Miracle-dz/UniFAR-FTUs huggingface dataset:
Providers' perspectives on inbound medical tourism in Central America and the Caribbean: factors driving and inhibiting sector development and their health equity implications.

Background Many governments and health care providers worldwide are enthusiastic to develop medical tourism as a service export. Despite the popularity of this policy uptake, there is relatively little known about the specific local factors prospectively motivating and informing development of this sector. Objective To identify common social, economic, and health system factors shaping the development of medical tourism in three Central American and Caribbean countries and their health equity implications. Design In-depth, semi-structured interviews were conducted in Mexico, Guatemala, and Barbados with 150 health system stakeholders. Participants were recruited from private and public sectors working in various fields: trade and economic development, health services delivery, training and administration, and civil society. Transcribed interviews were coded using qualitative data management software, and thematic analysis was used to identify cross-cutting issues regarding the drivers and inhibitors of medical tourism development. Results Four common drivers of medical tourism development were identified: 1) unused capacity in existing private hospitals, 2) international portability of health insurance, vis-a-vis international hospital accreditation, 3) internationally trained physicians as both marketable assets and industry entrepreneurs, and 4) promotion of medical tourism by public export development corporations. Three common inhibitors for the development of the sector were also identified: 1) the high expense of market entry, 2) poor sector-wide planning, and 3) structural socio-economic issues such as insecurity or relatively high business costs and financial risks. Conclusion There are shared factors shaping the development of medical tourism in Central America and the Caribbean that help explain why it is being pursued by many hospitals and governments in the region. Development of the sector is primarily being driven by public investment promotion agencies and the private health sector seeking economic benefits with limited consideration and planning for the health equity concerns medical tourism raises.
GLOBAL SEEK OPTIMIZATION IN REAL-TIME DATABASE TRANSACTIONS: A NEW APPROACH

Real time database transactions must satisfy database consistency as well as timing constraints. Timing constraints are defined in terms of deadline. Numbers of algorithms are proposed to schedule real time database transactions in order to increase the overall performance of the disk. In this paper, we have proposed a new approach based on Two-way scan algorithm which gives better result than Two-way scan. In our new approach, Shortest Seek Time (SST) groups are formed like Two-way scan and then priority is assign to each transaction. Transaction having lowest priority value is served first. Consecutive groups are served one after the other. Transactions are served only if they are feasible.
LEVEL BASED NORMAL- ABNORMAL CLASSIFICATION OF MRI BRAIN IMAGES

This work proposes a new concept for the normal- abnormal classification of MRI brain images, a level based approach, and compare the result with the existing methods. The existing works does not consider the anatomical structure of the brain slices for the classification of MRI brain images. In the aspect of image processing, the anatomically similarity of the brain slices can be treated as the similarity of brain slices in the viewing aspect along with the actual anatomical structure. This work aimed to prove that the consideration of the anatomical structure for the normal– abnormal classification will improve the result of the classification. The existing work shows that the feature vector, statistical features along with gray level co-occurrence matrix (GLCM) features with support vector machine (SVM) classifier produce better results than other methods. It uses statistical features along with GLCM features as feature vector and SVM classifier. Related works in current literatures for the normal/abnormal classification of MRI images does not consider the anatomical structure of the brain slices. Because of the dissimilarity in the anatomical structure, it may produce undesirable results. In this proposed work, the anatomical structure of the brain slices is considered for the classification. To accompany this level based concept is introduced here. In the level based concept, the brain slices are classified into four levels depending on the similarity in the anatomical structure to implement the normal/abnormal classification at that particular level.
Analysis of limited-priority scheduling rules in discrete-time queues

