Miracle-dz/UniFAR-FTUs huggingface dataset:
Effects of clinical decision support and pharmacist prescribing authority on a therapeutic interchange program

Purpose. Results of an evaluation of therapeutic interchange (TI) program outcomes with use of prescriber alerts alone or in combination with pharmacist prescribing are reported. Methods. A retrospective single‐center study was conducted to compare TI outcomes before incorporation of prescriber alerts encouraging formulary agent use into the electronic medical record (period 1), after alert implementation (period 2), and after implementation and expansion of TI protocols including pharmacist prescribing authority (period 3). The evaluation focused on TI orders for 3 drug classes: angiotensin‐converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors (HMG‐CoA RIs). The primary outcome was formulary medication utilization. Results. In total, 2,881, 2,700, and 3,088 prescriptions for medications in the ACEI, ARB, or HMG‐CoA RI class were ordered during periods 1, 2, and 3, respectively. Overall formulary adherence improved from 78.3% in period 1 to 97.6% in period 2 and 99.2% in period 3 (p < 0.001 for both comparisons with period 1). The percentages of inappropriate dosing conversions were 51.6%, 37.2%, and 2.4% in periods 1, 2, and 3, respectively; the corresponding percentages of inappropriate discharge medications were 64.5%, 16.3%, and 2.4%. Conclusion. Percentages of formulary medications in 3 medication classes, considered separately and together, increased with the implementation of TI alerts for prescribers and the addition of TI‐related pharmacist prescribing authority. Over the same study periods, percentages of inappropriate dosing conversions and inappropriate discharge medications decreased.
Identifying Moral Distress Within Student Affairs Administration in Higher Education: Its Sources and Lived Experiences Among Student Conduct Administrators

The purpose of this mixed-methods study was to discover to what extent student affairs professionals in higher education identify moral distress and associated factors in their roles as college or university student conduct administrators and to identify the sources of this distress according to the lived experiences of these professionals. The application of moral distress from the field of nursing and bioethics was utilized as the framework for exploring this research problem. Through a descriptive cross-sectional survey design that utilized convenience sampling among student conduct administrators in the United States, this study incorporated the previously tested Moral Distress Thermometer. The data were analyzed according to the following three aims: (a) to quantify the extent of moral distress among student conduct administrators; (b) to qualitatively report lived-experience sources of moral distress among the participants; and, (c) to qualitatively describe constraining factors that inhibit ethical action among the participants. The mean moral distress rating reported on the Moral Distress Thermometer was 4.39 (n = 291), which was associated with the verbal anchor of “uncomfortable. ” Sources of moral distress for student conduct administrators included: (a) lack of agency or control; (b) compromised student learning; (c) behavior of colleagues; (d) public perceptions, pressures, and politics; and, (e) resource limitations. Internal constraints preventing student conduct administrators from enacting moral action
Ineffective insurance in lower and middle income countries is an obstacle to universal health coverage

Background Recent health policy efforts have sought to promote universal health coverage (UHC) as a means of providing affordable access to health services to populations. However, insurance schemes are heterogeneous, and some schemes may not provide necessary services to those covered. We explored the prevalence and determinants of ineffective insurance across 42 lower and middle income countries (LMICs) from the 2002-2004 World Health Survey. Methods Respondents were defined as having ineffective health insurance if they reported being insured and: were forced to borrow or sell personal items to pay for health services; had an untreated chronic condition; or had recently delivered a child outside of a skilled health facility (women only). Results Among the insured, 13% had ineffective insurance, which was most commonly due to having to borrow or sell to pay for health care. The likelihood of ineffective insurance was lowest in upper-middle income countries and higher in other lower-middle and low-income countries. Ineffective insurance also decreased with family wealth and was higher among rural residents. Conclusions Our findings suggest that a high proportion of insurance in LMICs is ineffective, particularly among those who need it most, and that attention should be paid to effectiveness when defining health insurance in policy conversations about UHC.
Three Auxin Response Factors Promote Hypocotyl Elongation1,2[OPEN]

Three Auxin Response Factors control hypocotyl elongation in Arabidopsis under environmental conditions that require rapid growth. The hormone auxin regulates growth largely by affecting gene expression. By studying Arabidopsis (Arabidopsis thaliana) mutants deficient in AUXIN RESPONSE FACTORS (ARFs), we have identified three ARF proteins that are required for auxin-responsive hypocotyl elongation. Plants deficient in these factors have reduced responses to environmental conditions that increase auxin levels, including far-red-enriched light and high temperature. Despite having decreased auxin responses, the ARF-deficient plants responded to brassinosteroid and gibberellin, indicating that different hormones can act partially independently. Aux/IAA proteins, encoded by IAA genes, interact with ARF proteins to repress auxin response. Silencing expression of multiple IAA genes increased hypocotyl elongation, suggesting that Aux/IAA proteins modulate ARF activity in hypocotyls in a potential negative feedback loop.
Expression of immunohistochemical markers in non-oropharyngeal head and neck squamous cell carcinoma in Ghana

