Miracle-dz/UniFAR-FTUs huggingface dataset:
Attributable costs and length of stay of hospital-acquired Clostridioides difficile: A population-based matched cohort study in Alberta, Canada

Abstract Objective: To determine the attributable cost and length of stay of hospital-acquired Clostridioides difficile infection (HA-CDI) from the healthcare payer perspective using linked clinical, administrative, and microcosting data. Design: A retrospective, population-based, propensity-score–matched cohort study. Setting: Acute-care facilities in Alberta, Canada. Patients: Admitted adult (≥18 years) patients with incident HA-CDI and without CDI between April 1, 2012, and March 31, 2016. Methods: Incident cases of HA-CDI were identified using a clinical surveillance definition. Cases were matched to noncases of CDI (those without a positive C. difficile test or without clinical CDI) on propensity score and exposure time. The outcomes were attributable costs and length of stay of the hospitalization where the CDI was identified. Costs were expressed in 2018 Canadian dollars. Results: Of the 2,916 HA-CDI cases at facilities with microcosting data available, 98.4% were matched to 13,024 noncases of CDI. The total adjusted cost among HA-CDI cases was 27% greater than noncases of CDI (ratio, 1.27; 95% confidence interval [CI], 1.21–1.33). The mean attributable cost was $18,386 (CAD 2018; USD $14,190; 95% CI, $14,312–$22,460; USD $11,046-$17,334). The adjusted length of stay among HA-CDI cases was 13% greater than for noncases of CDI (ratio, 1.13; 95% CI, 1.07–1.19), which corresponds to an extra 5.6 days (95% CI, 3.10–8.06) in length of hospital stay per HA-CDI case. Conclusions: In this population-based, propensity score matched analysis using microcosting data, HA-CDI was associated with substantial attributable cost.
Growth and reproductive traits of purebred and crossbred Romanov lambs in Eastern Anatolia

The performance of purebred Romanov (R) lambs and crossbred lambs of Romanov and Morkaraman (M) breeding were compared under a semi-intensive production system. The M breed is a fat-tailed breed native to Eastern Anatolia, Turkey. Analyses were conducted on data from 168 lambs produced from R and M ewes through laparoscopic artificial insemination (LAI) with the semen of pure R and F1 RxM rams. Pure R, F1 (RxM, ½ R), and ¼ R (RxM x M backcross) lambs were produced. The F1 and ¼ R lambs had heavier (P < 0.05) birth weights than R lambs while F1 and R lambs had heavier (P < 0.05) weaning weights than ¼ R lambs. The three groups of lambs differed (P < 0.05) from each other for age of puberty in males and females where with R lambs were the youngest, F1 lambs were intermediate, and ¼ R lambs were the oldest. The percentage of ewe lambs that exhibited estrus within one year of age was higher (P < 0.01) for R (100%) and F1 (67%) lambs than for ¼ R lambs (43%). In conclusion, improvement in growth and early reproductive traits can be obtained from crossbreeding the fat-tailed Morkaraman breed with the Romanov breed.
Cancer mortality in kidney transplant recipients: An Australian and New Zealand population‐based cohort study, 1980–2013

Cancer burden is increasing in kidney transplant recipients, but differences in mortality compared to the general population remain unclear. We sought to compare cancer mortality in paediatric and adult kidney transplant recipients with the general population and describe any differences, by site, age and sex, country and over time. We included kidney transplant recipients from the Australian and New Zealand Dialysis and Transplantation Registry, 1980–2013. Date of death and underlying cause of death were ascertained by data‐linkage and classified using ICD10AM codes. Indirect standardisation was used to estimate standardised mortality ratios (SMR). There were 5,284 deaths in 17,628 kidney transplant recipients over 175,084 person‐years of observation, including 1,061 (20%) cancer deaths. Relative cancer mortality was higher than the general population for all‐site (SMR 2.9, 95% CI 2.7–3.1) cancer and highest for nonmelanoma skin cancer (SMR 50.9, 95% CI 43.5–59.6) and lymphoma (SMR 42.2, 95% CI 35.3–50.5). Relative cancer mortality decreased with increasing age in men (p < 0.001) and women (p = 0.001) but never reached parity with the general population. Relative mortality did not change with age for skin and lip, or colorectal cancers (p‐value >0.1). Only relative colorectal cancer mortality increased over time (p = 0.002). Our study shows cancer mortality in kidney transplant recipients was higher than expected in the general population. The magnitude of excess mortality varied by cancer site, age and sex. Further evidence is needed to identify whether this variation is due to differences at diagnosis or access and effectiveness of cancer treatments in this population.
Improved exercise capacity in cyclophilin‐D knockout mice associated with enhanced oxygen utilization efficiency and augmented glucose uptake via AMPK‐TBC1D1 signaling nexus

