Miracle-dz/UniFAR-FTUs huggingface dataset:
Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot.

BACKGROUND Although corrective surgery for tetralogy of Fallot has been available for more than 30 years, the occurrence of late sudden death in patients in whom surgery was apparently successful remains worrisome. METHODS We studied long-term survival among 163 patients who survived 30 days after complete repair of tetralogy of Fallot, examining follow-up hospital records and death certificates when relevant. RESULTS The overall 32-year actuarial survival rate among all patients who survived surgery was 86 percent, as compared with an expected rate of 96 percent in a control population matched for age and sex (P < 0.01). Thirty-year actuarial survival rates were calculated for the patient subgroups. The survival rates among patients less than 5 years old, 5 to 7 years old, and 8 to 11 years old were 90, 93, and 91 percent, respectively--slightly less than the expected rates (P < 0.001, P = 0.06, and P = 0.02). Among patients 12 years old or older at the time of surgery, the survival rate was 76 percent, as compared with an expected rate of 93 percent (P < 0.001). The performance of a palliative Blalock-Taussig shunt procedure before repair, unlike the performance of a Waterston or Potts shunt procedure, was not associated with reduced long-term survival, nor was the need for a trans-annular patch at the time of surgery. Independent predictors of long-term survival were older age at operation (P = 0.02) and a higher ratio of right ventricular to left ventricular systolic pressure after surgery (P = 0.008). Late sudden death from cardiac causes occurred in 10 patients during the 32-year period. CONCLUSIONS Among patients with surgically repaired tetralogy of Fallot, the rate of long-term survival after the postoperative period is excellent but remains lower than that in the general population. The risk of late sudden death is small.
Eosinophil activation and preschool viral wheeze

Background: A study was undertaken to ascertain whether systemic eosinophil activation is associated with preschool viral wheeze (PVW). Methods: Urinary eosinophil protein X (uEPX) and serum total IgE (IgE) levels were measured in children admitted to hospital with PVW, and uEPX was measured 6 weeks after discharge. Two years after admission, current wheeze in children aged ⩾5 years was determined by questionnaire. Controls were recruited from children undergoing elective surgery (normal controls) and from those with skin prick test reactivity to foods (atopic controls). Results: There was no difference in uEPX levels between normal controls (n=15) and atopic controls (n=8). uEPX levels were increased in children with acute PVW (n=84; p<0.001 v normal controls, p<0.01 v atopic controls) and fell on convalescence (n=20, 95% CI −217 to −31 µg/mmol creatinine, p<0.05). In children with acute PVW there was no association between uEPX and serum IgE levels or markers of clinical severity. Respiratory questionnaires were returned for 25/55 eligible children. There was no difference in uEPX level during acute PVW when stratified by “current wheeze” (n=18) or “no wheeze” (n=7) 2 years later. Conclusions: Systemic eosinophil activation is associated with PVW but is not associated with serum IgE, clinical severity, or persistence of wheeze into the early school age period.
Effect of Prostaglandin I2 Analogs on Macrophage Inflammatory Protein 1α in Human Monocytes Via I Prostanoid Receptor and Cyclic Adenosine Monophosphate

Aims Inflammation plays critical roles in atherosclerosis. Chemokines are responsible for leukocyte trafficking and involve in inflammatory diseases. Macrophage inflammatory protein 1α (MIP-1α) has been implicated in atherosclerotic lesion formation. Prostaglandin I2 (PGI2) analog, used in pulmonary hypertension, has been reported to have anti-inflammatory functions. However, little is known about its role in the MIP-1α production in human monocytes. Methods We investigated the effects of 3 conventional (iloprost, beraprost, and treprostinil) and 1 new (ONO-1301) PGI2 analogs, on the expression of MIP-1α expression in human monocytes. Human primary monocytes from control subjects and THP-1 cell line were treated with PGI2 analogs, with or without lipopolysaccharide (LPS) stimulation. Supernatants were harvested to measure MIP-1α levels by enzyme-linked immunosorbent assay. To explore which receptors involved the effects of PGI2 analogs on the expression of MIP-1α expression, I prostanoid (IP) and E prostanoid, peroxisome proliferator-activated receptor (PPAR)-α, and PPAR-r receptor antagonists were used to pretreat THP-1 cells. Forskolin, a cyclic adenosine monophosphate (cAMP) activator, was also used to further confirm the cAMP involvement on the effect of PGI2 analogs in MIP-1α production. Results Three PGI2 analogs could suppress LPS-induced MIP-1α production in THP-1 cells and human primary monocytes. ONO-1301 had a similar effect. CAY 10449, an IP receptor antagonist, could reverse the suppressive effects on MIP-1α production of iloprost. Forskolin, a cAMP activator, also suppressed MIP-1α production in THP-1 cells. Conclusions Prostaglandin I2 analogs suppressed LPS-induced MIP-1α production in human monocytes via the IP receptor and cAMP pathway. The PGI2 analog may be potential in the treatment for atherosclerosis.
Enhancing Cloud Security and Privacy: Broadening the Service Level Agreement

