Miracle-dz/UniFAR-FTUs huggingface dataset:
Fever of unknown origin in the 1980s. An update of the diagnostic spectrum.

OBJECTIVE To determine the relative proportions of the diagnostic categories in patients with fever of unknown origin who were examined in the 1980s. STUDY DESIGN Prospective case series. SETTING General Internal Medicine Service based at University Hospital, Leuven, Belgium. PATIENTS One hundred ninety-nine consecutive patients meeting the classic criteria of fever of unknown origin who were treated in the 1980s. MAIN OUTCOME MEASUREMENT The final diagnosis established at discharge or during follow-up. RESULTS Infections were found in 45 patients (22.6%), tumors were found in 14 (7%), multisystem diseases were found in 42 (21.5%), drug-related fever was found in six (3%), factitious fever was found in seven (3.5%), habitual hyperthermia was found in five (2.5%), miscellaneous diseases were found in 29 (14.5%), and no diagnosis was reached in 51 (25.6%). CONCLUSIONS Tumors were a less important cause of fever of unknown origin in the 1980s. The same holds true for some infectious diseases, such as abscesses and hepatobiliary disorders. Multisystem diseases were more frequently found, and the number of undiagnosed cases increased. Although these shifts in the disease spectrum in fever of unknown origin most probably resulted from a constellation of factors, we suspect that these changes are mainly due to easy and early diagnosis by new diagnostic modalities, such as ultrasonography and computed tomography, of previously common causes of fever of unknown origin.
Computerized characterization of lung nodule subtlety using thoracic CT images

The goal of this work is to design computerized image analysis techniques for automatically characterizing lung nodule subtlety in CT images. Automated subtlety estimation methods may help in computer-aided detection (CAD) assessment by quantifying dataset difficulty and facilitating comparisons among different CAD algorithms. A dataset containing 813 nodules from 499 patients was obtained from the Lung Image Database Consortium. Each nodule was evaluated by four radiologists regarding nodule subtlety using a 5-point rating scale (1: most subtle). We developed a 3D technique for segmenting lung nodules using a prespecified initial ROI. Texture and morphological features were automatically extracted from the segmented nodules and their margins. The dataset was partitioned into trainers and testers using a 1:1 ratio. An artificial neural network (ANN) was trained with average reader subtlety scores as the reference. Effective features for characterizing nodule subtlety were selected based on the training set using the ANN and a stepwise feature selection method. The performance of the classifier was evaluated using prediction probability (PK) as an agreement measure, which is considered a generalization of the area under the receiver operating characteristic curve when the reference standard is multi-level. Using an ANN classifier trained with a set of 2 features (selected from a total of 30 features), including compactness and average gray value, the test concordance between computer scores and the average reader scores was 0.789 ± 0.014. Our results show that the proposed method had strong agreement with the average of subtlety scores provided by radiologists.
Will Break for Productivity: Generalized Symptoms of Cognitive Depletion

In this work, we address the symptoms of cognitive depletion as they relate to generalized knowledge workers. We unify previous findings within a single analytical model of cognitive depletion. Our purpose is to develop a model that will help us predict when a person has reached a sufficient state of cognitive depletion such that taking a break or some other restorative action will benefit both his or her own wellbeing and the quality of his or her performance. We provide a definition of each symptom in our model as well as the effect it would have on a knowledge worker's ability to work productively. We discuss methods to detect each symptom that do not require self assessment. Understanding symptoms of cognitive depletion provides the ability to support human knowledge workers by reducing the stress involved with cognitive and work overload while maintaining or improving the quality of their performance.
IDENTIFICATION OF GENETIC POLYMORPHISMS THROUGH COMPARATIVE DNA SEQUENCE ANALYSIS ON THE K-ras GENE: IMPLICATIONS FOR LUNG TUMOR SUSCEPTIBILITY

