Miracle-dz/UniFAR-FTUs huggingface dataset:
The Efficacy of a Computerized Assessment of Medication Adherence in Active Substance Users

Background: Self-reports of medication adherence are subject to recall errors and social desirability bias. The visual analogue scale (VAS) is a brief measure and minimally burdensome. Its accuracy among substance users needs confirmation. Methods: We administered the VAS on an audio computer-assisted self-interview (ACASI) to 102 HIV-positive active substance users. Viral load (VL) was obtained via chart review. Cohen κ assessed the overall agreement between VL suppression and adherence, and a receiver–operator characteristic (ROC) curve assessed the diagnostic performance. Results: The VAS estimates of adherence correlated with VL. Various cutoffs for adherence were associated with VL suppression, demonstrating fair to moderate agreement through κ. Area under the curve (AUC) demonstrated that the ACASI-administered VAS strongly predicted VL suppression (AUC = 0.79). Discussion: The VAS administered by ACASI is viable for measuring highly active antiretroviral therapy (HAART) adherence among substance users. Its benefits as a screening instrument may make it useful for both clinical and research purposes.
Seven-Year Experience with the Dumon Prosthesis

SummaryThe Dumon stent (or Endoxane), designed in 1987, is a flexible, multisized, studded, silicone prosthesis. This report describes the combined results of Dumon stent placement in Marseille, France (J.F.D.), Brescia, Italy (S.C.), Saint-Etienne, France (J.M.V.), and Barcelona, Spain (P.O.). The
Postmenopausal hormone therapy: critical reappraisal and a unified hypothesis.

OBJECTIVE To reconcile apparently conflicting evidence regarding the use of hormone therapy as a health-preserving strategy in postmenopausal women in light of that fact that findings from animal studies, human observation studies, and human clinical trials are consistent for outcomes such as fracture and breast cancer but differ for coronary heart disease (CHD). DESIGN Literature review and generation of a unified hypothesis consistent with all of the data. SETTING Animal trials, human observational studies, human studies of biologic intermediates, and human clinical trials. PATIENT(S) Premenopausal and postmenopausal women with or without antecedent CHD. MAIN OUTCOME MEASURE(S) Coronary heart disease events, proxies, risk factors, and related mechanisms. RESULT(S) The complex CHD responses to hormone therapy in recent human trials likely reflect a combination of [1] early erosion/rupture of "vulnerable" coronary plaque, which is made worse by hormone therapy, [2] long-term reduction in plaque formation, which is improved by hormone therapy, and [3] modulation of the vasculoprotective actions of estrogens by systemic progestogens. CONCLUSION(S) The unified hypothesis predicts that hormone therapy initiated at the time of menopause should produce a decrease in CHD over time. In contrast, hormone therapy begun years after menopause should produce an increase in CHD events shortly after therapy is begun, followed later by benefit. In women who require progestogens for endometrial protection, there should be greater CHD benefit from use of progestogens with less systemic activity. The unified hypothesis is consistent both with plausible biologic mechanisms and with evidence from animal studies, human observational studies, and human clinical trials such as the Women's Health Initiative. In the absence of evidence from human trials that specifically involve initiation of hormone therapy in perimenopausal women, practitioners and patients can use the unified hypothesis as a rational tool to guide decisions about clinical management.
Pulmonary complications after noncardiac surgery: A review of their frequency and prevention strategies

Abstract: Postoperative pulmonary complications are an important cause of postoperative morbidity and mortality after major noncardiac surgery. The reported frequency varies widely as defined by the definition of postoperative pulmonary complication, the patient population, and the type of surgery. The most common complications, namely, postoperative pneumonia and respiratory failure are strongly associated with the type of surgical procedure and other procedure specific factors. Among the patient related risk factors, age and the American Society of Anesthesiology class stratify the postoperative risk most powerfully. Preoperative spirometry may not offer incremental predictive benefit except in certain types of surgery. Potential strategies to reduce the postoperative complications include risk stratification for pneumonia and respiratory failure, adequate postoperative analgesia, short-acting neuromuscular blockade, postoperative lung expansion modalities, selective use of postoperative nasogastric decompression, laparoscopic surgery where possible, and nutrition.
Performance of the QuantiFERON-TB Gold Interferon Gamma Release Assay among HIV-Infected Children in Botswana

