Miracle-dz/UniFAR-FTUs huggingface dataset:
Predictors of clinical outcome in patients with heparin-induced thrombocytopenia treated with direct thrombin inhibition

We aimed to identify predictors of poor outcome in patients with heparin-induced thrombocytopenia, a serious immune-mediated reaction to heparin. All patients were treated with direct thrombin inhibition therapy, as part of two prospective studies. We performed a risk factor analysis of adverse outcomes (defined as death, amputation, new thrombosis, or their composite within a 37-day study period) in 809 patients from two reported prospective studies of the direct thrombin inhibitor argatroban in clinically diagnosed heparin-induced thrombocytopenia. We initially identified from among 14 baseline variables the significant predictors of poor outcome in the first study (304 patients), and then tested our resultant hypothesis in the second, independent study (505 patients), using multivariate analysis. Seven significant predictors were identified in the first study; three were confirmed in the second study. The strongest relationship occurred between the baseline platelet count and the composite of death, amputation, or new thrombosis (P = 0.0001), with the most severely thrombocytopenic patients being at greatest risk. The other significant associations were between renal impairment and death (odds ratio = 2.13, 95% confidence interval = 1.23–3.66, P = 0.007), and between cardiovascular surgery (particularly peripheral vascular surgery) and amputation (odds ratio = 3.39, 95% confidence interval = 1.65–6.95, P = 0.0009). In conclusion, in patients with clinically diagnosed heparin-induced thrombocytopenia, the severity of the baseline thrombocytopenia is the best predictor of death, amputation or thrombotic progression. The identification of higher risk subgroups for poor outcomes, such as patients with more severe thrombocytopenia or a history of renal impairment or peripheral vascular surgery, could allow more targeted therapy.
Relationship of genital injuries and age in adolescent and young adult rape survivors.

OBJECTIVE To examine the associations between age and genital injuries in adolescent and young adult women examined following rape. DESIGN & SETTING A retrospective review of 234 medical records from an emergency department sexual assault program. SAMPLE Women aged 14 to 29 years. Fifty percent of the sample was African American, 48% was White, and 2% was either Asian or an "other" race. MAIN OUTCOME MEASURES Genital injury was described by injury prevalence, frequency, and anatomical locations of injuries. RESULTS Overall genital injury prevalence was 62.8%. Younger age was not significantly associated with the presence or absence of genital injury. However, younger age was significantly associated with an increased number of genital injuries overall and to the thighs, labia minora, periurethral area, fossa navicularis, and vagina. CONCLUSION These findings support the need for further research to determine if the current care provided to rape survivors is age appropriate.
The effect of neuromuscular electrical stimulation during closed kinetic chain exercise on lower extremity performance following anterior cruciate ligament reconstruction

No studies have examined the effect of augmenting closed kinetic chain (CKCh) exercises with neuromuscular electrical stimulation (NMES) following anterior cruciate ligament (ACL) reconstruction. Therefore, the purpose of this study was to compare the effect of supplementing a CKCh training program with NMES during the initial six weeks following ACL reconstruction on anterior tibiofemoral joint laxity and the following CKCh performance activities: (1) unilateral squat, (2) 0.10 m lateral step‐up test and (3) anterior reach test. Twenty patients who underwent ACL reconstruction were randomly placed in two treatment groups post surgery: group 1 performed CKCh exercise with NMES applied to the quadriceps and hamstring musculature of the ACL reconstructed lower limb and group 2 performed CKCh exercise alone. Following five weeks of either CKCh training program, performance on the lower limb CKCh tests and knee arthrometry was compared between the two groups by multivariate analysis of variance. No significant difference was noted between the groups with respect to the non‐involved lower limb's performance. The ACL reconstructed lower limb in the combined CKCh and NMES group performed significantly better on the unilateral squat and lateral step‐up test than did the ACL reconstructed lower limb in the CKCh exercise alone group. It is concluded that augmenting CKCh training with NMES during the initial six weeks following ACL reconstruction produces a better lower limb performance effort than is attributable to a CKCh training program without NMES.
Câncer do reto baixo: radioterapia pré-operatória, excisão total perirretal e acesso videolaparoscópico

