Miracle-dz/UniFAR-FTUs huggingface dataset:
Mode of delivery and future fertility

A cohort of 22 948 women from a stable homogeneous population who gave birth for the first time between 1964 and 1983 were followed up prospectively. Analysis by mode of delivery showed that of those delivered by caesarean section 23·2% fewer had another pregnancy than those who had a spontaneous vaginal delivery. Women delivered by forceps were in an intermediate group. Miscarriage was more common in women who had been delivered by caesarean section. The relative infertility after caesarean section could not be accounted for by early sterilization, was not associated with maternal height or social status, and was only partly attributable to age.
A retrospective analysis of 96 "asp" (Megalopyge opercularis) envenomations in Central Texas during 1996.

BACKGROUND The most frequently reported caterpillar envenomation in Central Texas is by the puss caterpillar or "asp," Megalopyge opercularis. This caterpillar is described by patients and physicians as inflicting intense radiating pain. The intensity of symptoms may be underestimated leading to undertreatment. Adequate treatment protocols have been lacking and those in use are not very successful. We present a retrospective study of patients who were stung and contacted the Central Texas Poison Center. METHODS All human exposures to asp stings reported to the Central Texas Poison Center during 1996 were included. Inclusion criteria consisted of all cases documented as an asp envenomation by the specialists in poison information. Characterization of symptoms and treatment used were evaluated. RESULTS There were 96 exposures to asps reported. Ninety-five of the patients experienced local pain with 26 of these reporting intense radiating pain. Forty developed erythema, 27 described edema, and 9 complained of welts/hives. Other symptoms reported included white spots (4), pruritus (3), red streak (2), numbness (2), and individual accounts of chest pain, rash, ecchymosis, tingling, blister, and muscle spasm. There was no treatment modality that promptly relieved pain. DISCUSSION Although asp envenomations appear to be very common, clinical cases have rarely been documented. This may be due to physicians not recognizing the etiological agent. Pain may be very intense and standard pain management appears to be unsuccessful. CONCLUSION This study suggests that further examination of treatment modalities may be beneficial in addressing the morbidity of Megalopyge opercularis envenomations.
Challenges of Microfinance Access in Nigeria: Implications for Entrepreneurship Development

Small and Medium Enterprises (SMEs) are increasingly being accepted as valuable platforms to create jobs and improve livelihoods. The Nigerian government has enacted favorable laws and regulations on contracts, leasing, and corporate tax to encourage the development of SMEs. Nonetheless, many entrepreneurs in Nigeria cannot access loans given the high levels of poverty. The paper argues that microenterprise finance cannot be financially viable because small loans are too costly to administer and the profits from such lending too meager to permit profitability. Based on content analysis of available literature, it is found that microfinance institutions have collapsed in Nigeria due to poor loan quality, default in loan repayment, high transaction costs, widespread delinquency, and management deficiencies. Given these challenges, the paper recommends savings by microfinance institutions and measures from successful initiatives from countries such as Indonesia and Bangladesh. These will enable microfinance institutions to be self-sustaining and to increase outreach. DOI: 10.5901/mjss.2013. v4n6p611
Nosocomial Salmonellosis

Salmonella infections are an important source of morbidity in the United States, accounting for over 500 outbreaks each year and approximately two-thirds of foodborne outbreaks reported to the Centers for Disease Control. Up to 35% of reported Salmonella epidemics are in hospitals or chronic care facilities. Nosocomial outbreaks due to Salmonella have been second in frequency only to those caused by staphylococci. A recent review of data from the National Nosocomial Infection Study (1980-1984) suggests that Clostridium difficile is the most common recognized cause of nosocomial gastroenteritis (J.M. Hughs, Centers for Disease Control, personal communication). Epidemic salmonellosis is well recognized in acute care hospitals, particularly pediatric wards and newborn nurseries, as well as chronic care facilities, such as psychiatric institutions and homes for the elderly.
Theoretical Derivation of a Bias-reduced Expression for the Extrapolation of the Species Accumulation Curve and the Associated Estimation of Total Species Richness

Under-sampling becomes the current situation for an increasing part of biodiversity surveys, as more and more speciose assemblages and increasingly complex taxonomic groups are progressively addressed. Accordingly, (i) extrapolating the Species Accumulation Curve and (ii) estimating the total species richness of partially-sampled species assemblages (or taxonomic-groups)
The pelvic venous syndromes: analysis of our experience with 57 patients.