Interferon gamma release assays (IGRAs) are poorly studied in HIV-infected children. The authors prospectively evaluated QuantiFERON-TB Gold results and family-described tuberculosis (TB) risk factors in 100 HIV-infected children in Botswana. Median age was 10.2 years; 58 were girls, 92 had received the Bacillus Calmette–Guérin (BCG) vaccine, 98 were receiving antiretroviral therapy, and the median body mass index was 15.8 kg/m2. Eighty-nine children had undetectable viral loads and the median CD4 count was 962 cells/mm3. Eighteen children had been treated for TB in the last 3 years. In the last 3 years, 36 (including 9 with TB) had contact with persons with TB (26 within/15 outside the home and 5 had >1 contact). In all, 96 children had negative IGRAs, 3 were indeterminate, and 1 was positive. The positive IGRA was reported in a child treated for TB prior to 3 years. Interferon γ release assay positivity was rare in this pediatric cohort living in an area with a high prevalence of TB.
Prevalence and Pattern of Chronic Kidney Disease in Antiretroviral-Naïve Patients with HIV/AIDS

Background: Chronic renal failure and HIV/AIDS are both prevalent in Nigeria. We performed a cross-sectional analysis of renal function in newly diagnosed, treatment-naive HIV-infected patients before initiating highly active antiretroviral therapy. Methods: Treatment-inexperienced individuals were recruited. Patients with diabetes mellitus and hypertension were excluded. Plasma creatinine level was used to measure the estimated glomerular filtration rate ([eGFR] by Modification of Diet in Renal Disease equation). Predictors of creatinine and eGFR were determined by univariate and multivariate analyses. Results: We evaluated 183 patients. In all, 44 (24%) patients had a GFR <60 mL/min/1.73 m2, implying moderate chronic kidney disease (CKD). Considering the eGFR, 22 (12%) patients had stage 1, 117 (63.9%) stage 2, 13 (7.1%) stage 3, 27 (14.8%) stage 4, and 4 (2.2%) stage 5 CKD. Creatinine inversely correlated with CD4 (r = −.228, P = .025). CD4 predicts creatinine (odds ratio 1.6, 95% confidence interval 1.0-1.8, P = .003). Conclusion: In ART-naive patients, CKD is common, and low eGFR was associated with lower CD4 counts.
Behaviour problems after brain injury: incidence and need for treatment

The aim of this study was to identify the incidence and nature of behaviour problems following severe head injury. All severe head injuries in a known population were identified from a three-year period. Sixteen patients were assessed for behavioural problems shortly after injury, while still in hospital. The relatives' judgements of behavioural change observed at home, for a total of 33 patients from three consecutive years, was collected to compare the extent of behavioural problems during the years following injury. More behavioural problems were reported at home, by families, than by nursing and therapy staff in hospital. Relatives identified behaviour change in about 80% of the patients and significant practical problems were reported at home in about half of all severely head-injured people. Symptoms appeared to be persistent and tended to worsen over a three-year period following the injury. In particular, aggressive behaviour increased. Behaviour change did not correlate with either age or the severity of the injury as measured by post-traumatic amnesia. The results of this study draw attention to the need for treatment and support for the families of brain-injured patients showing behavioural disturbance, at home, after they have been discharged from hospital.
Baseline Neurocognitive Performance in Professional Lacrosse Athletes

