Miracle-dz/UniFAR-FTUs huggingface dataset:
Do Hospital Bed Reduction and Multiple System Reform Affect Patient Mortality?: A Trend and Multilevel Analysis in New Zealand Over the Period 1988–2001

Background:The impact of hospital and system restructuring on the quality and pattern of care is an important issue of public policy concern. Objective:To assess the effect on patterns of care and patient outcomes of a substantial reduction in public hospital bed availability and multiple reorganizations in New Zealand through the 1990s. Research Design:Trend analysis using both tabular and multilevel techniques. Subjects:Access to discharge data, amounting to 6,639,487 records, was secured for all 34 major public hospitals in New Zealand over the period 1988–2001. Outcome Measures:Number of discharges, admission rate, access levels, mean length of stay, unplanned readmission rate, and 60-day postadmission mortality rate. Results:Although the number of inpatient beds in use declined by one-third over the period and the national population grew by nearly one-fifth, discharge volumes increased significantly and rates of inpatient admission were maintained, as were access levels for vulnerable groups. These changes were accompanied by workload adjustments (a halving in length of stay and an increase by a quarter in readmission rates). Yet age-adjusted postadmission patient mortality decreased by a quarter over the period of study, a rate of decline that was slowed by the major workload adjustments but not by reform phase. Conclusions:Other things being equal, a substantial reduction in inpatient bed availability can be effected in national public hospital systems, while largely maintaining access and quality of care. However, the workload adjustments that are required may slow improvements in patient outcomes.
Transgenic Expression of IL-10 in T Cells Facilitates Development of Experimental Myasthenia Gravis1

Ab to the acetylcholine receptor (AChR) cause experimental myasthenia gravis (EMG). Th1 cytokines facilitate EMG, whereas Th2 cytokines might be protective. IL-10 inhibits Th1 responses but facilitates B cell proliferation and Ig production. We examined the role of IL-10 in EMG by using wild-type (WT) C57BL/6 mice and transgenic (TG) C57BL/6 mice that express IL-10 under control of the IL-2 promoter. We immunized the mice with doses of AChR that cause EMG in WT mice or with low doses ineffective at causing EMG in WT mice. After low-dose AChR immunization, WT mice did not develop EMG and had very little anti-AChR serum Ab, which were mainly IgG1, whereas TG mice developed EMG and had higher levels of anti-AChR serum Ab, which were mainly IgG2, in addition to IgG1. At the higher doses, TG mice developed EMG earlier and more frequently than WT mice and had more serum anti-AChR Ab. Both strains had similar relative serum concentrations of anti-AChR IgG subclasses and IgG and complement at the muscle synapses. CD8+-depleted splenocytes from all AChR-immunized mice proliferated in the presence of AChR and recognized a similar epitope repertoire. CD8+-depleted splenocytes from AChR-immunized TG mice stimulated in vitro with AChR secreted significantly more IL-10, but less of the prototypic Th1 cytokine IFN-γ, than those from WT mice. They secreted comparable amounts of IL-4 and slightly but not significantly reduced amounts of IL-2. This suggests that TG mice had reduced activation of anti-Torpedo AChR Th1 cells, but increased anti-AChR Ab synthesis, that likely resulted from IL-10-mediated stimulation of anti-AChR B cells. Thus, EMG development is not strictly dependent on Th1 cell activity.
Relationship between Parental Feeding Practices and Neural Responses to Food Cues in Adolescents

