Miracle-dz/UniFAR-FTUs huggingface dataset:
Pilot study into the causes of airway drying during continuous positive air pressure breathing

The airway surface liquid (ASL) lining the upper respiratory tract has an essential role in heat and moisture exchange, as well as having an important role in airway defense. Continuous positive air pressure (CPAP) users frequently report troublesome symptoms of airway dryness and nasal congestion. Clinical investigations have demonstrated that supplementary humidification reduces these symptoms but the reason for their occurrence remains unexplained. Previously, symptoms of nasal drying have been attributed to unidirectional airflow created by mouth leaks; however these still occur when leaks are absent. Tidal breathing stresses have previously been shown to regulate epithelial cell ionic fluid secretion and reabsorption into the ASL [1]. The purpose of this study was to determine whether augmented air pressures change overall mucosal ASL water supply and, if so, the extent of this effect. It is hypothesized that the low-level positive airway pressures used in CPAP therapy could reduce the ability of respiratory mucosa to humidify inhaled air as a result of reduced ASL supply from the airway mucosa. In an original in vitro experimental process, maximal bovine tracheal ASL supply was determined experimentally over a range of pressures. During simulated ambient pressure breathing, the maximal supply of ASL was found to compare well to previously published data (31.2l/cm.hr). However, CPAP pressures from 5 cm H2O above ambient were found to reduce ASL supply by 22% as shown by Figure 1. Statistical analysis (n=8) showed a significant difference existed between the ambient and CPAP results (p < 0.0001), and that there was no significant variation between all pressurized results (p = 0.716). Although the actual mechanism by which this occurs is unclear, these findings provide tracheal mucosa water flux data over the range of augmented pressures normally applied during CPAP therapy. It also provides a potential explanation for the troublesome airway drying symptoms associated with CPAP therapy and justifies the use of supplementary humidification during CPAP treatment. This work is an aspect of a larger program aimed at understanding and modeling the nasal breathing cycle with respect to CPAP conditions. Figure 1 Trachea maximal water flux during simulated breathing at ambient and augmented air pressure. Median values (shown by bold line) demonstrate a 22% reduction in maximal water flux from CPAP pressures of 5 cm H2O.
BCG: Do we have an alternative?

Vaccination is generally used as a form of immunoprophylaxis, so that administration of the vaccine even a long time before exposure to the wild-type infectious organism should afford protection. Since effector T and B cells are shortlived; a prime requisite for a vaccine is to generate immunological memory1. In the case of organisms such as mycobacteria which are obligate intracellular pathogens and which elicit granulomatous tissue reactions, artificial immunisation with live bacteria is required to induce protection.2,3 The only existing vaccine against tuberculosis is the BCG (Bacille Calmette - Guerin), an attenuated strain of M. bovis, and it is mandatory or officially recommended in 182 countries or territories. Under the Expanded Programme on Immunisation (EPI), started by the Government of India in 1978, BCG is recommended to be given to all infants 3-9 months after birth.4
Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women.

