Miracle-dz/UniFAR-FTUs huggingface dataset:
Managing an effective patient flow - A single ward´s impact on the acute patient flow

The increasing pressure on healthcare resources in Sweden requires that the system becomes more efficient and not only focus on additional resources as the solution since the healthcare also has legal responsibility for delivering care as cost-effective as possible. An identified factor that creates lower productivity in Sweden than in other Nordic countries is a slow patient flow. To create an efficient and leveled flow it is important that wards that affect each other have synchronized flows and also overview the whole patient flow instead of focusing only on a single ward when making improvements to prevent sub optimizations. The purpose with this master thesis is to give practical suggestions for a more efficient work with patient flow. This purpose is addressed by investing how a specific ward works with patient flow, both the acute and the elective, at a medium sized hospital. Furthermore, the study examines the coordination of the acute flow on an overall level and how it is affected of the work in the specific ward. Usage of Lean philosophy and process development have been shown to have great results in complex organizational environments. One such environment is the healthcare system, with several ingoing components, as well as different wards dependent on each other's functionality and therefore where it is important to improve the processes across the interfaces. Based on the analysis and the discussion three major improvement areas where found; i) Planning operations and separation of patient flows; ii) standardization and visualization of communication and processes; iii) Continuously work with improvements to evaluate and improve the processes. Several practical suggestions to create an efficient flow at the studied hospital are also presented in the conclusion.
Epidemiology of Chronic Dacryocystitis and Success Rate of External Dacryocystorhinostomy in Nepal

Purpose: To study the epidemiology of chronic dacryocystitis and the success rate of external dacryocystorhinostomy (DCR) in Nepal. Patients and Methods: This is a retrospective descriptive and interventional case series. A total of 662 records of patients with chronic dacryocystitis due to nasolacrimal duct obstruction, who were treated by means of external DCR without bicanalicular silastic tube intubation, were studied. Statistics: Mean for age with standard deviation and confidence intervals were calculated. The significance of the difference in means was calculated using the unpaired t-test. Results: Of 662 patients, 67.6% were female. The mean age of the patients was 27.4 ± 13.7 years (SE = 0.53, 95% CI = 26.34–28.46). Chronic dacryocystitis due to nasolacrimal duct obstruction was found in 86 patients (13.0%) from the high hills (mean age = 35.3 ± 11.4 years, 95% CI = 32.85–37.75), but most patients (576, 87.0%) were from the subtropical lowlands with a monsoon climate (mean age = 26.9 ± 13.3 years, 95% CI = 25.8–28.0; p = < 0.01). An overall success rate of 88.6% (89.8% for high-hill patients and 87.4% for those from the lowlands) was obtained after DCR. Conclusion: Chronic dacryocystitis is more common in the subtropical plains of Nepal with a monsoon climate than in the high hills. It is predominantly found in pre-menopausal females. External DCR without bicanalicular silastic tube intubation is an effective method for treating chronic dacryocystitis due to NLDO in these patients.
High-resolution 3D shallow crustal structure in Long Beach, California: Application of ambient noise tomography on a dense seismic array

Ambient noise tomography has proven to be effective in resolving shallow earth structure. We applied ambient noise tomography on a dense seismic array in Long Beach, California. The array was composed of more than 5200 stations with an average spacing close to 100 m. Three weeks of passive ambient noise were crosscorrelated between each station pair, which resulted in more than 13.5 million crosscorrelations within the area. Clear fundamental-mode Rayleigh waves were observed between 0.5 and 4 Hz, which were most sensitive to structure above 1-km depth. For each station pair, we applied frequency-time analysis to determine the phase traveltime dispersion, and, for each frequency, we applied eikonal tomography to determine the Rayleigh wave phase velocity map. The eikonal tomography accounted for ray bending by tracking the wavefront and allowed uncertainties to be estimated through statistical analysis. The compilation of phase velocity maps was then used to invert for 3D shear velocity structure. The inverted model showed clear correlation with the known geologic features such as the shallow south–north velocity dichotomy and a deeper fast anomaly associated with the Newport-Inglewood fault zone. Our results can potentially be used to complement traditional active source studies.
Targeted drugs for pulmonary arterial hypertension: a network meta-analysis of 32 randomized clinical trials

