Miracle-dz/UniFAR-FTUs huggingface dataset:
Thirty-day stroke mortality and associated clinical and laboratory factors among adult stroke patients admitted at Mulago hospital (Uganda)

Background Although stroke mortality in developing countries is more than 85%, the case fatality in Uganda is not known. Objective We determined 30 day case fatality, associated clinical and laboratory presentations among adult stroke patients admitted to Mulago Hospital. Design Prospective descriptive study Setting Mulago national referral hospital, Kampala, Uganda Participants Stroke patients presenting from July 2010 to January 2011. Intervention Patients presenting to the accident and emergency with stroke confirmed on brain computerised tomography (CT) scan were recruited consecutively and subsequently transferred to the neurology unit. Selected social demographics, clinical and laboratory presentations were obtained. Supportive care, specific treatment and rehabilitation services were offered to the participants. Main Outcome Measures Case fatality rate at 30 days Results Out of 150 eligible participants, 17 declined, 133 were enrolled into the study but 5 were lost to follow up. Data from 128 participants were analysed. The mean age was 62.3+15.7 years and 58.0% were females. Ischemic and haemorrhagic stroke contributed 79% and 21% respectively. Majority of participants 97 (76%) had only motor deficits and 78 (61%) had impaired consciousness. More than half of participants had high blood pressure at admission, with diastolic and systolic hypertension among 106 (83%) and 68 (53%) respectively. Forty eight (38%) participants had hyperglycemia, 42 (33%) leucocytosis, 13% elevated low density lipoprotein and 9% high triglycerides. No participant with ischemic stroke presented in time for thrombolysis. The 30 day case fatality was 43.8% and factors independently associated with it were Glasgow coma scale (GCS) < 9 p = 0.001and age 51-60 years P=0.044. Conclusion Thirty-day case fatality was high. Poor prognostic factors were GCS of <9 and age 51-60 years. Early presentation to hospital, intensive management, implementation of treatment guidelines and measures to prevent stroke should be emphasised. Key words : Mortality, Stroke, Uganda.
Information and professional support: key factors in the provision of family-centred early childhood intervention services.

BACKGROUND Much has been written on the principles of family-centred practice and on the service delivery methods and skills required of its practitioners. Far less has been written from the perspective of families whose children have a disability. The aims of this study were twofold: firstly to understand families' experiences of family-centred early childhood intervention services and secondly to explore other factors that might impact on these experiences. METHODS One hundred and thirty families attending two established early childhood intervention services in New South Wales, Australia completed a survey incorporating the Measure of Processes of Care-56, the Family Empowerment Scale, the Family Support Scale and the Parenting Daily Hassles Scale. RESULTS Consistent with previous research using the Measure of Processes of Care-56, 'respectful and supportive care' was the domain of care families rated to occur most and 'provision of general information' was the domain they rated to occur least. Significant positive relationships existed between families' ratings of family-centred care and feelings of empowerment. Being provided with general information was strongly correlated with family empowerment. Families' social support networks played an important role but support from professionals was most strongly correlated with families' experiences of family-centred care. Finally, families whose children's early intervention services were co-ordinated by a professional experienced significantly better care. CONCLUSIONS The provision of general information and professional support are key components of family-centred early childhood intervention services.
Profiles of family needs of children and youth with cerebral palsy.

BACKGROUND To identify profiles of family needs of families of children and youth with cerebral palsy (CP), and determine whether profile membership is related to child, family and service characteristics. METHODS Participants were mostly mothers (80%) of 579 children and youth with CP. A family member completed modified version of the Family Needs Survey and questionnaires about their child, family and services. Research assistants determined the Gross Motor Function Classification System levels. K-means cluster analysis identified profiles of needs. Cluster membership was analysed to examine differences in clusters based on selected characteristics. RESULTS Four profiles of needs were identified: Low needs, Needs related to community and financial resources, Needs related to child health condition and High needs. Profile membership was differentiated based on child/youth gross motor function, adaptive behaviour, family relationships, family income, access and effort to co-ordinate services. CONCLUSION Despite heterogeneity among individuals with CP and their families, four profiles of family needs were identified. In total, 51% of families had low needs suggesting that they are effectively managing their children's health conditions while 11% of families had high needs that may require high levels of services and supports. Service providers are encouraged to partner with families, provide anticipatory guidance and co-ordinate services.
Climate-driven diversity loss in a grassland community

