Miracle-dz/UniFAR-FTUs huggingface dataset:
Comprehensive Facility‐Wide Approach Improves Outcomes after Lower Extremity Surgical Arthroplasty in an Acute Care Hospital

Abstract: The number of total knee and hip arthroplasty is predicted to rise 174% and 673%, respectively, over the next 20 years due to the expected rise in the baby boomer population. Along with increased numbers or procedures performed is the rise in cost and potential medical complications from hospitalizations. The purpose of this study is to describe one rural hospital's facility‐wide procedure to streamline processes and standardize care without compromising patient medical needs prior to, and during, the acute phase of total knee and hip arthroplasty. Data were compared before and after the facility‐wide procedure was implemented. Results found shorter length of hospital stay and significantly more discharges directly home all without increasing medical complications after the facility‐wide procedure was implemented.
Sustaining Nurse‐Rapid HIV Testing in the U.S. Department of Veterans Affairs: Lessons Learned from a Comparative Evaluation

Abstract: Routine HIV testing in primary care is now recommended in the United States. The U.S. Department of Veterans Affairs (VA) has increased the number of patients tested for HIV, but overall HIV testing rates remain low. A promising intervention for increasing HIV testing is nurse‐initiated rapid testing (NRT). The purpose of this study was to build upon our previous research by implementing NRT in primary care clinics at two geographically distinct VA medical centers, and then conduct an evaluation to identify the barriers and facilitators to implementing and sustaining it. Semistructured telephone interviews were conducted with providers and stakeholders at two VA medical centers, one each on the East Coast and in the Southwest. Fieldnotes were developed following each interview and qualitatively coded for emerging themes. Findings indicate NRT was well integrated in both settings. NRT took little time to conduct, was well received by patients, and did not disrupt clinical scheduling. However, there were some sustainability challenges, including difficulties using the electronic medical record, and the challenges of new care practice structures. Implementing NRT is feasible in VA primary care settings. However, organizational challenges should be taken into account for subsequent efforts to implement NRT in VA primary care settings.
VI. Meta-Analysis of Calcitonin for the Treatment of Postmenopausal Osteoporosis

Objective: To review the effect of calcitonin on bone density and fractures in postmenopausal women. Data Source: We searched MEDLINE and EMBASE from 1966 to 2000 and examined citations of relevant articles and the proceedings of international osteoporosis meetings. We contacted osteoporosis investigators to identify additional studies and primary authors for unpublished data. Study Selection: We included 30 studies that randomized women to calcitonin or an alternative (placebo or calcium and/or vitamin D) and measured bone density or fracture incidence for at least 1 yr. Data Extraction: For each trial, three independent reviewers assessed the methodological quality and abstracted data. Data Synthesis: Calcitonin reduced the incidence of vertebral fractures, with a pooled relative risk (RR) of 0.46 [95% confidence interval (CI) 0.25-0.87, P = 0.02, n = 1404, 4 trials]. However, the RR from the one relatively large randomized controlled trial (RCT) was 0.79 (95% CI 0.62-1.00, P = 0.05, n = 1108). For nonvertebral fractures, the pooled RR was 0.52 (95% CI 0.22-1.23, P = 0.14, n = 1481, 3 trials). Once again, the single large trial showed a less impressive effect than the smaller trials (RR 0.80, 95% CI 0.59-1.09, P = 0.16, n = 1245). For bone density of the lumbar spine, the pooled weekly dose of 250 to 2800 IU per week resulted in significant increase in the weighted mean difference (WMD) of 3.74 (2.04-5.43, P < 0.01, n = 2260, 24 trials). The combined forearm showed a similar effect, with a WMD of 3.02 (95% CI 0.98-5.07, P < 0.01, n = 468, 9 trials). At the femoral neck, the pooled weighted mean difference showed a nonsignificant trend toward benefit, WMD 3.80 (95% CI-0.32-7.91, P = 0.07, 9 trials, n = 513). Methodologically weaker studies tended to show greater effects on bone density, and the lumbar spine results suggested the possibility of publication bias. Conclusions: Calcitonin likely increases bone density in postmenopausal women predominantly at the lumbar spine and forearm for weekly doses of greater than 250 IU, although the true effect may be smaller than the pooled estimate would suggest. Calcitonin likely reduces the risk of vertebral fracture; its effect on nonvertebral fracture remains uncertain.
Gait asymmetry detection in older adults using a light ear-worn sensor

