Miracle-dz/UniFAR-FTUs huggingface dataset:
MEAN-VARIANCE VERSUS MEAN–EXPECTED SHORTFALL MODELS: AN APPLICATION TO WHEAT VARIETY SELECTION

Abstract One of the most popular risk management strategies for wheat producers is varietal diversification. Previous studies proposed a mean-variance model as a tool to optimally select wheat varieties. However, this study suggests that the mean–expected shortfall (ES) model (which is based on a downside risk measure) may be a better tool because variance is not a correct risk measure when the distribution of wheat variety yields is multivariate nonnormal. Results based on data from Texas Blacklands confirm our conjecture that the mean-ES framework performs better in term of selecting wheat varieties than the mean-variance method.
Unexpected distribution of hepatitis C virus genotypes in patients on hemodialysis and kidney transplant recipients

The distribution of hepatitis C virus (HCV) genotypes in patients on hemodialysis and in kidney transplant recipients was compared with that observed in a control group composed of HCV‐infected individuals from the general population. A total of 340 patients were included in the study: 46 with end‐stage renal disease on regular hemodialysis treatment, 22 kidney transplant recipients and 272 controls matched for sex and age at a 4:1 ratio (controls to patient). HCV genotype was determined by sequencing of the 5′ untranslated region of the HCV genome. No difference was observed in the distribution of HCV genotypes in hemodialysis patients and renal transplant patients (P = 0.47). However, when each of these groups was compared with the control group, a significant difference was detected in the genotype distribution (P < 0.001). In hemodialysis and renal transplant patients the most prevalent subtype was 1a, followed by 1b, 3, and other less prevalent genotypes (2, 4, and 5), whereas in the control group the most prevalent subtype was 1b, followed by 3, 1a, and others. That observation may reflect differences in the epidemiology of HCV infection, viral characteristics and host factors in renal patients in comparison to the control group. J. Med. Virol. 69:489–494, 2003. © 2003 Wiley‐Liss, Inc.
Impact of adolescent pregnancy on hypertension in postmenopausal women

Objective: Several studies have reported the detrimental effects on maternal health due to pregnancy during adolescence, but no studies have reported the influence of adolescent pregnancy on blood pressure in women's later life. Method: We investigated whether there was an association between adolescent pregnancy and the risk of hypertension in Korean postmenopausal women. This study used the data of 2538 postmenopausal women from the Korean National Health and Nutrition Examination Survey in 2010–2011. Multivariate logistic regression analyses were used to evaluate the independent association between adolescent pregnancy and hypertension by adjusting for potential confounding factors. Results: Postmenopausal women with a history of adolescent pregnancy had a higher prevalence of hypertension than those without a history of adolescent pregnancy. After fully adjusting for potential confounding factors such as age, lifestyle, sociodemographic factors, known hypertension risk factors, and reproductive factors, a history of adolescent pregnancy was significantly associated with hypertension (odds ratio, 1.702; 95% confidence interval, 1.125–2.574). Conclusion: This study showed that a history of adolescent pregnancy is significantly and independently associated with a higher risk of hypertension in postmenopausal women.
Boundary work and the introduction of acute care nurse practitioners in healthcare teams.

AIM This article is a report of a study of boundary work following the introduction of an acute care nurse practitioner role in healthcare teams. BACKGROUND Acute care nurse practitioners enacting their roles in healthcare teams have faced a number of challenges including a mix of positive and negative views of the acute care nurse practitioner role from healthcare team members and acute care nurse practitioner roles crossing the boundaries between the medical and nursing professions. Understanding the process by which the boundaries between professions changed following the introduction of an acute care nurse practitioner role was important since this could affect scope of practice and the team's ability to give patient care. METHODS The study was conducted in two university-affiliated teaching hospitals in Canada. A descriptive multiple case study design was used. Data were collected from March to May 2009. RESULTS Participants (N = 59) described boundary work as a process that included: (1) creating space; (2) loss of a valued function; (3) trust; (4) interpersonal dynamics; and (5) time. The development of trust among team members was essential. The co-location of team members working on common projects, and medical and nursing leadership facilitated boundary work. CONCLUSION The micro-level processes of boundary work in healthcare teams have important implications for the development of full scope of practice for acute care nurse practitioners, effective inter-professional teamwork and the integration of new roles in healthcare systems. Future research needs to be undertaken in different contexts, and with patients and families.
Maternal Infection, Fetal Inflammatory Response, and Brain Damage in Very Low Birth Weight Infants