Social context, specifically within the family, influences adolescent eating behaviours and thus their health. Little is known about the specific mechanisms underlying the effects of parental feeding practices on eating. We explored relationships between parental feeding practices and adolescent eating habits and brain activity in response to viewing food images. Fifty- seven adolescents (15 with type 2 diabetes mellitus, 21 obese and 21 healthy weight controls) underwent fMRI scanning whilst viewing images of food or matched control images. Participants completed the Kids Child Feeding Questionnaire, the Childrens’ Dutch Eating Behaviour Questionnaire (DEBQ) and took part in an observed meal. Parents completed the Comprehensive Feeding Practices Questionniare and the DEBQ. We were particularly interested in brain activity in response to food cues that was modulated by different feeding and eating styles. Healthy-weight participants increased activation (compared to the other groups) to food in proportion to the level of parental restriction in visual areas of the brain such as right lateral occipital cortex (LOC), right temporal occipital cortex, left occipital fusiform gyrus, left lateral and superior LOC. Adolescents with type 2 diabetes mellitus had higher activation (compared to the other groups) with increased parental restrictive feeding in areas relating to emotional control, attention and decision-making, such as posterior cingulate, precuneus, frontal operculum and right middle frontal gyrus. Participants with type 2 diabetes mellitus also showed higher activation (compared to the other groups) in the left anterior intraparietal sulcus and angular gyrus when they also reported higher self restraint. Parental restriction did not modulate food responses in obese participants, but there was increased activity in visual (visual cortex, left LOC, left occipital fusiform gyrus) and reward related brain areas (thalamus and parietal operculum) in response to parental teaching and modelling of behaviour. Parental restrictive feeding and parental teaching and modelling affected neural responses to food cues in different ways, depending on motivations and diagnoses, illustrating a social influence on neural responses to food cues.
Imaging of cochlear implant electrode array with flat-detector CT and conventional multislice CT: comparison of image quality and radiation dose

Conclusion: Cochlear implantation assessment is possible using commercially available standard flat-detector computed tomography (FD-CT) protocols. Image quality is superior to multislice CT (MSCT). The radiation dose of FD-CT is lower in comparison with MSCT standard protocols and may therefore overcome the limitations of MSCT in the evaluation of cochlear implants. Objective: FD-CT offers higher spatial resolution than MSCT. Our objective was to compare the image quality of FD-CT to conventional MSCT in the visualization of a cochlear implant electrode array with respect to radiation exposure. Methods: An isolated temporal bone specimen was scanned using a commercially available FD-CT system and a 4 and 64 row MSCT scanner. Different scanning protocols were used. Image quality was assessed by four independent readers using a scoring system with different criteria describing delineation of the cochlea and the electrode array, image noise and spatial resolution. Radiation dose was measured using the CT dose index (CTDI) and a 16 cm acrylic phantom. Results: Image quality was rated superior for FD-CT for all criteria by all readers. Single electrode contacts were only visible in FD-CT and assessment of implant position was improved by FD-CT. The radiation dose of FD-CT was half that of MSCT standard protocols.
Diagnosis and Treatment of Osteoporosis in High-Risk Patients Prior to Hip Fracture

Purpose: Hip fractures in older adults are common and serious events. Patients who sustain fragility hip fractures are defined as having osteoporosis. Patients with dementia or a history of a prior fragility fracture are at increased risk of a future fracture. This study assesses prefracture osteoporosis diagnosis and treatment in high-risk groups. Methods: A case–control analysis of a database of all patients age ≥60 years admitted for surgical repair of nonpathological, low-impact femur fracture between May 2005 and October 2010 was performed. Results: Of 1070 patients, 511 (47.8%) had dementia and 435 (40.7%) had been diagnosed with osteoporosis prior to admission. Patients with dementia were more likely to have a diagnosis of osteoporosis prior to their fracture than those without dementia (43.8% vs 37.7%, P < .05). Twenty-five percent of the total study population had been treated with calcium and vitamin D (Cal+D) prior to admission, and 12% with other osteoporosis medications. There was a trend toward patients with dementia being more likely to have been on Cal+D prior to admission (27.6% vs 22.5%, P = .06), but no difference in treatment with other agents (10.8% vs 13.1%, P = .25). Patients with prior fragility fractures were more likely to be on Cal+D (32.3% vs 25.0%, P < .02); however, there was no difference in the use of other osteoporosis medications (12.3% vs 12%, P = .90). Conclusion: Fewer than half of patients that presented with hip fractures were diagnosed with osteoporosis prior to fracture and primary preventative treatment rates were low. Although patients with dementia are more likely to be diagnosed with osteoporosis, they were not more likely to be treated, despite having a greater risk. Additionally, those with prior fragility fractures are often not on preventative treatment. This may represent a missed opportunity for prevention and room for improvement in order to reduce osteoporotic hip fractures.
Corneal rat‐to‐mouse xenotransplantation and the effects of anti‐CD4 or anti‐CD8 treatment on cytokine and nitric oxide production

