Miracle-dz/UniFAR-FTUs huggingface dataset:
CAUSES OF OBSTRUCTIVE JAUNDICE

Objective: To evaluate the causes of obstructive jaundice in our set-up. Design & Duration: Prospective, cross sectional study from July 2005 to December 2006. Setting: Surgical ‘D’ Ward, Khyber Teaching Hospital, Peshawar. Patients: A total of 50 cases of obstructive jaundice were included in the study. Patients who were lost to follow-up were excluded. Methodology: All cases were thoroughly investigated and their cause established. Different procedures were performed and the patients discharged home after their condition stabilized. They were followed-up and assesed for short and long term complications. Results: Out of the total 50 patients half (25) were males and the rest females. Their age of the patients ranged from 46 to 93 years. All patients had jaundice, while abdominal pain, pruritis and abdominal mass were other presenting complaints. The causes of obstructive jaundice included gall stones in 20 (40%) patients, mass head of pancreas in 16 (32%), and biliary strictures in 4 (8%) cases while hepatic abscesses, pseudopancreatic cyst, cholangiocarcinoma, choledochal cyst and periampullary carcinoma each accounted for two cases. Conclusion: Obstructive Jaundice is commonly caused by gall stones, pancreatic tumours, biliary strictures and malignancies in our set-up.
Power and Client-Centred Practice: An Insider Exploration of Occupational Therapists' Experiences

Background. Although problems with power sharing are frequently described in discussions about client-centred practice, little research has explored occupational therapists' experiences with this model of service delivery. To critically examine this aspect of occupational therapy, an insider study was conducted. Purpose. The objectives of the study were to explore therapists' experiences with client-centred practice and to reveal how power works within this practice and in the health service environment. Method. Semi-structured interviews with 9 therapists were conducted and a thematic analysis of these transcripts was completed. A variety of institutional documents were reviewed and analysed. Results. Three main themes were identified: the different interpretations of occupational therapy discourse, the power of context and the continuum of client-therapist interactions. Clinical Implications. It is important to consider the various competing discourses and institutional practices that frame the therapeutic relationship when evaluating methods to improve client-centred practice.
Assessment of the Technical Condition of the Aircraft Fuel System by Its Main Elements in Flight

The serviceability of the aircraft's on-board systems have to be monitored in flight. Each on-board system has a built-in control, but it is hard to control condition of the entire avionics on-board in flight. The issue of organizing health monitoring and test algorithms for the on-ooard maintenance system is considered. The algorithm is implemented using Mamdani's fuzzy logic. First, the condition of the main elements of the aircraft's fuel system is evaluated, and then the flawless function of the fuel system as a whole is constructed. Using fuzzy logic eliminates the need to work with accurate input data and allow to operate inaccurate data.
ABC and VED analysis of the drug store of a tertiary care teaching hospital.

Introduction: Substantial improvement can be brought about in the hospital inventory and drug expenditure by inventory control techniques. These include ABC and VED analysis. The present study was planned to identify the drug categories which need stringent management. Materials and Methods: The ABC and VED analysis of the drugs used by SGH, Pune, India was conducted for the financial year 2011-2012 to identify the items needing stringent management control. Results: The total number of the items used by the medical store was 291. The total annual drug expenditure (ADE) was Rs. 6, 98, 74, 457. By ABC analysis, it was found that 13.4%, 16.5% and 70.1% items belonged to A, B and C category respectively, accounting for 69.1%, 19.2% and 11.7% of ADE. VED analysis showed that 50.9%, 40.2% and 8.9% were V, E, and D category items respectively, accounting for 55.2%, 41.5% and 3.3% of ADE. By ABC-VED matrix analysis, 57%, 35% and 8% were found to be category I, II and III items respectively, accounting for 85.3%, 14.2% and 0.5% of ADE. Conclusion: The study depicted the items belonging to category I which requires top managerial control, also the items
Early Discharge after Hip Arthroplasty with Home Support: Experience at a uk District General Hospital

