Miracle-dz/UniFAR-FTUs huggingface dataset:
Mathematical Modeling to Evaluate Disease Control Policy

In this dissertation I assessed three distinct policy questions: the implications of introducing a new tuberculosis diagnostic in southern Africa, the potential value of research related to HIV treatment policy in South Africa, and the causal effect of state cigarette taxes imposed between 1996 and 2013 on health outcomes in the United States. In Chapter 1 I investigated use of a new TB diagnostic, Xpert MTB/RIF, to replace sputum smear-based diagnostic algorithms in southern Africa. Analyses were undertaken using a dynamic mathematical model, taking account of TB transmission and natural history, HIV epidemiology, TB drug resistance, and disease control interventions. Results suggest Xpert may substantially reduce TB morbidity and mortality, and modestly reduce transmission, while significantly increasing demands on healthcare resources. Xpert adoption was estimated to cost $711 to $1,083 per DALY averted, representing good value for money according to conventional benchmarks. In Chapter 2 I estimated the value of new research on various targets relevant to HIV treatment policy in South Africa. I implemented the analysis with a mathematical model of HIV epidemiology, simulating HIV transmission, disease progression, and receipt of treatment. I used Value of Information (VOI) methods to identify priority research areas, based on the welfare gains possible by obtaining better information prior to decision-making. High priority research targets included issues of cost and implementation, relative infectiousness during late HIV, the reduction in
Stable isotope variation in pathological bone

Bone samples taken at autopsy from seven individuals from western Canada are studied histologically and the bone protein is analysed for stable isotopes of carbon and nitrogen. The objective of the study is to determine if pathological conditions result in variations in bone protein stable isotope ratios. Of the seven individuals sampled, three are normal and four are pathological. The latter include post-paralytic atrophy, healing fracture, active periostitis and healing osteomyelitis. The normal samples are included in order to determine how much variation to expect in different segments of a bone. In the three samples analysed, the variation is ±0.3 for δ13C and ±0.2 for δ15N. Three of the four pathological specimens exceed normal variation. The greatest variation occurs in the bone with osteomyelitis from an individual who had AIDS (the diseased segment was approximately 2‰ greater for δ15N than the two normal segments from the same individual). The higher nitrogen isotope ratio in the bone segment with osteomyelitis is most likely a result of the fact that the collagen was formed from the catabolism of existing proteins in the body. This finding has implications for the interpretation of nitrogen isotope ratios in individuals who may have died from wasting diseases. Copyright © 1999 John Wiley & Sons, Ltd.
Skin lesions in anti-Pm-Scl-70 positive systemic sclerosis-dermatomyositis overlap syndrome improve during local PUVA phototherapy.

ejd.2013. 2136 Auteur(s) : Mosab Mohanna1 mohanna.mosabtariq@usz.ch, Oliver Distler2, Haiko Sprott2, Thomas Kundig1, Lars E. French1, Gunther Hofbauer1 1 Department of Dermatology, 2 Department of Rheumatology, University Hospital Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland Overlap syndrome comprises at least two connective tissue diseases. Autoantibodies against Pm-Scl-70 identify one with overlapping features of scleroderma and polymyositis where hands may show Raynaud's phenomenon, edema, [. ]
Evaluation of outcomes of a medication therapy management program for patients with diabetes.

