Miracle-dz/UniFAR-FTUs huggingface dataset:
Burden of Severe Acute Malnutrition in under-five Children (2–59 Months) Admitted in a Tertiary Care Hospital of Delhi

Objective The aim of the present study is to assess the burden of severe acute malnutrition (SAM) and other malnutrition in a tertiary care hospital in Delhi. Methods All patients aged 2-59 months admitted from August 2012 to July 2014 were screened for malnutrition by anthropometry using standard techniques, and SAM was diagnosed as per guidelines [1, 2]. Results During the study period, 4520 children of age 2-59 months were admitted and complete data of 4354 children were available, which were analysed. Of these, 50.4% were underweight, 44.6% were stunted, 33.5% were wasted, 0.76% had oedematous malnutrition and 18.3% had SAM. Of all patients with SAM, 80% were <24 months old, with 54.1% males and 45.9% females. Moderate acute malnutrition was present in 21.4%. Associated co-morbidities were diarrhoea or respiratory infection or both. Conclusion Hospitals of Delhi have a high load of complicated SAM and need adequate infrastructure and facilities for management of these children.
The Quest for Osteoporosis Mechanisms and Rational Therapies: How Far We've Come, How Much Further We Need to Go

During the last 40 years, understanding of bone biology and the pathogenesis of osteoporosis, the most common and impactful bone disease of old age, has improved dramatically thanks to basic and clinical research advances, genetic insights from humans and rodents, and newer imaging technologies. Culprits of osteoporosis are no longer a matter of speculation based on in vitro observations. Instead, they can be identified and dissected at the cellular and molecular level using genetic approaches; and their effect on distinct bone envelopes and anatomic regions can be functionally assessed in vivo. The landscape of pharmacotherapies for osteoporosis has also changed profoundly with the emergence of several potent antiresorptive drugs as well as anabolic agents, displacing estrogen replacement as the treatment of choice. In spite of these major positive developments, the optimal duration of the available therapies and their long‐term safety remain matters of conjecture and some concern. Moreover, antiresorptive therapies are used indiscriminately for patients of all ages on the assumption that suppressing remodeling is always beneficial for bone, but rebound remodeling upon their discontinuation suggests otherwise. In this invited perspective, I highlight the latest state of knowledge of bone‐intrinsic and extrinsic mechanisms responsible for the development of osteoporosis in both sexes; differences between the mechanisms responsible for the effects of aging and estrogen deficiency; and the role of old osteocytes in the development of cortical porosity. In addition, I highlight advances toward the goal of developing drugs for several degenerative diseases of old age at once, including osteoporosis, by targeting shared mechanisms of aging. © 2018 American Society for Bone and Mineral Research.
Patient Similarity in Prediction Models Based on Health Data: A Scoping Review

Background Physicians and health policy makers are required to make predictions during their decision making in various medical problems. Many advances have been made in predictive modeling toward outcome prediction, but these innovations target an average patient and are insufficiently adjustable for individual patients. One developing idea in this field is individualized predictive analytics based on patient similarity. The goal of this approach is to identify patients who are similar to an index patient and derive insights from the records of similar patients to provide personalized predictions. Objective The aim is to summarize and review published studies describing computer-based approaches for predicting patients’ future health status based on health data and patient similarity, identify gaps, and provide a starting point for related future research. Methods The method involved (1) conducting the review by performing automated searches in Scopus, PubMed, and ISI Web of Science, selecting relevant studies by first screening titles and abstracts then analyzing full-texts, and (2) documenting by extracting publication details and information on context, predictors, missing data, modeling algorithm, outcome, and evaluation methods into a matrix table, synthesizing data, and reporting results. Results After duplicate removal, 1339 articles were screened in abstracts and titles and 67 were selected for full-text review. In total, 22 articles met the inclusion criteria. Within included articles, hospitals were the main source of data (n=10). Cardiovascular disease (n=7) and diabetes (n=4) were the dominant patient diseases. Most studies (n=18) used neighborhood-based approaches in devising prediction models. Two studies showed that patient similarity-based modeling outperformed population-based predictive methods. Conclusions Interest in patient similarity-based predictive modeling for diagnosis and prognosis has been growing. In addition to raw/coded health data, wavelet transform and term frequency-inverse document frequency methods were employed to extract predictors. Selecting predictors with potential to highlight special cases and defining new patient similarity metrics were among the gaps identified in the existing literature that provide starting points for future work. Patient status prediction models based on patient similarity and health data offer exciting potential for personalizing and ultimately improving health care, leading to better patient outcomes.
Research on help-seeking for mental illness in Africa: Dominant approaches and possible alternatives

