Miracle-dz/UniFAR-FTUs huggingface dataset:
Risk Factors for Surgical Site Infection After Posterior Lumbar Spinal Surgery

Study Design. A retrospective study. Objective. The purpose of this study was to identify the independent risk factors for postoperative surgical site infection (SSI) after posterior lumbar spinal surgery based on the perioperative factors analysis. Summary of Background Data. SSI is one of the most common complications after spinal surgery. Previous studies have identified different risk factors for postoperative SSI after lumbar spinal surgery. However, most of the studies were focused on the patient and procedure-related factors. Few studies reported the correlation between laboratory tests and postoperative SSI. Methods. A retrospective study was carried out in a single institution. Patients who underwent posterior lumbar spinal surgery between January 2010 and August 2016 were included in this study. All patients’ medical records were reviewed and patients with postoperative SSI were identified. Perioperative variables were included to determine the risk factors for SSI by univariate and multivariate regression analysis. Results. A total of 2715 patients undergoing posterior lumbar spinal surgery were included in this study. Of these patients, 64 (2.4%) were detected with postoperative SSI, including 46 men and 18 women. Diabetes mellitus (P = 0.026), low preoperative serum level of calcium (P = 0.009), low preoperative and postoperative albumin (P = 0.025 and 0.035), high preoperative serum glucose (P = 0.029), multiple fusion segments (P < 0.001), increased surgical time and estimated blood loss (P = 0.023 and 0.005), decreased postoperative hemoglobin (P = 0.008), and prolonged drainage duration (P = 0.016) were found to be the independent risk factors for SSI. Multilevel fusion and a history of diabetes mellitus were the two strongest risk factors (odds ratio = 2.329 and 2.227) for SSI. Conclusion. Based on a large population analysis, previous reported risk factors for SSI were confirmed in this study while some new independent risk factors were identified significantly associated with SSI following lumbar spinal surgery, including preoperative low serum level of calcium, decreased preoperative and postoperative albumin, and decreased postoperative hemoglobin. Level of Evidence: 4
The educational and financial impact of using patient educators to teach introductory physical exam skills

Purpose: Physical exam skills are essential to core competencies for physicians in training. It is increasingly difficult to secure time and funding for physician faculty to teach these critical skills. This study was designed to determine whether Patient Educators (PE) (non-physician instructors) in an introductory clinical medicine (ICM) course (1) were as effective as physician faculty in teaching the physical exam, (2) impacted consistency of student performance on a final practical exam, and (3) whether this model was cost effective. Method: PE were introduced into an ICM course at the University of Minnesota from 2006 to 2008. Each year, students’ physical exam competencies were evaluated by a performance-based head-to-toe examination and 6 months later by an objective structured clinical examination (OSCE). Differences in test scores between years and variability (i.e., consistency) among yearly scores were assessed. The cost per student was calculated by considering a stable compensation cost per hour for the required number of physician faculty, standardized patients, and PE in each year. Results: Mean student performance was statistically lower with PE, but only by two percentage points. The amount of variation within the medical student classes’ physical exam skills remained stable as the use of PE expanded. Total educator salary costs per student declined from $449 in 2006 to $196 in 2008. Conclusions: In terms of sustainability and student performance, the use of trained lay educators has equivalent outcomes and is less costly for physical exam instruction in the pre-clinical years.
Analyzing the relationship between institutional framework and financial inclusion in rural Uganda