One hundred and thirty-eight consecutive patients undergoing hip arthroplasty and accelerated discharge at our institution over 6 months were reviewed. Our protocol included transfer to a dedicated home support team. No minimal incision techniques or special anaesthetic / analgesic techniques were used. 66% of patients having primary joint replacements went home by the third post operative day and 91% by the fourth day. Re-admission rates were under 1% whilst under the care of the home support team. Patient satisfaction was high. 94% said they would use the service again. This protocol has saved over 1500 bed days per year whilst maintaining standards of care.
Comparative evaluation of therapeutic efficacy of Thornton adjustable positioner with Karwetzky activator in the management of obstructive sleep apnea syndrome

Background: Mandibular advancement devices (MAD) are recognized as an effective option in the management of obstructive sleep apnea (OSA). Thornton adjustable positioner (TAP) allows gradual forward titration of mandible to optimize treatment outcome. Karwetzky activator is a fixed MAD and titration is not possible. Therefore a study was under taken to compare the therapeutic efficacy of TAP with Karwetzky activator in the management of OSA. Methods: Twenty polysomnography diagnosed OSA patients were prescribed TAP (Group I) and another twenty were prescribed Karwetzky activator (Group II). The therapeutic efficacy was evaluated on Apnea-Hypopnea Index (AHI) and Epworth Sleepiness Scale (ESS). Results: The percentage improvement in AHI scores in Group I was 52.48% compared to 42.37% in Group II. Statistically significant improvement (P<.001) in AHI and ESS scores was observed in Group I and Group II.75% and 55% positive responders (AHI improvement of >50) in Group I and Group II respectively were observed. Conclusion: Therapeutic efficacy and clinical acceptance of TAP was superior to Karwetzky activator. Superior performance of TAP can be attributed to gradual titration and optimum mandibular positioning.
The Distribution of Cement Penetration into Bovine Acetabular Bone Utilising Various Pressurisation Techniques

Most mechanical failures of acetabular fixation within ten years of primary cemented hip replacement are attributable to a failure to achieve good initial fixation of bone and cement. Several studies have suggested that to achieve good fixation between bone and cement between 3 mm and 5 mm of cement penetration into bone is desirable. Whilst several acetabular cement pressurisation systems exist, little is known about the effects of cement pressurisation on the pattern of penetration of cement into cancellous bone within the pelvis. The current paper assesses the penetration of bone cement into bovine acetabular bone by various pressurisation techniques. We found that pressurisation with the use of a swab in glove or the DePuy pressuriser led to improvement in cement penetration both in terms of maximum depth and also percentage cover of the cup by cement (p < 0.05). There was no significant difference in mean maximal penetration between the use of the pressuriser and the swab in a glove technique (p = 0.3). If only a plain cup was used as a pressuriser, the penetration achieved was significantly lower in comparison to use of a pressuriser (p < 0.02). When compared to previously documented acrylic models, the pattern of intrusion noted in the bovine model was different: penetration was lower at the equatorial and base regions of the acetabulum.
Successful Multidisciplinary Interventions for Arterio-Venous Fistula Creation by the Pacific Northwest Renal Network 16 Vascular access Quality Improvement Program

Background: In December 2001, 44.2% of hemodialysis (HD) patients in the Northwest Renal Network (NWRN 16) received dialysis using an arteriovenous fistula (AVF). Substantial differences were noted in percentages of patients with AVF, ranging from 5% to 90% of the facility population, suggesting wide variation in physician practice patterns within the Network. To address the needs of facilities having <40% AVF, NWRN 16 provided education and tools for their vascular access decision-makers to promote AVF creation. Methods: In 2002, the Network sponsored 4 regional workshops targeted to nephrologists, vascular surgeons, dialysis nurses, and interventional radiologists. Results: 46 facilities (43% of all Network facilities) had <40% AVF in use in December, 2001, dialyzing 2940 patients (Invited Units). Percent AVF in use in all the Invited Facilities increased from 31.3% pre-intervention to 39.8% at 1 year (p<0.001 vs pre) to 56.2% at four years: 79.8% increase in the prevalent AVF rate over a four-year period (95% confidence interval: 77.8% to 81.7%). Conclusion: Low prevalent AVF rates in many NWRN 16 facilities may have resulted from differences in physician practice patterns. The success of Network 16 AVF Intervention demonstrates the effectiveness of Network education promoting multidisciplinary teamwork, innovative strategies to increase AVF rates among dialysis patients. (J Vasc Access 2007; 8: 3-11)
THE IMPACT OF HIV/AIDS ON EDUCATION SYSTEMS IN THE EASTERN AND SOUTHERN AFRICA REGION AND THE RESPONSE OF EDUCATION SYSTEMS TO HIV/AIDS: LIFE SKILLS PROGRAMMES