BACKGROUND The pelvic venous syndromes comprise a group of poorly understood disorders of the pelvic and gonadal venous circulation. The objective of this paper was to review our experience with the pelvic venous syndromes and, in the light of the current literature, make management recommendations. MATERIALS AND METHODS Fifty-seven female patients (age range, 24 to 48 years; mean, 34 years) with symptoms of pelvic pain, dysuria, dysmenorrhea, dyspareunia, and the presence of vulval and pelvic varices were studied. Diagnosis included physical examination, Doppler scan, duplex ultrasound scan, computed tomography, magnetic resonance imaging, and retrograde cinevideoangiography. The symptoms were classified as: 1, mild (n = 15); 2, moderately severe (n = 19); and 3, severe (n = 23). Group 1 was treated with sclerotherapy/local excision of vulval varices. Group 2 had gonadal vein resection (GVR; n = 12) and sclerotherapy or gonadal vein coil embolization (GVE; n = 7) and sclerotherapy. Only the incompetent side was treated. Patients in group 3 with isolated hypogastric vein tributary reflux were treated either with hypogastric vein tributaries division (HVTD) or with embolization (HVTE) as the only procedure. Those with combined gonadal and hypogastric vein reflux were treated with HVTE followed by GVR. The follow-up period ranged from 2.5 to 24 years (mean GVR/HVTD, 12.4 years; mean GVE/HVTE, 2.3 years). Pain improvement was assessed with a visual analog scale and through mailed questionnaires (response rate, 100%). Patient results were classified as excellent (asymptomatic), moderate (mild discomfort), or no improvement. RESULTS In group 1, 12 patients had excellent results and three had moderate results. In group 2, 10 patients treated with GVR had excellent results, one had moderate results, and one had no improvement. Three patients treated with GVE were asymptomatic, and four had no improvement. In group 3, three patients treated with HVTD were asymptomatic and two had no improvement. Five patients treated with HVTE were asymptomatic, and one had no improvement. Of the 12 patients treated with HVTE and GVR, 10 were asymptomatic, one had moderate results, and one had no improvement. CONCLUSION Local excision of vulval varices and sclerotherapy were sufficient in patients with mild symptoms. Gonadal vein excision produced better results than GVE. In patients with isolated hypogastric vein reflux, embolization was a better option than surgical treatment. GVR preceded by embolization of the incompetent tributaries of the internal iliac vein was indicated in patients with combined reflux and severe symptoms. Supplemental sclerotherapy of vulval varices is recommended after control of the intrapelvic reflux.
Expression pattern of peptidylarginine deiminase in rat and human Schwann cells

The peptidylarginine deiminase (PAD) family of enzymes are responsible for conversion of protein‐bound arginine to citrulline in most tissues of the body and are garnering increased interest for their physiological and pathological roles. Although it has been shown that oligodendrocytes of the CNS express the PAD isoenzyme type 2, nothing is presently known about PAD expression in Schwann cells, the myelinating cells of the PNS. To evaluate PAD expression in the PNS, cultivated rat and human Schwann cells and slices of fetal, juvenile, and normal and regenerated adult sciatic nerves were examined with RT‐PCR, Western blot, and immunohistochemical analysis. Samples from cerebellar cultures and skin served as positive controls. One of the principle findings was that cultivated Schwann cells expressed significant levels of mRNA and protein for the PAD isoenzymes 2 and 3. PAD1 and PAD4, however, were not expressed in any types of Schwann cells. Using double immunofluorescence, the majority of PAD2 staining was localized in immature cell stages. Moreover, increased amounts of PAD2, PAD3, and peptidyl‐citrulline were also found in human fetal and rat juvenile and regenerated sciatic nerves as compared to similar normal adult specimens. Neuronal and inducible nitric oxide synthases, enzymes that convert free arginine to citrulline, were also expressed in Schwann cells; however, their massive induction by LPS/K+, was not reflected in an enhanced peptidyl‐citrulline immunosignal. These data suggest that, similar to the CNS, citrullination of proteins may also exert a specific role in thecourse of PNS development and repair. © 2007 Wiley Periodicals, Inc. Develop Neurobiol, 2008
Severe corneoscleral infection. A complication of beta irradiation scleral necrosis following pterygium excision.

