Miracle-dz/UniFAR-FTUs huggingface dataset:
Decision Analysis of Surgical Treatment Indications for Metastatic Epidural Spinal Cord Compression

Metastatic epidural spinal cord compression (MESCC) occurs when tumour invades the epidural space and compresses the spinal cord. Despite Level 1 evidence that surgery is the most effective treatment for MESCC, there is controversy regarding the role of surgery because of fear that patients who have a short survival will spend a large fraction of their remaining life recovering from surgery and potential complications. This controversy could be resolved by decision-analysis of MESCC treatments using quality-adjusted-life-years (QALYs). There have been two barriers to conducting decision-analysis of QALYs for MESCC: (a) lack of utility data, and (b) skepticism regarding decision-analysis. The first four research chapters in this thesis address these barriers. The final research chapter reports a decision-analysis of QALYs on the role of surgery in MESCC. Chapter 1 provides background information on the controversy regarding surgical treatment for MESCC and the rationale for each of the subsequent chapters. Chapter 2 reports a psychometric validation study of a web-based utility valuation module for MESCC. In Chapter 3, application of this module to a general population utility valuation study with a market research panel is described. In Chapter 4, the beneficial properties of Bayesian statistical analysis to minimizing “arbitrariness” in probabilistic sensitivity analysis are described in relation to prognostication for MESCC. Chapter 5 presents a strategy for simplifying and enhancing the transparency of Markov cohort simulation. Finally, the work presented in the research chapters is applied in Chapter 6 to conduct Markov cohort simulation to determine if patients with short survival derive net health-related quality-oflife benefit from surgery. Pragmatic research around barriers to decision-analysis of QALYs for MESCC was conducted to resolve the controversy regarding the role of surgery in the treatment of MESCC. Under most circumstances, MESCC patients who can ambulate prior to treatment derive net HRQoL benefit from surgery, even if prognosis is poor. Non-ambulatory patients can derive net HRQoL benefit but only if the morbidity of surgery is relatively low. It is my hope that the work used to address barriers to decision-analysis of QALYs will be disseminated and applied in other clinical problems.
Enhanced autophagy alleviates injury during hindlimb ischemia/reperfusion in mice

Previous studies examining whether autophagy has a protective or deleterious role during ischemia/reperfusion (I/R) injury have reported a varying role in different organs and remains a matter of debate. The aim of the current study was to explore the role of autophagy in hindlimb I/R injury in a murine model. An increase in apoptosis was observed in vitro, in C2C12 myoblast cells, following hypoxia/reoxygenation (H/R), while downregulation of autophagic flux was induced by chloroquine as compared with the vehicle group under hypoxia and H/R conditions. In vivo, an increase in severe damage of gastrocnemius muscles was observed in the I/R and ischemia groups compared with the control group, was more severe in the I/R group compared with the ischemia group. Electron microscopy revealed an increased number of autophagosomes in the ischemia group, whereas a reduced number was detected in the I/R group. Following administration of rapamycin, the infarct size ratio and cell apoptosis was significantly reduced, while the amount of autophagosomes significantly increased in the ischemic phase. In conclusion, autophagy is upregulated in the ischemia phase and downregulated in the reperfusion phase. Notably, upregulation of autophagy via rapamycin intervention during ischemia alleviated skeletal muscle damage, suggesting a potential protective role during hindlimb I/R injury.
Perception of Cardiovascular Risk and Use of Technologies in Health in Adults with Obesity

