Miracle-dz/UniFAR-FTUs huggingface dataset:
Knowledge and practice regarding smoking among staff members of a hospital in Kigali, Rwanda

Background: The use of tobacco is the single most preventable cause of death and disease in our society and despite the information delivered through materials or messages to increase awareness of the harms of tobacco, many people continue to smoke. Smoking in Rwanda is prohibited in public areas although staff in a large hospital in Kigali continue to smoke. The question arises whether the smoking behaviour of these hospital workers is due to a lack of knowledge regarding the health consequences of tobacco use, and if they are aware of strategies that can be used to help give up smoking. The smoking rates of health workers is important as it has been shown that nurses who smoke are less likely to intervene with smoking cessation programmes with patients and less inclined to advocate tobacco control policies. Method: A descriptive survey was used to establish the knowledge and practices of smoking among staff members of a large hospital in Kigali, Rwanda. A sample of 135 people was drawn from a population of 600 staff members who were working in the hospital for the year 2003. Results: Responses were received from 122 participants. The proportion of smokers amongst the participants was found to be 12.2%, which is higher than the estimation of prevalence of smoking amongst adults in Rwanda (10.6%). Conclusion: Despite a comprehensive ban of smoking advertisements, as well as restrictions on smoking in public areas by the government in Rwanda, the findings in this study revealed that the number of smokers is still high even in settings that offer health care services to the public.
Viscous Metamorphosis of Blood Platelets and Clot Retraction *

1 Viscous metamorphosis of the blood platelets is defined to include all the changes observed in these cells during blood coagulation, the result of which is the liberation of the various platelet factors. 2 A “retraction‐inhibition test” is described, which was used in the search for the plasma cofactors of viscous metamorphosis. It was shown that the factors involved in the formation and action of thromboplastin (i.e. antihemophilic globulin, the factors V, VII, IX, and calcium), either alone or combined, are without effect on washed platelets. The same was found for thrombin, when it was incubated with thoroughly washed platelets. 3 Viscous metamorphosis is induced by thrombin together with a cofactor from plasma or serum, provided that small amounts of a metal ion, most probably calcium, are also present. 4 The cofactor is a thermostable substance of low molecular weight. It is conveniently obtained by dialysis from plasma. 5 Retraction of the blood clot is explained as the result of spontaneous contraction of material liberated from the thrombocytes during the first phase of viscous metamorphosis. No evidence was found for factors liberated from the platelets and causing active contraction of the fibrin fibers. 6 The concentration of “dialyzable factor” determines the extent of retraction in a platelet containing fibrin clot. 7 Some implications of the results obtained are discussed.
INFERTILITY:

Using qualitative data based on interviews with 22 married infertile couples living in western New York State, we describe the ways in which husbands and wives interact in the process of constructing their infertility. The wives experienced infertility as a cataclysmic role failure. Husbands tended to see infertility as a disconcerting event but not as a tragedy. Couples tended to see infertility as a problem for wives. Frustration and lack of communication were typical consequences of the confrontation of husbands' and wives' perspectives on infertility. Interactions with medical professionals tended to reinforce these consequences. These interactions between wives, husbands, and medical professionals may lead to taking wrong directions in treatment and to ignoring treatment options. Some of the problems we describe could be lessened by adopting a model of couple-centered treatment in a setting that incorporated routine counseling.
Antibacterial effect of Kenger gum on mutans streptococci and its cytotoxic effect on the 3T3 fibroblast cell line.

