Miracle-dz/UniFAR-FTUs huggingface dataset:
How should aortic arch aneurysms be treated in the endovascular aortic repair era? A risk-adjusted comparison between open and hybrid arch repair using propensity score-matching analysis.

OBJECTIVES Recent advances in endovascular aortic repair have changed the treatment of aortic arch aneurysms. The purpose of this study was to compare the early and mid-term outcomes of open repair and hybrid arch repair for aortic arch aneurysms. METHODS This study included 143 and 50 patients who underwent open aortic repair and hybrid thoracic endovascular aortic repair (TEVAR), respectively, for non-dissecting aortic arch aneurysms from 2008 to 2013. The European System for Cardiac Operative Risk Evaluation II scores were 4.35 ± 3.65% and 7.78 ± 5.49% for the open and hybrid TEVAR groups, respectively (P < 0.001). Furthermore, 35 patients from each group were matched using propensity scores to adjust for differences in patient characteristics. RESULTS There was no significant difference in early mortality between the open and hybrid groups (3 vs 2%, P = 0.76). Early morbidity was equivalent in both groups, but intensive care unit (ICU) lengths of stay were shorter in members of the hybrid group (4.7 vs 1.6 days, P = 0.018). During the follow-up, survival rates were not significantly different (87 vs 81% at 3 years, P = 0.13), but reinterventions for the aortic arch were required in 1 patient (pseudoaneurysm) in the open group and 5 (endoleak in 4, brachiocephalic artery stenosis in 1) in the hybrid group. The rates of freedom from reintervention at 3 years were 99% in the open group and 80% in the hybrid group (P < 0.001). Propensity score matching yielded similar results for shorter ICU and hospital lengths of stay and more frequent reintervention in the hybrid group. CONCLUSIONS Surgical outcomes in both groups were satisfactory. Hybrid TEVAR was superior in terms of early recovery from surgery; however, open arch repair showed more reliable long-term outcomes. When properly selected according to patient risk, these two strategies improve the surgical results in all patients with aortic arch aneurysms.
Retaining the Older Nurse

The nursing workforce is aging more rapidly than the workforce as a whole, and fewer young people are entering the profession. It is imperative that older nurses be retained, not only for their experience and expertise, but also to prevent worsening an already critical nursing shortage. A descriptive survey design was used to determine the knowledge base and plans for the aging RN workforce by North Carolina hospitals and nursing homes. Nurses over age 55 made up 14.1% of the respondents’ RN staff. Most administrators are aware of the aging workforce and wish to retain older nurses. Unfortunately, 94% of facilities have no policies in place to address the needs of older nurses, and 87% admitted to having no immediate plans to do so. Specific recommendations are made to assist nurse managers in retaining the older RN.
Effect of Financially Punished Audit and Feedback in a Pediatric Setting in China, within an Antimicrobial Stewardship Program, and as Part of an International Accreditation Process

Background Prior authorization, audit and feedback, and pay for performance are the three core “active” strategies of antimicrobial stewardship program (ASP), yet little is known about the individual or combined benefits of such programs, particularly in a pediatric setting. Objectives The aim of this study was to compare these core ASP strategies and determine the incremental effect of financially punished audit and feedback. Methods During the journey to the Joint Commission International accreditation, a tertiary pediatric medical center performed two different hospital-wide stewardship interventions in succession. The first stage without formalized ASPs served as pre-intervention period, January 2011 to April 2011. The ASP used prior authorization alone during the first-intervention period, May 2011 to September 2011. In October 2011, financially punished audit and feedback was introduced, marking the start of the second-intervention period, October 2011 to November 2012. We compared the differences of the change in monthly average use of antibiotics and expenditure on antibiotics before and after the ASP changes by using interrupted time series via dynamic regression. The main end points included the proportions of antibiotic prescriptions and expenditure on antibacterial relative to all medications. Results Before the second-intervention period, neither the proportion of antibiotic prescriptions nor the proportion of expenditure on antibiotics declined significantly in both ambulatory and inpatient settings. However, after the introduction of financially punished audit and feedback, the proportion of both antibiotic prescriptions (β = −6.269, P < 0.001, and reduction = 59.4% for outpatients; β = −1.235, P < 0.001, and reduction = 19.8% for inpatients) and expenditure on antibiotics (β = −7.777, P < 0.001, and reduction = 46.7% for outpatients; β = −4.933, P = 0.001, and reduction = 16.3% for inpatients) dropped immediately. Conclusion The combination of more than one core strategies (prior authorization, audit and feedback, and pay for performance) will be more effective than one strategy alone.
Blood perfusion changes during sacral nerve root stimulation versus surface gluteus electrical stimulation on in seated spinal cord injury