Purpose The purpose of this paper is to report the findings on the mediating effect of social network in the relationship between institutional framework and financial inclusion in rural Uganda. Design/methodology/approach The study employs a cross-sectional research design to collect data used to test for mediation under this study. Structural equation model (SEM) through use of bootstrap in the Analysis of Moment Structures (AMOS) was adopted to establish the existence and type of mediation by social network in the relationship between institutional framework and financial inclusion. Findings Social network had a partial mediating effect in the relationship between institutional framework and financial inclusion. In addition, institutional framework through its regulative, normative and cultural-cognitive pillars also exhibited a significant direct effect on financial inclusion. Besides, social network had a positive and significant effect on financial inclusion. This suggest that there exist both a direct effect of institutional framework on financial inclusion and an indirect effect of institutional framework through social network on financial inclusion. Research limitations/implications While the sample for this study was big enough, it limited itself to only poor households in rural Uganda. Besides, the current study adopted cross-sectional design, thus, leaving out longitudinal design to investigate the characteristics in the sample over time. Practical implications The study makes significant empirical contribution and implications to financial inclusion policy makers on evidence of the critical role played by social network in indirectly enhancing the relationship between institutional framework and financial inclusion of the poor who are vulnerable to exclusion by main stream financial services’ providers. Originality/value The study recommends that social network, which acts as a conduit through which useful information flow and can be shared, plays a critical role in mediating the relationship between institutional framework and financial inclusion in rural Uganda. Therefore, the study contributes to existing body of literature by highlighting the mediating influence of social network in the relationship between institutional framework and financial inclusion, especially in rural Uganda.
Preoperative Lateral Popliteal Nerve Block for Intraoperative and Postoperative Pain Control in Elective Foot and Ankle Surgery: A Prospective Analysis

Background: Limiting postoperative pain and minimizing systemic narcotic complications are important considerations in foot and ankle surgery to maximize patient comfort and promote early discharge from the hospital. Nerve blocks are valuable additions to perioperative care. A variety of nerve blocks have been advocated, but few reports have evaluated a preoperative supine approach for popliteal block in foot and ankle surgery. Methods: We prospectively evaluated the effectiveness of a preoperative popliteal block in 25 consecutive patients undergoing a variety of foot and ankle procedures, as well as the length of block coverage, patient satisfaction, and any complications. Patients were monitored clinically and by a questionnaire at various time increments: preoperatively, in the post-anesthesia care unit (PACU), postoperative day one, and postoperative week one. Results: Postoperatively, 15 of 25 patients had a complete block (motor and sensory), five of 25 patients demonstrated motor function, but denied sensation or pain, and the remaining five of 25 had sensation to light touch but no motor function or pain. None of the patients reported pain postoperatively in the PACU within an hour after surgery. The average time the block lasted was 14 hours. Overall satisfaction with the block on postoperative day one and week one was 4.8 out of 5. There were no intraneural injections, neurologic sequelae, or complications. Conclusions: We suggest that a preoperative nerve block for a sedated patient in the operating room saves time, avoids patient discomfort, augments general anesthesia, provides good postoperative pain control, and has high patient satisfaction with no significant complications
Distinguishing Benign From Malignant Intraductal Papillary Mucinous Tumors of the Pancreas by Imaging Techniques

Objectives: It is often difficult to differentiate benign from malignant intraductal papillary mucinous tumors (IPMTs). This study aimed to differentiate them using various imaging techniques. Methods: Receiver operating characteristic curves were used to establish optimal cutoff values to differentiate benign from malignant tumors in 121 patients with histologically confirmed IPMTs. Results: For branch duct type, accuracy for malignancy was highest using endoscopic ultrasonography (EUS) to measure the cyst diameter, and accuracy was 68.2% at a cutoff value of 33.9 mm. For main duct type, accuracy was highest, 71.1% at a cutoff value of 8.4 mm for main duct diameter, with magnetic resonance cholangiopancreatography. For all imaging techniques and findings, accuracy was highest using EUS, 76.4% at a cutoff value of 5.4 mm for height of protrusion. Each imaging technique had a positive predictive value of 80% if the cut off value for the height of the protruding lesion was met. Conclusions: Malignancy can be strongly suspected when the height of protrusion exceeds the respective cutoff values. EUS was most effective to differentiate benign IPMTs from malignant tumors by assessing the height of protrusion.
Insulin Glargine and Cancer Risk: An Opinion Statement of the Endocrine and Metabolism Practice and Research Network of the American College of Clinical Pharmacy

