Miracle-dz/UniFAR-FTUs huggingface dataset:
Effect of a geriatric consultation team on functional status of elderly hospitalized patients. A randomized, controlled clinical trial.

STUDY OBJECTIVE To evaluate the impact of a geriatric consultation team on the functional status of hospitalized elderly patients. DESIGN Randomized controlled clinical trial. SETTING University-affiliated referral Veterans Administration Medical Center. PATIENTS One hundred and seventy-eight hospitalized elderly men 75 years or older admitted to medical, surgical, and psychiatry services, but excluding patients admitted to intensive care units. INTERVENTION Eighty-eight intervention group patients received multidimensional evaluation by an interdisciplinary geriatric consultation team composed of a faculty geriatrician, geriatrics fellow, geriatric clinical nurse specialist, and a social worker trained in geriatrics. Results of the evaluation, including problem identification and recommendations, were given to the patients' physicians. Ninety control group patients received only usual care. MEASUREMENTS AND MAIN RESULTS Intervention and control groups were comparable initially. The major outcome variable was the Index of Independence in the Activities of Daily Living (ADL) (Katz). Thirty-nine percent of the total study population was functionally independent on admission, 27% required assistance with one to three ADL, 22% required assistance with four to six ADL, and 12% were completely dependent. Many patients remained unchanged from admission to discharge: intervention group, 38%; control group, 39%. In the intervention group, 34% improved and 28% declined; in the control group, 26% improved and 36% declined. Although these changes reflected a trend toward greater improvement in the intervention group, the results were not statistically significant. CONCLUSIONS Among elderly patients entering an acute-care hospital, approximately 60% had some degree of, and one third had serious functional disability. Such patients are at risk for further decline during hospitalization. A geriatric consultation team was unable to alter the degree of functional decline. Geriatric units or consultation teams may have to offer direct preventive or restorative services in addition to advice if improvements are to be made.
Current Management of Presbyopia

Presbyopia is a physiologic inevitability that causes gradual loss of accommodation during the fifth decade of life. The correction of presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. Different approaches on the cornea, the crystalline lens and the sclera are being pursued to achieve surgical correction of this disability. There are however, a number of limitations and considerations that have prevented widespread acceptance of surgical correction for presbyopia. The quality of vision, optical and visual distortions, regression of effect, complications such as corneal ectasia and haze, anisometropia after monovision correction, impaired distance vision and the invasive nature of the currently techniques have limited the utilization of presbyopia surgery. The purpose of this paper is to provide an update of current procedures available for presbyopia correction and their limitations.
Understanding the role of the middle level leader in New South Wales Catholic secondary schools

The role that leadership plays in schools is well documented. In particular, the roles of principals and teachers have received considerable research interest both in Australia and internationally. Those who lead from the middle level of leadership in secondary schools however, have received much less research interest. As such, those who are responsible for leading the learning from a faculty or subject department perspective formed the research interest of this study. This study has aimed to provide a better understanding of the role of middle level leader in New South Wales (Australia) Catholic secondary schools. The research explored the role as it was practised by eight middle level leaders, in six different Catholic secondary schools, in a regional diocese of New South Wales. The study investigated what middle level leaders did in their role, how their articulated role descriptions matched with the lived experience of their role and how the role has evolved over time. Principals of the eight middle level leaders were also interviewed to examine how their expectations aligned with those holding the role. In addition, the study sought to find whether there was unfulfilled potential in the role of middle level leadership. A conceptual framework was developed from the literature to identify key aspects at play for the role. The framework also illustrates the silences and those under-researched areas in the research literature. It highlights how this study might inform potential future understandings. The research methodology used a qualitative, multiple case study approach. It included two rounds of interviews with the eight middle level leader participants, interviews with their principals, as well as focus groups of middle level leaders and document analyses. Data were analysed and reduced to produce eight key themes. These themes provided insight into how the role was experienced. It is clear from this study that there is a need to better frame the role, subject to its local context, with clear role expectations, boundaries and authority. This reframing would be best served by engaging in a distributed leadership approach, where middle level leaders are empowered to lead learning and to make greater contributions to leadership in the school more generally. There appears to be unfulfilled potential in the role at present. It is incumbent on senior leaders to tap into this potential so the role can be strengthened to benefit schools and students. Notably, middle level leaders and their principals are generally not well aligned in terms of their expectations. An outcome of this study is a series of seven recommendations to bring about a re-imagination of the role. A model of effective middle level leadership is developed from the research to illustrate the potential for the role with its attendant complexity and demands.
An alternative recovery algorithm based on SL0 for multiband signals

