose – The purpose of this paper is to provide a framework for enhancing security policy management in the Grid.Design/methodology/approach – The Grid security policy reconciliation problem is presented. A generic view on the security policy notion is adopted and the security policy ontology notion is introduced and used.Findings – In the course of this work it was found that, in order to enhance security policy management in the Grid, Grid entities should have the ability to negotiate their security policies. It was also found that, in order to achieve security policy negotiation, effective security policy semantics manipulation towards security policy reconciliation is needed. Finally, it was established, through the use of an example, that if appropriate means are used for security policy reconciliation then incompatible security policy representations can be transformed into compatible ones.Research limitations/implications – Research limitations stem from the adoption of a generic view on the secu.
Utility of (1-3)-β-D-glucan testing for diagnostics and monitoring response to treatment during the multistate outbreak of fungal meningitis and other infections.

BACKGROUND The 2012 outbreak of fungal meningitis associated with contaminated methylprednisolone produced by a compounding pharmacy has resulted in >750 infections. An important question facing patients and clinicians is the duration of antifungal therapy. We evaluated (1-3)-β-d-glucan (BDG) as a marker for monitoring response to treatment. METHODS We determined sensitivity and specificity of BDG testing using the Fungitell assay, by testing 41 cerebrospinal fluid (CSF) specimens from confirmed cases of fungal meningitis and 66 negative control CSF specimens. We also assessed whether BDG levels correlate with clinical status by using incident samples from 108 case patients with meningitis and 20 patients with serially collected CSF. RESULTS A cutoff value of 138 pg/mL provided 100% sensitivity and 98% specificity for diagnosis of fungal meningitis in this outbreak. Patients with serially collected CSF were divided into 2 groups: those in whom BDG levels declined with treatment and those in whom BDG remained elevated. Whereas most patients with a decline in CSF BDG had clinical improvement, all 3 patients with continually elevated BDG had poor clinical outcomes (stroke, meningitis relapse, or development of new disease). CONCLUSIONS Our data suggest that measuring BDG in CSF is a highly sensitive test for diagnosis of fungal meningitis in this outbreak. Analysis of BDG levels in serially collected CSF demonstrated that BDG may correlate with clinical response. Routine measurement of BDG in CSF may provide useful adjunctive data for the clinical management of patients with outbreak-associated meningitis.
Predicting online channel use for an online and print magazine: a case study

Purpose – The purpose of this paper is to develop and empirically test a conceptual model to predict the determinants of online channel use in a multi‐channel environment.Design/methodology/approach – A case study of a free, multi‐channel entertainment magazine is used to statistically analyse a proposed model of customers' channel use (n=224) using an online survey of real consumers.Findings – The findings in the paper confirm a number of determinants of consumer attitudes. Subjective norms and consumer attitudes positively affect behavioural intention to use and intentions directly relate to actual use. The results also indicate that three constructs (i.e. enjoyment, marketing efforts and age), one from each three main determinant groups (i.e. marketing variables, individual difference variables and channel attributes), are likely to be an accurate predictor of consumer attitudes.Practical implications – The paper shows that enjoyment was an important factor among the younger, socially aware and somewha.
Single Ca2+ channels and exocytosis at sensory synapses

Abstract Hair cell synapses in the ear and photoreceptor synapses in the eye are the first synapses in the auditory and visual system. These specialized synapses transmit a large amount of sensory information in a fast and efficient manner. Moreover, both small and large signals with widely variable kinetics must be quickly encoded and reliably transmitted to allow an animal to rapidly monitor and react to its environment. Here we briefly review some aspects of these primary synapses, which are characterized by a synaptic ribbon in their active zones of transmitter release. We propose that these synapses are themselves highly specialized for the task at hand. Photoreceptor and bipolar cell ribbon synapses in the retina appear to have versatile properties that permit both tonic and phasic transmitter release. This allows them to transmit changes of both luminance and contrast within a visual field at different ambient light levels. By contrast, hair cell ribbon synapses are specialized for a highly synchronous form of multivesicular release that may be critical for phase locking to low‐frequency sound‐evoked signals at both low and high sound intensities. The microarchitecture of a hair cell synapse may be such that the opening of a single Ca2+ channel evokes the simultaneous exocytosis of multiple synaptic vesicles. Thus, the differing demands of sensory encoding in the eye and ear generate diverse designs and capabilities for their ribbon synapses.
Vaccinated children and adolescents with pertussis infections experience reduced illness severity and duration, Oregon, 2010-2012.