Diabetes mellitus has reached epidemic proportions worldwide, eliciting extensive research on both the disease process and its treatment. Regardless of diabetes type, the progressive nature of the disease makes insulin the long‐term mainstay of diabetes management. Recently, the insulin analog glargine was reported in several epidemiologic studies to be associated with an increased risk of cancer. Inconsistent study results and media attention have caused much angst and concern to health care professionals and the general population. A clear understanding of the current evidence is needed to adequately develop a patient‐oriented risk:benefit assessment. Members of the Endocrine and Metabolism Practice and Research Network of the American College of Clinical Pharmacy evaluated available evidence to provide guidance and discussion on the risk of cancer with insulin glargine use. We believe the current link between insulin glargine and cancer is tenuous but merits further evaluation. An independent analysis of all available glargine clinical trial data should be performed, and a vigorous postmarketing safety study of glargine should be conducted. Until more substantial data are available, however, neither the choice of initial insulin therapy nor insulin maintenance regimens should be influenced by the current information linking insulin glargine to cancer.
Elevated levels and functional capacity of soluble CD40 ligand in systemic lupus erythematosus sera.

OBJECTIVE To measure soluble CD40 ligand (sCD40L) in sera from patients with systemic lupus erythematosus (SLE) and to study the functional capacity of sCD40L in mediating B cell activation. METHODS A 2-site enzyme-linked immunosorbent assay (ELISA) was used to measure sCD40L in the sera of 66 SLE patients, 30 disease control patients, and 23 healthy subjects. Induction of B cell activation antigen expression was used to assess the functional capacity of sCD40L in SLE sera. RESULTS The mean concentration of sCD40L was statistically significantly higher (P < 0.0001) in SLE patients than in disease controls or healthy subjects, and segregation of SLE patients by severe, moderate, or mild extent of disease showed a relationship between disease severity and sCD40L concentration. Western blot analysis demonstrated the presence of the 18-kd band of sCD40L in SLE sera, and the results of a 1-site ELISA protocol suggested that some of the product in SLE sera was present in dimer or trimer form. Functional studies showed that 10 ng/ml of recombinant CD40L, a level present in some SLE sera, induced increased expression of CD95 on B cells. Several SLE sera also induced CD95 or CD86 on Ramos B cells, a result that was inhibited by anti-CD40L monoclonal antibodies. CONCLUSION The soluble form of CD40L is present in the sera of most patients with SLE and may have the capacity to mediate B cell activation. Aberrant expression of CD40L might be predicted to result in activation of bystander B cells, including those that have encountered self antigens, and to contribute to autoantibody secretion.
Enhanced inflammatory cell profiles in schistosomiasis-induced pulmonary vascular remodeling

Schistosomiasis (bilharzia) is a neglected parasitic disease caused by trematode flatworms of the genus Schistosoma which affects over 240 million people worldwide. It is characterized by the formation of inflammatory granulomas around deposited parasite eggs. Recent studies have revealed that immune and inflammatory responses play a crucial role in pathogenesis of schistosomiasis. The aim of this paper is to systematically evaluate the number and distribution of inflammatory cells in S. mansoni-infected mice at different doses and time points. Immunohistochemistry was performed on lung and liver tissue sections from Schistosoma-infected mice and uninfected healthy controls. Positively stained cells in whole-lung/liver tissue sections, surrounding the eggs, and in the different compartments of the tissues, were counted. We found a significant increase in the number of mast cells (toluidine blue+), CD3+ cells, CD14+ cells, CD68+ cells, and CD15+ cells in Schistosoma-infected tissues compared with untreated healthy controls (P ≤ 0.05 for all). Our findings revealed altered and enhanced immune cell infiltration in schistosomiasis. We suggest that these cells may contribute to the pathophysiology of Schistosoma resulting in pulmonary vascular remodeling.
Serum interleukin (IL)‐1, IL‐2, sIL‐2Ra, IL‐6 and thrombopoietin levels in patients with chronic myeloproliferative diseases

