Miracle-dz/UniFAR-FTUs huggingface dataset:
Identification of Socio-Demographic, Behavioral Patterns and Their Relationship with HIV Status among Female Sex Workers

The prevalence of HIV in high risk population is influenced significantly the behavioral and sociodemographic characteristics. However, considering the complexity of behavior among female sex workers, the relationship between a particular behavioral pattern and the HIV status of this “at risk” population assumes significance. Data generated in a community-based cross-sectional study earlier carried out to assess the prevalence estimates, at district level, of HIV status in eight districts of State of Andhra Pradesh, India was used to carry out factor analysis to explore the role of demographic and behavioral pattern and their relationship with the HIV status among female sex workers. Data on 3083 female sex workers in the study revealed that there existed nine patterns among demographic and behavioral characteristics, which explained 62% of the total variation through factor analysis. Further, cluster analysis was performed to identify the groups of individuals having similar characteristics. Two of those clusters had sizeable numbers having similar characteristics. FSWs belonging to cluster 2 had significantly high risk factors compared with Cluster 1. The overall prevalence of HIV was 11.4% (10.6% in cluster 1 and 15.9% in cluster 2) among high risk population. There exists a strong relationship between behavioral patterns and HIV positive.
Is Rivaroxaban Associated With Shorter Hospital Stays and Reduced Costs Versus Parenteral Bridging to Warfarin Among Patients With Pulmonary Embolism?

Objective: We sought to compare the length of stay (LOS) and total costs for patients with pulmonary embolism (PE) treated with either rivaroxaban or parenterally bridged warfarin. Methods: This retrospective claims analysis was performed in the Premier Database from November 2012 to March 2015. Adult patients were included if they had a hospital encounter for PE (an International Classification of Diseases, Ninth Revision code = 415.1×) in the primary position, a claim for ≥1 diagnostic test for PE on day 0 to 2, and initiated rivaroxaban or parenteral anticoagulation/warfarin. Rivaroxaban users (allowing ≤2 days of prior parenteral therapy) were 1:1 propensity score matched to patients receiving parenterally bridged warfarin. Length of stay, total costs, and readmission for venous thromboembolism (VTE) or major bleeding during the same or subsequent 2 months following the index event were compared between cohorts. Analysis restricted to patients with low-risk PE was also performed. Results: Characteristics of the matched PE cohorts (n = 3466 per treatment) were well balanced. Rivaroxaban use was associated with a 1.36-day shorter LOS and $2304 reduction in total costs compared to parenterally bridged warfarin (P < .001 for both). Rates of readmission for VTE were similar between cohorts (1.7% vs 1.6%; P = .64). No difference was observed between treatments for readmission for major bleeding (0.2% vs 0.2%; P > .99). In analyses restricted to low-risk patients (n = 1551 per treatment), rivaroxaban was associated with a 1.01-day and a $1855 reduction in LOS and costs, respectively (P < .001 for both). Rates of readmission were again similar between treatments (P > .56 for all). Conclusion: Rivaroxaban significantly reduced hospital LOS and costs compared to parenterally bridged warfarin, without increasing the risk of readmission.
The Antithrombotic Potential of Tinzaparin and Enoxaparin Upon Thrombin Generation Triggered In Vitro by Human Ovarian Cancer Cells IGROV1

