Miracle-dz/UniFAR-FTUs huggingface dataset:
Airway Management in ICU Settings

Maintenance of patent airway, adequate ventilation, and pulmonary gas exchange is very important in critically ill patients. Airway management in intensive care patients differs significantly from routine surgical procedures in the operating room. The airway compe‐ tence in intensive care unit (ICU) should be coping with the rapidly evolving advances in airway management. Therefore, efforts should be focused on the three pillars of air‐ way master: airway providers as intensivists or critical care physicians, equipment, and operational plans. Not all institutions can afford all airway equipment in the market; however, they should make sure that critical care providers have a full access to the avail‐ able tools and they are comfortable using it. Educational sessions and refresher courses should be tailored to meet the competence level of the ICU providers and equipment availability. Operational plan includes developing institutional airway protocols and implementing difficult airway guidelines. The protocols should consider different staff‐ ing models of ICU and make sure all the time at least one member of the team with the highest experience in airway should be always available. The aim of writing this chapter is to enable the intensivist to optimize their use of airway equipment and managing high‐ risk patients in ICU.
Obesity, Nutrition, and Physical Activity for People with Significant Disabilities.

: This review of literature focuses on health issues for individuals with Intellectual Disabilities (ID), Intellectual and Developmental Disabilities (IDD), and Multiple Impairments (MI). This population has two to three times higher overweight and obesity prevalence than typically developing individuals. Furthermore, they have higher risk for obesity related diseases such as reduced lifespan and quality of life. Contributing factors for higher rates of overweight or obesity, effective interventions, and barriers to health knowledge and practice are discussed. Implications and future research needs are highlighted.
Understanding the dynamic regulation of SOCS3

In the past two decades, it has become evident that signal transduction pathways are more than two dimensional pathways consisted of proteins that are just activated or supressed in response to distinct cues. Instead, the dynamic nature of key proteins regulates the strength and quality of the signal. Several key signal transduction pathways are controlled by negative feedback loops that are highly dynamic and demonstrate oscillatory behaviours. Negative feedback regulation of the JAK/STAT pathway by Suppressors of Cytokine Signalling (SOCS) is an example of oscillatory signalling. We sought to investigate the oscillatory capacity of the tumour suppressor protein SOCS3 and its role in important cellular functions using whole-cell population and single-cell analysis. An important aspect of cell biology using experimental cell-population techniques is to produce a synchronized cell culture. Serum starvation and subsequent shock is able to capture the oscillatory behaviour of SOCS3 protein to some extent. However, the average response in whole-cell population systems demonstrated to be ‘noisy’ leading to establishment of a single-cell analysis system. To investigate SOCS3 oscillation at the single cell level, we first attempted to generate cell clones stably expressing SOCS3 C-terminal GFPSpark fusion protein from its respective endogenous promoter to monitor its expression in real time with confocal microscopy. Despite careful optimization of each step of CRISPR/Cas9 strategy, the generation of GFPSpark knockin cell line was not successful. Finally, we utilised the tandem fluorescent protein timer (tFT) strategy to investigate localisation and trafficking of SOCS3 protein and monitor its promoter activity in response to different stimuli. The use of tFT provided us the ability to analyse SOCS3 dynamics across spatial and temporal dimensions under either normal culture conditions or different treatments that are known to influence on SOCS3 half-life and degradation rates.
Programmed Cell Death 1 (PD-1) Ligand (PD-L1) Expression in Solid Tumors As a Predictive Biomarker of Benefit From PD-1/PD-L1 Axis Inhibitors: A Systematic Review and Meta-Analysis.