A number of growth factors are involved in clonal haematopoietic expansion and their clinical significance in patients with chronic myeloproliferative diseases requires further evaluation. Using enzyme‐linked immunosorbent assays, we analysed serum levels of interleukin (IL)‐1a, IL‐1b, IL‐2, IL‐6, the soluble IL‐2 receptor alpha (sIL‐2Ra), and thrombopoietin (TPO), in 25 individuals with myelofibrosis with myeloid metaplasia (MMM), 40 with essential thrombocythaemia (ET), eight with polycythaemia vera (PV), 10 patients with chronic myeloid leukaemia (CML) and 27 normal controls. These were correlated with clinicopathological characteristics including overall survival, and histopathological bone marrow features, including angiogenesis. The serum derived from patients with MMM, ET, PV and CML contained significantly higher IL‐2 and sIL‐2Ra than healthy subjects, while IL‐6 levels were higher only in MMM and CML than controls. IL‐2, sIL‐2Ra and IL‐6 levels were raised during the transformation phase of CML, during progression of MMM to AML, and ET and PV to myelofibrosis (P < 0·001). There was a positive correlation between IL‐2, sIL‐2Ra, IL‐6 and angiogenesis in bone marrow samples. Cytokines may be useful markers for predicting clinical evolution, reflecting increased angiogenesis. This requires further evaluation to guide diagnostic and therapeutic options.
Atopic wheezing and early life antibiotic exposure: a nested case–control study

Several factors including early‐life antibiotic usage have been implicated in the rising prevalence of allergic sensitization and asthma. A nested case–control study comparing antibiotic exposure of 37 sensitized children with recurrent wheeze (age 3–5 yr) and 37 non‐sensitized children who had never wheezed was carried out within a population‐based birth cohort (matching for age, sex, parental atopy, allergen exposure, and pet ownership). We collected data on antibiotic prescriptions during first 3 yr of life (timing, type, indication) from the primary care medical records. Significantly, more cases than controls received one or more antibiotic courses during the first year of life (92% vs. 70%, p = 0.04). The median time to first antibiotic course was shorter for the cases than the controls (6 vs. 8 months, p = 0.03). The total number of antibiotic receipts was greater amongst cases in each of the first 3 yr of life, but this reached significance only when the whole three‐year period was considered (249 vs. 182 courses, p = 0.05). The increased ratio of antibiotic receipt in cases over controls was highest in the first year of life (1.32, 95% CI 0.99–1.78). Significantly more cases than controls were prescribed antibiotics for lower respiratory tract infection during the first 3 yr (p = 0.007), but not during the first year of life (p = 0.52). Antibiotics use by class was similar in the two groups. Our data support the hypothesis that early life exposure to broad‐spectrum antibiotics may have a causative role in sensitisation and the expression of wheeze.
Pain catastrophizing in youths with physical disabilities and chronic pain.

OBJECTIVE The current study examined the associations between catastrophizing and pain intensity, psychological adjustment, functional ability, and community participation in youths with physical disability and chronic pain. METHODS Participants consisted of 80 youths, aged 8-20 years, with cerebral palsy (n = 34), neuromuscular disease (n = 22), or spina bifida (n = 24). Measures from a cross-sectional survey included demographic, pain, and disability information, the Pain Catastrophizing Scale, the Child Health Questionnaire, and the Functional Disability Inventory. RESULTS Results suggested that catastrophizing was significantly associated with pain intensity and psychological adjustment; however, catastrophizing did not demonstrate significant associations with functional ability or community participation. CONCLUSIONS The study extends previous findings of significant associations between catastrophizing and both pain intensity and psychological adjustment to samples of youths with chronic pain and disabilities not previously examined. Further research that examines the causal association between catastrophizing and outcomes in youths with chronic pain and physical disability is warranted.
Factors Affecting International Reserves with Special Reference to India

