Miracle-dz/UniFAR-FTUs huggingface dataset:
Clinical and polysomnographic characteristics in patients with morning headache

Background: The relation between headaches and sleep disorders are complex and heavily questioned. However, there is still controversy about this interrelationship. Objective: To describe the clinical and polysomnographic characteristics of patients with morning headache, and to compare them with patients without morning headaches. Methods: Prospective study between April and August 2009. One hundred and eight patients were included consecutively and by convenience. All patients were submitted to polysomnography and were distributed in the group with headache (group 1) or the group without headache (group 2). Results: Morning headache was reported by 33 (30.6%) patients, 17 (51.5%, p = 0.02) women. The clinical characteristics in the group of morning headache were 42.4% with disease in upper respiratory system, 72.7% with anxiety, 45% with headache in general, 54% with neurocognitive symptoms, 81.2% reported non restorative sleep and 60.6% had insomnia (all p< 0.05). Among the polysomnographic features surveyed, the only variable that showed statistical significance was wake after sleep onset. Almost 43% (vs. 20%) of patients with morning headaches were in normal range. Conclusions: It was not possible to conclude that the presence of the increase apnea/hypopnea indices, desaturation relevant and intermittent and disruption of sleep patterns are sufficient to modulate, by itself, the occurrence of morning headaches. Sleep disorders can act as a trigger for morning headaches in susceptible individuals with specific clinical profile
Automatic cine-based detection of patients at high risk of heart failure with reduced ejection fraction in echocardiograms

ABSTRACT Heart failure with reduced ejection fraction (HFrEF) is associated with high mortality rates. The identification of patients with HFrEF in urgent and emergent situations can be delayed in the absence of clinicians skilled in acquiring and interpreting echocardiography (echo) images. Although the standard-of-care for measuring ejection fraction (EF) involves segmentation of the left ventricle in echo, experienced interpreters often opt for visual estimation of EF in clinical settings. In this paper, we mimic this process using dual-channel deep neural networks for segmentation-free classification of echo cine loops: low-risk ( ) vs. high-risk (reduced EF, i.e. ). The proposed architecture utilises densely connected networks for extraction of unsupervised spatial features. Temporal embedding is then achieved by aggregating these frame-level feature vectors and feeding them through recurrent blocks. We use 949 and 237 clinical echo exams to train and validate the proposed method, respectively. We demonstrate that direct cine-based detection of patients at high-risk of HFrEF is feasible using densely connected convolutional and recurrent-based architectures.
Epigenomic prediction of cardiovascular disease risk and interactions with traditional risk metrics

Epigenome-wide association studies for cardiometabolic risk factors have discovered multiple loci associated with incident cardiovascular disease (CVD). However, few studies have sought to directly optimize a predictor of CVD risk. Furthermore, it is challenging to train multivariate models across multiple studies in the presence of study- or batch effects. Here, we analyzed existing DNA methylation data collected using the Illumina HumanMethylation450 microarray to create a predictor of CVD risk across three cohorts: Women’s Health Initiative, Framingham Heart Study Offspring Cohort, and Lothian Birth Cohorts. We trained Cox proportional hazards-based elastic net regressions for incident CVD separately in each cohort, and used a recently-introduced cross-study learning approach to integrate these individual predictions into an ensemble predictor. The methylation-based risk score (MRS) predicted CVD time-to-event in a held-out fraction of the Framingham dataset (HR per SD = 1.28, p = 2e-3) and predicted myocardial infarction status in the independent REGICOR dataset (OR per SD = 2.14, p = 9e-7). These associations remained after adjustment for traditional cardiovascular risk factors and were similar to those from elastic net models trained on a directly merged dataset. Additionally, we investigated interactions between the MRS and both genetic and biochemical CVD risk, showing preliminary evidence of an enhanced predictive power in those with less traditional risk factor elevation. This investigation provides proof-of-concept for a genome-wide, CVD-specific epigenomic risk score and suggests that the DNA methylation data may enable the discovery of high-risk individuals that would be missed by alternative risk metrics.
Assessing Perceptions of Posttraumatic Stress Disorder Among a Cohort of Noncontracted ROTC Cadets

Assessing Perceptions of Posttraumatic Stress Disorder Among a Cohort of Noncontracted ROTC Cadets by Stephen P. Gontz MFS, National University, 2010 BS, Armstrong Atlantic State University, 2004 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Criminal Justice
Randomised Comparison between the Efficacy of Two Doses of Nebulised Dexmedetomidine for Premedication in Paediatric Patients