Twenty-four patients (1993-1997) with cancer of the lower rectum (tumors situated between the pectinate line and four cm above it) underwent abdominoperineal excision by laparoscopic approach and its results were studied and analyzed. Only adenocarcinoma tumors were evaluated regardless of age and gender. All patients were submitted to preoperative radiotherapy (4.000 cGy) and operated on ten days after the end of the irradiation. The anatomic observation of the specimens excised by laparoscopy led to the conclusion that a total mesorrectum excision (total peri-rectal excision) was achieved in 91.3% of the patients. Preoperative radiotherapy did not create intra-operative hazard or change the surgical procedure. None of the patients had intra-operative rupture of the tumor or pelvic spillage of carcinomatous cells. The extension of linfonodal excision was similar to the one obtained by open surgery, with an average of 12 lymphnodes dissected by specimen, with positive perirrectal lymphnodes in 33.3% of the patients, or in 72.7% of the patients with Dukes C tumors and in 100% of the tumors with low grade of cellular differentiation. The proportion of positivity (number of metastatic lymphnodes in relation to the number of extirpated lymphnodes) varied from a minimum of 11.11% to a maximum of 75%. The rate of local recurrence observed after abdominoperineal excision of the rectum by laparoscopic approach with total excision of the perirretum in patients previously irradiated was of 4.2%, patient with Dukes C tumor and low grade of cellular differentiation. There were no portal implantation in the series.
Health care providers' engagement in smoking cessation with pregnant smokers.

OBJECTIVE To review how health care providers' (HCPs) engage in smoking cessation (SC) with pregnant smokers, and to examine the effect of system-level approaches and training initiatives to promote SC provision by HCPs. DATA SOURCES A comprehensive search of the CINAHL, COCHRANE Library, EMBASE, ERIC, MEDLINE, PsycINFO, and SIGLE databases was conducted. STUDY SELECTION Selected studies assessed the behaviors of HCPs working among pregnant/postpartum girls and women, employed a quantitative approach, and had clearly defined behavioral outcomes of HCPs' delivery of SC to pregnant smokers. DATA EXTRACTION A total of 988 studies were obtained from the literature search, of which 28 publications met the inclusion criteria. The data extracted from the articles are presented under the following areas: how HCPs are engaging pregnant smokers and approaches to enhancing SC by HCP with pregnant smokers. DATA SYNTHESIS Although more than 50% of HCPs are likely to ask women about their smoking status and advise pregnant smokers to quit, fewer than 50% either assess readiness to change, assist in smoking cessation, or arrange for follow-up appointments/referrals. Important provider-specific, patient-specific, and system/organizational barriers were found to hinder the provision of SC by HCP. Several system-level and training approaches to enhancing HCP's engagement in SC with pregnant smokers show merit. CONCLUSIONS Few HCPs working with pregnant women use all the components of the Agency for Healthcare Research and Quality clinical guidelines. However, system-level and training approaches are effective ways to enhance HCP's engagement in SC; although, the effects of such initiatives may not be sustained. Factors such as the gender of the provider, geographical location, and the use of women-centered treatment approaches could be further examined in relation to provision of SC by HCPs among pregnant smokers.
Implementation of cervical cancer screening: A demonstration in a rural community of North India

Context: S trategies for implementation of cervical screening are the need of the hour while effective screening tests for early detection exist. Aim: To demonstrate the implementation of cervical cancer screening by aided visual tests in a North Indian rural community. Setting and Design: Cross-sectional study in a rural setting. Subjects and Methods: Baseline survey of community perspectives of screening and identification of eligible women of age 30-59 years was performed by Accredited Social Health Activists (ASHAs). Screening was targeted on 7604 women by the methods of visual inspection of cervix using acetic acid (VIA), by using lugol's iodine (VILI) tests and by Pap test. Screen positives were referred to colposcopy and further management. Data on evaluation parameters was collected. Statistical Analysis: Screening test performances were assessed by sensitivity, specificity and positive/negative predictive values (PPV/NPV) for detection of histological CIN II+. Results: Study showed coverage of 65.6% of total eligible women (7604). Extent of agreement of visual testes (VIA/VILI) between nurses and doctor was 77.3-100%. Screen positivity rates by VIA, VILI and Pap were 9.7%, 13.5% and 2.6%, respectively. Screen positives turned up for confirmatory diagnosis were 78%. Acceptance of treatment was 76%. Screen positivity of VIA and VILI declined (P < 0.001) with increase in age. Sensitivity, specificity, and PPV of VIA were 59.0%, 92.3% and 3.6% and of VILI were72.7%, 89.6% and 3.3% respectively. NPV was 99% in all the tests. Conclusion: Implementation of screening by aided visual tests was successfully demonstrated through utilization of ASHAs for motivation, achievement of good coverage and good response in clinical management of screen positives.
Systemic analgesics for children