There is growing concern within the global mental health arena that interventions currently being executed to scale up mental health services in Africa will be ineffective unless simultaneous steps are taken to address people’s help-seeking behaviour. Drawing upon two conceptual tools arising from science and technology studies (STS), those of a “classification system” and “the black box,” this paper looks critically at discursive constructions of help-seeking in Africa within mental health research over the last decade. Research in this area can be divided into two dominant traditions: the knowledge-belief-practice survey and indigenous-knowledge-system approaches. Although the content and value-codes between these approaches differ, structurally they are very similar. Both are mediated by the same kind of system of classification, which demarcates the world into homogenous entities and binary oppositions. This system of ordering is one of the most stubborn and powerful forms of classification buried in the “black box” of the modernist/colonial knowledge archive and is fraught with many questionable Eurocentric epistemological assumptions. I consider whether there might be other ways of understanding help-seeking for mental illness in Africa and discuss two studies that illustrate such alternative approaches. In conclusion, I discuss some of the challenges this alternative kind of research faces in gaining more influence within contemporary global mental health discourse and practice.
Correlates of Caregiver Participation in a Brief, Community-Based Dementia Care Management Program

Purpose of the Study The evidence base for dementia care management interventions for informal caregivers (CGs) is strong, yet enrollment and sustained engagement in academic and community-based research trials is low. This study sought to examine rates and correlates of participation in a community-based, telephone-delivered dementia care management program designed to address logistic and practical barriers to participation in CG trials and services. Design and Methods Participants included 290 CGs of older, community-dwelling, low-income care recipients (CRs) who met criteria for enrollment in a collaborative dementia care management program that provides assessment, psychosocial support and education, and connection to community resources via telephone. Cross-sectional analyses examined the association between CG-related (e.g., financial status, relationship to CR, caregiving burden) and CR-related (e.g., functional limitations, symptom severity) factors and CG enrollment and engagement. Results The majority of CGs were non-Hispanic White, female, financially stable, and adult children of the CRs. Over half of CGs lived with the CR and provided 20 or more hours of care per week. Roughly half of CGs refused care management services. Adjusted logistic regression models revealed that perceived caregiving burden and financial status were related to initial enrollment and engagement in services once enrolled, respectively. Implications A significant proportion of CGs refuse free, convenient, evidence-based dementia care management services, underscoring the need for further examination of correlates of program acceptance. Nonetheless, community-based programs that address barriers may improve enrollment and engagement rates among CGs, including those who are especially vulnerable to negative CG and CR outcomes.
Discrepancies Between Perceived Benefit of Opioids and Self-Reported Patient Outcomes

Abstract Objective There is little empirical evidence supporting the long-term use of opioid therapy for chronic pain, suggesting the need to reevaluate the role of opioids in chronic pain management. Few studies have considered opioid use and opioid cessation from the perspective of the patient. Methods This prospective structured interview study included 150 new patients seeking treatment for chronic pain at an outpatient tertiary care pain clinic. Results Of the 150 patients, 56% (N = 84) reported current opioid use. Opioids users reported higher pain severity (t(137) = -3.75, P < 0.001), worse physical functioning (t(136) = -3.82, P < 0.001), and more symptoms of depression (t(136) = -1.98, P = 0.050) than nonusers. Among opioid users, 45.6% reported high pain (>7), 60.8% reported low functioning (>7), and 71.4% reported less than a 30% reduction in pain severity since starting opioids, suggesting that many patients are unlikely to be receiving adequate benefit. Overall, 66.3% of current opioid users reported moderate to high opioid-related difficulties on the prescribed opioids difficulties scale, and patients with depression were more likely to report greater difficulties. There was no association between helpfulness of opioids over the past month and opioid-related difficulties (r(75) = -0.07, P = 0.559), current pain severity (r(72)=0.05, P = 0.705), or current pain interference (r(72) = 0.20, P = 0.095). Conclusions Despite clinical indicators that question the benefit, patients may continue to report that their opioids are helpful. Such discrepancies in patients’ perceptions will likely pose significant barriers for implementing opioid cessation guidelines in clinical practice.
Offspring risk of obesity in childhood, adolescence and adulthood in relation to gestational diabetes mellitus: a sex-specific association.

Background Animal data suggest sexually dimorphic programming of obesity in response to altered intrauterine environment, but the longitudinal impact of gestational diabetes mellitus (GDM) on sex-specific risk of offspring obesity in humans is unclear. Methods We conducted a prospective analysis of 15 009 US individuals (7946 female and 7063 male) from the Growing-Up Today Study, who were followed from 1996 (ages 9-14 years) through 2010. Height and weight from validated questionnaires were used to derive body mass index (BMI) at different ages. Obesity during childhood (< 18 years) and adulthood (≥ 18 years) were defined using the International Obesity Task Force and the World Health Organization criteria. GDM exposure was identified through self-reported questionnaires from mothers. Relative risks were estimated using multivariable log-binomial regression models with generalized estimating equations accounting for clustering within the same family. Results Male offspring born from pregnancies complicated by GDM had higher BMI compared with non-GDM offspring and had increased risk of obesity; the adjusted relative risk [RR, 95% confidence interval (CI)] was 1.47 (1.11-1.95) for all age groups, 1.59 (1.05-2.41) for late childhood, 1.48 (1.06-2.06) for adolescence and 1.39 (1.00-1.94) for early adulthood. No significant association between obesity and maternal GDM was observed among female participants (RR = 0.97, 95% CI: 0.71-1.33). Conclusions The association of GDM with offspring obesity from late childhood through early adulthood may differ by sex; a significant association was observed among male but not female offspring.
The relationship between depression and executive function and the impact of vascular disease burden in younger and older adults

