Miracle-dz/UniFAR-FTUs huggingface dataset:
Participatory Learning of Medical Students through Development of Innovative Training Modules for Community Health Workers

Background: Community Medicine is a subject which receives relatively less attention in medical curriculum. Active participation of students in preparation of training modules for Community Health Workers (CHWs) could facilitate their learning in topics related to Community Medicine. This study aimed to involve medical students in the preparation of training modules for CHWs and assess the effects of their participation on their knowledge about targeted diseases. Methods: An interventional study where all 144 undergraduate fifth-semester students from Bharati Vidyapeeth University Medical College, Pune, India posted at Community Medicine Department participated in the preparation of training modules for CHWs on HIV/AIDS, tuberculosis, malaria and diabetes and completed pre- and post-intervention questionnaire. Each completed questionnaire was assigned a score based on a marking system. The data was analysed using paired t test. Results: Statistically significant improvement in knowledge was found (pre-test mean score: 5.79, post-test mean score: 14.15, t = 26.93, p<0.001). All faculty opined that community visits followed by health education module preparation activity were innovative components in this study. All 119 participants agreed that their knowledge about targeted diseases improved due to module preparation activity. Conclusion: Active participation of students can facilitate their learning behavior. Students became aware of the principles of ‘Group Dynamics’ as a result of active involvement in training module preparation.
Obesity, Mortality, and the Obesity Paradox

The percentage of the population who are obese has grown dramatically on a worldwide basis over the last several decades, although the growth in the prevalence of obesity has slowed recently at a high level in the United States. Although there have been numerous studies of the effect of this trend on mortality, the findings have been inconsistent and controversial, in part because of methodological differences and the complexity of the relationships between obesity and mortality. The objective of this article is to discuss the issues surrounding these relationships and to shed light on the likely effects of the obesity epidemic on mortality. Of particular interest is the so-called obesity-mortality paradox, where mortality experience is lower for overweight and in some cases obese individuals than for those of normal weight. Although more recent studies of the relationship between mortality and obesity seem to indicate those who are obese have experienced a reduced percentage of additional mortality, this may in part be due to the shorter average time those currently obese have been exposed to their condition, the heterogeneity of the normal and obese populations, measurement issues including treatment of smokers and those who are ill, and study design limitations. An increased number of premature deaths may arise as more individuals who are obese are exposed for a longer period to excess adiposity. Although public policy issues surrounding obesity are being addressed with a great deal of activity and publicity, they have and will continue to prove quite challenging for both individuals and society to manage and overcome. The prevalence of obesity has had and will continue to have a significant effect on the mortality experience in most areas of actuarial practice. As a result, it is important for actuaries to enhance their understanding of these effects.
Decreasing Failure-to-rescue Events in the Era of Rapid Response Systems

In-hospital medical emergencies including in-hospital cardiac arrests, unplanned ICU admissions, and unexpected deaths occur frequently and represent, in many of the cases, failure of the health care system to recognize and respond promptly to signs of deterioration. Rapid response systems are an intervention for this problem, but benefits remain uncertain. In this review, we discuss the epidemiology of in-hospital medical emergencies, the different components of the response system, and potential improvements to decrease failure-to-rescue events.
Novel combination of simulation and Lean methodology to improve operating room turnover

We describe a novel combination of medical simulation and Lean process improvement methodology applied to improve operating room (OR) turnover time (TOT). Excess OR TOT (time between one patient's exit and next patient's entry) negatively impacts throughput, patient care and revenue generation. Elimination of waste and improvement in efficiency are highly desirable. Lean methodology, applied to healthcare, seeks improvement by eliminating waste, revising processes and identifying/resolving problems at a root-cause level.1–4 Staff are engaged in change through weeklong rapid improvement events (RIE) to redesign, test and implement new work processes. An RIE includes critical assessment of the current state, mapping current processes, identification of the desired state, examination of process gaps, brainstorming improvements and experimentation to develop solutions and improve standard work.1 To address the issue of excess OR TOT, taking an OR out-of-service would be disruptive to patient care and cost-prohibitive. A simulated OR provided a potential opportunity to rapidly and repeatedly recreate the turnover process, develop and practice standard work, experiment without patient harm/disruption of care and engage staff members in designing and implementing improvements by encouraging experimentation with change. To capture this opportunity, the perioperative services, hospital-wide process improvement and simulation centre teams collaborated. ### Setting The Institute for Medical Simulation and Advanced Learning (IMSAL) and Jacobi Medical Center (JMC), a municipal hospital, Bronx, New York, …
A dual role for UCMA in osteoarthritis-Inhibition of aggrecanases and promotion of bone turnover.

