Miracle-dz/UniFAR-FTUs huggingface dataset:
Childbirth experiences and mother-infant relationships in Uganda

A high proportion of women in sub-Saharan Africa survive severe negative childbirth experiences each year, yet little is known about the psychological impact of maternal experiences on the mother and her baby in those countries. There is evidence from high income countries that the effects of posttraumatic stress symptoms following childbirth on mothers and their families can be long lasting. The aim of this exploratory mixed methods study was to examine the possible association between childbirth experiences and mother-infant interactions in a purposive sample of high risk mothers who delivered at an urban tertiary hospital in Uganda. The sample comprised of 49 mothers aged between 18-38 years and their 4-5-monthold babies. Each mother-infant dyad was observed in a 10-minute video recorded social interaction at home. All mothers completed self-report questionnaires assessing demographic factors, childbirth experiences, posttraumatic stress symptoms arising from labour and delivery, postpartum depression and maternal attachment style. Individual narrative interviews with 41 mothers were conducted exploring their experiences of pregnancy, labour, delivery and time spent at the hospital post-delivery. Quantitative data was analysed using descriptive statistics, Pearson correlations, ANOVA, and hierarchical multiple regressions and the narratives using structural narrative analysis. The findings were integrated using the weave strategy. Quantitative findings showed that fear of death, emergency caesarean section and prolonged labour were the most common problems during labour and delivery. Childbirth experiences were negatively associated with mother-infant interactions. Posttraumatic stress symptoms and postnatal depression were not associated with mother-infant interactions. The women’s experiences at the hospital partially predicted mother-infant interactions. Women’s narratives showed that experiences of childbirth were influenced by the mothers’ level of planning for pregnancy, personal circumstances, and cultural and religious beliefs about childbirth. The mothers’ experiences of childbirth demonstrated elements of restitution, chaos and quest narratives, mirroring aspects of illness narratives seen in populations living with chronic health conditions. These findings show that negative childbirth experiences present risks to both women’s postnatal mental health and their interactions with their infants. Two urgently required interventions for this population of women and their babies should involve 1) hospital organisational changes and staff training on quality intrapartum care. 2) Development and provision of trauma and attachment-based interventions for mothers and their infants.
Cost-based analysis of operative maxillofacial fracture managements

Aims: There is no current study presenting a descriptive cost-based analysis of operative maxillofacial fracture managements in Turkey. Therefore, this study attempted to investigate the overall treatment costs of maxillofacial traumas. Materials and Methods: Maxillofacial trauma patients treated between January 2012 and December 2016 with at least 12 months of follow-up were included in this study. Parameters including age, gender, etiology of injury, site of trauma, additional traumas, comorbidities, length of hospitalization, treatment technique and material used in surgery, duration of surgery, complication rates, and hospital costs for treatments were analyzed retrospectively. The costs were converted into USD ($) according to the currency exchange rate. Results: The most cost-effective (351$) was the teenage group (10–17 years) and the most expensive (793$) was the group over 61 years of age with significant differences. Etiologically, assaults were statistically significantly (P = 0.047) cheaper than motorbike accidents. The most expensive treatments were tetrad site fractures, and the most cost-effective treatments were maxillary fractures. The total costs of tetrad site fractures (1088$) was statistically significantly expensive than that of maxillary fractures (245$) (P = 0.006). Additional injuries caused statistically significantly higher costs to maxillofacial trauma treatments (P = 0.002). Closed techniques or plate fixations with six holes or less were statistically significantly cheaper than plate fixations with more than six holes (P < 0.001). Maxillofacial treatments had a complication rate of 8.6%. Complications caused statistically significantly higher treatment costs (P = 0.038). Conclusions: The results of this study suggest that maxillofacial surgeons should use the resources in the most effective way to maintain low complication rates and treatment costs in managing maxillofacial traumas.
Hematological profile of human immunodeficiency virus-infected children