In the present study, the authors performed a comparative DNA sequence analysis of the K-ras gene. By comparing sequences from different mouse inbred strains, the authors have identified new nucleotide polymorphisms in the noncoding regions of mouse K-ras gene. They have also identified noncoding DNA segments evolutionarily conserved among the human, mouse, and rat. Computational analysis for transcription factor binding sites suggests that these polymorphic and conserved DNA sequences harbor potential cis-regulatory elements, which may contribute to the transcriptional regulation of the K-ras gene. Further studies on these potential regulatory sites may help to elucidate the fundamental mechanism underlying allele-specific activation and expression of K-ras gene in hybrid mouse lung tumors, which determines lung tumor susceptibility in mice.
The Needle in the Haystack: What Drives Labor and Product Market Reforms in Advanced Countries?

The political economy literature has put forward a multitude of hypotheses regarding the drivers of structural reforms, but few, if any, empirically robust findings have emerged thus far. To make progress, we draw a parallel with model uncertainty in the growth literature and provide a new version of the Bayesian averaging of maximum likelihood estimates (BAMLE) technique tailored to binary logit models. Relying on a new database of major past labor and product market reforms in advanced countries, we test a large set of variables for robust correlation with reform in each area. We find widespread support for the crisis-induces-reform hypothesis. Outside pressure increases the likelihood of reform in certain areas: reforms are more likely when other countries also undertake them and when there is formal pressure to implement them. Other robust correlates are more specific to certain areas-for example, international pressure and political factors are most relevant for product market and job protection reforms, respectively.
Early differentiation of retinal ganglion cells: an axonal protein expressed by premigratory and migrating retinal ganglion cells

A monoclonal antibody, RA4, was developed that recognizes retinal ganglion cell axons in the mature retina. Between embryonic days 3 and 9, the RA4 antigen was associated with cell bodies in certain regions of the retina in addition to the ganglion cell axons. The RA4-positive cells were of 3 types: an apolar cell adjacent to the ventricular surface, a bipolar cell that spanned the thickness of the retina, and a monopolar cell in the ganglion cell layer. Evidence suggests that these cells are premigratory and migrating retinal ganglion cells. The expression of the RA4 antigen is the earliest indicator of ganglion cell differentiation yet reported. The existence of RA4-positive apolar cells along the outer surface of the retina suggests that the ganglion cell phenotype is expressed as soon as the cell becomes postmitotic. Approximately 20% of the migrating ganglion cells were in pairs. The paired cells most likely arose from the terminal division of a germinal cell. One possibility suggested by these data is that a ganglion cell- specific germinal cell arises from a pluripotent germinal cell. Immunoblots and other analyses revealed the RA4 antigen to be a 140 kDa cytoplasmic protein in the retina. RA4 also recognized many long tract axons in the brain. In the brain, the RA4 epitope was observed on proteins with at least 7 different molecular weights. Evidence suggests that different cell types may express the RA4 antigen with slightly different molecular weights.
Dynamic Regulation of Schwann Cell Enhancers after Peripheral Nerve Injury*

Background: Nerve injury induces Schwann cells to remove myelin coating and secrete factors that stimulate nerve regeneration. Results: ChIP-seq was used to identify injury-regulated enhancers in peripheral nerve. Conclusion: Dynamically regulated enhancers identify target sequences of injury-regulated transcription factors in Schwann cells. Significance: These data elucidate transcription factor pathways that coordinate Schwann cell responses in peripheral nerve injury. Myelination of the peripheral nervous system is required for axonal function and long term stability. After peripheral nerve injury, Schwann cells transition from axon myelination to a demyelinated state that supports neuronal survival and ultimately remyelination of axons. Reprogramming of gene expression patterns during development and injury responses is shaped by the actions of distal regulatory elements that integrate the actions of multiple transcription factors. We used ChIP-seq to measure changes in histone H3K27 acetylation, a mark of active enhancers, to identify enhancers in myelinating rat peripheral nerve and their dynamics after demyelinating nerve injury. Analysis of injury-induced enhancers identified enriched motifs for c-Jun, a transcription factor required for Schwann cells to support nerve regeneration. We identify a c-Jun-bound enhancer in the gene for Runx2, a transcription factor induced after nerve injury, and we show that Runx2 is required for activation of other induced genes. In contrast, enhancers that lose H3K27ac after nerve injury are enriched for binding sites of the Sox10 and early growth response 2 (Egr2/Krox20) transcription factors, which are critical determinants of Schwann cell differentiation. Egr2 expression is lost after nerve injury, and many Egr2-binding sites lose H3K27ac after nerve injury. However, the majority of Egr2-bound enhancers retain H3K27ac, indicating that other transcription factors maintain active enhancer status after nerve injury. The global epigenomic changes in H3K27ac deposition pinpoint dynamic changes in enhancers that mediate the effects of transcription factors that control Schwann cell myelination and peripheral nervous system responses to nerve injury.
Fatal cyclophosphamide cardiomyopathy: its clinical course and treatment.