Corneal xenotransplantation may be an alternative approach to overcome shortage of allografts for clinical transplantation. Orthotopic corneal rat‐to‐mouse xenotransplantation and syngeneic transplantation was performed and the effects of anti‐CD4 and anti‐CD8 treatments on corneal xenograft survival and production of cytokines, interleukin (IL)‐2, IL‐4, IL‐10, γ‐interferon (IFN‐γ) and nitric oxide (NO) were evaluated. RT‐PCR was used to determine the expression of genes for cytokines and inducible nitric oxide synthase (iNOS) in the grafts. The presence of iNOS protein in grafts was detected by immunofluorescent staining. We found that corneal xenotransplantation was associated with a strong upregulation of genes for both Th1 and Th2 cytokines and with NO production in the graft. Treatment of xenograft recipients with mAb anti‐CD4, but not anti‐CD8, resulted in a profound inhibition of IL‐2, IL‐4 and IL‐10 production, and in a significant prolongation of corneal xenograft survival. The results show that upregulation of Th2 cytokines after corneal xenotransplantation does not correlate with xenograft rejection. Rather, corneal graft rejection is associated with the expression of genes for IFN‐γ and iNOS and with NO production.
DNA replication stress-induced loss of reproductive capacity in S. cerevisiae and its inhibition by caloric restriction

In many organisms, attenuation of growth signaling by caloric restriction or mutational inactivation of growth signaling pathways extends lifespan and protects against cancer and other age-related diseases. The focus of many efforts to understand these effects has been on the induction of oxidative stress defenses that inhibit cellular senescence and cell death. Here we show that in the model organism S. cerevisiae, growth signaling induces entry of cells in stationary phase into S phase in parallel with loss of reproductive capacity, which is enhanced by elevated concentrations of glucose. Overexpression of RNR1 encoding a ribonucleotide reductase subunit required for the synthesis of deoxynucleotide triphosphates and DNA replication suppresses the accelerated loss of reproductive capacity of cells cultured in high glucose. The reduced reproductive capacity of these cells is also suppressed by excess threonine, which buffers dNTP pools when ribonucleotide reductase activity is limiting. Caloric restriction or inactivation of the AKT homolog Sch9p inhibits senescence and death in stationary phase cells caused by the DNA replication inhibitor hydroxyurea or by inactivation of the DNA replication and repair proteins Sgs1p or Rad27p. Inhibition of DNA replication stress represents a novel mechanism by which caloric restriction promotes longevity in S. cerevisiae. A similar mechanism may promote longevity and inhibit cancer and other age-related diseases in humans.
Alcohol Mixed with Energy Drinks: Consumption Patterns and Motivations for Use in U.S. College Students

Binge drinking in college students is widespread and known to cause significant harms and health hazards for the drinker. One factor that may be exacerbating hazardous drinking in young people is the new popular trend of consuming alcohol mixed with energy drinks (AmED). However, rates of AmED use and motivations for AmED consumption in college students have not been well established. In this study, 706 undergraduate college students from a university in the United States participated in a web-based survey that queried self-reported alcohol, energy drink, and AmED use. In addition, motivations for using AmEDs were assessed. The results indicated that for all participants, 81% reported that they have tried at least one energy drink in the past and 36% reported consumption of at least one energy drink in the past 2 weeks. Alcohol consumption patterns were similar to findings from U.S. national surveys of college drinking, as 37% of respondents were classified as binge drinkers and 23% abstained from drinking. In the whole sample (including the alcohol abstainers), 44% reported trying AmED at least once and 9% reported AmED consumption at least once in the past 2 weeks. 78% of respondents agreed with the statement that AmEDs appeal to underage drinkers. When AmED users were asked about various motivations for consuming AmEDs, users reported that they consumed these beverages to get drunk and reduce sedation compared to alcohol alone. In conclusion, the consumption of AmEDs is common in U.S. college students. Motivations for using AmEDs include the reduction of the sedative effects of alcohol, an important interoceptive cue that one should stop drinking.
Prevalence of Nasal Staphylococcus aureus Carriage in the Patients Undergoing Hemodialysis and Evaluation of Risk Factors and Laboratory Parameters