Background: A documented relationship between ovarian cancer and thrombosis does exist. Low-molecular-weight heparins (LMWHs) are cornerstone drugs in the primary prevention and treatment of venous thromboembolic events in patients with cancer. However, cancer cells may alter the efficiency of these antithrombotic agents. Objective: We aimed to characterize the procoagulant phenotype of human epithelial ovarian adenocarcinoma cells, IGROV1, and to compare the capacity of tinzaparin and enoxaparin to inhibit thrombin generation triggered by these cells. Methods: Thrombin generation induced by different concentrations of IGROV1 cells on platelet poor plasma (PPP) was assessed by the calibrated automated thrombogram assay. Tissue factor (TF) expression was studied using Western blot analysis. Then, the experimental model of thrombin generation was used to compare the inhibitory effect of clinically relevant concentrations of both tinzaparin and enoxaparin. The inhibitory concentration 50 (IC50) of the mean rate index and the endogenous thrombin potential and the 2-fold increase in lag time were analyzed on the basis of the anti-Xa and anti-IIa activities of the LMWHs. Results: IGROV1 cells suspended into PPP resulted in a significant increase in thrombin generation in the absence of any exogenous source of TF and phospholipids. Tissue factor was expressed by IGROV1 cells. Tinzaparin was a more potent inhibitor of thrombin generation than enoxaparin. The inhibition of thrombin generation induced by IGROV1 cancer cells depended mainly on the anti-Xa activity of the LMWHs. Conclusion: This experimental study in ovarian cancer cells demonstrates that the antithrombotic activity of LMWHs is not completely predicted by the anti-Xa or anti-IIa activities measured in PPP.
Rev-erbα dynamically modulates chromatin looping to control circadian gene transcription

Chromosome dynamics and cellular clocks Many genes undergo daily or circadian changes in their rate of transcription. Kim et al. explored the mechanism by which the circadian clock is linked to chromosome dynamics (see the Perspective by Diettrich Mallet de Lima and Göndör). They used a chromosome conformation capture technique (Hi-C) to identify the interactions of adjacent DNA fragments and determine how DNA looping that altered such interactions changed over daily cycles. The repressive transcription factor Rev-erbα, which functions as part of the mammalian clock mechanism, appears to bind to chromatin and recruit a protein complex that evicts other proteins that enhance looping, thus favoring enhancer-promoter interactions. Science, this issue p. 1274; see also p. 1212 The mechanism by which cellular clocks control chromatin dynamics is explored. Mammalian physiology exhibits 24-hour cyclicity due to circadian rhythms of gene expression controlled by transcription factors that constitute molecular clocks. Core clock transcription factors bind to the genome at enhancer sequences to regulate circadian gene expression, but not all binding sites are equally functional. We found that in mice, circadian gene expression in the liver is controlled by rhythmic chromatin interactions between enhancers and promoters. Rev-erbα, a core repressive transcription factor of the clock, opposes functional loop formation between Rev-erbα–regulated enhancers and circadian target gene promoters by recruitment of the NCoR-HDAC3 co-repressor complex, histone deacetylation, and eviction of the elongation factor BRD4 and the looping factor MED1. Thus, a repressive arm of the molecular clock operates by rhythmically modulating chromatin loops to control circadian gene transcription.
Interleukin-1β Enhanced Action of Kinins on Extracellular Matrix of Spontaneous Hypertensive Rat Cardiac Fibroblasts

Interaction between an enhanced action of kinins and cytokines is accepted as important to the cardioprotective effect of angiotensin-converting-enzyme inhibitors. Kinins mediate their effects through B1 and B2 subtype receptors that may be modulated by cytokines including interleukin (IL)-1β. We examined expression of kinin receptors and the effects of bradykinin (B2 agonist) and des-Arg10-kallidin (B1 agonist) on extracellular matrix components of adult rat cardiac fibroblasts with or without prior exposure to IL-1β. We compared responses of cells cultured from spontaneously hypertensive (SHR) and normotensive Wistar-Kyoto (WKY) hearts. mRNA levels of kinin receptors, procollagens, promatrix metalloproteinases (proMMP-2 and proMMP-9), and tissue inhibitors of metalloproteinase (TIMP-1 and TIMP-2) were all assessed by a semiquantitative RT-PCR. In the absence of IL-1β, SHR cells expressed more B2 receptor, procollagen α1(I), procollagen α1(III), and proMMP-9 mRNA than WKY cells. IL-1β exposure enhanced B1, B2, proMMP-2, and proMMP-9 mRNA in cells of both strains to equivalent levels. Zymographic studies confirmed the results of proMMPs. Following IL-1β treatment, bradykinin attenuated procollagens α1(I) and α1(III) mRNA expression in SHR but not WKY cells. In contrast, des-Arg10-kallidin did not show any significant effects in either SHR or WKY cells. Our findings indicate greater extracellular matrix turnover in cultured SHR cardiac fibroblasts than WKY under basal conditions, an IL-1β stimulation of turnover in cells from both strains, and a strain-differential effect of bradykinin following cytokine treatment. These results imply a genetically determined response of cardiac extracellular matrix and the potential of direct enhancement of the efficacy of kinins by the local release of IL-1β in hearts genetically programmed to exhibit excessive remodeling to injury.
What Matters to Low-Income Patients in Ambulatory Care Facilities?

