Miracle-dz/UniFAR-FTUs huggingface dataset:
Desire for pain relief in labour in Northeastern Nigeria

Labour pain is a distressing and psychologically traumatizing experience to the parturient but little data exist in the Northeastern part of Nigeria regarding pain relief in labour, despite its many advantages. To determine the knowledge, desire and access to pain relief in labour as well as perception of labour pain. This is a cross sectional study of two hundred and fifty five women in two tertiary institutions in north-eastern Nigeria. Patients attending the antenatal clinics or staying in the lying in ward of the hospital after delivery were interviewed and questionnaires filled. One hundred and ninety (74.5%) were undelivered while 65(25.5%) were in the immediate postpartum period. One hundred women were interviewed at the University of Maiduguri Teaching Hospital (UMTH) while 155 were interviewed at the Federal medical Centre Gombe. The interviews centred on their perception of pain and duration of labour. The mean age and parity were 27.6 ± 5.7 and 2.8 ± 2.1 respectively. About 80% of those interviewed rated labour pain as severe to agonizing, 82% had no knowledge of pain relief in labour while 81.6 and 78.8% would like pain relief and recommended same, respectively. Only 11% of those interviewed were given pain relief in labour. The majority of women, 64.7% considered their labour as not prolonged. Parity (P = 0.0002), ethnicity (P = 0.020) and duration of labour (P = 0.00017) significantly influenced pain perception in labour while education (P = 0.25) and age (P = 0.4) had no significant influence on pain perception in labour. Although many of the women were not aware of pain relief in labour, the overwhelming majority would want and have recommended pain relief in labour. Key words: Labour pain, knowledge, desire
Evaluation of total concentration and size distribution of bacterial and fungal aerosol in healthcare built environments

This study aims to assess the levels and size distribution of airborne bacteria and fungi in two different types of orthopaedic theatres (conventionally ventilated and laminar flow), a general ward and outdoors in a hospital. The sampling was carried out with an Andersen six-stage viable impactor over a period of eight weeks. The highest mean concentration of total bacteria was found outdoors followed by the general ward, conventionally ventilated theatre and laminar flow theatre. With reference to Gram-negative bacteria, the general ward had the highest mean concentration followed by outdoors and the conventionally ventilated theatre. No Gram-negative bacteria were detected in the operating theatre with laminar flow. Similar to bacteria, the higher concentration of fungi was present outdoors and in the general ward as compared to the operation theatres. In general, higher concentrations were found in the conventionally ventilated theatre than the laminar flow theatre. In terms of size distribution, in the ward and outdoors the dominant bacteria, Gram-negative bacteria and fungi were in the size range of 3.3–4.7 µm or 2.1–3.3 µm. The bacterial concentrations in the conventionally ventilated operating theatre were mostly in coarse size fraction compared to fine fraction for the theatre with laminar flow.
Mixed-method process evaluation of the Welsh National Exercise Referral Scheme

Purpose – Primary-care referral to community-based exercise specialists (exercise referral) is common in the UK despite limited evidence of effectiveness. A recent pragmatic randomised trial of the Welsh National Exercise Referral Scheme (NERS), demonstrated promising impacts upon physical activity and mental health. This paper presents a mixed-method process evaluation exploring how outcomes were achieved. Design/methodology/approach – Structured observation, implementer interviews and routine data assessed the extent to which NERS was implemented as intended. Baseline trial data were combined with routine monitoring data for the purposes of profiling uptake and adherence. Semi-structured patient interviews explored processes of change and the emergence of social patterning in responses to the scheme. Findings – NERS offered patients a programme of supervised, group-based discounted exercise. However, motivational interviewing, goal-setting and patient follow-up protocols were delivered poorly. The high degree of professional support was perceived as helping patients to build confidence and assimilate into exercise environments. Patient-only classes provided social contacts, a supportive context and realistic models. Patterning in uptake emerged from access issues, with uptake lower among non-car owners. Adherence was poorer among mental health patients, younger patients and those who were least active prior to referral to NERS. Originality/value – In practice, although the NERS RCT demonstrated positive impacts on physical activity and mental health, process evaluation data indicate that the intervention was not entirely delivered as intended. Mixed-method process evaluation served crucial functions in understanding implementation and functioning, offering insights into the roles of professional support and exercise classes in promoting activity and mental health, and the emergence of social patterning in responses to an ERS.
B Vitamins and the Risk of Total Mortality and Cardiovascular Disease in End-Stage Renal Disease: Results of a Randomized Controlled Trial

