Miracle-dz/UniFAR-FTUs huggingface dataset:
Sustainability of collaborative care interventions in primary care settings

• Summary: We assessed patient and provider barriers and facilitators to sustainability of a collaborative depression care model for depression treatment in predominantly Hispanic diabetes patients in safety net care clinics. • Findings: Semi-structured interviews and focus groups were conducted with patients and providers at two community clinics participating in a randomized controlled effectiveness trial of the Multi-faceted Depression and Diabetes Program (MDDP), a socioculturally adapted collaborative care model. Analysis identified eight themes grouped into three categories: barriers, facilitators, and recommendations for program sustainability. Barriers included patient concerns about use of medication and provider concerns about use of psychotherapy, increased workload for clinic staff, delay in receiving outcomes data, and lack of resources to sustain the program. Facilitators included patient benefits such as improved clinical outcomes, quality of care received, access, and satisfaction; provider benefits such as increased awareness and reduced anxiety; and clinic benefits in the form of reduced costs of care. Recommendations included changes in communication patterns among providers, specific changes in procedures, changes in resources, and changes in clinic organizational culture. • Applications: Sustainable adoption of collaborative depression care for underserved populations in safety net care systems by organizational decision-makers and providers requires: stable funding and qualified staff; technologies to facilitate provider access to easily applied treatment guidelines, information exchange between primary care physicians and depression care providers, and routine monitoring of patient depression symptoms and treatment adherence and satisfaction; and treatment consistent with patient preferences.
The Role of Dihydropyridine Calcium Channel Blockers in the Treatment of Hypertension and Cardiovascular Disease - An Update

Recent evidence supports a central role for calciumchannel blockers (CCBs), and in particular thedihydropyridine (DHP) agents, in the treatment ofhypertension and cardiovascular disease (CVD). We review here the findings of recent trials,systematic reviews and meta-analyses that rebutthose of the single, yet widely-publicised, earlierunfavourable meta-analysis.
High fat diet and associated changes in the expression of micro‐RNAS in tissue: Lessons learned from animal studies

Environment and genetic factors play an important role in the development of obesity, and diet is one of the main contributing factors to this disease. High fat intake is associated with body weight gain, leading to obesity and other metabolic diseases. MicroRNAs (miRNAs) are a group of small, noncoding RNAs that are important regulators of gene expression at posttranscriptional level. Studies have shown that high fat intake, independent of body weight status, can significantly impact both negatively and positively the expression of miRNAs and thus the biological function of tissues such as adipose, skeletal, and cardiac muscle, liver, neuronal, and endothelial. This review will summarize the effects of high calorie diet in the form of high fat intake on miRNA expression in various tissues of animal models and of high fat fed offspring. We will also briefly review the impact of different dietary lipids on miRNA expression. Given changes in miRNA expression have been associated with the development of many diseases including obesity, understanding their biological role could have important clinical implications and offer tangible therapeutic targets for the prevention, management, and/or treatment of obesity and other lifestyle-related disorders.
The Mediterranean Diet decreases LDL atherogenicity in high cardiovascular risk individuals: a randomized controlled trial.

SCOPE Traditional Mediterranean diet (TMD) protects against cardiovascular disease through several mechanisms such as decreasing LDL cholesterol levels. However, evidence regarding TMD effects on LDL atherogenic traits (resistance against oxidation, size, composition, cytotoxicity) is scarce. METHODS AND RESULTS We assessed the effects of a 1-year intervention with a TMD on LDL atherogenic traits in a random sub-sample of individuals from the PREDIMED study (N = 210). We compared two TMDs: one enriched with virgin olive oil (TMD-VOO, N = 71) and another with nuts (TMD-Nuts, N = 68), versus a low-fat control diet (N = 71). After the TMD-VOO intervention, LDL resistance against oxidation increased (+6.46%, p = 0.007), the degree of LDL oxidative modifications decreased (-36.3%, p<0.05), estimated LDL particle size augmented (+3.06%, p = 0.021), and LDL particles became cholesterol-rich (+2.41% p = 0.013) relative to the low-fat control diet. LDL lipoproteins became less cytotoxic for macrophages only relative to baseline (-13.4%, p = 0.019). No significant effects of the TMD-Nuts intervention on LDL traits were observed versus the control diet. CONCLUSION Adherence to a TMD, particularly when enriched with virgin olive oil, decreased LDL atherogenicity in high cardiovascular risk individuals. The development of less atherogenic LDLs could contribute to explaining some of the cardioprotective benefits of this dietary pattern.
The phenolic fraction of extra virgin olive oil modulates the activation and the inflammatory response of T cells from patients with systemic lupus erythematosus and healthy donors.