BACKGROUND Bordetella pertussis causes severe respiratory illness among infants and adolescents. High proportions of breakthrough infection have been observed. To understand the effect of vaccination in the era of acellular pertussis vaccines (DTaP and Tdap), we assessed if vaccination status is associated with disease severity and duration. METHODS The Multnomah County Health Department conducts enhanced pertussis surveillance for 1.7 million residents in the Portland, Oregon, metropolitan area. Surveillance activities include ascertaining demographics, clinical presentation, cough duration, vaccination history, and other health outcomes. Utilizing Advisory Committee on Immunization Practices (ACIP) routine vaccination recommendations, we analyzed a cohort of persons aged 6 weeks to 18 years with confirmed pertussis to assess illness severity and duration by vaccination status. Analysis was conducted using both logistic regression (disease severity) and survival analysis (cough duration). RESULTS During 2010-2012, 98.7% (n = 624) of patients with confirmed pertussis in our cohort had vaccination, treatment, demographic, and outcome information. Among these patients, 45% (n = 286) were ACIP up to date with vaccinations. Ever-vaccinated cases were significantly less likely to be hospitalized or develop severe illness (adjusted odds ratio [aOR], 0.2; 95% confidence interval [CI], .1-.8 and aOR, 0.4; 95% CI, .2-.9, respectively). ACIP up-to-date patients stopped coughing significantly more rapidly than unvaccinated patients (adjusted hazard ratio, 1.7; 95% CI, 1.3-2.2). CONCLUSIONS Patients with pertussis vaccination had decreased morbidity characterized by less severe illness and significantly reduced illness duration. Therefore, vaccination is recommended among at-risk individuals, and research into the nature of the residual vaccine immunity is warranted.
Critical Reflections on Information Systems: A Systemic Approach

Chapter I . 1 A Systemic Approach for the Formalization of the Information Systems Concept: Why Information Systems are Systems? Manuel Mora, UAA & DEPFI-UNAM, Mexico Ovsei Gelman, UNAM, Mexico Francisco Cervantes, ITAM, Mexico Marcelo MejÍa, ITAM, Mexico Alfredro Weitzenfeld, ITAM, Mexico
Congenital Partial Hemihypertrophy Involving Marked Malocclusion

True hemihypertrophy involves not only the soft tissues of the body but the hard tissues as well. Individuals in whom hypertrophy is so pronounced as to be readily discernible are so rare that up to 1939 (1) only 103 cases had been reported. Hemihypertrophy is generally described as being of 3 types: Total, in which an entire side of the body is involved; Partial, in which only a portion of the body is involved; and Crossed, in which some part of each side of the body is involved. The following case is one of a congenital partial hemihypertrophy. Because of its unusual nature and because of the fact that accumulated data may eventually lead to a fuller knowledge as to the etiology of the condition, it was felt that a report of the case would be valuable.
Cardiac sodium channelopathy associated with SCN5A mutations: electrophysiological, molecular and genetic aspects

Abstract Over the last two decades, an increasing number of SCN5A mutations have been described in patients with long QT syndrome type 3 (LQT3), Brugada syndrome, (progressive) conduction disease, sick sinus syndrome, atrial standstill, atrial fibrillation, dilated cardiomyopathy, and sudden infant death syndrome (SIDS). Combined genetic, electrophysiological and molecular studies have provided insight into the dysfunction and dysregulation of the cardiac sodium channel in the setting of SCN5A mutations identified in patients with these inherited arrhythmia syndromes. However, risk stratification and patient management is hindered by the reduced penetrance and variable disease expressivity in sodium channelopathies. Furthermore, various SCN5A‐related arrhythmia syndromes are known to display mixed phenotypes known as cardiac sodium channel overlap syndromes. Determinants of variable disease expressivity, including genetic background and environmental factors, are suspected but still largely unknown. Moreover, it has become increasingly clear that sodium channel function and regulation is more complicated than previously assumed, and the sodium channel may play additional, as of yet unrecognized, roles in cardiac structure and function. Development of cardiac structural abnormalities secondary to SCN5A mutations has been reported, but the clinical relevance and underlying mechanisms are unclear. Increased insight into these issues would enable a major next step in research related to cardiac sodium channel disease, ultimately enabling improved diagnosis, risk stratification and treatment strategies.
Comparison of Ca2+ transients and [Ca2+]i in the dendrites and boutons of non‐fast‐spiking GABAergic hippocampal interneurons using two‐photon laser microscopy and high‐ and low‐affinity dyes

