Miracle-dz/UniFAR-FTUs huggingface dataset:
Zoledronic acid versus pamidronate as palliative therapy in cancer patients: A Canadian time and motion analysis

Pamidronate was an important advance in the palliative treatment of patients with cancer. However, pamidronate must be infused over at least 2 hours in most patients. Zoledronic acid represents the next-generation bisphosphonate with a potential for improved efficacy in the palliative care setting. One important advantage of zoledronic acid is that it can be administered over a 15-minute infusion. To measure the overall efficiency of zoledronic acid as compared with pamidronate in the outpatient setting, a USA microcosting model was adapted to Canadian inputs. Time and motion data were collected from six patients being treated with zoledronic acid or pamidronate in three USA outpatient cancer clinics. Resource use and time impact on outpatient clinical staff were reanalyzed using Canadian cost estimates. This included the evaluation of fixed, variable, and labour costs obtained from Canadian sources. The manufacturer provided drug costs. The base case analysis assumed a 5300-ft2 out-patient chemotherapy clinic with eight infusion chairs designated for bisphosphonate administration in the province of Ontario. Mean treatment times in the original USA data collected were 2 hours, 52 minutes for pamidro-nate, and 1 hour, 6 minutes for zoledronic acid (a difference of 1 hour, 46 minutes). In the Canadian version of the microcosting model, the overall treatment cost was Can$673 for pamidronate and Can$682 for zoledronic acid (2001 Canadian dollars). Findings suggest that the shorter zoledronic acid infusion time would allow an additional 27 bisphosphonate patients to be treated per day. Alternatively, approximately one additional hour of chair time could be made available with each zoledonic acid infusion. Sensitivity analyses revealed that (a) the base case results were consistent when geographic region was varied, and (b) the shorter the infusion time for zoledronic acid relative to pamidronate, the lesser the cost difference and more patients could be treated daily. In conclusion, zoledronic acid may enhance the overall efficiency of outpatient chemotherapy clinics by reducing patient waiting time for bisphosphonate administration. These benefits would be obtained at an incremental cost of Can$9 per infusion.
Letter to the Editor Rebuttal: Patent Foramen Ovale and Unexplained Ischemic Cerebrovascular Events in Children

We thank Dr. Kenny and associates for their comments regarding our article considering the possible role of patent foramen ovale (PFO) in unexplained ischemic cerebrovascular events in children [1]. We agree that children who suffered ischemic cerebrovascular events of unknown cause are often inadequately evaluated for PFO [2]. However, studies regarding evaluation of children for a right-to-left shunt across the PFO are lacking and therefore, children are investigated on the basis of data derived from adult patient population. In adults, contrast transesophageal echocardiography (TEE) is the standard method for PFO detection, especially when performed with Valsalva maneuver (VM) [3]. However, deep sedation is necessary for adequate TEE in children thus preventing VM to be performed during examination. Dr. Kenny and his colleagues therefore suggested use of contrast transthoracic echocardiography (TTE) with at least 5 VMs and also sniffing to detect PFO in children. However, no data are available to support using the suggested method in children. Our experience with both a contrast TTE and TEE for PFO detection in children was disappointing. Therefore, we started to use contrast transcranial Doppler (TCD) with VM for this purpose [4]. Exact location of a right-to-left shunt is not clear using contrast TCD evaluation and small pulmonary arteriovenous malformation (PAVM) may be missed using this technique. Fortunately, PAVM is very rare and only coexistence of PAVM and PFO would be easily missed. In this situation, only percutaneous PFO closure would be rightfully performed while a right-to-left shunt across the PAVM would persist undetected. In contrast, in a patient having a false-positive contrast TCD test because of transpulmonary shunting, we would nowadays continue cardiac catheterization performing selective pulmonary arteriographies and in addition contrast TEE with selective injections of echocardiographic contrast into both pulmonary arteries. Detection of PAVM would allow us immediate percutaneous closure and elimination of a right-to-left shunt. In conclusion, Dr. Kenny and associates suggested using contrast TTE with VM and sniffing to detect PFO in children but there are no data to support using the suggested method in children. On the basis of our experience, we believe that contrast TCD with VM is particularly suitable for PFO detection in children. Furthermore, we believe that refinement of contrast TCD technique and protocol in children is necessary following the suggestions in the Letter to the Editor in this issue of Catheterization and Cardiovascular Interventions written by Dr. Sharma and associates.
Relation of total homocysteine level with metabolic and anthropometric variables in obese children and adolescents