ABSTRACT The objective of this article is to examine dynamic changes of ischial blood perfusion during sacral nerve root stimulation against surface functional electrical stimulation (FES). Fourteen adults with suprasacral spinal cord injury (SCI) were recruited. The gluteal maximus was activated by surface FES or stimulating sacral nerve roots by functional magnetic stimulation (FMS) or a sacral anterior root stimulator implant (SARS). Ischial skin index of hemoglobin (IHB) and oxygenation (IOX) was measured.Skin blood perfusion was significantly higher during FMS than the baseline (IHB 1.05 ± 0.21 before vs.1.08 ± 0.02 during stimulation, p = 0.03; IOX 0.18 ± 0.21 before vs. 0.46 ± 0.30, p = 0.01 during stimulation). Similarly, when using the SARS implant, we also observed blood perfusion significantly increased (IHB 1.01 ± 0.02 before vs.1.07 ± 0.02 during stimulation, p = 0.003; IOX 0.79 ± 0.81 before vs. 2.2 ± 1.21 during stimulation, p = 0.036). Among four participants who completed both the FMS and FES studies, the magnitude of increase in both parameters was significantly higher during FMS. This study demonstrates sacral nerve root stimulation confer better benefit on blood perfusion than applying traditional FES in SCI population.
Knowledge, awareness and practice of the importance of hand-washing amongst children attending state run primary schools in rural Malawi

A study was undertaken to determine the efficacy of hygiene practices in 2 primary schools in Malawi. The study determined: (1) presence of Escherichia coli on the hands of 126 primary school pupils, (2) knowledge, awareness and hygiene practices amongst pupils and teachers and (3) the school environment through observation. Pupil appreciation of hygiene issues was reasonable; however, the high percentage presence of E. coli on hands (71%) and the evidence of large-scale open defaecation in school grounds revealed that apparent knowledge was not put into practice. The standard of facilities for sanitation and hygiene did not significantly impact on the level of knowledge or percentage of school children’s hands harbouring faecal bacteria. Evidence from pupils and teachers indicated a poor understanding of principles of disease transmission. Latrines and hand-washing facilities constructed were not child friendly. This study identifies a multidisciplinary approach to improve sanitation and hygiene practices within schools.
A performance evaluation framework for constituency development fund construction projects in Kenya

Performance criteria and measures among construction projects reflect the value of the project stakeholders on how they would be viewing the projects they undertake. From the literature review, it was established that one of the challenges facing public construction projects is the lack of sufficient and formal approaches on which to evaluate project performance. It is against this background that the present work attempts to develop a theoretical framework of the performance evaluation of construction projects based on six key performance indicators (KPIs) namely time, cost, quality, safety, minimum site disputes and environmental impact. In so doing, the paper considers the perceptions of 160 stakeholders in construction projects comprising of clients, consultants and contractors on recently completed Constituency Development Fund (CDF) projects in Kakamega, Vihiga Bungoma and Busia Counties. We have identified the Key Performance Indicators (KPIs) in public construction projects through exploratory factor analysis and demonstrated the relationship between KPIs and overall project performance with the help of a conceptual diagram. The diagram reveals how performance of apublic construction project can be assessed in terms of the above six performance indicators. We have concluded by highlighting the contribution of the paper to the existing body of project management literature and providing recommendations for future research.
Empirical Analysis of Process Quality Aspects in the German Agri-Food Sector