This chapter introduces a new priority mechanism in discret e-time queueing systems that compromises between first-come-first -se ved (FCFS) and head-of-line (HoL) priority. In this scheduling disciplin e – which we dubbed slotbound priority – customers of different priority classes en teri g the system during the same time-slot are served in order of their respective pr iority class. Customers entering during different slots are served on a FCFS basis. I n this chapter we study the delay in anN-class discrete-time queueing system under slot-bound pri ority. General independent arrivals and class-specific general se rvice-time distributions are assumed. Expressions for the probability generating fu ction of the delay of a random typej customer are derived, from which the respective moments are easily obtained. The tail behaviour of these distributions is analysed as well, and 2-2 DELAY IN A MULTICLASS SLOT-BOUND PRIORITY SYSTEM some numerical examples show the effect slot-bound priorit y can have on the performance measures.
Bachelor studies for nurses organised in rural contexts - a tool for improving the health care services in circumpolar region?

OBJECTIVES This article is based on a pilot study of Finnmark University College's off-campus bachelor programme (BA) for nurses, organised in rural areas. The objectives were to explore whether these courses had contributed to reduced vacancies; whether the learning outcome of the off-campus courses was the same as the on-campus programme, and how the education had influenced the nurses' professional practice in local health services. STUDY DESIGN In the study we used mixed strategies in data collection and analyses. METHODS Data about course completion, average age, average grades and retention effect were collected in 2009/2010 from 3 off-campus classes and their contemporary on-campus classes. Then 7 of the off-campus nurses were interviewed. A content analytical approach to the data was employed. RESULTS With retention of 93%, the off-campus BA course for nurses has been one of the most effective measures, particularly in rural areas. The employers' support for further education after graduating seems to be an important factor for the high retention rate. Teaching methods such as learning activities in small local groups influenced the nurses' professional development. Local training grants, supervision and a local learning environment were important for where they chose their first job after graduation. CONCLUSIONS The study confirms that nurses educated through off-campus courses remain in the county over time after graduating. The "home-grown" nurses are familiar with the local culture and specific needs of the population in this remote area. The study confirms findings in other studies, that further education is an important factor for nurses' retention.
Performance Variability in Mixed-Integer Programming

The performance of mixed-integer programming solvers is subject to some unexpected variability that appears, for example, when changing from one computing platform to another, when permuting rows and/or columns of a model, when adding seemingly neutral changes to the solution process, etc. This phenomenon has been observed for decades, but only recently has it started to be methodologically analyzed with the two possible aims of either reducing or exploiting it, ideally both. In this tutorial we discuss the roots of performance variability, we provide useful tips to recognize it, and we point out some severe misinterpretations that might be generated by not performing/analyzing benchmark results carefully. Finally, we report on the most recent attempts to gain from variability.
Systemic aspects of conjugal resilience in couples with a child facing cancer and marrow transplantation

Introduction The negative impact of paediatric cancer on parents is well known and is even greater when intensive treatments are used. This study aimed to describe how couples whose child has received a transplant for the treatment of leukaemia view conjugal resilience and to evaluate the role of we-ness as a precursor of conjugal adjustment. Methods Four parental couples were interviewed. Interviews were analysed in two ways: inductive thematic analysis and rating of verbal content with the We-ness Coding Scale. Results Participants report that conjugal resilience involves the identification of the couple as a team and cohesion in the couple. Being a team generates certain collaborative interactions that lead to conjugal resilience. A sense of we-ness in parents is associated with fluctuation in the frequency of themes. Discussion Participants’ vision of conjugal resilience introduced novel themes. The sense of we-ness facilitates cohesion and the process of conjugal resilience.
Self-respect through ability to keep fear of frailty at a distance: Successful ageing from the perspective of community-dwelling older people.

