Miracle-dz/UniFAR-FTUs huggingface dataset:
Effectiveness of Simulation-based Clinical Skills Training for Medical Students in Respiratory Medicine: A Pilot Study.

OBJECTIVE To assess the effectiveness of high-fidelity simulation-based medical education (HF-SBME) in teaching and learning respiratory clinical examination in medical students. STUDY DESIGN Quasi-experimental pilot study. PLACE AND DURATION OF STUDY The Aga Khan University, Karachi, from November 2018 to January 2020. Methodology: This study was conducted amongst third year medical students at the University. Students were assigned to intervention (IG) or control groups (CG). The IG underwent training for the respiratory clinical examination on a high-fidelity simulator mannequin, while the CG received the conventional practice session on standardised patients. Students were assessed on their respiratory clinical examination skills in five domains, and each domain was scored between 1-3 points (poor=1, fair=2, good=3) for a maximum composite score of 15. Feedback on use of SBME was also obtained from students. RESULTS There were no statistically significant differences in demographics for the CG (n=41) and IG (n=40). Composite score for control and intervention groups was not significantly different (CG: 12.9 ± 1.89 vs. IG: 12.0 ± 2.35; p=0.067). However, a greater percentage of CG students were rated good in all five domains, with the difference being statistically significant for ability to correlate findings with clinical history (CG: 87.8% vs. IG: 67.5%; p=0.028). CONCLUSION Although medical students perceived HF-SBME as a beneficial teaching modality, it did not translate into improved performance. More research is required to determine the utility of HF-SBME in a developing country, like Pakistan. Key Words: Simulation, High-fidelity, Medical education, Developing country, Clinical skills.
Application of three-dimensional Raman imaging to determination of the relationship between cellular localization of diesel exhaust particles and the toxicity

Abstract A diesel exhaust particle (DEP) is a type of particulate matter that is easily produced from combustion in a diesel power engine. It has been reported that DEPs can cause short- and long-term health problems. This is because DEPs are complex mixtures that are highly inhalable through the airways due to their small particle size. However, the relationship between intracellular localization of DEPs after their deposition in the lungs and the subsequent biological responses remains to be clarified. This is due to difficulties in distinguishing particles that are inside the cells from those that are outside. In this study, A549 human lung epithelial cells were exposed to DEPs at concentrations of 0, 25, 75, or 200 µg/mL for different periods, after that particles in the A549 cells were analyzed by three-dimensional (3D) images obtained from a Raman microscope. The cytotoxic effects of DEPs on the A549 cells were investigated by measuring cell viability, the levels of intracellular reactive oxygen species (ROS) and cell death. The Raman microscopy revealed that the particles invaded the A549 cells, and at a concentration of 200 µg/mL, they markedly decreased cell viability, increased intracellular ROS production, triggered late apoptosis/necrosis and induced nuclear damage. These results suggest that intracellular DEPs exposed at a high concentration may be highly toxic and can impair the viability of A549 cells. Furthermore, the 3D images from the Raman microscopy can be used to evaluate intracellular particle dynamics.
Influence of Various Thong Style Flip-flops on Gait Kinematics and Lower Leg Electromyography

