Miracle-dz/UniFAR-FTUs huggingface dataset:
Influence of Hospital Wastewater Discharged from University of Benin Teaching Hospital ( UBTH ) , Benin City on its Receiving Environment

The bacteriological and physiochemical qualities of hospital wastewater discharged into the environment from University of Benin Teaching Hospital (UBTH), Benin City was investigated to assess the influence of the hospital wastewater in the receiving environment. The bacteriological parameters were carried out using the standard microbiological techniques. The bacteriological parameters examined were total heterotrophic bacterial counts, which had values ranging from 1.9x10 to 8.3x10 cfu/ml. The total coliform 7 12 counts ranged from 1.2x10 to 1.6x10 MPN/100ml. The isolated and characterized isolates included eight (8) 3 3 bacterial genera. The bacterial isolates were Klebsiella, Pseudomonas, Escherichia, Serratia, Staphylococcus, Streptococcus, Proteus and Bacillus. The bacterial genera, Klebsiella, Pseudomonas and Serratia were the most frequently distributed isolates in the hospital wastewater. Physiochemical parameters studied revealed that the hospital wastewaters though show some parameters whose values are higher than the WHO to percent levels. Other falls within the WHO acceptable limits. There is therefore, contamination of the receiving environment (water, soil and air) due to the discharged hospital wastewater, which could probably be hazardous to human health.
Zero-voltage-switching buck converter with low-voltage stress using coupled inductor

This study presents a new zero-voltage-switching (ZVS) buck converter. The proposed converter utilises a coupled inductor to implement the output filter inductor as well as the auxiliary inductor which is commonly employed to realise ZVS for switches. Additional magnetic core for the auxiliary inductor in traditional ZVS converters is eliminated and hence reduced cost is achieved. Moreover, thanks to the series connection between the input and output, the switch voltage stress in the steady state is reduced and thus the ZVS operation can be easier achieved. Then the leakage inductor current circulating in the auxiliary switch is decreased, contributing to reduced conduction losses. In particular, low-voltage rating devices with low on-state resistance can be adopted to further improve efficiency in applications with non-zero output voltage all the time, such as the battery charger. Furthermore, the reverse-recovery problem of the diode is significantly alleviated by the leakage inductor of coupled inductor. In the study, operation principle and steady-state analysis of the proposed converter are presented in detail. Meanwhile, design considerations are given to obtain circuit parameters. Finally, simulations and experiments on a 200 W prototype circuit validate the advantages and effectiveness of the proposed converter.
A low-complexity near-optimal algorithm for blind estimation of pseudo-noise sequences in DSSS communication systems

A novel algorithm is proposed for blind estimation of the spreading sequence in direct-sequence spread-spectrum (DSSS) communication systems. This algorithm is based on the maximum likelihood decision rule. Due to high computational complexity, the maximum likelihood method is feasible only for spreading sequence with very short periods. The novel algorithm has two steps for estimation. At first, a prior estimation of the spreading sequence is obtained via a simple algorithm which has a very low computational complexity. In the second step, using the prior estimation and the maximum likelihood decision rule, the estimation accuracy increases greatly. The proposed algorithm can reach the performance of the eigen value decomposition (EVD) method with low computational complexity.
Clinicians' perspectives on patient satisfaction in adult congenital heart disease clinics--a dimension of health care quality whose time has come.

OBJECTIVES Patient-centered care and patient satisfaction represent key dimensions of health care quality. This is relevant for the growing number of patients with life-long conditions. In the present study, our goal was to examine clinicians' attitudes and behavior with respect to patient satisfaction in adult congenital heart disease outpatient clinics. METHODS A 34-question survey was developed to assess adult congenital heart disease clinicians' awareness, attitudes, and behavior relative to patient satisfaction and administered in-person or online to clinicians from the largely U.S.-based Adult Congenital Heart Association's database of adult congenital heart disease health care providers. RESULTS Overall, 267 questionnaires were filled out: 108 were collected in person (79% response rate) and 159 online (17.5% response rate). Responses were received from physicians (161); nurses (73); physician assistants (20); and others (13). Although 85% of clinicians believed it was important to inquire about patient satisfaction, only 28% reported routinely inquiring about this dimension of care. Only 34% claimed they had adequate training to cope with varying levels of patient satisfaction, 44% stated that their department utilized patient satisfaction surveys, and 37% received feedback from the hospital management in the preceding 12 months. In multivariate analyses, clinicians that received feedback from the hospital management and had adequate training were more likely to inquire about patient satisfaction. CONCLUSION Although patient satisfaction is perceived as an important dimension of quality care by adult congenital heart disease clinicians, most of them reported insufficient institutional support to achieve this. Our findings suggest that clinicians would benefit from health care organizations engaging them in the delivery of this dimension of health care quality.
Natural history and predictors of outcome for non‐cardiac chest pain: a prospective 4‐year cohort study