Achieving security and privacy in the cloud is not a trivial exercise. Indeed, the difficulties associated with achieving this goal are both many and highly complex, and present one of the major barriers to the uptake of cloud computing. Yet, we know cloud computing offers the possibility of substantial economic benefit to firms, as well as providing great agility, which can offer a competitive advantage in today's difficult trading conditions. We address this issue by considering whether greater accountability, and particularly a broadening of the scope of Service Level Agreements, can enhance cloud security and privacy.
Ageing, health inequalities and the welfare state: A multilevel analysis

Comparative studies of health inequalities have largely neglected age and ageing aspects, while ageing research has often paid little attention to questions of social inequalities. This article investigates cross-country differences in gradients in self-rated health and limiting long-standing illness (LLSI) in middle-aged and in older people (aged 50–64 and 65–80 years) linked to social class, and degrees to which the social health gradients are associated with minimum pension levels and expenditure on elderly care. For these purposes, data from the European Social Survey (2002–2010) are analysed using multilevel regression techniques. We find significant cross-level interaction effects between class and welfare policies: higher expenditure on elderly care and particularly more generous minimum pensions are associated with smaller health inequalities in the older age group (65–80 years). It is concluded that welfare policies moderate the association between social class and health, highlighting the importance of welfare state efforts for older persons, who are strongly reliant on the welfare state and welfare state arrangements such as pensions and care policies.
Prandial Options to Advance Basal Insulin Glargine Therapy: Testing Lixisenatide Plus Basal Insulin Versus Insulin Glulisine Either as Basal-Plus or Basal-Bolus in Type 2 Diabetes: The GetGoal Duo-2 Trial

OBJECTIVE To provide evidence-based options on how to intensify basal insulin, we explored head-to-head prandial interventions in overweight patients with type 2 diabetes inadequately controlled on basal insulin glargine with or without 1–3 oral antidiabetic agents (OADs). RESEARCH DESIGN AND METHODS Patients were randomized to lixisenatide once daily or insulin glulisine given once or thrice daily, added to glargine, with or without metformin, if HbA1c remained ≥7 to ≤9% (≥53 to ≤75 mmol/mol) after 12 weeks of glargine optimization with OADs other than metformin stopped at the start of optimization. Coprimary end points at 26 weeks were 1) noninferiority (95% CI upper bound <0.4% [<4.4 mmol/mol]) in HbA1c reduction with lixisenatide versus glulisine once daily, and either 2a) noninferiority in HbA1c reduction for lixisenatide versus glulisine thrice daily or 2b) superiority in body weight change for lixisenatide versus glulisine thrice daily. Fasting and postprandial plasma glucose, composite efficacy/safety end points, and adverse events were also assessed. RESULTS Baseline characteristics were similar between arms (n = 298, diabetes and basal insulin duration of 12.2 and 3.2 years, respectively; BMI 32.2 kg/m2). HbA1c improved from 8.5% to 7.9% (69 to 63 mmol/mol) with glargine optimization and further to 7.2%, 7.2%, and 7.0% (55, 55, and 53 mmol/mol) with lixisenatide and glulisine once daily and thrice daily, respectively; all coprimary end points were met. Symptomatic hypoglycemia and body weight were lower in lixisenatide versus glulisine patients. More gastrointestinal events occurred with lixisenatide. CONCLUSIONS Short-acting glucagon-like peptide-1 receptor agonists as add-on to basal insulin may become a preferred treatment intensification option, attaining meaningful glycemic targets with fewer hypoglycemic events without weight gain versus basal-plus or basal-bolus in uncontrolled basal insulin-treated type 2 diabetes.
Isoflurane Protects Human Kidney Proximal Tubule Cells against Necrosis via Sphingosine Kinase and Sphingosine-1-Phosphate Generation