Abstract Background: In this study, we aimed to determine the nasal carriage rate of Staphylococcus aureus and risk factors in hemodialysis (HD) patients. Methods: One hundred eighty-four HD patients were evaluated. A second sample was taken from the subjects, the wipe samples of whom were isolated as S. aureus. And subjects whose second samples’ results were the same were deemed as S. aureus carriers. Results: Fifty-two (28.3%) patients were identified as S. aureus carriers. In the control group, S. aureus carriage has been found out as 14.9% in 116 healthy subjects. The isolation rate of S. aureus has been found statistically significantly high in the age group of 41–61 years. But, methicillin-resistant S. aureus (MRSA) isolation ratio has been statistically high in the group over the age of 61 years. Sepsis history and gastrointestinal system disease development is closely related to bacterial isolation. MRSA isolation ratios have been found high in chronic lung disease patients, diabetic patients, patients with infection history, and patients with impaired general state of health. The carriage ratios have been found higher in the patients who are settled in urban areas, are subjected to dialysis for more than 10 years, and are hospitalized in the past year. However, the difference between the other groups is not statistically significant. Conclusions: S. aureus carriage must be screened on regular intervals in HD patients. Nasal S. aureus carriage follow-up and treatment is a process that will protect patients from more severe clinical pictures.
Identification of Amino Acid Residues in BK Virus VP1 That Are Critical for Viability and Growth

ABSTRACT BK virus (BKV) is a ubiquitous pathogen that establishes a persistent infection in the urinary tract of 80% of the human population. Like other polyomaviruses, the major capsid protein of BKV, virion protein 1 (VP1), is critical for host cell receptor recognition and for proper virion assembly. BKV uses a carbohydrate complex containing α(2,3)-linked sialic acid attached to glycoprotein and glycolipid motifs as a cellular receptor. To determine the amino acids important for BKV binding to the sialic acid portion of the complex, we generated a series of 17 point mutations in VP1 and scored them for viral growth. The first set of mutants behaved identically to wild-type virus, suggesting that these amino acids were not critical for virus propagation. Another group of VP1 mutants rendered the virus nonviable. These mutations failed to protect viral DNA from DNase I digestion, indicating a role for these domains in capsid assembly and/or packaging of DNA. A third group of VP1 mutations packaged DNA similarly to the wild type but failed to propagate. The initial burst size of these mutations was similar to that of the wild type, indicating that there is no defect in the lytic release of the mutated virions. Binding experiments revealed that a subset of the BKV mutants were unable to attach to their host cells. These motifs are likely important for sialic acid recognition. We next mapped these mutations onto a model of BKV VP1 to provide atomic insight into the role of these sites in the binding of sialic acid to VP1.
Patients' views and feelings on the community-based teaching of undergraduate medical students: a qualitative study.

BACKGROUND The 1993 directive Tomorrow's Doctors recommended an increase in community-based teaching. In response, many new programmes have been established focusing on the teaching of clinical skills to pairs or groups of students in general practice, when patients are asked to see the students in the practice or in their homes, specifically to assist with teaching. This differs from the traditional model of teaching primary care, when one student sits with the doctor while s/he consults. Although current research suggests that patients are happy for one student to be present during a consultation with their GP, little or nothing is known about their views of this new method of teaching basic clinical skills in the community. If the new community-based teaching programmes are to be sustainable, continuing support from the patients is necessary. Students have been taught clinical skills in the community at University College London Medical School for several years. Research has demonstrated its effectiveness and its popularity with students. However, to date, patients' views have not been explored. OBJECTIVE Our aim was to determine the patients' views and feelings on community-based teaching, in order to discover both the positive and negative aspects for participating patients. METHOD A qualitative semi-structured interview study was carried out in undergraduate teaching general practices in North London. RESULTS Respondents felt very positive about participating in the community-based teaching programme. There were two underlying components to this: altruism and personal gain. Within altruism, reasons included: provision of a service to the community and repaying the system. Aspects of personal gain included: improved knowledge, improved self-esteem and companionship. Patient concerns included: embarrassment, reinforcement of the sick role and concerns about student access to notes. CONCLUSIONS Patients enjoy their involvement in community-based teaching and perceive themselves as making a valuable contribution. The findings of the research will be reassuring for doctors who presently are involved and those who plan to be involved in the future. Doctors need to be aware of the possible shifts in the doctor-patient relationship when actively seeking patients' help in the teaching.
Comparison of Gene Expression Profile in Embryonic Mesencephalon and Neuronal Primary Cultures