SCOPE Systemic lupus erythematosus (SLE) is a chronic multiorgan autoimmune disease characterized by immune deregulation, which involves altered T-cell response and imbalance of cytokine production. The phenolic fraction (PE) of extra virgin olive oil (EVOO) possesses anti-inflammatory and immunomodulatory properties and exerts preventive effects in murine models of immune-inflammatory diseases, such as SLE. The present study was designed to determine the in vitro effects of the PE from EVOO on peripheral blood mononuclear cells (PBMC) from inactive patients with SLE and healthy donors. METHODS AND RESULTS T-cell phenotype was investigated by flow cytometry, cytokine levels were determined by ELISA, and protein expression was detected by Western blot. The PE of EVOO decreased the frequency of CD69+ cells and the secretion of IFN-γ, TNF-α, IL-6, IL-1β, and IL-10. Moreover, PE increased the expression of I-kappa-B-α and decreased extracellular signal regulated kinase phosphorylation on PBMC from patients with SLE and healthy donors. CONCLUSION PE modulates cytokine production and attenuates induced T-cell activation, probably through NF-κB signaling pathway, providing the first evidence that PE from EVOO has an anti-inflammatory and immunomodulatory role in SLE patients and it might therefore be considered as a dietary complement in SLE management.
Serum carotenoids and colorectal cancer risk: A case-control study in Guangdong, China.

SCOPE Previous epidemiological studies on the association between circulating carotenoids and the risk of colorectal cancer drew inconclusive conclusions. This study aimed to examine serum carotenoids in relation to colorectal cancer risk in a Chinese population. METHODS AND RESULTS One case-control study beginning from July 2010, consecutively recruited 538 eligible colorectal cancer cases and 564 age (5-year interval) and sex frequency-matched controls. Serum levels of α-carotene, β-carotene, β-cryptoxanthin, lycopene and lutein/zeaxanthin were detected by HPLC. Unconditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence internal (CI) after adjusting for various confounders. Serum levels of α-carotene, β-cryptoxanthin and lycopene were found to be inversely associated with colorectal cancer risk. The adjusted ORs of the highest quartile relative to the lowest quartile serum level were 0.49 (95% CIs 0.33-0.72) for α-carotene, 0.44 (95% CIs 0.29-0.66) for β-cryptoxanthin, and 0.36 (95% CIs 0.24-0.54) for lycopene, respectively. The association between serum β-carotene, lutein/zeaxanthin and colorectal cancer risk was not statistically significant. CONCLUSION The results indicated that the incidence of colorectal cancer was associated with lower serum levels of α-carotene, β-cryptoxanthin and lycopene among Chinese population residing in Guangdong.
In‐home nighttime predictive low glucose suspend experience in children and adults with type 1 diabetes