Poor, uninsured, and minority patients depend disproportionately on hospital outpatient departments (OPDs) and freestanding health centers for ambulatory care. These providers confront significant challenges, including limited resources, greater demand for services, and the need to improve quality and patient satisfaction. The authors use a survey of patients in OPDs and health centers in New York City to determine which aspects of the ambulatory care visit have the greatest influence on patients’ overall site evaluation. The personal interaction between patients and physicians, provider continuity, and the general cleanliness/appearance of the facility stand out as high priorities. Access to services and interactions with other facility staff are of significant, although lesser, importance. These findings suggest ways to restructure the delivery of care so that it is more responsive to the concerns of low-income patients.
A Comparative Analysis of Lipid Profile among Rural and Urban School Going Male Adolescents in Katsina State, Nigeria

Aim: The study is aimed at analyzing blood samples from 484 male school going adolescents; of which 263 were randomly selected from a public school in Katsina metropolis (urban setting) and 221 from a public school in Batsari (rural setting) for the levels of serum total cholesterol (TC), high density lipoprotein cholesterol (HDL - CH), low density lipoprotein cholesterol (LDL - CH) and triacyl glycerol (TG) in order to ascertain a risk of cardiovascular disease ( CVD). Study Design: A cross sectional study was conducted among male adolescents from urban and rural settings aged between 12 - 18 years attending public secondary schools in Katsina State Nigeria to assess their nutritional status.
The Effect of Care Team Composition on the Quality of HIV Care

Compared to single-clinician care, care provided by multiple clinicians might result in higher-quality care, especially if some of them have condition-specific expertise and complementary knowledge, skills, and roles. Individual physician continuity, which has been shown to be associated with care quality, necessarily decreases when care is provided by multiple clinicians. This study uses data from the HIV Cost and Services Utilization Study to assess the effect of care team composition on the quality of HIV care. In adjusted analyses, care teams composed of three or more clinicians were associated with more consistent prescribing of pneumocystis carinii pneumonia prophylaxis when medically indicated ( p < .01). Patients with multiple physicians generally reported worse care coordination, however, and had more inappropriate use of emergency services. These findings indicate both advantages and disadvantages to having multiple clinicians. More effort should be devoted to facilitating coordination when multiple clinicians provide care.
Cost Sharing and HEDIS Performance

Physicians, health plans, and health systems are increasingly evaluated and rewarded based on Health Plan Effectiveness Data and Information Set (HEDIS) and HEDIS-like performance measures. Concurrently, employers and health plans continue to try to control expenditures by increasing out-of-pocket costs for patients. The authors use fixed-effect logit models to assess how rising copayment rates for physician office visits and prescription drugs affect performance on HEDIS measures. Findings suggest that the increase in copayment rates lowers performance scores, demonstrating the connection between financial aspects of plan design and quality performance, and highlighting the potential weakness of holding plans and providers responsible for performance when payers and benefit plan managers also influence performance. Yet the effects are not consistent across all domains and, in many cases, are relatively modest in magnitude. This may reflect the HEDIS definitions and suggests that more sensitive measures may capture the impact of benefit design changes on performance.
Evaluating the Better Access Initiative: What do Consumers Have to Say?

