Miracle-dz/UniFAR-FTUs huggingface dataset:
NEUROCYSTICERCOSIS IN CHILDREN AT GMC, CHARAK HOSPITAL, POKHARA

Neurocysticercosis (NCC) is a common cause of seizure and major cause of neurological illness globally. It is one of the major causes of epilepsy in children. Fewer studies were done in the past regarding NCC in Nepal. However study on NCC in children in Gandaki Medical College (GMC), Charak Hospital is the first of its kind. 23 children with CT scanning of head that were consistent with NCC over a period of 18 months at GMC, Charak Hospital were included as study subjects. Although there are so many diagnostic tools including MRI, immunological and serological tests for the detection of NCC, CT scanning of the head was used for its diagnosis in this study. 17.3% of the study subjects were found to have suffered from NCC. Girls (60%) outnumbered boys (40%); it was more commonly seen in 10-15 years age group (47.83%). Three main clinical presentations were Seizure (100%), Headache (73.91%) and Vomiting (30.43%). Most of the cases had ring enhancing lesion at colloidal stage. All patients were treated with albendazole, dexamethasone and antiepileptic drugs (AED) and advised strongly to continue for the period of at least 2 years without failure. NCC should be considered and CT/MRI head must be performed in all children above 5 years of age presented as seizure, headache or vomiting where Taenia solium (TS) infestations are found endemic.
Incidence and Predictors of Hypertension Among Rural Chinese Adults: Results From Liaoning Province

OBJECTIVE We wanted to determine the incidence of hypertension and its risk factors among rural Chinese adults. METHODS A population-based sample of 24,360 rural Chinese adults aged 35 years and older and free from hypertension at baseline was observed from 2004–2006 to 2008. Incident hypertension was defined as a systolic pressure of 140 mm Hg or greater, diastolic pressure of 90 mm Hg or greater, or current use of antihypertensive medication. RESULTS During a mean follow-up period of 28 months, 29.6% of men and 23.4% of women developed hypertension. The age-adjusted incidence was higher in men (12.75 per 100 person-years) than in women (10.04 per 100 person-years). Among men, independent predictors of incident hypertension were baseline age (hazard ratio [HR] = 1.11; 95% confidence interval [CI], 1.10–1.13), Mongolian ethnicity (HR = 1.09; 95% CI, 1.01–1.18), use of alcohol, (HR = 1.14; 95% CI, 1.06–1.23), high income vs low income (HR = 1.11; 95% CI, 1.00–1.22; and HR = 1.11; 95% CI, 1.03–1.20), prehypertension vs normotension (HR = 1.18; 95% CI, 1.08–1.28), overweight and obesity (HR = 1.28; 95% CI, 1.17–1.40), baseline salt intake (HR = 1.00; 95% CI, 1.00–1.01) and family history of hypertension (HR = 1.14; 95% CI, 1.03–1.27). With the exception of use of alcohol and mean income, the results were similar for women, except that low physical activity was shown as a risk factors as well. The awareness, treatment, and control rates for newly developed hypertension were 29.9%, 19.5%, and 1.5%, respectively. CONCLUSIONS These data indicate that the incidence of hypertension is high among these rural Chinese adults and that it is associated with many risk factors. Our findings further suggest that most newly developed hypertension cases are not treated. The increases in hypertension are probably related to rapid social changes in our country and may apply to other areas of the developing world. These findings call for urgent improvements in hypertension prevention and control programs in rural China.
Participatory Decision Making, Patient Activation, Medication Adherence, and Intermediate Clinical Outcomes in Type 2 Diabetes: A STARNet Study