Background: Concussions have become a major public health concern for both youth and professional athletes. The long-term consequences of concussion can be debilitating or even life threatening. To reduce these concerns, baseline neurocognitive performance can aid decision making in postconcussion recovery and return to play for athletes sustaining concussions. To date, these data are not available for lacrosse athletes. Purpose: To present baseline neurocognitive performance for Major League Lacrosse (MLL) players and to determine differences between athletes with and without a history of concussion. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective review was conducted of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores from MLL players who completed baseline testing from June 2010 to June 2011. Inclusion required a valid baseline test and no history of concussion in the 3 months prior to testing. Means ± standard deviations were computed for all demographic variables and ImPACT composite scores including visual and verbal memory, reaction time, and visual motor processing speed. Independent-samples t tests were used to determine differences between athletes with and without a history of concussion. Results: Valid baseline ImPACT testing was available for 235 MLL athletes (mean age, 25.1 ± 3.0 years). Forty percent of MLL athletes (n = 94) reported a history of concussion, with 14% of those (n = 13) reporting a history of 3 or more previous concussions. There were no differences on any demographic variables between MLL athletes with and without a history of concussion. MLL athletes with a history of concussion had lower ImPACT composite scores than those without a history of concussion, although only the verbal memory composite was found to be statistically significant (MLL with concussion, 83.2 ± 10.8 vs MLL without concussion, 86.9 ± 9.5; P = .007). Conclusion: This study establishes baseline ImPACT scores for MLL and demonstrates that athletes with a history of concussion have poorer neurocognitive performance compared with MLL athletes without a history of concussion. Clinical Relevance: These data can serve as normative values for subsequent testing following concussion to assess neurocognitive recovery.
Performance enhancement and IoT based monitoring for smart home

In recent years, home automation has become so popular due to its numerous advantages. The home environment has witnessed a rapid introduction of network enabled digital technology. This technology comes with new and exciting opportunities to increase the connectivity of different devices within the home for the purpose of home automation. This paper aims at designing a basic home automation system of controlling multiple appliances which can be monitored and accessed from anywhere in the world with very low cost. The technology incorporates Raspberry Pi and the web server. The Raspberry Pi and Arduino integrated with Nrf modules are used to monitor the home environment appliances, and the readings are passed to the web server designed. The parameters or commands sent through web page are monitored frequently and if any threats found the mobile connected to this web server is alerted through an alarm or message. The user can access this application from anywhere in the world. The result produced is low cost advantageous and absolute. Performance Analysis of different protocols (MQTT, HTTP and CoAP) is estimated using visualizations.
PS53 Effect Of Geographical Access To Health Facilities On Child Mortality In Rural Ethiopia: A Community Based Cross Sectional Study

Background There have been few studies which have examined associations between access to health care and child health outcomes in remote populations most in need of health services. This study assessed the effect of travel time and distance to health facilities on mortality in children under five years in a remote area of rural north-western Ethiopia. Methods This study involved a randomly selected cross sectional survey of 2,058 households. Data were collected during home visits to all resident women of reproductive age (15–49 years). A geographic information system (GIS) was used to map all households and the only health centre in the district. The analysis was restricted to 2,206 rural children who were under the age of five years during the five years before the survey. Data were analysed using random effects Poisson regression. Results 90.4% (1,996/2,206) of children lived more than 1.5 hours walk from the health centre. Children who lived >1.5hrs from the health centre had a two–three fold greater risk of death than children who lived<1.5 hours from the health centre (children with travel time 1.5–<2.5hrs adjusted relative risk [adjRR] 2.3[0.95–5.6], travel time 2.5–<3.5hrs adjRR 3.1[1.3–7.4] and travel time 3.5–<6.5hrs adjRR 2.5[1.1–6.2]). Conclusion Distance to a health centre had a marked influence on under five mortality in a poor, rural, remote area of Ethiopia. This study provides important information for policy makers on the likely impact of new health centres and their most effective location in remote areas.
Hearing Loss

In the UK, there are 9 million people who are deaf or hard of hearing and potentially facing significant communication barriers. Hearing loss can be broadly divided into two main types—conductive and sensorineural. The former is usually caused by pathology within the external or middle ear, the latter by inner ear disease (the cochlea or neural pathway to the auditory cortex). A patient can also have a mixed picture with both conductive and sensorineural elements. This article describes the initial assessment and investigation of a patient presenting with hearing loss, outlines the more common causes of both conductive and sensorineural deafness and outlines strategies to optimize hearing.
The acceptance of process innovations in drug supply – An empirical analysis of patient-individualized blister packaging in stationary nursing facilities