Background depression is associated with worse executive function, but underlying mechanisms might differ by age. Aims to investigate whether vascular disease burden affects the association between depression and executive dysfunction differentially by age. Method among 83,613 participants of Lifelines (population-based cohort study), linear regression analyses were applied to examine the association between executive function (Ruff Figural Fluency test, dependent variable) and depression according to DSM-IV criteria (Mini International Neuropsychiatric Interview, independent variable). Results adjusted for demographic characteristics, major depressive disorder was associated with a lower level of executive function in both younger and older adults. Minor depressive disorder was only associated with worse executive function in younger adults. Adding vascular disease burden to the final model with major depressive disorder, reduced this strength of this association by 5.9% in younger and 5.0% in older adults. Conclusions major depression was associated with worse executive function across the lifespan, but minor depression only in younger adults. The impact of vascular burden on the association did not differ between younger and older adults. Therefore, vascular risk reduction is important in both age groups.
Frequency Speed of Kick Test Performance Comparison Between Female Taekwondo Athletes of Different Competitive Levels

Abstract Santos, JFS and Franchini, E. Frequency speed of kick test performance comparison between female taekwondo athletes of different competitive levels. J Strength Cond Res 32(10): 2934–2938, 2018—Construct validity is a desirable characteristic in any performance test to differentiate athletes. However, no taekwondo-specific test was investigated with this purpose. The purpose of this study was to compare female taekwondo athletes grouped in different competitive levels. Forty-two female taekwondo athletes divided into International/National (median [interquartile range]; n = 21, age: 20 [18–25] years; body mass: 60 [53–72] kg; height: 164 [161–170] cm; and practice time: 8 [5–13] years) and State/Regional group (median [interquartile range]; n = 21; age: 18 [17–25] years; body mass: 57 [52–63] kg; height: 165 [160–172] cm; and practice time: 5 [2–8] years) volunteered to participate in this study. The female taekwondo athletes performed frequency speed of kick test (FSKT) with 10 seconds (FSKT10s) and intermittent 90 seconds (FSKTmult) during the competitive period. Differences between international/national and state/regional group were observed, with superiority to international/national group, for FSKT10s (U = 114.5, p = 0.007, ESr (effect size) = −0.42 [small]), FSKT1 (U = 127.0, p = 0.016, ESr = −0.37 [small]), FSKT2 (U = 108.5, p = 0.004, ESr = −0.45 [small]), FSKT3 (U = 127.0, p = 0.015, ESr = −0.37 [small]), and FSKTtotal (U = 124.0, p = 0.015, ESr = −0.38 [small]). Based on the results of this study, the FSKT seems to be a good tool to discriminate performance of female taekwondo athletes and could be used by coaches and athletes in their evaluation routines.
The Effect of Supplemental Oxygen in Obesity Hypoventilation Syndrome.

STUDY OBJECTIVES Low flow supplemental oxygen is commonly prescribed to patients with obesity hypoventilation syndrome (OHS). However, there is a paucity of data regarding its efficacy and safety. The objective of this study was to assess the medium-term treatment efficacy of adding supplemental oxygen therapy to commonly prescribed treatment modalities in OHS. METHODS In this post hoc analysis of a previous randomized controlled trial, we studied 302 sequentially screened OHS patients who were randomly assigned to noninvasive ventilation, continuous positive airway pressure, or lifestyle modification. Outcomes at 2 mo included arterial blood gases, symptoms, quality of life, blood pressure, polysomnography, spirometry, 6-min walk distance, and hospital resource utilization. Statistical analysis comparing patients with and without oxygen therapy in the three treatment groups was performed using an intention-to-treat analysis. RESULTS In the noninvasive ventilation group, supplemental oxygen reduced systolic blood pressure although this could be also explained by a reduction in body weight experienced in this group. In the continuous positive airway pressure group, supplemental oxygen increased the frequency of morning confusion. In the lifestyle modification group, supplemental oxygen increased compensatory metabolic alkalosis and decreased the apnea-hypopnea index during sleep. Oxygen therapy was not associated with an increase in hospital resource utilization in any of the groups. CONCLUSIONS After 2 mo of follow-up, chronic oxygen therapy produced marginal changes that were insufficient to consider it, globally, as beneficial or deleterious. Because supplemental oxygen therapy did not increase hospital resource utilization, we recommend prescribing oxygen therapy to patients with OHS who meet criteria with close monitoring. Long-term studies examining outcomes such as incident cardiovascular morbidity and mortality are necessary. CLINICAL TRIALS REGISTRATION Clinicaltrial.gov, ID: NCT01405976.
Data governance activities: a comparison between scientific and practice-oriented literature