We previously reported in HEK 293T cells that silencing the mitochondrial peptidyl prolyl isomerase cyclophilin‐D (Cyp‐D) reduces Vo2. We now report that in vivo Cyp‐D ablation using constitutive Cyp‐D knockout (KO) mice also reduces Vo2 both at rest (∼15%) and during treadmill exercise (∼12%). Yet, despite Vo2 reduction, these Cyp‐D KO mice ran longer (1071 ± 77 vs. 785 ± 79 m; P = 0.002), for longer time (43 ± 3 vs. 34 ± 3 min; P = 0.004), and at higher speed (34 ± 1 vs. 29 ± 1 m/s; P ≤ 0.001), resulting in increased work (87 ± 6 vs. 58 ± 6 J; P ≤ 0.001). There were parallel reductions in carbon dioxide production, but of lesser magnitude, yielding a 2.3% increase in the respiratory exchange ratio consistent with increased glucose utilization as respiratory substrate. In addition, primary skeletal muscle cells of Cyp‐D KO mice subjected to electrical stimulation exhibited higher glucose uptake (4.4 ± 0.55 vs. 2.6 ± 0.04 pmol/mg/min; P ≤ 0.001) with enhanced AMPK activation (0.58 ± 0.06 vs. 0.38 ± 0.03 pAMPK/β‐tubulin ratio; P ≤ 0.01) and TBC1 (Tre‐2/USP6, BUB2, Cdcl6) domain family, member 1 (TBC1D1) inactivation. Likewise, pharmacological activation of AMPK also increased glucose uptake (3.2 ± 0.3 vs. 2.3 ± 0.2 pmol/mg/min; P ≤ 0.001). Moreover, lactate and ATP levels were increased in these cells. Taken together, Cyp‐D ablation triggered an adaptive response resulting in increased exercise capacity despite less oxygen utilization associated with increased glucose uptake and utilization involving AMPK‐TBC1D1 signaling nexus. —Radhakrishnan, J., Baetiong, A. , Kaufman, H. , Huynh, M. , Leschinsky, A. , Fresquez, A. , White, C. , DiMario, J. X. , Gazmuri, R. J. Improved exercise capacity in cyclophilin‐D knockout mice associated with enhanced oxygen utilization efficiency and augmented glucose uptake via AMPK‐TBC1D1 signaling nexus. FASEB J. 33, 11443–11457 (2019). www.fasebj. org
Improved determination of Neisseria gonorrhoeae gyrase A genotype results in clinical specimens.

BACKGROUND The emergence of drug-resistant Neisseria gonorrhoeae has prompted the development of rapid molecular assays designed to determine antimicrobial susceptibility. One common assay uses high-resolution melt analysis to target codon 91 of the gyrase A gene (gyrA) to predict N. gonorrhoeae susceptibility to ciprofloxacin. METHODS We extracted DNA from remnant clinical specimens that had previously tested positive for N. gonorrhoeae using the Aptima Combo 2 for CT/NG assay (Hologic, San Diego, CA, USA). We selected DNA extracts from specimens with indeterminate, WT and mutant gyrA genotype results from a previous study using high-resolution melt analysis to detect the gyrA codon 91 mutation. We re-tested those specimens using the recently CE-marked ResistancePlus GC (beta) assay (SpeeDx, Sydney, Australia). RESULTS Of 86 specimens with indeterminate gyrA genotypes on high-resolution melt analysis, the ResistancePlus GC (beta) assay (SpeeDx) identified 30 (35%) WT, 22 (26%) mutant and 34 (40%) indeterminate gyrA genotypes. CONCLUSIONS The ResistancePlus GC (beta) assay showed improved N. gonorrhoeae gyrA genotype determination compared with a prior gyrA genotypic high-resolution melt assay.
Temporal evolution of beta bursts in the parkinsonian cortical and basal ganglia network