BACKGROUND Osteoporosis is an abnormal reduction in bone mass and bone deterioration leading to increased fracture risk. Risedronate belongs to the bisphosphonate class of drugs which act to inhibit bone resorption by interfering with the activity of osteoclasts. OBJECTIVES To assess the efficacy of residronate in the primary and secondary prevention of osteoporotic fractures in postmenopausal women. SEARCH STRATEGY We searched CENTRAL, MEDLINE and EMBASE. Relevant randomized controlled trials published between 1966 to 2007 were identified. SELECTION CRITERIA Women receiving at least one year of risedronate for postmenopausal osteoporosis were compared to those receiving placebo or concurrent calcium/vitamin D or both. The outcome was fracture incidence. DATA COLLECTION AND ANALYSIS We carried out study selection and data abstraction in duplicate. Study quality was assessed through the reporting of allocation concealment, blinding and withdrawals. Meta-analysis was preformed using relative risks and a >15% relative change was considered clinically important. MAIN RESULTS Seven trials were included in the review representing 14,049 women. Relative (RRR) and absolute (ARR) risk reductions for the 5 mg dose were as follows. Risk estimates for primary prevention were available only for vertebral and non vertebral fractures and showed no statistically significant effect of risedronate on fractures. For secondary prevention, a significant 39% RRR in vertebral fractures (RR 0.61, 95% CI 0.50 to 0.76) with 5% ARR was found. For non-vertebral fractures, a significant 20% RRR (RR 0.80, 95% CI 0.72 to 0.90) with 2% ARR and for hip fractures there was a significant 26% RRR (RR: 0.74, 95% CI 0.59 to 0.94) with a 1% ARR. When primary and secondary prevention studies were combined, the reduction in fractures remained statistically significant for both vertebral (RR 0.63, 0.51 to 0.77) and non vertebral fractures (RR 0.80, 0.72 to 0.90)For adverse events, no statistically significant differences were found in any of the included studies. However, observational data has led to concerns regarding the potential risk for upper gastrointestinal injury and, less commonly, osteonecrosis of the jaw. AUTHORS' CONCLUSIONS At 5 mg/day a statistically significant and clinically important benefit in the secondary prevention of vertebral, non-vertebral and hip fractures was observed, but not for wrist. The level of evidence for secondary prevention is Gold (www.cochranemsk.org) for vertebral and non-vertebral and Silver for hip and wrist. There were no statistically significant reductions in the primary prevention of vertebral and non-vertebral fractures. The level of evidence is Silver.
A prospective study on the efficacy of two-dose influenza vaccinations in cancer patients receiving chemotherapy.

OBJECTIVE Cancer patients receiving chemotherapy are at risk of acquiring influenza infections. Two-dose vaccination is a proposed strategy for increasing vaccination efficacy; however, this has yet to be confirmed in this population. The purpose of this study was to clarify the efficacy and safety of this strategy. METHODS We conducted a multicentre prospective study on a two-dose vaccination regimen in cancer patients receiving chemotherapy. Second vaccinations were performed in patients who did not respond to all three viral strains after the first vaccination. Serum haemagglutination inhibition titres were measured to determine the patients' immunological response, 2 weeks prior to the first vaccination, 3-5 weeks after each vaccination, and at the end of the influenza season. RESULTS We enrolled 109 patients, including 70 with solid tumours, 36 with haematological malignancies, and 3 with both cancer types. Among the total patients, the proportion of patients with protective titres against the three viral strains increased significantly from 3 to 27% (P < 0.01) following vaccination. Among the 79 patients who received a second vaccination, the proportion of those with protective titres against the individual strains increased by 10% (H1N1), 8% (H3N2), and 3% (B) compared with after the first vaccination. Serious adverse events were not observed. CONCLUSIONS We recommend influenza vaccinations for cancer patients, including those receiving chemotherapy. Also, the additional benefit of the second vaccination may be limited.
Implementing Lean Six Sigma Methodologies in the Radiology Department of a Hospital Healthcare System

Increased focus is being placed on the quality of care provided by Hospital Healthcare Systems around the country. Caught in the middle between tightening government standards, stricter compliance guidelines for insurance companies, and the basic mission to serve those in need with quality and compassion; hospitals are looking for ways to improve their processes (services) for the benefit of all. CT (Computed Tomography – CAT Scan) and MRI (Magnetic Resonance Imaging) services in the hospital radiology departments are revenue-generating areas. The reimbursement rates for these services are very high, the scan times (especially in CT) are relatively low, and so the potential for additional revenue to the hospital comes with increasing patient capacity for these services. However, it is also a very competitive time for hospital radiology departments as many outpatient diagnostic centers are being built, drawing patients and physicians to their fast, efficient, no hassles approach to imaging. This brings additional hurdles to the already struggling hospitals. The Sisters of St. Francis Health Services (SSFHS) group enlisted the aid of faculty at IUPUI to address issues within their organization. The objectives: improve the key performance indicators directly tied to patient and physician satisfaction, improve and streamline CT/MR processes, increase the capacity to perform CT/MR services, and regain a portion of the referral base lost to outpatient diagnostic centers. To address these issues, Lean/Six Sigma methodologies were implemented. Considerable success has been documented in the manufacturing industry using these models, but little has been done in the service-based industry of healthcare so an uncharted area was being entered. Specially organized teams were created for the project within the hospital organization. Faculty experts provide education and training to these individuals in Lean/Six Sigma methodologies modified to fit healthcare services. The radiology project has been initiated and current results positively support the successful transferability of these manufacturing-originated methodologies into service-based applications. Modeling, simulations, and Cost/ROI of implementation projections for these projects are also being developed. These activities insure transportability of the models between hospitals so the benefit can be felt system-wide.
Short-term Home-Delivered Meal Intervention and the Health, Nutrition and Functional Status of Hospital-discharged Older Adults