• Previously, the use of two‐photon scanning microscopy to characterize Ca2+ transients at the individual bouton level has been primarily limited to glutamatergic terminals. • No previous study has attempted to record Ca2+ dynamics in individual boutons in response to somatic stimulation or to compare them with the Ca2+ dynamics recorded in the dendrites of the same GABAergic interneurons located in the CA1 area of the rat hippocampus. In addition, the endogenous buffer capacity that affects the decay of transients was also estimated. • This study was limited to interneurons that responded to somatic current stimulation at frequencies <60 Hz and that had cell bodies located in the stratum radiatum. • The amplitudes of the Ca2+ transients and changes in [Ca2+]i that occurred in response to somatic single or burst stimulation were much higher in boutons (428 nm/AP) than in dendrites (49 nm/AP). These data were calculated as unperturbed values, which excluded the modulatory effect of the dye's buffer capacity and the possible failure to reach equilibrium in dye concentrations in dendrites and boutons. Therefore, the higher density of Ca2+ channels expressed in boutons might account for the nine‐fold difference in Δ[Ca2+]i observed in boutons and dendrites. • Our results indicate that care should be taken when using high‐ and low‐affinity dyes to measure [Ca2+]i in boutons to avoid saturation and the erroneous calculation of [Ca2+]i.
Reply to Uçkay et al.

TO THE EDITOR—We welcome the comments by Uçkay and colleagues and thank them for their attention to detail. We also thank Dr Duncan for his enlightening editorial [1]. It is true that there has never been convincing evidence that patients with preoperative asymptomatic bacteriuria (ASB) are really at increased risk of prosthetic joint infection (PJI). Nevertheless, urine screening before total joint replacement has found its way into clinical practice among the orthopedic community. Analysis of previous articles on this subject [2–6] is hampered by their heterogeneous definition of ASB (positive culture vs sediment>5 leukocytesper highpowerfield in others) and heterogeneous antibiotic treatment regimens (no specific antibiotics vs surgery during the course of antibiotic treatment vs antibiotic treatment exclusively after surgery), and also by the low numbers of total joint replacements involved. We recognize that our results are based on a relatively small number of cases of PJI; nevertheless, with almost 2500 total joint replacements, roughly 300 cases of ASB, and 41 cases of infection, this is, to the best of our knowledge, the largest article on this subject [7]. Our finding that ASB was associated with increased risk for subsequent PJI is not based on a causal relationship. On the contrary, our study demonstrates that bacteria found in PJI were different from the pathogens of ASB.We believe that ASB serves as a surrogate marker for some yet not fully understood vulnerability to infection, particularly by gram-negative microorganisms. Whether it is caused by a distorted skin flora, as the article by Ollivere et al [8] seems to suggest, or by some kind of defective immune response remains unclear. Additional studies are needed to confirm
The role of myogenic mechanisms in human cerebrovascular regulation

• The autoregulatory capacity of the cerebral vasculature allows for maintenance of relatively stable blood flow in the face of fluctuating arterial pressure to protect neural tissue from wide swings in oxygen and nutrient delivery. • We recently found that neurogenic control plays an active role in autoregulation. Although myogenic pathways have also been hypothesized to play a role, previous data have not provided an unequivocal answer. • We examined cerebral blood flow responses to augmented arterial pressure oscillations with and without calcium channel blockade, and characterized autoregulation via a robust non‐linear method. • Blockade significantly altered the non‐linearity between pressure and flow, particularly at the slowest fluctuations, and the same rate of change in pressure elicited a larger change in flow than at baseline. • These results show that myogenic mechanisms also play a significant role in cerebrovascular regulation, and help us better understand physiological mechanisms that underlie cerebral autoregulation in humans.