PURPOSE Participatory decision making (PDM) is associated with improved diabetes control. We examine a causal model linking PDM to improved clinical outcomes that included patient activation and medication adherence. METHODS This observational study was conducted in 5 family physician offices. Diabetic patients were recruited by mail and by completing a study interest card at the conclusion of their office visit. Two survey questionnaires, administered 12 months apart, elicited patients’ ratings of their physician’s PDM style at baseline and their level of activation and medication adherence both at baseline and at follow-up. Measures of glycated hemoglobin (hemoglobin A1c), systolic blood pressure, and low-density lipoprotein (LDL) cholesterol were abstracted from the medical record starting 12 months before the baseline survey to 12 months after the follow-up survey. A path analysis using a structural equation model was used to test hypotheses. RESULTS We mailed questionnaires to 236 participants; 166 (70%) returned the baseline questionnaire, and 141 (80%) returned the follow-up questionnaire. Hemoglobin A1c levels, systolic blood pressure, and LDL cholesterol values all declined significantly, and patient activation and medication adherence improved. PDM at baseline was associated with patient activation at follow-up. Patient activation at follow-up was associated with medication adherence at follow-up, and medication adherence at follow-up was associated with change in hemoglobin A1c levels and LDL cholesterol values but not with systolic blood pressure. CONCLUSIONS Participatory decision making during primary care encounters by patients with type 2 diabetes resulted in improvements in hemoglobin A1c levels and LDL cholesterol values by improving patient activation, which in turn improved medication adherence.
Impact of Electronic Health Record Clinical Decision Support on Diabetes Care: A Randomized Trial

PURPOSE We wanted to assess the impact of an electronic health record–based diabetes clinical decision support system on control of hemoglobin A1c (glycated hemoglobin), blood pressure, and low-density lipoprotein (LDL) cholesterol levels in adults with diabetes. METHODS We conducted a clinic-randomized trial conducted from October 2006 to May 2007 in Minnesota. Included were 11 clinics with 41 consenting primary care physicians and the physicians’ 2,556 patients with diabetes. Patients were randomized either to receive or not to receive an electronic health record (EHR)–based clinical decision support system designed to improve care for those patients whose hemoglobin A1c, blood pressure, or LDL cholesterol levels were higher than goal at any office visit. Analysis used general and generalized linear mixed models with repeated time measurements to accommodate the nested data structure. RESULTS The intervention group physicians used the EHR-based decision support system at 62.6% of all office visits made by adults with diabetes. The intervention group diabetes patients had significantly better hemoglobin A1c (intervention effect −0.26%; 95% confidence interval, −0.06% to −0.47%; P=.01), and better maintenance of systolic blood pressure control (80.2% vs 75.1%, P=.03) and borderline better maintenance of diastolic blood pressure control (85.6% vs 81.7%, P =.07), but not improved low-density lipoprotein cholesterol levels (P = .62) than patients of physicians randomized to the control arm of the study. Among intervention group physicians, 94% were satisfied or very satisfied with the intervention, and moderate use of the support system persisted for more than 1 year after feedback and incentives to encourage its use were discontinued. CONCLUSIONS EHR-based diabetes clinical decision support significantly improved glucose control and some aspects of blood pressure control in adults with type 2 diabetes.
Preventing Life-Sustaining Treatment by Default

Many physicians will at some point care for patients who will receive life-sustaining treatment by default, because there are no instructions available from the patient as to what kind of care is preferred, and because surrogates are likely to ask for everything to be done when they do not know a patient’s preferences. We use the methods of ethics informed by qualitative focus group research to identify 5 pathways to life-sustaining treatment by default originating with the patient’s preferred decision-making style: deciding for oneself or letting others decide. We emphasize preventing the ethically unwelcome outcome of life-sustaining treatment by default by increasing the frequency with which patients make clear decisions or clearly express their values and goals that they then communicate to physicians or surrogates.
Response of native and exotic maple seedling banks to removal of the exotic, invasive Norway maple (Acer platanoides).

