Miracle-dz/UniFAR-FTUs huggingface dataset:
An Institutional Perspective on Accountable Care Organizations

We employ aspects of institutional theory to explore how Accountable Care Organizations (ACOs) can effectively manage the multiplicity of ideas and pressures within which they are embedded and consequently better serve patients and their communities. More specifically, we draw on the concept of institutional logics to highlight the importance of understanding the conflicting principles upon which ACOs were founded. Based on previous research conducted both inside and outside health care settings, we argue that ACOs can combine attention to these principles (or institutional logics) in different ways; the options fall on a continuum from (a) segregating the effects of multiple logics from each other by compartmentalizing responses to multiple logics to (b) fully hybridizing the different logics. We suggest that the most productive path for ACOs is to situate their approach between the two extremes of “segregating” and “fully hybridizing. ” This strategic approach allows ACOs to develop effective responses that combine logics without fully integrating them. We identify three ways that ACOs can embrace institutional complexity short of fully hybridizing disparate logics: (1) reinterpreting practices to make them compatible with other logics; (2) engaging in strategies that take advantage of existing synergy between conflicting logics; (3) creating opportunities for people at frontline to develop innovative ways of working that combine multiple logics.
Velopharyngeal Dysfunction and Sleep Apnea-A Survey to Ascertain Surgical Practice Patterns

Objective To determine if all cleft surgeons uniformly and adequately evaluate patients with cleft for obstructive sleep apnea (OSA) and consider OSA in treatment of velopharyngeal dysfunction (VPD). Design A 22-question survey was administered via e-mail to 1117 surgeons who were members of the American Cleft Palate-Craniofacial Association. Logistic regression was used to determine if management was affected by years in practice, clinical volume, field of training, and region of practice. Main Outcome Measures We sought to determine if years in practice, clinical volume, region of practice, and surgical specialty affected surgeons’ evaluation of OSA and their approaches to VPD. Results A total of 231 surgeons responded (21% response rate), and 67% stated that they had trained in plastic surgery. With increasing years of practice, surgeons were less likely to refer patients for preoperative and postoperative sleep studies (P = .00 and P = .001, respectively), screen patients for sleep apnea (P = .008), or change their management based on a sleep study (P = .001). There were no significant differences in screening or testing for OSA based upon clinical volume. Among those surveyed, otolaryngologists were more likely to refer patients for postoperative sleep studies (P = .028). Surgeons in the Southeast were more likely to change their management based upon a sleep study (P = .038). Conclusions Statistically significant trends in screening and testing for OSA in the setting of VPD were identified by this survey. Notably, older surgeons were less likely to investigate OSA in their patients, and not all specialties equally refer for postoperative sleep studies.
Increased Myo-Inositol in Primary Motor Cortex of Contact Sports Athletes without a History of Concussion.

Abstract The objective of the study was to determine whether repetitive hits to the head at a subclinical level are associated with structural and functional brain abnormalities and whether these effects are influenced by high levels of fitness associated with intense physical activity. Seventy-two college students were recruited: 24 nonathletic, 24 athletes practicing a varsity contact sport, and 24 athletes practicing a varsity noncontact sport. They were recruited for a neuropsychological evaluation and a magnetic resonance imaging session that included magnetic resonance spectroscopy of primary motor cortex (M1) and prefrontal cortex and susceptibility-weighted imaging. There was no evidence for reduced cognitive performance or presence of micro bleeds in contact sports athletes. Abnormalities in contact sports athletes were found for myo-inositol concentration (mIns) in M1, where levels were significantly higher compared with noncontact sports athletes (p = 0.016) and nonathletes (p = 0.029). In pref.
Cellular Strain Assessment Tool (CSAT): Precision Controlled Cyclic Uniaxial Tensile Loading