Title of Document: SHORT-TERM HOME-DELIVERED MEAL INTERVENTION AND THE HEALTH, NUTRITION AND FUNCTIONAL STATUS OF HOSPITAL-DISCHARGED OLDER ADULTS Ucheoma Onyinyechi Akobundu Doctor of Philosophy 2008 Directed By: Nadine R. Sahyoun, PhD, RD Associate Professor Department of Nutrition and Food Science Background: Following discharge from the hospital, homebound older adults remain at risk of poor dietary intake and adverse outcomes due to declines in health experienced during hospitalization. However, once home, timely receipt of in-home nutrition services by older adults is challenged by gaps in the continuum of care. Greater insight into the nutrition and wellness service needs of this population is needed to improve service coordination. Methods: Staff at six home-delivered meal (HDM) programs in six US states enrolled 566 hospital-discharged, homebound older adults into a five-month HDM intervention project. Sociodemographic, nutrition and health risk data were collected at baseline, at 2 months after the initial assessment or at termination of home delivered meal services, and at 5 months after the initial assessment. Statistical Analyses: Bivariate and multivariate analyses were used to examine relationships between sociodemographic, social, nutritional, and health risk factors, and participant food shopping/meal preparation ability. In addition, associations between these risk factors, adverse changes in living arrangement and short-term HDM program participation were evaluated. An assessment of the food items and cooking appliances available in the home was also performed. Results: This dissertation suggests that among the hospital-discharged older adults studied: (a) many had a variety of foods available but reported being unable to prepare meals, (b) those who experienced adverse changes in living arrangement over the course of the intervention were more likely to report poor health and nutrition status, functional impairment, and social isolation following hospital discharge, and finally, (c) those who maintained or restored their ability to accomplish food-related instrumental activities of daily living such as shopping and preparing meals were shorter-term users of HDM compared to longer-term users. Conclusion: Homebound older adults can benefit from timely enrollment to community-based programs nutrition and wellness services like HDM, especially those who are unable to shop and prepare meals. There is also a need at discharge to identify social, functional and nutritional risk factors for adverse outcomes in older adult patients in order to provide appropriate referrals to nutrition and wellness services that can facilitate successful transitions from hospital to home. SHORT-TERM HOME-DELIVERED MEAL INTERVENTION AND THE HEALTH, NUTRITION AND FUNCTIONAL STATUS OF HOSPITALDISCHARGED OLDER ADULTS
Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study.

BACKGROUND In contrast to colorectal surgery, enhanced recovery pathways (ERPs) have not yet become standard practice after major upper abdominal surgery. The aim of this study was to assess the feasibility and outcomes after implementation of an ERP after liver a resection. METHODS Patients who underwent a liver resection in two consecutive 6-month periods before (July-December 2013) and after (January-June 2014) implementation of an ERP were included in a prospective study. Patients who underwent live donation, ALPPS (associating liver partition with portal vein ligation for staged hepatectomy) or concomitant procedures were excluded. Peri-operative outcomes were compared between groups, and multivariate analysis of factors influencing the length of hospital stay (LOS) was performed. RESULTS Two hundred and eleven patients (93 pre-ERP and 91 post-ERP patients) underwent a liver resection during the study period. There was no significant difference in the median LOS (P = 0.907) and 30-day readmission rates (P = 0.645) between the groups. Severe (Clavien grade III-V) complications were reduced in ERP patients (13.9% versus 4.3%; P = 0.039). On multivariate analysis, an increased age (< 0.001), open resection (< 0.001) and complications (< 0.001) were associated with an increased LOS. CONCLUSION Enhanced recovery after a liver resection appears to be safe, feasible and may reduce severe complications. However, the LOS was significantly influenced by patient age, open surgery and post-operative complications, but not by an ERP.
Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy.

