Miracle-dz/UniFAR-FTUs huggingface dataset:
Moving On: Transition of Teens With Type 1 Diabetes to Adult Care

Whereas “transfer of care,” in essence, refers to the act of handing over care from one physician or health care team to another, “transition of care” is far more involved with the before-and-after events surrounding transfer. The transition to adult medical care has long been defined by the Society of Adolescent Medicine as “the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-centered health care systems. ”1 The ultimate goal of such a transition is seamless, comprehensive, and developmentally appropriate health care throughout. Yet all too often, the partnership between those saying goodbye to emerging adults and those welcoming them is tenuous at best. E.A. Coleman put it succinctly as follows: “Complex problems like improving care transitions rarely can be solved with simple solutions. ”2 In this article, we address the transition of adolescents with type 1 diabetes from child- and family-centered care to adult-centered care. The 2008 clinical practice guidelines of the Canadian Diabetes Association3 recommend that, “To ensure ongoing and adequate metabolic control, pediatric and adult diabetes services should collaborate to prepare adolescents and young adults for the transition to adult diabetes care. ” This recommendation is supported by Grade C evidence, Level 3,4 but it fails to provide advice on the more practical hows and whens of transition. We focus here on three aspects of transition: 1 ) a model of life transitions first proposed by Hopson and Adams5 that highlights the complex psychological and psychosocial upheavals inherent in such transitions, 2 ) a brief review of the diabetes literature on the outcomes of transition, and 3 ) a review of the impact of interventions on these outcomes. More than 30 years ago, Hopson and Adams5 proposed a model of transition in an attempt to understand and manage …
Perceptions of Communication Style and Influences on Intervention Practices for Young Children with AAC Needs

The current study was designed to determine whether SLP perceptions of communication style (passive or active) affect their intervention planning and decision making for young children who require augmentative and alternative communication (AAC). A second goal was to determine whether SLPs who work with young children who use AAC target goals in intervention that promote and/or maintain an active communication style. An original survey was designed for the study. The SLP participants were asked to provide information about the design of AAC systems and the communicative opportunities made available to young children with AAC needs. Participants were recruited through email and were asked to respond to a Web-based survey. Eighty-nine preschool SLPs practicing in 20 states across the United States responded to the survey. Results indicated that many of the SLPs classified young children with AAC needs they have worked with as passive communicators. Furthermore, the SLPs reported differences in their intervention practices for children with AAC needs whom they considered active and passive communicators. The return rate for participants was small, and it is difficult to generalize the results. However, it appears that more emphasis needs to be placed on providing interventions that target communication skills that young children who use AAC need in order to be active communicators and to participate fully in their natural contexts.
CAUSES AND DURATION OF HOSPITALIZATION AND MORTALITY RATE IN INTENSIVE CARE UNITS IN CENTRAL PROVINCE

Aims: Since there are disagreements about the relationship between the duration of hospitalization and complications' outbreak and causes of mortality, this study was conducted to investigate the epidemiology of causes of hospitalization, complications and mortality of inpatients of intensive care units (ICU) of Markazi province hospitals. Methods: In this descriptive cross-sectional study, 981 patients who were admitted in ICUs of Markazi province in 2008 were selected as the participants of the study. Patients’ neurologic, respiratory and hemodynamic conditions, vital signs and physical injuries were analyzed and recorded in a check list. At the time of patients’ discharge or death, the final analysis was done in terms of the symptoms and signs of the disease. Data were analyzed using SPSS 11 statistical software and logistic regression, probability ratio and chi square tests. Results: The most common cause of death was cardiac arrhythmia (28.1%). The most prevalent cause of hospitalization was accident (12.6%) and coma (12.1%). The dominant complication among the respiratory complications was infection in all ICUs. The average hospitalization duration of studied patients was 7 days. Conclusions: Accident and heart diseases are the most common causes of death in ICU.
Worried Sick: The Experience of Debt Problems and their Relationship with Health, Illness and Disability

This paper examines social and demographic predictors of debt problems, whether debt problems tend to occur in combination with other problems and which people tend to experience long- rather than short-term debt. Data were extracted from a survey of 5,611 adults' experiences of civil justice problems, throughout England and Wales. Being in receipt of benefits and long-term illness or disability were the strongest predictors of debt, with long-term ill or disabled respondents also being more susceptible to long-term debt. We highlight the importance of advice interventions that recognise the link between civil justice problems and health, illness or disability.
Using the Choiceboard Creator™ app on an iPad© to teach choice making to a student with severe disabilities