Abstract Cartilage damage and subchondral bone changes are closely connected in osteoarthritis. How these processes are interlinked is however incompletely understood to date. Here, we investigate the mechanistic role of the cartilage-derived protein UCMA in osteoarthritis-related cartilage and bone changes. UCMA expression was assessed in healthy and osteoarthritic human and mouse cartilage. DMM-induced osteoarthritis was performed in WT and Ucma-deficient mice analysing cartilage and bone changes. UCMA-collagen interactions, effect of UCMA on aggrecanase activity and the impact of recombinant UCMA on osteoclast differentiation were studied in vitro. UCMA was found overexpressed in human and mouse osteoarthritic cartilage. DMM-triggered cartilage changes were aggravated in Ucma-deficient mice compared to WT littermates, showing increased structural damage, proteoglycan loss and chondrocyte cell death indicating chondroprotective effects of UCMA. Moreover, UCMA inhibited ADAMTS-dependent aggrecanase activity and directly interacted with cartilage-specific collagen types. In contrast, osteoarthritis-related bone changes were significantly reduced in Ucma-deficient mice, showing less pronounced osteophyte formation and subchondral bone sclerosis. Mechanistically, UCMA directly promoted osteoclast differentiation in vitro. UCMA links cartilage with bone changes in osteoarthritis, supporting cartilage integrity as an endogenous inhibitor of aggrecanases on the one hand, and promoting osteoclastogenesis and subchondral bone turnover on the other hand. Hence, UCMA represents an important link between cartilage and bone in osteoarthritis. This article is protected by copyright. All rights reserved.
Neuroprotective effects of herbal cocktail on cerebrovascular dysfunction in rats with induced hyperhomocysteinaemia

Introduction: Hyperhomocysteinaemia (HHcy) is an established risk factor for cardiovascular, cerebrovascular, peripheral vascular diseases and neurodegenerative disease. The effect of this HHcy on vascular diseases could potentially cause vascular pathology features. Experimental studies have demonstrated that Hcy can be neurotoxic to brain, hippocampus area. Methods: The present study was conducted to compare the possible neuroprotective effects of different herbal cocktail in HHcy-induced rats’ brain cerebrovascular dysfunction model. Rats were divided into nine groups: Group I - Controls received the same volume of saline solution (0.5 mL/100 g of body weight). Group II served as HHcy and received homocysteine 0.03 μmol/g of b.w. daily for 30 days. Group III served as HHcy and received homocysteine 0.03 μmol/g of b.w. + Artemisia Judaica extract (AJ) (50 mg/kg per oral by oral feeding needle with tuberculin syringe) daily for 30 days. Group IV served as HHcy and received homocysteine 0.03 μmol/g of b.w. + Panax ginseng extract (PG) (50 mg/kg per oral by oral feeding needle with tuberculin syringe) daily for 30 days. Group V served as HHcy and received homocysteine 0.03 μmol/g of b.w. + Polygonum multiflorum extract (PM) (400 mg/kg per oral by oral feeding needle with tuberculin syringe) daily for 30 days. Group VI served as HHcy and received homocysteine 0.03 μmol/g of b.w. + AJ + PG with the same dose of previous group daily for 30 days. Group VII served as HHcy and received homocysteine 0.03 μmol/g of b.w. + AJ + PM with the same dose of the previous group daily for 30 days. Group VIII served as HHcy and received homocysteine 0.03 μmol/g of b.w. + PG + PM with the same dose of the previous group daily for 30 days. Group IX served as HHcy and received homocysteine 0.03 μmol/g of b.w. + AJ + PG + PM with the same dose of previous group daily for 30 days. The hippocampus of brain samples was collected at the end of the experiment and measuring oxidative stress markers (CAT, SOD, MDA and NO), inflammatory mediators (IL-6 and BDNF), histopathological examination and comet assay. Results: Revealed data showed that the homocysteine induces SOD, CAT depletion, and an increase in AChE, MDA, NO, IL-6, and BDNF. A mixture of PG and PM or the individual treatments showed an ameliorative response for all parameters. In general, oxidative stress parameters, inflammatory mediator, neurotrophic factor, pathological examination and comet were degenerate against HHcy but did not differ significantly compared to AJ group. Conclusion: Better physiological and histological characteristics were in PG and PM and their combination groups compared with HHcy and ameliorated nearly the control group.
Dexamethasone(DEX)(6mg/sm/d) and Prednisolone(PRED)(60mg/sm/d) in Induction Therapy of Childhood ALL Are Equally Effective: Results of the 2nd Interim Analysis of EORTC Trial 58951