Background— In observational studies, hyperhomocysteinemia has been found to be a risk factor for total mortality and cardiovascular events in patients with end-stage renal disease. These patients have grossly elevated homocysteine levels that can be lowered by supplementation with folic acid and vitamin B12. We conducted a randomized clinical trial with B vitamins to reduce homocysteine levels and therefore cardiovascular events and total mortality. Methods and Results— This randomized, double-blind multicenter study was conducted in 33 dialysis centers in north and east Germany between July 2002 and July 2008. We randomly assigned 650 patients with end-stage renal disease who were undergoing hemodialysis to 2 postdialysis treatments: 5 mg folic acid, 50 &mgr;g vitamin B12, and 20 mg vitamin B6 (active treatment) or 0.2 mg folic acid, 4 &mgr;g vitamin B12, and 1.0 mg vitamin B6 (placebo) given 3 times per week for an average of 2 years. The primary outcome was total mortality; the secondary outcome was fatal and nonfatal cardiovascular events. The primary outcome occurred in 102 patients (31%) receiving the active treatment and in 92 (28%) receiving placebo (hazard ratio, 1.13; 95% confidence interval, 0.85 to 1.50; P=0.51). The secondary outcome occurred in 83 patients (25%) receiving the active treatment and in 98 (30%) receiving placebo (hazard ratio, 0.80; 95% confidence interval, 0.60 to 1.07; P=0.13). Conclusions— Increased intake of folic acid, vitamin B12, and vitamin B6 did not reduce total mortality and had no significant effect on the risk of cardiovascular events in patients with end-stage renal disease. Clinical Trial Registration— URL: www.anzctr. org.au. Unique identifier: ACTRN12609000911291. URL: www.cochrane-renal.org. Unique identifier: CRG010600027.
University Health Center Providers' Beliefs about Discussing and Recommending Sexual Health Prevention to Women College Students.

Sexual health concerns such as sexually transmitted infections and unintended pregnancy remain substantial health problems faced by young adults, especially college women. University healthcare providers may be instrumental in increasing female patients’ involvement in preventative sexual health behaviors, however little research has examined this issue. In-depth interviews were conducted with women’s clinic providers at a university health center using the Reasoned Action Approach (RAA) to better understand providers’ beliefs about discussing and recommending sexual health prevention to their patients. Providers felt comfortable and confident discussing and recommending various sexual health prevention behaviors and stated that a health history questionnaire is a useful tool to guide this process. However, they stated time restraints greatly limit their ability to adequately address preventative health practices when more pressing issues needed to be addressed. College health professionals should include providers as a component of prevention interventions and utilize providers as a mechanism to increase preventative health behaviors.
Endocrine and Metabolic Disturbances in Survivors of Hematopoietic Stem Cell Transplantation in Childhood and Adolescence

Background/Aims: The objective was to evaluate endocrine complications in survivors of hematopoietic stem cell transplantation (HSCT) performed during childhood. Methods: Endocrine dysfunction and metabolic syndrome parameters were assessed by chart review of 178 childhood HSCT survivors (median age at evaluation, 15.5 [range: 3.8–29.8] years; median follow-up, 8.5 [range: 2–23.4] years). Results: The following statistically significant associations were identified (p < 0.05 for all): growth hormone deficiency (17.4%) was associated with cranial/craniospinal irradiation, total body irradiation (TBI), allogeneic HSCT, and longer follow-up. Short adult stature (23.3% of patients who had attained adult height) was associated with cranial/craniospinal irradiation and, in females, with younger age at HSCT. Primary gonadal failure was more prevalent in females (52.6 vs. 24.1%), and was associated with TBI in males and with a primary diagnosis of hematological malignancy in females. Hypothyroidism (25.2%) was associated with previous neck/mediastinal irradiation. Metabolic disturbances included obesity (3.9%), type 2 diabetes (2.2%), impaired glucose tolerance (2.8%), and dyslipidemia (18.5%). Dyslipidemia was associated with a primary diagnosis of hematological malignancy, TBI, and a positive family history of dyslipidemia. Endocrine dysfunction was less frequent in patients who had received fludarabine. Conclusions: Patients after HSCT require long-term surveillance for the detection of endocrine and metabolic disorders. Nonmyeloablative conditioning regimens may reduce the incidence of these complications.
Paired response of motor units during voluntary contraction in Parkinsonism