Significance Prevalence and temporal dynamics of transient oscillations in the beta frequency band (15 to 35 Hz), referred to as β bursts, are correlated with motor performance. Disturbance of these activities is a candidate mechanism for motor impairment in Parkinson’s disease (PD), where the excessively long bursts correlate with symptom severity and are reduced by pharmacological and surgical treatments. Here we describe the changes in action potential firing that take place across multiple nodes of the cortical and basal ganglia circuit as these transient oscillations evolve. These analyses provide fresh insights into the network dynamics of β bursts that can guide novel strategies to interfere with their generation and maintenance in PD. Beta frequency oscillations (15 to 35 Hz) in cortical and basal ganglia circuits become abnormally synchronized in Parkinson’s disease (PD). How excessive beta oscillations emerge in these circuits is unclear. We addressed this issue by defining the firing properties of basal ganglia neurons around the emergence of cortical beta bursts (β bursts), transient (50 to 350 ms) increases in the beta amplitude of cortical signals. In PD patients, the phase locking of background spiking activity in the subthalamic nucleus (STN) to frontal electroencephalograms preceded the onset and followed the temporal profile of cortical β bursts, with conditions of synchronization consistent within and across bursts. Neuronal ensemble recordings in multiple basal ganglia structures of parkinsonian rats revealed that these dynamics were recapitulated in STN, but also in external globus pallidus and striatum. The onset of consistent phase-locking conditions was preceded by abrupt phase slips between cortical and basal ganglia ensemble signals. Single-unit recordings demonstrated that ensemble-level properties of synchronization were not underlain by changes in firing rate but, rather, by the timing of action potentials in relation to cortical oscillation phase. Notably, the preferred angle of phase-locked action potential firing in each basal ganglia structure was shifted during burst initiation, then maintained stable phase relations during the burst. Subthalamic, pallidal, and striatal neurons engaged and disengaged with cortical β bursts to different extents and timings. The temporal evolution of cortical and basal ganglia synchronization is cell type-selective, which could be key for the generation/ maintenance of excessive beta oscillations in parkinsonism.
A Systematic Review on the Possible Relationship Between Bilingualism, Cognitive Decline, and the Onset of Dementia

A systematic review was conducted to investigate whether bilingualism has a protective effect against cognitive decline in aging and can protect against dementia. We searched the Medline, ScienceDirect, Scopus, and ERIC databases with a cut-off date of 31 March 2019, thereby following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol. Our search resulted in 34 eligible studies. Mixed results were found with respect to the protective effect of bilingualism against cognitive decline. Several studies showed a protective effect whereas other studies failed to find it. Moreover, evidence for a delay of the onset of dementia of between 4 and 5.5 years in bilingual individuals compared to monolinguals was found in several studies, but not in all. Methodological differences in the set-up of the studies seem to explain these mixed results. Lifelong bilingualism is a complex individual process, and many factors seem to influence this and need to be further investigated. This can be best achieved through large longitudinal studies with objective behavioral and neuroimaging measurements. In conclusion, although some evidence was found for a cognitive reserve-enhancing effect of lifelong bilingualism and protection against dementia, to date, no firm conclusions can be drawn.
Nonadherence to tamoxifen in breast cancer survivors: A 12 month longitudinal analysis.

OBJECTIVE Previous research has shown that up to 50% of breast cancer survivors prescribed tamoxifen do not take it as recommended, which is associated with increased risk of recurrence and mortality. Little research has attempted to identify modifiable psychosocial factors associated with tamoxifen nonadherence. This study aimed to examine how tamoxifen adherence rates change over a year and to identify modifiable predictors of nonadherence. METHOD Three hundred and forty-five breast cancer survivors who were in their first year of tamoxifen prescription were sent questionnaires at 4 points over a 12-month period. Questionnaires assessed demographic and clinical factors, side effects, beliefs about the illness and medication, social support, distress and tamoxifen adherence. Adherence was assessed using the Medication Adherence Rating Scale. Latent Growth Modeling was used to identify predictors of tamoxifen nonadherence. RESULTS Reported rates of nonadherence increased over time (37-48%). Several demographic, clinical, and psychosocial variables were associated with nonadherence. Women who were nonadherent were more likely to be from a minority ethnic group, to have more negative medication beliefs and to have lower confidence in their ability to take tamoxifen. CONCLUSIONS These demographic and clinical variables can be used to identify women at higher risk of nonadherence. The modifiable psychosocial variables can be used as the basis for psychological interventions to improve adherence in this population. Interventions should focus on both intentional and unintentional nonadherence. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Body balance analysis of children and youth with intellectual disabilities.