Measuring gait asymmetry is an important feature when characterizing functional imbalance between limbs. This could be due to pathologies, such as osteoarthritis, stroke, or associated with the effects of surgeries such as hip arthroplasty. Generally, the study of asymmetry or imbalance has required the use of a gait lab or force plates, which could be expensive and difficult to use in home settings. This work validates the use of a light weight ear sensor (7.4 g) with an instrumented treadmill for 64 subjects (age (60.04 (15.36)) including healthy subjects (14) as well as subjects who had been treated for hip (17), knee-replacement surgery (21) and knee osteoarthritis (12). Subjects performed treadmill walking at several speeds on flat surfaces, inclines and declines. Accelerometer data from the ear sensor were segmented into consecutive steps and temporal features were extracted. The measures of gait cycle time and step-period asymmetry obtained from the ear sensor matched well those of the treadmill for flat surfaces, inclines and declines. The key implication of the study is that the proposed method could replace expensive equipment for monitoring temporal gait features in clinics as well as free-living environments, which is important for monitoring rehabilitation after surgery and the progress of diseases affecting limb imbalance.
Nonintubated Thoracoscopic Lobectomy for Lung Cancer

Objective:To evaluate the feasibility and safety of thoracoscopic lobectomy without endotracheal intubation. Summary Background Data:General anesthesia with single-lung ventilation is considered mandatory for thoracoscopic lobectomy for non–small cell lung cancer (NSCLC). Nonintubated thoracoscopic lobectomy has not been reported previously. Methods:From August 2009 through June 2010, some 30 consecutive patients with clinical stage I or II NSCLC were treated by nonintubated thoracoscopic lobectomy using epidural anesthesia, intrathoracic vagal blockade, and sedation. To evaluate the feasibility and safety of this novel technique, they were compared with a control group consisting of 30 consecutive patients with clinical stage I or II NSCLC who underwent thoracoscopic lobectomy using intubated general anesthesia from August 2008 through July 2009. Results:Collapse of the operative lung and inhibition of coughing were satisfactory in the nonintubated patients, induced by spontaneous breathing, and vagal blockade. Three patients in the nonintubated group required conversion to intubated-single lung ventilation because of persistent hypoxemia, poor epidural anesthesia pain control, and bleeding. One patient in each group was converted to thoracotomy because of bleeding. The 2 groups had comparable anesthesia durations, surgical durations, blood loss, and numbers of dissected lymph nodes. Patients who underwent nonintubated surgery had lower rates of sore throat (6.7% vs 40.0%, P = 0.002) and earlier resumption of oral intake (mean, 4.7 hours vs 18.8 hours, P < 0.001). Patients undergoing nonintubated surgery also had a trend toward better noncomplication rates (90% vs 66.7%, P = 0.057) and shorter postoperative hospital stays (mean, 5.9 days vs 7.1 days, P = 0.078). Conclusions:Nonintubated thoracoscopic lobectomy is technically feasible and is as safe as lobectomy performed with intubation in highly selected patients. It can be a valid alternative of single-lung-ventilated thoracoscopic surgery in managing early-stage NSCLC.
Surgical Stress Response and Postoperative Immune Function After Laparoscopy or Open Surgery With Fast Track or Standard Perioperative Care: A Randomized Trial