En este articulo se determinó la relación entre la Percepción del riesgo de enfermedad cardiovascular con el Nivel de uso de Tecnologías de la Información y Comunicación (TIC´s), así como el efecto explicativo del nivel de uso de las TIC´s y antecedentes para enfermedad cardiovascular en la Percepción del riesgo de enfermedad cardiovascular en adultos con obesidad. Este estudio es pertinente dado que la relación entre las variables propuestas, así como la relación de las TIC´s y otras variables sobre la percepción de riesgo de enfermedad cardiaca y cerebral aún no es del todo clara. Se realizó un estudio descriptivo-analítico realizado en una muestra de 260 adultos con obesidad. Se usaron los cuestionarios Percepción del Riesgo de enfermedad cardiovascular y Uso de TICS en pacientes atendidos en un centro de salud, se respetaron las normas éticas y se utilizó estadística descriptiva e inferencial. Se encontró relación entre la Percepción del riesgo de enfermedad cardiovascular y el uso de las TIC´s (rs =0,142, p=0,022). El Nivel de uso de TICS y antecedentes personales/familiares para el desarrollo de enfermedad cardiovascular fue un 14,3% en la percepción del riesgo de enfermedad cardiovascular. Se concluyó que la percepción del riesgo de enfermedad cardiovascular se relaciona con el Nivel de uso de Tecnologías de la información y comunicación en salud y es explicada en parte por el Nivel de uso de tecnologías de la información y comunicación y antecedentes de salud. Objective: This paper determined the relationship between the perception of risk of a cardiovascular disease with the level of use of Information and Communication Technology or ICT, as well as the explanatory effect of these ICTs and the history of cardiovascular disease in the perception of risk of cardiovascular disease in adults with obesity.Methods: This study is relevant since the relationship between the proposed variables, and the relationship of the ICTs and other variables about the risk perception of heart and brain disease is not very clear yet. An analytical-descriptive research was made on a sample of 260 obese adults. Questionnaires of risk perception of a cardiovascular disease and use of ICT in patients who receive care in a health center were used; ethical standards were observed and descriptive statistics and statistical inference were applied.Results: A relationship between risk perception of a cardiovascular disease and the use of ICTs was found (rs=0,142, p=0,022). The level of use of ICTs and personal/family history of disease for the development of a cardiovascular disease explain a 14,3% in the perception of risk of the disease.Conclusions: It was concluded that the perception of risk of cardiovascular disease was related to the level of use of Information and Communication Technologies regarding health, and it is partially explained by the level of use of the ICTs and health history.
Understanding Comorbidities and Their Contribution to Predictors of Medical Resource Utilization for an Age- and Sex-Matched Patient Population Living With HIV: Cross-Sectional Study

Background More than 60% of people aging with HIV are observed to have multiple comorbidities, which are attributed to a variety of factors (eg, biological and environmental), with sex differences observed. However, understanding these differences and their contribution to medical resource utilization remains challenging as studies conducted exclusively and predominantly among males do not translate well to females, resulting in inconsistent findings across study cohorts and limiting our knowledge of sex-specific comorbidities. Objective The objective of the study was to provide further insight into aging-related comorbidities, their associated sex-based differences, and their contribution to medical resource utilization, through the analysis of HIV patient data matched by sex. Methods International Classification of Disease 9/10 diagnostic codes that comprise the electronic health records of males (N=229) and females (N=229) were categorized by individual characteristics, chronic and mental health conditions, treatment, high-risk behaviors, and infections and the codes were used as predictors of medical resource utilization represented by Charlson comorbidity scores. Results Significant contributors to high Charlson scores in males were age (beta=2.37; 95% CI 1.45-3.29), longer hospital stay (beta=.046; 95% CI 0.009-0.083), malnutrition (beta=2.96; 95% CI 1.72-4.20), kidney failure (beta=2.23; 95% CI 0.934-3.52), chemotherapy (beta=3.58; 95% CI 2.16-5.002), history of tobacco use (beta=1.40; 95% CI 0.200-2.61), and hepatitis C (beta=1.49; 95% CI 0.181-2.79). Significant contributors to high Charlson scores in females were age (beta=1.37; 95% CI 0.361-2.38), longer hospital stay (beta=.042; 95% CI 0.005-0.078), heart failure (beta=2.41; 95% CI 0.833-3.98), chemotherapy (beta=3.48; 95% CI 1.626-5.33), and substance abuse beta=1.94; 95% CI 0.180, 3.702). Conclusions Our findings identified sex-based differences in medical resource utilization. These include kidney failure for men and heart failure for women. Increased prevalence of comorbidities in people living long with HIV has the potential to overburden global health systems. The development of narrower HIV phenotypes and aging-related comorbidity phenotypes with greater clinical validity will support intervention efficacy.
Long-Term Survival of Peritoneal Dialysis in Children: A Cohort Study