Multiband signal is a typical signal in the realm of modern communication, whose spectrum is the sum of several narrow band signals in frequency domain. Modulated Wideband Converter (MWC) system, which is based on the emerging theory of Compressed Sensing (CS), can sample multiband signals at a sub-Nyquist rate without carrier frequencies as a precondition. In this paper, a novel recovery strategy for MWC is proposed, exploiting Simultaneous Smoothed ℓ0 Norm (SL0), to reconstruct original signal from sub-Nyquist sampling data. This method approximates ℓ0 norm using a continuous function, which can improve the reconstruction accuracy. Simulation results demonstrate that the proposed algorithm is superior to the original Simultaneous Orthogonal Matching Pursuit (SOMP) algorithm.
What Matters Most for Equity and Inclusion in Education Systems

3 Acknowledgments . 4 Acronyms . 5 Chapter I: Why a SABER E&I Domain? 6 Where Do We Stand on E&I in Education? 6 Why Does E&I in Education Matter? 6 How Does SABER E&I Fit within the Broader SABER Initiative and Other Work on E&I? 8 Organization of the SABER E&I “What Matters” Paper . 11 Chapter II: Establishing an Enabling Environment and Providing Adequate Resources . 13 Lever 1: Strategy and Coordination Mechanism for E&I in Education . 13 Lever 2: Availability of an E&I Diagnostic to Inform the E&I Strategy . 16 Lever 3: E&I Targets and Financial Resources Needed to Achieve Targets . 17 Lever 4: Legal and Regulatory Frameworks for E&I in Education . 23 Lever 5: Education Management Information System for E&I . 25 Chapter III: Ensuring that All Children are Ready to Learn and in School . 27 Lever 1: Ensuring that Children Enter Primary School Ready to Learn . 28 Lever 2: Reducing the Cost of Schooling and Improving Affordability for the Poor . 29 Lever 3: Ensuring that Children Can Reach Schools in a Reasonable Time. 31 Chapter IV: Ensuring that All Children and Especially Vulnerable Groups Learn in School . 33 Lever 1: Ensuring that Basic Conditions for Learning in School Are Met . 34 Lever 2: Implementing Interventions that Increase Student Learning . 36 Lever 3: Meeting the Needs of Specific Vulnerable Groups . 39 Chapter V: Conclusion . 47 Annex 1: Progress Towards Education for All: Facts from the 2015 UNESCO Global Monitoring Report . 48 Annex 2: Examples of Work on Equity and Inclusion in Education by Other Organizations . 50 Annex 3: Public Spending and Education Outcomes . 52 Annex 4: Assessing Equity in Public Spending . 54 Annex 5: UNICEF Inclusive Education Benchmarking for Children with Disabilities . 55 References . 68
Quality of care, process, and outcomes in elderly patients with pneumonia.

CONTEXT Pneumonia is a frequent cause of hospitalization and death among elderly patients, but the relationships between processes of care for pneumonia and outcomes are uncertain, making quality improvement a challenge. OBJECTIVES To assess quality of care for Medicare patients hospitalized with pneumonia and to determine whether process of care performance is associated with lower 30-day mortality. DESIGN Multicenter retrospective cohort study with medical record review. SETTING A total of 3555 acute care hospitals throughout the United States. PATIENTS A total of 14069 patients at least 65 years old hospitalized with pneumonia. MAIN OUTCOME MEASURES Four processes of care: time from hospital arrival to initial antibiotic administration; blood culture collection before initial hospital antibiotics; blood culture collection within 24 hours of hospital arrival; and oxygenation assessment within 24 hours of hospital arrival. Associations between processes of care and 30-day mortality were determined with logistic regression analysis. RESULTS National estimates of process-of-care performance were antibiotic administration within 8 hours of hospital arrival, 75.5% (95% confidence interval [CI], 73.1-77.9); blood cultures before antibiotics, 57.3% (95% CI, 54.5-60.1); initial blood culture collection, 68.7% (95% CI, 66.2-71.2); and initial oxygenation assessment, 89.3% (95% CI, 87.5-90.9). Lower 30-day mortality was associated with antibiotic administration within 8 hours of hospital arrival (odds ratio [OR], 0.85; 95% CI, 0.75-0.96) and blood culture collection within 24 hours of arrival (OR, 0.90; 95% CI, 0.81-1.00). State and territory performance estimates varied from 49.0% to 89.7% for antibiotics given within 8 hours and from 45.6% to 82.6% for blood cultures drawn within 24 hours. CONCLUSIONS Administering antibiotics within 8 hours of hospital arrival and collecting blood cultures within 24 hours were associated with improved survival. The fact that states varied widely in the performance of these measures suggests that opportunities exist to improve hospital care of elderly patients with pneumonia.
Temporal patterns of late bowel and bladder radiotherapy toxicity in a randomised controlled trial assessing duration of neo-adjuvant hormones in prostate cancer