Background: Hematological disorder has been shown to be one of the leading manifestations of human immunodeficiency virus (HIV) infection. This could be from the virus itself or the accompanying opportunistic infections including malignancies. The manifestations include among others, anemia, leukopenia and thrombocytopenia. Objectives: The objective of this study is to determine the prevalence of anemia, leukopenia, and thrombocytopenia as well as assessing the relationship between antiretroviral therapy (ART) regimen and anemia. Materials and Methods: The study was a prospective study among HIV-infected children and adolescents aged 2 years to <18 years receiving ART at the Dalhatu Araf Specialist Hospital, Lafia Nasarawa State. A total of 263 clients were recruited consecutively. Known sickle-cell disease patients, those with ongoing sepsis and or those recently transfused were excluded from the study. Data were analyzed using the SPSS version 20.0 through a univariate and multivariate analysis, and reporting was done in tables and figure. Results: There are slightly more males than females, with a male-to-female ratio of 1.02:1. Children aged between 2 and 9 years accounted for over two-third of the study population. The prevalence of anemia, leukopenia, and thrombocytopenia was 32.7%, 11.4%, and 3.04%, respectively. More than two-third of the participants was on zidovudine-based regimen, and there is a statistically significant association between anemia and the use of zidovudine-based ART regimen. Conclusion: Anemia is the most common hematological abnormality among HIV-infected children and adolescents. There is an association between the use of zidovudine and occurrence of anemia. The use of alternative drug to zidovudine is advocated.
Autologous Smashed Follicular Dermal Graft with Epidermal Cell Suspension in Chronic Nonhealing Leg Ulcers

Wound healing is a multifaceted process. Restoration of the epithelium may occur either by migration of activated epithelial keratinocytes from the adjoining epithelium or by centrifugal migration of putative stem cells found in the bulge region of the hair follicle. Dermal collagen and glycosaminoglycans also play a key role in laying down the scaffold for vascular in-growth and population of the matrix with host fibroblasts. Despite the availability of a wide range of treatment modalities, chronic nonhealing leg ulcers remain a therapeutic challenge and cause significant patient morbidity. Hence, there is a further need to develop novel techniques which would be effective, safe, easily available, and affordable for the patient.
Determinants of discordant immune response in a cohort of human immunodeficiency virus-infected patients initiating antiretroviral therapy

Background: The introduction and wide use of highly active antiretroviral therapy (HAART) have significantly resulted in decline in morbidity and mortality from human immunodeficiency virus (HIV) infection and its related complications. These drugs can effectively induce virological suppression of the HIV-RNA replication to below the level of quantification, with eventual rise in the CD4+ cells counts. This is the therapeutic goal of using HAART in HIV-infected patients. However, some HIV-infected patients commencing HAART might have adequate virological suppression without a corresponding rise in CD4+ cells count-a phenomenon referred to as discordant immune response (DIR) or immunological nonresponse. Objective: The objective is to determine the factors associated with DIR among HIV-infected patients with adequate virological suppression, after initiating HAART. Materials and Methods: This study was a descriptive, retrospective, cross-sectional study that analyzed data from 200 HIV-infected adults that have been on HAART for 12 months descriptive statistics were used to describe the demographic profile of the participants, and binary logistic regression was used to assess the factors predicting DIR among the studied population. Results: One hundred and thirty-six (68%) were female with a mean age of 40.5 ± 10.9 years. The mean baseline CD4+ cells count was 162 ± 95.9 cells/mm3. Twelve months after HAART initiation, 64 (32%) of patients were immunological nonresponders. On multivariate analysis (logistics regression), patients initiating treatment at a higher CD4+ cells count >200 cells/mm3 (adjusted odds ratio [AOR] 3.89; confidence interval [CI]: 1.64–9.22; P = 0.002), the presence of anemia (hemoglobin <11.0 g/dl) (AOR 2.58; CI: 1.11–5.98; P = 0.027), and hepatitis C virus (HCV) positivity (AOR 9.84; CI: 3.10–18.12; P = 0.003) were independently associated with the development of DIR among the studied population. Conclusion: DIR among the studied population was common and associated with high baseline CD4+ cells count, baseline anemia, and HCV positivity from our HIV-infected patients. Thus, there is a need for adequate evaluation and monitoring of at-risk individuals to improve clinical outcomes.
Maximizing Learning and Creativity: Understanding Psychological Safety in Simulation-Based Learning