Objective Nebulised dexmedetomidine can be an easy alternative for preoperative sedation in paediatric patients, but data regarding its efficacy are very limited. Methods This prospective, randomised, double-blind study included 66 patients aged between 1 and 8 years. Patients were divided into two groups as D2 and D3. The D2 group received 2 μg kg−1 of nebulised dexmedetomidine, and the D3 group received 3 μg kg−1 of nebulised dexmedetomidine preoperatively. All the patients received general anaesthesia and caudal epidural analgesia with 0.75 mL kg−1 of 0.2% ropivacaine. Parental Separation Anxiety Scale at 30 min after the end of nebulisation, Mask Acceptance Score (MAS) during induction, haemodynamic variables, emergence agitation and duration of caudal analgesia were compared between the groups. Statistical analysis was done using Mann-Whitney U test and chi-square test. A p-value <0.05 was accepted as significant. Results All the parameters were comparable between the D2 and D3 groups; however, significantly more number of younger children was observed in the D3 group. Hence, further analysis was done after division into the lower age (1–3 years) and higher age (4–8 years) groups. In lower age group children, satisfactory parental separation was achieved in 100% of the patients in the D3 group compared to 20% of those in the D2 group (p=0.00). MAS was significantly better in the D3 group in both the lower (p=0.019) and higher (p=0.036) age groups. Conclusion We conclude that nebulised dexmedetomidine in a dose of 3 μg kg−1 provides better parental separation and mask acceptance in younger children.
Computational biomechanics of knee joint arthroplasty : a review

Computational models have been widely used for more than four decades to evaluate the mechanical behavior of knee joint arthroplasty. Validated computational models provide a virtual platform to develop optimal articular surfaces which achieve desired implant characteristics. This review paper provides a comprehensive overview of the computational models available to represent knee joint arthroplasty. A brief overview of knee joint anatomy and arthroplasty is provided, followed by computational model development techniques. Use of the computational models in development of knee joint arthroplasty and preor post-clinical evaluation is summarized. This review paper presents current modeling capabilities for implant design and stability, with further suggestions for studying the performance of implants on a population level. However, simulations must include closely corroborated multi-domain analysis in order to account for real-life variability.
Frequency of Helicobacter pylori infection in patients of chronic spontaneous urticaria

Objective To calculate the frequency of Helicobacter pylori infection by stool antigen assays in patients of chronic spontaneous urticaria. Methodology The study was cross-sectional & conducted in Dermatology outpatient department of Saifee Hospital Trust, Karachi, Pakistan. The duration of study was six months i.e. from July 1 st 2017 to December 31 st 2017. Clinically diagnosed, 130 adult cases of chronic spontaneous urticaria of either gender, age 18 years and above, having urticaria for 6 months or more were included via non-probability consecutive sampling technique. Stool for H pylori antigen assays were performed and results were recorded. Results In our study, the mean age was 33.4 ± 13.0 years. Mean duration of symptoms was 1.5 years. Out of 130 patients, 98 (75.4%) were female and 32 (24.6%) were male with a female to male ratio of 3:1. In our study, those who have urticaria for longer duration (more than 1 year) were more likely to have H pylori infection as compared to those who have shorter duration (P=<0.009). Overall, stool for H pylori antigen test was positive in 39 (30%) patients with urticaria (P=<0.001). Conclusion The number of cases with positive stool for H pylori antigen among chronic spontaneous urticaria patients is significantly higher and it is one of the main aetiopathogenic factors for this disease. Cases of urticaria should be routinely screened for H pylori infection and eradication therapy will be useful for control of disease.
The Role of the Physician in a Helicopter Emergency Medical Service

Abstract The purpose of this study was to measure the contributions of a physician crew member in a helicopter emergency medical service (HEMS) and to develop a method to utilize physician services more efficiently. A two-part study utilizing two independent sets of measurements of physician necessity was conducted. A post-flight questionnaire and the success rate for endotracheal intubation were used as measurement tools. With the passage of time, the fight nurses perceived the physician crew member' contribution to clinical judgment decreased from 21% to 1% of the flights and that the physician's contribution of technical skills (intubation) declined from 11% to 3%. The contribution to clinical decisions seemed more important on interhospital transports than on scene responses. The technical skills (judged by the tracheal intubation success rates) of a physician seemed more cogent on responses to the scene. When in the capacity of a second crew member with an experienced flight nurse, the endotracheal intubation success rate increased from 71% to 90%. Therefore, it seems that physician services could be restricted primarily to scene response flights. This limited utilization of flight physicians should make these physicians available for other duties.
Bayesian Analysis of the Relationship Between Belief Conflict and Occupational Dysfunction.