Background/Aims: We previously showed that the inhalational anesthetic isoflurane protects against renal ischemia reperfusion injury in part via sphingosine kinase (SK)-mediated synthesis of sphingosine-1-phosphate (S1P). In this study, we tested the hypothesis that isoflurane directly targets renal proximal tubule cells via SK activation, S1P synthesis and activation of S1P receptors to initiate cytoprotective signaling. Methods and Results: Isoflurane-mediated phosphorylation of extracellular signal-regulated kinase (ERK) and Akt and induction of HSP70 in human kidney proximal tubule (HK-2) cells were inhibited by dimethylsphingosine (DMS), an SK inhibitor, and VPC23019, an S1P1/3 receptor selective antagonist, in HK-2 cells. A selective S1P1 receptor agonist, SEW2781, mimicked isoflurane-induced phosphorylation of ERK and Akt and induction of HSP70. Moreover, isoflurane-mediated protection against H2O2-induced necrosis of HK-2 cells was significantly attenuated by an S1P1/3 receptor antagonist, VPC23019, and by SK inhibitors DMS or 4-[[4- (4-chlorophenyl)-2-thiazolyl]amino]phenol. Finally, overexpression of the SK1 enzyme in HK-2 cells protected against H2O2-induced necrosis. Conclusions: Collectively, our study demonstrates that S1P released via isoflurane-mediated SK1 stimulation produces direct anti-necrotic effects probably via S1P1 receptor-mediated cytoprotective signaling (ERK/Akt phosphorylation and HSP70 induction) in HK-2 cells. Our findings may help to unravel the cellular signaling pathways of volatile anesthetic-mediated renal protection and lead to new therapeutic applications of volatile anesthetics during the perioperative period.
Effect of an endurance-like exercise on the disposition and detection time of phenylbutazone and dexamethasone in the horse: application to medication control.

REASONS FOR PERFORMING STUDY Equine antidoping rules were established to prevent a horse's performance being altered after the administration of prohibited substances, including approved drugs used for legitimate treatment. Veterinarians have to advise owners or trainers on appropriate withholding times to guarantee that their horses may safely compete after drug administration. In order to propose tailored withdrawal times, several horse organisations released detection time (DT) values, for the main veterinary drugs used in horses. One of the possible limits to the information provided by published DTs in horses is the fact that they are determined from classic pharmacokinetic studies performed at rest under laboratory conditions. In field conditions, training and exercise programmes may have an influence on drug elimination. METHODS Dexamethasone (DMX) and phenylbutazone (PBZ) have been quantified in plasma and urine after solid phase extraction. The kinetic disposition of DXM (8 microg/kg) and PBZ (8 mg/kg) administered by i.v. route in 8 horses, was investigated in rest conditions and during a standardised 3 h test exercise according to a cross-over design. OBJECTIVES The aim of the present study was to compare the kinetic disposition of 2 test drugs, DMX and PBZ in rest vs. exercising conditions. RESULTS It was shown in 8 horses that a sustained 3 h of mild exercise slightly decreased the plasma clearance of both drugs (about 25% for DXM and 37% for PBZ) and this is mainly explained by the significant decrease of the corresponding hepatic clearance. In addition, as the volume of distribution was correlatively decreased, the plasma terminal half-life, which is a hybrid parameter of plasma clearance and volume of distribution, remains unchanged overall. CONCLUSION AND POTENTIAL RELEVANCE Establishing DTs or withdrawal times (WTs) are relevant as plasma and urine half-lives, but not clearance, are the main determinants of DT length. Veterinarians may realistically decide upon a WT for a legitimate drug based on the corresponding DT obtained under resting conditions providing this drug has a low hepatic extraction ratio and a safety margin is added to allow for all possible sources of variability.
The epidemiology of murder-suicide.