PURPOSE Drugs targeting the programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) pathway show significant clinical activity across several tumor types. However, a majority of patients do not respond to these agents. Use of biomarker assays to predict response to these agents is an active area of research; however, the predictive value of PD-L1 immunohistochemistry (IHC) assays is largely inconsistent across clinical trials. In this meta-analysis of clinical trials of PD-1/PD-L1-targeted agents, we evaluate the predictive value of a tumor and tumor-infiltrating immune cell PD-L1 IHC assay as a biomarker for objective response to PD-1/PD-L1 inhibitors. METHODS We searched databases (PubMed, Medline, ASCO abstracts, European Society for Medical Oncology abstracts, and Scopus) up until December 2016 for clinical trials using PD-1/PD-L1 inhibitors with reported PD-L1 biomarker data. Objective response rates (primary end point) from all phase I to III trials investigating nivolumab, pembrolizumab, atezolizumab, durvalumab, and avelumab in advanced solid tumors were collected. Odds ratios (ORs) for response in PD-L1-positive patients compared with PD-L1-negative patients were calculated using the DerSimonian-Laird random effects model to combine trials. We performed meta-analysis as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Forty-one distinct trials with 6,664 patients were identified. PD-L1 expression was predictive of favorable response across all tumor types (OR, 2.26; 95% CI, 1.85 to 2.75; P < .001), with the significantly largest effect observed in non-small-cell lung cancer (OR, 2.51; 95% CI, 1.99 to 3.17; P < .001). A subgroup analysis across all non-small-cell lung cancer trials using nivolumab and Dako clone 28-8 (Dako, Carpinteria, CA) IHC antibody assay yielded a significantly higher objective response rate in patients with tumor PD-L1 expression even at the minimum cutoff value of 1% (OR, 2.17; 95% CI, 1.03 to 4.57). CONCLUSION Our meta-analysis shows that tumor and tumor-infiltrating immune cell PD-L1 overexpression based on IHC is associated with significantly higher response rates to PD-1/PD-L1 axis inhibitors across a range of malignant solid tumors.
The Factors Related To The Occurence Of Diarrhea Among 3-to-6-month Baby In Working Area Of Puskesmas Ngoresan

In the developing countries, diarrhea still becomes the main cause of morbidity and mortality on children. In 2010 at Surakarta area, it was found 4.683 (36.91%) diarrhea cases on baby, where the number of cases increase than the same cases in the previous year. In the other hand, the coverage of exclusive breastfeeding in Surakarta city 2010 decrease to 20,35%. The aim of this study was to identify the factors related to the occurence of diarrhea among 3 to 6 months baby in working area of Puskesmas Ngoresan. The research method used is observational analytic with case control approach. It was done in working area of Puskesmas Ngoresan with 30 respondents for case group and 30 respondents for control group between April to May 2012. The formula feeding and the occurance of diarrhea were measured with directed interview. The data were analyzed by chi-square test using SPSS 17.0 for windows. The chi-square analysis showed the score of x 2 = 22.937 with α = 0.05. It showed that H o was rejected and H a was accepted, therefore it can be concluded that there was significant correlation between formula feeding and the occurance of diarrhea on 3-6 months baby in working area of Puskesmas Ngoresan.
Influence of severe plastic deformation on the structure and mechanical properties of eutectic Al-Zn-Mg-Fe-Ni alloy

The structure and phase evolution of the new eutectic high strength aluminium alloy Nikalin were investigated under high pressure torsion (HPT) by several numbers of the revolution of the anvil. The chemical composition of the investigated Nikalin alloy was as follows: Al (base)– 7.22Zn–2.95 Mg–0.52 Fe–0.57 Ni–0.2 Zr. (wt.%). The initial material was a coarse grained cast ingot after homogenization. It was established that the HPT process resulted in the deformation dissolution of the nanosized T-phase precipitates and the formation of a supersaturated aluminum solid solution simultaneously with the strong refinement of the structure to the grain-subgrain size of 130-150 nm. Due to that, the yield stress of the HPT alloy increased by a factor of 1.5, the ultimate tensile strength increased by a factor of 1.4, while preserving good ductility of 6-7%. The observed effect of the additional supersaturated solution upon HPT relative to the homogenized state appeared upon post-deformation annealing at 140 °C. An increase in the microhardness of the HPT alloy due to the MgZn2 phase precipitation was observed at 0.5- hours of annealing.
Peripheral Leukocytes and Intracerebral Hemorrhage