Abstract The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative (Better Access) aims to improve outcomes for people with common mental disorders by encouraging a multidisciplinary approach to their mental health care. The current paper presents consumers' views on Better Access. A total of 936 consumers completed a structured survey or took part in an interview about their experiences with Better Access. Participants appreciated the fact that Better Access made psychological care affordable. They accessed services because they had clear mental health symptoms, often exacerbated by stressful life events. Most were impressed by the quality of care available through Better Access, and found that the number of available sessions was sufficient to meet their needs. Most importantly, the vast majority experienced significant reductions in symptoms and improvements in coping abilities, and they attributed these changes to the care they received through Better Access. Consumers are the most important stakeholders in any debate about mental health care delivery. However, until now they have not been well-represented in discussions about Better Access. Our study gave them the opportunity to air their views, and their first-hand impressions of the initiative were generally very positive.
The Relationship Between Super Users' Attitudes and Employee Experiences With Clinical Information Systems

The purpose of this study is to examine the manner in which Super User attitudes toward clinical information systems (CIS) are associated with employee experiences with CIS implementation. Super Users (N = 82), selected by hospital administration to assist in implementation of the new CIS, completed a survey that assessed time spent in the Super User role as well as attitudes toward the role. These data were matched with hospital employee (N = 325) survey data about attitudes toward CIS and its impact on work processes. Time spent in the role of Super User was associated with employee attitudes; Super Users' perceptions about qualifications also predicted employee attitudes, particularly about care outcomes and perceptions about implementation of the CIS. The study suggests that as organizations encourage more time in the Super User role and develop more positive attitudes about this role, the possibility of positive employee attitudes toward CIS increases.
Review: Use of Electronic Medical Records for Health Outcomes Research

This review assessed the use of electronic medical record (EMR) systems in outcomes research. We systematically searched PubMed to identify articles published from January 2000 to January 2007 involving EMR use for outpatient-based outcomes research in the United States. EMR-based outcomes research studies (n = 126) have increased sixfold since 2000. Although chronic conditions were most common, EMRs were also used to study less common diseases, highlighting the EMRs’ flexibility to examine large cohorts as well as identify patients with rare diseases. Traditional multi-variate modeling techniques were the most commonly used technique to address confounding and potential selection bias. Data validation was a component in a quarter of studies, and many evaluated the EMR’s ability to achieve similar results previously achieved using other data sources. Investigators using EMR data should aim for consistent terminology, focus on adequately describing their methods, and consider appropriate statistical methods to control for confounding and treatment-selection bias.
Changes in Nursing Home Staffing Levels, 1997 to 2007

A positive relationship has been demonstrated between the quality of care delivered in nursing homes and the quality of nursing staff providing the care. The general perception, however, is that there is a decline in registered nurses’ staff hours in nursing homes. The primary objective of this study is to investigate whether the levels of registered nurses (RNs), licensed practical nurses (LPNs), and nursing assistants (NAs) as well as skill mix has changed in nursing homes between the years 1997 and 2007. A descriptive research design was employed on data derived from Online Survey Certification and Reporting System database. After accounting for facility size and ownership, it was found that more nursing homes have increased—rather than decreased—LPN and NA hours per resident day between 1997 and 2007. On the other hand, more nursing homes have decreased—rather than increased—RN hours per resident day and skill mix during the same time period.
Review: Engaging Patients as Vigilant Partners in Safety

Several initiatives promote patient involvement in error prevention, but little is known about its feasibility and effectiveness. A systematic review was conducted on the evidence of patients’ attitudes toward engagement in error prevention and the effectiveness of efforts to increase patient participation. Database searches yielded 3,840 candidate articles, of which 21 studies fulfilled the inclusion criteria. Patients share a positive attitude about engaging in their safety at a general level, but their intentions and actual behaviors vary considerably. Studies applied theories of planned behavior and indicate that self-efficacy, preventability of incidents, and effectiveness of actions seem to be central to patients’ intention to engage in error prevention. Rigorous evaluations of major educational campaigns are lacking. Interventions embedded within clinical settings have been effective to some extent. Evidence suggests that involvement in safety may be successful if interventions promote complex behavioral change and are sensitively implemented in health care settings.
Provider Attitudes Associated With Adherence to Evidence-Based Clinical Guidelines in a Managed Care Setting