OBJECTIVE To review the epidemiology, patterns, and major determinants of murder-suicide and to discuss the clinical and research strategies for identifying the individuals at greatest risk for this type of violence. DATA SOURCES Data were obtained from English-language articles based on searches using MEDLINE (from 1966), PsychINFO (from 1967), and EMBASE (from 1974) programs. In addition, relevant articles, books, and monographs identified from the reference list of retrieved articles were reviewed. STUDY SELECTION Case-control studies, descriptive epidemiologic surveys, and case series were chosen for review. DATA EXTRACTION Because of the limited scope of the pertinent research literature, all data relevant to the incidence, demographics, circumstances, and precipitants of murder-suicide were summarized by the authors. DATA SYNTHESIS Murder-suicide occurs with an annual incidence of 0.2 to 0.3 per 100,000 person-years and accounts for approximately 1000 to 1500 deaths yearly in the United States. The annual incidence of these events is relatively constant across industrialized nations and has not significantly changed over several decades. The principal perpetrators are young males with intense sexual jealousy, depressed mothers, or despairing elderly men with ailing spouses. The principal victims are female sexual partners or consanguineous relatives, usually young children. Clinical depression, specific motivations such as male sexual proprietariness or maternal salvation fantasies, and a history of previous suicide attempts are important in explaining underlying psychopathological mechanisms. CONCLUSIONS Murder-suicide occupies a distinct epidemiological domain that overlaps with suicide, domestic homicide, and mass murder. These events may be categorized into one of only several phenomenologic typologies that share similar demographics, motivations, and circumstances. Despite the disruption of families and communities caused by murder-suicide, there are no standardized operational definitions, validated taxonomic systems, or national surveillance networks for these events, all of which are needed to develop prevention strategies.
An Overlapping Generations Model for Monetary Policy Analysis

We integrate an overlapping generations model into a new monetarist framework and show that the Friedman rule is not optimal. This is because inflation makes saving for retirement less attractive, such that young agents optimally choose to increase their consumption at the expense of lower savings. On the other hand, old agents consume less due to the inflation tax. We show that for low inflation rates, the former effect dominates the latter, such that the Friedman rule is not optimal. However, this effect disappears for higher inflation rates such that the optimal rate is at an intermediate level.
The Dependency of People on the Great Barrier Reef, Australia

ABSTRACT Understanding how people are dependent on Large Scale Marine Protected Areas (LSMPAs) is important for understanding how people might be sensitive to changes that affect these seascapes. We review how resource dependency is conceptualized and propose that it be broadened to include cultural values such as pride in resource status, scientific heritage, appreciation of aesthetics, biodiversity, and lifestyle opportunities. We provide an overview of how local residents (n = 3,181 face-to-face surveys), commercial fishers (n = 210, telephone surveys), and tourism operators (n = 119 telephone surveys) are potentially dependent on the Great Barrier Reef (GBR), a region currently experiencing significant environmental, social, and economic change. We found that commercial fishers and tourism operators were dependent not only financially on the GBR, but also because of their age, years in the industry and region, lack of education, and the number of dependents. These stakeholders lacked flexibility to secure alternative employment. All stakeholder groups, regardless of economic imperatives, were dependent on the GBR because of their cultural connections. We propose that resource dependency also provides an umbrella concept to describe the cultural services provided by an ecosystem, which can be described through place-based dependence and place-identity.
Impacts of regional climate and teleconnection on hydrological change in the Bosten Lake Basin, arid region of northwestern China