ii Acknowledgements . iv List of Tables . viii List of Figures . ix List of Abbreviations . xiii Chapter I: Introduction . 1 Purpose . 6 Hypotheses . 7 Limitations . 7 Delimitations . 8 Definition of Terms.8 Chapter II: Review of Literature . 11 Section 1: Human Locomotion and the Phases of Gait . 12 Section 2: Anatomy of the foot and lower leg . 22 Section 3: The Foot Arches.28 Section 4: Influence of Footwear on Gait . 31 Section 5: Summary of the Literature . 53 Chapter III: Methods . 55 Participants . 55 vi Setting . 56 Instrumentation . 57 Design and Procedures . 70 Experimental Design and Data Analysis . 72 Chapter IV: Results . 74 Section 1: Participant Demographics . 74 Section 2: Normal Arch and Gait Kinematics . 75 Section 3: Footwear Arch and Arch Foot Type Kinematics . 83 Section 4: Normal Arch and Surface Electromyography . 104 Chapter V: Discussion . 108 Section1: Footwear and Gait Kinematics . 109 Section 2: Footwear Arch and Foot Arch Type . 121 Section 3: Surface Electromyography (sEMG) . 130 Section 4: Summary . 132 Section 5: Conclusions and Future Research . 141 References . 149 Appendix A: ANOVA Table for the Effect of Footwear on Gait Kinematics . 155 Appendix B: ANOVA Table for the Effect of Footwear and Arch Type on Gait Kinematics . 156 Appendix C: ANOVA Table for the Effect of Footwear on sEMG . 157 Appendix D: Raw Surface Electromyography Signal of Tibialis Anterior for One Stride Length . 158 Appendix E: Peak Dorsiflexion During Swing Phase . 159 Appendix F: Eversion at Midstance . 160
Comparison of the efficacy of microneedling versus CO2 fractional laser to treat striae alba: A randomized clinical trial

Striae distensae (SD) are common skin conditions that have posed a significant challenge regarding their assessment and treatment. The present study aimed to evaluate the efficacy of microneedling in comparison to fractional CO2 laser therapy. Similar striae were selected and photographed. Each side was randomly assigned to be treated with CO2 fractional laser or microneedling four times at monthly intervals and followed up for 10 months. Outcome measures including the length and width of the largest striae, dermatologist assessed improvement, patients' satisfaction, and visual analog scale (VAS) were assessed. Wilcoxon signed‐rank test and Mann‐Whitney U test were used to assess the efficacy of treatments. Forty patients with a mean age of 28.1 years were included. The median cross‐section of the largest striae decreased significantly in both groups (P‐value <0.001), without statistically significant differences between the two groups before and 6 months after treatment. VAS also improved significantly in both groups, and there were no statistically significant differences between the two treatments in all visits. No clinically significant adverse effects were observed. Fractional CO2 laser and microneedling are both efficient treatments to resolve SD. A new light should be shed on the microneedling modality as it is more economical than the other treatment options.
The paradox of immunosuppressants and COVID-19

For millions of people, taking immunosuppressive medication to control or prevent disease is a daily reality [1]. Rheumatological disease, inflammatory lung disease, organ transplantation and graft-versus-host disease are but a few of the immune dysregulation syndromes that may require short- or long-term immunosuppressive therapy (IST). Patients taking ISTs are frequently regarded as immunocompromised, sharing risks of increased infection susceptibility with cancer patients receiving chemotherapy, those with profound neutropenia from haematological malignancies, and individuals living with HIV. In the context of the immune-mediated respiratory failure associated with coronavirus disease 2019 (COVID-19), an apparent paradox arises: can ISTs both promote and protect against severe COVID-19? Lessons learned from a large registry analysis show worse COVID-19 outcomes for patients previously exposed to glucocorticoids https://bit.ly/306rNrk
An exploratory double‐blind, randomized, placebo‐controlled study to assess the efficacy of CitruSlim on body composition and lipid parameters in obese individuals

The prevalence of obesity in developing and developed countries has been well recognized, and the worldwide obesity rates have nearly tripled since 1975, according to the World Health Organization. CitruSlim, a standardized product containing a blend of Citrus bergamia and Eurycoma longifolia, can reduce cortisol, cholesterol, triglycerides, and hyperglycemia. These properties can contribute to reduction in body weight or body mass index (BMI) in obese patients. A randomized, double‐blind, placebo‐controlled clinical study was designed to evaluate the efficacy and tolerability of CitruSlim in body weight management in obese individuals, and the results were compared with that of placebo. A total of 97 participants were allocated, randomized, and treated with CitruSlim high‐dose (HD, 400 mg), CitruSlim low‐dose (LD, 200 mg), and placebo for 112 days. At the end of the study, CitruSlim HD and CitruSlim LD significantly reduced BMI compared to the placebo group and were well tolerated; however, it did not improve parameters associated with dyslipidemia and metabolic disturbances. The study findings suggested that CitruSlim was effective in reducing body weight in obese patients.
Factors Favoring the Development of Chronic Subdural Hematoma After Traumatic Acute Subdural Hematoma in the Elderly