Aim: To evaluate the total homocysteine (tHcy) level, a risk factor for atherosclerosis, atherothrombosis, and insulin resistance, for sex and pubertal state diff erences in obese children. Its relationship with metabolic and anthropometric parameters was also investigated. Materials and methods: Th e study involved obese children with a body mass index (BMI) above the 95th percentile who presented with the complaint of excessive weight gain, and healthy children with a BMI below the 85th percentile. Results: Th e study included 100 obese (mean age: 10.2 ± 2.7 years) and 71 healthy nonobese (mean age: 10.9 ± 2.6) children. A comparison of the data from the obese group and the control group revealed that the diff erences in BMI, BMI standard deviation score, tHcy, total cholesterol, triglyceride (TG), insulin, high-density lipoprotein (HDL), lowdensity lipoprotein (LDL), and homeostasis model assessment-insulin resistance (HOMA-IR) levels were statistically signifi cant (P 0.05). Conclusion: Th e results of this study showed that the tHcy level was higher in obese children than in healthy children. However, the tHcy level was not signifi cantly correlated with insulin resistance in obese children. Obese children should be routinely screened for high tHcy levels due to the potential atherosclerosis risks, and patients with high tHcy levels should be treated.
Conocimiento de la higiene de manos en estudiantes de enfermería

espanolLas manos de los estudiantes de enfermeria pueden ser el vector de la infeccion nosocomial. La mejora en el conocimiento sobre la higiene de manos (HM) reduce la infeccion nosocomial. Para ello debemos conocer el grado de adherencia al protocolo de lavado de manos (LM) por parte de los alumnos de enfermeria Para ello se paso un cuestionario estructurado de la OMS para profesionales de salud, antes y despues de llevar a cabo un taller formativo. Han participado en el Estudio un total de 63 alumnos de dos cursos de grado en enfermeria de la Universidad de Extremadura (UEX), con una predominancia del sector femenino en 76,2 % (48) y 23,8 % (15) para el masculino.Se obtuvo datos muy significativos (p EnglishNursing students� hands can be the vector of nosocomial infection. Improving knowledge about hand hygiene (HM) reduces nosocomial infection. This is the reason we must know the degree of adherence to hand washing protocol (LM) by nursing students For this purpose, a WHO structured questionnaire for health professionals was done before and after putting a training workshop into practice. A total of 63 students from two nursing degree courses of UEX have participated in the study, with female sector predominance 76.2% (48) and 23.8% (15) for the male. Very significant data were obtained (p
Safety and effectiveness of a Patient Blood Management Programme in surgical patients – the study design for a multicentre epidemiological non‐inferiority trial by the German PBM network

Patient blood management (PBM) concepts aim to identify patients with anemia and optimize their treatment including use of preoperative iron substitution, blood‐sparing techniques and adequate transfusion practice. PBM concepts thus have great potential to increase patient safety and clinical outcome. Nevertheless, up to now, structured PBM programmes have only been implemented in very few hospitals in Germany and safety data regarding clinical outcome parameters is rare.
Training Behavioral Research Methods to Staff in an Early and Intensive Behavioral Intervention Setting: A Program Description and Preliminary Evaluation

The extensive clinical activity occurring in the area of early and intensive behavioral intervention (EIBI) for children with autism represents a promising opportunity to conduct research on clinically relevant problems and on effectiveness and efficiency of various procedures. However, many practitioners providing these services may not have received adequate training in conducting single-case design research in field settings. Training practitioners to implement such research has the potential to improve the use of the scientist-practitioner model in these settings and expand the base of scientific knowledge in this area. Through the current training program, we used a modified behavioral skills training (BST) approach to teach practitioners to prepare and implement single-case design research protocols in an applied setting. Participants were able to learn and apply a number of important research skills as evidenced by statistically significant improvements on six tests throughout training and high scores on homework assignments that required staff to engage in various research-related behaviors. The results are discussed in the context of preparing EIBI settings for greater research productivity.
A four-step health promotion approach for changing dietary patterns in Europe