PURPOSE To evaluate the antibacterial effect of Kenger gum on mutans streptococci (in vivo) and Streptococcus mutans (in vitro) and its cytotoxic effect on the 3T3 fibroblast cell line. MATERIALS AND METHODS In vitro antibacterial activity of Kenger gum extracts against S.mutans was determined by the disk-diffusion method. The broth dilution method was used to determine the minimum inhibitory concentration (MIC). The cytotoxic effect on 3T3 fibroblast cells at different time intervals was determined using cell culture and viability assays. Clinical studies were then performed on 20 healthy adult subjects, where a sugar-free chewing gum was used as a control. To determine the MS counts, oral rinse samples were taken before chewing as well as 30 and 60 min after 15 min of chewing. Repeated-measures ANOVA was used to compare the bacteria level in the oral rinse samples between the two chewing gums. The Least Significant Difference test was used for adjustment for multiple comparisons. RESULTS The MIC of the acetone extract of Kenger gum was 30 μg/ml. The acetone extract of Kenger gum possessed moderate antiproliferative properties against the non-tumorigenic cell line 3T3. A statistically significant decrease was observed for both chewing gums at 30 and 60 min. The decrease continued at 60 min after chewing Kenger gum, while the values for control gum tended to approach the baseline after 60 min. CONCLUSION This preliminary study showed that Kenger gum had particular and prolonged antibacterial activity against S. mutans and salivary mutans streptococci.
Fernández et al. Respond to “Natural Versus Unnatural Sex Ratios”

We thank Wilcox and Baird (1) for their interesting and thought-provoking comments on our paper (2). We agree that evidence from studies of human sex ratios at birth is mixed and difficult to interpret. Our initial objective in trying to understand the findings of our study was, indeed, to test the Trivers-Willard hypothesis that periods of scarcity were associated with an increase in the proportion of females at livebirth (3). Contrary to expectation, we found a large increase in the number of males at livebirth during the 1990s in Cuba.Wewere unable to explain this finding and, although we considered and cannot exclude the possibility of sex-specific abortion, we think this unlikely to be the main explanation for our findings. The experience of the 2 authors who live in Cuba is that, although ultrasonography was available in Cuba during this period, sex-specific selection is not considered part of the Cuban culture where females are valued as much asmales. We have recently become aware that a rapid increase in the sex ratio had been observed in 3 countries in the Caucasus (Armenia, Georgia, and Azerbaijan) in the last decade of the 20th century (4). We consider that understanding changes to society that impact on the sex ratio is an important area of research, as the impact of a large, sustained change to the demographic structure of society may have consequences for decades to come.
A phenomenological study of four students' experiences of voluntary counselling and testing

Voluntary counselling and testing (VCT) has become a vital process in combating the spread of HIV/AIDS. Yet little has been published on how students experience the process of VCT. This study sought to describe and understand the experiences of voluntary counselling and testing among four students at Tshwane University of Technology. This research project focussed on students’ experiences when reporting for voluntary counselling and testing. The results were used to make recommendations for strategies to increase the accessibility and uptake of VCT by students. Using a phenomenological approach, tape recorded interviews were conducted with the four students of Tshwane University of Technology (TUT). The data were then categorised into five themes relating to the experience of VCT: emotions, perceptions, actions, thoughts and desires. The results showed that the students were mostly dissatisfied with the VCT clinic’s procedures and the counsellor’s attitudes. Also evident from this study was that counsellors’ professionalism, peer support, and a service that offers both pre- and post-test counselling play a significant role in students’ use of VCT. The findings of this study suggest that the following could be used as strategies to motivate students to utilise VCT services of VCT: (1) increase access and acceptability of VCT for students; (2) ensure access to factual information in the form of counselling; (3) make counselling a priority.
Changes in method for obtaining better outcomes in the recruitment of synthetic drug users