OBJECTIVE To measure the impact of an employer-sponsored, pharmacist-provided medication therapy management (MTM) program on clinical outcomes and social and process measures for patients with diabetes with or without associated comorbid conditions. METHODS Prospective longitudinal study that took place at seven independent pharmacies in Lucas County, OH. A total of 228 patients with diabetes were enrolled. At 6-month intervals, patients were counseled by their pharmacists. Outcome measures included clinical outcomes (glycosylated hemoglobin [A1C], systolic blood pressure (SBP), and diastolic blood pressure [DBP]), social measures (caffeine intake, alcohol consumption, smoking, and exercise), and process measures (visits to ophthalmologist, podiatrist, and dentist). Wilcoxon signed-rank test and percentages were used to report findings. RESULTS Mean (± SD) A1C concentration decreased from 7.08 ± 1.54% to 6.89 ± 1.30% at 12 months. Patients with A1C levels greater than 7% at baseline averaged a decrease of 0.5% at 6 months and 0.75% at 12 months. Mean SBP values decreased significantly from baseline to 12 months. A total of 87 patients with a baseline SBP greater than 130 mm Hg experienced a significant change in blood pressure from baseline to 6 months (-7.1 ± 3.32 mm Hg), and 65 patients experienced a significant change in blood pressure from baseline to 12 months (-11.49 ± 0.15 mm Hg). A total of 104 patients with a baseline DBP more than 80 mm Hg experienced a significant decrease of 4.44 ± 1.25 mm Hg at 6 months. Caffeine and alcohol consumption and smoking decreased and exercise increased. In addition, the percentage of patients who visited specialists increased. CONCLUSION Patients with diabetes experienced improvements in multiple clinical, social, and process measures.
Evaluation of Cepheid SmartCycler and EuroClone Duplicareal time Dual Easy CT assay for confirmation of Chlamydia trachomatis

assay for the confirmation of Roche COBAS TaqMan positive tests by comparing results obtained by each method. Consecutive clinical C. trachomatis positive (n = 67) and random negative (n = 17) urogenital samples received at a general district hospital in the North East of England over a 6-month period were examined. Of the total 67 TaqMan-positive samples, 62 (92.5%) of them were also positive by the SmartCycler/EuroClone. There were 5 discrepancies in total (7.5%) and 17 samples were negative on both Roche TaqMan and SmartCycler/EuroClone. The sensitivity and specificity of the method were 92.5 and 100%, respectively. To further assess its specificity, the SmartCycler/EuroClone method was challenged with additional organisms and proved to possess the ability of avoiding false-positive results by correctly identifying these as C. trachomatis DNA negative. Finally, it was found that confirmation of positive C. trachomatis by the SmartCycler/EuroClone method increases the turn around time of chlamydia investigation by 2-folds. In conclusion, the SmartCycler/EuroClone method gave good concordance with the established Roche TaqMan method and proved to be highly suitable for confirmation testing of C. trachomatis positive samples. The remarkable specificity and acceptable sensitivity also confirms its suitability and reliability for this purpose.
Immunohistochemical identification of interleukin 1α and β in human eccrine sweat‐gland apparatus

Bouin‐fixed paraffin sections or acetone‐fixed cryostat sections were labelled with the avidinbiotin complex (ABC) or peroxidase‐antiperoxidase (PAP) method using three monoclonal antibodies (MAbs) and two polyclonal antisera to human recombinant interleukin i beta (IL‐iβ) and three polyclonal antisera to human recombinant interleukin iα (IL‐iα). In the secretory coil both IL‐α and β were detected in the clear, but not in the dark cells. Both luminal and basal cells of the coiled and straight ducts expressed IL‐iα and β, the IL‐i labelling being more intense in the luminal cells. IL‐i was not usually detected in the initial portion of the intraepidermal eccrine sweat duct, whereas intense labelling was seen in the upper part including through the stratum corneum. In skin biopsies of the palm, taken after exercise, there was only faint IL‐i labelling of the secretory cells, whereas the luminal cells of the dermal ducts showed intense labelling for both IL‐iα and β. In the acrosyringium, exercise did not alter the pattern for IL‐iα and β, except that in the palm, some of the antibodies to IL‐iβ produced a more intense immunolabelling of the acrosyringeal cells. This study identifies a distinct and similar distribution of the two forms of IL‐i throughout the eccrine sweat‐gland apparatus and indicates that part of the IL‐i epidermal pool originates from the sweat.
Effects of Gender on Age-related Changes in Muscle Thickness in the Elderly

