Miracle-dz/UniFAR-FTUs huggingface dataset:
Enhanced Web-Based Otitis Study Case vs Simple Paper-Case: Impact on Medical Student Objective Structured Clinical Exam (OSCE) Performance

Abstract Background: Distance education methods have taken on greater importance as medical student education has moved off campus into the community. What the best methods are for conveying information to students at distant sites has not been determined. Objective: To determine if students at distant community sites who received an otitis media study case by e-mail that was enhanced with a referral to a web-based otitis study case, performed better on otitis OSCE stations than students who received the same case not enhanced with visuals or referrals to a web-based otitis case. Design/Methods: Students were randomized by community site to receive either the enhanced (E) or simple otitis study case (S). Students were e-mailed an otitis media study case during the 5th week of the rotation. Those randomized to the E-case received a case that started with a case scenario followed by a "Task" that instructed them to go to this web address: http://www.aap. org/otitismedia/www/vc/ear/index.cfm (American Academy of Pediatrics Otitis Web Site). They were then to select "Case 1" which was a continuation of the case scenario present on their e-mail. A list of learning objectives was also printed on the e-mail. Students receiving the S-case viewed the same case scenario and objectives, but were not instructed to go to the web-page. All students rotated through two OSCE otitis stations. In the first station they interviewed a simulated patient(OSCE-SP) and counseled her on the management of her 12 month old with otitis. Within that station they viewed a video of a pneumoscopic exam of two ears, one ear with otitis and the other ear normal. At the 2nd otitis station the student presented the case to a faculty and was asked a series of questions about otitis media(OSCE-PR). Scores on the two stations were compared by group. Results: There were 198 students who took the OSCE. 178 (90%) responded to a survey that indicated they had opened and read the e-mailed case. There were 87 students in the E-group and 91 in the S-group. The mean ±s.d. OSCE-SP station score for the E-group was 72.6 ±12.0 vs 75.4 ±9.8 for the S-group, p=0.09. For the otitis presentation station the scores for the E-group and S-group were respectively, 82.9 ±9.6 and 83.7 ±9.4, p=0.55. Conclusions: These data suggest that enhanced visual distance education cases may offer no distinct advantage over simple paper-type case study guides.
Steroid myopathy in cancer patients

To the Editor: In their interesting article,1 Lopez et al. present data on the association between quantitative spectral EEG and subsequent cognitive and functional decline and survival in patients with probable Alzheimer's disease (AD). The authors report that patients with abnormal EEGs reach the defined endpoints for cognitive function and activities of daily living sooner than patients with normal EEGs. Abnormal EEG results were not related to an increased risk of mortality in these patients. Based on these results, the authors conclude that abnormal EEG results predict disease progression but not physical survival. We have two main methodologic problems with the interpretation of …
Community Support as a Moderator of Postdisaster Mental Health Symptoms in Urban and Nonurban Communities

Abstract Objective We examined the association between disaster exposure, community support, and mental health outcomes in urban and nonurban participants of Galveston and Chambers counties after Hurricane Ike. The moderating effect of community support was evaluated as a protective factor relative to postdisaster mental health. Methods A representative population-based sample of 157 urban and 714 nonurban adults were interviewed 12 to 17 months after the hurricane about their mental health functioning, disaster exposure, and perceptions of community support. Results A series of multiple regressions demonstrated that disaster exposure was associated with mental health outcomes for both groups. The strength of the association varied across population samples.Community support moderated the association between interpersonal effects of the disaster and posttraumatic stress disorder (PTSD) and depression outcomes in nonurban participants and the association between property damage and PTSD in urban participants. Conclusions Community support played a larger role in reducing PTSD and depression symptoms associated with the interpersonal effects of a disaster in the nonurban sample only. Communities may play a more beneficial role in the recovery process in nonurban areas that have elevated levels of injury or death attributed to a disaster. (Disaster Med Public Health Preparedness. 2013;0:1–9)
Thoracoscopic repair of congenital diaphragmatic hernia in infancy.