BACKGROUND Children and adolescents with intellectual disabilities (IDs) are an identified group with postural disturbances resulting from a lack of integration among the visual, vestibular and proprioceptive systems. The insufficient level of maturity of the sensory systems is at least partly responsible for disturbances in maintaining body balance. More sway can increase the risk of falls and body injuries. The aims of the study were (1) to compare the ability to maintain the body balance of children and youth with a varying degree of ID, both with the eyes open and closed, and (2) to determine to what extent factors such as sex, level of ID, visual stimulus and body height independently affect the ability to maintain body balance in children and adolescents with ID. METHOD The study involved 131 people aged 13-21 years (65 girls and 66 boys). The participants were classified as (1) with mild disability (42 girls and 47 boys) and (2) with moderate disability (23 girls and 19 boys), based on IQ test results. Sway measures were collected with the Zebris platform, with the eyes open and closed. Sway path, sway path in anterio-posterior and medio-lateral directions and sway area were analysed. RESULTS Boys with moderate ID were characterised by a significantly more sway indicating their worse postural balance ability than boys with mild ID, both in the trials with open eyes and closed ones. The type of test (eyes open/eyes closed) to a small extent had influenced the body balance of the examined children with ID. Results of analyses of covariance had showed that all analysed factors (sex, level of ID, type of the test performance and body height), irrespectively from direction of sway (sway path in anterio-posterior and medio-lateral directions), worked independently influencing body balance. CONCLUSIONS It could be assumed that lower height, moderate disability and male sex are factors significantly reducing ability of maintenance of balance of children and youth with ID.
Single‐nucleotide polymorphisms associated with pemphigus vulgaris: Potent markers for better treatment and personalized medicine

Pemphigus vulgaris (PV) is a rare autoimmune blistering disorder, which could affect both skin and mucosal surfaces. There is increasing evidence that genetics plays a critical role in PV development, severity and prognosis. Single‐nucleotide polymorphisms (SNPs) are the most common type of genetic variation among people and have been widely evaluated in most diseases. However, there are few studies regarding the roles of SNPs in the PV. Here, we reviewed both pathogenic and protective roles of the SNPs in non‐HLA genes regarding the PV. Among the large number of studied SNPs, it was found that several SNPs in different genes might control the susceptibility of PV, including TNFA (rs361525, rs1800629, rs1800629), IL10 (rs1800871, rs1800896, rs1800871, and rs1800872), IL6 (rs1800795), CTLA4 (rs231775), ICOS (rs10932029), CD86 (rs1129055), DSG3 (rs8085532, rs3911655, rs3848485, rs3794925, rs1466379), ST18 (rs2304365, rs17315309) and TAP2 (rs7454108), probably in a population‐specific manner. Moreover, SNPs in glucocorticoid receptor, also known as nuclear receptor subfamily 3 group C member 1 (NR3C1) gene, including rs11745958, rs17209237, rs33388, rs7701443 as well as rs116855232 at NUDT15, seem to be associated with therapeutic outcomes in PV patients. Additionally, variations in the other genes involved in the drugs' metabolisms, pharmacokinetics and pharmacodynamics such as rs396991 in FCGR3A gene could be used for the prediction of clinical response to drugs and side effects. Taken together, SNPs seem to be valuable tools for better management of PV patients. Further studies need to be conducted to evaluate SNPs in genes that control immune responses and apoptosis.
Association of Hyperchloremia With Unfavorable Clinical Outcomes in Adults With Diabetic Ketoacidosis