Introduction Traumatic acute subdural hematoma (TASDH) is by far the most common traumatic brain injury in elderly patients presented to the emergency department, and a number of those treated conservatively will develop chronic subdural hematoma (CSDH). The factors contributing to chronicity were not well studied in the elderly; therefore, we retrospectively analyzed our elderly patients with acute subdural hematomas to identify the risk factors which might contribute to the development of subsequent CSDH. Methods A retrospective analysis of 254 patients with TASDH admitted between 2012 and 2016 to our level 2 trauma department in a community hospital was collected. Data include age, sex, comorbid conditions, CT findings, anticoagulant therapy, surgical interventions, disposition after discharge, and mortality. Data on those readmitted within the first 2 months with the diagnosis of CSDH were also studied (group A), and compared to those not readmitted (group B). Multiple logistic regression was used to determine the risk factors associated with readmission at P ≤ . 05. Institutional review board approval was obtained for this study. Results There were 254 patients who were admitted with TASDH, 144 male (56.7%) and 110 female (43.3%), with the mean age of 71.4 (SD ± 19.38) years. Only 37 patients (14.6%) went for surgery in their initial admission. A total of 14 patients (5.6%) were readmitted subsequently with the diagnosis of CSDH within two months of initial discharge (group A). Only four patients (28.5%) were on anticoagulant therapy and these patients went for emergency craniotomy for evacuation of hematoma. All 14 patients had a history of coronary artery disease and hypertension and only 5 (35.7%) were diabetic. Review of head CT on initial admission of those patients revealed 4 patients (28.5%) had multiple lesions and 4 (28.5%) had tentorial/falax bleeding and 4 (28.5%) had a shift. The initial size and thickness of the bleeding was 1.4-5 mm. The adjusted model identified diabetes, race, and initial disposition as significant risk factors (P < .05). Conclusion Risk associated with the transformation of TASDH to CSDH is difficult to assess in those group of elderly patients because of the small number; however, diabetes, race, and initial disposition to home pointed toward a risk for future development of CSDH and those patients should be followed clinically and radiographically over the next few months after discharge, particularly those on anticoagulant therapy.
Effect of 2–6 weeks of systemic steroids on bone mineral density in children

Background The use of systemic steroids for 6+ weeks in children is associated with decreased bone mineral content (BMC) and density (BMD). However, the effects of a shorter duration of use on BMD are unknown. Purpose To determine the effect of the use of systemic steroids for 2–6 weeks on BMD and BMC in pediatric patients. Methods Twenty-five pediatric patients (21 with tuberculosis, 2 with systemic juvenile idiopathic arthritis, 1 with inflammatory bowel disease, 1 with autoimmune hemolytic anemia) who received systemic steroids for 2–6 weeks and 25 age- and sexmatched controls were enrolled. BMC, BMD, and z scores of the whole body (WB), lumbar spine (LS), nondominant distal radius (DR), and total body less the head (TBLH) were determined by dual-energy x-ray absorptiometry at baseline, the end of steroid therapy or 6 weeks (whichever was earlier; first follow-up), and at the end of 3 months from baseline (second follow-up) in patients and at baseline in controls. The values were adjusted for confounding variables. Continuous and categorical variables were compared using Student t test and the chi-square test or Fisher exact test, respectively. Pairwise comparisons employed Bonferroni correction. Results Statistically significant decreases in BMC, BMD, and all z scores were observed. BMC declined by 5.37%, 2.08%, 1.82%, and 2.27%, and 11.42%, 3.75%, 3.34%, and 4.17% for WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. Similarly, BMD declined by 2.01%, 2.31%, 2.18%, and 1.70% and 4.59%, 3.76%, 3.14%, and 3.50% for the WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. A significant negative correlation was found among bone densitometric parameters, duration, and cumulative dose. Conclusion The use of systemic steroids for 2–6 weeks in pediatric patients decreased the BMD and BMC of trabecular and cortical bones, an effect that persisted after discontinuation.
Generic Engineering Competencies: A Review and Modelling Approach