Parkinson (1817) believed that the whole complex of Parkinsonism, including tremor, was due to abnormal function of the upper part of the spinal cord and the medulla oblongata. Though a great deal of clinical, pathological, and experimental work, including surgical operation for the Parkinsonian syndrome, has led us to believe that the site of pathology is much higher, in the basal ganglia, it is interesting to note that recent physiological studies are revealing unsuspected disturbances at the level of the medulla and the cord. The part played by the spinal cord and its connexions is not insignificant (Das Gupta, 1962) and so an important pathological mechanism of Parkinsonism lies much closer anatomically to what Parkinson himself suggested over a century ago. The importance of this local pathology is once again suggested by an observation which is the subject of this paper. It was made incidentally during a study of the behaviour of single motor units of voluntary muscle during sustained isometric contraction, using a steel needle electrode specially prepared for the discrete recording of single motor units. The technique has been fully described elsewhere (Das Gupta and Simpson, 1962). Observations were made on 10 patients with paralysis agitans. All had tremor as well as rigidity but records were taken when there was no overt tremor or when tremor was so slight as not to affect the picture. A prominent feature of the firing pattern of single motor units during sustained voluntary contraction was a tendency for the spike discharges to be grouped in pairs (Fig. 1). The intervals between the two spikes were extremely variable, from 20 msec. to over 80 msec. , but usually between 30 and 60 msec. With the very localized pick-up area of the electrodes used, it was easy to recognize individual units by their characteristic shape. This criterion left no room for doubt that both spikes of a pair originated from one unit. When there was overt tremor during an experiment there was always synchronous
Leuprolide Acetate Inhibits Spinal Cord Inflammatory Response in Experimental Autoimmune Encephalomyelitis by Suppressing NF-κB Activation

Objective: Recent findings have shown that gonadotropin-releasing hormone (GnRH) administration in an animal model of multiple sclerosis (experimental autoimmune encephalomyelitis, EAE) improves clinical signs of locomotion. The present study was designed to determine whether the administration of the synthetic analog of GnRH, leuprolide acetate (LA) - besides its effects on clinical signs of locomotion - also has an effect on the activation/expression levels of molecular markers of EAE, namely transcription nuclear factor (NF)-κB and the proinflammatory cytokines IL-1ß, IL-17A, IL-23 and TNF-a. Methods: EAE spinal cords were collected from control and LA-administered rats. Lumbar sections were processed at four different time points during the course of the disease to analyze NF-κB activation by chemiluminescent Western blot, and during the EAE recovery phase to evaluate proinflammatory cytokine levels by quantitative real-time PCR. Results: It was found that LA administration to EAE rats promoted a significant reduction of NF-κB activation during the course of the disease and also decreased the mRNA expression levels of the proinflammatory cytokines IL-1ß, IL-17A and TNF-a in the EAE recovery phase; both effects are consistent with the decrease in the severity of clinical signs of locomotion induced by the treatment. Conclusion: LA causes a reduction in the severity of locomotor activity, as well as in the activation of NF-κB and the number of proinflammatory markers in rats with EAE. These results suggest the use of this agonist as a potential therapeutic approach for multiple sclerosis.
An identification by adapting the fictitious controller to data