About 70,000 people in the US die or suffer significant disability from spontaneous intracerebral hemorrhage (ICH) every year. No proven treatment is available that improves ICH outcomes. Since hematoma volume is the strongest predictor of ICH outcome, limiting hematoma expansion has been the primary goal of recent ICH clinical trials. Causes of secondary injury after the initial hemorrhage include hematoma expansion and cerebral edema. Identifying blood biomarkers associated with neurological deterioration and/or prognosis after ICH is a critical step for developing new therapies. Biomarkers that are mechanistically associated with hemostasis failure or cerebral edema would provide direction for exploring therapeutic targets, and identify patients in need of hemostatic or anti-inflammatory therapy. Peripheral white blood cell (WBC) count has been associated with hemorrhage volume and functional outcomes after ICH. However, it is unknown whether elevated WBCs represent an acute phase response or whether there is a pathophysiologic role of peripheral WBCs in ICH. Neutrophils and monocytes are predominant WBCs and peripheral neutrophil and monocyte infiltration have been found to contribute to secondary injury in animal models of ICH. Circulating monocytes particularly are well recognized to express significant amounts of tissue factor, interact with platelets, and modulate inflammation as well as thrombosis and hemostasis. We conducted the first human study to explore absolute monocyte counts in relation to ICH. We found that baseline peripheral monocyte count was independently associated with 30-day casefatality in ICH patients who presented to the emergency department within 12 hours of symptom onset. Absolute monocyte count, a readily available and ubiquitous biomarker at presentation in ICH patients, may represent a novel prognostic tool after ICH.
Renal cell carcinoma in a semi-urban population of south-western Nigeria

Objective : To describe the demographic features, treatment challenges and prognosis of renal cell carcinoma (RCC) in a semi-urban population of south-western Nigeria Design : A retrospective review of RCC managed between January 2007 and December 2014 Setting : Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, southwestern Nigeria Subjects : Fifty-one patients with histologically confirmed RCC Interventions: Radical nephrectomy, Immunotherapy Main outcome measures : Surgical outcomes Results : A total of 51 cases were reviewed, representing 46.8/100,000 of all new patients. Age range was 21 to 83 years, with peak in third decade and male to female ratio of 1:1.5. Identified risk factors were systemic hypertension (15.7%), smoking (11.8%) and obesity (3.9%). Triad of haematuria, loin pain and loin mass was found in 13.7% while 5.9% were discovered incidentally. The right and left kidneys were involved in 41.2% and 58.8% respectively. Radical nephrectomy was the most common procedure done (78.4%). Surgical complications included excessive primary haemorrhage (8.5%), surgical site infection (6.4%) and duodenal injury (2.1%) while mortality was (2.1%). Adjuvant immunotherapy with sunitinib/sorafenib was given in 7.8% of patients. The histologic types were clear cell (60.8%), chromophobe (17.6%), papillary (13.7%), sarcomatoid (3.9%), mixed (1.9%) and multilocular cystic RCC (1.9%). Clear cell variant were low grade with good prognosis. Poor prognostic factors were sarcomatoid histology and late presentation Conclusion : RCC is more common in females mainly of the younger age group in our environment. Radical nephrectomy remains the mainstay of management, including in advanced cases.
Fertility knowledge, care seeking behavioral pattern and attitudes of infertile men in Lagos, Nigeria

Background: The objective was to study the extent of infertility knowledge, attitude and care seeking behavioral pattern of infertile men in Lagos. Methods: A cross sectional study was carried out using questionnaire between 2009 and 2014. Adult males who were clinically infertile, visiting the clinics for the first time and consented were studied. Descriptive statistics were used for the analysis. Results: Only 226 men, mean age 38±5.8 years participated. Up to 20.8% had sired a child for between >1 but <2, 20.4% for 2-5 and 58.8% for ≥6 years. Couples had coitus for once and >3 times (mean coitus 2.3±0.9 times) weekly. Only 11.1% knew about male-female factor infertility. Up to 42.9% knew about fertility and the sign of female ovulation and 38.1% correctly defined clinical infertility. Up to 40.3% switched treatment for competency of the new places and exorbitant price by 22.1%. Sixty-six (29.2%) made the first visit to a proper care place within a period >1 but <2 years, 45.1% within 2-3 years and 25.7% waited for >3 years. Majority (50 %) sought to know the causes of infertility, 14.6% how to improve fertility and 6.6% the reality of male infertility. Conclusions: Majority of the participants sought inappropriate help and delayed in seeking appropriate care. Poor collaboration and referral system observed. There is need for edification of both care providers and seekers to be ethical in their actions. Infertility care cost intervention is needed.
Treating Neonatal Abstinence Syndrome from Clinical Perspectives