Echolucent images (EL) of cerebral white matter, seen on cranial ultrasonographic scans of very low birth weight newborns, predict motor and cognitive limitations. We tested the hypothesis that markers of maternal and feto-placental infection were associated with risks of both early (diagnosed at a median age of 7 d) and late (median age = 21 d) EL in a multi-center cohort of 1078 infants <1500 ×g. Maternal infection was indicated by fever, leukocytosis, and receipt of antibiotic; feto-placental inflammation was indicated by the presence of fetal vasculitis (i.e. of the placental chorionic plate or the umbilical cord). The effect of membrane inflammation was also assessed. All analyses were performed separately in infants born within 1 h of membrane rupture (n= 537), or after a longer interval (n= 541), to determine whether infection markers have different effects in infants who are unlikely to have experienced ascending amniotic sac infection as a consequence of membrane rupture. Placental membrane inflammation by itself was not associated with risk of EL at any time. The risks of both early and late EL were substantially increased in infants with fetal vasculitis, but the association with early EL was found only in infants born ≥1 after membrane rupture and who had membrane inflammation (adjusted OR not calculable), whereas the association of fetal vasculitis with late EL was seen only in infants born <1 h after membrane rupture (OR = 10.8;p= 0.05). Maternal receipt of antibiotic in the 24 h just before delivery was associated with late EL only if delivery occurred <1 h after membrane rupture (OR = 6.9;p= 0.01). Indicators of maternal infection and of a fetal inflammatory response are strongly and independently associated with EL, particularly late EL.
Methodological aspects of high‐frequency ultrasound of skin in children

Background: High‐frequency ultrasound of the skin has recently been introduced for assessment of systemic effects in the cutis and subcutis of oral and inhaled glucocorticoids in children. However, the use of high‐frequency skin ultrasound in clinical trials is invalidated because important methodological aspects have not been addressed. The aim of the present study was to evaluate inter‐ and intraobserver, day to day and diurnal variations of measurement of thickness of cutis and subcutis, and the fraction of low echogenic pixels (fLEP) in the cutis and, furthermore, to assess effects of exercise on the cutis and subcutis and variations in subcutaneous thickness between anatomical locations in children with a high‐frequency B‐mode ultrasound scanning device.
Gilbert cell Mixer design in 65nm CMOS technology

The article reports the design of Gilbert cell mixer using 65 CMOS technology. Cadence software is used to process the circuit design. The proposed down-conversion mixer uses a double balanced Gilbert cell to provide the required performance in gain conversion and isolation among ports. The supply voltage of 1.8V uses a new degenerating structure to improve linearity. The resonant frequency is around 1.9 GHz. The target in this work is minimizing size as well the power consumption (2.17mW). Acceptable linearity with 1dB compression point is −2.54 dBm. The third intercept point (IIP3) is optimized to 6 dBm. The conversion gains of LNA and Mixer is 10 dB when one IF port is terminated to 50Ω. The noise figure obtained at the output is 22dB.
Patients' perceptions of a pre-admission clinic.

AIM Patients' perceptions of a pre-admission clinic in an orthopaedic hospital were explored. The clinic was developed as a collaborative initiative between nursing and medical staff. METHODS The methodological approach to this study was inductive and informed by grounded theory. Data was collected using unstructured interviews and analysed using constant comparative analysis. RESULTS The clinic appeared to relieve patients' anxiety, however, the way in which it did so was complex. Patients thought they were given factual information relating to surgery in the clinic and this was conceptualized as 'given information'. Patients also told of certain experiences in the clinic, which included the caring environment, individualized care and efficiency. These experiences were powerful tools in giving information to patients and are conceptualized as 'experienced information'. CONCLUSION Both 'experienced information' and 'given information' were important in relieving anxiety. Coping styles of patients differed. Individual patients selected from the clinic what they found useful in terms of 'given information' and 'experienced information' in accordance with their individual coping styles.
Evaluating the validity of multiple imputation for missing physiological data in the national trauma data bank