Acute decompensating cardiomyopathy induced by cyclophosphamide is usually irreversible. To investigate the clinical course and the outcome of therapy, 13 patients (1.7%) with grade III acute cardiomyopathy and hypotension who were treated with ablative transplant regimens between January 1980 and September 1995 were analyzed. Eight of nine patients died of acute fatal restrictive cardiomyopathy with unresponsive hypotension (ARCH), whereas three of four patients who survived the initial episode died of subacute congestive heart failure (SCHF). Acute fatal restrictive cardiomyopathy was characterized with extreme sensitivity to volume overload, myocardial edema and a rapidly fatal course. It was associated with progressive, unresponsive hypotension, reduced left ventricular stroke work index (LVSWI: 29.29 +/- 9.74 g-m/beat/m2) and markedly reduced systemic and pulmonary vascular resistance indices (SVRI: 429.72 +/- 168.84, PVRI: 58.63 +/- 45.08 dyne.sec/cm5.m2). Subacute CHF was identified by myocardial edema, dilated chambers and biventricular pump failure represented by decreases in fractional shortening (FS: 19.5 +/- 4.9%). Of 10 patients who received conventional therapy, nine died and one sustained chronic CHF. One of three patients with ARCH on antioxidant therapy of ascorbic acid and theophylline survived the episode. The data suggests peripheral vascular collapse may also be responsible for fatal ARCH.
Patient Reports of Preventable Problems and Harms in Primary Health Care

BACKGROUND Despite recent attention given to medical errors, little is known about the kinds and importance of medical errors in primary care. The principal aims of this study were to develop patient-focused typologies of medical errors and harms in primary care settings and to discern which medical errors and harms seem to be the most important. METHODS Thirty-eight in-depth anonymous interviews of adults from rural, suburban, and urban locales in Virginia and Ohio were conducted to solicit stories of preventable problems with primary health care that led to physical or psychological harm. Transcriptions were analyzed to identify, name, and organize the stories of errors and harms. RESULTS The 38 narratives described 221 problematic incidents that predominantly involved breakdowns in the clinician-patient relationship (n = 82, 37%) and access to clinicians (n = 63, 29%). There were several reports of perceived racism. The incidents were linked to 170 reported harms, 70% of which were psychological, including anger, frustration, belittlement, and loss of relationship and trust in one’s clinician. Physical harms accounted for 23% of the total and included pain, bruising, worsening medical condition, and adverse drug reactions. DISCUSSION The errors reported by interviewed patients suggest that breakdowns in access to and relationships with clinicians may be more prominent medical errors than are technical errors in diagnosis and treatment. Patients were more likely to report being harmed psychologically and emotionally, suggesting that the current preoccupation of the patient safety movement with adverse drug events and surgical mishaps could overlook other patient priorities.
A Study on the Interrelations of Decision-Making Factors of Information System (IS) Upgrades for Sustainable Business Using Interpretive Structural Modeling and MICMAC Analysis

