Miracle-dz/UniFAR-FTUs huggingface dataset:
The Adoption and Implementation of Kaiser Permanente's Guideline for Purchasing Chemicals: An In-Depth Case Study

Author(s): Foushee, Christina Marie | Advisor(s): Newcomer, Robert | Abstract: This study uses organizational change, diffusion of innovation, and strategic management theories to explore the adoption and implementation of an innovative process for purchasing chemicals and chemical-containing products at Kaiser Permanente (KP), the largest not-for-profit health system in the United States. Case study methodology and content analysis were used to design and analyze this study. Interviews were conducted with key decision makers at KP headquarters in Oakland, California and with informants from nongovernmental organizations that partnered with KP in purchasing chemicals purchasing efforts. In addition to interviews (n = 19), private and public documents (n = 22) were examined and analyzed to triangulate the data. This exploratory study carefully documents the complex factors that influenced an innovation in the purchase of chemicals and chemical-containing products by an industry leader widely recognized for its environmental stewardship initiatives. This study highlights specific organizational successes at KP in driving the design and manufacture of environmentally preferable product alternatives. However, it also characterizes the substantial contextual and regulatory barriers that KP confronted as it tried to establish a more sustainable base of operations. These barriers included: (a) difficulty acquiring product information; (b) difficulty reducing chemicals and chemicals of concern in the supply chain due to various factors, such as lack of available alternatives; (c) limited organizational resources to pursue or verify product information or create new products; (d) difficulty addressing the large and complex range of products that enter KP's supply chain; and (e) difficulty surmounting barriers posed by existing regulations governing chemicals.
Custom Impression Trays In Prosthodontics - Clinical Guidelines

Prosthodontist always desire to make accurate impression for successful prosthesis. To achieve accurate impressions dentist need to access the tissue to be recorded, selection of accurate stock tray, technique for making accurate and well-adapted custom impression tray, ideal impression materials and techniques for making accurate impression. A dentist usually uses stock tray for making primary impression as well as final impression due to lack of knowledge like, optimum material for making custom impression tray, adequate extension, required thickness and designs of spacer, tissue stops, escape holes, tray handles and polymerization time regarding custom impression trays in prosthodontics. This article will encourage the dentists to use accurate design of custom impression trays in clinical practice. This will help in reducing chair side time and will give good adaptation of final prosthesis; hence, dentist will receive patient appreciation in practice.
Effect of acupressure on women with urodynamic stress incontinence

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Mercury in Hair of Mothers and Infants: Influencing Factors Assessment in the Southern shores of the Caspian Sea (Iran)

Background: Mercury (Hg) is a hazardous metal responsible for environmental contamination and human intoxication. Methyl mercury bio-accumulation through food chain can be responsible for chronic mercury exposure of South Caspian Sea communities with a diet rich in fish. Uncertainties about exposure levels that could have damaging consequences for nervous system development of infants makes bio-monitoring of Hg a necessity in Southern Caspian Sea populations. Methods: Mercury concentration in the hair of 70 pairs of mothers and their breastfed infants were assessed and its relationship with influencing factors was evaluated. Results:Calculated levels of mercury exposure of both infants and mothers indicated concentrations less that the recommended levels by WHO and EPA reference. Total mean mercury concentrations in infants hair was 0.48±0.32 μg / g and for mothers was 0.19±0.09 μg / g. Correlation analysis showed that mercury concentration in the hair of infants was significantly (P=0.002, R=0.371) associated with mercury levels in the hair of their mothers. The influence of other variables such as living location, age of mothers, infants‘ sex, weight, the amount of fish and sea food consumption of mother, and the number of dental amalgam fillings, were examined as well as. Conclusion: The amount of fish and sea food consumption by mothers and the living location were the variables that significantly affected hair mercury concentrations of mothers and infants. Also the age of infants (p=0.02) and the number of dental amalgam fillings of mothers (p=0.016) significantly affected the hair mercury levels in infants. Hair
DIABETES MELLITUS, OBESITY, HYPERTENSION: RISK FACTORS FOR METABOLIC SYNDROME