Cells throughout our body are exposed to various forms of mechanical stimuli[1, 2]. To examine effects of mechanical cyclic strain on vascular cells, several types of strain devices have been developed, and the methods of force application range from use of dynamic indenters[3] to vacuum pressures (both positive[4] or negative[5, 6]) to stretch the bottom surface of the elastic substrate to which the cells are cultured. A number of custom uniaxial strain devices have been developed to examine cells that are normally exposed to lateral stresses[7–11]. However, a limitation to most uniaxial strain devices is that they can only accommodate a limited number of samples[8–12] at one time. Most devices also lack a platform to perform consistent clamping and loading of samples, which can significantly alter substrate strain[8, 9, 13] and ultimately, introduce large variations between experiments. Here we present a computer controlled precision strain application system composed of a custom multi-well uniaxial Cellular Strain Assessment Tool (CSAT) (Figure 1), a microscope adaptable mini CSAT, and custom elastomeric polydimethylsiloxane (PDMS) plates. The effect of cyclic tensile strain on the migration of endothelial cells was also analyzed in this study. Human umbilical vein endothelial cells (HUVECs), cultured in 2D directly on elastomeric polydimethylsiloxane (PDMS) substrates were exposed to cyclic tensile strain at physiologic levels, and demonstrated to enhance EC migration.Copyright © 2009 by ASME
Neonatal Estrogen Stimulates Proliferation of Periductal Fibroblasts and Alters the Extracellular Matrix Composition in the Rat Prostate* * This work was supported by NIH grant DK-40890 (to G.S.P.) and the Research Funds of the Department of Veterans Affairs (to M.J.W.).

The purpose of this study was to examine whether changes in extracellular matrix (ECM) molecules are associated with the growth inhibition and differentiation defects of the prostate gland following neonatal exposure to estradiol. Using immunocytochemistry (ICC), laminin and collagen IV were localized to the basement membrane (BM) as well to the basal lamina of the periductal smooth muscle of the control developing prostates. In contrast, fibronectin and collagen III were localized throughout the stromal ECM. Exposure to neonatal estrogen altered the staining profile for specific ECM molecules. In the estrogenized rats, a thick layer of cells negative for laminin and collagen IV was observed adjacent to the BM. Electron microscopy and ICC for α-actin, fibronectin, and vimentin identified this multicellular layer of periductal cells as differentiated fibroblasts. Peripheral to these fibroblasts, actin-positive smooth muscle formed a second layer of periductal stromal cells. PCNA labeling showed that estrog.
Virus-Specific CD8+ T Cells Infiltrate Melanoma Lesions and Retain Function Independently of PD-1 Expression

It is well known that CD8+ tumor-infiltrating lymphocytes (TILs) are correlated with positive prognoses in cancer patients and are used to determine the efficacy of immune therapies. Although it is generally assumed that CD8+ TILs will be tumor-associated Ag (TAA) specific, it is unknown whether CD8+ T cells with specificity for common pathogens also infiltrate tumors. If so, the presence of these T cells could alter the interpretation of prognostic and diagnostic TIL assays. We compared TAA-specific and virus-specific CD8+ T cells in the same tumors using murine CMV, a herpesvirus that causes a persistent/latent infection, and vaccinia virus, a poxvirus that is cleared by the host. Virus-specific CD8+ TILs migrated into cutaneous melanoma lesions during acute infection with either virus, after a cleared vaccinia virus infection, and during a persistent/latent murine CMV infection. Virus-specific TILs developed independently of viral Ag in the tumor and, interestingly, expressed low or intermediate levels of full-length PD-1 in the tumor environment. Importantly, PD-1 expression could be markedly induced by Ag but did not correlate with dysfunction for virus-specific TILs, in sharp contrast to TAA-specific TILs in the same tumors. These data suggest that CD8+ TILs can reflect an individual’s immune status, rather than exclusively representing TAA-specific T cells, and that PD-1 expression on CD8+ TILs is not always associated with repeated Ag encounter or dysfunction. Thus, functional virus-specific CD8+ TILs could skew the results of prognostic or diagnostic TIL assays.
High-Resolution Metatranscriptomics Reveals the Ecological Dynamics of Mosquito-Associated RNA Viruses in Western Australia