This study investigated the effect of gender on age-related changes in muscle thickness (Mt) in the elderly, with relation to the differences due to the location of muscle groups. Mt values at the forearm, upper arm anterior and posterior, abdomen, subscapular, thigh anterior and posterior, and lower leg anterior and posterior were determined using ultrasonography in 188 men and 204 women aged 65 to 79 yrs. The men had thicker muscles than the women, with a greater relative difference in the upper limb and trunk compared to the lower limb muscles. For the men, Mt values at the upper limb, thigh and abdomen were negatively correlated to age (r =-0.330 to -0.214, p<0.05). For the women, only the Mt at the thigh anterior showed a significant negative correlation with age (r =-0.346, p<0.05). At the thigh anterior, there was no significant difference between both genders in the slope of the regression line for the relationship between age and percentages of Mt to the mean value for the subjects aged 65 to 69 yrs of men and women, respectively, suggesting that the rate of the age-related loss of Mt at this site was independent of gender. These results were the same even when Mt was expressed as the value relative to (body mass)1/3, calculated to normalize the influence of the difference in body mass. The findings obtained here indicated that, in an age span from 65 to 79 yrs, 1) gender difference in muscle thickness was more apparent in the upper limb and trunk than in the lower limb muscles, and 2) men showed significant age-related losses in muscle thickness at more body sites as compared to women, especially at the upper limb and abdomen.
Management of pulmonary infection : experimental studies on oral immunization and surfactant replacement therapy

This thesis aims at evaluating two "new" concepts for the management of pneumonia. The first concept, oral immunization, seems a promising approach towards prevention of pneumonia. Extensive programs have been developed for active immunoprophylaxis to immunize against specific microbial pathogens, and vaccines introduced into clinical practice since the 1970s include those against H. influenzae, meningococs, pneumococs, pseudomonas, hepatitis B virus and rabies. However, controversies surrounding established vaccines and the search for vaccines against other pathogens constantly stimulate investigations on the development of new vaccines. Therefore, and because oral administration of vaccines is convenient, much attention has been paid to the development of vaccines for oral administration. It is proven that oral administration of vaccine of viral or bacterial origin can induce a mucosal immune response, but the possibility of oral immunization with bacterial lysate for the prevention of viral pneumonia has not been well documented. The first part of this thesis presents investigations on oral immunization with a new polyvalent bacterial lysate against both bacterial and viral pathogens that may cause pneumonia. The second concept, surfactant replacement therapy, has already proven its value in the prevention and treatment of idiopathic respiratory distress syndrome (IRDS) of the newborn, which is caused by a surfactant deficient state of the premature lungs. Several studies on the origin and nature of the adult respiratory distress syndrome (ARDS) have demonstrated a surfactant deficient state of the lungs of ARDS-patients and frrst clinical trials of surfactant replacement in ARDS patients have proven the beneficial effects of surfactant replacement. Pneumonia may lead to a clinical syndrome closely resembling ARDS. Therefore, the second part of this thesis presents investigations on surfactant replacement therapy during ARDS-like viral pneumonia
Patient Emergency Planning & Teletriage: The ACH Reduction Connection

Patient-centered emergency planning is a multifaceted process that begins with the completion of an acute care hospitalization (ACH) risk assessment that provides for the identification of patients at risk for rehospitalization. Once a patient is identified as high risk, an emergency plan of care must then be collaboratively developed based on the findings from the assessment, followed by the effective triage of incoming calls from patients/caregivers. This article discusses the fundamentals of this triad: ACH risk assessment, emergency planning, and teletriage. The experiences of two home care agencies in two different states of the United States that have implemented these interventions is also shared.
The Effects of the Levels of Burnout Midwives Working in Ağrı on the Job Satisfaction and Empathic Tendencies of Them