Purpose The purpose of this paper is to explore the current literature on data governance in scientific and practice-oriented publications, and to provide a comparative analysis of the activities reported for data governance. Data have become a key organisational asset and data governance both a necessary and critical activity. Design/methodology/approach A comprehensive literature review is conducted in order to identify the published material that reflects the current state of knowledge. A systematic procedure was followed that identified 61 publications that explicitly mention data governance activities. Open coding techniques were applied to conduct content analysis, resulting in the identification of 591 concepts. A critical analysis also identified gaps in the literature. Findings The analysis identified 120 data governance activities which are understood as: “action” plus “area of governance” plus “decision domain” (e.g. define data policies for data quality). The authors define and present a data governance activities model based on the analysis. The analysis also shows a higher volume of data governance activities reported by practice-oriented publications that are associated with the “implement” and “monitor” actions of the areas of governance across the decision domains compared with scientific publications, whereas The authors found that the scientific publications focus more on defining activities. The results contribute to identifying research gaps and concerns on which ongoing and future research efforts can be focused. Research limitations/implications This paper is of interest to both academics and practitioners, as it helps them understand the activities associated with a data governance programme. Current literature fails to provide a comprehensive understanding of the data governance activities that are required when considering a data governance programme. Therefore, the proposed model for data governance activities can be used to give insights into these activities. Originality/value To the knowledge of the authors, this study is the first to explicitly consider data governance activities from both an academic and practice-oriented perspective.
Stochastic Pareto near-optimal strategy for weakly-coupled large-scale systems with imperfect local state measurements

This paper is concerned with the infinite horizon stochastic Pareto-optimal static output feedback control problem for a class of weakly-coupled large-scale systems with state-dependent noise. Necessary conditions, which are related with the solutions of the cross-coupled stochastic algebraic Riccati equations (CSAREs), are given for the existence of a controller that guarantees exponentially mean square stable (EMSS) of the system and minimizes a cost function. After analyzing the asymptotic structure for the solutions of the CSAREs, we will construct a parameter independent Pareto near-optimal controller. We will also propose a new sequential numerical algorithm for solving the reduced-order CSAREs. A numerical example for a practical megawatt-frequency control problem will be solved to show the efficiency of the proposed algorithm.
Enhanced Intratumoral Delivery of SN38 as a Tocopherol Oxyacetate Prodrug Using Nanoparticles in a Neuroblastoma Xenograft Model

Purpose: Currently, <50% of high-risk pediatric solid tumors like neuroblastoma can be cured, and many survivors experience serious or life-threatening toxicities, so more effective, less toxic therapy is needed. One approach is to target drugs to tumors using nanoparticles, which take advantage of the enhanced permeability of tumor vasculature. Experimental Design: SN38, the active metabolite of irinotecan (CPT-11), is a potent therapeutic agent that is readily encapsulated in polymeric nanoparticles. Tocopherol oxyacetate (TOA) is a hydrophobic mitocan that was linked to SN38 to significantly increase hydrophobicity and enhance nanoparticle retention. We treated neuroblastomas with SN38-TOA nanoparticles and compared the efficacy with the parent prodrug CPT-11 using a mouse xenograft model. Results: Nanoparticle treatment induced prolonged event-free survival (EFS) in most mice, compared with CPT-11. This was shown for both SH-SY5Y and IMR-32 neuroblastoma xenografts. Enhanced efficacy was likely due to increased and sustained drug levels of SN38 in the tumor compared with conventional CPT-11 delivery. Interestingly, when recurrent CPT-11–treated tumors were re-treated with SN38-TOA nanoparticles, the tumors transformed from undifferentiated neuroblastomas to maturing ganglioneuroblastomas. Furthermore, these tumors were infiltrated with Schwann cells of mouse origin, which may have contributed to the differentiated histology. Conclusions: Nanoparticle delivery of SN38-TOA produced increased drug delivery and prolonged EFS compared to conventional delivery of CPT-11. Also, lower total dose and drug entrapment in nanoparticles during circulation should decrease toxicity. We propose that nanoparticle-based delivery of a rationally designed prodrug is an attractive approach to enhance chemotherapeutic efficacy in pediatric and adult tumors. Clin Cancer Res; 24(11); 2585–93. ©2018 AACR.