WEBB, S. L. , T H. PENDERGAST IV, AND M. E. DWYER (Drew University, Biology Department, Madison, NJ 07940.) Response of native and invasive maple seedling banks to removal of the exotic, invasive Norway maple (Acer platanoides). J. Torrey Bot. Soc. 128:000-000. 2001. -Acer platanoides is an exotic, invasive tree in eastern deciduous forests of North America where past research shows it to thrive in the forest interior and to suppress understory diversity. To test the efficacy of restoration strategies and to probe dynamics of this tree's seedling bank, trees and seedlings of Acer platanoides were removed in 1997 from a mixed maple forest carpeted by an even mix of exotic Acer platanoides and native Acer saccharum seedlings. The treatments were removal of trees (height > 1.5 m) and removal of small seedlings (height < 1.5 m), using a crossed design with a total of 80 permanent plots, all sampled before removals and two years later. After two years, removal of Acer platanoides trees had caused an increase in native Acer saccharum seedling densities over those in control areas and had caused a decrease of new Acer platanoides recruitment. Conversely, removal of Acer platanoides seedlings initiated far more new Acer platanoides than Acer saccharum seedlings. The Acer platanoides seedling bank was partially, but not fully, replenished two years after its removal. Although removal of canopy trees appears effective as a restoration tool, other exotic species (especially Lonicera japonica, Alliaria petiolata, and Robinia pseudoacacia) proliferated where tree removals opened the canopy. Restoring the pre-invasion community will thus require future intervention.
Differences in Pain Perceptions between Automated Breast Ultrasound and Digital Screening Mammography

A prospective single-site survey was performed to gauge perceived pain during automated breast ultrasound (ABUS) and digital x-ray mammography (XRM). Patients also described differences in duration of the exams, provided their bra size, and indicated whether they would recommend ABUS to a friend. Pain was measured on a Likert-type visual analog scale (1–10). Participants were 199 female volunteers who also participated in the prospective, multicenter, nationwide clinical research study SOMO•INSIGHT. There was a mean pain and/or discomfort score of 6.41 (± 2.41) for XRM and a mean score of 1.86 (± 1.24) for ABUS (P = .001). Bra size and perceived examination duration played no role in determining patient pain and/or discomfort. One hundred percent of patients who participated said that they would recommend ABUS to a friend. These data suggest that if ABUS is proven to be a valuable adjunctive screening test for breast cancer among women with dense breast tissue, its routine use will be well tolerated by patients.
The Enduring Impact of What Clinicians Say to People With Low Back Pain

PURPOSE The purpose of this study was to explore the formation and impact of attitudes and beliefs among people experiencing acute and chronic low back pain. METHODS Semistructured qualitative interviews were conducted with 12 participants with acute low back pain (less than 6 weeks’ duration) and 11 participants with chronic low back pain (more than 3 months’ duration) from 1 geographical region within New Zealand. Data were analyzed using an Interpretive Description framework. RESULTS Participants’ underlying beliefs about low back pain were influenced by a range of sources. Participants experiencing acute low back pain faced considerable uncertainty and consequently sought more information and understanding. Although participants searched the Internet and looked to family and friends, health care professionals had the strongest influence upon their attitudes and beliefs. Clinicians influenced their patients’ understanding of the source and meaning of symptoms, as well as their prognostic expectations. Such information and advice could continue to influence the beliefs of patients for many years. Many messages from clinicians were interpreted as meaning the back needed to be protected. These messages could result in increased vigilance, worry, guilt when adherence was inadequate, or frustration when protection strategies failed. Clinicians could also provide reassurance, which increased confidence, and advice, which positively influenced the approach to movement and activity. CONCLUSIONS Health care professionals have a considerable and enduring influence upon the attitudes and beliefs of people with low back pain. It is important that this opportunity is used to positively influence attitudes and beliefs.
In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices

We highlight primary care innovations gathered from high-functioning primary care practices, innovations we believe can facilitate joy in practice and mitigate physician burnout. To do so, we made site visits to 23 high-performing primary care practices and focused on how these practices distribute functions among the team, use technology to their advantage, improve outcomes with data, and make the job of primary care feasible and enjoyable as a life’s vocation. Innovations identified include (1) proactive planned care, with previsit planning and previsit laboratory tests; (2) sharing clinical care among a team, with expanded rooming protocols, standing orders, and panel management; (3) sharing clerical tasks with collaborative documentation (scribing), nonphysician order entry, and streamlined prescription management; (4) improving communication by verbal messaging and in-box management; and (5) improving team functioning through co-location, team meetings, and work flow mapping. Our observations suggest that a shift from a physician-centric model of work distribution and responsibility to a shared-care model, with a higher level of clinical support staff per physician and frequent forums for communication, can result in high-functioning teams, improved professional satisfaction, and greater joy in practice.
Development and Validation of a Family History Screening Questionnaire in Australian Primary Care

PURPOSE We aimed to validate a family history screening questionnaire in an Australian primary care population designed to identify people at increased risk for breast, ovarian, colorectal, and prostate cancer; melanoma; ischemic heart disease; and type 2 diabetes. METHODS We prospectively validated the questionnaire in 6 general practices in Perth, Western Australia among 526 patients aged 20 to 50 years who responded to a single invitation from their general practice. They completed the 15-item questionnaire before a reference standard 3-generation pedigree was obtained by a genetic counselor blinded to the questionnaire responses. We calculated diagnostic performance statistics for the questionnaire using the pedigree as the reference standard. RESULTS A combination of 9 questions had the following diagnostic performance, expressed as value (95% CI), to identify increased risk of any of the 7 conditions: area under the receiver operating characteristic curve 84.6% (81.2%–88.1%), 95% sensitivity (92%–98%), and 54% specificity (48%–60%). The combination of questions to detect increased risk had sensitivity of 92% (84%–99%) and 96% (93%–99%) for the 5 and 6 conditions applicable only to men and women, respectively. The specificity was 63% (28%–52%) for men and 49% (42%–56%) for women. The positive predictive values were 67% (56%–78%) and 68% (63%–73%), and the false-positive rates were 9% (0.5%–17%) and 9% (3%–15%) for men and women, respectively. CONCLUSIONS This simple family history screening questionnaire shows good performance for identifying primary care patients at increased disease risk because of their family history. It could be used in primary care as part of a systematic approach to tailored disease prevention.
Cardiovascular Risk and Statin Use in the United States

PURPOSE Statins reduce the risk of mortality and coronary artery disease in individuals at high cardiovascular risk. Using nationally representative data, we examined the relationships between statin use and cardiovascular risk, diagnosis of hyperlipidemia, and other risk factors. METHODS We analyzed data from the 2010 Medical Expenditure Panel Survey, a nationally representative survey of the US civilian noninstitutionalized population. The study sample had a total of 16,712 individuals aged 30 to 79 years. Those who reported filling at least 2 statin prescriptions were classified as statin users. We created multiple logistic regression models for statin use as the dependent variable, with cardiovascular risk factors and sociodemographic factors as independent variables. RESULTS Overall, 58.2% (95% CI, 54.6%–61.7%) of individuals with coronary artery disease and 52.0% (95% CI, 49.4%–54.6%) of individuals with diabetes aged older than 40 years were statin users. After adjusting for cardiovascular risk factors and sociodemographic factors, the probability of being on a statin was significantly higher among individuals with both hyperlipidemia and coronary artery disease, at 0.44 (95% CI, 0.40–0.48), or hyperlipidemia only, at 0.32 (95% CI, 0.30–0.33), than among those with coronary artery disease only, at 0.11 (95% CI, 0.07–0.15). A similar pattern was seen in people with diabetes. CONCLUSIONS In this nationally representative sample, many people at high risk for cardiovascular events, including those with coronary artery disease, diabetes, or both, were not receiving statins despite evidence that these agents reduce adverse events. This undertreatment appears to be related to placing too much emphasis on hyperlipidemia and not enough on cardiovascular risk. Recently released guidelines from the American College of Cardiology and the American Heart Association offer an opportunity to improve statin use by focusing on cardiovascular risk instead of lipid levels.
Frequency and Prioritization of Patient Health Risks from a Structured Health Risk Assessment