Nutrition policies to prevent nutrition-related diseases already exist in many countries. Not many countries have been successful in implementing their dietary recommendations, mainly because of the individual focus of nutrition education policies. Experts have been telling people what foods are good for them but have failed to build a supportive environment which would enable people to exercise a healthy choice. This article identifies four steps to a new approach for nutrition promotion. It is based on the idea that a multi-disciplinary approach and promotional activities linked to existing social networks on an individual level close to daily life will be more effective than traditional nutrition education. As an example in this field the SUPER-project, a community based five-country nutrition promotion project is described. This project, based on the four steps described in the article, is being carried out in five different experimental situations to produce a working model for this approach.
Open problems in color constancy : discussion

This paper discusses a number of open problems in color constancy theory whose correct solution is a prerequisite for the theory of the phenomenon. Solutions employing suitable visually meaningful versus physically meaningful basis functions (principal components) are examined. In the former case the starting point is an estimate of the first derivative of the reflectance (illuminant), essential for defining color, instead of an estimate of the reflectance (illuminant), as in the latter. Conceptual consequences are discussed. Mathematical and physical constraints are identified. We compare the results of theories that do or do not ignore them. The following questions are considered. (1) Do unique solutions of the estimation problem exist everywhere in the object-color solid belonging to the illuminant? (2) Are they physically meaningful, i.e., at least nonnegative? (3) Are they representative for reflectance and spectral distribution functions? (4) What role plays metamerism? © 2014 Optical Society of America OCIS codes: (330.0330) Vision, color, and visual optics; (330.1690) Color; (330.1720) Color vision; (330.1715) Color, rendering and metamerism. http://dx.doi. org/10.1364/JOSAA.31. 000338
Patients and Agents: Mental Illness, Modernity and Islam in Sylhet, Bangladesh

Patients and Agents: Mental Illness, Modernity and Islam in Sylhet, Bangladesh Alyson Callan Berghahn Books, 2012, £53.00, hb, 252 pp. ISBN: 9780857454881 This fascinating book does exactly what is says in the subtitle: it provides an anthropological insight into how people in Sylhet, a city and
Autoimmune Hepatitis in Children: A Report of Ten Cases

Clinical and laboratory features and the outcome of ten cases (nine female, one male) (age range 7-14 years, mean 10.7±2.2 years) with autoimmune hepatitis are described. The diagnosis was established by the laboratory features of elevated serum transferases, hypergammaglobulinemia, presence of autoantibodies, liver histology, excluding viral and metabolic etiologies and by a prompt response to corticosteroid therapy. One patient was associated with celiac disease. Chronic active hepatitis was present histologically in seven children while in three, cirrhosis with portal hypertension had already been established. All patients received steroids. Azathioprine was instituted in three patients in addition to steroid therapy. The patients were followed up for 1- 9 years (mean 4.1±3.0 years). One patient relapsed during maintenance therapy, and two patients died within less than one year probably because of poor compliance to treatment. In one patient treatment was withdrawn after three years and no relapse occurred during the six months of follow-up. Control liver biopsies were done in six patients after two years of treatment in which five showed histological improvement. We conclude that autoimmune hepatitis in childhood has a wide spectrum of clinical features including the absence of symptoms, acute hepatitis and established cirrhosis with portal hypertension. Autoimmune hepatitis should be kept in mind in the differential diagnosis of both acute and chronic liver diseases of children. Autoimmune hepatitis carries a high mortality if left untreated but has a favourable outcome when treatment is initiated early in the course of the disease.
The Contribution of a Driving Simulator in the Driving Evaluation of Stroke and Disabled Adolescent Clients