Overnight predictive low glucose suspend (PLGS) reduces hypoglycemia across all ages; however, there are no reports on behavior or experience differences across age groups, especially in pediatrics. As run‐in for a subsequent randomized clinical trial (RCT), 127 subjects (50% male) ages 4–45 yr utilized the experimental PLGS system nightly for 5–10 nights (PLGS active phase). We analyzed the number of blood glucose (BG) checks and boluses given per age group. During the subsequent 42 night RCT phase, we analyzed sensor use, skin reactions, errors, and reasons why the experimental system was not used. In 821 nights of active PLGS, subjects ages 4–6 yr (and their parents) tested BG levels 75% of nights compared with 65% of nights (7–10 yr), 53% of nights (11–14 yr), 33% of nights (15–25 yr), and 28% of nights (26–45 yr), respectively (p < 0.001). Likewise, youngest subjects (and parents) administered insulin boluses 56% of nights during active PLGS use compared with 48%, 33%, 20%, and 25%, respectively (p < 0.001). This was unrelated to study requirements. During the RCT phase, subjects 4–6 yr experienced more frequent and severe skin reactions (p = 0.02), while adult subjects (26–45 yr) wore individual sensors a median of 26 h longer than the youngest subjects (p < 0.001). Technical problems with the sensor (errors, miscalibrations, etc.), traveling, and BG levels >270 at bedtime (study requirement) were primary contributors to non‐system use. Understanding the different use patterns and challenges in pediatrics and adolescence is needed to direct patient education to optimize use of PLGS and future artificial pancreas systems.
A survey of youth with new onset type 1 diabetes: Opportunities to reduce diabetic ketoacidosis

Pediatric patients in Colorado with new onset type 1 diabetes (T1D) presenting with diabetic ketoacidosis (DKA) increased from 29.9% to 46.2% from 1998 to 2012. The purpose of this study was to compare differences between patients with newly diagnosed T1D who presented in DKA with those who did not across three domains: sociodemographic factors, access to medical care, and medical provider factors, aiming to identify potential targets for intervention.
Australian Parents' Beliefs About Adolescent Sexuality and HIV/AIDS

Abstract Parents of 16-year-olds (N= 98) were administered a questionnaire which assessed their beliefs about their own and other teenagers' sexual behaviour and attitudes and concerns about HIV/ AIDS. They were also asked about their communication with their teenage child about sexuality and HIV/AIDS prevention. Parents tended to view their own teenager in a more positive light than adolescents generally. For example, parents rated their teenagers' sexual behaviours and attitudes more conservatively than they did teenagers ‘in general,’ and assumed that the former had a lower risk for HIV transmission. A functional basis for parental beliefs is presented as an explanation of these discrepancies and the implications for HIV/AIDS education are discussed.
Prediction of Postoperative Blood Loss Using Thromboelastometry in Adult Cardiac Surgery: Cohort Study and Systematic Review.

OBJECTIVE The aim was to evaluate the predictive value of thromboelastometry for postoperative blood loss in adult cardiac surgery with cardiopulmonary bypass. DESIGN Retrospective cohort study and systematic review of the literature. SETTING A tertiary university hospital. PARTICIPANTS 202 patients undergoing elective cardiac surgery. INTERVENTIONS Thromboelastometry was performed before cardiopulmonary bypass and 3 minutes after protamine administration. MEASUREMENTS AND MAIN RESULTS The cohort study showed that the preoperative and postoperative thromboelastometric positive predicting value was poor (0%-22%); however, the negative predicting value was high (89%-94%). The systematic review of the literature to evaluate the predictive value of thromboelastometry for major postoperative bleeding in cardiac surgery resulted in 1,311 articles, 11 of which were eligible (n = 1,765; PubMed and Embase, until June 2016). Two studies found a good predictive value, whereas the other 9 studies showed a poor predictability for major postoperative bleeding after cardiac surgery. The overall negative predicting value was high. CONCLUSIONS Thromboelastometry does not predict which patients are at risk for major postoperative bleeding.
Long-Term Follow-Up of Fibromyalgia Patients Who Completed a Structured Treatment Program versus Patients in Routine Treatment