Background: The National Trauma Data Bank (NTDB) is plagued by the problem of missing physiological data. The Glasgow Coma Scale score, Respiratory Rate and Systolic Blood Pressure are an essential part of risk adjustment strategies for trauma system evaluation and clinical research. Missing data on these variables may compromise the feasibility and the validity of trauma group comparisons. Aims: To evaluate the validity of Multiple Imputation (MI) for completing missing physiological data in the National Trauma Data Bank (NTDB), by assessing the impact of MI on 1) frequency distributions, 2) associations with mortality, and 3) risk adjustment. Methods: Analyses were based on 170,956 NTDB observations with complete physiological data (observed data set). Missing physiological data were artificially imposed on this data set and then imputed using MI (MI data set). To assess the impact of MI on risk adjustment, 100 pairs of hospitals were randomly selected with replacement and compared using adjusted Odds Ratios (OR) of mortality. OR generated by the observed data set were then compared to those generated by the MI data set. Results: Frequency distributions and associations with mortality were preserved following MI. The median absolute difference between adjusted OR of mortality generated by the observed data set and by the MI data set was 3.6% (inter-quartile range: 2.4%-6.1%). Conclusions: This study suggests that, provided it is implemented with care, MI of missing physiological data in the NTDB leads to valid frequency distributions, preserves associations with mortality, and does not compromise risk adjustment in inter-hospital comparisons of mortality.
Induction of Specific Immune Responses by Severe Acute Respiratory Syndrome Coronavirus Spike DNA Vaccine with or without Interleukin-2 Immunization Using Different Vaccination Routes in Mice

ABSTRACT DNA vaccines induce humoral and cellular immune responses in animal models and humans. To analyze the immunogenicity of the severe acute respiratory syndrome (SARS) coronavirus (CoV), SARS-CoV, spike DNA vaccine and the immunoregulatory activity of interleukin-2 (IL-2), DNA vaccine plasmids pcDNA-S and pcDNA-IL-2 were constructed and inoculated into BALB/c mice with or without pcDNA-IL-2 by using three different immunization routes (the intramuscular route, electroporation, or the oral route with live attenuated Salmonella enterica serovar Typhimurium). The cellular and humoral immune responses were assessed by enzyme-linked immunosorbent assays, lymphocyte proliferation assays, enzyme-linked immunospot assays, and fluorescence-activated cell sorter analyses. The results showed that specific humoral and cellular immunities could be induced in mice by inoculating them with SARS-CoV spike DNA vaccine alone or by coinoculation with IL-2-expressing plasmids. In addition, the immune response levels in the coinoculation groups were significantly higher than those in groups receiving the spike DNA vaccine alone. The comparison between the three vaccination routes indicated that oral vaccination evoked a vigorous T-cell response and a weak response predominantly with subclass immunoglobulin G2a (IgG2a) antibody. However, intramuscular immunization evoked a vigorous antibody response and a weak T-cell response, and vaccination by electroporation evoked a vigorous response with a predominant subclass IgG1 antibody response and a moderate T-cell response. Our findings show that the spike DNA vaccine has good immunogenicity and can induce specific humoral and cellular immunities in BALB/c mice, while IL-2 plays an immunoadjuvant role and enhances the humoral and cellular immune responses. Different vaccination routes also evoke distinct immune responses. This study provides basic information for the design of DNA vaccines against SARS-CoV.
Neuroimaging of ischemic stroke with CT and MRI: advancing towards physiology-based diagnosis and therapy

Acute ischemic stroke is the third leading cause of death and the major cause of significant disability in adults in the USA and Europe. The number of patients who are actually treated for acute ischemic stroke is disappointingly low, despite availability of effective treatments. A major obstacle is the short window of time following stroke in which therapies are effective. Modern imaging is able to identify the ischemic penumbra, a key concept in stroke physiology. Evidence is accumulating that identification of a penumbra enhances patient management, resulting in significantly improved outcomes. Moreover, unexpectedly large proportions of patients have a substantial ischemic penumbra beyond the traditional time window and are suitable for therapy. The widespread availability of modern MRI and computed tomography systems presents new opportunities to use physiology to guide ischemic stroke therapy in individual patients. This article suggests an evidence-based alternative to contemporary acute ischemic stroke therapy.
Genetic polymorphism and protein conformational plasticity in the calmodulin superfamily: Two ways to promote multifunctionality