Background Pulmonary arterial hypertension (PAH) is a devastating disease and ultimately leads to right heart failure and premature death. A total of four classical targeted drugs, prostanoids, endothelin receptor antagonists (ERAs), phosphodiesterase 5 inhibitors (PDE-5Is), and soluble guanylate cyclase stimulator (sGCS), have been proved to improve exercise capacity and hemodynamics compared to placebo; however, direct head-to-head comparisons of these drugs are lacking. This network meta-analysis was conducted to comprehensively compare the efficacy of these targeted drugs for PAH. Methods Medline, the Cochrane Library, and other Internet sources were searched for randomized clinical trials exploring the efficacy of targeted drugs for patients with PAH. The primary effective end point of this network meta-analysis was a 6-minute walk distance (6MWD). Results Thirty-two eligible trials including 6,758 patients were identified. There was a statistically significant improvement in 6MWD, mean pulmonary arterial pressure, pulmonary vascular resistance, and clinical worsening events associated with each of the four targeted drugs compared with placebo. Combination therapy improved 6MWD by 20.94 m (95% confidence interval [CI]: 6.94, 34.94; P=0.003) vs prostanoids, and 16.94 m (95% CI: 4.41, 29.47; P=0.008) vs ERAs. PDE-5Is improved 6MWD by 17.28 m (95% CI: 1.91, 32.65; P=0.028) vs prostanoids, with a similar result with combination therapy. In addition, combination therapy reduced mean pulmonary artery pressure by 3.97 mmHg (95% CI: −6.06, −1.88; P<0.001) vs prostanoids, 8.24 mmHg (95% CI: −10.71, −5.76; P<0.001) vs ERAs, 3.38 mmHg (95% CI: −6.30, −0.47; P=0.023) vs PDE-5Is, and 3.94 mmHg (95% CI: −6.99, −0.88; P=0.012) vs sGCS. There were no significant differences in all-cause mortality and severe adverse events between prostanoids, ERAs, PDE-5Is, sGCS, combination therapy, and placebo. Conclusion All targeted drugs for PAH are associated with improved clinical outcomes, especially combination therapy. However, all these drugs seem to show less favorable effects on survival in the short-term follow-up, suggesting further clinical trials are required.
Comparison of Ultrasound-Guided Axillary Brachial Plexus Block Techniques: Perineural Injection versus Single or Double Perivascular Infiltration

Purpose We compared three methods of ultrasound-guided axillary brachial plexus block, which were single, and double perivascular (PV) infiltration techniques, and a perineural (PN) injection technique. Materials and Methods 78 patients of American Society of Anesthesiologists physical status I-II undergoing surgery of the forearm, wrist, or hand were randomly allocated to three groups. 2% lidocaine with epinephrine 5 µg/mL was used. The PN group (n=26) received injections at the median, ulnar, and radial nerve with 8 mL for each nerve. The PV1 group (n=26) received a single injection of 24 mL at 12-o'clock position of the axillary artery. The PV2 group (n=26) received two injections of 12 mL each at 12-o'clock and 6-o'clock position. For all groups, musculocutaneous nerve was blocked separately. Results The PN group (391.2±171.6 sec) had the longest anesthetic procedure duration than PV1 (192.8±59.0 sec) and PV2 (211.4±58.6 sec). There were no differences in onset time. The average induction time was longer in PN group (673.4±149.6 sec) than PV1 (557.6±194.9 sec) and PV2 (561.5±129.8 sec). There were no differences in the success rate (89.7% vs. 86.2% vs. 89.7%). Conclusion The PV injection technique consisting of a single injection in 12-o'clock position above the axillary artery in addition to a musculocutaneous nerve block is equally effective and less time consuming than the PN technique. Therefore, the PV technique is an alternative method that may be used in busy clinics or for difficult cases.
The Gut Microbial Community of Midas Cichlid Fish in Repeatedly Evolved Limnetic-Benthic Species Pairs

