Miracle-dz/UniFAR-FTUs huggingface dataset:
Teaching evidence-based medicine using a problem-oriented approach

Abstract Background: Faculty of Medicine, Suez Canal University is adopting an innovative curriculum. Evidence-based medicine (EBM) has been integrated into problem based learning (PBL) sessions as a responsive innovative paradigm for the practice and teaching of clinical medicine. Aims: To integrate EBM in the problem based sessions of the sixth-year students, and to assess students’ and tutor satisfaction with this change. Methods: EBM training was conducted for sixth-year students (196) including four theoretical, and eight practical sessions. Sixteen EBM educational scenarios (problems) were formulated, according to sixth-year curriculum. Each problem was discussed in two sessions through steps of EBM, namely: formulating PICO questions, searching for and appraising evidence, applying the evidence to the clinical scenario and analysing the practice. Students and tutors satisfaction were evaluated using a 3-point ratings questionnaire. Results: The majority of students and faculty expressed their satisfaction about integrating EBM with PBL and agreed that the problems were more stimulating. However, 33.6% of students indicated that available time was insufficient for searching literatures. Conclusion: Integrating EBM into PBL sessions tends to be more interesting and stimulating than traditional PBL sessions for final year students and helps them to practice and implement EBM in clinical context.
New Modified English and Hindi Oswestry Disability Index in Low Back Pain Patients Treated Conservatively in Indian Population

Study Design Prospective cohort study along with questionnaire. Purpose To measure the correlation of the visual analogue score (VAS), with (Oswestry disability Index [ODI], version 2.1a) in English, and modified ODI (English and Hindi version). To validate translated version of the modified ODI in English version to Hindi. Overview of Literature Conflicting evidence in literature regarding the ability for existing ODI score to accurately measure the pain associated disability. Methods One hundred and three patients conservatively treated for low back pain were enrolled in the study. The Pearson correlation coefficient for VAS and ODI along with the Cronbach α and test-retest reliability for Hindi version using the intraclass correlation coefficient was recorded. The new proposed translated Hindi version of ODI was carried out with established guidelines. Results The mean age in English and Hindi version of ODI was 53.5 years and 58.5 years, respectively. The gender ration was 21:24 in the English version and 35:23 in the Hindi version. The mean follow-up in English and Hindi version of ODI was 3.4 months and 50.27 months, respectively. The Cronbach coefficient α=0.7541 for English ODI and 0.9913 for Hindi ODI was recorded for the both modified versions. Conclusions The new modified ODI is time saving and accurate, and it avoids the need to measure other scores and has stronger correlation with VAS score compared to the previous scores. We recommend this version for both English and Hindi speaking population as an assessment tool to measure the disability related to pain.
Applying the World Report on Disability to children’s communication

Abstract Purpose: The World Report on Disability is an important milestone in the recognition of people with disabilities; however, the Report acknowledges that people with communication difficulties may be underrepresented in estimates of disability. Consequently, this article applies the nine recommendations from the World Report on Disability to supporting children’s communication skills. Method: Australia is similar to most Minority World countries since it places high regard on articulate and literate communication. Recent large-scale Australian studies of children with speech, language and communication needs were reviewed to determine prevalence, impact and associated environmental and personal factors. Studies of met and unmet need were reviewed and discussed in relation to legislation and policies. Results: Recent years have seen improvements in the collection of and access to disability data about children’s communication, including the involvement of children in research about the impact of communication difficulties on their lives. The prevalence of speech and language impairment in children is high and is associated with poorer educational and social outcomes at school-age. Significant unmet need for services was noted, and there were differences in health, education and disability policies regarding access to services. Conclusions: Updated legislation, policies and practices are needed to more effectively support access to services to support children’s communication across health, education and disability sectors. Implications for Rehabilitation There is a high prevalence of speech and language impairment in Australian children. Childhood speech and language impairment (and associated communication disability) can impact educational, social, behavioural and occupational outcomes throughout life. Many Australian children do not have sufficient access to targeted services (including speech-language pathology) to ameliorate the impact of their communication disability. Formulation of a national strategy to support children children’s communication is required.
Cross-Layer Resource Allocation Model for Cellular-Relaying Network Performance Evaluation