A component of the driving evaluation in the Occupational Therapy Department at The Rehabilitation Centre is a Doron Driving Simulator. There are limited formal evaluations of simulator usefulness reported. The objective of this study was to evaluate the contribution of the Doron Driving Simulator in the driving evaluation of stroke and disabled adolescent clients. Data collected included historical information and print-outs of the simulator scores, as well as subjective information from the clients. These data were collected in two phases for 56 clients referred for a driving evaluation. Results were compared between phases and between client groups. The benefits of simulator use included appropriate assessment of driving aids, perceived improvement in client self-confidence related to driving, and scores predictive of satisfactory on road performance for each group. The major difference in the use of the simulator between client groups was that it served as a training tool for basic driving skills for the adolescents. For the stroke clients it provided a basic evaluation with little training benefit before going on the road. Less therapist time was required for effective simulator use than was initially perceived. The simulator appears to be an important adjunct to the therapists' observations and on road evaluation in the driving evaluation process.
PREVALENCE OF C.TRACHOMATIS INFECTION AMONG AHVAZ FEMALES WITH VAGINAL DISCHARGE

Background: C. trachomatis is one of the most important agents of sexually transmitted diseases (STD). Untreated cases of vaginal infection with this bacterium may end up with infertility, scaring and ectopic pregnancy. In most cases infection with C. trachomatis is silent (70-80%) but when overt infection occurs the symptoms include: cervicitis, urethritis, and endometritis. Since prevalence of C. trachomatis was not studied in our city, this project was performed to evaluate the role of this bacterial agent in vaginosis. Material and Methods: Two hundred and two specimens from vaginal discharge of out-patients referring to gynecology ward of Ahvaz hospitals were collected and tested for C. trachomatis by PCR. Results: Out of 202 specimens, 33 (16.3%) were positive for C. trachomatis. Conclusion: The findings of this study show a high prevalence of C. trachomatis which indicates that special attention must be paid to detection and management of this infection.
Selection and use of disinfectants

Disinfection is an essential means of reducing the number of viable microorganisms on surfaces, devices and the skin. A wide range of disinfectant products are available, which vary in terms of their active ingredients, how they can be applied and their intended use. This article discusses the use of chemical disinfectants and the factors affecting their activity. In particular, it highlights the importance of understanding product labelling, efficacy claims and the regulatory requirements underpinning their application in practice.
Comparison of ultrasound and Scheimpflug methods for central corneal thickness.

Aim: The central corneal thickness (CCT) of healthy individuals was measured with an ultrasonic pachymeter (UP) and the Scheimpflug imaging system (SIS) and the results were compared to evaluate the agreement between the two methods in this study. Materials and Methods: The 61 subjects who had no ocular pathology or systemic disease except blepharitis were included in the study. CCT measurements of all subjects were performed with the UP (Sonomed 300P Pacscan) and SIS (Nidek Optical biometer AL-Scan) devices and the results were compared. The t test and the Bland-Altman plot were used as the statistical methods. Results: The study sample consisted of 61 cases including 20 males and 41 females. The mean age was 41.8±12.4 (20-58) years for the males and 46.2±9 (24-60) years for the females with no statistically significant difference (P=0.116). The mean CCT measurement of all the 61 subjects was 544.5±31 μm in the right eyes and 547.3±33 μm in the left eyes with UP, 530.7±27.6 μm in the right eyes and 531.6±25.5 μm in the left eyes with SIS. The CCT in the SIS results was an average of 13.8 μm thinner than the UP results in the right eye, 15.7 μm in the left eye and this difference Original Research Article Ersekerci et al.; BJMMR, 8(8): 677-683, 2015; Article no.BJMMR. 2015.493 678 was statistically significant (p=0.001 in right and left eyes). A high degree of agreement was found between the two methods with the Bland-Altman plot. Conclusion: A high degree of agreement was found between SIS and UP regarding CCT measurements and the mean SIS results were 13.8 μm and 15.7 μm thinner than the UP results in the right eyes and left eyes respectively.
The Treatment Gap

Summary: A simple definition of the treatment gap is the number of people with a condition or disease who need treatment for it but who do not get it. It is an underutilised measure of health care. In epilepsy, it has been estimated by the direct method, during prevalence studies, and indirectly from the amount of antiepileptic drugs consumed in the country and the number of people with active epilepsy. The treatment gap in epilepsy is very high in the developing world. Possible causes of the treatment gap have been listed, but these have not been investigated.
Examining the Relationship between Inflammatory Markers and Menopausal Status in Breast Cancer Patients Undergoing Chemotherapy Treatment