PURPOSE To describe the frequency and patient-reported readiness to change, desire to discuss, and perceived importance of 13 health risk factors in a diverse range of primary care practices. METHODS Patients (n = 1,707) in 9 primary care practices in the My Own Health Report (MOHR) trial reported general, behavioral, and psychosocial risk factors (body mass index [BMI], health status, diet, physical activity, sleep, drug use, stress, anxiety or worry, and depression). We classified responses as “at risk” or “healthy” for each factor, and patients indicated their readiness to change and/or desire to discuss identified risk factors with providers. Patients also selected 1 of the factors they were ready to change as most important. We then calculated frequencies within and across these factors and examined variation by patient characteristics and across practices. RESULTS On average, patients had 5.8 (SD = 2.12; range, 0–13) unhealthy behaviors and mental health risk factors. About 55% of patients had more than 6 risk factors. On average, patients wanted to change 1.2 and discuss 0.7 risks. The most common risks were inadequate fruit/vegetable consumption (84.5%) and overweight/obesity (79.6%). Patients were most ready to change BMI (33.3%) and depression (30.7%), and most wanted to discuss depression (41.9%) and anxiety or worry (35.2%). Overall, patients rated health status as most important. CONCLUSIONS Implementing routine comprehensive health risk assessments in primary care will likely identify a high number of behavioral and psychosocial health risks. By soliciting patient priorities, providers and patients can better manage counseling and behavior change.
On Vibration Sensation and Finger Touch in Stringed Instrument Playing

The vibration levels in four traditional stringed instruments during playing have been investigated, including the double bass, violin, guitar, and the piano. The vibration levels, which were measured at several positions and at different dynamic levels, were evaluated with respect to reported thresholds for detection of vibrotactile stimuli. The results show that the vibration levels are well above threshold for almost all positions on the instruments in normal playing. It is concluded that the perceived vibrations may be of some assistance with regard to intonation in ensemble playing, in particular for the bass instruments. The finger forces exerted when playing the bowed strings, as well as the touch forces in piano playing were studied briefly. It was concluded that the kinesthetic forces perceived in playing may assist the timing in performance.
Psychiatric Rehabilitation Services in Turkey

The first rehabilitation therapy in Turkey was performed in Bakirkoy State Mental Hospital in the late 1930s by Mazhar Osman, the chief of the psychiatry hospital. He achieved the first steps of occupational therapy. In the 1960s, increased attention was paid to occupational therapies, and the long-term inpatients were provided with courses and sheltered workshops. A day hospital, community mental health clinics, sheltered workshops, supervised work placement, and half-way homes were integrated into the treatment. In the 1990s, delays in rehabilitation occurred, and the day hospital was closed. Since then, medication has dominated treatment. Rehabilitation programs are not well coordinated, and the patient accessibility is limited. In late 2005, a day hospital was reestablishment at Bakirkoy State Training and Research Hospital for Psychiatry, Neurology and Neurosurgery to carry out a psychosocial rehabilitation program and psychosocial rehabilitation for outpatients, acute inpatients, chronic inpatients, and their relatives. Future plans include social skill training groups, family training groups, case management, and improvement of occupational and vocational therapies. Other rehabilitation services are also reemerging: Kocaeli University Hospital has a day hospital, and the State Hospital of Manisa for Psychiatry recently added a rehabilitation. In addition, half-way houses are being built for patients receiving treatment at the State Hospital of Elazig. There is an increasing interest in rehabilitation in Turkey requiring new models and attempts at improvement.