Psychological safety refers to the belief that one can express oneself without fear of the negative consequences or feedback that their speech, comment, or action might generate. It is about the willingness of learners or workers in an organization, in expressing themselves physically, cognitively, and emotionally. Psychological safety is very dynamic and will continue to evolve and change, with the interplay of a variety of external and internal factors affecting the individual, the organization, or the community. It is also closely linked to the culture in the organization, the institution, or the department. It has become a new norm, especially in high-frequency, high-intensity, and high-performance institutions and workplaces, that psychological safety must be mainstreamed and should not be just an incidental element. It also serves as a foundation for effective learning. When people feel safe and comfortable, they are more open to development, growth, and negotiating change. This is a current opinion piece by the author, who is the Director of The SingHealth Duke NUS Institute of Medical Simulation in Singapore. This is the largest and most comprehensive facility in Singapore, which is also the largest in South-East Asia. It has accreditation by the Society for Simulation in Healthcare. The paper is unique in sharing the perspectives of psychological safety in simulation-based education as well as many of the issues related to culture, which can trump strategy. Characteristics and attributes for facilitators, team training and dynamics, as well as the issue of power and hierarchy are also addressed.
A Comparative Study to Assess the Efficacy of Fractional Carbon Dioxide Laser and Combination of Fractional Carbon Dioxide Laser with Topical Autologous Platelet-rich Plasma in Post-acne Atrophic Scars

Context: Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit prevalent in adolescent population. Atrophic acne scarring negatively affects the quality of life. Although challenging to treat, the introduction of fractional carbon dioxide (CO2) laser and platelet-rich plasma (PRP) therapy for atrophic scars has opened up new avenues. Aim: The aim of this study was to evaluate and compare the efficacy of fractional CO2 laser alone and in combination with topical PRP in treating post-acne atrophic scars. Subjects and Methods: A hospital-based prospective, double-blinded, randomized, and comparative study was conducted. A total of 33 cases with post-acne atrophic scars of moderate to severe grade were randomly allotted into Group A and Group B who were treated for three monthly sessions of fractional CO2 laser followed by topical PRP and fractional CO2 laser monotherapy, respectively. Evaluation at baseline and every visit was carried out and compared at the end of 12 weeks. Results: Of the 33 patients, 25 completed the study. The mean change in score was higher in subjects of Group A. The mean scar score significantly reduced in both groups. The mean visual analog scale was higher in Group A. The reduction in scar score was significantly higher in patients with rolling scars and boxcar scars and least in ice pick scars. Erythema, edema, pain, and hyperpigmentation were higher in Group B. Conclusion: Combination therapy with PRP is more efficacious in reducing post-acne atrophic scars and reducing adverse effects of laser therapy as compared to fractional CO2 laser monotherapy.
Reliability of transcutaneous bilirubin estimation during phototherapy in term infants: A hospital-based observational study