The Metabolic Syndrome (MS) is a combination of interrelated metabolic abnormalities that significantly increase the risk of cardiovascular disease, Diabetes Mellitus Type 2 (DM2) and Obesity. Based on estimates from the Centers for Disease Control and Prevention, 57 million adults were classified as having metabolic syndrome in 2008, and this number climbed to 79 million in 2012. (Central) Obesity is a hallmark of all Metabolic Syndrome. Obesity as measured by waist circumference or BMI. It is the strongest risk factor for Metabolic Syndrome. Intra-abdominal obesity is direct delivery of pro-inflammatory adipokines and free fatty acids (FFA) to the liver, adversely affecting hepatic metabolism. Excess adipose tissue associated with obesity promotes the conversion of cortisone to cortisol due to overexpression of 11β- HSD1. Hypertension is the most significant CVD risk factor involved in MS prognosis. Persistent hypertension is a primary risk factor for stroke, heart attack, heart failure, aneurysm, and end-organ damage leads to imbalance in metabolic disturbance. DM2 is a crucial factor in MS and is highly predictive of Cardiovascular Disease. There is an increase in free fatty acids which promote oxidative stress, endothelial dysfunction, vascular damage, and atheroma formation. These all contributing risk factor promote pathogeensis of MS. Non Pharmacological, Pharmacological treatment and herbal plants available to treat MS. Several Plants showing some good therapeutic activity on MS like Lonicera japonica, Viscum album, Litchi chinensis, Artocarpus heterophyllus, Psidium guajava , Polyalthia longifolia. Among all Lonicera japonica may be used to treat metabolic syndrome in future. WO
Re‐evaluation of benzyl alcohol (E 1519) as food additive

Abstract The Panel on Food Additives and Flavourings (FAF) provided a scientific opinion re‐evaluating the safety of benzyl alcohol (E 1519) when used as a food additive. The Panel considered that adequate exposure and toxicity data were available. Benzyl alcohol (E 1519) is authorised as a food additive in the EU in accordance with Annex III to Regulation (EC) No 1333/2008. The Panel considered benzyl alcohol of low acute toxicity with no concern with respect to genotoxicity and carcinogenicity and established an acceptable daily intake (ADI) of 4 mg/kg body weight (bw) per day based on a no observable adverse effect level (NOAEL) of 400 mg/kg bw per day from the carcinogenicity study in rats. The mean and high exposure estimates in the refined exposure scenarios were maximally 0.27 and 0.81 mg/kg bw per day in toddlers, respectively. The exposure estimates to benzyl alcohol (E 1519) were below the ADI of 4 mg/kg bw per day in all population groups. The Panel noted that also the exposure in the regulatory maximum level exposure assessment scenario is below the ADI in all population groups. The Panel concluded that the exposure to benzyl alcohol (E 1519) does not raise a safety concern at the reported uses and use levels.
Randomized controlled trial of erdosteine for acute cough in children with colds

Background T h e prevalence of the common cold in children is high, v.ith 30% of cases exhibiting an acute cough, the most common complaint by parents. Erdosteine, a recently developed cough medicine, is available for children. Erdosteine has been reported to increase mucodliary clearance, act as an antioxidant and prevent bacterial adhesion. Objective To assess the clinical improvement in acute cough in children \\lith a common cold taking erdosteine vs. a placebo. Methods We conducted a double􀀾blind, randomized, controlled trial at the Public Health Center of Gedongtengen, Yogyakarta with 140 children selected by a consecutive sampling method. Research subjects were randomized by computer program into two treatment groups, those receiving erdosteine therapy and those receiving a placebo. Both groups were monitored for 6 days. A scoring system was used to assess the improvement of acute cough symptoms and analyzed by Chi-square test. Results No significant differences in basic characteristics, cough severity, or environment were found among the 140 children with common cold in the two groups. After 6 days of treatment, no significant difference in clinical improvement of acute cough was found between the erdosteine (65 subjects improved out of 70) and placebo groups (62/70),92.5% and 88.6%, respectively (P=0.382). Conclusion Erdosteine was not more effective than the placebo for treatment of acute cough in children with common cold.
Fusobacterium nucleatum prevents apoptosis in colorectal cancer cells via the ANO1 pathway