This paper puts forward the view that engineering educators have a responsibility to prepare graduates for engineering work and careers. The current literature reveals gaps between the competencies required for engineering work and those developed in engineering education. Generic competencies feature in these competency gaps. Literature suggests that improving the development of generic competencies in engineering graduates has met with barriers. One identified problem is that a relatively low status is assigned to generic competencies in engineering education. This review focuses on competencies that are required by professional engineers across all engineering disciplines, in Australia, Europe, New Zealand, and the USA. The literature suggests that engineering educators should focus on developing “generic engineering competencies” rather than separate generic competencies and engineering competencies. A method, developed at the University of Western Australia for identifying the generic engineering competencies required by engineers graduating in Australia, is outlined.
Precarious Work in Midlife: Long-Term Implications for the Health and Mortality of Women and Men

Although prior research documents adverse health consequences of precarious work, we know less about how chronic exposure to precarious work in midlife shapes health trajectories among aging adults. The present study uses longitudinal data from the Health and Retirement Study to consider how histories of precarious work in later midlife (ages 50–65) shape trajectories of health and mortality risk after age 65. Results show that greater exposure to unemployment, job insecurity, and insufficient work hours in midlife predicts more chronic conditions and functional limitations after age 65. Characteristics of precarious work also predict increased mortality risk in later life. Findings indicate few gender differences in linkages between precarious work and health; however, women are more likely than men to experience job insecurity throughout midlife. Because precarious work is unlikely to abate, results suggest the need to reduce the health consequences of working in precarious jobs.
Reconstruction of Silica Exposure at a Foundry for Evaluation of Exposure-Response

The reconstruction of working lifetime exposures to silica at a large foundry was described. Through the use of interviews with long-term employees, a history of the facility was developed for the years 1960–90, areas of similar work activities were identified and work locations for those with various job titles were documented over time. Two thousand and seventy historical industrial hygiene measurements of exposure collected during these three decades were linked to work area and an estimate of average respirable silica concentration was calculated for each area, by year. Overall, exposures declined between 1960 and 1990; however, substantial differences in exposure were estimated across work areas. Exposure at a specific job was calculated from the estimates of work-area respirable silica concentration, weighted by the amount of time persons with that job were in the area. These job-related exposure estimates were used to calculate three exposure metrics for persons employed in the foundry: cumulative, working lifetime average and highest daily exposure.
Updated Molecular Spectrum of β-Thalassemia Mutations in Duhok Province, Northern Iraq: Ethnic Variation and the Impact of Immigration

Abstract Immigration impact on genetic epidemiology of thalassemia worldwide is well-recognized. Over the past decade, the Duhok Province of Northern Iraq attracted a large number of immigrants. To assess whether immigration had contributed to changes in the mutation spectrum of β-thalassemia (β-thal) in the region, we recruited 218 registered patients with symptomatic β-thal. The recruited patients included 50 (22.9%) from resettled migrant families. A total of 431 β-thal alleles were fully characterized, with 20 different thalassemia mutations, the most frequent being IVS-II-1 (G>A) (HBB: c.315 + 1G>A), IVS-I-6 (T>C) (HBB: c.92 + 6T>C), codon 5 (–CT) (HBB: c.17_18delCT), IVS-I-110 (G>A) (HBB: c.93-21G>A), codon 44 (–C) (HBB: c.135delC), codon 8 (–AA) (HBB: c.25_26delAA) and IVS-I-1 (G>A) (HBB: c.92 + 1G>A) constituting 72.8% of the total. Some differences in mutation spectrum were observed compared to earlier studies from this same province, the most notable of which were the higher frequencies of IVS-I-110 and codon 8. Interestingly, the highest proportions of alleles related to immigrants were encountered in these two allele groups. Ethnic variation was also documented, so that while Muslim Kurds had IVS-II-1, IVS-I-6, IVS-I-110, codon 5 and codon 44 as their most frequent mutations, the most frequent among Kurdish Yazidis, were codon 5, codon 44, codon 8 and IVS-I-6. These ethnic variations and changes in mutation spectrums are important and should be taken in consideration to ensure effective implementation of the thalassemia preventive program.
Parametric Study of Offshore Pipeline Wall Thickness by DNV-OS-F101, 2010