Objective: To evaluate the effect of laparoscopic or open colectomy with fast track or standard perioperative care on patient's immune status and stress response after surgery. Methods: Patients with nonmetastasized colon cancer were randomized to laparoscopic or open colectomy with fast track or standard care. Blood samples were taken preoperatively (baseline), and 1, 2, 24, and 72 hours after surgery. Systemic HLA-DR expression, C-reactive protein, interleukin-6, growth hormone, prolactin, and cortisol were analyzed. Results: Nineteen patients were randomized for laparoscopy and fast track care (LFT), 23 for laparoscopy and standard care (LS), 17 for open surgery and fast track care (OFT), and 20 for open surgery and standard care (OS). Patient characteristics were comparable. Mean HLA-DR was 74.8 in the LFT group, 67.1 in the LS group, 52.8 in the OFT group, and 40.7 in the OS group. Repeated-measures 2-way analysis of variance (ANOVA) showed this can be attributed to type of surgery and not aftercare (P = 0.002). Interleukin-6 levels were highest in the OS group. Repeated-measures 2-way ANOVA showed this can be attributed to type of surgery and not aftercare (P = 0.001). C-reactive protein levels were highest in the OS group. Following repeated-measures 2-way ANOVA, this can be attributed to type of surgery and not aftercare (P = 0.022). Growth hormone was lowest in the LFT group. Following repeated-measures 2-way ANOVA, this can be attributed to type of aftercare and not to type of surgery (P = 0.033). No differences between the groups were seen regarding prolactin or cortisol. No differences in (infectious) complication rates were observed between the groups. Conclusions: This randomized trial showed that immune function of HLA-DR in patients undergoing laparoscopic surgery with fast track care remains highest. This can be attributed to type of surgery and not aftercare. These results may indicate a reason for the accelerated recovery of patients treated laparoscopically within a fast track program as described in the LAparoscopy and/or FAst track multimodal management versus standard care (LAFA-Trial) (www.trialregister.nl, protocol NTR222).
On the size of graphs with complete-factors

A spanning subgraph H of a graph G is called a Kl-factor if each component of H is isomorphic to the complete graph of order l. We determine the minimum size for any graph to have a Kl-factor. Relating this result, we give a new short proof of the Erdos-Gallai theorem on the maximum size of graphs with at most β independent edges.
The longest cycle of a graph with a large minimal degree

We show that every graph G on n vertices with minimal degree at least n/k contains a cycle of length at least [n/(k − 1)]. This verifies a conjecture of Katchalski. When k = 2 our result reduces to the classical theorem of Dirac that asserts that if all degrees are at least 1/2n then G is Hamiltonian.
Prisoner’s Dilemma

To the Editor: A l-Sahaf et al1 report that the removal of the primary tumor led to a progressive phenotype of lung metastases that exhibited upregulation of genes involved in adhesion, invasion, and angiogenesis. I hope to give a simplified explanation of the process on the basis of game theory. A few clinical investigations suggest that while surgical removal of primary breast cancer favorably modifies the natural history for some patients, it may also hasten metastatic development for others. The concepts underlying this disease paradigm, that is, tumor homeostasis, tumor dormancy, and surgery-driven enhancement of metastasis development, have a long history.2 The evolution of cooperation has a well-established theoretical framework based on game theory. At a fundamental level, the field of game theory evolved from the mathematical exploration of conflict situations between rational entities that make predictable and reproducible choices. Subsequent mathematical formulae are derived from and are dependent on these prerequisites.3
Identification and characterization of Mini1, a gene regulating rice shoot development.

The aerial parts of higher plants are generated from the shoot apical meristem (SAM). In this study, we isolated a small rice (Oryza sativa L.) mutant that showed premature termination of shoot development and was named mini rice 1 (mini1). The mutant was first isolated from a japonica cultivar Zhonghua11 (ZH11) subjected to ethyl methanesulfonate (EMS) treatment. With bulked segregant analysis (BSA) and map-based cloning method, Mini1 gene was finally fine-mapped to an interval of 48.6 kb on chromosome 9. Sequence analyses revealed a single base substitution from G to A was found in the region, which resulted in an amino acid change from Gly to Asp. The candidate gene Os09g0363900 was predicted to encode a putative adhesion of calyx edges protein ACE (putative HOTHEAD precursor) and genetic complementation experiment confirmed the identity of Mini1. Os09g0363900 contains glucose-methanol-choline (GMC) oxidoreductase and NAD(P)-binding Rossmann-like domain, and exhibits high similarity to Arabidopsis HOTHEAD (HTH). Expression analysis indicated Mini1 was highly expressed in young shoots but lowly in roots and the expression level of most genes involved in auxin biosynthesis and signal transduction were reduced in mutant. We conclude that Mini1 plays an important role in maintaining SAM activity and promoting shoot development in rice.
Bounds for the harmonious chromatic number of a graph