Background: There is little information about the survival rate of pediatric peritoneal dialysis (PD) patients and its risk factors. Therefore, the aim of the present study was to assess survival rate and its risk factors in Iranian children undergoing PD. Materials and Methods: Demographic and laboratory data of 407 Iranian children (up to 19 years old) undergoing PD, from 20 centers in Iran were included. The outcome of interest in our study was survival rate and determination of its risk factors in PD children. The joint models of longitudinal and time-to-event data analysis was used. Results: The median duration of follow-up was 537 (interquartile range: 146 to 1,177) days. Finally, 72 (17.7%) patients died during a period of 23 years. Our results showed that one-year survival rate of PD patients was 93.6% and five-year survival rate was 76.9%. In addition, the most important risk factors for the PD all-cause mortality were age (HR=0.9301; 95% CI: 0.9031 to 0.9587), serum creatinine (HR=0.8907; 95% CI: 0.8138 to 0.9750), platelet count (HR=0.9999; 95% CI: 0.99995 to 0.99999), aspartate aminotransferase level (HR=1.0001; 95% CI: 0.9999, 1.0002), alkaline phosphatase (HR=0.9989; 95% CI: 0.9982 to 0.9997), renal solute clearance rate (HR=0.9839; 95% CI: 0.9700 to 0.9981), and normalized protein catabolic rate (HR=0.4031; 95% CI: 0.1879, 0.8648). Conclusion: The survival rate of Iranian pediatric PD patients is similar to other countries. It is suggested that laboratory assessment be continually
Routing Protocols for WMNs: A Survey

Routing is one of the most challenging issues encountered in the Wireless Mesh Networks (WMNs) due to the dynamic nature of WMNs. The survey observes that literature is rich with wide range of routing protocols. Each protocol has its own features which we have briefly discussed. The routing protocols could be divided into three categories i.e. reactive, proactive and hybrid. In this paper we have reviewed wide range of existing routing protocols which are being applied for wireless mesh networks. The literature survey also points to the rising popularity of soft computing based approaches to the optimal cost path evaluation as compared to the classical or hard computing based approaches.
Human papillomavirus and health decision-making: Perceptions and accountability in college

Objective: To identify knowledge and beliefs about the human papillomavirus (HPV) among students in a residential academic institution, including perceptions of safety of the HPV vaccine, perceptions of cancer correlation with HPV, and independence/interdependence in health decision-making. Design: A qualitative study was used. Setting: Participants were recruited from a small private US university. Methods: In-depth, semi-structured interviews. Results: Study findings highlight the need for improved communication about sex and general preventive health care between young adults, their parents and health providers, including the campus health services centre. Findings point to the importance of appropriate health care messaging at the time of the HPV vaccine (if given in adolescence) throughout college. While mothers played a crucial part in helping young adults make sense of health and health care decisions, self-reliance and self-protection were strong drivers of decision-making. Conclusion: As college students progress from dependent child to independent adult, they shift from reliance on others, especially mothers, for health guidance to an emerging self-reliance and self-protective stance. Central to this experience is navigating health decisions by using information from one’s childhood and integrating new knowledge as one emerges into adulthood. College health care providers and related disciplinary faculty have the opportunity to support students during this transition.
Running-related musculoskeletal injuries, risk factors and treatment among Kenyan runners