Gut bacterial communities are now known to influence a range of fitness related aspects of organisms. But how different the microbial community is in closely related species, and if these differences can be interpreted as adaptive is still unclear. In this study we compared microbial communities in two sets of closely related sympatric crater lake cichlid fish species pairs that show similar adaptations along the limnetic-benthic axis. The gut microbial community composition differs in the species pair inhabiting the older of two crater lakes. One major difference, relative to other fish, is that in these cichlids that live in hypersaline crater lakes, the microbial community is largely made up of Oceanospirillales (52.28%) which are halotolerant or halophilic bacteria. This analysis opens up further avenues to identify candidate symbiotic or co-evolved bacteria playing a role in adaptation to similar diets and life-styles or even have a role in speciation. Future functional and phylosymbiotic analyses might help to address these issues.
Types of Support Accessed by Families of Young Children with Disabilities Living in Alberta.

This longitudinal study inventoried the types of services accessed by a sample of Alberta families of children with or at-risk for disabilities. We explored the role of severity of disability, parental stress, and family income on services accessed. With few exceptions, services were accessed more frequently as the children’s lives progressed but higher income families accessed more services than lower income families, even though the latter families had children with more severe disabilities. Difficulties accessing services and lack of services were reported by lower income families. The authors conclude that integrated services are necessary to improve access for those families most in need.
Milrinone enhances relaxation to prostacyclin and iloprost in pulmonary arteries isolated from lambs with persistent pulmonary hypertension of the newborn

Prostacyclin is a pulmonary vasodilator and is produced by prostacyclin synthase and stimulates adenylate cyclase (AC) via the prostacyclin receptor (IP) to produce cAMP. Forskolin is a direct stimulant of AC. Phosphodiesterase 3 hydrolyzes cAMP and is inhibited by milrinone. Objective: To characterize the prostacyclin-AC-cAMP pathway in the ovine ductal ligation model of persistent pulmonary hypertension of the newborn (PPHN). Setting: University-based laboratory animal facility. Subjects: Lambs delivered to time-dated pregnant ewes. Interventions: Fifth generation pulmonary arteries (PA) and lung parenchyma were isolated from control fetal lambs (n = 8) and fetal lambs with PPHN induced by antenatal ductal ligation (n = 9). We studied relaxation responses to various agonists (milrinone, forskolin, prostacyclin, and iloprost, a prostacyclin analog) that increase cAMP in PA after half-maximal constriction with norepinephrine and pretreatment with propranolol ± indomethacin. Lung protein levels of prostacyclin synthase, IP, AC2, and phosphodiesterase 3A were analyzed by Western blot and cAMP by enzyme-linked immunoassay. Main Results: Milrinone relaxed control and PPHN PA and pretreatment with indomethacin significantly impaired this response. Relaxation to milrinone, prostacyclin, and iloprost were significantly impaired in PA from PPHN lambs. Pretreatment with milrinone markedly enhanced relaxation to prostacyclin and iloprost in PPHN PA, similar to relaxation in control PA. Relaxation to forskolin was similar in control and PPHN PAs indicating normal AC activity. Protein levels of prostacyclin synthase and IP were decreased in PPHN lungs compared with control, but AC2, cAMP, and phosphodiesterase 3A remained unchanged. Conclusions: Prostacyclin and iloprost are dilators of PAs from PPHN lambs and their effect is enhanced by milrinone. This combination therapy may be an effective strategy in the management of patients with PPHN.
Cancer mortality during the 1968–1994 period in a mining area in France

We performed a geographical analysis of cancer mortality in the communes surrounding an industrial mining complex (Salsigne, France) where suspicious levels of pollution due to arsenic were measured. Compared with that observed in a control area, we showed a significant excess of mortality due to all cancer types (ratio of standard mortality ratios (ratio of SMRs)=1.1), lung cancer (ratio of SMRs=1.8), pharynx cancer (ratio of SMRs=2.1) in the whole population, and due to digestive system cancer (ratio of SMRs=1.3) among women. The results were similar after controlling for the occupation distribution in the populations. Excluding mining complex workers deaths from the deaths in the studied populations did not modify the pattern of our results. We concluded that the excess of cancer deaths could not be exclusively due to potential professional exposures among the workers of the mining complex and are probably explained by environmental contamination.
Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors

AIM To assess the safety and feasibility of laparoscopic and endoscopic co-operative surgery (LECS) for early non-ampullary duodenal tumors. METHODS Twelve patients with a non-ampullary duodenal tumor underwent LECS at our hospital. One patient had two mucosal lesions in the duodenum. The indication for this procedure was the presence of duodenal tumors with a low risk for lymph node metastasis. In particular, the tumors included small (less than 10 mm) submucosal tumors (SMT) and epithelial mucosal tumors, such as mucosal cancers or large mucosal adenomas with malignant suspicion. The LECS procedures, such as full-thickness dissection for SMT and laparoscopic reinforcement after endoscopic submucosal dissection (ESD) for epithelial tumors, were performed for the 13 early duodenal lesions in 12 patients. Here we present the short-term outcomes and evaluate the safety and feasibility of this new technique. RESULTS Two SMT-like lesions and eleven superficial epithelial tumor-like lesions were observed. Seven and Six lesions were located in the second and third parts of the duodenum, respectively. All lesions were successfully resected en bloc. The defect in the duodenal wall was manually sutured after resection of the duodenal SMT. For epithelial duodenal tumors, the ulcer bed was laparoscopically reinforced via manual suturing after ESD. Intraoperative perforation occurred in two out of eleven epithelial tumor-like lesions during ESD; however, they were successfully laparoscopically repaired. The median operative time and intraoperative estimated blood loss were 322 min and 0 mL, respectively. Histological examination of the tumors revealed one adenoma with moderate atypia, ten adenocarcinomas, and two neuroendocrine tumors. No severe postoperative complications (Clavien-Dindo classification grade III or higher) were reported in this series, but minor leakage secondary to pancreatic fistula occurred in one patient. CONCLUSION LECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors.
Antidiabetic Potential of Commonly Consumed Legumes: A Review

Over the last few decades, lifestyle changes have resulted in a drastic increase in the incidence of diabetes all over the world, especially in the developing countries. Oral hypoglycemic agents and insulin form the mainstay in controlling diabetes, but they have prominent side effects and fail to significantly alter the course of diabetic complications. Appropriate diet and exercise programs that form a part of lifestyle modifications have proven to be greatly effective in the management of this disease. Dietary therapy is showing a bright future in the prevention and treatment of diabetes. Legumes, owing to their high nutritive value, are increasingly being used in dietetic formulations in the treatment and prevention of diabetes on account of their antidiabetic potential. Given this background, this paper reviews the glucose- and lipid-lowering action possessed by various commonly consumed legumes through several animal and human studies. It is concluded that the various legumes not only have varying degrees of antidiabetic potential but are also beneficial in decreasing the risk factors for cardiovascular and renal disease.
Conjunctive Query Answering for the Description Logic SHIQ

Conjunctive queries play an important role as an expressive query language for Description Logics (DLs). Although modern DLs usually provide for transitive roles, it was an open problem whether conjunctive query answering over DL knowledge bases is decidable if transitive roles are admitted in the query. In this paper, we consider conjunctive queries over knowledge bases formulated in the popular DL SHIQ and allow transitive roles in both the query and the knowledge base. We show that query answering is decidable and establish the following complexity bounds: regarding combined complexity, we devise a deterministic algorithm for query answering that needs time single exponential in the size of the KB and double exponential in the size of the query. Regarding data complexity, we prove co-NP-completeness.
Recursion in reconfigurable computing: A survey of implementation approaches

Reconfigurable systems are widely used nowadays to increase performance of computationally intensive applications. There exist a lot of synthesis tools that automatically generate customized hardware circuits from specifications in both high-level and hardware description languages. However, such tools have a limited applicability because they are unable to handle recursive functions whereas it is known that recursion is a powerful problem-solving method widely used in computer science. Therefore a great deal of research effort is aimed at efficient implementation of recursion in reconfigurable hardware. This paper presents the state of the art in this area. The existing proposals are described, analyzed, and compared according to such criteria as level of parallelism supported, approach to concurrency, ease of use, availability of automated high-level synthesis tools, etc.
Iron overload in children who are treated for acute lymphoblastic leukemia estimated by liver siderosis and serum iron parameters.