An information system (IS) upgrade is an essential way to enhance the competitiveness of an organization. Specifically, the decision making processes surrounding IS upgrades is one of the most important parts of an organization’s competitiveness in regard to business sustainability. Previous research studies on IS upgrade decisions have focused on implementing a more efficient decision-making system by determining when IS upgrades should be performed based on the cost factor, from the perspective of both users and experts. However, if the decision making of an IS upgrade is delayed or not performed accurately due to the limitations of a specific business environment, such as a job, position, or cost, an organization can lose its business competitiveness. In this context, the present study determines the main factors involved in decision making processes surrounding IS upgrades, and analyzes the interrelations among these factors in an organization with regard to users, managers, and experts. The interpretive structural modeling (ISM) method is used as an analytical tool to analyze the characteristics and interrelations of factors based on a real system model called the User-Centered Training System (UCTS). Based on the results, the present study provides a deeper insight into decision-making factors and directional models, and allows for a more efficient management of the decision-making problem of an IS upgrade caused by differences in the business environment between each layer (i.e., users, managers, and experts). Specifically, according to our results, users are more likely to think about the positive effects and benefits they could have on their work, rather than about organizational benefits. By contrast, managers reason that IS upgrades should have a positive impact on the overall organizational goals and benefits. Finally, experts think that an IS upgrade should benefit both the organization and users. Taken together, the results of the present study are meaningful in that they clearly show the interrelationships between the decision-making factors on each of the levels.
Clinical effectiveness of autologous platelet-rich plasma and Peptide-enhanced bone graft in the treatment of intrabony defects.

BACKGROUND The goal of periodontal therapy has always been the regeneration of lost attachment apparatus. The use of platelet-rich plasma (PRP) plus anorganic bovine-derived matrix and peptide 15 (ABM/P-15) for periodontal regenerative therapy offers a potentially useful modality for treating periodontal osseous defects. However, it is unknown whether a combination of these materials enhances the outcome of periodontal regenerative therapy. Therefore, this study was carried out to compare the effectiveness of the two regenerative techniques (autologous PRP plus ABM/P-15 versus autologous PRP) in treating intrabony defects in humans by analyzing the clinical and radiologic parameters. METHODS Using a split-mouth design, 28 intrabony defects were treated with autologous PRP (control) or a combination of autologous PRP and ABM/P-15 (test). Clinical parameters such as plaque index, sulcus bleeding index, probing depth, attachment level, and gingival marginal level were recorded at baseline and 9 months postoperatively. Hard tissue measurements such as defect fill, defect resolution, and change in alveolar crest height were also recorded using spiral computed tomography (CT). RESULTS A statistically significant difference was observed in all clinical parameters in the test group compared to the control group. Furthermore, spiral CT images revealed significantly greater bone fill in the test group. CONCLUSIONS A combination of PRP plus ABM/P-15 was more effective than PRP alone in the treatment of intrabony defects. Further studies using a larger sample size are necessary to confirm the results of the present study.
Price and Behavioural Signals to Encourage Water Conservation

The global problem of water resource constraints is pertinent to the UK and particularly acute in the south and east of England. A greater emphasis is being placed on water demand management in the UK, with a need to find a balance among social, environmental, economic and political goals. Putting a price on water is conceptually straightforward but often challenging in implementation. As water bills are typically small relative to household income in the UK, expenditure-led incentives may be insufficient, and so it is important that attitudeled behavioural interventions are also considered for conservation purposes. There is increased penetration of water meters in the UK and there is evidence that metering in itself leads to greater awareness of water use. Development and introduction of conservationoriented tariffs and behavioural interventions to manage demand have been modest compared to in some other locations. Also, there is a lack of evidence of how tariff signals and behavioural signals interact in the UK. This report reviews international experience of price and non-price approaches to manage residential water demand, with a focus on drawing insights regarding the effectiveness of Increasing Block Tariffs and information-based behavioural interventions. It then offers some insights on the extent to which lessons from elsewhere may be transferable to the UK context.
Water and social activism in Canada