With population ageing, there is an increased interest in how to promote a good old age. A predominant concept in these discussions is successful ageing, which is mainly based on researchers' definitions. This article aims to explore successful ageing from the perspective of community-dwelling older people (24 persons aged 77-90 years). Individual open interviews were conducted and analysed according to qualitative content analysis. An overarching theme was formulated as "self-respect through ability to keep fear of frailty at a distance". This embraced the content of four categories: "having sufficient bodily resources for security and opportunities", "structures that promote security and opportunities", "feeling valuable in relation to the outside world", and "choosing gratitude instead of worries". Ageing seems to be a dynamic process rather than a static structure and might therefore be susceptible to actions. Paying attention to attitudes and treating the older person with respect, particularly with regard to worries about increasing vulnerability, can lead to better ways of promoting successful ageing.
[Corrigendum] Estrogen receptor β inhibits estradiol-induced proliferation and migration of MCF-7 cells through regulation of mitofusin 2.

Following the publication of this article, an interested reader drew to our attention an anomaly associated with Fig. 2, which presented the results of a wound‑healing assay performed to determine whether estradiol (E2) was able to exert an influence on MCF‑7 cell migration. Specifically, in comparing the 'Control' and the '10‑8/mol/l' panels, the data for the 'Control' panel had erroneously been included as the '10‑8/mol/l' panel, albeit the latter panel appeared in a slightly reorientated position and was stretched longitudinally. After having re‑examined our original data, we realize that the inclusion of the identical data for the '10‑8/mol/l' panel was incorrect. Subsequently, we have re-captured the images, and a corrected version of Fig. 2 is presented here. The Figure now correctly demonstrates that E2 enhanced cell motility in a dose‑dependent manner in the concentration range of E2 from 10-9 mol/l to 10-6 mol/l. This error did not overall affect the conclusions reported in the study. We sincerely apologize for this mistake, and thank the reader of our article who drew this matter to our attention. Furthermore, we regret any inconvenience this mistake has caused. [the original article was published in the International Journal of Oncology 42: 1993‑2000, 2013; DOI: 10.3892/ijo.2013. 1903].
Autophagy in Dendritic Cells and B Cells Is Critical for the Inflammatory State of TLR7-Mediated Autoimmunity

Individuals suffering from autoimmune disorders possess a hyperactive cellular phenotype where tolerance to self-antigens is lost. Autophagy has been implicated in both the induction and prevention of autoimmunity, and modulators of this cellular recycling process hold high potential for the treatment of autoimmune diseases. In this study, we determine the effects of a loss of autophagy in dendritic cells (DCs), as well as both B cells and DCs, in a TLR7-mediated model of autoimmunity, similar to systemic lupus erythematosus, where both cell types are critical for disease. Although a loss of DC autophagy slowed disease, the combined loss of autophagy in both cell types resulted in a lethal sepsis-like environment, which included tissue inflammation and hyperproduction of inflammasome-associated cytokines. Ablation of B cell signaling reversed this phenotype, indicating that activation of these cells is an essential step in disease induction. Thus, autophagy plays a dichotomous role in this model of disease.
Delivery should happen soon and my pain will be reduced: understanding women's perception of good delivery care in India.

Background Understanding a woman's perspective and her needs during childbirth and addressing them as part of quality-improvement programmes can make delivery care safe, affordable, and respectful. It has been pointed out that the patient's judgement on the quality and goodness of care is indispensible to improving the management of healthcare systems. Objective The objective of the study is to understand the aspects of care that women consider important during childbirth. Design Individual in-depth interviews (IDIs) and focus-group discussions (FGDs) with women who recently delivered were the techniques used. Seventeen IDIs and four FGDs were conducted in Jharkhand state in east India between January and March 2012. Women who had normal deliveries with live births at home and in primary health centres were included. To minimise recall bias, interviews were conducted within 42 days of childbirth. Using the transcripts of interviews, the data were analysed thematically. Results Aspects of care most commonly cited by women to be important were: availability of health providers and appropriate medical care (primarily drugs) in case of complications; emotional support; privacy; clean place after delivery; availability of transport to reach the institution; monetary incentives that exceed expenses; and prompt care. Other factors included kind interpersonal behaviour, cognitive support, faith in the provider's competence, and overall cleanliness of the facility and delivery room. Conclusions Respondents belonging to low socio-economic strata with basic literacy levels might not understand appropriate clinical aspects of care, but they want care that is affordable and accessible, along with privacy and emotional support during delivery. The study highlighted that healthcare quality-improvement programmes in India need to include non-clinical aspects of care as women want to be treated humanely during delivery - they desire respectful treatment, privacy, and emotional support. Further research into maternal satisfaction could be made more policy relevant by assessing the relative strength of various factors in influencing maternal satisfaction; this could help in prioritising appropriate interventions for improved quality of care (QoC).
Impact of scanning parameters and breathing patterns on image quality and accuracy of tumor motion reconstruction in 4D CBCT: a phantom study