The present dissertation examines determinants of farmers' decision behavior to approve or disapprove process quality schemes in food production. A key methodology used in this study is discrete choice experiments (DCE) that are applied to reveal farmers' preferences and willingness-to-accept for production schemes. Although many people are critical towards modern agricultural practices and some consumers are willing to pay price increments for certain process qualities, the availability of milk that is produced without using GMO and high-welfare meat remain limited. The private sector as well as the German government responds with the establishment of production schemes and standards to meet consumers’ demand. However, there is a perception that incentives for farmers are not sufficient to encourage the desired changes of farming practices. This study examines farmers’ acceptance of milk production without GM-feedstuff (Chapter 2), as well as improved housing conditions and animal-friendly livestock handling in dairy and pig farming (Chapter 3 and 4). Furthermore, estimates of consumers’ willingness-to-pay for high welfare cutlets were used to simulate markets for pork produced in accordance with defined farm animal welfare standards (Chapter 4). In addition, farmers’ support of cooperation between dairies in the form of the joint milk collection to the production of cost-effective and more environmentally friendly was subject of the study in Chapter 5. The results of the case studies show that not only economic indicators are relevant for a farmers’ decision making, but also "soft factors", such as the general attitude towards animal welfare or genetic engineering and also the perception of the supplier relationship quality between the dairy company’s management and the farmer. This information can be used to design production concepts more efficient and thus achieve a greater degree of acceptance.
Double-blind placebo controlled study of alpha-adrenergic receptor antagonists (doxazosin) for treatment of voiding dysfunction in the pediatric population.

PURPOSE We sought to determine whether the alpha-adrenergic antagonist doxazosin could be used as primary therapy in children with voiding dysfunction. MATERIALS AND METHODS Children were assigned to maintain a voiding diary and then randomly divided into a double-blind placebo controlled protocol (0.5 mg doxazosin or placebo). Duplicate uroflow studies with post-void residual evaluations and assessment of dysfunctional voiding scores were performed on initiation and completion of the study. At the conclusion parents were asked to rank the perceived improvement of the urinary incontinence (ie parental subjective perception of improvement). RESULTS No significant differences between doxazosin (18) and placebo (20) treated patients were found in the number of incontinent days per week, severity of incontinent episodes or alterations in uroflow patterns. Although not significant, 2 findings suggested a beneficial effect of doxazosin over placebo. Specifically, doxazosin decreased the number of incontinent episodes weekly from a median of 18 to 4, while the number of incontinent episodes weekly in the placebo group remained essentially unchanged, decreasing from 15 to 14 (p = 0.13). Doxazosin also improved the dysfunctional voiding scores over placebo, for an improvement of -3 vs 0 points. Further substantiating a doxazosin effect over placebo was the subjective perception of the parents that doxazosin significantly improved urinary continence (p <0.02). CONCLUSIONS Compared to placebo, doxazosin did not demonstrate a significant objective benefit, but produced a significant subjective benefit in the treatment of urinary incontinence secondary to voiding dysfunction.
Prevalence and phylogenetic analysis of HTLV‐1 in a segregated population in Iran

Human T‐lymphotropic virus type 1 (HTLV‐1) infection is an important health issue that affects a variety of endemic areas. The Khorasan province, mainly its capital Mashhad in northeastern Iran, was reported to be as one of these endemic regions. Torbat‐e Heydarieh, a large city Southwest border to Mashhad with a segregated population was investigated for the prevalence and associated risk factors of HTLV‐1 infection in 400 randomly selected individuals. Blood samples were tested for the presence of HTLV‐1 antibodies via the ELISA method and then were confirmed by an Immunoblot test. For the presence of HTLV‐1 in lymphocytes of infected subjects, PCR was performed on LTR and TAX regions. DNA sequencing of LTR fragment was also carried out to determine the phylogenetic of HTLV‐1, using the Maximum likelihood method. HTLV‐1 sero‐reactivity (sero‐prevalence) among the study population was 2% (8/400), of which 1.25% had HTLV‐1 provirus in lymphocytes (actual prevalence). HTLV‐1 infection was significantly associated with the age, marital status, and history of blood transfusion (P < 0.05). However, there were no statistical differences between HTLV‐1 infection, and gender, surgery, and hospitalization. In regression analysis, age showed the most significant correlation with the infection (P = 0.006, OR = 4.33). Based on our phylogenetic study, the HTLV‐1 prevalent sequence type of Torbat‐e Heydarieh belongs to the cosmopolitan subtype A. HTLV‐1 prevalence in Torbat‐e Heydarieh (1.25%) is low comparing to those of both Mashhad (2–3%) and Neishabour (3.5–5%) in the province of Khorasan. Thus, traveling mobility and population mixing such as marriage, bureaucratic affairs, occupation, and economic activities could be the usual routs of HTLV‐1 new wave of spreading in this segregated city. J. Med. Virol. 88:1247–1253, 2016. © 2015 Wiley Periodicals, Inc.
Fatigue in systemic lupus erythematosus: contributions of disordered sleep, sleepiness, and depression.