Abstract Background. To assess the temporal patterns of late gastrointestinal (GI) and genitourinary (GU) radiotherapy toxicity and resolution rates in a randomised controlled trial (All-Ireland Cooperative Oncology Research Group 97-01) assessing duration of neo-adjuvant (NA) hormone therapy for localised prostate cancer. Material and methods. Node negative patients with > 1 of: PSA > 20 ng/mL, Gleason score ≥ 7, and stage T3 or more, were included. Follow-up, including toxicity assessment, was three-monthly in the early stages and yearly thereafter. Results. Median follow-up from the end of RT was 6.8 years. In the interval between 90 days following the end of RT and the last toxicity assessment, GI and GU toxicity (any grade) was found in 50% and 51% of 240 and 241 patients, respectively. For those who did develop toxicity, the median time from end of RT until the first development of any grade GI or GU toxicity was 1.2 years and 1.6 years, respectively, whilst median time to final resolution was 1.6 years and 2.2 years, respectively. Grade 2 (G2) or greater GI and GU toxicity occurred in 29 (12.1%) and 40 (16.6%) patients, respectively. The proportion with unresolved G2 + GI and GU toxicity was 89% and 79%, respectively, in year 1, 69% and 65% in year 2, 59% and 52% in year 3 and 27% and 32% in year 5. Conclusion. Long-term toxicities continue to occur many years after NA hormone therapy and RT. The rate of occurrence does not appear to reduce within the time frame during which our patients were followed. The percentage of patients suffering from G2 + toxicity at any time is however low. Resolution of these toxicities continues for the duration of the follow-up.
A Prospective Study of Symptomatic Hypoglycaemia in Childhood Diabetes

A prospective study of symptomatic hypoglycaemia was conducted in 47 children over a 14‐week period using a questionnaire completed at home for each episode of hypoglycaemia. Twenty‐nine children (62%) experienced 150 episodes during the study. The average incidence was once every 33 days (range 0–5.2 mo−1). Hypoglycaemia occurred more frequently in children with lowest haemoglobin A1 levels. Episodes were not randomly distributed in time; hypoglycaemia occurred significantly more frequently in the evening, in the early morning and around midday. The majority of episodes were judged to be mild but 2 children had nocturnal convulsions and glucagon was used on three occasions. Symptomatic nocturnal hypoglycaemia occurred one or more times in 30% of the children. Daytime episodes were manifested by tremor, feeling weak, dizziness, pallor, and other symptoms and signs. In 46% of cases the cause was not evident to parents or children, but 25% were related to physical activity.
RON receptor tyrosine kinase in human gliomas: expression, function, and identification of a novel soluble splice variant