Abstract The natural history of non‐cardiac chest pain (NCCP) is poorly understood. We aimed to assess the 2‐ and 4‐year outcomes of patients with chest pain, and determine whether baseline characteristics could predict outcomes (mortality, continued chest pain and quality of life). This was a prospective cohort study in a tertiary teaching hospital (Nepean Hospital), Sydney, Australia. All subjects who presented with acute chest pain to the emergency department were recruited at baseline (n = 197). Mortality data were obtained from death certificates on the entire cohort at 4 years; 129 (65%) patients responded to a 2 year follow‐up and 92 (47%) to a 4‐year follow‐up questionnaire. At baseline, there were 126 (60%) NCCP patients and 71 cardiac patients. Chest pain continued to be reported in the majority of individuals (>65%) at follow‐up. Over the 2‐year period, NCCP disappeared among 10% (n = 9/88), but remained present in the remaining 90% (n = 79). In comparison, 69% (n = 28/41) of the cardiac chest pain (CCP) patients continued to have chest pain at the 2‐year follow‐up (NCCP vs CCP: P < 0.001). At the 4‐year follow‐up, 71% (n = 45/64) and 81% (23/27) continued to have NCCP and CCP respectively. The mortality rate among the entire cohort over the 4‐year study was 9% (17/197). The cardiac mortality rate for patients initially diagnosed with CCP was 11% (8/71); compared with 5.5% (7/126) (P = 0.16) among patients initially diagnosed with NCCP who subsequently died from a cardiac cause. Outcomes in terms of mortality did not significantly differ between cardiac and NCCP patients. Both groups experienced continued chest pain during the follow‐up period. Non‐cardiac chest pain does not always confer an excellent long‐term prognosis.
Magnetic Resonance Imaging Findings of Inverted Papilloma: Differential Diagnosis with Malignant Sinonasal Tumors

Background Computed tomography and magnetic resonance imaging (MRI) are the techniques of choice for pretreatment staging in neoplasms of the sinonasal tract. In inverted papilloma (IP), the information provided by computed tomography regarding characterization of the lesion is rather nonspecific. The present retrospective study was performed in the attempt to identify distinguishing features of IP on MRI. Methods MRI examinations of 23 patients affected by IP (16 primary and 7 recurrent) and 23 patients affected by malignant tumors (MT; 12 adenocarcinomas, 9 squamous cell carcinomas, and 2 neuroendocrine carcinomas) of the sinonasal tract were evaluated. IP arose from the lateral nasal wall in 17 cases, the maxillary sinus in 5 cases, and the nasal septum in 1 case. The signal intensity of IP and MT was compared with muscles on spin-echo (SE) T2 and SE T1 images; contrast enhancement was compared with nasal septum mucosa. Possible specific MRI patterns in the two groups of patients were investigated. Bone involvement was graduated as remodeling or erosion (focal, ≤15 mm; intermediate, >15 mm and ≤30 mm; extended, >30 mm). The size of the lesions was assessed by measuring the greatest diameter on MRI. Parametric statistics in the form of Student's t-test or chi-squared test was used for data comparison. Results IP showed a columnar pattern in all 23 cases by enhanced SE T1 images and in 16 of 23 lesions (>20 mm in diameter) by SE T2. This pattern was observed in only 1 of the 23 MTs; pathological examination of that specimen showed multiple foci of IP associated with squamous cell carcinoma. Bone remodeling was observed in 19 of 23 IPs, which in four patients was associated with focal (two cases) or intermediate (two cases) erosion. In MT, remodeling was present, which was always combined with focal (2 cases) or extended (21 cases) erosion. A strong correlation was found between the pattern of bone changes and histology (p = 0.00001). Bone alterations did not correlate with the size of the IP. The mean size of the IPs was significantly less than that of MT (33.9 ± 15.7 mm versus 59 ± 16 mm; p = 0.0003). Conclusion A columnar pattern is a reliable MRI indicator of IP and reflects its histological architecture (positive predictive value of 95.8%). The combination of this finding with the absence of extended bone erosion allows for the confident discrimination of IPs from MTs. (American Journal of Rhinology 18, 305–310, 2004)
Systematic Comparative Protein Expression Profiling of Clear Cell Renal Cell Carcinoma