Background:Blood sampling method is the most common but invasive method for bilirubin estimation. Transcutaneous bilirubin (TCB) estimation, on the other hand is non-invasive. Objectives: The aim was to compare neonatal bilirubin estimation by serum bilirubin and transcutaneous bilirubinometer methods both pre- and during phototherapy and establish the precision of transcutaneous bilirubinometer. Materials and Methods: This prospective hospital-based observational study was conducted on 350 term neonates over a period of 2 years. Bilirubin was estimated in all newborn by both serum bilirubin and transcutaneous method, at the time of admission in nursery (prephototherapy), at 6 h after phototherapy (while neonates were still under phototherapy treatment), and at withholding phototherapy, and a photo opaque patch of 2.5 cm was used to cover the area on midforehead and transcutaneous bilirubin was estimated from this area after removing it during phototherapy. All data were tabulated and analyzed by relevant statistical tests. Results: A total of 350 term healthy newborns with mean gestational age of 38 ± 2 weeks and mean birth weight of 2.97 ± 0.9 kg were studied. Correlation analysis revealed a significant correlation between total serum bilirubin and transcutaneous method (TCB) measurements of bilirubin. When these methods were compared at pre-phototherapy, at 6 hours after phototherapy and before withholding phototherapy, correlation coefficient(r) of 0.9571, 0.7988, and 0.9206 were seen respectively. The precision levels of transcutaneous bilirubinometer (BiliCheck™) were good because plotting of Bland–Altman graphs showed maximum (>97%) data within agreement limits at all stages of phototherapy. Conclusion: Our study revealed good correlation and precision of transcutaneous bilirubinometer both before and during phototherapy. Thus, it supports the previous studies which justify the use of transcutaneous bilirubinometer in assessing newborn jaundice during phototherapy.
Relationship of body mass index, abdominal obesity, and metabolic parameters with depression among reproductive-age women

Background and objective: Obesity has been widely regarded as a public health concern because of its adverse impact on health. The aim of this study is to examine the relationship of body mass index, abdominal obesity, and metabolic parameters with depression among reproductive-age women. Subjects and methods: Two hundred and seventy-one women who admitted to the Endocrine and Diet Polyclinic of İzmir Bozyaka Training and Research Hospital, Turkey were included. Sociodemographic characteristics were gathered using a data collection form. Biochemical findings were examined in fasting blood samples and anthropometric measurements were taken. Depressive symptoms of participants were measured with Beck Depression Inventory. This study was performed with the permission from Chief Physician of Izmir Bozyaka Training and Research Hospital (No. 4.35.94.02-003) and approval from the Senate Ethics Committee of Hacettepe University Faculty of Medicine (Decision No. 431-1305). Results: Mean score of participants for Beck Depression Inventory was 17.8 ± 11.8. Body weight, body mass index and waist circumference were higher in the group with high level of depressive symptoms than in the group with low level of depressive symptoms (P < 0.05). Fasting blood glucose, fasting insulin, Homeostasis Model Assessment-Insulin Resistance value, triglyceride and low-density lipoprotein cholesterol were also higher in the group with high level of depressive symptoms than in the group with low level of depressive symptoms; but only HOMA-IR and triglyceride differences were statistically significant (P < 0.05). Being overweight or obese was associated with increased risk of high level of depressive symptoms (OR = 4.853, 95% CI: 2.646–8.903). Although the ratio of having high level of depressive symptoms was higher in women with abdominal obesity (50.3%) compared to women without abdominal obesity (39.5%), the difference was not statistically significant (P = 0.078). Conclusion: In this study, it was determined that the level of depressive symptoms was higher in overweight or obese women than women with normal body weight. It may be useful to monitor women who apply for weight control in terms of risk of depression.
Profiling urinary tract infections bacteria among elderly population in a Nigerian Teaching Hospital

There have been conflicting reports about prevalence of Urinary Tract Infections (UTIs) causing bacteria in elderly in recent times. This study aims to evaluate the prevalence and resistance pattern of UTIs causing bacteria in elderly Nigerian patients. A prospective cross-sectional study was carried out among elderly patients attending the general and medical outpatients’ clinics of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Patients aged 60 years and above with at least two signs of UTIs were purposefully selected for the study. Clean catch mid-stream urine specimens from 100 eligible patients were examined for significant bacteriuria. Identification and antibiotics susceptibility patterns of the isolates were determined using standard techniques. Data were analysed using descriptive statistics such as frequency and percentage. Association between variables was determined using Chi-squared test. P values<0.05 were considered significant. One hundred elderly outpatients were evaluated. Majority of the study participants were males (68, 68.0%) and (64, 64.0%) were married. More than half of the participants (59, 59.0%) had no significant bacteriuria. Among the participants with significant bacteriuria (41, 41.0%), males (29/41, 70.7%, p=0.001) were more than the females (12, 29.3%). Klebsiella pneumoniae (19/41, 46.3%) was the most isolated organism in the participants’ urine specimens, (35/41, 85.4%) of the isolates were resistant to nitrofurantoin. Klebsiella pneumoniae was the most isolated UTIs-causing bacteria among the elderly evaluated. Physicians need to be aware of trends in profiles of UTIs-causing bacteria for effective diagnosis of the disease in elderly. Journal of Medical and Biomedical Sciences (2017) 6(3), 15 - 22
Hardness vs. (Very Little) Structure in Cryptography: A Multi-Prover Interactive Proofs Perspective