Objective : Chemotherapy failure derived from drug resistance is the most important reason causing the recurrence in colorectal cancer patients. Therefore, it is necessary to shed light on the mechanism of chemotherapy resistance in colorectal cancer patients. Methods : We looked into the contribution of Fusobacterium nucleatum and ANO1 to chemoresistance in the human colorectal carcinoma cell lines. We silence and overexpress ANO1 in HCT116 and HT29 cells with lentivirus and siRNA knockdown technique in the absence or presence of F. nucleatum, oxaliplatin or 5-fluorouracil (5-FU). ANO1, p-pg, cleaved PARP, cleaved caspase-3, and EGFR expression was measured by Western blot. Cell apoptosis was measured by flow cytometry. Results : We found that F. nucleatum promoted ANO1 expression on colon cancer cells. Moreover, ANO1 prevent colon cancer apoptosis from oxaliplatin and 5-FU. Additionally, knockdown ANO1 expression could block F. nucleatum protective effects and increase the apoptosis effects induced by oxaliplatin and 5-FU. Therefore, F. nucleatum might be biologically involved in the development of colon cancer chemoresistance via ANO1 pathway. Conclusions : Taken together, our findings provide a valuable insight into clinical management and therapy, which may ameliorate colorectal cancer patient outcomes.
Cervical precancer and cancer, past, present and future.

Abstract This review is a short summary of the very long history of invasive and in situ carcinomas of the cervix. The items considered in this paper are the etiology of cervical cancer by a sexually transmitted agent proposed about 150 years ago by Domenico Rigoni Stern, the birth of radical surgery for the treatment of cervical invasive carcinoma with the Wertheim operation in 1898, radium therapy and chemotherapy, cytological diagnosis, the birth of colposcopy, microcolposcopy, the definition of carcinoma in situ, dysplasia and microcarcinoma, the birth of the International Federation for Cervical Pathology and Colposcopy, condylomatosis lesions of the cervix and some HPVs as agents of cervical pre-cancer and cancer, and finally the concept of vaccination against oncogenic HPV types. All these constitute an integral part of common medical practice.
Effects of heavy alcohol intake on lipoproteins, adiponectin and cardiovascular risk

The effect of alcohol intake on the pathophysiology of atherosclerotic cardiovascular disease is controversial, especially with respect to heavy alcohol intake. The pathobiology behind atherosclerosis is a complex and multiparametric phenomenon, therefore a self-organizing map (SOM), an unsupervised learning based artificial neural network technique, was applied in the present work. This study was carried out to investigate the effect of heavy alcohol intake on the pathophysiology of atherosclerosis, including several lipoproteins and adiponectin, an adipocytederived cytokine that may ameliorate atherosclerosis. Firstly, the effect of heavy alcohol intake on the capacity of HDL and its subclasses (HDL2 and HDL3) to mediate cholesterol efflux from macrophages was studied. Secondly, data of ultracentrifugally isolated lipoproteins were fed into SOM analysis to investigate whether this method can find diverse lipoprotein phenotypes from the heterogeneous lipoprotein data. Thirdly, the aforementioned method was applied to multivariate data of alcohol drinkers to study whether distinct metabolic profiles are associated to heavy alcohol consumption. The results revealed that HDL2, not HDL3, of heavy alcohol drinkers had an enhanced capacity to remove cholesterol from macrophages when compared with control persons. SOM analysis enhanced the ultracentrifugally based lipoprotein data and depicted several novel lipoprotein phenotypes. In addition, lipoprotein-based SOM analysis found two distinct metabolic profiles in heavy alcohol drinkers: an anti-atherogenic and a metabolic syndrome-like profile with opposite metabolic features, such as characteristics of lipoproteins, plasma concentration of adiponectin and prevalence of metabolic syndrome. These profiles also tended to differ in their CV risk. In conclusion, the enhanced cholesterol efflux capacity of HDL2 in heavy drinkers is an antiatherogenic change linked to alcohol drinking. However, clinically it may be important to be aware that although heavy alcohol drinkers have a low LDL-C level, they differ in their other lipoprotein measures, forming distinct phenotypes with potentially different CV risks. Finally, SOM analysis of ultracentrifugally based lipoprotein data generates in silico classification of lipoprotein particles and thereby offers a new tool for lipoprotein research.
Understanding Modifiable and Unmodifiable Older Adult Fall Risk Factors to Create Effective Prevention Strategies