The enhancement of cellular networks with relaying technologies is expected to bring significant technoeconomic benefits at the expense of more complex resource allocation. Suitable models for solving network dimensioning problems in cellular-relaying networks must handle radio resource allocation among hundreds of links and tackle interactions between networking layers. For this purpose, we propose a novel cross-layer resource allocation model based on average interference and ideal rate adaptation for the physical layer (PHY), time shares for the medium access layer, and fluid flows for the transport and network layers. We formulate a centralized social welfare maximization problem. When the routes are selected with an a priori algorithm, we show that the resource allocation problem admits an equivalent convex formulation. We show a numerical example for how to use the proposed framework for configuring the backhaul link in a practical relaying network. The overall problem of selecting routes and allocating time shares and link rates is nonconvex. We propose an iterative suboptimal algorithm to solve the problem based on a novel approximation of PHY. We state and prove several convergence properties of the algorithm and show that it typically outperforms routing based on signal-to-noise ratio only.
Multi-Element Analysis of Saline Matrices by Inductively Coupled Plasma Mass Spectrometry Following On-line Preconcentration Using a Knotted Reactor

A versatile preconcentration system for trace element determination by ICPMS was developed. It is composed of a commercial flow injection analysis system (FIAS) retrofitted with a home-made control unit containing three solenoid valves and working concomitantly with the FIAS, permitting selection and segmentation of sample, reagent, washing solution and elution flow. The knotted reactor used had a length of 200 cm and was made from 0.05 cm i.d. PTFE tubing. The method applies ammonium 1-pyrrolidinedithiocarbamate (APDC) as complexant, allowing the preconcentration and quantitative multi-element determination of Cu, Ni, V, Co, Nb, Mo, In, Sb and Bi. Ethanol and 4-methyl-2-pentanone were tested as eluents. Recovery tests using complex matrices and spike concentrations of 200 ng L^–1 showed typical values in the range of 90% to 110%. Relative standard deviations were < 7% for elution with ethanol and < 5% with methyl isobutyl ketone. For simulated freshwater samples using 4-methyl-2-pentanone as an eluent, a sample loading rate of 5.0 ml min^–1, and a preconcentration time of 60 s, detection limits (ng L^–1) were in the range of 0.02 (Bi) to 30 (Cu). Under these conditions, analytical frequency was about 15 samples per hour. The feasibility of the method was demonstrated by the succesful analysis of wastewater and seawater certified reference materials.
Use of Sensitivity Analysis to Assess Reliability of Metabolic and Physiological Models

Because ethical considerations often preclude directly determining the human health effects of treatments or interventions by experimentation, such effects are estimated by extrapolating reactions predicted from animal experiments. Under such conditions, it must be demonstrated that the reliability of the extrapolated predictions is not excessively affected by inherent data limitations and other components of model specification. This is especially true of high‐level models composed of ad hoc algebraic equations whose parameters do not correspond to specific physical properties or processes. Models based on independent experimental data restricting the numerical space of parameters that do represent actual physical properties can be represented at a more detailed level. Sensitivities of the computed trajectories to parameter variations permit more detailed attribution of uncertainties in the predictions to these low‐level properties. S‐systems, in which parameters are estimated empirically, and physiological models, whose parameters can be estimated accurately from independent data, are used to illustrate the applicability of trajectory sensitivity analysis to lower‐level models.
POLYMORPHONUCLEAR LEUKOCYTE DYSFUNCTION SYNDROME IN PATIENTS WITH INCREASING SEPSIS SEVERITY