Background: there is some biologic and clinical evidence that DEX is more efficient than PRED at similarly anti-inflammatory doses in the treatment of childhood ALL. Previous trials have called for PRED doses (40 mg/sm/d) lower than those of PRED traditionally used in EORTC trials. In order to check whether the claimed superiority of DEX might be dose-dependent, we conducted a randomized phase III trial comparing DEX (6 mg/sm/d) to PRED (60 mg/sm/d) (conventional dose) in induction therapy. Methods: the trial was opened in 12/1998 to all newly diagnosed children with ALL up to 18 y. of age. After the opening of the Interfant trial in 1999, children Results: between 12/1998 and 2/2008, a total of 1853 ALL pts were randomized; as of 2/2008, 1703 pts were evaluable for EFS analysis. At a median follow up of 4.3 y. , the 5 y. EFS rate was 82.1% (SE 1.5%) for the pts in the DEX arm and 82.4% (SE 1.5%) in the PRED arm (hazard ratio (HR) = 0.99, 98.8% CI 0.72–1.36, p=0.94); the futility boundary was crossed. In precursor-B ALL pts, the 5 y. EFS rate was 84.2% (DEX) vs 84.1% (PRED) (HR=0.95, p=0.75) and in precursor-T ALL the 5y. EFS rate was 70.7% vs 72.0% (HR=1.06, p=0.83). Isolated and combined CNS relapse crude rates were 1.1% each (DEX) vs 1.6% and 2.2% (PRED) respectively (resp.). The 5-y CNS incidence rate was 2.9% (DEX) vs 4.9% (PRED), the non-CNS incidence rate was 10.9% (DEX) vs 9.4% (PRED), and the 5-yr death in CR incidence rate was 2.7% (DEX) vs 2.1% (PRED). During induction the incidence of grade 3–4 infection was very similar in the two arms. During post-induction consolidation (“protocol IB”), it was higher in the DEX arm (23.5% vs 21.1%), in particular in pts randomized to prolonged L-asparaginase arm: 29.1% (DEX) vs 21.8% (PRED). Conclusion: DEX and PRED, used at the doses of resp. 6 and 60 mg/sm/d during induction, had equal efficacy. DEX decreased by 2.0% the 5-yr CNS incidence rate but increased by 1.5% the non-CNS incidence rate and by 0.6% the death in CR incidence rate. DEX in induction entails a higher infection rate during the consolidation, particularly when L-asparaginase is pursued throughout this phase. The optimal dosage of either glucocorticoid, compatible with acceptable toxicity, remains to be determined.
A New Model for Diagnosing Sleep Apnea through Features Extraction of the SpO2 Signal

Obstructive Sleep Apnea (OSA), is thenmost common form of different types of sleep-related breathing disorders. It is characterized by repetitive cessations of respiratory flow during sleep, which occur due to a collapse of the upper airway at the level of the oropharynx. The traditional diagnosis of OSA requires an expensive and complex overnight procedure called polysomnography (PSG). PSG contains several biomedical signals recording set, such as EEG, EOG, EMG, ECG, respiration and SpO2. In contrast,simple monitoring systems can be built as cheaper alternatives to the current PSGs in the diagnosis of OSA, which can also reduce the abundant burdens of hospital sleep centers.In this study, we develop a comprehensive feature set based on the arterial oxygen saturation signal measured by pulse oximetry (SpO2) to obtain high quality signal features in discriminating the OSA. The three features of Spo2 signal which are Delta Index, Central Tendency Measure with radius 0.5 (ctm50) and Oxygen Desaturation Index(odi3) are extracted, tested and evaluated using the MATLAB toolset. It was found that SpO2 signal characteristics could be helpful in order to evaluate sleep quality.
Leczenie stwardnienia rozsianego. Zalecenia Polskiego Towarzystwa Neurologicznego