OBJECTIVE To clarify the role of sleep disorders, sleepiness, and depression in patients with systemic lupus erythematosus (SLE) who complain of disabling tiredness. METHODS Patients with SLE (31 women, 4 men) with disabling tiredness were evaluated with the Epworth Sleepiness Scale (ESS) and overnight polysomnography, followed by daytime multiple sleep latency tests (MSLT) and the Beck Depression Inventory (BDI). Their polysomnography was compared with 17 healthy, asymptomatic controls. RESULTS Polysomnography of the patients in comparison with healthy controls showed impaired sleep efficiency (p < 0.02), high arousal frequencies (p < 0.01), increased stage 1 sleep (p < 0.02), decreased stage 3/4 slow-wave sleep (p < 0.02), and a high percentage (77% of patients) with increased alpha-EEG non-REM sleep. In 23% of patients periodic limb movement (PLM) disorder was observed (mean PLM index 31.1 +/- 15); 26% of patients had obstructive sleep apnea (mean apnea/hypopnea index 19.3 +/- 10), and one patient had narcolepsy-cataplexy. Remarkably, 51% of patients were excessively sleepy on both the ESS and MSLT (mean sleep latency < 10 min). This excessive daytime sleepiness was not related to sleep restriction. There was no association between sleepiness and SLE disease features such as neuropsychiatric SLE, medications, fibromyalgia, or disease activity. As a whole, the study group reported mild to moderate depression (mean BDI = 15.8 +/- 9.9). Within the group, the sleepy patients had lower BDI scores than the non-sleepy patients (p < 0.02), and fewer of the sleepy patients were depressed (p < 0.04). CONCLUSION Primary sleep disorders, sleepiness, and depression are common in tired SLE patients. Tiredness in SLE that is the result of excessive daytime sleepiness can be distinguished from tiredness of depression. Such distinctions will help identify appropriate treatment for tired patients with SLE.
Neural decoding of goal locations in spatial navigation in humans with fMRI

We demonstrate that multivoxel pattern analysis can be used to decode place‐related information in fMRI. Subjects performed a working memory version of the Morris water maze task in a virtual environment with a single wall cue. The voxel data that corresponds to when subjects were located at the goal was extracted for seven regions implicated in spatial navigation, and then used to train a pattern classifier based on partial least squares. Using a leave‐one‐out (LOO) test procedure, goal locations at E, W, N positions (relative to the cue as S) were predicted significantly better than a naïve classifier for voxels in medial prefrontal cortex, hippocampus, and inferior parietal cortex. Prediction with voxels from other regions involved in navigation was also better than a naïve classifier, which raises the possibility that goal‐location information is widely disseminated among the navigation network. It turns out that predictive capability of all regions combined significantly decreases, relative to no change, only when voxel data from the hippocampus is left out. This implies that the hippocampus contains some unique information that identifies goal locations, whereas other regions contain information that also identifies goal locations but is more redundant. Classification of goal locations is an important step toward decoding a variety of place‐related information in spatial navigation with fMRI. Hum Brain Mapp, 2010. © 2009 Wiley‐Liss, Inc.
Small area variations and welfare loss in the use of outpatient antibiotics