ABSTRACT Production of oxygen radicals is required for both microbicidal and tissue-toxic effector functions of granulocytes. Inasmuch as an ambivalent role of polymorphonuclear leukocytes (PMNs) may become apparent during sepsis, we studied levels of hydrogen peroxide (H2O2) production by PMNs depending upon the nature of different particulate and soluble stimuli in patients with increasing sepsis severity. Patients with sepsis (n = 15), severe sepsis (n = 12), or septic shock (n = 33) were prospectively enrolled in the study. Healthy volunteers of comparable age and sex served as controls (n = 50). Unopsonized and opsonized zymosan particles were used to assess adhesion, phagocytosis, and the associated H2O2 production. Zymosan particles are rich in &bgr;-glucans and lectin structures that are known to trigger H2O2 production via two major non-toll-like receptor pathogen recognition receptors, comprising the lectin-binding site in the &agr;-chain (CD11b) of the complement receptor type 3 and the more recently identified nonclassical C-type lectin, dectin-1. To determine H2O2 production upon cell activation by soluble stimuli, PMNs were activated by the chemotactic tripeptide (N-formyl-methionyl-leucyl-phenylalanine [fMLP]) alone or after priming of cells by preincubation with tumor necrosis factor &agr;. To get insight into the changes of fMLP receptor classical intracellular signaling pathways, PMNs were also incubated with the calcium ionophore A23187 and the phorbol ester phorbol myristate acetate, bypassing receptor-dependent signal transduction to directly activate calcium/calmodulin kinase- and protein kinase C-dependent pathways, respectively. As compared with healthy volunteers, levels of H2O2 production by PMNs from septic patients varied depending upon the nature of the activating signal: reduced (zymosan), unchanged (phorbol myristate acetate, opsonized zymosan), and enhanced (spontaneous, fMLP, fMLP + tumor necrosis factor &agr;, A23187), with the changes most pronounced in patients with septic shock. Specifically, phagocytosis of zymosan and the associated H2O2 production were significantly decreased whereas spontaneous and stimulated H2O2 production elicited by soluble stimuli strongly increased. Thus, these findings suggest the development of a PMN dysfunction syndrome in patients with increasing sepsis severity. Moreover, as binding of zymosan particles to the PMNs' surface remained unchanged despite increasingly suppressed phagocytosis and associated H2O2 production, observed effects are likely to reflect defects in signaling by the lectin-binding site of CD11b and/or the &bgr;-glucan receptor dectin-1, respectively.
Direct and indirect estimates of gene flow among wild and managed populations of Polaskia chichipe, an endemic columnar cactus in Central Mexico

Microsatellite markers were used to obtain direct and indirect estimates of gene flow in populations of Polaskia chichipe under different management regimes, in order to understand the genetic consequences of gene flow in the evolutionary process of domestication. P. chichipe is a columnar cactus endemic to the Tehuacan Valley, Central Mexico, and has come under domestication for its edible fruit. Morphological, phenological, physiological, and reproductive differences, apparently attributable to artificial selection, exist between wild and managed populations, which grow sympatrically. However, strong gene flow may counteract the effects of this selection. In this study, we used paternity analysis to demonstrate that although most of the pollinations occur among individuals within the same population at distances < 40 m, pollen flow from other populations is considerable (27 ± 5%). Heterogeneity in pollen clouds sampled by mother plants (FST = 0.12) indicated nonrandom mating, which is probably due to temporal heterogeneity in pollen movement. Spatial structure on local and regional scales is consistent with an isolation‐by‐distance model. The similarity of indirect, direct and demographic estimates of neighbourhood size (74–250 individuals) suggests that this genetic structure is representative of an equilibrium state. These results suggest that traditional management practices have conserved the genetic resources of this species in situ, but also that gene flow is counteracting the effect of domestication to some degree. We discuss our results in the general context of genetic exchange between cultivated and wild populations during the domestication process.
Perspectives on the use of and service needs of cancer preventive services for ethnic minorities in Hong Kong: a study protocol.