Four‐dimensional, cone‐beam CT (4D CBCT) substantially reduces respiration‐induced motion blurring artifacts in three‐dimension (3D) CBCT. However, the image quality of 4D CBCT is significantly degraded which may affect its accuracy in localizing a mobile tumor for high‐precision, image‐guided radiation therapy (IGRT). The purpose of this study was to investigate the impact of scanning parameters (hereinafter collectively referred to as scanning sequence) and breathing patterns on the image quality and the accuracy of computed tumor trajectory for a commercial 4D CBCT system, in preparation for its clinical implementation. We simulated a series of periodic and aperiodic sinusoidal breathing patterns with a respiratory motion phantom. The aperiodic pattern was created by varying the period or amplitude of individual sinusoidal breathing cycles. 4D CBCT scans of the phantom were acquired with a manufacturer‐supplied scanning sequence (4D‐S‐slow) and two in‐house modified scanning sequences (4D‐M‐slow and 4D‐M‐fast). While 4D‐S‐slow used small field of view (FOV), partial rotation (200°), and no imaging filter, 4D‐M‐slow and 4D‐M‐fast used medium FOV, full rotation, and the F1 filter. The scanning speed was doubled in 4D‐M‐fast (100°/min gantry rotation). The image quality of the 4D CBCT scans was evaluated using contrast‐to‐noise ratio (CNR), signal‐to‐noise ratio (SNR), and motion blurring ratio (MBR). The trajectory of the moving target was reconstructed by registering each phase of the 4D CBCT with a reference CT. The root‐mean‐squared‐error (RMSE) analysis was used to quantify its accuracy. Significant decrease in CNR and SNR from 3D CBCT to 4D CBCT was observed. The 4D‐S‐slow and 4D‐M‐fast scans had comparable image quality, while the 4D‐M‐slow scans had better performance due to doubled projections. Both CNR and SNR decreased slightly as the breathing period increased, while no dependence on the amplitude was observed. The difference of both CNR and SNR between periodic and aperiodic breathing patterns was insignificant (p>0.48). At end‐exhale phases, the motion blurring was negligible for both periodic and aperiodic breathing patterns; at mid‐inhale phase, the motion blurring increased as the period, the amplitude or the amount of cycle‐to‐cycle variation on amplitude increased. Overall, the accuracy of localizing the moving target in 4D CBCT was within 2 mm under all studied cases. No difference in the RMSEs was noticed among the three scanning sequences. The 4D‐M‐fast scans, free of volume truncation artifacts, exhibited comparable image quality and accuracy in tumor motion reconstruction as the 4D‐S‐slow scans with reduced imaging dose (0.60 cGy vs. 0.99 cGy) due to the use of faster gantry rotation and the F1 filter, suggesting its suitability for clinical use. PACS number: 87.55. Qr
Quantitative evaluation of patient setup uncertainty of stereotactic radiotherapy with the frameless 6D ExacTrac system using statistical modeling.