Background: The Finnegan scoring system which is used to initiate and guide neonatal abstinence syndrome (NAS) therapy has several limitations that make it difficult to be used by many healthcare providers. Therefore in practice many experienced clinicians use their clinical judgements for initiating and continuation of NAS treatment. Objectives: Assessing the degree of association between clinical judgments of experienced neonatologists and the Finnegan scoring system to initiate NAS treatment, and identifying the most prevalent items of the Finnegan scoring system which are independently associated with the need for NAS treatment. Methods: This multi-centric prospective cohort study evaluated 60 admitted neonates who were born to illicit drugs dependent mothers and exhibited signs and symptoms of NAS. Neonates were evaluated based on the Finnegan scoring system once at birth and every four hours. Three consecutive Finnegan scores of ≥ 8 or two consecutive Finnegan scores of ≥ 12 were considered as the requirement for treatment with morphine. Five expert neonatologists with > 15 years of experience, who were blinded to the Finnegan score results visited the patients and their clinical judgments for initiating the medical treatment for NAS were recorded. Results: Based on the Finnegan scoring system 26.7%, and based on the clinical judgment 30% of neonates required medical treatment. There was an excellent correlation between Finnegan scoring system and clinical judgment of experienced neonatologists (r = 0.75, P < 0.001), which was highly sensitive (87.5%) and specific (90.9%) in detecting neonates with NAS who required medical treatment. Tremor (P < 0.001), convulsion (P = 0.001), projectile vomiting (P = 0.001), increased muscle tonicity (P = 0.02), tachypnea (P = 0.04), and poor feeding (P = 0.04) were the items of the Finnegan score that regardless of their severity were independently associated with the requirement for pharmacologic treatment. Conclusions: In special circumstances when using Finnegan scoring system in regular basis is not applicable, initiating NAS treatment based on the clinical judgments of expert neonatologists can be acceptable. Tremor, convulsion, increased muscle tonicity, tachypnea, projectile vomiting, and poor feeding can be used for screening neonates after birth for early identification of opioid-exposed infants who might require medical treatment.
Time-Reassigned Multisynchrosqueezing Transform for Bearing Fault Diagnosis of Rotating Machinery

The impulse features in a condition monitoring (CM) signal usually imply the occurrence of a defect in a rotating machine. To accurately capture the impulse components in a CM signal, a concentrated time-frequency analysis (TFA) method based on time-reassigned synchrosqueezing transform (TSST) is proposed. First, the limitation of the TSST method in dealing with strong frequency-varying signals is explored. Second, an iteration procedure is introduced to address the blurry time frequency representation problem of TSST. The convergence of the iteration algorithm is also analyzed. Finally, an algorithm is proposed to extract the impulse features for signal reconstructions, which are also useful for an accurate diagnosis of the fault type. A simulated noise-contaminated signal and three sets of experimental data are employed in this article to evaluate the performance of the proposed method. Results obtained from this article confirm that the proposed method has a better performance in dealing with impulsive-like signals than other TFA methods.
The place of living, school and family influence on the pattern of physical activity and sedentary behavior of adolescents: a cross sectional study