Abstract In the present paper, we propose a new identification method by adapting the “fictitious controller” to the obtained data in the closed loop experiment. A fictitious controller, which is introduced in this paper, consists of the nominal model with unknown plant parameters and the implemented controller used in the closed loop. One of the key points of the present method is the adaptation of such a controller to the actual experiment data. Moreover, the adaptation can be performed by using an off-line nonlinear optimization. Since the required material in the proposed method is only one-shot experimental data under the normal operation like step responses, this method has a practical advantage in the sense that the costs and time for the identification can be reduced.
Timeliness of primary childhood vaccination in a rural area of Puducherry, South India: evidence from routine management information system

Background: Immunization plays an important role in reducing mortality due to vaccine preventable diseases in children. In areas with high vaccine coverage, age-appropriate vaccination or timeliness of vaccination will be helpful in assessing quality of vaccination program. The objective was to assess the delay in primary childhood vaccination in a primary health center (PHC) of rural Puducherry. Methods: A record based study was conducted in a primary health center situated in rural Puducherry using data from immunization and antenatal records. Children born between 1 st January 2009 and 30 th November 2013 were included in the study. Delay in vaccination of diphtheria-tetanus-pertussis 1 (DPT1), DPT2, DPT3 and measles were studied. Results: A total of 457 children were included, 52.5% were males, and 47.5% were females. Immunization coverage was 100% for all vaccines. Delay in vaccination more than 2 weeks from the due date of vaccination for DPT1, DPT2, DPT3 and measles were 7.4%, 41.9%, 64.4% and 38.8% respectively. Median (interquartile range) days of delay for DPT1, DPT2, DPT3 and measles was found to be 6 (4-8), 13 (7-20), 19 (12-30) and 11 (4-24) respectively. Children with higher birth order were vaccinated with significant delay for DPT3 (p = 0.008). Delay in vaccination was less in children from the village where PHC is located (p < 0.001). Conclusion: Vaccination coverage for DPT and measles is high. There are delays in vaccination for DPT and measles, though not so high, there is scope for improving timeliness of vaccination in this rural area.
Heart Failure Is Common and Under-Recognized in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

Background: Heart failure (HF) prevalence in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) varies depending on study cohort and is not well characterized. This study sought to determine prevalence and predictors of HF in ARVC/D. Methods and Results: Clinical HF, defined as at least 1 HF sign or symptom, was retrospectively adjudicated for 289 patients meeting ARVC/D Task Force Criteria. HF was present in 142 patients (49%): 113 had isolated RV involvement and 29 had evidence of LV dysfunction. Average age of HF onset was 40±14 years. Most commonly reported symptoms were exertional dyspnea (78%) and fatigue (73%). Only 40% (n=57/142) had signs of volume overload. Left-sided HF signs were rare. Patients with clinical HF before ARVC/D diagnosis (n=31) were older (P=0.005) and met fewer Task Force Criteria (P=0.013) than those who developed HF after ARVC/D presentation. Female sex (odds ratio, 2.2; 95% confidence interval, 1.21–4.01; P=0.01) and lateral precordial T-wave inversions (odds ratio, 9.87; 95% confidence interval, 1.07–91.1; P=0.043) were associated with increased odds of HF. Additionally, patients with symptomatic LV dysfunction had higher odds of lateral precordial T-wave inversions (odds ratio, 18.4; 95% confidence interval, 2.92–116.18; P=0.002). Patients with HF were more likely to undergo heart transplantation (15/142 versus 1/147; P<0.001) or die during study follow-up period (7 versus 0; P=0.007). Conclusions: HF symptoms, especially exertional dyspnea, are common in ARVC/D; yet, classic left-sided signs are typically absent and less than half have evidence of volume overload. Given the unique predominately right-sided phenotype, a large portion of patients with HF may be under-recognized.
The Dual Syk/JAK Inhibitor Cerdulatinib Antagonizes B-cell Receptor and Microenvironmental Signaling in Chronic Lymphocytic Leukemia