IMPORTANCE Elucidation of the relationship between belief conflict and occupational dysfunction in occupational health is needed. Knowledge of this relationship is important to the development of preventive occupational therapy. OBJECTIVE To examine the relationship between belief conflict and occupational dysfunction. DESIGN Cross-sectional study. Participants were recruited via nonrandom sampling, and data were analyzed with Bayesian modeling. SETTING Health care institutions in Japan. PARTICIPANTS Participants were 890 health care workers. OUTCOMES AND MEASURES Data were collected by means of the Participant Profile, the Assessment of Belief Conflict in Relationship-14 (ABCR-14), and the Classification and Assessment of Occupational Dysfunction. RESULTS Belief conflict and occupational dysfunction showed moderate to strong positive correlations. The cutoff value for the ABCR-14 was estimated to be 58 points. The odds ratio indicated that groups with high belief conflict were very likely to experience occupational dysfunction. CONCLUSIONS AND RELEVANCE These findings show that belief conflict and occupational dysfunction are more than moderately associated. Longitudinal studies are needed to prove the causal relationship between belief conflict and occupational dysfunction. WHAT THIS ARTICLE ADDS Considering that those falling into the high-belief-conflict group are likely to experience occupational dysfunction, it is necessary to focus efforts not only on teamwork but also on the improvement of health. Preventive occupational therapy needs to assume a leading role in improving the occupational health of health care workers who experience belief conflict and occupational dysfunction.
The impact of hospital nurse staffing, work environment and patient-centeredness on the quality of care and patient safety

The healthcare industry is complex in nature. The quality of care and patient safety has become a national and international priority. Limited efforts have been made on improving nursing care in order to optimize the outcomes of care. This study empirically investigated the impact of hospital nurse staffing and work environment on the quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals. The mediating effect of patient-centeredness on the effect of both hospital nurse staffing and work environment on the quality of care and patient safety was also investigated. A cross-sectional survey was conducted on 12 private hospitals. Data was collected, through questionnaires, from 652 nurses, with a 61.8 % response rate. The stratified simple random sampling was used to allow nurses from all shifts to participate in the study. Regression analyses and the Hayes PROCESS macro were conducted to test the hypotheses. The results showed that staffing had an insignificant negative impact on the outcomes of care, whereas work environment had a significant positive impact. Moreover, it was found that patient-centeredness significantly mediated the effect of both staffing and work environment upon the outcomes. A model for improving the quality of care and patient safety was proposed. The practical implications indicated that patientcenteredness suppresses the negative impact of nursing shortage and shift length, and complements the positive impact of work environment on the outcomes of care. Further mediators are recommended for future research on the impact of both hospital nurse staffing and work environment on the quality of care and patient safety.
PEMODELAN SISTEM PENDUKUNG KEPUTUSAN KLINIS DENGAN METODE FUZZY WEIGHTED PRODUCT

Pneumonia merupakan penyakit batuk pilek disertai napas sesak atau napas cepat, proses infeksi akut yang mengenai jaringan paru-paru (alveoli) biasanya disebabkan oleh masuknya kuman bakteri, yang ditandai oleh gejala klinis batuk, demam tinggi dan disertai adanya napas cepat ataupun tarikan dinding dada bagian bawah ke dalam serta penyakit terbanyak yang mengakibatkan kematian untuk setiap tahunnya, terbatasnya tenaga medis di puskesmas dibanding dengan jumlah penduduk berakibat sering terlambatnya pelayanan terhadap pasien pneumonia. Tujuan penelitian ini adalah membuat pemodelan sistem pendukung keputusan klinis untuk mendiagnosis pasien pneumonia pada orang dewasa. Sistem ini dirancang sebagai alat bantu tenaga medis dalam mendiagnosis pasien pneumonia. Pemodelan Sistem Pendukung Keputusan Klinis dikembangkan dengan metode Fuzzy Weighted Product. Pemberian nilai masing-masing fitur dan vektor bobot direpresentasikan dalam bentuk bilangan Fuzzy Segitiga dan tahap perangkingan menggunakan Weighted Product. Sistem diuji dengan cara memasukkan data gejala pneumonia tanpa melibatkan seorang pakar. Hasil penelitian menunjukkan bahwa sistem dapat mendukung untuk mendiagnosis penyakit pneumonia.
Exercise as A Potential Therapeutic Target for Diabetic Cardiomyopathy: Insight into the Underlying Mechanisms