Significance Whereas a dominant conservation paradigm proposes that species are being lost from ecological communities with a consequent loss of ecosystem function, recent analyses have concluded there is no globally consistent trend toward lower community diversity. In a study of Californian grassland communities, we show that 15 years of climatic drying—consistent with the forecasts for this and other semiarid regions under climate change—have led to directional losses of plant species richness, especially of native annual forb (“wildflower”) species with traits indicative of low drought tolerance. Although many anthropogenic impacts may increase or not affect community diversity, our result underlines that declining plant community diversity may be especially likely in climates that are becoming more arid and less productive. Local ecological communities represent the scale at which species coexist and share resources, and at which diversity has been experimentally shown to underlie stability, productivity, invasion resistance, and other desirable community properties. Globally, community diversity shows a mixture of increases and decreases over recent decades, and these changes have relatively seldom been linked to climatic trends. In a heterogeneous California grassland, we documented declining plant diversity from 2000 to 2014 at both the local community (5 m2) and landscape (27 km2) scales, across multiple functional groups and soil environments. Communities became particularly poorer in native annual forbs, which are present as small seedlings in midwinter; within native annual forbs, community composition changed toward lower representation of species with a trait indicating drought intolerance (high specific leaf area). Time series models linked diversity decline to the significant decrease in midwinter precipitation. Livestock grazing history, fire, succession, N deposition, and increases in exotic species could be ruled out as contributing causes. This finding is among the first demonstrations to our knowledge of climate-driven directional loss of species diversity in ecological communities in a natural (nonexperimental) setting. Such diversity losses, which may also foreshadow larger-scale extinctions, may be especially likely in semiarid regions that are undergoing climatic trends toward higher aridity and lower productivity.
Husband's Circular Migration and the Status of Women left behind in Lamerd District, Iran

Iranian women often serve as temporary heads of household as husbands work elsewhere, returning home at intervals for several months. Results of this preliminary study in Lamerd District in Fars Province, with a high incidence of such patterns, show that, overall, wives of migrants are not ‘left-behind women’ as reported in other countries when husbands migrate. Rather, wives of migrating husbands report a higher level of satisfaction with economic resources and no greater physical or mental health problems relative to those in non-migrant relationships. Counter to expectations, autonomy reported by migrants' wives does not differ from that reported by wives of non-migrant men. Data suggest that work-migrant males, in particular urban migrants, may be more exposed to sexually transmitted diseases. Our findings are limited, being based on data on experiences of women in one district in Iran. There is need for more comprehensive studies based on representative samples.
Obesity and kidney transplantation

Purpose of review Obesity has reached epidemic proportions in the United States. It is a risk factor for developing, among others, heart disease, stroke, type 2 diabetes, and chronic kidney disease (CKD), and thus a major public health concern and driver of healthcare costs. Although the prevalence of obesity in the CKD/end-stage kidney disease population is increasing, many obese patients are excluded from the benefit of kidney transplant based on their BMI alone. For this reason, we sought to review the experience thus far with kidney transplantation in obese patients and associated outcomes. Recent findings Obesity is associated with a lower rate of referral and waitlisting, and lower likelihood of kidney transplantation. Despite increased risk for early surgical complications and delayed graft function, experience from multiple centers demonstrate a clear survival benefit of transplantation over dialysis in most obese patients, and comparable graft and patient survival rates to nonobese recipients. Summary Data suggest that long-term transplant outcomes among obese recipients are similar to those among nonobese. Strategies to achieve pretransplant weight reduction and minimally invasive surgical techniques may further improve results of kidney transplantation in obese recipients.
Miniaturized mitogenome of the parasitic plant Viscum scurruloideum is extremely divergent and dynamic and has lost all nad genes