Malignant gliomas are incurable because of their diffuse infiltration of the surrounding brain. The recepteur d’origine nantais (RON) receptor tyrosine kinase is highly expressed in several epithelial cancer types and mediates tumorigenic, pro‐invasive as well as metastatic effects. Analyzing RON expression in human gliomas, we found that different splice variants with known oncogenic activity are expressed in glioblastomas (GBM). In addition, the RON ligand macrophage‐stimulating protein (MSP) is secreted by cultured GBM cells. MSP showed no mitogenic effect on GBM cells but displayed significant chemotactic activity for several GBM cell lines. We identified a novel splice variant, RONΔ90, which is generated by a transcript missing exon 6. As a result of a frameshift, translation is terminated in exon 7, resulting in a truncated soluble protein. RONΔ90 transcripts are expressed in normal human brain as well as in low grade astrocytomas but only in approximately 50% of highly malignant astrocytomas. In addition, RONΔ90 is detectable in supernatants of GBM cell lines. We cloned the RONΔ90 cDNA, and purified the recombinant protein from transfected cells. RONΔ90 inhibited MSP‐induced phosphorylation of cellular RON and also attenuated basal activation levels. In addition, RONΔ90 inhibited MSP‐induced glioma cell migration as well as random motility. To conclude, RONΔ90 is a novel soluble receptor variant with antagonistic activity that may act as a physiological modulator of RON signaling. The expression of several oncogenic RON splice variants in malignant gliomas suggests that these could represent candidate targets for treatment with agents inhibiting RON activity.
Plasma cytomegalovirus DNA, pp65 antigenaemia and a low CD4 cell count remain risk factors for cytomegalovirus disease in patients receiving highly active antiretroviral therapy

ObjectiveTo study the natural history and the current risk factors for cytomegalovirus (CMV) disease in the context of highly active antiretroviral therapy (HAART). SettingProspective multicentre cohort in 15 university hospitals in France. MethodsA group of 198 patients with CD4 cell count < 100 × 106 cells/l (or < 200 × 106 cells/l under HAART for at least 2 months), no previous CMV disease and CMV-positive serology were followed every 4 months clinically and for virological testing including HIV RNA and CMV blood markers (culture, pp65 antigenaemia, plasma CMV DNA and CMV late mRNA by the polymerase chain reaction). ResultsAt inclusion, median CD4 was 77 × 106 cells/l (0–308) and 85% of the patients received protease inhibitors. The percentage of patients receiving HAART reached 99% at 12 months. After a follow-up of 23.6 months, the incidence of CMV disease was 3.2/100 patient-years [95% confidence interval (CI) 1.3–5.0]. In univariate Cox models, all the CMV markers, a CD4 cell count remaining < 75 × 106 cells/l and an HIV viral load > 100 000 copies/ml were predictive for CMV disease. The hazard ratios for CMV disease were 11 for blood culture; 14 and 70 for pp65 antigenaemia of ⩾ 1 and ⩾ 100 nuclei/200 000 cells, respectively; 35 for plasma CMV DNA; 6 for CMV mRNA; 29 for CD4 < 75 × 106 cells/l; and 12 for HIV RNA > 100 000 copies/ml. In a stepwise multivariate analysis, only three covariates were independently associated with the occurrence of a disease: plasma CMV DNA, pp65 antigenaemia ⩾ 100 nuclei/200 000 cells and a CD4 count < 75 × 106 cells/l. ConclusionCMV blood markers and CD4 count < 75 × 106 cells/l remain risk factors for CMV disease in patients receiving HAART. Analysis of plasma CMV DNA by the polymerase chain reaction is a reproducible and standardized tool that could be used as a decision marker for initiating CMV pre-emptive therapy.
Expression of S100A4 and Met: Potential Predictors for Metastasis and Survival in Early-Stage Breast Cancer