The upper bound for the harmonious chromatic number of a graph given by Zhikang Lu and by C. McDiarmid and Luo Xinhua, independently (Journal of Graph Theory, 1991, pp. 345–347 and 629–636) and the lower bound given by D. G. Beane, N. L. Biggs, and B. J. Wilson (Journal of Graph Theory, 1989, pp. 291–298) are improved. © 1994 Wiley Periodicals, Inc.
Origins and mechanisms of hysteresis in organometal halide perovskites

Inorganic–organic halide organometal perovskites, such as CH3NH3PbI3 and CsPbI3, etc, have been an unprecedented rising star in the field of photovoltaics since 2009, owing to their exceptionally high power conversion efficiency and simple fabrication processability. Despite its relatively short history of development, intensive investigations have been concentrating on this material; these have ranged from crystal structure analysis and photophysical characterization to performance optimization and device integration, etc. Yet, when applied in photovoltaic devices, this material suffers from hysteresis, that is, the difference of the current–voltage (I–V) curve during sweeping in two directions (from short-circuit towards open-circuit and vice versa). This behavior may significantly impede its large-scale commercial application. This Review will focus on the recent theoretical and experimental efforts to reveal the origin and mechanism of hysteresis. The proposed origins include (1) ferroelectric polarization, (2) charge trapping/detrapping, and (3) ion migration. Among them, recent evidence consistently supports the idea that ion migration plays a key role for the hysteretic behavior in perovskite solar cells (PSCs). Hence, this Review will summarize the recent results on ion migration such as the migrating ion species, activation energy measurement, capacitive characterization, and internal electrical field modulation, etc. In addition, this Review will also present the devices with alleviation/elimination of hysteresis by incorporating either large-size grains or phenyl-C61-butyric acid methyl ester molecules. In a different application, the hysteretic property has been utilized in photovoltaic and memristive switching devices. In sum, by examining these three possible mechanisms, it is concluded that the origin of hysteresis in PSCs is associated with a combination of effects, but mainly limited by ion/defect migration. This strong interaction between ion motion and free charge carrier transport can be modulated by the prevalent crystalline structure, chemical passivation, and an external photo/electrical field.
Book review Your guide to E-Health:third millenium medicine on the Internet

There are two main sets of ideas in this book. The first concerns the ways that the Internet can be used by theaverage health care consumer to obtain advice from health care professionals or from other people who share hisor her health problems. The second concerns the ways in which health care professionals (and mainly doctors)can take advantage of the Internet to improve their own clinical practice, and make a contribution to improvingthe operation of the health care system as a whole.
Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

The Japanese Society of Hepato‐Biliary‐Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract and ampullary carcinomas in 2008. Novel treatment modalities and handling of clinical issues have been proposed after the publication. New approaches for editing clinical guidelines, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, also have been introduced for better and clearer grading of recommendations.
Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: The EUROSTAR experience