Abstract Purpose of the study Process innovations in drug supply can be an instrument to avoid future cost increases in health services. Besides economic and technical aspects, the success of such process innovations depends on the acceptance of the groups concerned. This paper examines the effect of patient-specific drug supply on involved physicians and nursing staff. Methods Eighty-two caregivers and 15 physicians involved in a project about patient-specific drug blistering were questioned based on a research study accomplished from June 2009 to January 2011. The survey on the consequences for physicians, nursing staff, and patients was carried out by using a structured and anonymous questionnaire. Results The interviewed caregivers as well as the physicians agree in principle on patient-individualized blistering as a useful process innovation in drug supply. In particular, time relief for the nursing staff as well as rising security of supply is positively assessed. The slow adjustment of medication is evaluated to be a disadvantage. Discussion The results of the survey demonstrate that the affected group of professionals does not fundamentally reject process innovations in drug supply. By applying certain conditions, patient-specific drug blistering can possibly lead to an increasing efficiency in pharmaceutical supply.
Gestation and Birthweight in Dizygotic Twins: Girls Call the Tune

Abstract Unlike-sex twins provide a unique natural experiment to investigate the influence of sex on gestation. Our data showed that length of gestation of unlike-sex pairs is similar to that of female same-sex pairs, and significantly (0.4 wks, p = .02) longer than that of male same-sex pairs. Birthweight of female unlike-sex twins was similar to female same-sex twins, but male unlike-sex twins weighed 78 g more than male same-sex twins ( p = .001). These data show that in unlikesex pairs it is the girl that prolongs gestation for her brother, resulting in a higher birthweight than that of same-sex boys.
An Access Point Coordination System for Improved VoIP/WLAN Handover Performance

With layer 2 and 3 handover algorithms, wireless LAN can allow users to roam between different access points without breaking the connection to the Internet. However, one of the biggest problems in roaming is the latency in the handoff process. Recently, Ramani and Savage (2005) have proposed a new scheme called SyncScan which can reduce the overall handoff latency in layer 2 by more than 80%. However, this scheme assumes that the beacon transmission schedule among the access points is known a priori, and the beacons are transmitted on time. In this paper, we will propose a self-organized access point coordination system to generate and maintain a conflict-free beacon transmission schedule. Also, we will present a performance evaluation of the SyncScan scheme by studying the effect of beacon transmission delay due to data traffic, and mobility on handover performance
Parents’ Experiences of Toothbrushing with Children

Globally, dental caries is one of the most prevalent diseases and is more common in children living in deprived areas. Dental caries is preventable, and guidance in the United Kingdom recommends parental supervised brushing (PSB): a collection of behaviors—including twice-daily toothbrushing with fluoridated toothpaste—that should begin upon eruption of the first tooth (approximately 6 to 12 mo of age) and for which children need to be helped or supervised by an adult until at least 7 y of age. The aim of this study was to explore parents’ experiences of toothbrushing with their young children and to establish barriers and facilitators to PSB at individual, interpersonal, and environmental levels according to the theoretical domains framework. Qualitative semistructured interviews guided by the framework were conducted with 27 parents of young children (<7 y) in 2 deprived areas of the United Kingdom. Framework analysis was used. Parents were not aware of national guidance concerning their active involvement in toothbrushing; however, they did have detailed knowledge of toothbrushing practices for children, and their intentions were to brush their children’s teeth themselves twice every day as part of a family routine. Nonetheless, parents’ difficulties experienced in managing their children’s challenging behavior and the environmental context of their stressful lives meant that many parents adopted a role of simply reminding their children to brush or watching them brush. As such, the main barriers to PSB among parents living in deprived areas were skills in managing their children’s behavior and environmental influences on family life. The results of our study have clear implications for the development of appropriate interventions to address the modifiable barriers to improve parental adoption of PSB. Knowledge Transfer Statement: The results of this study will be used to develop a behavior change intervention to encourage parental supervised brushing. The intervention—which is likely to be delivered through health practitioners rather than dental teams—will be developed to reduce dental caries among young children and will require evaluation in terms of its clinical and cost effectiveness.
Robotically Assisted Minimally Invasive Surgery in a Pediatric Population: Initial Experience, Technical Considerations, and Description of the da Vinci® Surgical System