ABSTRACT This paper describes an intervention to teach the use of the Choiceboard Creator app on an iPad for choice making to a student with autism, severe intellectual disability, and challenging behavior. This app provides flexibility in the number of pictures and blank distractors displayed, produces voice output, shuffles the picture arrangement after each activation, and makes the selected picture more salient by enlarging it once it has been selected. The effectiveness of the intervention was explored using a multiple baseline across three settings. Pre- and post-assessments of the student’s ability to select a picture given the spoken word or the object and to select the object given the spoken word or the picture explored the further development of picture skills. The student learned to use a display of three pictures in free play, a display of two pictures in morning circle, and a display of five pictures at morning tea.
Lower gastrointestinal endoscopy: A review of the patient population of Kumasi

Background: Endoscopy is important in the investigation of symptoms arising from the lower gastrointestinal (LGI) tract. Characteristics of patients undergoing LGI endoscopy (LGIE) in Kumasi, Ghana, are largely unknown. This paper reviews the indications and findings of diagnostic LGIE in three endoscopic centers in Kumasi, Ghana. Patients and Methods: A review of the records of all patients undergoing diagnostic LGIE in the three centers from October 2006 to December 2011 was undertaken. Results: Three hundred and twenty-four LGIE procedures were performed. The most common primary indication was bleeding per rectum. The most common primary endoscopic finding was hemorrhoids (42.0%) followed by colorectal tumors (9.6%). 31.8% of the patients had normal endoscopic findings. Most pathologies found on LGIE were more common in patients aged 45 or older. Among patients whose indication for LGIE was bleeding per rectum, almost half had hemorrhoids as their primary finding while 13.9% had either a colorectal tumor or polyp. Conclusion : The proportion of our patient population found to have a colorectal tumor or its precursor was not insignificant. We thus recommend patients aged 45 or older presenting with LGI symptoms in Kumasi to undergo LGIE, especially if the main symptom is bleeding per rectum.
Immunochemical Studies of Human β2‐Microglobulin

jS^-Microglobulin (jŜ m) was initially isolated with immunoglobulin domains (Fig. 1) from urine of patients with renal tubular suggesting a receptor function for ^^m within malfunction due to chronic cadmium the immune system (18, 70). Accordingly, ̂ 2"^ poisoning or Wilson's disease (5). It is a was demonstrated on lymphocyte plasma predominant component in "tubular membranes where it occurred in association proteinuria" together with a^-microgiobulin with the serologically defined histo(= retinol binding protein) and lysozyme. All compatibility antigens HLA-A, B and C of these proteins are of low molecular weight (for review see ref. 50). ^^m is present as a (12,000-21,000) and are normally catabolized non-covalently attached light chain on the by filtration through the renal glomeruli heavier (MW 43,000) HLA glycopeptide that followed by reabsorption in the renal tubules carries the alloantigeneic specificities (Fig. 2). (61). Disorders affecting epithelium cells of While jŜ m is a water soluble, "extrinsic" the proximal renal tubules will cause an membrane protein associated with plasma enhanced excretion of these low molecular membranes only through its interaction with weight proteins, while a reduction in the other membrane proteins, HLA alloantigens glomerular filtration rate will result in are intrinsic membrane proteins possessing a increased serum concentration (61, 82). hydrophobic domain that penetrates the Accordingly, estimation of jŜ m has been phospholipid bilayer of the plasma membrane appreciated as useful in renal function studies (17, 72). The binding of ^^"^ to plasma ranging from sophisticated analysis of renal membranes is not simply due to passive graft function in the immediate postadsorption from blood plasma since de novo transplantation period (78) to large-scale synthesis has been demonstrated by screening in industrial medicine of workers lymphocytes in vitro (6). The ^2"^ and HLA exposed to a potentially nephrotoxic agent (34, poly peptides seem to be catabolized at a 51) similar rate on the plasma membrane (16) but Structural analysis demonstrated that ^^m the fate of the proteins is different. While ^2"^ ^̂ consists of 100 amino acids (MW 12,000) released to the surrounding medium, the arranged in a single peptide chain tailed up by intrinsic HLA molecule seems to be an intrachain disulphide bond between two internalized and catabolized within the cell cystine residues in positions 25 and 87 (5, 18). (16). Accordingly, the majority (98%) of ^2"^ j32m is devoid of carbohydrate (5). The in body fluids is present in free form complete amino acid sequence has been uncomplexed to HLA, while the remainder is determined and shows considerable homology associated with modified HLA (54).
In-patient adolescent services