The hardness of highly-structured computational problems gives rise to a variety of public-key primitives. On one hand, the structure exhibited by such problems underlies the basic functionality of public-key primitives, but on the other hand it may endanger public-key cryptography in its entirety via potential algorithmic advances. This subtle interplay initiated a fundamental line of research on whether structure is inherently necessary for cryptography, starting with Rudich’s early work (PhD Thesis ’88) and recently leading to that of Bitansky, Degwekar and Vaikuntanathan (CRYPTO ’17). Identifying the structure of computational problems with their corresponding complexity classes, Bitansky et al. proved that a variety of public-key primitives (e.g., public-key encryption, oblivious transfer and even functional encryption) cannot be used in a black-box manner to construct either any hard language that has NP -veri(cid:28)ers both for the language itself and for its complement, or any hard language (and even promise problem) that has a statistical zero-knowledge proof system (cid:21) corresponding to hardness in the structured classes NP ∩ coNP or SZK , respectively, from a black-box perspective. In this work we prove that the same variety of public-key primitives do not inherently require even very little structure in a black-box manner: We prove that they do not imply any hard language that has multi-prover interactive proof systems both for the language and for its complement (cid:21) corresponding to hardness in the class MIP ∩ coMIP from a black-box perspective. Conceptually, given that MIP = NEXP , our result rules out languages with very little structure. Already the cases of languages that have IP or AM proof systems both for the language itself and for its complement, which we rule out as immediate corollaries, lead to intriguing insights. For the case of IP , where our result can be circumvented using non-black-box techniques, we reveal a gap between black-box and non-black-box techniques. For the
Optimal and Error-Free Multi-Valued Byzantine Consensus Through Parallel Execution

Multi-valued Byzantine Consensus (BC) , in which n processes must reach agreement on a single L -bit value, is an essential primitive in the design of distributed cryptographic protocols and fault-tolerant distributed systems. One of the most desirable traits for a multi-valued BC protocol is to be error-free . In other words, have zero probability of producing incorrect results. The most eﬃcient error-free multi-valued BC protocols are built as extension protocols , which reduce agreement on large values to agreement on small sequences of bits whose lengths are independent of L . The best extension protocols achieve O ( Ln ) communication complexity, which is optimal, when L is large relative to n . Unfortunately, all known error-free and communication-optimal BC extension protocols require each process to broadcast at least n bits with a binary Byzantine Broadcast (BB) protocol. This design limits the scalability of these protocols to many processes, since when n is large, the binary broadcasts signiﬁcantly inﬂate the overall number of bits communicated by the extension protocol. In this paper, we present Byzantine Consensus with Parallel Execution (BCPE) , the ﬁrst error-free and communication-optimal BC extension protocol in which each process only broad-casts a single bit with a binary BB protocol. BCPE is a synchronous and deterministic protocol, and tolerates f < n/ 3 faulty processes (the best resilience possible). Our evaluation shows that BCPE ’s design makes it signiﬁcantly more scalable than the best existing protocol by Ganesh and Patra. For 1,000 processes to agree on 2 MB of data, BCPE communicates 10 . 92 × fewer bits. For agreement on 10 MB of data, BCPE communicates 6 . 97 × fewer bits. BCPE also matches the best existing protocol in all other standard eﬃciency metrics.