Objective: To determine whether patients with fibromyalgia [FMS], treated in a tertiary care setting, got worse over time, remained the same, or got better. Methods: Validated self-report questionnaires and checklists were sent at two-year intervals to patients who were screened for entry into a six-month FMS treatment program. Patients were divided into subgroups based on whether they finished the program or did not enter or finish. They were followed for up to nine years. Results: The subgroup that finished the six-month program had lower Fibromyalgia Impact Questionnaire and Beck Depression Inventory and higher Quality of Life Scale scores over time than the subgroup that did not enter the program or finish. The Fibromyalgia Impact Questionnaire scores of program finishers were significantly lower at three to four years [P =. 031] and seven to nine years [P =. 001]. Beck Depression Inventory scores were significantly lower at three to four years [P =. 047]. The Quality of Life Scale scores were not significantly different at any measurement. Over the survey period, a majority of the total group rated their FMS symptoms and physical abilities as better than when they were pretested for the program. Up to 35 percent had periods of time without symptoms and nearly 50 percent rated their general health as good or excellent. A majority of patients whether they finished the program or not took medications for sleep, exercised, and used relaxation and self-talk coping strategies. Use of both pain medications and anti-depressants increased over the course of the study. Conclusions: Patients treated in a comprehensive program had consistently lower FMS impact, depression, pain, and fatigue scores over time. Patients who did not enter or complete the program were as likely take sleep medication, exercise or use self-management techniques over time but did not perceive themselves to be doing as well as those who completed the program.
Using deep learning to segment breast and fibroglandular tissue in MRI volumes

Purpose: Automated segmentation of breast and fibroglandular tissue (FGT) is required for various computer‐aided applications of breast MRI. Traditional image analysis and computer vision techniques, such atlas, template matching, or, edge and surface detection, have been applied to solve this task. However, applicability of these methods is usually limited by the characteristics of the images used in the study datasets, while breast MRI varies with respect to the different MRI protocols used, in addition to the variability in breast shapes. All this variability, in addition to various MRI artifacts, makes it a challenging task to develop a robust breast and FGT segmentation method using traditional approaches. Therefore, in this study, we investigated the use of a deep‐learning approach known as “U‐net. ” Materials and methods: We used a dataset of 66 breast MRI's randomly selected from our scientific archive, which includes five different MRI acquisition protocols and breasts from four breast density categories in a balanced distribution. To prepare reference segmentations, we manually segmented breast and FGT for all images using an in‐house developed workstation. We experimented with the application of U‐net in two different ways for breast and FGT segmentation. In the first method, following the same pipeline used in traditional approaches, we trained two consecutive (2C) U‐nets: first for segmenting the breast in the whole MRI volume and the second for segmenting FGT inside the segmented breast. In the second method, we used a single 3‐class (3C) U‐net, which performs both tasks simultaneously by segmenting the volume into three regions: nonbreast, fat inside the breast, and FGT inside the breast. For comparison, we applied two existing and published methods to our dataset: an atlas‐based method and a sheetness‐based method. We used Dice Similarity Coefficient (DSC) to measure the performances of the automated methods, with respect to the manual segmentations. Additionally, we computed Pearson's correlation between the breast density values computed based on manual and automated segmentations. Results: The average DSC values for breast segmentation were 0.933, 0.944, 0.863, and 0.848 obtained from 3C U‐net, 2C U‐nets, atlas‐based method, and sheetness‐based method, respectively. The average DSC values for FGT segmentation obtained from 3C U‐net, 2C U‐nets, and atlas‐based methods were 0.850, 0.811, and 0.671, respectively. The correlation between breast density values based on 3C U‐net and manual segmentations was 0.974. This value was significantly higher than 0.957 as obtained from 2C U‐nets (P < 0.0001, Steiger's Z‐test with Bonferoni correction) and 0.938 as obtained from atlas‐based method (P = 0.0016). Conclusions: In conclusion, we applied a deep‐learning method, U‐net, for segmenting breast and FGT in MRI in a dataset that includes a variety of MRI protocols and breast densities. Our results showed that U‐net‐based methods significantly outperformed the existing algorithms and resulted in significantly more accurate breast density computation.
The kidney in pediatric liver transplantation: An updated perspective

CKD continues to detract from the success of improved survival in pediatric liver transplantation, and its presence is likely under recognized. Here we review the literature regarding the prevalence, etiology, and management of renal dysfunction in pediatric liver transplant recipients. Long‐term studies suggest the prevalence of CKD to be 25–38% by 5–10 yr post‐transplant. While important, sole use of serum creatinine overestimates renal function in this population. Screening for and treatment of persistent proteinuria and hypertension as well as minimization of nephrotoxic insults are the mainstays to delay or prevent CKD progression. Office‐based blood pressure measures are less sensitive than ABPM, which is specifically recommended by the American Heart Association for its ability to diagnose masked hypertension in pediatric liver transplant recipients. Long‐term risk of CKD is predominantly secondary to CNI toxicity. CNI minimization protocols have shown promise in slowing progression of CKD while maintaining graft function, but large‐scale randomized control trials with long‐term follow‐up are needed.
Separation of scatter from small MV beams and its effect on detector response