Abstract Objective: The EUROSTAR (European Collaborators on Stent/graft techniques for aortic aneurysm repair) Registry was established in 1996 to collect data on the outcome of treatment of patients with infrarenal aortic aneurysms with endovascular repair. To date, 88 European centers of vascular surgery have contributed. The purpose of the study was to evaluate the results of this treatment in the medium term (up to 4 years) according to the analysis of "hard" or primary end points of rupture, late conversion, and death. Patients and Methods: Patients with aortic aneurysms suitable for endovascular aneurysm repair were notified to the EUROSTAR Data Registry Centre before treatment to eliminate bias due to selective reporting. The following information was collected on all patients: (1) demographic details and the anatomic characteristics of their aneurysms, (2) details of the endovascular device used, (3) complications encountered during the procedure and the immediate outcome, (4) results of contrast enhanced computed tomographic imaging at 3, 6, 12, and 18 months after operation and at yearly intervals thereafter, and (5) all adverse events. Life table analysis was performed to determine the cumulative rates of (1) death from all causes, (2) rupture, and (3) late conversion to open repair. Risk factors for rupture and late conversion were identified through regression analysis. Results: By March 2000, 2464 patients had been registered, and their mean duration of follow-up was 12.19 months (SD, 12.3 months). There were 14 patients with confirmed rupture of their aneurysms. The cumulative rate (risk) of rupture was approximately 1% per year. Emergency surgery was undertaken in 12 (86%) patients, of whom five (41.6%) survived. Two patients who were not treated surgically also died, which resulted in an overall death rate of 64.5% (9/14) of the patients. Significant risk factors for rupture were proximal type I endoleak ( P =.001), midgraft (type III) endoleak ( P =.001), graft migration ( P =.001), and postoperative kinking of the endograft ( P =.001). Forty-one patients underwent late conversion to open repair with a perioperative mortality rate of 24.4% (10/41). The cumulative rate (risk) of late conversion was approximately 2.1% per year. Risk factors (indications) for late conversion were proximal type I endoleak ( P =.001), midgraft (type III) endoleak ( P =.001), type II endoleak ( P =.003), graft migration ( P =.001), graft kinking ( P =.001), and distal type I endoleak ( P =.001). Conclusions: Endovascular repair of infrarenal aortic aneurysms with the first- and second-generation devices that predominated in this study was associated with a risk of late failure, according to an analysis of observed hard end points of 3% per year. Action taken to address the risk factors identified by the study may improve results in the future. (J Vasc Surg 2000;32:739-49.)
Cost-effectiveness of vaccination against pneumococcal pneumonia in The Netherlands

Because of the prevalence of pneumococcal pneumonia and the substantial morbidity and mortality associated with many pneumococcal infections, considerable efforts have been made in disease prevention, using a polyvalent polysaccharide pneumococcal vaccine. Although the WHO has endorsed a policy of universal vaccination of all elderly people, the economic aspects of such a policy have not been determined. Using a decision tree framework, this paper examines the cost-effectiveness of various strategies of pneumococcal vaccination for the elderly in The Netherlands. For various age categories, the economic attractiveness of the vaccination of all individuals as well as the vaccination of only those individuals with a specific disease has been calculated. We conclude that, allowing for some uncertainty regarding key variables such as the vaccine efficacy and the hospital admission rate, the vaccination of all individuals above the age of 65 years is comparable in terms of cost-effectiveness to many existing health care interventions. The vaccination of individuals above the age of 55 years with chronic lung disease or chronic heart disease is similarly attractive from an economic point of view, as is the vaccination of individuals above the age of 65 years with diabetes mellitus.
Negative life events predict performance on an executive function task in young adults with developmental disabilities.

BACKGROUND Recent research with typically developing children indicates that chronic stress can be detrimental to the development of executive function. This study extends this work to individuals with developmental disabilities and examines the longitudinal relationship between an indicator of chronic stress, negative life events, and performance on a task of executive function within a group of 30 individuals with early identified developmental disabilities. METHODS Multilevel modelling was used to analyse the relationship between cumulative negative life events and response time on a Flanker task. RESULTS As hypothesized, individuals who had experienced more cumulative negative life events in their families demonstrated longer response time, an indicator of less efficient executive function. CONCLUSIONS The association between cumulative negative life events and executive function for children with developmental disabilities suggests the prominent role of the environment for development in this domain. These findings also suggest the importance of providing services, resources, and interventions that will help families adaptively cope with stressful circumstances.
Respiratory physiology in neonates and infants

Traditional methods of measurement of respiratory function in infants, such as whole body plethysmography, have been difficult to apply in clinical environments. Newer techniques for measuring lung mechanics, such as the use of forced exploratory flow-volume curves, can be easily used at the bedside and international standards are being produced to ensure maximum accuracy and reproducibility. Although continuous measurements obtained during tidal breathing are affected by many variables, there is increasing interest in the use of these bedside measurements of pulmonary function in clinical management and epidemiological studies.