Calcium signaling pathways control a variety of cellular events such as gene transcription, protein phosphorylation, nucleotide metabolism, and ion transport. These pathways often involve a large number of calcium-binding proteins collectively known as the calmodulin or EF-hand protein superfamily. Many EF-hand proteins undergo a large conformational change upon binding to Ca2+ and target proteins. All members of the superfamily share marked sequence homology and similar structural features required to sense Ca2+. Despite such structural similarities, the functional diversity of EF-hand calcium-binding proteins is extraordinary. Calmodulin itself can bind >300 different proteins, and the many members of the neuronal calcium sensor and S100 protein families collectively recognize a largely different set of target proteins. Recent biochemical and structural studies of many different EF-hand proteins highlight remarkable similarities and variations in conformational responses to the common ligand Ca2+ and their respective cellular targets. In this review, we examine the essence of molecular recognition activities and the mechanisms by which calmodulin superfamily proteins control a wide variety of Ca2+ signaling processes.
Two-Year Single-Center Experience with Thoracic Endovascular Aortic Repair Using the EndoFit Thoracic Stent-Graft

Purpose: To analyze our single-center experience of thoracic endovascular aortic aneurysm repair (TEVAR) using the EndoFit Thoracic Aortic Endograft. Methods: A retrospective review was conducted of 87 consecutive patients (64 men; median age 67.8±8.7 years, range 24–88) undergoing TEVAR using the EndoFit thoracic stent-graft from December 2005 to December 2007. Slightly more than half (n=46) of the patients had thoracic aortic aneurysm, while 41 had thoracic aortic dissection. Seventeen cases were performed emergently. All patients had imaging follow-up before discharge; at 1, 3, and 6 months; and annually thereafter. Results: The technical success rate was 100%. Fifty-five (63.2%) patients had different debranching procedures to extend the proximal or distal landing zone. The in-hospital and 30-day mortality rate was 9.2% (8/87). Neurological complications occurred in 8 (9.3%) patients, including 5 strokes (2 fatal) and 3 cases of paraplegia. One intraoperative massive bleeding from an ascending aortic debranching anastomosis was rescued with the aid of a pump. Five patients had immediate proximal type I endoleak; 3 were remedied with a proximal cuff, 1 was rescued with tri-lobe balloon, and 1 was left untreated. One type II endoleak remains under observation. The average follow-up was 15.2 months (range 5–29), during which 10 (11.5%) patients died of causes unrelated to the aneurysm or stent-graft. All the extra-anatomical bypasses and stent-grafts were patent; no stent-graft kinking, collapse, or dislocation was detected. Two post-TEVAR proximal endoleaks were remedied with a proximal cuff after debranching. There was no post-TEVAR rupture or conversion to open surgery. Conclusion: Our 2-year single-center experience using the EndoFit system for TEVAR showed a high technical success rate and a low incidence of device- or aneurysm-related complications. The flexible, hydrophilic introducer was easy to insert and track through the vasculature. The debranching techniques to extend the landing zones not only broaden the applicability of TEVAR but also reduce post-TEVAR complications.
The Effect of Diabetes and Impaired Glucose Tolerance on Mortality in Malta