Abstract Managing postoperative pain in children usually involves systemic analgesics, often combined with local anaesthetic techniques. Systemic analgesia is commonly administered by the oral, rectal or intravenous routes; less commonly, the buccal or subcutaneous routes are used. Generally, transdermal, intranasal and intramuscular administration are not used postoperatively.
Trends and spatial patterns of fine-resolution aerosol optical depth–derived PM2.5 emissions in the Northeast United States from 2002 to 2013

ABSTRACT Clarifying the trends in quantity, location, and causes of PM2.5 (particulate matter with an aerodynamic diameter <2.5 μm) emission changes is critical for evaluating and improving emission control strategies and reduce the risk posed to human health. According to the National Emissions Inventory (NEI) released by the U.S. Environmental Protection Agency (EPA), a general downward trend in PM2.5 emissions has been observed in the United States over the past decade. Although this trend is representative at the national level, it lacks the precision to locate emission hotspots at a finer scale. Moreover, the changes reported in the NEI are likely confounded by periodic modification of inventory methods, and imprecision for area sources. In this regard, it is imperative to acquire emission inventories with as much spatial and temporal details as possible to further our knowledge of particle emissions, exposure levels, and associated health risks. In this study, we employed the PEIRS (Particle Emission Inventory using Remote Sensing) approach (Tang et al., 2016) predict triennial-averaged emissions at 1 km × 1 km resolution across the Northeast United States from 2002 to 2013. Notably, the PEIRS approach is able to capture both primary emission and secondary formation of PM2.5. Regional emission trends were evaluated using quantile regression, and source-oriented trends were modeled with land use regression. The analysis found a regional decrease in PM2.5 emissions of 3.3 tons/yr/km2 (18%) over the 12-yr period. Furthermore, the rate of emission change at the extremes of the emission distribution was significantly different than that of the mean. Both quantile regression and spatial trends imply that the majority of the reduction in PM2.5 emissions was attributable to highly developed spaces such as metropolitan areas and important traffic corridors. This urban-rural disparity was particularly apparent during the cold season. Indirect evidence suggested that the emission decline during the warm season is primarily attributed to less secondary particle formation. These findings warrant closer investigation of the impact of seasonality on PM2.5 emissions. Implications: Emission trend analysis provides crucial information for evaluating and enhancing the efficacies of emission control strategies as well as studying air pollution associated health risks. In this study, the patterns and trends of year-round and seasonal PM2.5 emission over the Northeast United States are presented at a spatial resolution of 1 km × 1 km for the period of 2002–2012.
Formaldehyde and carbon dioxide air concentrations and their relationship with indoor environmental factors in daycare centers

ABSTRACT The aim of this study was to measure the air concentrations of carbon dioxide (CO2) and formaldehyde (HCHO) in daycare centers to determine relevant influencing factors, including temperature, relative humidity (RH), type of facility, number of children, type of ventilation system, ventilation time, and air cleaning system. The authors measured HCHO, CO2, temperature, and RH in the center of classrooms in 289 daycare centers. Spearman’s correlation and Mann–Whitney analyses were used to examine the relationships and differences in HCHO and CO2 for varying temperatures, RH values, and categorical indoor environmental factors. There were no significant differences in the HCHO and CO2 air concentrations with varying numbers of children, ventilation times, or ventilation and air cleaning system types. However, both the HCHO and CO2 air concentrations were significantly different for varying RH values, which were divided into five categories (p < 0.001). Only the HCHO air concentrations were significantly different for varying temperatures, which were divided into five categories (p < 0.001). Significant correlations were found between HCHO air concentrations and the temperature (r = 0.35, p < 0.0001), RH (r = 0.51, p < 0.0001), and CO2 (r = 0.36, p < 0.0001). The study results support maintaining an appropriate temperature and RH range for reducing airborne HCHO in daycare centers. Further research is needed to elucidate the precise mechanisms responsible for the relationships observed in this study. Implications: Data from 289 daycare centers in Seoul, South Korea, indicate that HCHO concentrations show a positive correlation with indoor temperature and relative humidity. This indicates that keeping temperatures low will help keep HCHO concentrations low, by both a direct and an indirect effect, since low temperatures also cause low relative humidity.
Particle count and black carbon measurements at schools in Las Vegas, NV and in the greater Salt Lake City, UT area