Objective: To describe the problems encountered and resolved in the course of using respondent-driven sampling (RDS), targeted canvassing (TARC), and ethnographic fieldwork (EFW) to recruit ecstasy and/or lysergic acid diethylamide (LSD) users. Method: This study is nested within a larger project designed to investigate the course of drug use, sexual risk behaviors, and psychiatric comorbidities in 240 ecstasy/LSD users. Eligible participants were males and females with ages ranging from 18 to 39 years, who reported ecstasy and/or LSD use at least once during the 90 days prior to interview and were not under treatment for drug and alcohol problems. Strategies were implemented sequentially, over four-month time frames for each method, aiming at fulfilling study objectives. Results: The final sample included 174 participants (64.36% males). Eight (4.6%) were selected using RDS, 26 (14.94%) with TARC, and 140 (80.45%) using EFW. RDS recruited participants with a higher education level, employed, and with a higher monthly income. Conversely, a higher frequency of drug usage and a higher number of drugs ever used were evident among participants selected via EFW. Conclusions: Different recruitment techniques reached different types of participants. EFW showed the best performance, granting access to the largest number of participants and with a higher number of drugs ever used. Both RDS and TARC required more time to recruit participants and yielded a lower number of eligible subjects. Participants recruited via RDS had a higher socioeconomic level but also a shorter lifetime history of drug use.
Burden of illness for patients with non-dialysis chronic kidney disease and anemia in the United States: review of the literature

Objective: To assess the health-related quality of life (HRQL) and economic burden of chronic kidney disease (CKD) related anemia in non-dialysis patients in the United States (US) via literature review. Methods: MEDLINE, EMBASE, PROQOLID, and Cochrane Library/Renal Group Resources were searched. Studies were appraised for patient populations, disease-specific versus generic HRQL assessments, and type and magnitude of health-related costs. Results: The treatment costs for CKD patients with anemia compared to those without anemia were significantly higher and were blunted but persistent after controlling for comorbidities and confounders. Intervention with erythropoiesis stimulating agents (ESA) decreased anemia and avoided hospital admissions. Costs were higher when anemia was poorly controlled or untreated. HRQL burden was mainly due to physical limitations and difficulty in ability to perform activities of daily living. Significant positive correlations between increases in hemoglobin levels and HRQL measures were reported. Conclusions: Although evidence is limited, the economic and HRQL burden of non-dialysis CKD-related anemia is substantial. Under-treatment of anemia may contribute to higher resource consumption and higher costs; however, patient co-morbidities, use of erythropoietin-stimulating agents, and overall management introduce potential confounds. The contribution of anemia to humanistic disease burden is due to a constellation of factors, including physical activity and functional status.
The invisible work of the district nursing team: methodological problems associated with exploring skills

This paper begins by identifying the context and extent of grade-mix changes in the district nursing service, drawing attention to significant dilution in grade mix at a time of considerable organizational change. The paper goes on to argue that there is no easy formula for providing sound evidence on which policy and management decisions about grade mix can be based. It suggests that the focus on tasks in much of the research on district nursing does not offer a sufficient basis for making grade-mix decisions, because nursing skills are not made explicit. The paper then makes reference to one ethnographic research study in order to illustrate and explore some of the methodological difficulties associated with trying to provide evidence of the use of district nursing skills, focusing in particular on the invisible work undertaken by team members. The paper concludes that if differences in the use of skills by different grades of nurse can be identified, then further increases in grade dilution will have consequences for patient care and must therefore address issues of quality in order to comply with the principles of clinical governance.
Monte Carlo evaluation of the potential benefits of flattening filter free beams from the Oncor® clinical linear accelerator.

OBJECTIVES To evaluate the potential privileges of flattening filter-free (FFF) photon beams from Oncor® linac for 6 MV and 18 MV energies. METHODS A Monte Carlo (MC) model of Oncor® linac was built using BEAMnrc MCCode and verified by the measured data using 6 MV and 18 MV energies. A comprehensive set of data was also characterized for MC model of Oncor® machine running with and without flattening filter (FF) for 6 MV and 18 MV beams in six field sizes. The investigated characteristics included mean energy, energy spectrum, photon spatial fluence, superficial dose, percent depth dose (PDD), dose output, and out-of-field dose with two indexes of lateral dose profile and isodose curve at three depths. RESULTS Using FFF enhanced the energy uniformity 3.4±0.11% (6 MV) and 2.05±0.09% (18 MV) times and improved dose output by factor of 2.91 (6 MV) and 4.2 (18 MV) on the central axis, respectively. Using FFF also reduced the PDD dependencies by 9.1% (6 MV) and 5.57% (18 MV). In addition, using FFF had a lower out-of-field dose due to the reduced head scatter and softer spectra. CONCLUSIONS The findings in this study suggested that using FFF, Oncor® machine could achieve better treatment results with lower dose toxicity and a shorter beam-on time.
Osteocalcin: a novel vascular metabolic and osteoinductive factor?