ABSTRACT Mosquitoes harbor a high diversity of RNA viruses, including many that impact human health. Despite a growing effort to describe the extent and nature of the mosquito virome, little is known about how these viruses persist, spread, and interact with both their hosts and other microbes. To address this issue we performed a metatranscriptomics analysis of 12 Western Australian mosquito populations structured by species and geographic location. Our results identified the complete genomes of 24 species of RNA viruses from a diverse range of viral families and orders, among which 19 are newly described. Comparisons of viromes revealed a striking difference between the two mosquito genera, with viromes of mosquitoes of the Aedes genus exhibiting substantially less diversity and lower abundances than those of mosquitoes of the Culex genus, within which the viral abundance reached 16.87% of the total non-rRNA. In addition, there was little overlap in viral diversity between the two genera, although the viromes were very similar among the three Culex species studied, suggesting that the host taxon plays a major role in structuring virus diversity. In contrast, we found no evidence that geographic location played a major role in shaping RNA virus diversity, and several viruses discovered here exhibited high similarity (95 to 98% nucleotide identity) to those from Indonesia and China. Finally, using abundance-level and phylogenetic relationships, we were able to distinguish potential mosquito viruses from those present in coinfecting bacteria, fungi, and protists. In sum, our metatranscriptomics approach provides important insights into the ecology of mosquito RNA viruses. IMPORTANCE Studies of virus ecology have generally focused on individual viral species. However, recent advances in bulk RNA sequencing make it possible to utilize metatranscriptomic approaches to reveal both complete virus diversity and the relative abundance of these viruses. We used such a metatranscriptomic approach to determine key aspects of the ecology of mosquito viruses in Western Australia. Our results show that RNA viruses are some of the most important components of the mosquito transcriptome, and we identified 19 new virus species from a diverse set of virus families. A key result was that host genetic background plays a more important role in shaping virus diversity than sampling location, with Culex species harboring more viruses at higher abundance than those from Aedes mosquitoes.
CYP3A5 genotype and its impact on vincristine pharmacokinetics and development of neuropathy in Kenyan children with cancer

Vincristine (VCR) is a critical part of treatment in pediatric malignancies and is associated with dose‐dependent peripheral neuropathy (vincristine‐induced peripheral neuropathy [VIPN]). Our previous findings show VCR metabolism is regulated by the CYP3A5 gene. Individuals who are low CYP3A5 expressers metabolize VCR slower and experience more severe VIPN as compared to high expressers. Preliminary observations suggest that Caucasians experience more severe VIPN as compared to nonCaucasians.
A study of medication-related problems in stroke patients: A need for pharmaceutical care

Objective: The study was aimed to assess the incidence and characteristics of drug-related problems (DRPs). Methods: A prospective, observational study was conducted among 133 patients with stroke disease who were aged 18 years or older and admitted to the general medicine ward. During the 6 months study period, the incidence of DRPs was identified using the Pharmaceutical Care Network Europe Foundation classification system, version 6.2. Findings: A total of 133 patients were screened for DRPs. Among them, 120 patients have at least one DRP. A total of 254 DRPs were identified (on average, 2.015 DRPs per each patient case). Conclusion: Increasing the evidence of the incidence of medication-related problems in tertiary care hospitals indicates the need for the establishment of a clinical pharmacist in hospital settings.
Verification of Maximal Oxygen Uptake in Obese and Nonobese Children