BACKGROUND Minimally invasive surgical techniques, specifically the thoracoscopic approach, have been applied to congenital diaphragmatic hernia (CDH) with varying outcomes from selected centers. The aim of our study was to examine the rate of successful completion and compare outcomes between open and thoracoscopic approaches in CDH repair. METHODS We performed a retrospective analysis of infants with CDH repair (From February 2004 to January 2008). Patients were divided into thoracoscopic and open groups, based on operative approach. We analyzed demographic, clinical, and hospitalization characteristics to compare the completion rate and outcomes in these two groups. RESULTS Analysis of 31 infants with CDH (14 thorascocopic and 17 open) demonstrated no differences in sex (P = 0.132), age (P = 0.807), birthweight (P = 0.256), weight at operation (P = 0.647), pulmonary hypertension (P = 0.067), preoperative intensive care unit (ICU) days (P = 0.673), ventilator days (P = 0.944), or use of a patch (P = 0.999) between the groups. Seventy-nine percent of thoracoscopic operative approaches were completed successfully. There was a significant difference between the open and thoracoscopic groups with respect to estimated gestational age (39 versus 36.5 weeks; P = 0.006) and operating room time (70 versus 145 minutes; P = 0.004). The total (P = 0.662), ICU (P = 0.889), and postoperative (P = 0.619) length of stay and days on ventilator (P = 0.705), as well as days until initial enteral feeds (P = 0.092), were not significantly different between groups. There were no deaths and no evidence of recurrence, with a mean follow-up of 346 days. CONCLUSIONS In our early experience, the thoracoscopic approach for congenital diaphragmatic hernia repair was completed in 80% of our patient population with minimal exclusion criteria. Further study, with larger sample sizes, is needed to ascertain differences in outcomes, such as length of stay and initiation of enteral feeding.
BMP-9 Induced Endothelial Cell Tubule Formation and Inhibition of Migration Involves Smad1 Driven Endothelin-1 Production

Background Bone morphogenetic proteins (BMPs) and their receptors, such as bone morphogenetic protein receptor (BMPR) II, have been implicated in a wide variety of disorders including pulmonary arterial hypertension (PAH). Similarly, endothelin-1 (ET-1), a mitogen and vasoconstrictor, is upregulated in PAH and endothelin receptor antagonists are used in its treatment. We sought to determine whether there is crosstalk between BMP signalling and the ET-1 axis in human pulmonary artery endothelial cells (HPAECs), possible mechanisms involved in such crosstalk and functional consequences thereof. Methodology/Principal Finding Using western blot, real time RT-PCR, ELISA and small RNA interference methods we provide evidence that in HPAECs BMP-9, but not BMP-2, -4 and -6 significantly stimulated ET-1 release under physiological concentrations. This release is mediated by both Smad1 and p38 MAPK and is independent of the canonical Smad4 pathway. Moreover, knocking down the ALK1 receptor or BMPR II attenuates BMP-9 stimulated ET-1 release, whilst causing a significant increase in prepro ET-1 mRNA transcription and mature peptide release. Finally, BMP-9 induced ET-1 release is involved in both inhibition of endothelial cell migration and promotion of tubule formation. Conclusions/Significance Although our data does not support an important role for BMP-9 as a source of increased endothelial ET-1 production seen in human PAH, BMP-9 stimulated ET-1 production is likely to be important in angiogenesis and vascular stability. However, increased ET-1 production by endothelial cells as a consequence of BMPR II dysfunction may be clinically relevant in the pathogenesis of PAH.
Understanding the Development of Minimum Unit Pricing of Alcohol in Scotland: A Qualitative Study of the Policy Process