The aim of this study was to determine the influence of place of living, type of school, and family background on the physical activity and sedentary behavior of adolescents. 1,280 adolescents took part in the research: 694 boys and 586 girls aged 16–19 from Poland. Physical activity (PA) and sedentary behavior (SB) were evaluated by IPAQ-long version. A multiple regression analysis was used to evaluate the influence of socio-economic factors on physical activity and sedentary behavior. The results suggested a difference between boys and girls in all domains of physical activity and sedentary behavior. The results also indicated that social factors influence physical activity and sedentary behavior in different ways. After adjusting the model to BMI and age tested, the key determinants for boys’ physical activity were: type of leisure time in the family and place of living, while for girls – type of school and type of leisure time in the family. Sedentary behavior of both sexes were strongly dependent on type of school, and – for boys – parents’ education and type of leisure time in the family were also important. The results suggest the need for continuous monitoring of physical activity and seated behavior as well as taking into account a wide spectrum of social factors in which adolescents grow. Interventions and strategies to promote physical activity should focus on family involvement and uniting family and educational institutions operating in local environments.
Retention of early career registered nurses: the influence of self-concept, practice environment and resilience in the first five years post-graduation

Health care systems depend on viable health professional workforces. Nurse workforce projections for Australia indicate that by 2030 the demand for nurses will exceed supply. Retaining nurses is an ongoing problem both in Australia and globally. This study investigates nurse self-concept, practice environment and resilience, and how these three factors influence the retention of early career registered nurses (ECRNs). ECRNs are defined as RNs in the first 5 years of practice post-graduation. The researchers used a cross-sectional design for the study. Survey responses were elicited from 161 ECRNs in one Australian hospital and health service using four survey instruments: The Nurse Self-Concept Questionnaire, the Practice Environment Scale of the Nursing Work Index, the Connor–Davidson Resilience Scale and the Nurse Retention Index. Study findings demonstrate correlations between ECRN retention intentions and nurse self-concept, practice environment and resilience. The significance of these factors at different points during the first five years of practice emphasises the need for judicious and well-timed use of strategies to positively influence nurse retention. Longitudinal research investigating the significance of influencing factors over time would further contribute to our understanding of ECRN retention intentions.
Quality and safety of handover in intensive care

Introduction Handover is an inevitable and essential aspect of caring for critically ill patients and information handed over should be accurate, succinct, and sufficient to allow the seamless continuation of care between teams. Objectives To assess staff involvement, time taken for the handover, key components addressed, availability of a standard format and factors causing disturbances to an effective handover were the key components studied to determine the quality and safety. Methodology Study population were doctors and nursing offices working in the general and specialised ICUs of the National Hospital of Sri Lanka, De Soysa maternity hospital and the Castle street hospital for women. Study period was July to September 2013. Sample size was 120. Data was collected using a self-administered questionnaire based on the guidelines on clinical handover by the Australian Medical Association. Data was analysed as simple percentages and review of absolute numbers using bar and pie charts for each ICU. Results The doctor’s presence in the nurse’s handover and nurse’s presence in doctor’s handover was less than 70% in all the ICUs. There was no fixed time for handover in 92% of ICU shifts and nearly 90% of times it happened after the conclusion of the shift and the average time taken was 30mins. Compliance with the recommended content of handover was more than 60% in almost all the ICUs. There was no structured format for handover in any of the ICUs. Telephone calls were the most common distracting factor identified. Conclusion / Recommendations Handover can be made more effective and safe with implementation of a printed handover sheet for use as well as an overlapping shift pattern in duty rosters, dedicated time and a place for handover.
Skeletal Muscle Dysfunction in Critical Illness

Despite improvements in critical illness survival rates with recent developments in medical care, many patients still have long‐term physical disabilities following stays in the intensive care unit (ICU). Critical illness–induced muscle weakness, so‐called ICU‐acquired weakness (ICU‐AW), is a common occurrence in approximately 50% of critically ill patients in the ICU requiring mechanical ventilation for >7 days. ICU‐AW contributes to increases in duration of mechanical ventilation and lengths of ICU and hospital stays and may persist among survivors for several years after discharge. Risk factors for ICU‐AW include systemic inflammatory responses, severe sepsis, muscle inactivity, hyperglycemia, and use of neuromuscular blockers. Thus, the development of muscle wasting is suggested to be associated with pathophysiological alterations leading to an imbalance between muscle proteolysis and proteosynthesis through several cellular signaling networks. This chapter presents a review of the literature regarding critical illness–induced muscle wasting and describes potential treatment of excessive muscle catabolism.