World international reserves holdings have accelerated sharply in recent times. Countries particularly developing ones are competitive enough to hoard these reserves and top 10 major holders are mostly from Asia. Interestingly India comes only ninth among them. Developing countries, particularly India, are in line to hoard foreign reserves and there are certain factors that affect international reserves holdings. This study analysed the impact of few macroeconomic factors on these reserves. Augmented Dickey Fuller (ADF) and Phillips-Perron (PP) tests were employed to check the stationarity of the variables on the time series data that were of annual frequency. It was found that all variables were co-integrated signalling long-run relationship. Error correction mechanism (ECM) was implemented to get short-run dynamics for which a negative relation was established for trade openness (TRDOP) which contradicts previous studies. The negative relationship of TRDOP with international reserves in India could be due to the outcome of sustained trade deficits of Indian balance of payments. The economic growth variable exhibits a positive relationship which is consistent with previous studies. All variables were found significant at a 5 per cent level. The ECM suggested the same results as its long-run counterpart.
Ultrastructural examination of diffuse and specific tectopulvinar projections in the tree shrew

Two pathways from the superior colliculus (SC) to the tree shrew pulvinar nucleus have been described, one in which the axons terminate in dense (or specific) patches and one in which the axon arbors are more diffusely organized (Luppino et al. [1988] J. Comp. Neurol. 273:67–86). As predicted by Lyon et al. ([2003] J. Comp. Neurol. 467:593–606), we found that anterograde labeling of the diffuse tectopulvinar pathway terminated in the acetylcholinesterase (AChE)‐rich dorsal pulvinar (Pd), whereas the specific pathway terminated in the AChE‐poor central pulvinar (Pc). Injections of retrograde tracers in Pd labeled non‐γ‐aminobutyric acid (GABA)‐ergic wide‐field vertical cells located in the lower stratum griseum superficiale and stratum opticum of the medial SC, whereas injections in Pc labeled similar cells in more lateral regions. At the ultrastructural level, we found that tectopulvinar terminals in both Pd and Pc contact primarily non‐GABAergic dendrites. When present, however, synaptic contacts on GABAergic profiles were observed more frequently in Pc (31% of all contacts) compared with Pd (16%). Terminals stained for the type 2 vesicular glutamate transporter, a potential marker of tectopulvinar terminals, also contacted more GABAergic profiles in Pc (19%) compared with Pd (4%). These results provide strong evidence for the division of the tree shrew pulvinar into two distinct tectorecipient zones. The potential functions of these pathways are discussed. J. Comp. Neurol. 510:24–46, 2008. © 2008 Wiley‐Liss, Inc.
Examining the impact of experiential value on emotions, self-connective attachment, and brand loyalty in Korean family restaurants

ABSTRACT This study examines how experiential value as perceived by customers of Korean family restaurants influences consumption emotions, self-connective attachment to the restaurant brand, and, ultimately, brand loyalty. Having conducted a comprehensive literature review, the study proposes and estimates a model that specifies the interrelationships among four dimensions of experiential value (i.e., atmosphere, escapism, customer return on investment, and service excellence), and latent variables of positive and negative emotions, self-connective attachment, and brand loyalty. Analysis with structural equation modeling was conducted with data collected from customers of family restaurants in South Korea. The results show that dimensions of experiential value influence either positive or negative emotions. The emotion variables, together with self-connective attachment, also mediate the relationships between perceived value of dining experience and brand loyalty.
Students' Attitudes Toward E-learning in Kuwait's Higher Education Institutions

In developed countries, the delivery of many courses in higher education sectors has changed. New technology has been used inside and outside the classroom to enhance student learning. In Kuwait e-learning is used in the private higher education sector but has not officially been used in the public higher education sector. Strategies for using e-learning in the public sector are needed. This paper presents an overview of students' attitudes towards e-learning in Kuwaiti Higher Education. The investigation was conducted at the College of Business Studies (CBS), a government sector, at which e-learning had not been previously used, and at the Gulf University for Science and Technology (GUST) representing the private sector. A study was carried out to examine students' attitude toward e-learning, and data was collected using a questionnaire which was applied for students in both sectors. The study results indicated that the students in both sectors were keen to use e-learning and there are some significant differences between male and female students in their attitudes to and use of e-learning materials. The results of this study will benefit higher education institutions in Kuwait and other Muslim countries in the region in determining how to use ICT for appropriate e-learning in teaching Information Technology and other subjects in a culturally acceptable way.