Diabetes mellitus is associated with cardiovascular, ophthalmic, and renal comorbidities. Among these, diabetic cardiomyopathy (DCM) causes the most severe symptoms and is considered to be a major health problem worldwide. Exercise is widely known as an effective strategy for the prevention and treatment of many chronic diseases. Importantly, the onset of complications arising due to diabetes can be delayed or even prevented by exercise. Regular exercise is reported to have positive effects on diabetes mellitus and the development of DCM. The protective effects of exercise include prevention of cardiac apoptosis, fibrosis, oxidative stress, and microvascular diseases, as well as improvement in cardiac mitochondrial function and calcium regulation. This review summarizes the recent scientific findings to describe the potential mechanisms by which exercise may prevent DCM and heart failure.
Chronic pancreatitis fibrogenesis : the role of TGFB pathway inhibitor Smad7 in the fibrosis development

Chronic pancreatitis is characterized by progressive inflammation, acinar atrophy and fibrosis. Transforming growth factor-B signaling (TGFB) is the most potent fibrogenic cytokine known, and its increased expression is a common denominator for fibrosis in chronic pancreatitis. Smad7 is induced by the TGFB superfamily members as an intracellular inhibitory feedback antagonizing TGFB signaling. To investigate the functional role of Smad7 in vivo, we induced chronic pancreatitis by repeated administration of cerulein in mice that are either ubiquitous or conditional deficient of Smad7. Mice with general deficient of Smad7 showed more severe response to chronic pancreatitis induction as indicated by a stronger accumulation of extracellular matrix (ECM), increased levels of inflammatory cells and mesenchymal cells/myofibroblasts. Mice with fibroblasts-specific deficient of Smad7 showed slightly higher fibrotic index but the production of different ECM proteins and the number of fibroblasts and inflammatory cells were not affected, although in vitro studies confirmed increased activation of mutant pancreatic stellate cells. Mice with myeloid cellsspecific deficient of Smad7 exhibited fewer number of macrophages and pancreatic stellate cells and less fibronectin deposition, which might be related to the reduced capacity of Smad7 deficient macrophages to support pancreatic stellate cells’ survival. Thus, targeting TGFB signaling by Smad7 demonstrates diverse effects in different contexts, and Smad7 can exert both exacerbated and protective properties in experimental chronic pancreatitis. Tamoxifen is widely used for the induction of CreERT-mediated genomic recombination in conditional mouse models, but it also affects the fibrotic response in several disease models. In order to investigate a possible effect of tamoxifen on pancreatic fibrogenesis and to evaluate an optimal treatment scheme in an experimental pancreatitis mouse model, we gave administered tamoxifen by oral gavage to both male and female C57BL/6J mice, and then waited for different periods of time before inducing chronic pancreatitis by cerulein. We observed a sex-specific and time-dependent effect of tamoxifen on the fibrotic response both in vivo and in vitro, and a 2-week waiting period before cerulein administration is suggested to reduce tamoxifen side effects to a minimum for the described fibrosis model in female
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA)