OBJECTIVE To assess the precipitating factors, clinical course, and treatment of 11 cases of severe intraocular infections of radionecrosis after pterygium excision in an attempt to minimize the devastating ocular sequelae. DESIGN AND SETTING From the database of cases of radionecrosis at Royal Perth (Australia) Hospital and Lions Eye Institute, Perth, we identified 11 cases of severe intraocular infection complicating radionecrosis. We reviewed the case notes and the available radiotherapy records (n = 8). PATIENTS Eleven patients admitted during an 8-year period. RESULTS Mean (+/- SD) dose of radiotherapy was 22.7 +/- 1.0 Gy and mean latency period, 14.45 +/- 2.5 years. Among the six proven bacterial cases, Pseudomonas was identified in four, Staphylococcus aureus in one, and Streptococcus pneumoniae was involved in one bilateral case. Among the four fungal cases, Petriellidium boydii was indicated in two, and Fusarium and Scedosporium inflatum in one each. The condition may remain undiagnosed for some time and mimic a posterior scleritis, serous retinal detachment, or pseudotumor. INTERVENTIONS Early débridement and culture; close microbiological assistance; and systemic antimicrobials for a prolonged period. Perforation or incipient perforation necessitated penetrating keratoplasties in seven patients and repeated keratoplasties in three. MAIN OUTCOME MEASURES The use of radiotherapy following pterygium excision should be limited and only low doses used. Ulcer beds and calcific plaques at sites of radionecrosis should not be directly covered without first performing adequate sterilization. Removal of plaques may precipitate sepsis; ulcer beds and plaques harbor infective agents. CONCLUSION Severe radionecrosis may expose a patient to a lifelong risk of intraocular sepsis and profound visual morbidity. Conjunctival autografting is a safer method to reduce recurrence rate after pterygium excision.
IMECE—Implementation of mathematical, experimental, and computer‐based education: A special application of fluid mechanics for civil and environmental engineering students

A novel educational methodology, Implementation of Mathematical, Experimental, and Computer‐based Education (IMECE), where its name was derived from the letters of the word “imece” (a Turkish tradition) by taking into account the integrative meaning of this cultural concept, was proposed to explore the synergistic effect of the conventional mathematical solution procedure, visual application, and MATLAB‐based simulation on the perceptions and learning quality of the engineering students. Within the scope the present research carried out both at the state university (undergraduate and graduate levels) and at the foundation university (undergraduate level), water discharge problem (a special case of the Bernoulli's principle/Toricelli's law) was chosen as an example application. In the study, the experimental results of three different tank models (vertical cylindrical, conical, and spherical) and the solution algorithms written in MATLAB were presented in detail, and new empirical equations were also developed for each laboratory scale system depending on the experimental data. The effectiveness of the proposed IMECE method was evaluated statistically within the framework of both “Student Survey” and “Student Assessment” conducted with the participation of 84 students. Based on the mean scores obtained for all participating students, the results of the statistical tests indicated that the quantitative performance (or effectiveness) of the applied IMECE methodology was determined as 97.73%, 67.36%, and 82.55% for the perception/satisfaction section, the learning section, and the overall evaluation category, respectively.
Biochemical methane potential of different organic wastes and energy crops from Estonia

The biochemical methane potential (BMP) of different Estonian substrates as alternative sources for biogas production was studied. For this purpose, the BMP test was carried out in batch mode at mesophilic temperature (36°C). Substrates were divided into 2 groups: agricultural substrates (silage, hay, cattle and pig slurry) and food industry residues (milk, brewery and cereal industry residues). Methane yields obtained were between 286-319 -1 for silage and hay, 238-317 L kgVS -1 for animal slurry and 272-714 L kgVS -1 for agro-industrial wastes. The highest methane yield was obtained from sour cream (714 L kgVS -1 ), the lowest (238 L kgVS -1 ) from cattle slurry. In overall, our results suggest that all tested substrates can be treated anaerobically and are potential sources for the production of methane.
PD‐1/PD‐L1, PD‐1/PD‐L2, and other co‐inhibitory signaling pathways in transplantation