AAM:The this study was carried out descriptively for the purpose of determining the effect level of burnout has on the job satisfaction and empathic tendencies of midwives. METHOD: The findings of the study were obtained using a questionnaire directed at the socio-demographic and occupational characteristics of midwives, the Maslach Burnout Inventory, the Minnesota Job Satisfaction Scale, and the Empathic Tendency Scale.100 midwives working at AA°rA½ Maternity and Pediatrics Hospital, AA°rA½ State Hospital, Health Care Centers 1, 2, 3, 4, and 6, Center for Maternal and Infant Health, and Family Planning center established the population of the study. 74 midwives willing to participate in the study constituted the sample group. The data obtained was evaluated using a SPSS 14.0 (Statistical Package for Social Science) software program. Numbers and percentages, a significance test for the difference of two means, the Man Whitney U Test, the Kruskal-Wallis Test, and correlation analysis were used to evaluate the data. RESULTS: The majority of the midwives participating in the study are aged 30 and under, and are medical vocational high school graduates. A third of the married midwives, approximately half of the midwives participating in the study, have children. Just over a half of the midwives are at second base and work full-time during the day, most of them are contract employees, and have been working for 1-5 years. Over half of the midwives participating in the study chose their profession willingly and the majority of them expressed that their profession was satisfying economically. It was determined that the age, education level, and working position of the midwives, together with the economical satisfaction of the job, and obtaining a certificate of merit did not affect burnout, whereas, marital status, having children, the organization they worked for, their years of service, and working hours did affect burnout. A significant inverse relationship was determined between the levels of burnout with job satisfaction and the score means of empathic tendencies. CONCLUSAON: As midwives burnout level increases,studies determines that their job satisfaction and empathic tendencies decrease.
Multidrug-Resistant Pseudomonas aeruginosa Ventilator-Associated Pneumonia: The Role of Endotracheal Aspirate Surveillance Cultures

BACKGROUND Inappropriate antibacterial treatment of ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) pathogens is associated with increased mortality. Endotracheal aspirate (ETA) surveillance cultures potentially identify MDR pathogens, particularly MDR Pseudomonas aeruginosa, resulting in improved selection of therapy in patients who subsequently develop VAP. OBJECTIVE To investigate the role of ETA surveillance cultures in the identification of MDR P. aeruginosa in newly intubated adults who subsequently develop VAP. METHODS Daily ETA surveillance cultures for P. aeruginosa were collected in all adults newly intubated for 48 hours or more. Patients with preexisting lung disease or colonization or infection with P. aeruginosa were excluded. Risk factors and outcomes of patients newly colonized with MDR P. aeruginosa were assessed. RESULTS Seventy-five patients newly colonized with P aeruginosa were identified. Twenty (27%) of these patients were colonized with a P. aeruginosa isolate that was MDR (resistant to >3 classes of antibiotics). Six patients were colonized by an isolate resistant to all tested classes of antibiotics. Forty-five percent of patients colonized with MDR P. aeruginosa subsequently developed VAP. Prior receipt of fluoroquinolones was an independent predictor of colonization with MDR P. aeruginosa (OR 11.82; 95% CI 2.10 to 66.46; p = 0.005). CONCLUSIONS Performance of routine surveillance cultures may aid in the early detection of MDR P. aeruginosa, improving the initiation of early and appropriate antibiotic therapy for patients who subsequently develop VAP.
Fospropofol: A New Sedative–Hypnotic Agent for Monitored Anesthesia Care

Objective: To summarize the published clinical data on fospropofol, critically review the safety and efficacy information, and provide pertinent information for formulary review. Data Sources: Data were collected from searches of MEDLINE (1966–June 30, 2009), EMBASE (1974–June 30, 2009), bibliographies of manuscripts, and www.fda. gov. Key search terms included fospropofol, Lusedra, Aquavan, sedative–hypnotic, and monitored anesthesia care. Study Selection and Data Extraction: All Phase 1, Phase 2, and Phase 3 clinical trials studying the safety and efficacy of fospropofol were reviewed. Data Synthesis: Fospropofol is a water-soluble prodrug of propofol, a potent sedative–hypnotic agent. Propofol is highly lipophilic and is formulated in lipid-containing solvents, which have known disadvantages, including pain on injection, narrow therapeutic window with the potential to cause deep sedation, high lipid intake during long-term sedation, and risk of infection resulting from bacterial contamination. Due to its water solubility, fospropofol eliminates some of the known lipid emulsion–associated disadvantages of propofol and provides a more predictable peak onset of activity and more gradual recovery to a full state of consciousness. The pharmacokinetic and pharmacodynamic profiles of fospropofol make it an attractive agent for sedation for procedures of short duration. Unfortunately, the number of patients studied has been relatively small and the amount of safety data is limited. Of concern are reports of hypoxemia and hypotension; these reports are limited in number, but the episodes are serious and may require acute intervention. Although fospropofol holds promise for procedural sedation, due to limited safety data, the Food and Drug Administration has limited approval of fospropofol to monitored anesthesia care in patients undergoing diagnostic or therapeutic procedures. Conclusions: Fospropofol is a viable addition to the class of sedative–hypnotic agents due to the minimization of unwanted adverse effects of propofol and maintenance of a favorable pharmacokinetic profile facilitating sedation, anxiolysis, and rapid recovery. However, there are limited safety data to justify its use without the presence of dedicated anesthesia personnel.
Parents’ knowledge and use of child restraints in regional and rural NSW: Results from a survey