BACKGROUND Intake of supplements containing iron or a combination of iron and folic acid by pregnant women may improve maternal health and pregnancy outcomes. Recently, intermittent supplementation regimens have been proposed as alternatives to daily regimens. OBJECTIVES To assess the effectiveness and safety of daily and intermittent use of iron or iron+folic acid supplements by pregnant women. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2009) and contacted relevant organisations for the identification of ongoing and unpublished studies. SELECTION CRITERIA All randomised or quasi-randomised trials evaluating the effect of supplementation with iron or iron+folic acid during pregnancy. DATA COLLECTION AND ANALYSIS We assessed the methodological quality of trials using the standard Cochrane criteria. Two authors independently assessed which trials to include in the review and one author extracted data. MAIN RESULTS We included 49 trials, involving 23,200 pregnant women. Overall, the results showed significant heterogeneity across most prespecified outcomes and were analysed assuming random-effects. The trials provided limited information related to clinical maternal and infant outcomes.Overall, daily iron supplementation was associated with increased haemoglobin levels in maternal blood both before and after birth and reduced risk of anaemia at term. These effects did not differ significantly between women receiving intermittent or daily iron or iron+folic acid supplementation. Women who received daily prenatal iron supplementation with or without folic acid were less likely to have iron deficiency at term as defined by current cut-off values than those who received no treatment or placebo. Side effects and haemoconcentration (a haemoglobin level greater than 130 g/L) were more common among women who received daily iron or iron+folic acid supplementation than among those who received no treatment or placebo. The risk of haemoconcentration during the second and third trimester was higher among those on a daily regimen of iron supplementation. The clinical significance of haemoconcentration remains uncertain. AUTHORS' CONCLUSIONS Universal prenatal supplementation with iron or iron+folic acid provided either daily or weekly is effective to prevent anaemia and iron deficiency at term. We found no evidence, however, of the significant reduction in substantive maternal and neonatal adverse clinical outcomes (low birthweight, delayed development, preterm birth, infection, postpartum haemorrhage). Associated side effects and particularly haemoconcentration during pregnancy may suggest the need for revising iron doses and schemes of supplementation during pregnancy and adjust preventive iron supplementation recommendations.
Früherkennung und Prävention der Osteoporose bei Männern

Zusammenfassung Etwa sechs Prozent der über 50-jährigen Männer sind in Deutschland von Osteoporose betroffen. Obgleich bereits eine breite Palette an Medikamenten zur Behandlung der männlichen Osteoporose zur Verfügung steht, und Männer mit osteoporotischen Frakturen eine deutlich höhere Mortalität als Frauen mit Frakturen haben, werden Männer seltener behandelt. Nach einer Hüftfraktur werden etwa zwei Drittel aller Frauen mit einem osteoporosespezifischen Medikament behandelt, bei Männern ist es aber nur die Hälfte. Bei Männern stehen in 50–60 % der Fälle sekundäre Osteoporosen im Vordergrund, bei postmenopausalen Frauen hingegen nur bei 30 %. Die häufigsten Risikofaktoren bei der männlichen Osteoporose sind Nikotinkonsum, systemische Glukokortikoide, Alkoholkonsum, chronisch obstruktive Atemwegserkrankungen und der Hypogonadismus. Screening hinsichtlich des Vorliegens von Risikofaktoren ist daher bei Männern zur Früh-erkennung der Osteoporose unerlässlich. Im positiven Falle ist eine systematische osteologische Abklärung inklusive Knochendichtemessung, Bildgebung der Wirbelsäule und Labordiagnostik erforderlich. Prävention muss bereits im Kindesund Jugendalter erfolgen durch körperliche Aktivität, eiweiß- und kalziumreiche Ernährung kombiniert mit adäquater Vitamin-D-Versorgung. Bereits bei Diagnosestellung von Erkrankungen, die mit der Entwicklung einer Osteoporose verbunden sein können, ist osteologische Diagnostik erforderlich. Nur so kann der Entwicklung einer Osteoporose frühzeitig begegnet werden.
Renal function and urological complications after radical hysterectomy with postoperative radiotherapy and platinum-based chemotherapy for cervical cancer