This thesis on water and social activism in Canada is a journey into the realm of shared social understanding. Water is too precious to all forms of life to simply permit commodification for the benefit of a few at the expense of the many. The Sun Belt case adjudicated under the North American Free Trade Agreement (NAFTA) when compared with what prevailed under previous Canadian national law reveals severe limits to state sovereignty. A high measure of support has already been manifest around concerns and considerations which pertain to water and the potential for the growth of social activism with reference to water may well be unprecedented in Canada. There are fundamental inequalities found within the Sun Belt case. Current international trade policy coupled with private banking practices does not value the principles of sustainability, equality and justice because it is committed to the commodification of the “commons”. This thesis uses a variety of sources to oppose the present discourses followed by governments according to the doctrines found in the study of classical economics within a capitalist context. Dr. Rennie Warburton, Supervisor (Department of Sociology) Dr. Peter Stephenson, Committee Member (Department of Anthropology) Dr. Ken Hatt, Committee Member (Department of Sociology) Dr. Honore France, Committee Member (Faculty of Education) Dr. Pamela Moss, External Examiner (Faculty of Human and Social Development)
An update on the pharmacological strategies in the treatment of HIV-1-associated adipose redistribution syndromes

Introduction: With the introduction of combination antiretroviral therapy (ART) for HIV infection in the mid-1990s, descriptions of morphological changes and metabolic disturbances in treated patients began to emerge. HIV-1/highly active ART-associated lipodystrophy syndrome (HALS) involves metabolic abnormalities and diverse forms of anomalous fat distribution. The current review focuses on the pathophysiological basis and the clinical evidence for the use of several medical strategies in the management of HALS. Areas covered: We have covered the most relevant studies related to the pharmacological strategies in the treatment of HALS, with attention to the current and novel antiretroviral agents. Expert opinion: The most commonly used strategies for HALS reversion have included modification of host-dependent factors, including those related to HIV-1 infection and those associated with ART. Preventive and medical strategies have been associated with moderate success. The only intervention that offers an immediate aesthetical improvement for patients with HALS so far has been plastic surgery.
VALIDATION OF AN ANEURYSMAL SUBARACHNOID HEMORRHAGE GRADING SCALE IN 1532 CONSECUTIVE PATIENTS

OBJECTIVEThe two most commonly used aneurysmal subarachnoid hemorrhage grading scales are the Hunt and Hess and World Federation of Neurological Societies scales. Neither has achieved universal acceptance, however, owing to concerns regarding either subjectivity or lack of correlation with outcomes, respectively. A grading scale based entirely on the Glasgow Coma Scale (GCS) was recently proposed. We have prospectively evaluated the GCS grading system and compared it with the Hunt and Hess and World Federation of Neurological Societies scales for predictive accuracy. METHODSData from 1532 consecutive patients with intracranial aneurysms admitted to our institution between January 1991 and June 2005 were analyzed. The Glasgow Outcome Scale was the primary outcome measure. Mortality and length of stay were secondary measures. The scales were evaluated using simple and multivariable logistic and linear regression. Receiver operating characteristic curves were used to assess predictive accuracy for the Glasgow Outcome Scale. Prognostic factors were assessed with ordinal multivariable logistic regression. RESULTSThe GCS grading system was most strongly associated with all outcome measures and was the strongest predictor of mortality and persistent vegetative state. Age, vasospasm, hydrocephalus, and intracranial hematoma were found to be significant prognostic elements. CONCLUSIONThe GCS grading system is more strongly associated with outcomes than either the Hunt and Hess or World Federation of Neurological Societies scales, and it is an equivalent to a slightly better predictor of Glasgow Outcome Scale outcomes. Its simplicity, proven inter-rater reliability, and wide level of familiarity among health care personnel render the GCS grading system a superior grading scale for aneurysmal subarachnoid hemorrhage severity, warranting its consideration for universal use.