Significance The mitochondrial genomes of flowering plants are characterized by an extreme and often perplexing diversity in size, organization, and mutation rate, but their primary genetic function, in respiration, is extremely well conserved. Here we present the mitochondrial genome of an aerobic parasitic plant, the mistletoe Viscum scurruloideum. This genome is miniaturized, shows clear signs of rapid and degenerative evolution, and lacks all genes for complex I of the respiratory electron-transfer chain. To our knowledge, this is the first report of the loss of this key respiratory complex in any multicellular eukaryote. The Viscum mitochondrial genome has taken a unique overall tack in evolution that, to some extent, likely reflects the progression of a specialized parasitic lifestyle. Despite the enormous diversity among parasitic angiosperms in form and structure, life-history strategies, and plastid genomes, little is known about the diversity of their mitogenomes. We report the sequence of the wonderfully bizarre mitogenome of the hemiparasitic aerial mistletoe Viscum scurruloideum. This genome is only 66 kb in size, making it the smallest known angiosperm mitogenome by a factor of more than three and the smallest land plant mitogenome. Accompanying this size reduction is exceptional reduction of gene content. Much of this reduction arises from the unexpected loss of respiratory complex I (NADH dehydrogenase), universally present in all 300+ other angiosperms examined, where it is encoded by nine mitochondrial and many nuclear nad genes. Loss of complex I in a multicellular organism is unprecedented. We explore the potential relationship between this loss in Viscum and its parasitic lifestyle. Despite its small size, the Viscum mitogenome is unusually rich in recombinationally active repeats, possessing unparalleled levels of predicted sublimons resulting from recombination across short repeats. Many mitochondrial gene products exhibit extraordinary levels of divergence in Viscum, indicative of highly relaxed if not positive selection. In addition, all Viscum mitochondrial protein genes have experienced a dramatic acceleration in synonymous substitution rates, consistent with the hypothesis of genomic streamlining in response to a high mutation rate but completely opposite to the pattern seen for the high-rate but enormous mitogenomes of Silene. In sum, the Viscum mitogenome possesses a unique constellation of extremely unusual features, a subset of which may be related to its parasitic lifestyle.
Continuous evolutionary change in Plio-Pleistocene mammals of eastern Africa

Significance Many have argued that major developments in mammalian (including human) evolution were timed with large and sudden changes to Earth’s climate. Our new analyses of the eastern African Plio-Pleistocene mammalian fossil record indicate that most species originations and extinctions took place continuously and gradually. This means that evolution was not clustered in short intervals, nor were sudden global climatic changes the main cause of species extinction in the past. Global climate may have influenced longer-term (million year) evolutionary trends, but local environmental changes and species interactions were more important at shorter (100,000 y) time scales. Much debate has revolved around the question of whether the mode of evolutionary and ecological turnover in the fossil record of African mammals was continuous or pulsed, and the degree to which faunal turnover tracked changes in global climate. Here, we assembled and analyzed large specimen databases of the fossil record of eastern African Bovidae (antelopes) and Turkana Basin large mammals. Our results indicate that speciation and extinction proceeded continuously throughout the Pliocene and Pleistocene, as did increases in the relative abundance of arid-adapted bovids, and in bovid body mass. Species durations were similar among clades with different ecological attributes. Occupancy patterns were unimodal, with long and nearly symmetrical origination and extinction phases. A single origination pulse may be present at 2.0–1.75 Ma, but besides this, there is no evidence that evolutionary or ecological changes in the eastern African record tracked rapid, 100,000-y-scale changes in global climate. Rather, eastern African large mammal evolution tracked global or regional climatic trends at long (million year) time scales, while local, basin-scale changes (e.g., tectonic or hydrographic) and biotic interactions ruled at shorter timescales.
Accuracy in Identifying the Source of Subarachnoid Hemorrhage in the Setting of Multiple Intracranial Aneurysms

BACKGROUND Subarachnoid hemorrhage cases with multiple cerebral aneurysms frequently demonstrate a hemorrhage pattern that does not definitively delineate the source aneurysm. In these cases, rupture site is ascertained from angiographic features of the aneurysm such as size, morphology, and location. OBJECTIVE To examine the frequency with which such features lead to misidentification of the ruptured aneurysm. METHODS : Records of patients who underwent surgical clipping of a ruptured aneurysm at our institution between 2004 and 2014 and had multiple aneurysms were retrospectively reviewed. A blinded neuroendovascular surgeon provided the rupture source based on the initial head computed tomography scans and digital subtraction angiography images. Operative reports were then assessed to confirm or refute the imaging-based determination of the rupture source. RESULTS One hundred fifty-one patients had multiple aneurysms. Seventy-one patients had definitive hemorrhage patterns on initial computed tomography scans and 80 patients had nondefinitive hemorrhage patterns. Thirteen (16.2%) of the cases with nondefinitive hemorrhage patterns had discordance between the imaging-based determination of the rupture source and intraoperative findings of the true ruptured aneurysm, yielding an imperfect positive predictive value of 83.8%. Of all multiple aneurysm cases with subarachnoid hemorrhage treated by surgical or endovascular means at our institution, 4.3% (13 of 303) were misidentified. CONCLUSION Morphological features cannot reliably be used to determine rupture site in cases with nondefinitive subarachnoid hemorrhage patterns. Microsurgical clipping, confirming obliteration of the ruptured lesion, may be preferentially indicated in these patients unless, alternatively, all lesions can be contemporaneously and safely treated with endovascular embolization.
Comparison of Cemented and Non-cemented Allografts in Dogs with Osteosarcoma