Background Minimum unit pricing of alcohol is a novel public health policy with the potential to improve population health and reduce health inequalities. Theories of the policy process may help to understand the development of policy innovation and in turn identify lessons for future public health research and practice. This study aims to explain minimum unit pricing’s development by taking a ‘multiple-lenses’ approach to understanding the policy process. In particular, we apply three perspectives of the policy process (Kingdon’s multiple streams, Punctuated-Equilibrium Theory, Multi-Level Governance) to understand how and why minimum unit pricing has developed in Scotland and describe implications for efforts to develop evidence-informed policymaking. Methods Semi-structured interviews were conducted with policy actors (politicians, civil servants, academics, advocates, industry representatives) involved in the development of MUP (n = 36). Interviewees were asked about the policy process and the role of evidence in policy development. Data from two other sources (a review of policy documents and an analysis of evidence submission documents to the Scottish Parliament) were used for triangulation. Findings The three perspectives provide complementary understandings of the policy process. Evidence has played an important role in presenting the policy issue of alcohol as a problem requiring action. Scotland-specific data and a change in the policy ‘image’ to a population-based problem contributed to making alcohol-related harms a priority for action. The limited powers of Scottish Government help explain the type of price intervention pursued while distinct aspects of the Scottish political climate favoured the pursuit of price-based interventions. Conclusions Evidence has played a crucial but complex role in the development of an innovative policy. Utilising different political science theories helps explain different aspects of the policy process, with Multi-Level Governance particularly useful for highlighting important lessons for the future of public health policy.
Prediction of Insulin-Dependent T2DM in Patients Using Machine Learning Model

Diabetes, a widespread and enduring chronic ailment, exerts its impact on millions of people across the globe. Individuals with diabetes need regular insulin injections to sustain optimal blood sugar levels. Insulin is indispensable for persons with type 1 diabetes, although persons with type 2 diabetes may require insulin at a later stage. However, the current approaches for suggesting insulin dosage frequently prove inadequate, exhibiting either imprecision or complex procedures. Certain approaches require individuals to bear the responsibility, necessitating the manual calculation of insulin dosage using blood sugar levels and other factors—a complex and prone-to-error undertaking. Some individuals require closed-loop insulin administration devices, which are expensive and include wearing a continuous glucose monitoring (CGM) system. Recent estimates indicate that over 40% of patients who are suffering from (T2DM) in India and Gulf countries are utilizing insulin either on its own or in conjunction with Oral Antidiabetic Drugs (OADs) at any one moment. Lack of sufficient understanding regarding the use of insulin is expected to impact the acceptance, adherence, and effectiveness of therapy. This highlights the urgent requirement to examine the knowledge, and attitude, and suggest the usage of insulin to patients with both juvenile and type 2 diabetes. Insulin therapy is a crucial component of diabetes treatment; individuals with juvenile diabetes and the majority of those with type 2 diabetes will need insulin at some point. Proper injection technique is crucial for achieving glycemic control when using injectable medications such as human insulin, insulin analog, and glucagon-like peptide-l receptor agonists to manage diabetes. The proposed study focuses on determining the subset of individuals with diabetes who are taking both insulin and Oral Antidiabetic Drugs (OAD), and to assess the influence of insulin on glycemic control, ultimately resulting in improved diabetes management.
Comparison of nutrient intake, life style variables, and pregnancy outcomes by the depression degree of pregnant women

The aim of this study was to analyse effects that the degree of depression have on the life style variables, nutrient intake, iron indices and pregnancy outcome. Subjects were 114 pregnant women who were receiving prenatal care at a hospital in Seoul. We collected data for general characteristics and lifestyle variables from general survey instrument and for depression score from the questionnaire on depression. Dietary intakes of subjects were estimated by 24 hour dietary recall method. Also we analysed iron indices and pregnancy outcomes. We classified subjects by 10 point, which was the average depression score, into two groups [Low depression score group (LS) : High depression score group (HS)]. As to the intakes of total calcium, plant-calcium, plant-iron, potassium, total folate and dietary folate, LS group was far higher than HS group (P < 0.05, P < 0.05, P < 0.01, P < 0.001, P < 0.05, and P < 0.01, respectively). As to pre-pregnancy alcohol drinking, LS group had 41.9% in non-drinker, which was far higher than 28% in HS group in non-drinker (P < 0.05). As for drinking coffee during pre-pregnancy, pregnant women who don't drink coffee in LS group took 43.6%, which was higher than 38% in HS group (P < 0.01). Regarding delivery type, the cesarean section in LS group (18%) was significantly lower than that in HS group (45%) (P < 0.01). Bivariate analysis showed that birth weight was significantly associated with the gestational age (P < 0.01). The pregnant women with higher depression score tended to have undesirable life habit, which might affect negative pregnancy outcomes. A better understanding of how depression and intake of nutrients work together to modulate behavior will be benefit nutritional research.
On the Optimality of Averaging in Distributed Statistical Learning