Purpose The purpose of this study was to examine whether a supramaximal constant-load verification test at 105% of the highest work rate would yield a higher V˙O2max when compared with an incremental test in 10- to 12-yr-old nonobese and obese children. Methods Nine nonobese (body mass index percentile = 57.5 ± 23.2) and nine obese (body mass index percentile = 97.9 ± 1.4) children completed a two-test protocol that included an incremental test followed 15 min later by a supramaximal constant-load verification test. Results The V˙O2max achieved in verification testing (nonobese = 1.71 ± 0.31 L·min−1 and obese = 1.94 ± 0.47 L·min−1) was significantly higher than that achieved during the incremental test (nonobese = 1.57 ± 0.27 L·min−1 and obese = 1.84 ± 0.48 L·min−1; P < 0.001). There was no significant group (i.e., nonobese vs obese)–test (i.e., incremental vs verification) interaction, suggesting that there was no effect of obesity on the difference between verification and incremental V˙O2max (P = 0.747). Conclusion A verification test yielded significantly higher values of V˙O2max when compared with the incremental test in obese children. Similar results were observed in nonobese children. Supramaximal constant-load verification is a time-efficient and well-tolerated method for identifying the highest V˙O2 in nonobese and obese children.
Management of post‐traumatic epilepsy: An evidence review over the last 5 years and future directions

Post‐traumatic epilepsy (PTE) is a relatively underappreciated condition that can develop as a secondary consequence following traumatic brain injury (TBI). The aim of this rapid evidence review is to provide a synthesis of existing evidence on the effectiveness of treatment interventions for the prevention of PTE in people who have suffered a moderate/severe TBI to increase awareness and understanding among consumers. Electronic medical databases (n = 5) and gray literature published between January 2010 and April 2015 were searched for studies on the management of PTE. Twenty‐two eligible studies were identified that met the inclusion criteria. No evidence was found for the effectiveness of any pharmacological treatments in the prevention or treatment of symptomatic seizures in adults with PTE. However, limited high‐level evidence for the effectiveness of the antiepileptic drug levetiracetam was identified for PTE in children. Low‐level evidence was identified for nonpharmacological interventions in significantly reducing seizures in patients with PTE, but only in a minority of cases, requiring further high‐level studies to confirm the results. This review provides an opportunity for researchers and health service professionals to better understand the underlying pathophysiology of PTE to develop novel, more effective therapeutic targets and to improve the quality of life of people with this condition.
A genome-wide CRISPR screen reconciles the role of N-linked glycosylation in galectin-3 transport to the cell surface

ABSTRACT Galectins are a family of lectin binding proteins expressed both intracellularly and extracellularly. Galectin-3 (Gal-3, also known as LGALS3) is expressed at the cell surface; however, Gal-3 lacks a signal sequence, and the mechanism of Gal-3 transport to the cell surface remains poorly understood. Here, using a genome-wide CRISPR/Cas9 forward genetic screen for regulators of Gal-3 cell surface localization, we identified genes encoding glycoproteins, enzymes involved in N-linked glycosylation, regulators of ER-Golgi trafficking and proteins involved in immunity. The results of this screening approach led us to address the controversial role of N-linked glycosylation in the transport of Gal-3 to the cell surface. We find that N-linked glycoprotein maturation is not required for Gal-3 transport from the cytosol to the extracellular space, but is important for cell surface binding. Additionally, secreted Gal-3 is predominantly free and not packaged into extracellular vesicles. These data support a secretion pathway independent of N-linked glycoproteins and extracellular vesicles. Summary: A CRISPR screen identified genes that regulate the cell surface localization of galectins, and data support a secretion pathway for galectin-3 that is independent of N-linked glycoproteins and extracellular vesicles.
The hearing benefit of cochlear implantation for individuals with unilateral hearing loss, but no tinnitus