ABSTRACT As part of two separate studies aimed to characterize ambient pollutant concentrations at schools in urban areas, we compare black carbon and particle count measurements at Adcock Elementary in Las Vegas, NV (April–June 2013), and Hunter High School in the West Valley City area of greater Salt Lake City, UT (February 2012). Both schools are in urban environments, but Adcock Elementary is next to the U.S. 95 freeway. Black carbon (BC) concentrations were 13% higher at Adcock compared to Hunter, while particle count concentrations were 60% higher. When wind speeds were low—less than 2 m/sec—both BC and particle count concentrations were significantly higher at Adcock, while concentrations at Hunter did not have as strong a variation with wind speed. When wind speeds were less than 2 m/sec, emissions from the adjacent freeway greatly affected concentrations at Adcock, regardless of wind direction. At both sites, BC and particle count concentrations peaked in the morning during commute hours. At Adcock, particle count also peaked during midday or early afternoon, when BC was low and conditions were conducive to new particle formation. While this midday peak occurred at Adcock on roughly 45% of the measured days, it occurred on only about 25% of the days at Hunter, since conditions for particle formation (higher solar radiation, lower wind speeds, lower relative humidity) were more conducive at Adcock. Thus, children attending these schools are likely to be exposed to pollution peaks during school drop-off in the morning, when BC and particle count concentrations peak, and often again during lunchtime recess when particle count peaks again. Implications: Particle count concentrations at two schools were shown to typically be independent of BC or other pollutants. At a school in close proximity to a major freeway, particle count concentrations were high during the midday and when wind speeds were low, regardless of wind direction, showing a large area of effect from roadway emissions even when the school was not downwind of the roadway. At the second school, which sits in an urban neighborhood away from freeways, high particle counts occurred even though solar radiation was low during wintertime conditions, meaning that exposure to high particle counts can occur throughout the year.
Zur Frühdiagnose der Spondylarthritis ankylopoetica (Morbus Bechterew-Strümpell-Marie)1

Die Spondylarthritis ankylopoetica (Sp. ank.) wird immer erst dann festgestellt, wenn die reparativen Vorgänge, die der Entzündung des Wirbelsäulenbandapparates folgen und späterhin sie begleiten, zu einer schweren Beeinträchtigung der Wirbelsäulenfunktion geführt haben. Zur Zeit der Entstehung der Sp. ank. , d. h. zu der Zeit, in der die Funktionsstöruiig der Wirbelsäule noch nicht feststellbar ist, entzieht sie sich der klinischen Feststellung in den meisten Fällen. Wenn es auch falsch wäre, zwischen nur entzündlichen und nur reparativen Vorgängen im klinischen Verlauf zu unterscheiden, insofern als auch während der Vernarbung die Entzündung immer weiter schreitet, muß man doch zur Zeit des Beginnes der Sp. ank. ein nur oder ganz vorwiegend entzündliches Stadium annehmen. Nur wenn es gelingt, dieses Stadium zu erkennen, besteht wenn überhaupt die Möglichkeit, eine Heilung zu erzielen, die ohne die deletären Folgen der Narbenbildung mit Ankylose und Bandverknöcherung einhergeht. Die rechtzeitige Erkennung der Sp. ank. , d. h. die Erkennung im entzündlichen Stadium, bevor die versteienden Vernarbungen eingetreten sind oder bereits nennenswerte Fortschritte gemacht haben, setzt voraus, daß wir an die Entstehung einer Sp. ank. denken. Der Zweck dieser Ausführungen ist der, auf einige klinische Erscheinungen hinzuweisen, die den Verdacht auf die Entwicklung einer Sp. ank. wecken müssen. Dazu muß ich zunächst einige Worte über die Ätiologie sagen. Daß die Sp. ank. mit iii den großen Komplex der rheumatisehen Krankheiten gehört, ist ja nicht anzuzweifeln. Was sie aber heraushebt aus allen anderen Formen sind neben der Schwere der bleibenden Läsionen und manchen Besonderheiten des ariatomisehen Bildes folgende Tatsachen: Die Sp. ank. befällt (fast) nur Männer. Wenn sie auch gelegentlich meist erst im späteren Verlauf wirbelsäuleirnahe Gelenke mitbefällt, so fehlt doch das für den Rheumatismus charakteristische Wandern" in den Gelenken. Sie beginnt und verläuft immer am gleichen Gelenksystem. Sie beginnt symmetrisch und bleibt es im großen und ganzen während des Verlaufes. Sie schreitet kontinuierlich entlang der Wirbelsäule fort. wobei sie deren gesamten Bandapparat befällt, wenn sie auch gelegentlich einzelne Gelenke ausläßt. Auf wie schwachen Füßen die hormonale Erklärung der Bevorzugung des männlichen Geschlechts steht, habe ich a. a. O. aus-
Assimilative capacity–based emission load management in a critically polluted industrial cluster