The purpose of this study is to evaluate patient setup accuracy and quantify individual and cumulative positioning uncertainties associated with different hardware and software components of the stereotactic radiotherapy (SRS/SRT) with the frameless 6D ExacTrac system. A statistical model is used to evaluate positioning uncertainties of the different components of SRS/SRT treatment with the Brainlab 6D ExacTrac system using the positioning shifts of 35 patients having cranial lesions. All these patients are immobilized with rigid head-and-neck masks, simulated with Brainlab localizer and planned with iPlan treatment planning system. Stereoscopic X-ray images (XC) are acquired and registered to corresponding digitally reconstructed radiographs using bony-anatomy matching to calculate 6D translational and rotational shifts. When the shifts are within tolerance (0.7 mm and 1°), treatment is initiated. Otherwise corrections are applied and additional X-rays (XV) are acquired to verify that patient position is within tolerance. The uncertainties from the mask, localizer, IR -frame, X-ray imaging, MV, and kV isocentricity are quantified individually. Mask uncertainty (translational: lateral, longitudinal, vertical; rotational: pitch, roll, yaw) is the largest and varies with patients in the range (-2.07-3.71mm,-5.82-5.62mm,-5.84-3.61mm;-2.10-2.40∘,-2.23-2.60∘,and-2.7-3.00∘) obtained from mean of XC shifts for each patient. Setup uncertainty in IR positioning (0.88, 2.12, 1.40 mm, and 0.64°, 0.83°, 0.96°) is extracted from standard deviation of XC. Systematic uncertainties of the frame (0.18, 0.25, -1.27mm, -0.32∘, 0.18°, and 0.47°) and localizer (-0.03, -0.01, 0.03 mm, and -0.03∘, 0.00°, -0.01∘) are extracted from means of all XV setups and mean of all XC distributions, respectively. Uncertainties in isocentricity of the MV radiotherapy machine are (0.27, 0.24, 0.34 mm) and kV imager (0.15, -0.4, 0.21 mm). A statistical model is developed to evaluate the individual and cumulative systematic and random positioning uncertainties induced by the different hardware and software components of the 6D ExacTrac system. The uncertainties from the mask, localizer, IR frame, X-ray imaging, couch, MV linac, and kV imager isocentricity are quantified using statistical modeling. PACS number(s): 87.56. B-, 87.59. B.
Ocular brachytherapy dosimetry for 103Pd and 125I in the presence of gold nanoparticles: a Monte Carlo study.

The aim of the present Monte Carlo study is to evaluate the variation of energy deposition in healthy tissues in the human eye which is irradiated by brachytherapy sources in comparison with the resultant dose increase in the gold nanoparticle (GNP)-loaded choroidal melanoma. The effects of these nanoparticles on normal tissues are compared between 103Pd and 125I as two ophthalmic brachytherapy sources. Dose distribution in the tumor and healthy tissues has been taken into account for both brachytherapy sources. Also, in certain points of the eye, the ratio of the absorbed dose by the normal tissue in the presence of GNPs to the absorbed dose by the same point in the absence of GNPs has been calculated. In addition, differences of the absorbed dose in the tumor observed in the comparison of simple water phantom and actual simulated human eye in presence of GNPs are also a matter of interest that have been considered in the present work. The difference between the eye globe and the water phantom is more obvious for 125I than that of the 103Pd when the ophthalmic dosimetry is done in the presence of GNPs. Whenever these nanoparticles are utilized in enhancing the absorbed dose by the tumor, the use of 125I brachytherapy source will greatly amplify the amount of dose enhancement factor (DEF) in the tumor site without inflicting much damage to healthy organs, when compared to the 103Pd source. For instance, in the concentration of 30 mg GNPs, the difference amongst the calculated DEF for 125I between these phantoms is 5.3%, while it is 2.45% for 103Pd. Furthermore, in Monte Carlo studies of eye brachytherapy, more precise definition of the eye phantom instead of a water phantom will become increasingly important when we use 125I as opposed to 103Pd. PACS number(s): 87.53. Jw, 87.85. Rs, 87.10. Rt.