In the mammalian central nervous system (CNS) an important contingent of dopaminergic neurons are localized in the substantia nigra and in the ventral tegmental area of the ventral midbrain. They constitute an anatomically and functionally heterogeneous group of cells involved in a variety of regulatory mechanisms, from locomotion to emotional/motivational behavior. Midbrain dopaminergic neuron (mDA) primary cultures represent a useful tool to study molecular mechanisms involved in their development and maintenance. Considerable information has been gathered on the mDA neurons development and maturation in vivo, as well as on the molecular features of mDA primary cultures. Here we investigated in detail the gene expression differences between the tissue of origin and ventral midbrain primary cultures enriched in mDA neurons, using microarray technique. We integrated the results based on different re-annotations of the microarray probes. By using knowledge-based gene network techniques and promoter sequence analysis, we also uncovered mechanisms that might regulate the expression of CNS genes involved in the definition of the identity of specific cell types in the ventral midbrain. We integrate bioinformatics and functional genomics, together with developmental neurobiology. Moreover, we propose guidelines for the computational analysis of microarray gene expression data. Our findings help to clarify some molecular aspects of the development and differentiation of DA neurons within the midbrain.
Determination of the minimal clinically important difference scores for the Cystic Fibrosis Questionnaire-Revised respiratory symptom scale in two populations of patients with cystic fibrosis and chronic Pseudomonas aeruginosa airway infection.

BACKGROUND The Cystic Fibrosis Questionnaire-Revised (CFQ-R) is a validated patient-reported outcome (PRO) containing both generic scales and scales specific to cystic fibrosis (CF). The minimal clinically important difference (MCID) score for a PRO corresponds to the smallest clinically relevant change a patient can detect. MCID scores for the CFQ-R respiratory symptom (CFQ-R-Respiratory) scale were determined using data from two 28 day, open-label, tobramycin inhalation solution (TIS) studies in patients with CF and chronic Pseudomonas aeruginosa airway infection. At study enrollment, patients in the study 1-exacerbation had symptoms indicative of pulmonary exacerbation (n = 84; < 14 years of age, 31 patients; > or = 14 years of age, 53 patients); patients in study 2-stable had stable respiratory symptoms (n = 140; < 14 years of age, 14 patients; > or = 14 years, 126 patients). METHODS The anchor-based method utilized a global rating-of-change questionnaire (GRCQ) that assessed patients' perceptions of change in their respiratory symptoms after TIS treatment. The mean change from baseline CFQ-R-Respiratory scores were mapped onto the GRCQ to estimate the MCID. The two distribution-based methods were as follows: (1) 0.5 SD of mean change in CFQ-R-Respiratory scores (baseline to end of TIS treatment); and (2) 1 SEM for baseline CFQ-R-Respiratory scores. Triangulation of these three estimates defined the MCIDs. RESULTS MCID scores were larger for patients in study 1-exacerbation (8.5 points) than for those in study 2-stable (4.0 points), likely reflecting differences in patient disease status (exacerbation/stable) between these studies. CONCLUSIONS Patient benefit from new and current CF therapies can be evaluated using changes in CFQ-R-Respiratory scores. Using the MCID provides a systematic way to interpret these changes, and facilitates the identification of CF treatments that improve both symptoms and physiologic variables, potentially leading to better treatment adherence and clinical outcomes. Trial registration (study 1-exacerbation): Australian-New Zealand Clinical Trials Registry Identifier: ACTRN 12605000602628 Trial registration (study 2-stable): ClinicalTrials.gov Identifier: NCT00104520.