Transplantation of cells, tissues and vascularized solid organs is a successful therapeutic intervention for many end‐stage chronic diseases. The combination of co‐stimulatory blockade with the delivery of negative signals to T cells through co‐inhibitory receptors would provide a robust approach to modulating T‐cell receptor signaling and improving alloantigen‐specific control of transplant rejection. This approach based on fundamental knowledge of APC/T‐cell interactions may complement conventional therapies in the near future to reinforce long‐term allograft survival, and permit minimal immunosuppression. The focus of this review was primarily on two major co‐inhibitory signaling pathways, namely PD‐1/PD‐L1/PD‐L2 and BTLA/CD160/HVEM/LIGHT that have been thoroughly characterized in murine models of transplantation using genetically modified mice, specific monoclonal antibodies and fusion proteins.
Mesenteric Lymphadenectomy in Well-Differentiated Appendiceal Neuroendocrine Tumors

BACKGROUND: Surgical resection is the primary therapy for local and locally advanced appendiceal neuroendocrine tumors. The role of mesenteric lymphadenectomy in these patients is undefined. OBJECTIVE: The purpose of this study was to define the role and prognostic significance of mesenteric lymphadenectomy. DESIGN: This was a retrospective, observational study. SETTINGS: A population-based cohort from the National Cancer Institute Surveillance, Epidemiology, and End Results registry (January 1988 to November 2013) was used. PATIENTS: Patients with well-differentiated neuroendocrine tumors and nonmixed histologies undergoing surgical resection were included. MAIN OUTCOME MEASURES: The risk of lymph node metastases as a function of tumor size and overall survival with respect to lymph node count and tumor size was measured. Lymph node cut-point was determined using the Contal and O’Quigely method. RESULTS: Of the 573 patients who met the inclusion criteria, 64% were women, 79% were white, and 76% were <60 years of age. Seventy percent of the tumors were ⩽2 cm, and 77% were lymph node negative. Median lymph nodes retrieved were 0 (interquartile range, 0–14). The probability of nodal metastases was 2.7% in tumors ⩽1.0 cm, 31.0% in tumors 1.1 to 2.0 cm, and 64.0% in tumors >2.0 cm. The probability of a positive lymph node increased with increasing lymph node count up to 26 lymph nodes. An ideal cut-point of 12 lymph nodes was identified by statistical modeling. After adjustment in the multivariable model, the group with 12 or fewer lymph nodes examined had significantly worse overall survival (HR = 4.33 (95% CI, 1.54–12.15); p = 0.005; 5-year survival, 88% versus 96%) than the group with more than 12 lymph nodes examined. LIMITATIONS: Analysis was limited by the variables available in the database. CONCLUSIONS: This is the largest study to date that looks at prognostic significance of lymph node count for well-differentiated appendiceal neuroendocrine tumors. Overall survival was worse where 12 or fewer lymph nodes were identified for tumors >1 cm. See Video Abstract at http://links.lww. com/DCR/A352.
Global Urine Metabolomics in Patients Treated with First-Line Tuberculosis Drugs and Identification of a Novel Metabolite of Ethambutol

ABSTRACT Population level variation of drug metabolism phenotype (DMP) has great implications in treatment outcome, drug-related side effects, and resistance development. In this study, we used a gas chromatography-time of flight-mass spectrometry (GC-TOF-MS)-based untargeted urine metabolomics approach to understand the DMP of a tuberculosis (TB) patient cohort (n = 20) from Tripura, a state in the northeastern part of India. Urine samples collected at different postdose time points (2 h, 6 h, 12 h, 24 h, 36 h, and 48 h) from these newly diagnosed TB patients receiving first-line anti-TB drugs were analyzed, and we have successfully detected three of the four first-line drugs, viz., isoniazid (INH), ethambutol (ETB), and pyrazinamide (PZA). The majority of their known metabolites, acetyl-isoniazid (AcINH), isonicotinic acid (INA), isonicotinuric acid (INTA), 2,2′-(ethylenediimino)-dibutyric acid (EDBA), 5-hydroxypyrazinamide (5OH-PZA), pyrazinoic acid (POA), and 5-hydroxypyrazinoic acid (5OH-POA), were also detected. Analyzing the variation in abundances of drugs and their known metabolites and calculating the metabolic ratios in these samples, we offer comprehensive DMP information on this small patient cohort that represents Tripura, India. The majority (75%) of these patients are found to be slow acetylators of INH. The average metabolic ratios of POA/PZA and 5OH-POA/POA are 3.16 ± 3.03 and 6.09 ± 6.15, respectively. Employing correlation analysis of the metabolomics metadata and a manual prediction of drug catabolism, we have proposed 2-aminobutyric acid (AABA) as a novel metabolite of ETB. These observations indicate the usefulness of GC-MS-based metabolomics to characterize the DMP at a population level and also to identify novel drug metabolites.
Developmental delay and related factors