Objective: Hyperchloremia is associated with worsened outcomes in various clinical situations; however, data are limited in patients with diabetic ketoacidosis (DKA). The purpose of this study was to determine the effect of hyperchloremia on time to DKA resolution. Methods: We conducted a retrospective cohort study of adult patients admitted with incident DKA from January 2013 through October 2017 and stratified by the development of hyperchloremia versus maintaining normochloremia. The primary outcome was time to final DKA resolution. Secondary outcomes included time to initial DKA resolution, incidence of acute kidney injury (AKI) on admission, in-hospital development of AKI, and hospital length of stay (LOS). Results: Of the 102 patients included, 52 developed hyperchloremia. Patients with hyperchloremia had longer times to final DKA resolution compared to those with normochloremia (median 22.3 [interquartile range, IQR, 15.2-36.9] vs 14.2 [IQR 8.8-21.1] hours; P = .001). Time to initial DKA resolution was also longer in patients who developed hyperchloremia compared to those who did not (median 16.3 vs 10.9 hours; P = .024). More patients with hyperchloremia developed in-hospital AKI (26.9% vs 8.0%; P = .01). Median hospital LOS was significantly longer in the hyperchloremia cohort (P < .001). On Cox regression analysis, time to DKA resolution was significantly longer with each 1 mmol/L increase in serum chloride (HR 0.951; P < .001). Conclusion: The presence of hyperchloremia in patients with DKA was associated with increased time to DKA resolution, risk of in-hospital AKI, and hospital LOS. Further evaluation of the avoidance or treatment of hyperchloremia in DKA is needed.
Female college student weight perception discordance

Abstract Objectives Examine the prevalence of body weight perception discordance, and its relationship with physical activity and mental health among college women. Participants and methods Data were collected from a convenience sample of female undergraduates enrolled in general education health and wellness courses at a large, northeastern United States university (n = 1607) via direct email using previously validated measures that assessed: demographics; physical activity; weight goals and perceptions; mental health and sleep; and, physical activity enjoyment, self-efficacy, and goal setting. Analyses included one-way analysis of variance analyses and chi-square tests for independence. Results Though most women had accurate weight status perceptions (n = 987, 62.6%), there was a tendency to overestimate weight status (n = 482, 31.2%) that was associated with greater depressive symptoms. Conclusion A relatively large minority of women demonstrated discordant weight status perceptions, which were associated with adverse mental health outcomes. Colleges should consider improving healthy weight status perception education among women to improve mental health.
Characterizing injury at a tertiary referral hospital in Kenya

Introduction Injury accounts for more than 5.8 million deaths globally with an increasing burden in the developing world. In Kenya, trauma is one of the top 10 leading causes of death. However, no formal continuous injury surveillance systems are in place to inform injury prevention, pre-hospital care or emergency department management. The aim of this study was to implement a hospital-based trauma registry to characterize high acuity injuries presenting to a private tertiary, teaching and referral hospital in Kenya. Methods From January to December 2015, data was prospectively collected at a private tertiary, teaching and referral hospital in Nairobi, Kenya. Patients presenting with a traumatic injury for the first time who were admitted to the hospital for at least 48 hours were included in the study. Basic information pertaining to demographics, details of the injury, pre-hospital care and transport, hospital-based management, length of stay and disposition were collected. An injury severity score (ISS) was calculated on each patient and stratified by the mechanism of injury. Descriptive statistics and multivariate logistic regression were used to analyze data and assess risk factors associated with injury severity. Results There were 101 patients included in the study, the majority of whom were 30 to 39 years of age and male (63%). Seventy-one per cent of patients had a preexisting medical condition with hypertension (26%) and diabetes (13%) being the most common. The most common mechanism of injury was fall (46%) followed by road traffic incidents (RTI) (32%). Most injuries took place at home (43%). Most RTI were caused by cars (63%), with the driver being the most frequently injured (38%). The most common mode of arrival to the emergency department was by private car (72%). The median time between the accident and arrival at the emergency department was 1hr 10 minutes. The majority of the patients had injuries to one area (83%) with the extremities/bony pelvis (72%) being the most common. The median Injury Severity Score was 5 (range 1–34) with the majority (90%) classified as minor injuries (ISS<12). The highest severity of injury as determined by ISS was seen in gunshot wounds. Conclusions Injured patients in Kenya showed concordance with prior studies looking at injury prevalence in the developing world when looking at demographics and place of injury. However, differences were found when looking at the mechanism of injury, with falls surpassing road traffic incidents. A delayed presentation to the hospital was also noted in this patient population. Given the rate of traumatic injuries in Kenya and their contribution to morbidity, mortality and overall healthcare costs, there is a need to implement formal trauma registries in all major hospitals in Kenya to generate more data that can be used to improve injury prevention, the overall trauma system and enhance training and preparedness.