A common approach to statistical learning with big-data is to randomly split it among $m$ machines and learn the parameter of interest by averaging the $m$ individual estimates. In this paper, focusing on empirical risk minimization, or equivalently M-estimation, we study the statistical error incurred by this strategy. We consider two large-sample settings: First, a classical setting where the number of parameters $p$ is fixed, and the number of samples per machine $n\to\infty$. Second, a high-dimensional regime where both $p,n\to\infty$ with $p/n \to \kappa \in (0,1)$. For both regimes and under suitable assumptions, we present asymptotically exact expressions for this estimation error. In the fixed-$p$ setting, under suitable assumptions, we prove that to leading order averaging is as accurate as the centralized solution. We also derive the second order error terms, and show that these can be non-negligible, notably for non-linear models. The high-dimensional setting, in contrast, exhibits a qualitatively different behavior: data splitting incurs a first-order accuracy loss, which to leading order increases linearly with the number of machines. The dependence of our error approximations on the number of machines traces an interesting accuracy-complexity tradeoff, allowing the practitioner an informed choice on the number of machines to deploy. Finally, we confirm our theoretical analysis with several simulations.
Inhibition of cuneate neurones: its afferent source and influence on dynamically sensitive ‘tactile’ neurones

1. Responses were recorded in decereberate, unanaesthetized cats from individual cuneate neurones in order to determine firstly, the afferent sources of inhibition on cuneate neurones and secondly, the influence of afferent‐induced inhibition on those response features of dynamically sensitive tactile neurones which determine their capacity to code information about parameters of tactile stimuli.
Legionella: Molecular Microbiology

A banal virosis, no doubt Fever fades away, back at work I feel weary, I’ll be all right, I’m sure What, now? My body itches Could this be an allergy? A pill to halt the itching Again ill, what does this nausea mean? Could this be dengue? It’s on the borders, the global warming … And yet, I didn’t leave the city In Buenos Aires you can’t … Just in case, I have a test done I can’t believe it, the test is positive Spread the news, could be more cases, — Needs confirmation, it can’t happen here Why not? Imported cases, Aedes thriving … There must be others, we must warn people — We are not sure, can’t happen here At last, new test confirms. You must warn people Not even now? What about the others? Those who don’t know, they are at risk — It won’t spread, can’t happen here As a physician I feel responsible Please spread the news It did happen here!
Impacts of Sediment Dredging on Phosphorus Dynamics in a Restored Riparian Wetland

A wetland restoration project within the Muskegon Lake watershed (MI) was initiated in 2012 to increase fish and wildlife habitat by hydrologically reconnecting former agricultural land to its adjacent stream. However, to reduce the risk of sediment phosphorus (P) releasing into downstream waters upon hydrologic reconnection, the wetland was drained and P-rich sediments were dredged. I evaluated restoration success by measuring sediment P release in the wetland after dredging and compared those results to studies that measured P release before dredging. Sediment cores were incubated under two water temperatures (ambient; +2° C) and two oxygen levels (oxic; hypoxic). My results showed that maximum P release rates in all four after-dredging treatments were reduced by 95-99 %. These results suggest that 1) sediment removal is an effective approach for reducing sediment P release in wetlands restored on agricultural land, and 2) the remaining substrate is not currently susceptible to increased P release as a result of increased temperature or decreased dissolved oxygen. While internal P loading was drastically reduced, P adsorption isotherm experiments suggested that the deep dredging depth (~1 m on average) exposed sediments with significantly reduced binding capacities, resulting in the wetland acting as a phosphate sink only when water column soluble reactive phosphorus concentrations are over 40 μg L. Ultimately, this study shows that sediment dredging can be a useful technique to balance the goals of habitat restoration and water quality improvements in wetlands restored on former agricultural lands.
Tyrosinase-Cre-Mediated Deletion of the Autophagy Gene Atg7 Leads to Accumulation of the RPE65 Variant M450 in the Retinal Pigment Epithelium of C57BL/6 Mice