Background: To formulate individually tailored therapy for patients with early-stage breast cancer, it is necessary to identify biomarkers for predicting metastasis and survival. Methods: A homogeneous cohort of 92 T1-2N0M0 breast carcinoma patients with a long-term follow-up were divided into two groups: the metastasis group (n = 41) and the disease-free group (n = 51). We evaluated the ability of risk discrimination of six biomarkers, including S100A4, Met, bcl-2, p53, survivin, and HER-2/neu, in early-stage breast cancer. Results: In multiple logistic regression analysis, only S100A4 expression (odds ratio = 5.37, p = 0.008) and Met expression (odds ratio = 6.91, p = 0.002) were independent predictors of distant relapse. Multivariate Cox models showed S100A4 and Met expressions were associated with 10-year disease-free survival (DFS) (risk ratio 3.2 and 4.0, respectively); however, tumor size and histological grade were not significant predictors. The 10-year DFS of T1-2N0M0 patients was 55.4%. T1-2N0M0 patients with S100A4-positive tumors had a significantly worse 10-year DFS than those with S100A4-negative tumors (29.0 vs. 68.9 %, p = 0.001). The 10-year DFS in T1-2N0M0 patients with Met-negative tumors was 82.4 vs. 39.7% if Met expression was positive (p = 0.0002). S100A4, but not Met, was still a significant predictor of 10-year DFS in T1N0M0 breast carcinoma patients (p = 0.02). For the T2N0M0 subgroup, both S100A4 and Met were significantly correlated with survival. The 10-year DFS of T2N0M0 patients with S100A4-negative and Met-negative tumors was 92.3%; in those with S100A4-positive and Met-positive tumors, however, it was only 11.8%. Conclusions: S100A4 expression is an indicator of a poor prognosis for T1N0M0 breast cancer. In addition, the combination of S100A4 and Met expression gives the best risk group discrimination in the T2N0M0 subgroup. S100A4 expression appears to be an earlier step in the metastatic progression compared to Met expression in early-stage breast carcinoma.
A 4-year review of pediatric mental health emergencies in Alberta.

OBJECTIVE We sought to determine and compare rates of pediatric mental health presentations and associated costs in emergency departments (EDs) in Alberta. METHODS We examined 16 154 presentations by 12 589 patients (patient age < or = 17 yr) between April 2002 and March 2006 using the Ambulatory Care Classification System, a province-wide database for Alberta. The following variables of interest were extracted: patient demographics, discharge diagnoses, triage level, disposition, recorded costs for ED care, and institutional classification and location (i.e., rural v. urban, pediatric v. general EDs). RESULTS A 15% increase in pediatric mental health presentations was observed during the study period. Youth aged 13-17 years consistently represented the most common age group for first presentation to the ED (83.3%). Of the 16 154 recorded presentations, 21.4% were related to mood disorders and 32.5% to anxiety disorders. Presentations for substance misuse or abuse were the most prevalent reasons for a mental health-related visit (41.3%). Multiple visits accounted for more than one-third of all presentations. Presentations for mood disorders were more common in patients with multiple compared with single visits (29.3% v. 16.9%), and substance abuse or misuse presentations were more common in patients with single compared with multiple visits (47.4% v. 30.5%). The total direct ED costs for mental health presentations during the study period was Can$3.5 million. CONCLUSION This study provides comprehensive data on trends of pediatric mental health presentation, and highlights the costs and return presentations in this population. Psychiatric and medical care provided in the ED for pediatric mental health emergencies should be evaluated to determine quality of care and its relationship with return visits and costs.
The Role of IL-4 in Heligmosomoides polygyrus-Induced Alterations in Murine Intestinal Epithelial Cell Function1

IL-4 and IL-13 promote gastrointestinal worm expulsion, at least in part, through effects on nonlymphoid cells, such as intestinal epithelial cells. The role of IL-4/IL-13 in the regulation of intestinal epithelial function during Heligmosomoides polygyrus (Hp) infection was investigated in BALB/c mice infected with Hp or treated with a long-lasting formulation of recombinant mouse IL-4/αIL-4 complexes (IL-4C) for 7 days. Separate groups of BALB/c mice were drug-cured of initial infection and later reinfected and treated with anti-IL-4R mAb, an antagonist of IL-4 and IL-13 receptor binding, or with a control mAb. Segments of jejunum were mounted in Ussing chambers, and short circuit current responses to acetylcholine, histamine, serotonin, PGE2, and glucose were determined. Although only modest changes in epithelial cell function were observed during primary Hp infection, IL-4C or a secondary Hp infection each induced more dramatic changes, including increased mucosal permeability, reduced sodium-linked glucose absorption, and increased Cl− secretory response to PGE2. Some, but not all, effects of IL-4C and Hp infection were dependent on enteric nerves. Hp-induced changes in epithelial function were attenuated or prevented by anti-IL-4R mAb. Thus, IL-4/IL-13 mediate many of the effects of Hp infection on intestinal epithelial cell function and do so both through direct effects on epithelial cells and through indirect, enteric nerve-mediated prosecretory effects. These immune system-independent effector functions of IL-4/IL-13 may be important for host protection against gastrointestinal nematodes.