Abstract This article seeks to explain local variations in the use of antibiotics in the community and to assess the welfare loss due to heterogeneous attitudes towards the risk of bacterial resistance. Quarterly data on antibiotic sales from 240 small areas in Switzerland over the course of one year are used. An econometric ad-hoc model with spatial lags is proposed in which the demand for antibiotics varies according to the socioeconomic characteristics of the population, the incidence of infections, antibiotic price and local health care supply. Using residual variations we then evaluate the welfare loss due to varying antibiotic prescription styles. Significant differences are observed in the per capita antibiotic consumption across local areas. Individual income, the demographic structure of the population, physician density and the price of drugs are all relevant determinants. We estimate that unexplained variations may account for 12% of the total antibiotic spending in the community, thus leading to a ₠ 6.8 ml loss per year. Understanding the determinants of variations in outpatient antibiotic consumption may help to design more effective policies to counter the threat of bacterial resistance. Our estimate of the welfare loss due to heterogeneous attitudes towards antibiotic treatment is comparable to the expected cost of implementing measures to improve the dissemination of information on bacterial resistance among patients and doctors.
Self-correction in biomedical publications and the scientific impact

Aim To analyze mistakes and misconduct in multidisciplinary and specialized biomedical journals. Methods We conducted searches through PubMed to retrieve errata, duplicate, and retracted publications (as of January 30, 2014). To analyze publication activity and citation profiles of countries, multidisciplinary, and specialized biomedical journals, we referred to the latest data from the SCImago Journal & Country Rank database. Total number of indexed articles and values of the h-index of the fifty most productive countries and multidisciplinary journals were recorded and linked to the number of duplicate and retracted publications in PubMed. Results Our analysis found 2597 correction items. A striking increase in the number of corrections appeared in 2013, which is mainly due to 871 (85.3%) corrections from PLOS One. The number of duplicate publications was 1086. Articles frequently published in duplicate were reviews (15.6%), original studies (12.6%), and case reports (7.6%), whereas top three retracted articles were original studies (10.1%), randomized trials (8.8%), and reviews (7%). A strong association existed between the total number of publications across countries and duplicate (rs = 0.86, P < 0.001) and retracted items (rs = 0.812, P < 0.001). A similar trend was found between country-based h-index values and duplicate and retracted publications. Conclusion The study suggests that the intensified self-correction in biomedicine is due to the attention of readers and authors, who spot errors in their hub of evidence-based information. Digitization and open access confound the staggering increase in correction notices and retractions.
Environmental complexity, seasonality and brain cell proliferation in a weakly electric fish, Brachyhypopomus gauderio

SUMMARY Environmental complexity and season both influence brain cell proliferation in adult vertebrates, but their relative importance and interaction have not been directly assessed. We examined brain cell proliferation during both the breeding and non-breeding seasons in adult male electric fish, Brachyhypopomus gauderio, exposed to three environments that differed in complexity: (1) a complex natural habitat in northern Uruguay, (2) an enriched captive environment where fish were housed socially and (3) a simple laboratory setting where fish were isolated. We injected fish with BrdU 2.5 h before sacrifice to label newborn cells. We examined the hindbrain and midbrain and quantified the density of BrdU+ cells in whole transverse sections, proliferative zones and two brain nuclei in the electrocommunication circuitry (the pacemaker nucleus and the electrosensory lateral line lobe). Season had the largest effect on cell proliferation, with fish during the breeding season having three to seven times more BrdU+ cells than those during the non-breeding season. Although the effect was smaller, fish from a natural environment had greater rates of cell proliferation than fish in social or isolated captive environments. For most brain regions, fish in social and isolated captive environments had equivalent levels of cell proliferation. However, for brain regions in the electrocommunication circuitry, group-housed fish had more cell proliferation than isolated fish, but only during the breeding season (season × environment interaction). The regionally and seasonally specific effect of social environment on cell proliferation suggests that addition of new cells to these nuclei may contribute to seasonal changes in electrocommunication behavior.