Summary This study compares the radiographic and histological appearance of cemented and non-cemented massive cortical allografts in dogs that underwent a limb sparing procedure for osteosarcoma of the distal radius. Treatment consisted of removal of the affected bone and pancarpal arthrodesis using non-cemented (n = 13) or cemented (n = 47) fresh-frozen allografts. Allografts were evaluated using a radiographic and histological scoring system and compared statistically between groups. Allografts with better healing received a higher radiographic score and a lower histological score. The mean radiographic scores, for proximal union and distal union, were significantly greater in the non-cemented group at most evaluation periods. Complications after the operation included screw, plate, allograft and host bone failure, infection and local tumour recurrence. Screw failure in the allograft and allograft failure were significantly more common in the non-cemented group. Histological examination was performed on 44 dogs and cement increased the mean combined histological scores, and mean healing scores of the distal host-graft interface significantly. The use of cemented allografts significantly decreases complications associated with implant loosening or allograft failure but may slightly delay allograft healing. At this point, the clinical relevance of the delay in healing is questionable and the benefits of intramedullary PMMA would appear to outweigh this relative delay in healing. This study evaluated 60 radial allografts after limb sparing procedures using a standardized radiological and histological scoring system. The use of cemented allografts significantly decreased complications associated with implant loosening or allograft failure but may slightly delay allograft healing.
The development needs of nurse prescribers

Aim To determine the continuing professional development (CPD) needs of nurse prescribers. Method This exploratory study was undertaken in one NHS trust. It was conducted in two phases using qualitative and quantitative methods. Semi-structured interviews were conducted with 12 nurse prescribers in the first phase. Analysis of these interviews informed the development of a questionnaire that was sent to 350 nurse prescribers in phase two of the study. Results The questionnaire generated a 69 per cent response rate (n=241). The majority of respondents said they found prescribing a useful and essential part of their core practice. There were frustrations concerning the limited formulary, and there was a high level of awareness of effectiveness. The most significant training need identified was in pharmacological knowledge. The most useful systems that supported practice were said to be peer groups. GPs were seen as very helpful, but in some cases as creating a barrier to nurse prescribing. Conclusion Nurse prescribers need ongoing support from their employing organisation at all levels. Isolated working environments are not conducive to developing practice. Educational needs and information systems need to be more robust to support developing practice.
Subset of early radial glial progenitors that contribute to the development of callosal neurons is absent from avian brain

Significance Understanding development and evolution of the neocortex has important implications. We describe here a major difference between avian and mammalian dorsal pallial progenitors regarding their fate restrictions. In mouse cortex we identified an early population of radial glial cells that are delayed in the generation of neurons. After self-renewal and transit-amplifying mitoses, these murine progenitors become committed to the genesis of upper-layer callosal pyramidal neurons and glia. In the chick embryonic pallium we identified a homologous population of progenitors; however, these have no delayed neurogenesis and their lineage is therefore not segregated from that of the other pallial progenitors. We hypothesize on the relation between the early neurogenic delay of progenitors and the origin of the corpus callosum. The classical view of mammalian cortical development suggests that pyramidal neurons are generated in a temporal sequence, with all radial glial cells (RGCs) contributing to both lower and upper neocortical layers. A recent opposing proposal suggests there is a subgroup of fate-restricted RGCs in the early neocortex, which generates only upper-layer neurons. Little is known about the existence of fate restriction of homologous progenitors in other vertebrate species. We investigated the lineage of selected Emx2+ [vertebrate homeobox gene related to Drosophila empty spiracles (ems)] RGCs in mouse neocortex and chick forebrain and found evidence for both sequential and fate-restricted programs only in mouse, indicating that these complementary populations coexist in the developing mammalian but not avian brain. Among a large population of sequentially programmed RGCs in the mouse brain, a subset of self-renewing progenitors lack neurogenic potential during the earliest phase of corticogenesis. After a considerable delay, these progenitors generate callosal upper-layer neurons and glia. On the other hand, we found no homologous delayed population in any sectors of the chick forebrain. This finding suggests that neurogenic delay of selected RGCs may be unique to mammals and possibly associated with the evolution of the corpus callosum.