Background We aimed to clarify renal functional changes long term and serious urological complications in women with cervical cancer who undergo radical hysterectomy followed by pelvic radiotherapy and/or platinum-based chemotherapy to treat the initial disease. Methods Data on 380 women who underwent radical hysterectomy at the National Kyushu Cancer Center from January 1997 to December 2013 were reviewed. Main outcome measures were the estimated glomerular filtration rate (eGFR) and monitored abnormal urological findings. Results Postoperative eGFR was significantly lower than preoperative eGFR in 179 women with surgery alone and in 201 women with additional pelvic radiotherapy and/or chemotherapy (both P < 0.01). Two types of univariate analyses for eGFR reduction in women after treatment showed that older age, advanced stage, pelvic radiotherapy, and platinum-based chemotherapy were significant variables on both analyses. Two types of multivariate analyses showed that platinum-based chemotherapy or pelvic radiotherapy were associated with impaired renal function (odds ratio 1.96, 95% confidence interval 1.08-3.54 and odds ratio 2.85, 95% confidence interval 1.12-7.24, for the respective analyses). There was a higher rate of bladder wall thickening in women with pelvic radiotherapy had than those without it (17.4% vs. 2.7%, P < 0.01). One serious urological complication (intraperitoneal rupture of the bladder) occurred among women who underwent pelvic radiotherapy (0.6% vs. 0%). Conclusions Surgeons should be aware that eGFR is reduced after platinum-based chemotherapy and/or postoperative pelvic radiotherapy. Serious and life-threatening urological complications are rare, but surgeons should be aware of the possibility during the long follow-up.
Analgesia postoperatoria con morfina intratecal en cirugía proctológica

Introduccion : El dolor postoperatorio es un tipo especial de dolor agudo, de gran repercusion en el sector de la salud. Un control optimo del mismo en procederes proctologicos y del perine es un verdadero reto. Su tratamiento correcto puede aliviar el sufrimiento y permitir la movilizacion temprana y acortar la estadia hospitalaria . Objetivos: Identificar la utilidad de opioides en analgesia postoperatoria en cirugia proctologica. Metodo : Se realizo un estudio experimental, a simple ciegas, comparativo y prospectivo, para seleccionar la dosis de morfina intratecal a utilizar para la analgesia postoperatoria en pacientes a quienes se les realizo cirugia proctologica en el Servicio de Anestesia y Reanimacion del Hospital Docente Clinico Quirurgico Dr. Salvador Allende durante el 2009. La muestra estuvo constituida por 210 pacientes, seleccionados de forma aleatoria. Se agruparon en tres grupos segun la dosis de morfina administrada: Grupo I (74 pacientes) se administro 3 µg/Kg; Grupo II (68 pacientes) 4 µg/Kg y en el Grupo III (68 pacientes) 5 µg/Kg. Resultados : El valor medio de la duracion de la analgesia en horas en el Grupo I fue de 11,97 ± 1,67 DS, en el grupo II fue de 21,54 ± 2,29 y en el III de 21,4 ± 2,03. El prurito fue el efecto adverso con mayor incidencia, seguido por la retencion urinaria, las nauseas y los vomitos. Conclusiones : La dosis de 4 µg/Kg parece ser la mas recomendable para la analgesia postoperatoria con morfina intratecal en cirugia proctologica si se toma en cuenta la duracion de la analgesia y los efectos adversos encontrados en nuestro estudio.