DNV-OS-F101 includes the concept development, design, construction, operation,and abandonment of offshore pipeline systems. The main objective of this offshore standard (OS) is to ensure that pipeline systems are safe during the installation and operational period. The pipeline design philosophy also includes public safety and environmental protection. The mechanical wall thickness design of a pipeline shall follow the design objectives and safety philosophy. This new design code includes a very sophisticated design procedure to ensure a safe pipeline, public safety, and environmental protection. This paper presents the results ofa parametric study for the wall thickness design of offshore pipelines. A design matrix was developed to cover the many design factors of pipeline integrity, public safety, and environmental protection. Sensitivity analyses of the various parameters were carried out to identify the impacts on offshore pipeline design.
Efficient linear-quadratic filtering

We present two approaches to efficient linear-quadratic (LQ) filtering. The first of these is implemented in the frequency domain and requires less computations than the second (time domain) approach. The savings are similar to those obtained by executing linear filtering in the frequency domain with the use of the Fast Fourier Transform (FFT). The one drawback of the frequency domain method is the delay that is induced that is related to FFT length. A time domain method that does not suffer from this delay problem is subsequently derived. Our time domain approach involves rearranging the LQ filtering structure so that the quadratic part of the system consists of a bank of linear filters that can be run in parallel. The inputs to these linear filters are products of the original input signal.
Effects of Varying Levels of Data Use to Intensify a Multisyllabic Word Reading Intervention for Upper Elementary Students With or at Risk for Reading Disabilities

For students who show inadequate response to research-based intervention, intensification of intervention using data-based decision making (DBDM) is recommended. There is a paucity of research on upper elementary students related to the efficacy of (a) word reading interventions and (b) DBDM procedures. This randomized controlled trial examined the differential effects of data use at two timepoints to intensify a multisyllabic word reading intervention for Grades 4 and 5 students with or at risk for reading disabilities (RD). Eighty-eight students were randomly assigned to one of three conditions: initial customization of the intervention (IC-only), initial customization with DBDM (IC + DBDM), or a business-as-usual comparison condition. Results indicated that (a) students in both treatment conditions outperformed the comparison condition on multisyllabic word reading and (b) students in the IC + DBDM condition also outperformed comparison students on decoding. Implications, including the use of DBDM in addition to IC-only as well as methods for decision-making within a small-group context, are discussed.
Antiretroviral therapy experience, satisfaction, and preferences among a diverse sample of young adults living with HIV

ABSTRACT Youth and young adults living with HIV (YLWH) have a high HIV infection rate and suboptimal oral medication adherence. Biomedical researchers hope that long-acting antiretroviral therapy (LAART) modalities can help those who struggle with daily oral adherence. While adults living with HIV have expressed interest in LAART, little research has explored perspectives of YLWH. This study explores ART experiences and perspectives on LAART through qualitative interviews with twenty diverse YLWH (18–29) in the United States. Data were analyzed using framework analysis. Most participants were satisfied with their current ART yet had experienced side effects or had struggled with daily adherence. Preferences for improving daily oral ART included making pills smaller and reformulating ART into flavored chewable gummies. Most expressed enthusiasm for LAART, although needle aversion and previous injection drug use were potential barriers for some. Approximately half were interested in an ART patch, though its visibility and fear of stigmatization was concerning. Few expressed interest in implantable ART, calling it unappealing. Although younger people are most likely to benefit from these advancements in HIV treatment, additional research is needed to identify gaps in uptake and to further explore perspectives of YLWH to improve the success of new treatment modalities.