Purpose: B-cell receptor (BCR)–associated kinase inhibitors, such as ibrutinib, have revolutionized the treatment of chronic lymphocytic leukemia (CLL). However, these agents are not curative, and resistance is already emerging in a proportion of patients. IL4, expressed in CLL lymph nodes, can augment BCR signaling and reduce the effectiveness of BCR kinase inhibitors. Therefore, simultaneous targeting of the IL4- and BCR signaling pathways by cerdulatinib, a novel dual Syk/JAK inhibitor currently in clinical trials (NCT01994382), may improve treatment responses in patients. Experimental Design: PBMCs from patients with CLL were treated in vitro with cerdulatinib alone or in combination with venetoclax. Cell death, chemokine, and cell signaling assay were performed and analyzed by flow cytometry, immunoblotting, q-PCR, and ELISA as indicated. Results: At concentrations achievable in patients, cerdulatinib inhibited BCR- and IL4-induced downstream signaling in CLL cells using multiple readouts and prevented anti-IgM- and nurse-like cell (NLC)–mediated CCL3/CCL4 production. Cerdulatinib induced apoptosis of CLL cells, in a time- and concentration-dependent manner, and particularly in IGHV-unmutated samples with greater BCR signaling capacity and response to IL4, or samples expressing higher levels of sIgM, CD49d+, or ZAP70+. Cerdulatinib overcame anti-IgM, IL4/CD40L, or NLC-mediated protection by preventing upregulation of MCL-1 and BCL-XL; however, BCL-2 expression was unaffected. Furthermore, in samples treated with IL4/CD40L, cerdulatinib synergized with venetoclax in vitro to induce greater apoptosis than either drug alone. Conclusions: Cerdulatinib is a promising therapeutic for the treatment of CLL either alone or in combination with venetoclax, with the potential to target critical survival pathways in this currently incurable disease. Clin Cancer Res; 23(9); 2313–24. ©2016 AACR.
CALL FOR PAPERS Cigarette Smoke-Induced Lung Endothelial and Alveolar Epithelial Injury Cigarette smoke extract suppresses the RIG-I-initiated innate immune response to inﬂuenza virus in the human lung

Cigarette smoke extract suppresses the RIG-I-initiated innate immune response to inﬂuenza virus in the human lung. Am J Physiol Lung Cell Mol Physiol L821–L830, 2011. smoking is the major cause of chronic obstructive pulmonary disease (COPD) and predis-poses subjects to severe respiratory tract infections. Epidemiological studies have shown that cigarette smokers are seven times more likely to contract inﬂuenza infection than nonsmokers. The mechanisms underlying this increased susceptibility are poorly characterized. Retinoic acid-inducible gene (RIG)-I is believed to play an important role in the recognition of, and response to, inﬂuenza virus and other RNA viruses. Our study focused on how cigarette smoke extract (CSE) alters the inﬂuenza-induced proinﬂammatory response and suppresses host antiviral activity in the human lung using a unique lung organ culture model. We ﬁrst determined that treatment with 2–20% CSE did not induce cytotoxicity as assessed by LDH release. However, CSE treatment inhibited inﬂuenza-induced IFN-inducible protein 10 protein and mRNA expression. Induction of the major antiviral cytokine IFN- (cid:1) mRNA was also decreased by CSE. CSE also blunted viral-mediated RIG-I mRNA and protein expression. Inhibition of viral-mediated RIG-I induction by CSE was prevented by the antioxidants N -acetyl-cysteine and glutathione. These ﬁndings show that CSE suppresses antiviral and innate immune responses in inﬂuenza virus-infected human lungs through oxidative inhibition of viral-mediated induction of the pattern recognition receptor RIG-I. This immunosuppressive effect of CSE may play a role in the enhanced susceptibility of smokers to serious inﬂuenza infection in the lung. bromide (Invitrogen) for and vol- umes were calculated using 5.0 software (Molecular Dy-namics). Ampliﬁed DNA band densities were normalized to the corre- sponding GAPDH densities to correct for potential differences in Immunohistochemistry Molecular Probes). Trans-mitted light and ﬂuorescent microscopy images were obtained using a Zeiss LSM-510META laser scanning confocal microscope.