This investigation examined effects of climate change, measured as annual, seasonal, and monthly air temperature and precipitation from 1958 to 2010, on water resources (i.e., runoff) in the Bosten Lake Basin. Additionally, teleconnections of hydrological changes to large-scale circulation indices including El Nino Southern Oscillation (ENSO), Arctic Oscillation (AO), North Atlantic Oscillation (NAO), Tibetan High (XZH), westerly circulation index (WI), and northern hemisphere polar vortex area index (VPA) were analyzed in our study. The results showed the following. (1) Annual and seasonal air temperature increased significantly in the Bosten Lake Basin. Precipitation exhibited an increasing trend, while the significance was less than that of temperature. Abrupt changes were observed in 1996 in mountain temperature and in 1985 in plain temperature. (2) Runoff varied in three stages, decreasing before 1986, increasing from 1987 to 2003, and decreasing after 2003. (3) Precipitation and air temperature have significant impacts on runoff. The hydrological processes in the Bosten Lake Basin were (statistically) significantly affected by the northern hemisphere polar vortex area index (VPA) and the Tibetan High (XZH). The results of this study are good indicators of local climate change, which can enhance human mitigation of climate warming in the Bosten Lake Basin.
Analysis of E-Band Path Loss and Propagation Mechanisms in the Indoor Environment

Millimeter-wave transceivers will feature massive phased-array antennas whose pencilbeams can be steered toward the angle of arrival of the propagation path having the maximum power, exploiting their high gain to compensate for the greater path loss witnessed in the upper spectrum. For this reason, maximum-power path-loss models, in contrast to conventional ones based on the integrated power from an omnidirectional antenna, may be more relevant. Yet to our knowledge, they do not appear in the literature save for one reference. In this paper, we compare both model types at 83.5 GHz for four indoor environments typical of hotspot deployments in line-of-sight (LOS) and non-LOS conditions up to a range of 160 m. To fit the models, we conducted a measurement campaign with over 3000 different transmitter–receiver configurations using a custom-designed channel sounder capable of extracting the delay and 3-D angle of arrival of the received paths with super-resolution. The models are supported by a detailed analysis of the propagation mechanisms of direct transmission, reflection, and knife-edge diffraction to shed light on their interplay in the E-band regime.
Referrals to high-quality cardiac surgeons: patients' race and characteristics of their physicians.

OBJECTIVE To examine the referral process to cardiac surgeons in order to explain racial disparities in access to high-quality cardiac surgeons. DATA SOURCES/STUDY SETTINGS All white and black Medicare fee-for-service patients undergoing coronary artery bypass graft (CABG) surgery in New York State during 1997-1999. STUDY DESIGN A retrospective analysis of referral patterns for white and black patients in relation to the quality of the cardiac surgeon, measured by the surgeon's risk-adjusted mortality rate (RAMR), and in relation to characteristics of the physician providing the majority of cardiac care before the surgery. The average RAMRs of the surgeons to whom different physicians referred patients were compared using t-tests and paired t-tests. A hierarchical multivariate regression model was estimated to test hypotheses about the effect of physicians' characteristics on referrals of blacks to low-quality surgeons. DATA EXTRACTION METHOD Variables were constructed from Medicare claims. PRINCIPAL FINDINGS The differential in surgeons' quality for white and black patients is partially due to the physician providing the majority of cardiac care before the surgery. There is both across- and within-physician variation in referrals. Of the physician characteristics investigated, only the number of black patients referred to CABG and the percent of all cardiac referrals to the same hospital decrease the difference in surgeons' quality between whites and blacks. CONCLUSIONS Several different pathways lead blacks to cardiac surgeons of lower quality. Further research is needed to understand the causes and inform policies designed to minimize disparities in access to high-quality providers.
Regional ancillary services procurement in simultaneous energy/reserve markets

Ancillary services are essential to the reliability and security of power system operation in any competitive electricity market environment. Procurement of ancillary services must take into account effective use of the capacity under emergency conditions, delivery time, transmission limitations, and local area requirements. Regional procurement of ancillary services is an approach that results in effective distribution of reserves and ensures continuous reliability in the event of a contingency occurring anywhere in the system. However, most ISOs procure and price ancillary services based on the least-cost service with little regard to zonal dispersion. In general, such an approach is not sufficient to ensure continuous reliability and security of the power system This paper presents a new methodology and numerical examples for procuring and pricing ancillary services on a regional basis, with an explicit representation of imports in a simultaneous energy/reserve market environment.