Parent-reported and observed use of child restraints has increased in many countries in recent times and is high for children in Australia (>90%). However, many children are sub-optimally protected because the restraints they are using are too big for them. This study sought to explore possible reasons for this using a survey of parents and carers (N = 284) of children aged 6 years and under. Questions addressed parents’/carers’ knowledge about the "best size" ranges for restraints available on the Australian market, the types of restraints they were using with their children and frequency of use as well as their views on fitting restraints to vehicles. Results indicate that, though parents are well informed about the benefits of child restraints, they are less well informed about appropriate sizes for different restraints, especially those suitable for older children. In particular, more than 50% of these parents gave minimum age/weights for booster seats that were too low. The majority of the parents in this sample were reportedly using a restraint appropriate for the child’s age. However, over 30% of the children in the 4-6 year old group were arguably too small for the restraints they were using. These results suggest that interventions to improve children’s protection as passengers should target parents’ perceptions of when to move children into larger restraints. It seems particularly critical to emphasise erring on the side of caution in relation to the upper age/weight for both forward facing child seats and boosters in order to encourage parents to retain children in these until they have truly outgrown them.
Reducción de la desnutrición crónica en las bases biosociales para la promoción de la salud y el desarrollo

This article advances theoretical and conceptual arguments to justify efforts to reduce chronic malnutrition as a basic component of any strategy for promoting health and development in countries with a high malnutrition prevalence. The arguments rest on four cardinal principles of contemporary social epidemiology, in whose framework reducing chronic malnutrition would be a key strategic component: the social determinants approach, the life course as the clinical-epidemiological paradigm, the concept of heredity and population health, and recognition of the family as a social determinant. Added to these are the close association between nutrition, health, and development, on the one hand, and the political significance of any strategy that makes the fight against chronic malnutrition the most visible focus of programmatic action.
Late Sleeping Affects Sleep Duration and Body Mass Index in Adolescents

During adolescence, there is a tendency to sleep late and sleep less because of altered psychosocial and life-style changes. Recent studies have demonstrated the link between sleeping less and gaining weight in children, adolescents, and adults. We studied the effect of late sleeping and sleeping less on body mass index (BMI) in medical college freshmen. All participants were adolescents (104 male and 38 female adolescents, mean age 17.77±0.79 years). After obtaining informed consent, they filled out a questionnaire about their sleeping habits. Height and weight were measured after a brief history taking and clinical examination. BMI increased significantly with decrease in total sleep duration and with delayed bedtime. Late sleeping individuals (after midnight) had significantly less sleep duration (6.78 hours v 7.74 hours, P<0.001), more day time sleepiness (85.2% v 69.3%, P=0.033) and more gap between dinner time and going to sleep (234.16 min v 155.45 min, P<0.001). Increased BMI in late sleepers may be explained by low physical activity during the day caused by excess sleepiness and increased calorie intake with a gap of 5-6 hours between dinner and sleep. Sleep habits of late sleeping and sleeping less contribute to increase BMI in adolescents. Iran J Med Sci 2010; 35(1): 57-60.