OBJECTIVE To evaluate a secondary liver iron overload and its fate in children who are treated conventionally for acute lymphoblastic leukemia and to assess whether serum soluble transferrin receptor (sTfR) is useful in detecting iron load. METHODS Liver siderosis was estimated histologically from liver biopsy specimens of 30 children (aged 2.6-17.6 years) close to or at the end of therapy using total iron score (TIS). Serum iron parameters and sTfR were measured at the same time and in 22 patients 1 to 3 years after therapy. RESULTS In 19 (63%) of 30 patients, liver TIS was >15, indicating at least moderate iron overload. Serum ferritin, iron, and transferrin iron saturation levels were highest and transferrin level lowest in the patients with the highest liver iron content. Serum sTfR levels did not differ significantly between the patients with varying amounts of liver iron. TIS correlated most significantly positively with serum ferritin (r(S) = 0.899), transferrin iron saturation (r(S) = 0.764), and the amount of transfused red blood cells (r(S) = 0.783). Serum iron parameters normalized in most patients during the follow-up. In 3 (14%) of 22 patients, serum ferritin level remained high (>1000 microg/L). CONCLUSIONS Long-term iron overload is detected in at least 14% of children after therapy for acute lymphoblastic leukemia. Serum sTfR is an inappropriate marker for liver iron overload, whereas ferritin seems to be the most useful serologic marker for it.
Symbol Error Rate of OFDM Systems with Carrier Frequency Offset and Channel Estimation Error in Frequency Selective Fading Channels

In this paper we present an analytical approach to evaluate the symbol error rate (SER) of OFDM systems subject to carrier frequency offset (CFO) and channel estimation error in Rayleigh flat fading and frequency selective fading channels. Based on correct modeling of the correlation between channel estimates and received signals with carrier frequency offset, the symbol error rate can be numerically evaluated by averaging symbol error rate on different subcarriers using an analytical expression of double integrals. The results illustrate that our analysis can approximate the simulative performance very accurately if the power delay profile of fading channels and carrier frequency offset are known.
Reconceptualizing the Model of Multiple Dimensions of Identity: The Role of Meaning-Making Capacity in the Construction of Multiple Identities

We reconceptualize Jones and McEwen's (2000) model of multiple dimensions of identity by incorporating meaning making, based on the results of Abes and Jones's (2004) study of lesbian college students. Narratives of three students who utilize different orders of Kegan's (1994) meaning making (formulaic, transitional, and foundational, as described by Baxter Magolda, 2001) illustrate how meaning-making capacity interacts with the influences of context on the perceptions and salience of students' multiple social identities. Implications for theory, research, and professional practice are discussed.
In vitro availability of iron and zinc: effects of the type, concentration and fractions of digestion products of the protein

An in vitro dialysis method was employed to determine the effect on the Fe and Zn absorption of the type (beef, pork and soyabean) and the amount (10 and 30 g/kg) of protein present. In addition, the effects of lowand high-molecnlar-weight (LMW and HMW respectively) digestion products were investigated. After in vitro digestion and dialysis a lower percentage of N, Fe and Zn was found in the LMW fractions from beef, pork and soyabean proteins when the protein level was increased from 10 to 30 g/kg; the higher level of protein being associated with a lower percentage of hydrolysed protein. The highest percentage levels of intrinsic Fe were always found in the HMW fractions, independent of the type and the level of proteins studied, while in the case of Zn, both HMW and LMW fractions gave similar values. An interaction was found between inorganic Zn and non-haem-Fe. The addition of inorganic Zn (10 pg/ml) caused a significant decrease in the in viiro availability of Fe from soyabean protein, while it did not affect the dialysability of intrinsic Fe from beef and pork proteins. Our results showed that the type and the level of the protein had a positive effect on the dialysability of extrinsic Fe. We postulate that the effect of a protein on the absorption of extrinsic Fe could be accounted for by free amino acids and/or small peptides released during the digestion process and also by the undigested or partiallydigested HMW fractions of hydrolysed proteins which could play a fundamental role in the availability of this essential element.