iii EXECUTIVE SUMMARY As a new millennium dawns, the HIV/AIDS pandemic continues to ravage the Eastern and Southern Africa Region (ESAR). The statistics are disturbing: at least 40 million people are infected with HIV in sub-Saharan Africa. Much of the impact of HIV/AIDS afflicts children and women, the primary focus of UNICEF programmes. The bulk of new AIDS cases are among young people, aged 15-25 and females are disproportionately affected. The ability of girls and women to protect themselves from HIV is constrained by their status in society. Decades of improvements in social welfare are likely to be undermined by the uninhibited progression of the epidemic. Life expectancy in some countries has already started on a downward spiral and is expected to drop to 30 years or less in nine sub-Saharan countries by the year 2010. AIDS-related mortality has begun to eliminate the gains made in child survival over the past 20 years. Children will be the most affected as a result of HIV/AIDS as they live with sick relatives in households stressed by the drain on their resources. They will be left emotionally and physically vulnerable by the illness or death of one or both parents. Subsequently, children who have lost one or both parents are more likely to be removed from school, to stay home to care for the sick and to be pulled into the informal economy to supplement lost income. This is especially the case for girls. The first part of this paper describes the impact of HIV/AIDS on the education sector in ESAR and points to the fact that as a result of all these social and economic processes, the AIDS epidemic is beginning to have a serious impact on the education sector, specifically on the demand for, supply of, and the management and quality of education provided at all levels. As a result of HIV/AIDS, there are relatively fewer children needing education. Fewer children are being born because of the early death of one or both parents. Moreover, fewer parents will want to send their children to school, and there will be fewer families who are able to afford to send their children to school. Fewer students in the education system and lower demand for places in education programmes, will most probably lead to a smaller supply of facilities and places. Schools that have enrolments below a certain minimum may therefore be closed and …
Frequency of ABO and Rh blood groups in the Jazan region of Saudi Arabia

Objectives: Among 30 blood group systems ABO & Rh blood groups are clinically significant. So they are called major blood groups. Frequencies of ABO blood groups and Rh types show geographic variations. The objective of this study was to estimate frequencies of ABO and Rh blood groups in native Saudi blood donors in Jazan region. Methodology: A total of 30481 healthy donors, donating blood for various reasons at Blood Bank Department of King Fahd Central Hospital in Jazan from January 2002 to December 2008 were evaluated for the ABO and Rh blood groups. Only Saudi nationals were included in this study. Results: Out of 30481 donors, 18909 (62%) were group O, 8411(27.6%) were group A, 2662 (8.7%) were group B and 499 (1.7%) were group AB. Rh+ were 28988 (95%) and 1493 (5%) were Rh-. The results of this study were compared with results of the Southwest and the Eastern regions of Saudi Arabia. Conclusion: This study confirmed that blood group O was the most common of the ABO blood group system in the Jazan region. AB blood group was quite rare and Rh positive was more common than Rh negative phenotype. Significant differences were observed between the results of this study and the results of the Southwest and the Eastern regions of Saudi Arabia in the distribution of both ABO groups and the Rh phenotypes.
Medium-to-long Term DEXA Analysis of an Uncemented (AML) Femoral Component