In a cross-sectional observational study of Rochester (New York) primary care physicians (PCPs) enrolled in a pay-for-performance (P4P) collaboration, the authors investigated attitudinal factors associated with provider adherence to evidence-based clinical guidelines targeted by explicit incentives. The multivariable adherence model linked guideline adherence rates to provider attitudes among 186 survey respondents, adjusting for individual, practice, and community characteristics. Adherence was defined as the percentage of expected services that were delivered. Attitudes associated with adherence, independent of specialty and prior behavior, were financial salience (adjusted odds ratio [OR] = 3.6; 95% confidence interval [CI] = 1.7-8.4), peer cooperation (OR = 2.0; 95% CI = 1.0-4.0), control (OR = 0.5; 95% CI = 0.3-1.0), and autonomy regarding the health plan (OR = 0.3; 95% CI = 0.1-0.6). The most adherent providers perceived P4P as financially salient and felt supported by peers. Some PCPs might have perceived P4P and external interventions as challenging their autonomy and “crowding out” their intrinsic motivation, leading them to reduce efforts aimed at guideline adherence.
The Blocking Effect of Epidural Analgesia on the Adrenocortical and Hyperglycemic Responses to Surgery

The adrenocortical and hyperglycemic responses to hysterectomy were studied in five groups of patients receiving: general anesthesia (group I), general anesthesia + epidural analgesia extending from Th10‐S4–5 (group II), general anesthesia + epidural analgesia extending from Th8‐S4–5 (group III), general anesthesia + epidural analgesia extending from Th4–6‐S5 (group IV) and epidural analgesia extending from Th4‐S5 without general anesthesia (group V).
Third-molar mineralization and eruption correlated to chronologic age in Turkish children and adolescents

The number of criminal cases involving Turkish juveniles has increased in recent years. To date, there is no method for chronological age estimation according to third-molar mineralization in Western Turkish children and adolescents. The aim of this study was to investigate the mandibular third molar development according to the eight stages (A–H) of the Demirjian method and to compare third-molar development according to gender and age with previous data. The digital orthopantomograms of 1120 white Turkish children (406 boys, mean age 15.17 ± 3.80 years, and 714 girls, mean age 16.83 ± 3.59 years) aged 7 to 22 years, from the Western Anatolia region were retrospectively reviewed. The Turkish population reached stage H at a mean age of 20 years in both genders. Dental mineralization in Western Turkish children was delayed at stages D–G but advanced at stage H compared with that in Turkish children in other regions. Third molar root development can reliably estimate the mean age and age range for a juvenile of unknown chronological age, especially compared with the standard deviation obtained using other techniques for calculating the skeletal age of the hand-wrist or long bones.
A child‐to‐child approach to promoting healthier snacking in primary school children: a randomised trial in Northern Ireland

Aims to assess the effectiveness of a child‐to‐child approach to promote healthier snacking in primary school children. A total of 55 schools in North and West Belfast were matched for socio‐economic status (SES). Ten schools were randomly selected and allocated into intervention and control groups. A total of 482 children took part. Older intervention children were given the “snacks facts” programme and became “teachers” in the child‐to‐child intervention. All children had baseline and final assessments made of their dental health knowledge (older children only), snacking knowledge and behaviours using questionnaires and rubbish bags. Older intervention children had greater increases in their mean knowledge scores compared with control children. Older intervention children had greater decreases in mean cariogenic snacking scores compared with control children. Younger children attending higher SES schools had significant decrease in mean cariogenic snacking score compared with children attending lower SES schools. Concludes that the child‐to‐child approach provided an avenue by which children improved their dental health knowledge and modified their snacking habits during break‐time at school.