Proteome-based technologies represent powerful tools for the analysis of protein expression profiles, including the identification of potential cancer candidate biomarkers. Thus, here we provide a comprehensive protein expression map for clear cell renal cell carcinoma established by systematic comparative two-dimensional gel electrophoresis-based protein expression profiling of 16 paired tissue systems comprising clear cell renal cell carcinoma lesions and corresponding tumor-adjacent renal epithelium using overlapping narrow pH gradients. This approach led to the mapping of 348 distinct spots corresponding to 248 different protein identities. By implementing restriction criteria concerning their detection frequency and overall regulation mode, 28 up- and 56 down-regulated single target spots were considered as potential candidate biomarkers. Based on their gene ontology information, these differentially expressed proteins were classified into distinct functional groups and according to their cellular distribution. Moreover, three representative members of this group, namely calbindin, gelsolin, and heart fatty acid-binding protein, were selected, and their expression pattern was analyzed by immunohistochemistry using tissue microarrays. Thus, this pilot study provides a significant update of the current renal cell carcinoma map and defines a number of differentially expressed proteins, but both their potential as candidate biomarkers and clinical relevance has to be further explored in tissues and for body fluids like serum and urine.
Clinical Role of Human Leukocyte Antigen in Health and Disease

Most of the genes in the major histocompatibility complex (MHC) region express high polymorphism that is fundamental for their function. The most important function of human leukocyte antigen (HLA) molecule is in the induction, regulation of immune responses and the selection of the T cell repertoire. A clinician's attention is normally drawn to a system only when it malfunctions. The HLA system is no exception in this regard, but in contrast to other systems, it also arouses interest when it functions well – too well, in fact. Population studies carried out over the last several decades have identified a long list of human diseases that are significantly more common among individuals that carry particular HLA alleles including inflammatory, autoimmune and malignant disorders. HLA‐disease association is the name of this phenomenon, and the mechanism underlying is still a subject of hot debate. Social behaviours are affected by HLA genes and preference for HLA disparate mates may provide ‘good genes’ for an individual's offspring. Also, certain HLA genes may be associated with shorter life and others with longer lifespan, but the effects depend both on the genetic background and on the environmental conditions. The following is a general overview of the important functional aspects of HLA in health and diseases.
Clostridium difficile toxins and enterococcal translocation in vivo and in vitro.

BACKGROUND Clostridium difficile toxins alter permeability in cultured enterocytes and may alter intestinal epithelial permeability to bacteria in vivo. Experiments were designed to test the effects of C. difficile toxins on in vitro interactions of Enterococcus gallinarum with cultured enterocytes, as well as on translocation of E. gallinarum in mice. MATERIALS AND METHODS Mature Caco-2 and HT-29 enterocytes were pretreated with C. difficile toxin A or toxin B followed by incubation with E. gallinarum. E. gallinarum-enterocyte interactions were assessed by quantitative culture. For in vivo experiments, antibiotic-treated mice were orally inoculated with C. difficile or saline, and all mice were orally inoculated 24 h later with E. gallinarum and sacrificed after another 24 h for analysis of cecal bacteria, cecal C. difficile toxin, and enterococcal translocation. Cecal C. difficile toxin was assayed as cytopathic effects on human foreskin fibroblasts. RESULTS Although neither toxin had a noticeable effect on bacterial internalization by cultured enterocytes, C. difficile toxins were associated with increased E. gallinarum transmigration across confluent enterocyte cultures. Mice orally inoculated with saline rather than C. difficile (n = 29) had no detectable cecal toxin, while mice orally inoculated with C. difficile (n = 30) had detectable cecal toxin. Viable E. gallinarum was recovered from the mesenteric lymph nodes of 97% of mice orally inoculated with saline followed by oral E. gallinarum, but only 37% of mice orally inoculated with C. difficile followed by oral E. gallinarum (P < 0.01). CONCLUSIONS These results suggested that observations with cultured enterocytes, demonstrating that C. difficile toxins facilitated bacterial migration across the intestinal epithelium, might have little in vivo relevance in a mouse model of antibiotic-induced C. difficile overgrowth.
Symptomatic, Familial, Perinatal, and Social Correlates of Computerized Axial Tomography (CAT) Changes in Schizophrenics and Bipolars