Osteocalcin, or bone Gla protein, is a small protein secreted by osteoblasts that can undergo γ-carboxylation. The γ-carboxylated form binds hydroxyapatite and is abundant in bone extracellular matrix. In contrast, the undercarboxylated circulating form has been implicated as a novel hormone and positive regulator of glucose homeostasis. Importantly, osteocalcin expression has been described in calcifying vascular smooth muscle cells (VSMCs), although the physiological significance of this observation has remained unclear. In this issue of Arteriosclerosis, Thrombosis, and Vascular Biology , Idelevich et al1 show that osteocalcin is potentially a novel regulator of osteochondrogenic differentiation of pathologically mineralizing VSMCs. They reveal that osteocalcin, via hypoxia-inducible factor 1α signaling, stimulates expression of osteochondrogenic transcription factors in VSMCs, as well as a shift in cellular metabolism toward glycolysis. This study provides the first evidence that osteocalcin may be an active player in vascular calcification, with its presence in the calcified vasculature, and potentially the circulation, activating novel signaling pathways that promote mineralization. See accompanying article: Idelevich A, Rais Y, Monsonego-Ornan E. Bone Gla protein increases HIF-1α-dependent glucose metabolism and induces cartilage and vascular calcification. Arterioscler Thromb Vasc Biol . 2011;31:e55–e71. Pathological mineralization of the vasculature has a detrimental effect on cardiovascular function and is associated with increased mortality in patients with aging, atherosclerosis, type 2 diabetes, and chronic kidney disease.2 Vascular smooth muscle cells (VSMCs) orchestrate the mineralization process, which is mediated in part by their osteochondrocytic differentiation in the vessel wall. This phenotypic transition is characterized by expression of Runx2 and Sox9, master transcription factors that regulate bone and cartilage differentiation during developmental osteochondrogenesis, as well as other bone- and cartilage-specific proteins, many with undefined functions.3 One of these proteins, osteocalcin, is a small γ-carboxylated protein that is expressed by both osteoblasts and VSMCs and abundantly deposited …
The behavior of endometrial hyperplasia. A long‐term study of “untreated” hyperplasia in 170 patients