Background & objective: The survival rates of high-risk infant have been improved as a result of advancesin medical knowledge, but future development of these children is becoming a matter of concern. Afterinfection and trauma, developmental and behavioral problems are the most common problems in pediatrics. Arange of factors are involved in behavior and development problems. Given the importance and prevalence ofdevelopmental disorders, the lack of detailed information on risk factors, this article aims to explore somefactors associated with developmental delay in children.Method and Material : This review was performed by searching PubMed, Ovid, SID, Scopus, Magiran andScience Direct databases using following key words: Child Development, Socioeconomic statue, Violence,Social support, Psychological factors, Unhealthy behavior, Social Determinants. A total of 55 article wereincluded in this review . Results: The main causes of developmental disabilities remain unknown. Development of children affectedby prenatal factors, psychological, social and biological factors, genetic, environmental factors and is dynamicinteraction Biological and Acquired factors.Key words: Developmental delay- Risk factors - Socioeconomic risk factors -Biological risk Factors-environmentalrisk factors
Skin potential, heart rate, and the span of immediate memory.

Relations between orienting response and span of immediate memory were studied by measuring skin potential responses (SPR) and heart rate (HR). Four conditions were studied by presenting letters in a tachistoscope and a 1000 cycle, 100 db tone simultaneous on some but not all trials. The conditions (15 Ss in each) were: tone and letters for 10 trials, then letters alone for 10 trials; tone and letters for 20 trials; only letters for 10 trials, followed by letters and tone for 10 trials; and only letters for 20 trials. The results showed: (1) positive SPR habituated and negative did not, (2) tone produced more SP activity, (3) HR showed a shift from acceleration to deceleration over 20 trials, but tone had no influence, (4) tone had no direct influence on span scores, (5) Ss showed improvement in number ol letters reported correctly. There was a significant correlation between span and negative SPR when tone was sounded (r =. 36).
A close shave

Dr Harwood raises many excellent examples of concerns individual anaesthetists will face in deciding whether to come to work during pandemic flu. I share these concerns. Social disruption will be an inevitable result of the pandemic. Schools will close, public transport will not run and doctors will fear to return home to their families. It remains to be seen if the supply of personal protective equipment and the training to use it will be sufficient. Dr Harwood is right to hold government answerable to these concerns. Given recent coronial verdicts into the deaths of servicemen in Afghanistan and Iraq, it is difficult to suppose that government will prove any less morally negligent during a pandemic. Nevertheless some of us will have to treat flu patients. As Dr Harwood states, ‘Doctors are paid for the skill and knowledge they possess. ’ but under what circumstances that gives us the right to withhold this skill and knowledge is the heart of this debate. Good Medical Practice 2006, as well as endorsing our skill and knowledge, also states that, ‘All patients are entitled to care to meet their clinical needs. You must not refuse to treat a patient because their medical condition may put you at risk. If a patient poses a risk to your health and safety, you should take all available steps to minimise risk, before providing treatment or making suitable alternative arrangements for treatment’ [1]. What alternative arrangements will there be when intensive care is overflowing and anaesthesia skill and knowledge is needed? Each of us will face this choice as an individual and for some of us legitimate reasons may exist that justify not coming to work during pandemic flu. We must be careful however not to turn our concerns into excuses for not doing the right thing. Additionally, we must guard against the expectation that it is the responsibility of single, childless and older colleagues to satisfy society’s need for anaesthesia skill and knowledge during a pandemic flu national crisis.