Computerized axial tomography (CAT) scans were blindly examined, and lateral ventricular-to-brain ratios calculated in 19 schizophrenic and 27 bipolar patients, and in an equal number of individually matched normal controls. Family history, early development, past psychiatric history, and current functioning and symptomatology were analyzed for all patients. Lateral ventricular enlargement on CAT was found in a significant proportion of both patient groups. Patients with such enlargement tended to have greater numbers of negative symptoms and poorer premorbid adjustment, but did not differ regarding family history of psychiatric illness. A subgroup of schizophrenics with presumed early brain damage was identified. This group had more marked ventricular enlargement, a greater number of negative symptoms, and an earlier onset of illness.
High rate of Charcot foot attacks early after simultaneous pancreas-kidney transplantation.

Background: Simultaneous pancreas-kidney transplantation is performed in type 1 diabetic patients with long standing diabetes and end stage renal disease. Morbidity and mortality rates early after transplantation are high, with lower limb amputations being an important event. However, no data are available on the exact rate of Charcot foot presentation after simultaneous pancreas-kidney transplantation. The aim of the present study was to examine the prevalence of Charcot foot in the population of simultaneous pancreas-kidney transplanted patients at our institution Methods: We retrospectively examined the medical files and radiographic documents of 66 consecutive patients transplanted in our institution. Demographic and historical data collected included gender, date of diagnosis of DM and nephropathy, mean HbA1c and mean C-peptide, retinopathy and data on renal replacement therapy. Data on immunosuppressive therapy and transplant outcome were also collected. Results: None of the patients was found to have Charcot foot before transplantation. 8 patients (12%) developed a Charcot foot afterwards (mean 1.8 ± 1.9 years post-transplantation) and four of them developed bilateral involvement in time (6%). No new Charcot foot attacks in the previously affected foot were recorded. Considering the pre-transplant demographic characteristics, all 66 patients were at high risk to develop Charcot foot. Comparing patients who developed Charcot foot to those who did not, a significant difference was only found for pre-transplant glycemic control (mean HbA1c 9.2 ± 1.0 vs. 8.0 ± 1.4, p = 0.01). In patients developing Charcot foot, acute rejection, graft failure and mortality show a trend to be more frequent (HR = 3.57, p = 0.164, HR = 4.56, p = 0.165 and HR = 2.46, p = 0.236, respectively). Conclusions: Charcot foot proves to be a frequent complication early after simultaneous pancreas-kidney transplantation. Considering the important morbidity and mortality of this complication, awareness of all healthcare providers treating transplanted patients is mandatory to detect a presentation early after onset. Prompt referral to a multidisciplinary diabetic foot clinic for further diagnosis and specialised treatment must always be considered.
Risks of oral anticoagulant therapy with increasing age.