Przedstawione zalecenia Polskiego Towarzystwa Neurologicznego, dotyczące leczenia stwardnienia rozsianego (SM, sclerosis multiplex ), są aktualnym stanowiskiem grupy polskich ekspertow w tym zakresie. Zalecenia te dotyczą postepowania w przypadku klinicznie izolowanego zespolu (CIS, clinically isolated syndrome ) sugerującego SM, leczenia rzutu choroby, terapii postaci rzutowo-remisyjnej, wtornie przewlekle postepującej, pierwotnie postepującej, a takze leczenia objawowego. Ujeto w nich kluczowe leki stosowane w terapii SM. W związku z dynamicznym rozwojem terapii SM bedą wymagaly okresowego uaktualniania.
Myocardial Ischemia on Exercise Stress Echocardiography Testing Is Not Associated with Changes in Troponin T Concentrations.

BACKGROUND Some posit that any amount of myocardial ischemia can be detected by high-sensitivity cardiac troponin assays. We hypothesized that patients with myocardial ischemia induced by exercise stress would have significantly higher increases in high-sensitivity cardiac troponin T (hs-cTnT) concentrations than patients without ischemia. METHODS We prospectively recruited for a biorepository 317 adult patients who presented to an academic hospital emergency department for evaluation possible ischemic symptoms and who were scheduled for exercise echocardiography. Blood samples were obtained before stress testing and 2-h post-testing. For this study, plasma hs-cTnT (Roche Diagnostics) concentrations were determined in a core laboratory blinded to clinical status. Absolute and relative changes between baseline and 2-h post-stress measurements were compared between patients with and without ischemia induced by stress testing. RESULTS The median age was 51 (44.0, 60.0) years, 45.9% were male, and 37.8% were African American. In total, 26 patients (8.1%) had myocardial ischemia induced by exercise. Median baseline, 2-h post-stress, and absolute δ concentrations were, respectively, 6.0, 8.0, and 0.2 ng/L for patients with evidence of ischemia; 3.8, 4.6, and 0.0 ng/L for those without; and 3.9, 4.9, and 0.0 ng/L overall. Baseline and 2-h hs-cTnT concentrations were higher among patients with abnormal stress tests (all P ≤0.05), but absolute and relative changes in hs-cTnT concentrations were not significantly different between individuals with ischemia and individuals without. CONCLUSIONS There was no evidence of change in hs-cTnT values in response to exercise stress testing, regardless of the presence of myocardial ischemia.
Macular carotenoid supplementation and visual function in early age-related macular degeneration

The carotenoids (lutein [L], zeaxanthin [Z] and meso-zeaxanthin [MZ]) are found at the macula, where they are collectively known as macular pigment (MP). The macula is a specialized part of the retina responsible for central vision. MP acts as a blue light filter, and its constituent carotenoids have antioxidant and anti-inflammatory properties. MP is believed to protect against progression of age-related macular degeneration (AMD), which is the leading cause of blindness in the developed world by protecting against oxidative stress. This PhD thesis answers three main research questions as follows: 1. what is the prevalence of AMD in the Republic of Ireland (ROI)? (research question 1); 2. what is the impact of supplementation using three different macular carotenoid formulations on MP and visual function in patients with non-advanced AMD over a three-year period? (research question 2); 3. Does the addition of MZ to the standard of care confer advantages or disadvantages to patients with non-advanced AMD in terms of visual outcomes and in terms of MP augmentation? (research question 3, main study). This thesis provides prevalence estimates of AMD in the ROI for the first time, and adds to the evidence with respect to the impact of macular carotenoid supplementation on visual function among patients with this condition.
Perceptions of indigenous people regarding mental illness at Cacadu district in the Eastern Cape province of South Africa