황색포도알균은 지역사회와 병원에서 발생하는 감염증 의 가장 중요한 원인균으로 그간 항생제 개발 및 내성의 역사와 그 궤적을 같이 하였다 1) . 항생제가 사용되기 전인 1940년 이전에는 황색포도알균 감염증의 사망률이 90%에 달했지만, 페니실린 항생제가 도입되면서 사망률은 급격 하게 떨어졌다. 그러나 페니실린을 사용하기 시작한지 10 년도 지나지 않아 황색포도알균 대부분이 페니실린에 듣 지 않게 되었다. 이러한 내성균주를 치료하기 위해 황색포 도알균이 분비하는 베타락탐분해효소에도 분해되지 않는 반합성 베타락탐 항생제인 methicillin이 1960년에 개발되 었지만, 곧 이 항생제에도 듣지 않는 methicillin-resistant S. aureus (MRSA)가 출현하였다. MRSA는 1961년 영국 에서 처음 출현하였으며, 1970년대 말부터 영국과 호주 등 지에서 새로운 유행균주 (EMRSA1)가 등장한 이후 전 세 계적으로 빈도가 급격히 증가하였고 1980년에 들어서는 병원내에 만연하게 되었다 2) . 최근에는 반코마이신에 감수 성이 저하된 균주 (VISA, vancomycin-intermediate S. aureus) 3, 4) 와 반코마이신에 전혀 듣지 않는 균주(VRSA, vancomycin-resistant S. aureus) 5-7) 가 보고되기도 하였다. 우리나라의 경우 1960년대에는 MRSA의 분리보고가 없었지만, 1977년 박 등이 5%의 MRSA 빈도를 보고한 이래 1980년도부터 급격히 증가하기 시작하였다. 최근에 는 우리나라 대부분의 종합병원이나 대학병원에서 분리 되는 S. aureus 균주 중 MRSA의 비율이 60~70%를 상 회하는 것으로 알려져 있다 8, 9) . 또한, MRSA는 우리나라 에서 발생하는 병원감염의 주요 원인균이다. 1997년 300 병상 이상 규모의 69개 병원을 대상으로 조사한 대한병 원감염관리학회의 보고에 따르면 우리나라 병원감염의 가장 흔한 원인균은 S. aureus (17.2%)였으며, 이 중 78.8%가 MRSA로 가장 흔하였다. 감염부위별로도 S. aureus는 수술부위감염(28.3%), 폐렴(23.5%), 균혈증 (15.5%)의 가장 흔한 원인균이었다 10) . 이처럼 MRSA는 항생제를 많이 사용하는 병원 환경 에서 발생한 황색포도알균 감염증의 주된 원인이며 건 강한 지역사회 거주인들 가운데서는 그 보균율이 매우 낮은 것으로 알려져 왔다. 과거 드물게 MRSA에 의한 지역사회 감염증이 보고되었지만, 1980년에 처음 발생한 예는 마약중독자(intravenous drug addicts)에서 발생한 것이었다. 하지만 1997년부터 1999년 사이에 미국 Minnesota와 North Dakota에서 건강한 4명의 어린이가 중증 패혈증으로 사망하였으며 12) , 원인병원체가 모두 MRSA라는 사실이 알려지면서 지역사회관련 MRSA에 대한 관심이 높아지기 시작하였다. 최근 외국에서 문제가 되고 있는 지역사회관련 MRSA 감염증은 기저질환이 없 는 건강한 사람에서 생긴다는 것이 이전과 큰 차이이다.
Socio-Demographic and Maternal Risk Factors of Malaria among Pregnant Women attending Ante- Natal Care in Zamfara State, Nigeria

Malaria is a major global health concern. It is one of the world’s most prevalent serious infectious diseases, with approximately 250 million cases and one million deaths per year. The aim of this study is to determine the socio-demographic and maternal risk factors associated with malaria among pregnant women attending ante-natal care in Zamfara State, Nigeria. An unmatched case control study was conducted among pregnant women attending ante-natal care in Zamfara State, Nigeria. A total of 581 pregnant women both cases and controls were obtained using multistage random sampling. Cases and controls were defined as pregnant women attending ante-natal care from the selected general hospitals in Zamfara State, confirmed with and without malaria respectively, using Giemsa staining method based on their medical records. Face to face interview and self-administered pretested questionnaire in English and Hausa languages were used to obtain information on socio-demographic characteristics and maternal history of the respondents from May to August 2014. Data was analysed using SPSS version 21, using simple descriptive and multivariate logistic regression were employed to determine the predictors of malaria. The overall response rate was 89.8%. Pregnant women ≤ 25 years of age (AOR = 1.695, 95% CI = 1.031, 2.789, p = 0.038), informal education (AOR = 9.390, 95% CI = 5.516, 15.985, p < 0.001), unemployed (AOR = 25.948, 95% CI = 14.831, 45.398, p < 0.001) and first trimester (AOR = 1.856, 95% CI = 1.126, 3.060, p 0.015) were the risk factors. This study has identified the risk factors of malaria in Zamfara State, Nigeria. The findings in this study can be used by policy makers in planning how to tackle the factors associated with malaria among pregnant women in Zamfara State.
TO BE IB: Creating Support Structures and Services for Title I High Schools Implementing the International Baccalaureate Programme

The International Baccalaureate (IB) has a long record and a strong reputation for providing a “gold standard’ of rigorous academic programs and exam systems, and for preparing and certifying students around the world to be ready for university entry. To “be IB” has become a mark of distinction. With its demanding requirements and assessments, its academic and international orientation, and its aspirations for admission to highly selective universities, IB has often been seen as an “elite” program, but while the original Diploma Programme was often both elective and selective, the MYP and PYP are more intended to be whole school programs, open to all students.