Background: There is dearth of data on Running-Related Musculoskeletal Injuries (RRMI) both locally and regionally. Objective: To determine the types, associated risk factors and treatment of RRMI among the runners in the North Rift region of Kenya. Methods: A cross-sectional descriptive study of Kenyan runners within selected training camps was conducted from January to March 2016. An interviewer administered questionnaire was used to collect data. Results: A total of 108 runners were interviewed with a male to female ratio of 5:1. The most common location of injury encountered were; posterior thigh or hamstring 43 cases (39.8%), knee 33 cases (30.6%), Achilles tendon 30 cases (27.8%) and groin injuries 24 cases (22.2%). Female runners sustained more hip injuries than the males (p=0.001) while male runners sustained more groin injuries (p=0.012). About 67% of the participants trained more than 15 hours per week while 75% ran over 150km weekly without recommended rest. There was poor health seeking behaviour with only 19% of the RRMI being seen in hospitals while the rest undergoing massaging within the camps for almost all the injuries. Conclusion: Hamstring injuries were the commonest RRMI. Most runners practised overtraining, used medicated ointments for first aid then underwent physiotherapy within the camps without proper investigations and thereafter returned to training before full recovery. Recommendations: Establishing a Sports Care Centre that will institute measures for preventive strategies, early diagnosis and management of RRMI by sports physicians. Keywords: Running-Related Musculoskeletal Injuries (RRMI), Kenyan runners
Organizational transformation in health care: an activity theoretical analysis

Purpose Older patients are at high risk of hospital readmission, which has led to an increasing number of screening and intervention programs. Knowledge on implementing screening tools for preventing readmissions in emergency department (ED), where the primary focus is often the present-day flow of patients, is scant. The purpose of this paper is to explore whether a new screening tool for predicting readmissions and functional decline in medical patients>65 years of age could be implemented and its influence on cross-continuum collaborations between the primary and secondary sectors. Design/methodology/approach The study took place in an ED in Denmark, in collaboration with the surrounding municipalities. An evaluation workshop with nurses and leaders from the ED and the surrounding municipalities took place with the aim of investigating the organizational changes that occurred in daily practice after the implementation of the screening tool. The workshop was designed and analyzed using cultural historical activity theory (CHAT). Findings The results showed that it was possible to develop collaboration between the two sectors during the test period. However, the screening tool created different transformations for the municipality employees and in the ED. The contradictions indicated that the screening tool did not mediate a general and sustained transformation in the cross-continuum collaboration. Research limitations/implications Screening tools are not objective, neutral or “acontexual” artifacts and must always be adapted to the local context and sectors. CHAT offers a perspective to understand the collective object when working with organizational transformations and implementation. Practical implications The study have shown that screening tools are not objective, neutral or “acontexual” artifacts and must always be adapted to the local context. This is called adaption process. This adaption requires time and resources that should be taken into consideration from the beginning of introduction of new screens. Originality/value This paper contributes with knowledge about CHAT which offers a way to understand the leading collective object when working with organizational transformations and implementation. CHAT focuses not only on the structural changes but also on the cultural aspects of organizational changes, which is important if we want to reach a sustained change and implement the new screening tool in different sectors.
Hibiscus sabdariffa extract augments the renoprotective effect of lisinopril against streptozotocin-induced diabetic nephropathy in rats