The goal of this study was to determine whether menopausal status accounts for the variability in circulating levels of inflammatory biomarkers that have been observed in studies examining women with breast cancer undergoing treatment. The hypothesis was that women with breast cancer who are pre-menopausal will have higher levels of inflammation compared to women with breast cancer who are post-menopausal. Data on inflammation (circulating levels of soluble Intercellular Adhesion Molecule-1 (sICAM-1), Vascular Endothelial Growth Factor (VEGF), Interleukin-6 (IL-6), C-Reactive Protein (CRP), Tumor Necrosis Factor- alpha (TNF-alpha) and P-selectin) and psychosocial measurements were collected from 85 women with newly diagnosed breast cancer within a few days before starting chemotherapy and approximately 2.5 months later at week 3 of cycle 4 of chemotherapy. In addition, each study participant filled out questionnaires assessing menopausal status and symptom severity, which asked about regular menses before/after chemotherapy (pre-menopausal status), irregular menses before/after chemotherapy (peri- menopausal status), post-menses before/after chemotherapy (post-menopausal status) and post-hysterectomy or post- oophorectomy before/after chemotherapy. Based on responses to the menopausal questionnaires, women were divided into two categories: either pre/peri (N = 29), meaning that the women were pre-menopausal or peri-menopausal before chemotherapy and pre-menopausal or peri-menopausal after chemotherapy or peri/post (N = 56), meaning that the women were peri-menopausal or post-menopausal before chemotherapy and post-menopausal after chemotherapy. Contrary to my hypothesis, multiple regression and canonical correlation statistical analyses indicated that menopausal status does not account for the variability observed in inflammatory biomarker data in women with breast cancer prior to or following chemotherapy
Osteoid osteoma of the fibula in a female rugby player

Osteoid osteomas are benign osteoblastic tumours encountered relatively commonly among skeletal lesions. Despite distinct clinical findings, atypical presentations make for a challenging or delayed diagnosis which may negatively affect a patient’s quality of life in the interim. We present the case of a young female rugby player with a subperiosteal osteoid osteoma of the distal fibula – a rare location for this type of tumour.
A Comparison of Quantitative T2 Mapping on Cardiovascular Magnetic Resonance Imaging with Metaiodobenzylguanidine Scintigraphy and Left Ventricular Functional Recovery in Dilated Cardiomyopathy: A Retrospective Pilot Study.

OBJECTIVE Metaiodobenzylguanidine (MIBG) scintigraphy is used to assess heart failure (HF) severity and to predict cardiac functional recovery. Cardiovascular magnetic resonance (CMR) imaging has recently been used to diagnosis HF. We evaluated CMR T2 mapping and MIBG scintigraphy in dilated cardiomyopathy (DCM) patients. METHODS Consecutively, 22 DCM patients [aged 56.8 ± 13.4 years; 6 women and 16 men; left ventricular ejection fraction (LVEF), 31.9 ± 10.7%] who underwent T2 mapping and MIBG scintigraphy were retrospectively evaluated. Echocardiography results were recorded at baseline and the 6-month follow-up. Patients with an increased LVEF ≥15% between the 2 measures were considered to be responders. We measured each patient's T2 values and MIBG indices [the heart-to-mediastinum ratio (H/M) in the early phase, H/M in the delayed phase, and the washout rate (WOR)] at baseline. We compared these values between the 12 responders and 10 non-responders. RESULTS The mean T2 value for all patients was 64.5 ± 6.6 ms. The mean values of early H/M, delayed H/M, and WOR were 2.06 ± 0.25, 1.94 ± 0.35, and 43.5 ± 11.8%, respectively. The T2 values were found to correlate with MIBG indices (p<0.05 for all) and were lower in the responders than non-responders (61.4 vs. 68.1 ms, p=0.013). MIBG indices were not significantly different. CONCLUSION Our study shows that the T2 values correlated with the MIBG indices and were increased in non-responders. T2 mapping may be useful in assessing the cardiac function and functional recovery in DCM patients.