Endometrial curettings from 170 patients with all grades of endometrial hyperplasia, who did not undergo a hysterectomy for at least 1 year were evaluated in order to correlate the histopathologic features with behavior. Follow‐up ranged from 1 to 26.7 years (mean, 13.4 years). Cytologic and architectural alterations were analyzed separately in order to assess their respective roles in predicting the likelihood of progression to carcinoma. Classification of proligerative lesions based solely on the presence of cytologic atypia revealed that atypia was a discriminant factor. Proliferations lacking cytologic atypia were designated hyperplasia and those displaying atypia were designated atypical hyperplasia. Only 2 (1.6%) of 122 patients with hyperplasia progressed to carcinoma compared with 11 (23%) of women with atypical hyperplasia (P = 0.001). Subclassification of the two forms of hyperplasia (those with cytologic atypia and those without) was performed using the degree of architectural abnormalities. Hyperplasia and atypical hyperplasia displaying marked glandular complexity and crowding producing a back‐to‐back appearance were designated complex hyperplasia (CH) and complex atypical hyperplasia (CAH), respectively. Hyperplasia and atypical hyperplasia with lesser degrees of glandular complexity and crowding were designated simple hyperplasia (SH) and simple atypical hyperplasia (SAH), respectively. Progression to carcinoma occurred in 1 (1%) of 93 patients with SH, in 1 (3%) of 29 patients with CH, in 1 (8%) of the patients with SAH, and in 10 (29%) of the patients with CAH. The differences between the four subgroups suggest a trend but are not statistically significant. The findings in this study provide a rationale for classifying noninvasive endometrial proliferations primarily on the basis of cytologic atypia since this is the most useful criterion in predicting the likelihood of progression to carcinoma. In addition, the presence of concommitant architectural alterations appears to identify a particularly high‐risk subgroup.
Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Background: The incidence of acute left-sided colonic diverticulitis (ACD) is increasing in the Western world. To improve the quality of patient care, a guideline for diagnosis and treatment of diverticulitis is needed. Methods: A multidisciplinary working group, representing experts of relevant specialties, was involved in the guideline development. A systematic literature search was conducted to collect scientific evidence on epidemiology, classification, diagnostics and treatment of diverticulitis. Literature was assessed using the classification system according to an evidence-based guideline development method, and levels of evidence of the conclusions were assigned to each topic. Final recommendations were given, taking into account the level of evidence of the conclusions and other relevant considerations such as patient preferences, costs and availability of facilities. Results: The natural history of diverticulitis is usually mild and treatment is mostly conservative. Although younger patients have a higher risk of recurrent disease, a higher risk of complications compared to older patients was not found. In general, the clinical diagnosis of ACD is not accurate enough and therefore imaging is indicated. The triad of pain in the lower left abdomen on physical examination, the absence of vomiting and a C-reactive protein >50 mg/l has a high predictive value to diagnose ACD. If this triad is present and there are no signs of complicated disease, patients may be withheld from further imaging. If imaging is indicated, conditional computed tomography, only after a negative or inconclusive ultrasound, gives the best results. There is no indication for routine endoscopic examination after an episode of diverticulitis. There is no evidence for the routine administration of antibiotics in patients with clinically mild uncomplicated diverticulitis. Treatment of pericolic or pelvic abscesses can initially be treated with antibiotic therapy or combined with percutaneous drainage. If this treatment fails, surgical drainage is required. Patients with a perforated ACD resulting in peritonitis should undergo an emergency operation. There is an ongoing debate about the optimal surgical strategy. Conclusion: Scientific evidence is scarce for some aspects of ACD treatment (e.g. natural history of ACD, ACD in special patient groups, prevention of ACD, treatment of uncomplicated ACD and medical treatment of recurrent ACD), leading to treatment being guided by the surgeon's personal preference. Other aspects of the management of patients with ACD have been more thoroughly researched (e.g. imaging techniques, treatment of complicated ACD and elective surgery of ACD). This guideline of the diagnostics and treatment of ACD can be used as a reference for clinicians who treat patients with ACD.
Auditory temporal gap detection in children with and without auditory processing disorder.

BACKGROUND Auditory gap detection is a measure of temporal acuity. The paradigm comes in two forms, distinguished by whether the sounds bounding the silent period are the same (within channel [WC]) or different (between channel [BC]). PURPOSE The purpose of this study was to test normal children and children referred for auditory processing disorder (APD) assessment, with both gap detection paradigms. RESEARCH DESIGN Best gap durations (i.e., shortest reliably detected gaps) were measured in a two-interval, two-alternative forced-choice design embedded within a modified method of limits, for both WC and BC paradigms, with stimuli presented at 55 dB HL. STUDY SAMPLE Sixteen control children and 20 children referred for APD assessment participated in the study. Of the 20 referred children, 9 were diagnostically positive for APD (APD+), and 11 were negative (APD-). The mean age of children in all three groups was 10-11 yr. DATA COLLECTION AND ANALYSIS Data collected were best gap durations for each paradigm, for each child. Group differences were assessed using Kruskal-Wallis analyses of variance. RESULTS WC best gap durations were very similar across the three participant groups. BC best gap durations varied significantly between listener groups, with the greatest difference being between controls and APD+ samples. CONCLUSIONS BC best gap durations differed among the listener groups while WC ones did not. This suggests that the relative timing perceptual operations required by the BC task are more susceptible to the perceptual disturbances in APD than is the simple event detection required by the WC task.