Purpose: Separating the scatter from the primary component of a MV beam to study detector response separately in each case for a better understanding of the role of different effects influencing the response in nonstandard fields. Methods: Detector response in three different experimental setups was investigated for a variety of different types (diamond, shielded and unshielded diodes, ionization chamber and film): (a). Detectors positioned in water under a thin steel pole blocking the central part of the beam, yielding only the response to the scatter part of the beam. (b). Detectors positioned in air under a PMMA cap to approximate the contribution of the primary beam without scatter. (c). Detectors positioned in water in the standard open field configuration to obtain a superposition of both. Results: Detector differences became more clearly observable when the primary beam was blocked and detector behavior heavily depended on the construction type. It was possible to calculate the response in the open fields from the values measured in the blocked configuration with 1% accuracy for all studied field sizes between 0.8 and 10 cm and for all detectors. Conclusions: The limitations of clinically used detectors in nonstandard situations were illustrated in the extreme situation of just scattered radiation reaching the detector. By experimentally separating scatter from the primary beam, the roles of different effects on the detector response were observed.
Autologous Chondrocytes in a Hyaluronic Acid Scaffold

Articular cartilage lesions, with their inherent limited healing potential, remain a challenging problem for orthopedic surgeons. Various techniques, both palliative and reparative, have been used to treat this pathology with variable success rates. In recent years, however, regenerative techniques, such as autologous chondrocyte implantation, have emerged as possible solutions for the treatment of chondral knee lesions. The use of classic autologous chondrocyte implantation (first generation) has been associated with several limitations. To address these problems, tissue-engineering techniques have been developed. We selected a biodegradable, biocompatible, hyaluronian-based scaffold for cell proliferation. This matrix autologous chondrocyte transplantation procedure avoids the use of periosteal flap, simplifies the surgical procedure, and can be performed using an arthroscopic procedure. Thus, the surgical morbidity and the recovery time for the patient are extremely reduced with no complications related to the periosteal flap. The short- to medium-term follow-up clinical and histological results are encouraging.
Management of older single functioning ventricles with outlet obstruction due to a restricted "VSD" in double inlet left ventricle and in complex double outlet right ventricle.

The occurrence of a restriction of the bulbo-ventricular foramen (BVF) in older patient with double inlet left ventricle (DILV) or tricuspid atresia (TA) with ventriculo-arterial discordance is a well-known condition. Today, the surgical management is to perform a Damus-type operation at the time of the bi-directional Glenn or at the Fontan completion. The ventricular septal defect (VSD) enlargement, associated with muscular resection and a patch enlargement of the subaortic accessory ventricular chamber, is rarely performed but remains indicated in cases with pulmonary valve atresia or regurgitation. This condition is essentially prevented by doing an early Norwood-type operation in the presence of DILV/TA with transposition of the great arteries associated with an aortic arch obstruction. The palliative switch operation is an option that was abandoned because of poor control of the pulmonary blood flow. It is only in cases of large unobstructed BVF that pulmonary artery banding could be undertaken in neonates, followed by close echocardiographic follow-up. The occurrence of a restriction or a closure of the VSD in complex DORV following a Fontan operation is a dramatic event and is quite "new business. " It has been recently recognized that the VSD becomes restricted in a number of patients with DORV-nc-VSD treated with a Fontan palliation. This new condition is not surprising knowing that 75% of the VSDs must be enlarged preventively in DORV-nc-VSD repair. In the setting of a Fontan circulation, the supra-systemic left ventricle has severe consequences the right ventricle performance. Attempts at surgical VSD enlargement or catheter-based procedures have resulted in almost constant recurrence. This recently reported complication is in favor of also performing a VSD enlargement at the time of the Fontan completion in complex DORV. It justifies the biventricular repair in complex DORV with two viable ventricles.