Introduction: Reports of robotically assisted minimal access surgery (RMAS) in the adult patient population have increased over the last several years. Few reports have addressed RMAS in pediatric patients. We present our initial RMAS experience with the da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, California), and discuss technical considerations, advantages, and disadvantages. Methods: From July 2002 to April 2003, the da Vinci surgical system was used in 20 pediatric patients (9 female, 11 male) with a mean age of 8.4 years (range, 4 months to 16 years). The mean weight of our patients was 38.7 kg (range, 6.8-82 kg). Procedures performed were: Nissen fundoplication (10, including 3 with gastrostomy tube placement and 1 with pyloroplasty), cholecystectomy (3), splenectomy (2), urachus resection (1), unilateral iliac and retroperitoneal lymphadenectomy (1), incisional biopsy retroperitoneal presacral mass (1), incisional biopsy hepatic mass (1), Gortex patch repair of a Morgagni diaphragmati.
The Effect of Time of Administration of Phenytoin on its Serum Levels and Pharmacodynamic Parameters in Patients of Generalised Tonic Clonic Seizures

The role of the time of administration of phenytoin on its serum levels and pharmacodynamic parameters was studied in two comparable groups of patients of grand mal_epilepsy stabilized on serum phenytoin therapy. In these patients, phenytoin was advised to be taken as a single daily dose either at 08.00 (Group M) or 20.00 (Group E) every day. A serum phenytoin level profile over 24 hours was obtained and all patients were clinically followed up for six months. Maximum serum concentration (C-max) of phenytoin was achieved significantly faster (p < 0.001) in patients of Group E. The total number of serum samples having toxic concentrations and also the incidence and severity of toxic effects of phenytoin was less in Group E. The study suggests that bedtime administration of phenytoin in patients of grand mal–epilepsy may lead to faster absorption of the drug and less side effects as compared with drug administration in the morning.
Aggregatibacter actinomycetemcomitans in African Americans with Localized Aggressive Periodontitis

This study aims to investigate the prevalence of the highly leukotoxic JP2 sequence versus the minimally leukotoxic non-JP2 sequence of Aggregatibacter actinomycetemcomitans within a cohort of 180 young African Americans, with and without localized aggressive periodontitis (LAP), in north Florida. The study included patients aged 5 to 25 y: 60 LAP patients, 60 healthy siblings (HS), and 60 unrelated healthy controls (HC). Subgingival plaque was collected from LAP sites—diseased (PD ≥5 mm with bleeding on probing) and healthy (PD ≤3 mm with no bleeding on probing)—and from healthy sites of HS and HC. Plaque DNA was extracted and analyzed by polymerase chain reaction for the detection of the JP2 and non-JP2 sequences of A. actinomycetemcomitans. Overall, 90 (50%) subjects tested positive for the JP2 sequence. Fifty (83.33%) LAP subjects were carriers of the highly leukotoxic JP2 sequence, detected in 45 (75%) diseased sites and 34 (56.67%) healthy sites. Additionally, JP2 carriage was found in 16 HS (26.67%) and 24 HC (40%; P < 0.0001, among groups). The non-JP2 sequence was detected in 26 (14.44%) total subjects: 17 (28.33%) LAP patients detected in equal amounts of diseased and healthy sites (n = 11, 18.33%), 6 (10%) HS sites, and 3 (5%) HC sites (P < 0.05, among groups). The JP2 sequence was strongly associated with LAP-diseased sites in young African Americans, significantly more so than the non-JP2 (ClinicalTrials.gov NCT01330719). Knowledge Transfer Statement: Clinicians may use the results of this study to identify susceptible individuals to aggressive periodontitis, potentially leading to more appropriate selection of therapeutic choices.