Each year, more than 1 in 4 older adults in the United States report a fall and 1 in 10 a fall injury. Using nationally representative data from the 2016 US Behavioral Risk Factor Surveillance System, we evaluated demographic, geographic, functional, and health characteristics associated with falls and fall injuries among adults aged 65 years and older. Analyses included descriptive statistics and multivariable logistic regression to produce crude and adjusted percentages by characteristic. Characteristics most strongly associated with increased fall risk in order of adjusted percentage were depression, difficulty doing errands alone, and difficulty dressing or bathing. Characteristics most strongly associated with fall injury risk in order of adjusted percentage were depression, difficulty dressing or bathing, and being a member of an unmarried couple. The diverse health and functional characteristics associated with increased falls and fall injuries confirm the importance of screening and assessing older adult patients to determine their individual unique risk factors. Health care providers can use tools and resources from the Centers for Disease Control and Prevention’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative to screen their older adult patients for fall risk, assess at-risk patients’ modifiable risk factors, and intervene to reduce risk by prescribing evidence-based interventions.
The effect of doxycycline on bone turnover and tumor markers in breast cancer (BC) patients with skeletal metastases

3198 Background: Doxycycline is a tetracycline analogue which is osteotropic with high affinity for mineralized bone. In experimental systems, it has anti-cancer effects including inhibition of matrix metallo proteinases, anti-angiogenic activity and a cytostatic effect on cancer cells. Methods: 17 patients with newly diagnosed bone metastases from BC, and no prior bisphosphonate therapy were treated with Doxycycline 100 mg po bid for 3 months. Treatment was discontinued for disease progression or unacceptable toxicity. Bone scans and serum bone markers [N-telopeptide (NTx - Osteomark NTx Serum) and bone specific alkaline phosphatase (BAP - Metra BAP)] were measured as markers of bone turnover and PTHrP as a marker of tumor progression at baseline and following 12 weeks of therapy. Patients subsequently received bisphosphonate therapy. The primary outcome was a 50% relative decrease in serum bone markers. Results: 12 patients were evaluable for response, 3 patients discontinued therapy due to toxicity and.
Expression of myosin heavy chain in neonatal human hearts

Abstract We have investigated the spatial distribution of the α and β isoforms of myosin heavy chain in the force-producing ventricular myocardium, the ventricular conduction system and the atrioventricular junctional region of five neonatal human hearts–three born prior to and two at term. The results can be summarized as follows: 1) the force-producing myocardium: in each heart, the β isoform was found to be the predominating isoform, β-negative cells never being observed. Considerable amounts of the α isoform were observed only in those hearts that were obtained from patients dying within the first two weeks of postnatal life. This transient expression is probably correlated with the postnatal increase in levels of circulating thyroid hormone. 2) the ventricular conduction system: in addition to the expression of the β isoform, a strong expression of the α isoform was detected in all the components of the ventricular conduction system in the two full-term hearts. In the preterm hearts, however, this strong expression was mainly restricted to the atrioventricular node and the penetrating atrioventricular bundle. The level of expression of the α isoform in the conduction system of the neonatal hearts, therefore, might reflect the state of maturity of this system at the time of birth. 3) the atrioventricular junctional region: in each heart examined, structures were detected that resembled immunohistochemically and morphologically the atrioventricular node. Although the expression of the isoforms of myosin heavy chain in the conduction system, and in these comparable structures, cannot, as yet, be interpreted with regard to function, these resemblances, coupled with the same developmental background for these structures (they all develop from the so-called “primary ring”) suggest functional affinities during this stage of cardiac development.
Diabetic Retinopathy Detection Based on Deep Learning