ABSTRACT In the present study, a modified approach was adopted to quantify the assimilative capacity (i.e., the maximum emission an area can take without violating the permissible pollutant standards) of a major industrial cluster (Manali, India) and to assess the effectiveness of adopted air pollution control measures at the region. Seasonal analysis of assimilative capacity was carried out corresponding to critical, high, medium, and low pollution levels to know the best and worst conditions for industrial operations. Bottom-up approach was employed to quantify sulfur dioxide (SO2), nitrogen dioxide (NO2), and particulate matter (aerodynamic diameter <10 μm; PM10) emissions at a fine spatial resolution of 500 × 500 m2 in Manali industrial cluster. AERMOD (American Meteorological Society/U.S. Environmental Protection Agency Regulatory Model), an U.S. Environmental Protection Agency (EPA) regulatory model, was used for estimating assimilative capacity. Results indicated that 22.8 tonnes/day of SO2, 7.8 tonnes/day of NO2, and 7.1 tonnes/day of PM10 were emitted from the industries of Manali. The estimated assimilative capacities for SO2, NO2, and PM10 were found to be 16.05, 17.36, and 19.78 tonnes/day, respectively. It was observed that the current SO2 emissions were exceeding the estimated safe load by 6.7 tonnes/day, whereas PM10 and NO2 were within the safe limits. Seasonal analysis of assimilative capacity showed that post-monsoon had the lowest load-carrying capacity, followed by winter, summer, and monsoon seasons, and the allowable SO2 emissions during post-monsoon and winter seasons were found to be 35% and 26% lower, respectively, when compared with monsoon season. Implications: The authors present a modified approach for quantitative estimation of assimilative capacity of a critically polluted Indian industrial cluster. The authors developed a geo-coded fine-resolution PM10, NO2, and SO2 emission inventory for Manali industrial area and further quantitatively estimated its season-wise assimilative capacities corresponding to various pollution levels. This quantitative representation of assimilative capacity (in terms of emissions), when compared with routine qualitative representation, provides better data for quantifying carrying capacity of an area. This information helps policy makers and regulatory authorities to develop an effective mitigation plan for air pollution abatement.
Statistical interpretation of texture for medical applications

Findings from transrectal ultrasound examinations of the prostate are usually based on the echogenicity observed by visual interpretation of the ultrasound image. Hypoechoic areas are typically suspected to be cancerous. Previous studies have indicated that a high percentage (as high as 96%) of cancerous lesions are hypoechoic, but only a moderate percentage (about 50%) of hypoechoic regions are cancerous. We have been investigating statistical measures of texture of digitized ultrasound images of the prostate to assess whether improved accuracies can be achieved for diagnosing prostate cancer and for identifying cancerous lesions. This paper presents our approach as well as results obtained for 17 patients, eight non-cancerous and nine cancerous. The results of a small `blind test,' based on seven subjects, are also presented. Recently, a pathological mount of a prostate cross-section from a prostatectomy was selected as a test case for applying texture analysis to detect prostatic adenocarcinoma. The approach and results are described. The results of both studies are encouraging, but must be considered exploratory due to the small data sets. The results do provide support to the idea that texture information in the prostate is related to a structural change in the gland when carcinoma occurs.