Abstract Conclusion: Cochlear implants improve the hearing abilities of individuals with unilateral hearing loss and no tinnitus. The benefit is no different from that seen in patients with unilateral hearing loss and incapacitating tinnitus. Objective: To evaluate hearing outcomes after cochlear implantation in individuals with unilateral hearing loss and no tinnitus and compare them to those obtained in a similar group who had incapacitating tinnitus. Methods: Six cases who did not experience tinnitus before operation and 15 subjects with pre-operative tinnitus were evaluated with a structured interview, a monosyllabic word test under difficult listening situations, a sound localization test, and an APHAB (abbreviated profile of hearing aid benefit) questionnaire. Results: All subjects used their cochlear implant more than 8 hours a day, 7 days a week. In ‘no tinnitus’ patients, mean benefit of cochlear implantation was 19% for quiet speech, 15% for speech in noise (with the same signal-to-noise ratio in the implanted and non-implanted ear), and 16% for a more favourable signal-to-noise ratio at the implanted ear. Sound localization error improved by an average of 19°. The global score of APHAB improved by 16%. The benefits across all evaluations did not differ significantly between the ‘no tinnitus’ and ‘tinnitus’ groups.
Human grooming in comparative perspective: People in six small-scale societies groom less but socialize just as much as expected for a typical primate.

OBJECTIVES Grooming has important utilitarian and social functions in primates but little is known about grooming and its functional analogues in traditional human societies. We compare human grooming to typical primate patterns to test its hygienic and social functions. MATERIALS AND METHODS Bayesian phylogenetic analyses were used to derive expected human grooming time given the potential associations between grooming, group size, body size, terrestriality, and several climatic variables across 69 primate species. This was compared against observed times dedicated to grooming, other hygienic behavior, and conversation among the Maya, Pumé, Sanöma, Tsimane', Yanomamö, and Ye'kwana (mean number of behavioral scans = 23,514). RESULTS Expected grooming time for humans was 4% (95% Credible Interval = 0.07%-14%), similar to values observed in primates, based largely on terrestriality and phylogenetic signal (mean λ = 0.56). No other covariates strongly associated with grooming across primates. Observed grooming time across societies was 0.8%, lower than 89% of the expected values. However, the observed times dedicated to any hygienic behavior (3.0%) or "vocal grooming," that is conversation (7.3%), fell within the expected range. CONCLUSIONS We found (i) that human grooming may be a (recent) phylogenetic outlier when defined narrowly as parasite removal but not defined broadly as personal hygiene, (ii) there was no support for thermoregulatory functions of grooming, and (iii) no support for the "vocal grooming" hypothesis of language having evolved as a less time-consuming means of bonding. Thus, human grooming reflects decreased hygienic needs, but similar social needs compared to primate grooming.
Dopaminergic Genetic Variants and Voluntary Externally Paced Exercise Behavior

Purpose Most candidate gene studies on the neurobiology of voluntary exercise behavior have focused on the dopaminergic signaling pathway and its role in the mesolimbic reward system. We hypothesized that dopaminergic candidate genes may influence exercise behavior through additional effects on executive functioning and that these effects are only detected when the types of exercise activity are taken into account. Methods Data on voluntary exercise behavior and at least one single-nucleotide polymorphism/variable number of tandem repeat (VNTR) were available for 12,929 participants of the Netherlands Twin Registry. Exercise activity was classified as externally paced if a high level of executive function skill was required. The total volume of voluntary exercise (minutes per week) as well as the volume specifically spent on externally paced activities were tested for association with nine functional dopaminergic polymorphisms (DRD1: rs265981, DRD2/ANKK1: rs1800497, DRD3: rs6280, DRD4: VNTR 48 bp, DRD5: VNTR 130–166 bp, DBH: rs2519152, DAT1: VNTR 40 bp, COMT: rs4680, MAOA: VNTR 30 bp), a polygenic score (PGS) based on nine alleles leading to lower dopamine responsiveness, and a PGS based on three alleles associated with both higher reward sensitivity and better executive functioning (DRD2/ANKK1: “G” allele, COMT: Met allele, DAT1: 440-bp allele). Results No association with total exercise volume or externally paced exercise volume was found for individual alleles or the nine-allele PGS. The volume of externally paced exercise behavior was significantly associated with the reward and executive function congruent PGS. This association was driven by the DAT1 440-bp and COMT Met allele, which acted as increaser alleles for externally paced exercise behavior. Conclusions Taking into account the types of exercise activity may increase the success of identifying genetic variants and unraveling the neurobiology of voluntary exercise behavior.