Sir: I was interested to read the report of Worrell and O'Herlihy ( Psychiatric Bulletin , June 2001, 25 , 219-222) summarising the views of psychiatrists on in-patient child and adolescent provision. I have completed a similar survey in Wales, with a response rate of 96% (25/26 responses). In
Weight Loss in Obese Prepubertal Children: The Influence of Insulin Resistance

Background. Insulin resistance (IR), a link of paramount importance between obesity and cardiovascular/metabolic complications, seems to be implicated in weight changes. Objective. To determine whether IR could influence weight status during a 1-year intervention program in obese prepubertal children. Methods. Forty-four children with IR (IR group) and 42 children without IR (NIR group) were enrolled. Body mass index standard deviation score (BMI-SDS), waist circumference (WC), and homeostasis model assessment (HOMA-IR) were evaluated. Results. NIR children showed a significant reduction of BMI-SDS and WC at final assessment (p = 0.009 and p = 0.001, respectively), whereas IR children presented unchanged values. HOMA-IR decreased after intervention in the NIR group (p = 0.0008), but was exacerbated in IR children (p = 0.004). A positive and significant association between HOMA-IR at baseline and BMI at follow-up was found (B ± SE = 0.87 ± 0.24, p = 0.001). HOMA-IR at baseline was also significantly associated with WC at follow-up (B ± SE = 2.12 ± 0.69, p = 0.003). Conclusions. IR seems to influence adiposity changes in obese prepubertal children. Further longitudinal studies are needed to verify the relationship between IR and weight loss during childhood.
The role of adiponectin gene variants in glycemic control in patients with Type 2 diabetes

Abstract The aim of this study was to investigate the association between glycemic control in Type 2 diabetes mellitus patients and common genetic variants of ADIPQO gene. A total of 427 Type 2 diabetes patients were recruited in the study and divided into two groups: 172 patients with good glycemic control and 249 with poor glycemic control. Genotyping of C11377G, G276T and T45G ADIPQO SNPs were carried out using restriction fragment length polymorphisms-polymerase chain reaction. The results showed that C11377G ADIPQO SNP is strongly associated with glycemic control in Type 2 diabetes patients. Patients with the GG genotype at adiponectin C11377G had better glycemic control than those with CC or CG genotypes. However, other examined SNPs were not correlated with glycemic control in Type 2 diabetes patients. Other parameters that impacted glycemic control include duration of the disease (p < 0.01), use of insulin therapy (p < 0.01) and presence of neuropathy complications (p < 0.01). However, no contribution was observed for gender, statin use, lipid profile and other oral medications to glycemic control (p > 0.05). Glycemic control among Type 2 diabetes patients might be affected by variants in ADIPQO gene.
NSI: A major occupational hazards among the health care workers in Nepal

A percutaneous piercing wound as in needle stick injury is a typically set by a needle point, but possibly also by other sharp instruments or objects. These events are of concern because of the risk to transmit blood-borne diseases through the passage of the hepatitis B virus (HBV), the hepatitis C virus (HCV), and the Human Immunodeficiency Virus (HIV), the virus which causes AIDS. The present study was done to determine the risk status regarding NSI among health care workers of Private Hospitals, Pokhara, Nepal. Samples were selected through purposive sampling. Self administered questionnaire & risk assessment tool were used to collect data. Study revealed that majority of health care workers were females (93%) with mean age of 22.66 years (±3.1). Sixty eight percent had got NSI, among them 41% had NSI more than 2times in life. Maximum NSI cases happened either by recapping of the needle (18%) or during disposal of sharps (16%) or while transferring a body fluid (blood) to a specimen bottle (15%). The study concludes that majority of health workers had NSI more than two times which denotes NSI is a major occupational hazard. Cases happened either by recapping of the needle or during disposal of sharps or while transferring a body fluid to a specimen bottle. DOI: http://dx.doi. org/10.3126/ijosh.v3i1. 9098 International Journal of Occupational Safety and Health, Vol 3 No 1 (2013) 22-25
Organ-specific antibodies in LADA patients for the prediction of insulin dependence