We present medium-to-long-term bone mineral density studies assessing bone resorption and remodelling around the cementless femoral component of a total hip arthroplasty (Depuy AML prosthesis). Bone mineral densities were compared with the unoperated side at a time interval of eight years between scans using dual energy X-ray absorptiometry. Initial proximal stress shielding is known but we show that this response continues into the medium to long term in relative terms. We have also found an overall trend for bone mineral density to increase around the prosthesis with the greatest changes occurring distally. The greatest real increase in bone mineral density occurred in Gruen zones 2, 3 and 5 with smaller increases in zones 1, 4, 6 and 7. However, when compared with the contralateral unoperated femur (thus considering systemic changes in bone mineral density), we found these changes only reached statistical significance in Gruen zones 5, 6 and 7. (Hip International 2008; 18: 195-9)
Health Impact of Workplace Health Promotion Programs and Methodological Quality of the Research Literature

Table 1 Topics Included in Search INTRODUCTION A comprehensive review of the published literature on the health impact of workplace health promotion programs was conducted to determine the health impact of workplace health promotion programs and the quality of the research methodology of the published literature. This study was funded by the Office of the Associate Director for HIV/AIDS at the Centers for Disease Control and Prevention as part of an effort to identify strategies that can be used for worksite AIDS prevention programs. This search was coordinated by Mark Wilson. I
Photodynamic Therapy with 5-Aminolevulinic Acid Induces Apoptosis and Caspase Activation in Malignant T Cells

Background: Preliminary studies have suggested that photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) can improve psoriasis and mycosis fungoides, two diseases where normal or malignant T cells playa central role. Objectives: To determine if ALA-PDT induces apoptosis and caspase activation in Jurkat cells, a malignant T-cell line. Methods: Jurkat cells were incubated with ALA in the presence of [14C]-thymidine followed by red light exposure. DNA fragmentation was measured 24 hours later with a DNA elution assay. The influence on DNA fragmentation of ALA concentration, time between ALA addition and light exposure, as well as light fluence were studied. The occurrence of oligonucleosome-sized DNA fragmentation was also studied with DNA electrophoresis. Caspase-3-like activity was monitored by measuring Ac-DEVD-AMC hydrolysis. Results: DNA fragmentation as high as 88% was observed 24 hours after ALA-PDT. The percentage of DNA fragmentation increased with increasing doses ofALA, red light fluence, as well as longer incubation time with ALA. DNA fragmentation was observed as early as 3 hours after ALA-PDT. The presence of apoptosis after ALA-PDT was confirmed by DNA electrophoresis. An increase in caspase-3-like activities was detected following ALA-PDT. Conclusion: ALA-PDT induces apoptosis and caspase-3-like activation in Jurkat cells.
Author's Reply

Nievelstein and Vermeij-Keers call attention to their work on the normal and abnormal development of the cloaca in relation to anorectal malformations [1,2]. In these studies they confirmed for the greater part new ideas that had emerged from my earlier investigation in normal pig embryos and pig embryos with hereditary congenital anorectal malformations [3,4], and had been related to the human condition [5]. There were also some differences of opinion. Those related to normal development, reiterated in their letter, have been discussed in a preceding monograph about the normal development of the human perineum [6] and were not repeated in the present article [7], which was primarily focused on malformations. In that monograph I have demonstrated that: (1) the cloaca becomes divided into urogenital and anal compartments by the disproportionate growth of the urogenital part over the anal part, and the classical descending urorectal (Letter: urogenital) septum does not exist; (2) the dorsal (anal) part of the cloaca forms the deep part of the permanent anal canal, which is also proven by the zone of typically cloacal pseudostratified columnar epithelium with anal glands at the linea dentata of the definitive anorectum; and (3) a ‘‘secondary occlusion’’ of the anorectal canal is a deceptive phenomenon caused by a high epithelium in a narrow segment of the canal that obscures a (persisting) central lumen. With secondary occlusion an illusion, defective recanalization cannot be considered as the mechanism responsible for causing a malformed or occluded anus at the normal position (apart from the unlikely process that persistence of a purely epithelial ‘‘plug’’ would lead to the essentially stromal permanent ‘‘imperforate anal membrane,’’ stenosis and buckle handle). The present study points at narrow, occasionally microscopic, canals between the dilated anorectum and the surface, i.e., ectopic anorectal canals, which may disappear later with blind-ending anorectum as a result. The observations disqualify the categorization proposed by the authors. Their magnetic resonance imaging study, which is impressive from a clinical point of view, was not referred in the present article [7] because it did not provide additional data to the much more detailed histological information of the present investigation.
THE GOLDEN RATIO OPTIMIZES CARDIOMELIC FORM AND FUNCTION