AIM To report a study protocol to explore the experience of cancer screening from the perspective of ethnic minorities in Hong Kong BACKGROUND Cancer is a major health problem, but screening can be effective in decreasing the incidence and mortality rates. Providing information on how to participate in recommended preventive measures and on accessibility to these services is a crucial step in promoting healthy behaviour. Ethnic minorities in Western countries are found to be less likely to use preventive services and encounter more barriers in doing so than the general population. DESIGN A mixed-method design with two phases has been chosen to meet the aims and objectives of the study, with Phase 1 using a self-reported survey and Phase 2 involving focus-group interviews. METHOD A convenience sample of 1540 South Asians (770 in each gender) will be recruited from community centres for the Phase 1 survey in 2013-2014, of whom 72-96 will be invited to participate in the Phase 2 interviews. The Survey and Behavioural Research Ethics Committee of the local university approved the study in March 2012. DISCUSSION The findings will provide detailed information on the use of cancer screening and the barriers that this minority population faces in Hong Kong. The findings will inform the government and policy-makers on the implementation of culture-specific interventions, so as to increase the screening uptake rate of this ethnic minority.
Gender, clamped hyperglycemia and arterial stiffness in patients with uncomplicated type 1 diabetes mellitus

Abstract Background: Diabetes mellitus (DM) reduces female gender-mediated protection against the development of renal disease possibly through effects on hyperglycemia. Women with DM also exhibit increased arterial stiffness, which may promote renal disease progression. The mechanisms responsible for increased arterial stiffness in women and the possible role of acute changes in ambient glycemia remain unknown. Methods: Blood pressure, augmentation index (AIx), pulse wave velocity (PWV) and circulating mediators of the renin angiotensin system and nitric oxide (cGMP) were measured in men (n = 22) and women (n = 19) with uncomplicated type 1 DM under clamped euglycemic and hyperglycemic conditions. Results: At baseline, men exhibited higher levels of angiotensin II (p = 0.030) and lower cGMP levels (p = 0.004), higher systolic blood pressure (124 ± 2 versus 109 ± 2 mmHg, p < 0.0001) and pulse pressure (42 ± 2 versus 58 ± 2 beats per minute, p < 0.0001). For arterial stiffness, radial (−8.0 ± 2.6% versus +5.4 ± 3.7%, p < 0.0001) and carotid AIx (−4.7 ± 2.9 versus +12.5 ± 3.0, p < 0.0001) were lower in men versus women. In contrast, carotid-femoral PWV was similar in men and women (5.20 ± 0.30 versus 5.13 ± 0.17, respectively, p = 0.853). In response to clamped hyperglycemia, systolic blood pressure increased in women (109 ± 2 to 112 ± 2 mmHg, p = 0.005) but not men. Serum aldosterone increased and cGMP declined in women but not in men. Clamped hyperglycemia did not influence arterial stiffness in either group and radial and carotid AIx remained higher in women. Conclusions: Arterial stiffness is higher in women with type 1 DM. This effect is not dependent on the effects of clamped hyperglycemia or neurohormonal activation.
Comparison of buccal microcirculation between septic and hemorrhagic shock