ABSTRACT Aim of the study: The aim of the present study was to define the frequency of organ-specific and non-organ-specific autoantibodies in a cohort of Latent Autoimmune Diabetes in Adults (LADA) patients and to test whether multiple antibodies positivity could be a predictor of early insulin dependence. Materials and methods: We enrolled 210 LADA and 210 type 2 diabetes mellitus (T2D) patients. In all subjects anti-islet antigen-2 (IA-2Ab), anti-thyroperoxidase (TPOAb), anti-zinc transporter 8 (ZnT8Ab), anti-nuclear (ANA), anti-parietal cell (APCA), anti-smooth muscle (ASMA), anti-mitochondrial (AMA), anti-liver kidney microsomes (LKM), and anti-reticulin (ARA) circulating antibodies were assessed. Results: The frequency of TPOAb, ZnT8Ab, APCA, and IA-2Ab positivity was, respectively, detected in 40.0%, 32.4%, 24.7%, and 9.5% of LADA patients, whereas their frequency was significantly lower in T2D patients (11.4%, 1.9%, 9.5%, and 0.0%, respectively, p < 0.001). The frequency of ANA was the same in both groups whereas the frequency of ASMA, ARA, AMA, and LKM was very low (range 0.0–3.3%). The presence of TPOAb associated with ZnT8Ab, IA-2Ab, or APCA allows one to predict the progression of disease with a high specificity but low sensibility. Conclusions: LADA patients show an increased frequency of organ- and non-organ-specific antibodies. Consequently, a screening is worthwhile in these patients. The simultaneous presence of TPOAb with ZnT8, IA-2Ab, or APCA may help differentiate clinical phenotypes and predict faster insulin dependence in LADA patients.
Selenium and Hormone Interactions in Female Patients with Hashimoto Disease and Healthy Subjects

Objective. To examine the correlation structure of parameters expressing selenium status, sex hormones secretion and thyroid function in a group of patients with Hashimoto disease and healthy female subjects. Method. Partial Least Square modeling was applied to parameters under study. Results. The correlations between relevant parameters were confirmed. Selenoenzyme glutathione peroxidase (GPX3) an progesterone played the most significant roles among factors contributing to thyroid stimulating hormone and free thyroxine regulation. Additionally, a correlation between GPX3 and estradiol was also observed which is in agreement with results reported by other authors. Patients with Hashimoto disease had lower glutathione peroxidase activities than healthy subjects. Conclusion. The integrated multivariate approach applied to a new group of patients dissimilar to the previous one, was validated by statistical adequacy as well ass meaningful interpretation.
Evaluation of haematological and serum electrolyte changes in Wistar rats administered with ethanolic extract of whole fruit of Lagenaria breviflora Robert

The effect of the ethanolic extract of the whole fruit of Lagenaria breviflora Robert was evaluated on haematological indices and serum electrolyte levels of Wistar rats. 25 adult rats were randomly but equally divided into 5 groups. The rats in group A (Control) were administered with 0.9% Physiological Saline, while rats in groups B to E were administered with the extract of 1000, 2000, 4000 and 8000 mg per Kg body weight respectively once daily for 14 days according to the acute and chronic toxicities studies conducted. The parameters evaluated were PCV, Hb concentration, MCV, MCH, MCHC values, RBC, WBC, neutrophils and lymphocytes counts. The serum electrolytes included Na+, Cl-, HCO3-, K+, Ca2+and HPO4-. The extract increased the mean PCV, RBC, WBC, Hb and MCV values of rats in the test groups, while MCH and MCHC decreased. The increase in the mean value of MCV, RBC and PCV coupled with decreased values of MCH and MCHC indicated increased production of reticulocytes (reticulocytosis), which suggest that the extract of the plant is capable of stimulating erythropoiesis. The mean lymphocyte values increased, while mean neutrophils values decreased for most of the test groups. There was evidence of electrolyte imbalance exhibited by significant (P < 0.05) reduction of HCO3- and Ca2+. This electrolytes imbalance was accompanied with significant (P < 0.05) elevation of BUN in the rats in the test groups, thus strongly incriminating renal injury as possible cause. It was concluded that prolonged administration of extract of L. breviflora elicit electrolyte imbalance and the extract of the plant is not haematoxic, rather, it stimulate erythropioesis Key words: Haematology, serum electrolytes, extract, Lagenaria breviflora, Wistar rats.
Anaplastic large cell lymphoma: a single institution experience from India.