Targeted gene knockout mouse models have helped to identify roles of autophagy in many tissues. Here, we investigated the retinal pigment epithelium (RPE) of Atg7f/f Tyr-Cre mice (on a C57BL/6 background), in which Cre recombinase is expressed under the control of the tyrosinase promoter to delete the autophagy gene Atg7. In line with pigment cell-directed blockade of autophagy, the RPE and the melanocytes of the choroid showed strong accumulation of the autophagy adaptor and substrate, sequestosome 1 (Sqstm1)/p62, relative to the levels in control mice. Immunofluorescence and Western blot analysis demonstrated that the RPE, but not the choroid melanocytes, of Atg7f/f Tyr-Cre mice also had strongly increased levels of retinoid isomerohydrolase RPE65, a pivotal enzyme for the maintenance of visual perception. In contrast to Sqstm1, genes involved in retinal regeneration, i.e. Lrat, Rdh5, Rgr, and Rpe65, were expressed at higher mRNA levels. Sequencing of the Rpe65 gene showed that Atg7f/f and Atg7f/f Tyr-Cre mice carry a point mutation (L450M) that is characteristic for the C57BL/6 mouse strain and reportedly causes enhanced degradation of the RPE65 protein by an as-yet unknown mechanism. These results suggest that the increased abundance of RPE65 M450 in the RPE of Atg7f/f Tyr-Cre mice is, at least partly, mediated by upregulation of Rpe65 transcription; however, our data are also compatible with the hypothesis that the RPE65 M450 protein is degraded by Atg7-dependent autophagy in Atg7f/f mice. Further studies in mice of different genetic backgrounds are necessary to determine the relative contributions of these mechanisms.
Chikungunya outbreak in Garo Hills, Meghalaya: An epidemiological perspective

Background & objectives: Chikungunya (CHIK) fever is a mosquito-borne disease caused by chikungunya virus (CHIKV). Chikungunya infection was first reported from India in 1963 from Kolkata. We report the serological and molecular evidence of an outbreak of chikungunya in northeast India that occurred in Tura, a hilly and forested terrain in Garo Hills district of Meghalaya. Methods: Blood samples (3 ml) collected from hospitalized patients during the outbreak were tested for IgM antibodies against CHIKV and followed up four months later. A repeat survey was carried out in the same area after four months from where cases had been reported. Blood samples were also collected from people with history of fever and body ache in the last four months. Persons showing IgM positivity against CHIKV in the repeat survey were followed up one and a half years later. All samples were also processed by RT-PCR assay for CHIK Envelope (E) 1 gene. Immature mosquitoes were collected, link reared and identified with standard keys. Virus incrimination studies were done on Aedes aegypti and Ae. albopictus mosquitoes collected during the survey. Results: Fever, headache and joint pain were the primary clinical presentations. Twenty three (35.93 %) of 64 samples reported during the outbreak were IgM positive for CHIK. Three samples showed PCR amplification. All these were IgM positive. The sequenced E1 gene revealed that the strains belonged to East Central South African (ECSA) genotype. Interpretation & conclusions: Field survey done after four months revealed that some individuals still had joint pain associated with episodes of headache and fever. It could be inferred that these persons might have contracted infection during the CHIK outbreak four months ago or during the intervening period which caused persistence of sequelae. ECSA genotype was found to be involved in the outbreak. Aedes albopictus was the predominant mosquito species collected during the outbreak.