Objective:Microcirculatory perfusion is disturbed in sepsis, and global hemodynamics does not necessarily reflect microcirculatory blood flow. In this study, we investigated the effect of the same level of mean arterial pressure (MAP) or cardiac index on the changes in buccal microcirculation between septic and hemorrhagic shock. Design:Prospective, controlled laboratory study. Setting:University-affiliated research laboratory. Interventions:A total of 20 Sprague-Dawley rats were divided into four groups: 1) septic shock induced by cecal ligation and perforation: when MAP decreased to 80 mm Hg, saline was infused at a rate of 25 mL·kg−1·hr−1 for 2 hrs; 2) both time- and MAP-matched hemorrhagic shock: ∼30% of total blood volume was withdrawn during the corresponding interval, followed by infusion aiming to restore MAP as required when MAP decreased to 80 mm Hg; 3) both time- and cardiac index–matched hemorrhagic shock: ∼40% of total blood volume was withdrawn during the corresponding interval until MAP decreased to 50 mm Hg, which generally generated a cardiac index similar to those in septic animals, followed by infusion at the same rate for 2 hrs; and 4) sham control: animals underwent the same procedure except no cecal ligation and perforation, bleeding, and infusion. Measurements and Main Results:Buccal microcirculation was visualized with the aid of an orthogonal polarization spectral image device. A semiquantitative score was calculated for vessels of <20 &mgr;m, primarily representing the capillaries. Impaired buccal capillary blood flows in septic animals were more severe than those in MAP-matched hemorrhagic animals and were similar to those in cardiac index–matched hemorrhagic animals during the hypoperfusion period before infusion. Significantly improved global hemodynamics after resuscitation cannot effectively improve the buccal capillary blood flows in septic animals, in contrast to those in MAP-matched and cardiac index–matched hemorrhagic animals. Conclusions:Impaired microcirculatory alteration in septic shock is more severe than hemorrhagic shock; microcirculation is relatively independent of improved systemic hemodynamics, in contrast to those in hemorrhagic shock.
Entropy-score: A method to detect DDoS attack and flash crowd

Nowadays the Internet plays a vital role in the growth of the economy for any nation. DDoS attacks are one of the major threat that hurting this growth as it affects the systems and network which uses the Internet for their business work. In DDoS attacks, victims bandwidth is flooded with the excessive amount of malicious or fake traffic due to which, the victim is unable to serve the legitimate users. There have been many different techniques proposed by the researchers which can detect DDoS attack efficiently. But they have many limitations and one of the important limitation of these techniques is their inability to differentiate flash crowd from DDoS attacks. Flash crowd is a scenario in which plenty of legitimate users tries to access a common server or system, so filtering of this kind of traffic may lead to business loss or credibility loss of the victim. In this context, we proposed a new detection method, Entropy-score. Which uses a hierarchical structure to analysis the incoming packets. In the proposed approach first, the entropy-based method is used for characterizing the incoming packets and then packet score based method is used for filtering the malicious packets. We implement this proposed method by using OMNET++ simulation tool and the experimental results show that Entropy-score method not only differentiates DDoS attacks traffic from Flash crowd but can also differentiate the attack traffic from the normal traffic.
Utility of the von Willebrand factor collagen binding assay in the diagnosis of von Willebrand disease

von Willebrand Disease (VWD) is the most common inherited bleeding disorder and also arises as an acquired defect (AVWS). VWD and AVWS are due to quantitative deficiencies and/or qualitative defects in von Willebrand factor (VWF), an adhesive plasma protein with multiple activities. Diagnosis of VWD is problematic, being subject to overdiagnosis, underdiagnosis, and misdiagnosis. This is largely due to limitations in current test procedures and an over‐reliance on these imperfect test systems for clinical diagnosis. VWF essentially acts to assist in the formation of a platelet thrombus to stop blood loss from sites of injury, achieving this by binding to platelets (primarily through the glycoprotein Ib receptor), binding to subendothelial matrix components (primarily collagen), and binding to factor VIII (FVIII), thus protecting FVIII from degradation and enabling its delivery to sites of vascular injury. VWD is classified into six separate types, which may each be differentially managed therapeutically, and this underscores the importance of a correct diagnosis. The current report concisely reviews the utility of a relatively underutilised assay, the VWF collagen binding assay (VWF:CB), in facilitating the correct diagnosis and typing of VWD. In particular, if laboratories do not utilise the VWF:CB, then (i) type 2M VWD will continue to be missed, and/or misdiagnosed as types 2A or 1 VWD, and (ii) types 2A, 2B and PT‐VWD will continue to be missed, or else be misdiagnosed as type 1 VWD or ITP. Am. J. Hematol. 92:114–118, 2017. © 2016 Wiley Periodicals, Inc.