A random sample of the middle‐aged population of Malta was studied in a diabetic survey in 1981. Among the 1537 survey responders, in 659 men and 878 women aged 40 years or more the prevalence of diabetes was 16 % in men and 18 % in women, and that of IGT 5 % in both sexes. By the end of 1985, 90 subjects (49 men: 41 women) had died. Mortality/1000 (95 % CI) was among subjects with normal, impaired glucose tolerance and diabetes in the age group 40–59 years 12 (5–19), 25 (23–73), and 61 (17–148), and in the age group of more than 60 years, 102 (68–136), 148 (59–237), and 178 (122–234), respectively. Age standardized mortality/1000 was in men 51, 28, and 100, and in women 34, 33, and 72 in the three categories of glucose tolerance, respectively. Among diabetic subjects aged 40–64 years the risk of death was increased seven‐fold as compared with normoglycaemic subjects. Among men there was an inverse association between body mass index and mortality in all categories of glucose tolerance. Among women, no clear trend between body mass index and mortality was found. The relative risk of death for subjects with diabetes adjusting for age, sex, and body mass index was 2.2 (odds ratio: 95 % CI 1.40 to 3.42) as compared with non‐diabetic subjects. The age‐adjusted survival curves for normoglycaemic subjects were similar for men and women. Among subjects with abnormal glucose tolerance the survival was slightly better in women than in men (p = 0.056). About half of the deaths were from cardiovascular disease and 7 % from diabetes mellitus.
INSULIN RESISTANCE AND POLYCYSTIC OVARY SYNDROME IN A CHINESE POPULATION.

OBJECTIVE Our study aimed to investigate glucose and lipid level as well as insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS). METHODS In a case-control study, 426 patients with PCOS were diagnosed according to Rotterdam criteria, and they were conducted in the morning after a 10-h fast. Participants received standard 75-g oral glucose tolerance test (OGTT). Plasma glucose and insulin levels were obtained at 0, 30, 60, 120, and 180 min. They also received the lipid evaluation; 95 healthy women with normal menstrual cycles served as controls. Thus, by modifying the homeostasis model assessment of insulin resistance (HOMA-IR) with the use of individual time-course values of glucose and insulin plasma levels, we developed a new assessment method, HOMA-Mx. RESULTS In our study, 23.71% of patients had abnormal glucose metabolism. With further impairment in glucose metabolism, the glucose and lipid level gradually increased (P<0.05), while the impaired glucose regulation (IGR) group showed greater insulin response than a type 2 diabetes mellitus (T2DM) group. Compared with healthy controls, both lean and obese PCOS patients with normal glucose tolerance (NGT) had a higher body mass index (BMI), and higher serum glucose, insulin, and lipid values. Additionally, the insulin value peaked at 30 min and 60 min in the lean and obese groups, respectively. HOMA-M30 proved to be the best predictive parameter (cutoff: 20.36, area under the curve [AUC]: 0.753) for assessment of IR in normal-weight patients and HOMA-IR (cutoff: 32.17, AUC: 0.868) was optimal in obese PCOS patients. CONCLUSIONS A new assessment method was developed for these groups: HOMA-M30 for lean PCOS patients and HOMA-M60 for obese patients, in order to focus on peak insulin values for early detection of IR.
Association between bowel symptoms, symptom severity, and quality of life in Swedish patients with fecal incontinence

Abstract Objectives. The association between abdominal symptoms, disease severity of fecal incontinence (FI), and quality of life (QoL) is not yet clear. We hypothesized that it would become clearer by prospective diary data. We also aimed to compare QoL of FI patients with ulcerative colitis (UC) patients in relapse and remission. Material and methods. Sixty-five consecutive female patients with FI recorded bowel symptoms prospectively on diary cards. QoL was evaluated with the disease specific short health scale questionnaire (SHS). Patients with UC in remission and relapse were used as a reference group regarding SHS. Results. FI patients had median 3.5 leakage episodes/week. In all, 48% of bowel movements were associated with urgency. Urgency was correlated to decreased QoL according to SHS domains: symptoms (Rho = 0.54, p = 0.0002), function (Rho = 0.48, p = 0.0008), and disease related worry (Rho = 0.32, p = 0.027). Abdominal pain and bloating, reported by nearly half of patients, correlated to deceased QoL but not to number of leakages. QoL of patients with FI compared to UC in active phase (n = 35) was similar. FI patients had decreased QoL compared to UC in remission (n = 94) in all dimensions of SHS: symptoms (p < 0.0001), function (p < 0.0001), disease related worry (p < 0.0001), and general well being (p = 0.03). Conclusion. Urgency and irritable bowel syndrome (IBS)-like symptoms were associated with decreased QoL in FI. Therefore, IBS should be considered as an important confounding factor in FI QoL studies. QoL in patients with FI was considerably decreased, in a similar extent as in patients with UC in relapse.