Recent years, deep learning in the image identiﬁcation has made great progress, showing good application prospects in medical image reading. Diabetic Retinopathy (DR) is an eye disease due to diabetes, which is the most ordinary cause of blindness. Traditional diabetic retinopathy detection is a manual and time-consuming and labor-intensive process, which requires a highly experienced clinician to examine and evaluate the digital color fundus photos of the retina. Therefore, it is crucial to use the deep learning technique to achieve automatic detection of diabetic retinopathy. In this paper, we proposed a diabetic retinopathy detection method based on deep learning and proposed a network structure named multi-self-attention. At ﬁrst, the image features were extracted through the InceptionV3 model, and then the feature maps was directly generated. Secondly, the feature maps, which can reﬂect condition of retina, will be input into multi-self-attention network structure, to calculate multi-self-attention feature. Finally, by convolutional layer and fully connected layer, the stage results about diabetic retinopathy will be obtained. With the experiments in TensorFlow framework , the eﬀectiveness of multi-self-attention network structure for feature extraction and classiﬁcation is proved.
Probability analysis of axillary lymph node metastasis in breast cancer patients using particle space-time distribution model

The possibility of axillary lymph node metastasis differs in different breast cancer patients and is the strongest prognostic indicator in breast cancer. The existing studies mainly explored the relationship of axillary ultrasound imaging and axillary lymph node metastasis, without exploring whether ultrasound imaging of breast tumour can affect and perform axillary lymph node prediction. Therefore, this Letter proposes a novel particle space-time distribution model to find the correlation between contrast-enhanced ultrasonography of breast tumour and axillary lymphatic metastasis. Starting from the imaging principle of dynamic contrast-enhanced ultrasonography, the particle space-time distribution model not only comprises space-time features of contrast-enhanced ultrasonography with an encoder–decoder network, but also the flow field information of microbubble particles is integrated into the space-time features that better serves the metastasis prediction by enhancing the particle distribution information. Extensive experiments on real patients have demonstrated that dynamic contrast-enhanced ultrasonography of breast tumour can be used to predict the probability of lymphatic metastasis. This conclusion can be interpretable from the clinical and pathological perspectives.
Young people's needs and preferences for health resources focused on pornography and sharing of sexually explicit imagery.

Public concerns have been raised about the effects that young people’s rapidly increasing access to online pornography has on their mental wellbeing, sexual development and gender norms and expectations. Young people are also increasingly exchanging personal sexually explicit images (also knowns as ‘sexts’ or ‘nudes’). When images are shared without the consent of the person in the image, severe social and mental health consequences can arise for the victim. In acknowledgement of these emerging issues, some recent sexual education campaigns and resources have attempted to provide educational information on pornography use and the sharing of personal sexually explicit images. However, these resources have been criticised as potentially damaging due to their victim-blaming and abstinence-focused approaches. It is essential to incorporate young people’s voices in the development of resources to ensure that they meet the information needs of their audience and improve marketability and appropriateness. There is currently little literature available to guide health promoters in developing resources on this emerging and sensitive topic; we aimed to contribute to addressing this gap in literature in our report.
Interdisciplinaridade e IHC: Possibilidades no Contexto da Licenciatura em Computação

A interdisciplinaridade é vista cada vez mais como um componente fundamental para a educação em todos os níveis. Neste artigo, analisamos opiniões, motivações e barreiras, percebidas por professores, para a disseminação de práticas interdisciplinares; e apresentamos práticas existentes em nossos cursos de graduação na área de Computação. Em particular, focamos no potencial da Interação Humano-Computador como uma área de conhecimento transversal e em como isso pode ser melhor explorado em cursos de Licenciatura em Computação. Consideramos os desafios inerentes às diferentes possibilidades para promover a interdisciplinaridade e a necessidade de repensar a estrutura atual da educação superior.