BACKGROUND Oral anticoagulation in the elderly is a dilemma. Although many elderly patients have strict indications for treatment with coumarin derivatives, the tendency toward an increased bleeding risk with age is a matter of concern. We investigated the risk of hemorrhage and thromboembolism according to age in patients who were treated with oral anticoagulants in the routine setting of an anticoagulation clinic. METHODS All patients of the Leiden Anticoagulation Clinic (Leiden, the Netherlands) who were treated because of mechanical heart valve prostheses (target, international normalized ratio [INR] of 3.5), atrial fibrillation (target, INR of 3.0), or after a myocardial infarction (target, INR of 3.0) between 1994 and 1998 were included in the study and grouped by age at the start of follow-up. We calculated incidence rates of major hemorrhage and thromboembolism per age group. RESULTS We included 4202 patients: 842 patients younger than 60 years; 1200 patients aged between 60 and 70 years; 1464 patients aged between 71 and 80 years; and 696 patients older than 80 years. The incidence rate of major hemorrhage rose gradually with age from 1.5 per 100 patient-years for patients younger than 60 years to 4.2 per 100 patient-years for patients older than 80 years, yielding a hazard ratio of 2.7 (95% confidence interval, 1.7-4.4). The incidence rate of major thromboembolism rose from 1.0 per 100 patient-years for patients younger than 60 years to 2.4 per 100 patient-years for patients older than 80 years (hazard ratio, 2.2; 95% confidence interval, 1.2-4.2). CONCLUSIONS The incidence of both bleeding and thromboembolic events increases sharply with advanced age. Because higher thromboembolic risk with age often makes it unfeasible to withhold oral anticoagulation from elderly patients, future studies should focus on ways to lower the bleeding risk.
Powder Compaction Properties of Sodium Starch Glycolate Disintegrants

ABSTRACT The compaction behavior of three “as supplied” commercially available grades of sodium starch glycolate (SSG), Explotab, Primojel, and Vivastar P, was investigated at compression speeds of 0.17 and 30 mm/sec. The results suggested that the three “as supplied” materials exhibit different compression and compaction behavior. Primojel and Explotab exhibited similar compactibility, whereas Vivastar P produced compacts of poor integrity. This behavior was not mirrored in the compressibility of the powders, where Vivastar P and Explotab exhibited similar performance. The materials were studied using x-ray diffraction, scanning electron microscopy, Carr's compressibility index, and swelling volume. In terms of material characteristics, all the products exhibited similar swelling in water. Primojel and Explotab retained most of the crystallographic order from the parent potato starch and exhibited comparable particle surface topographies. Vivastar P contained the lowest moisture level. However, it is not clear if the poor compactibility of Vivastar P is due to differences in moisture content, the reduced surface topography, or subtle differences in the SSG polymer structures (substitution, cross-linking, and crystallinity). Overall, even though the three commercial grades of sodium starch glycolate are successfully used as disintegrants, they do exhibit differences in their “as supplied” powder mechanical properties: Primojel and Explotab exhibit similar compactibility, whereas Vivastar P is poorly compactable but exhibits similar compressibility to Explotab. These observations may have implications when formulating poorly compactable or moisture-sensitive drugs.
Age-class differences in shoot photosynthesis and water relations of Fraser fir (Abies fraseri), southern Appalachian Mountains, USA.

Fraser fir (Abies fraseri (Pursh) Poir. ) is an endemic tree species found only in refugial mountain-top forests in the southern Appalachian Mountains, USA. Very few studies have investigated the ecophysiology of this species in its nat- ural environment. We measured and compared photosynthetic gas exchange and water relations of understory germinant seedlings ( 3 years old and ~0.15-1 m tall), and saplings (>10 years old and ~1-2 m tall) on a leaf-level basis. No significant differences in gas exchange were found among the age classes, although midday xy- lem water potentials were significantly different among the age classes. Differences in maximum photosynthesis (Amax) were 3 ans et ~0,15-1 m de haut) et des jeunes tiges (SA, >10 ans et ~1-2 m de haut) dans le sous-bois. Aucune difference significative dans les echanges gazeux n'a eteobservee entre les differentes classes d'age malgreles differences significatives entre les differentes classes d'age dans le cas du potentiel hydrique du xyleme a midi. Les differences dans la photosynthese maximum (Amax )etaient inferieures a 13% et variaient de 2,4 a 2,7 mmolm -2 s -1 (P = 0,26). La conductance foliaire maximum (gmax) variait de 0,16 a` 0,18 molm -2 s -1 , soit une variation de moins de 13% (P = 0,15). Le potentiel hydrique du xyleme a midi des SE et des SA etait semblable (-1,2 a` -1,4 MPa) mais les valeurs des GS etaient significativement moins negatives (-0,2 a` -0,5 MPa). Par consequent, les echanges gazeux et les relations hydriques dans ces classes d'age en sous-bois semblent similaires indiquant qu'il n'y a aucune contrainte particuliere chez la regeneration preetablie quelle que soit la classe d'age. (Traduit par la Redaction)