Both cardiac structure and hand proportion have been linked with the Fibonacci Series and the associated Golden Ratio the number 1.618 that has been postulated to be related to functional optimization. In this paper, evidence supporting the relation of the Golden Ratio to the hand and heart is presented. It is known that upper limb malformations are the commonest skeletal abnormalities in patients with congenital heart disease. Embryological studies on hand-heart syndromes have provided evidence for a cardiomelic developmental field, which is supported by candidate genes involved in patterning of the hand and heart. Precise molecular interactions govern a certain optimal model of cardiomelic development, for which the underlying physical rule remains unknown. It is hypothesized that the Golden Ratio may represent the mathematical basis for hand-heart development so as to achieve optimal form and function. Deregulation of this underlying patterning law may manifest as variation in hand-heart structure away from that as would be determined by the Golden Ratio. Altered hand proportion in turn may be of predictive value for cardiovascular defects and dysfunction.
Urokinase Lock or Flush Solution for Prevention of Bloodstream Infections Associated with Central Venous Catheters for Chemotherapy: A Meta-Analysis of Prospective Randomized Trials

Background: Intravascular devices (IVDs) carry significant risk of device-associated bloodstream infection (BSI). Catheter thrombosis increases the likelihood of microbial colonization of the catheter and BSI. Urokinase has been studied for the prevention of BSI associated with IVDs. We undertook a systematic review to determine the efficacy of urokinase-heparin lock or flush solution compared with heparin alone in preventing
Cryptosporidiosis in children less than three years old in Ciliwung Riverside, Kampung Melayu Village, Jakarta, Indonesia

Background Cryptosporidium infection is often found in children, especially children below three years old. Many risk factors can affect cryptosporidiosis prevalence. At this moment, the prevalence and risk factors of cryptosporidiosis in children in Jakarta are unknown. Objectives To determine the cryptosporidiosis prevalence, clinical manifestations, and risk factors in children below three years old. Methods This cross sectional study involved 474 subjects between the age of 0 to 35 months in Ciliwung riverside, Kampung Melayu village, from December 2005 until April 2006. Stool specimens were examined using modified acid-fast staining. Nutritional status was measured based on actual body weight over ideal body weight ratio (NCHS-CDC 2000). Results Cryptosporidium cysts were found in stool sample of 10/ 474 subject (2.1%). Most of the cases used ground water as a source for drinking and washing. All positive cases lived in houses with bad sanitation, flooded house and 9/10 cases had a crowded household. Cat and mice were the two most frequently found animals around the house. We found five asymptomatic cases and all of the cases were undernourished. Conclusions The prevalence of cryptosporidiosis in this study is 2.1%. Due to small number of cases no risk factor could be identified. Use of groundwater as a water source, bad sanitation, cat and mice around the house, flooded house, crowded household and undernourishment might be related to cryptosporidiosis prevalence. Half of the infected children were asymptomatic. [Paediatr Indones 2008;48:99-103].
The Effects of a Communication Training Program on Communication and Interpersonal Relationship for Student Nurses in Clinical Practice

Purpose: This study was done to Identify the effects of a communication training program on communication skills and interpersonal relationships. Method: A communication training program was provided to student nurses who were selected as participants during a course of clinical practice. Of the students 23 were assigned to experimental group and 22 to the control group. The experimental part of the study was done with the experimental group during 6 week program course. The control group received only a communication theory course. Results: Communication and interpersonal relations scores on the post-test in the experimental group were significantly higher than in the control group. Conclusion: This program allowed nursing students to advance their communication skills during their clinical trials. These are skills which are necessary for nursing practice. The study demonstrated that a group training program that can provide students with practical support by improving the personal relationship.