The aim of the study was to explore the perceptions of indigenous people and the role of Traditional Healers in the management of mental ill persons in Cacadu District, Eastern Cape Province, South Africa. This qualitative, exploratory and descriptive study consisted of nine relatives of mental health care users and six traditional healers. Data were collected from two categories namely, relatives of the Mental Health Care Users (MHCUs) and the Traditional healers. An interview guide was used to conduct in-depth face to face interviews. Data were analysed using two techniques, namely coding and reflective remarks. Participants indicated negative impact of mental illness as a result they portrayed great desperation regarding means of accessing cure for mental illness. Some participants showed insufficient knowledge regarding mental illness and had vast perceptions and beliefs regarding the origin of mental illness. Some key findings was that mental illness resulted in tension amongst family members with sick individuals over demanding and exhibiting abusive type of communication which led to serious disharmony within the family structure. Most participants expressed the burden that the family experience during the period when its member is affected by mental illness with regard amount of resources and support that is needed for the mentally ill individual. Families not only provide material resources such as food, clothing, shelter, and money; they are also instrumental in assisting the mentally ill individual to access medical care and community resources. Some family members go to an extent of hiring health caregiver. The relatives do not open up to the health care team about visiting traditional healers. Some family members confirmed that it is not easy to accept mental illness like other common physical illnesses. Some of the causes mentioned by the indigenous people are witchcraft, jealousy, amafufunyana, ukuthwasa and ancestral anger. Indigenous people of Cacadu District view mental illness as spiritual origin but they include western medication for the benefit of the mentally ill. However, the relatives of the MHCUs emphasised economic burden as the major problem brought about as a result of mental illness. The families are not certain about how the admission procedure is conducted. They only phone the police to arrest the person who is mentally ill not knowing that the person might end up in a mental hospital. There is a need for collaboration between Mental Health Care Practitioners/Providers and Traditional Healers in order for them to be more supportive than judgmental. This will prevent relatives of the MHCUs from being secretive in that way the chain of treatment will not be broken resulting to lesser treatment default.
Life beyond cancer: sexuality and fertility in cancer survivors

Due to progress in cancer diagnosis and cancer therapies, the population of cancer survivors in Europe is rapidly growing. Cancer survivors have multiple psycho-social needs: loss of fertility and problems in sexuality are two major concerns that, if not adequately treated, may negatively impact survivors’ psychological well-being and prevent the fulfillment of their existential plans, both at the individual and at the interpersonal level. Information and communication regarding these aspects are often neglected in the clinical practice whereas they must be addressed in a regular and systematic manner, and strategies to enhance communication and improve the provision of information should be implemented .
Integrative Upper-Limb Rehabilitation with BrightArm DuoTM in the Early Sub-Acute Phase of Recovery Post-Stroke

The Bright Arm Duo is a low-friction robotic rehabilitation table that adaptably trains dual arm movement and grasp through interaction with serious games. In early sub-acute phase post-stroke, N=3 experimental group received conventional rehabilitation plus 12 BrightArm Duo sessions, each inducing up to 600 arm and hand repetitions. N=9 control group received conventional rehabilitation only. Improvement for the experimental group was better than controls across 11 of 12 functional metrics and activities of daily living (p=0.006).
Differential Diagnosis of an Inferior Vena Cava Thrombosis/Hepatic Cyst Using an Abdominal Sonogram, Echocardiogram, Venography, and Computed Tomography Angiogram

The role of cardiac sonographers, as health care professionals, comprises facilitating a cardiologist’s diagnosis of valvular lesions, coronary artery disease, and congenital defects and assessing right-side pulmonary complications and so on. Occasionally, communication of differential diagnoses across several modalities, specialties, and healthcare providers is compulsory, in order to accurately confirm or deny an appropriate diagnosis for patients with unique presentations. This case study highlights the vital role of abdominal sonography, echocardiography, venography, and computed tomography in the diagnosis of a hepatic cyst. In addition, it demonstrates the appropriate measures that cardiac sonographers can take to fully investigate these lesions, especially when they are presumed to be a thrombosed inferior vena cava.