BACKGROUND Systemic anaplastic large cell lymphoma (ALCL) accounts for 2-8% of non-Hodgkin's lymphoma in adults and 10-15% in children. While there is ample data in the world literature about the clinical features and outcome of this disease, prognosis in Indian patients is largely unknown. OBJECTIVE To study the clinical, pathologic profile and outcome ALCL. MATERIALS AND METHODS Fifty patients who had pathologically proven diagnosis of systemic ALCL at our institute from June 2003 to May 2011 were included for retrospective analysis. This included 30 cases of anaplastic lymphoma kinase+ (ALK+), ALCL and 20 cases of anaplastic lymphoma kinase- (ALK-), ALCL. The hospital protocol for treatment of these patients included CHOP chemotherapy regimen in >15 years of age and MCP842 protocol with vinblastine for 1 year in <15 years of age. Event free survival was noted. These outcomes were correlated with ALK status, International Prognostic Index (IPI) score, and stage at presentation. RESULTS At a median follow-up of 36 months (range: 6-72 months) ALK- ALCL had a poor outcome. The 3 year event free survival in pediatric ALCL was 66.7%. In adults, this was 60% ALK+ ALCL was 60% and 20% in ALK- ALCL. CONCLUSIONS Systemic ALCL is an aggressive disease. CD3 + positivity is commonly seen in ALK- ALCL and ALK+, epithelial membrane antigen + positivity is seen in ALK+ ALCL. ALK- ALCL, advanced stage III, IV and high IPI score were associated with poor prognosis. The demographic profile and outcome in our study was similar to the world literature. With new drugs like crizotinib and brentuximab vedotin the future looks very promising.
Meta-analysis: Natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity

Abstract Background. NAFLD ranges from simple steatosis (SS) to non-alcoholic steatohepatitis (NASH). The natural history of NAFLD and the optimal strategy to identify subjects with progressive liver disease are unclear. Objectives. To assess the evidence in: (1) natural history of NAFLD; and (2) non-invasive methods to differentiate NAFLD histological subtypes. Design and setting. Among 4185 articles published on MEDLINE, Cochrane Library, EMBASE, Pubmed, national and International meeting abstracts through July 2010, 40 articles assessing the natural history of NAFLD and 32 articles evaluating the diagnostic accuracy of non-invasive tests against liver biopsy (LB) were included. Measurements. Two reviewers retrieved articles and evaluated study quality by appropriate scores. Main outcomes were pooled using random- or fixed-effects models. Results. NAFLD has an increased overall mortality (OR: 1.57, 95% CI: 1.18–2.10), deriving from liver-related and cardiovascular disease, and a 2-fold risk of diabetes. Compared to SS, NASH has a higher liver-related (OR for NASH: 5.71, 2.31–14.13; OR for NASH with advanced fibrosis: 10.06, 4.35–23.25), but not cardiovascular mortality (OR: 0.91, 0.42–1.98). Three non-invasive methods received independent validation: pooled AUROC, sensitivity and specificity of cytokeratin-18 for NASH are 0.82 (0.78–0.88), 0.78 (0.64–0.92), 0.87 (0.77–0.98). For NASH with advanced fibrosis, pooled AUROC, sensitivity and specificity of NAFLD fibrosis score and Fibroscan are 0.85 (0.80–0.93), 0.90 (0.82–0.99), 0.97 (0.94–0.99) and 0.94 (0.90–0.99), 0.94 (0.88–0.99) and 0.95 (0.89–0.99). Conclusions. NAFLD warrants screening for cardio-metabolic risk and for progressive liver disease. The combination of three noninvasive tests with LB may optimally individuate patients with NASH, with or without advanced fibrosis.