Diabetic nephropathy (DN) is the main cause of end stage renal disease. Complex mechanisms are implicated in the pathogenesis of DN including the accumulation of advanced glycation end products (AGEs), oxidative stress, and inflammation mediated through the upregulation of toll-like receptor 4 (TLR4). Hibiscus sabdariffa is widely used in food products possessing anti-oxidative, anti-inflammatory, anti-diabetic, and anti-hypertensive effects. The present study aimed to investigate the role of hibiscus extract against streptozotocin(STZ)induced DN compared to lisinopril, and to evaluate the effects of their combined administration. Rats were treated with hibiscus extract (100, 200, or 400 mg/kg), lisinopril (5 mg/kg), or lisinopril plus hibiscus extract (2.5/100 mg/kg) for 8 weeks. Hibiscus extract caused a dosedependent improvement of nephropathy, and suppressed oxidative stress, inflammation, and the upregulation of TLR4 induced by STZ. The effects of hibiscus extract (400 mg/kg) were comparable to lisinopril (5 mg/kg). Interestingly, the combined administration of lisinopril plus hibiscus extract (2.5/100 mg/kg) significantly improved the manifestations of nephropathy better than lisinopril or hibiscus extract alone. These results might support the application of hibiscus extract as an alternative to the conventional angiotensin-converting enzyme inhibitors (ACEIs) or at least as an adjunctive to augment their effects in DN. ‎
Multidrug Resistant Bacteria in Urinary Tract Infection: A Constant Threat to a Tertiary Care Health Set-up in North India

Introduction: Urinary tract infections (UTIs) is one of the most common bacterial infections. Irrelevant use of antibiotics has resulted in the emergence of resistant strains. Aims and objective: To identify and look for the antimicrobial resistance pattern of various isolates in a tertiary care teaching hospital. Methods: A retrospective study was conducted in a tertiary level hospital for 4 years (March 2014 to March 2018). A total of 41020 urine samples received in the laboratory and 6114 of them diagnosed to be culture positive UTI were processed for Antibiotic sensitivity by the standard microbiological procedure. Results: Out of 6114 culture, positive samples 2829 (46.27%) had significant bacteriuria. Females more affected (52.27%) than males (48.43%). Amongst fermenters (GNF), E.coli (52.7%) was most common followed by Klebsiella spp. (23.65%). Amongst the Gram-positive organisms Enterococcus spp. (3.67%) was more common followed by Staphylococcus saprophyticus (1.44%). While Pseudomonas spp. followed by Burkholderia sp were the common non-fermenters (GNNF). In GNF, imipenem, meropenem and amikacin were most effective drugs whereas, in GNNF, imipenem, meropenem and piperacillintazobactam were more effective. Linezolid and vancomycin were the most sensitive antibiotics in Gram-positive isolates. Conclusion: There is increasing resistance to, and nitrofurantoin noted in our study that is frequently considered drugs of choice for empiric therapy. It is important to determine trends in antimicrobials susceptibilities, to formulate local antibiotics policy that will guide the clinicians regarding the empirical choice for UTI to prevent misuse or overuse of antibiotics. Clinical significance: Because of the emerging resistance to the available group of antimicrobials, regular monitoring of the resistance pattern is essential for the clinicians to choose for the best empiric therapy.
The Interactive and Combined Effects of Domain-Specific Knowledge and Strategic Knowledge on Reading Comprehension

The literature in reading comprehension has demonstrated that both domain-specific knowledge and strategic knowledge are vital to good comprehension. However, few studies have actually compared the effects of the two types of knowledge on reading comprehension. Fewer studies have examined the effects of combining the two strategies even though cognitive theories indicate that true comprehension occurs when certain procedures act upon knowledge constructed from the text being read and "link" that knowledge with knowledge in the long-term memory. This study compared subjects receiving strategic knowledge and content knowledge to subjects receiving strategic knowledge only, subjects receiving content-knowledge only, and a control group. Subjects were 9- and 10-year-old students in four fourth-grade classrooms. The design was a pretest-posttest quasi-experimental design. Subjects were given the comprehension and verbal subtests of the Stanford Achievement Test. Based on these tests, subjects were identified as high- or low-ability readers. In addition, they were given a comprehension pretest designed by the instructor before intervention began. The intervention took place over a 4-week period and consisted of a different series of lessons presented by an independent instructor. After the intervention, subjects took the posttest. SAT subtest scores and pretest scores were used as covariates in the final analysis. Results showed a decrease in the posttest means and no differences among the four experimental groups. Lack of findings was attributed to several factors, including lack of interest in the reading material on the comprehension tests and brevity of the intervention.