Background Head and neck cancers include carcinomas of the oral cavity, larynx, sinonasal tract and nasopharynx. Studies on molecular expression of prognostic tumour markers in Ghana are scarce. The purpose of this study was to determine the expression of p53, p16, EGFR, Cyclin-D1 and HER2 among patients with non-oropharyngeal head and neck squamous cell carcinoma (HNSCC). Methodology Tissue microarrays from 154 histologically confirmed non-oropharyngeal HNSCC at the Komfo Anokye Teaching Hospital from 2006–2014 were constructed using duplicate cores of representative and viable areas from tumours. Expression of EGFR, p53, p16, Cyclin-D1 and HER2 was evaluated using immunohistochemistry. Results For non-oropharyngeal HNSCC, majority of the cases (66.2%; 102/154) had stage IV disease. EGFR was the most expressed molecular marker (29.4%; 25/85) followed by p53 (24.0%; 29/121), p16 (18.3%; 23/126) and Cyclin-D1 (10.0%; 12/120). HER2 was not expressed in any of the cases. There was a significantly (p = 0.022) higher expression of Cyclin-D1 in tumours of the oral cavity (19.6%; 9/46) than in those of the larynx (4.7%; 2/43) and nose (3.2%; 1/31). Tumours in stages I–III were more frequently positive for p16 (28.6%; 12/42) than tumours in stage IV (13.1%; 11/84). Conclusion Expression of p53, EGFR, p16 and Cyclin-D1 in non-oropharyngeal HNSCC in Ghana is largely similar to what has been reported in published studies from other countries.
Association of menopause and type 2 diabetes mellitus

Objective: Limited information is available on the direct effect of menopause and risk of type 2 diabetes mellitus (T2DM) among women with different metabolic types. We aimed to investigate whether menopause is a direct risk factor for T2DM. Methods: In this population-based cross-sectional study, women were recruited from a rural area of China from July to August 2013 and July to August 2014. Multivariate logistic regression analysis yielded adjusted odds ratios (ORs) and 95% CIs. Mediation analysis was performed to examine the contribution of age to menopause status-related T2DM. Results: We included 8,191 women (median age 56, interquartile range 47-65). The prevalence of T2DM was 13.22%. Risk of T2DM was increased with postmenopause versus premenopause status after adjustment (adjusted OR [aOR] = 1.90, 95% CI = 1.51-2.37), with the strongest association between postmenopause status and T2DM among women with body mass index (BMI) <24.0 kg/m2 (aOR, 3.25; 95% CI, 1.98-5.32). Risk of T2DM was increased with postmenopause status interacting with BMI, hypertension, triglycerides level, and waist circumference. On mediation analysis, age partially mediated the menopause status–T2DM association (indirect effect: OR = 1.27, 95% CI = 1.13-1.46; direct effect: OR = 1.88, 95% CI = 1.49-2.36). Conclusions: The prevalence of T2DM is high among women, and postmenopause status might be a stable and significant risk factor for T2DM; especially, postmenopausal women with normal weight should not be ignored in addressing the risk.
Modeling random crawling, membrane deformation and intracellular polarity of motile amoeboid cells

Amoeboid movement is one of the most widespread forms of cell motility that plays a key role in numerous biological contexts. While many aspects of this process are well investigated, the large cell-to-cell variability in the motile characteristics of an otherwise uniform population remains an open question that was largely ignored by previous models. In this article, we present a mathematical model of amoeboid motility that combines noisy bistable kinetics with a dynamic phase field for the cell shape. To capture cell-to-cell variability, we introduce a single parameter for tuning the balance between polarity formation and intracellular noise. We compare numerical simulations of our model to experiments with the social amoeba Dictyostelium discoideum. Despite the simple structure of our model, we found close agreement with the experimental results for the center-of-mass motion as well as for the evolution of the cell shape and the overall intracellular patterns. We thus conjecture that the building blocks of our model capture essential features of amoeboid motility and may serve as a starting point for more detailed descriptions of cell motion in chemical gradients and confined environments.
The Double Burdens of Mental Health Among AIDS Patients With Fully Successful Immune Restoration: A Cross-Sectional Study of Anxiety and Depression in China

Background: Anxiety and depression continue to be significant comorbidities for people with HIV infection. We investigated the prevalence of and factors associated with anxiety and depression among adult HIV-infected patients across China. Methods: In this cross-sectional study, we described clinical and psychosocial variables related to depression and anxiety in 4103 HIV-infected persons. Doctors assessed anxiety and depression by asking patients whether they had experienced anxiety or depression in the prior month. Patients also self-administered the Hospital Anxiety and Depression (HAD) scale; those with score ≥8 on HAD-A/D were considered to be at high risk of anxiety or depression. Results: Associations between socio-demographic, psychosocial, and ART-related clinical factors and risk of depression or anxiety were investigated using multivariable logistic regression. Among patients assessed between 9/2014 and 11/2015, 27.4% had symptoms of anxiety, 32.9% had symptoms of depression, and 19.0% had both. Recentness of HIV diagnoses (P = 0.046) was associated with elevated odds of anxiety. Older age (P = 0.004), higher educational attainment (P < 0.001), employment (P = 0.001), support from family / friends (P < 0.001), and sleep disturbance (P < 0.001), and number of ART regimen switches (P = 0.046) were associated with risk of depression, while neither sex nor transmission route showed any associations. There were no significant associations with HIV-specific clinical factors including current CD4+ T cell count and current viral load. Conclusions: Prevalence of symptoms of anxiety and depression is high in this cohort of treatment-experienced HIV patients. Psychological and social-demographic factors, rather than HIV disease status, were associated with risk of depression and anxiety. This finding highlights the need to deliver interventions to address the mental health issues affecting HIV-infected persons with fully successful immune restoration across China.
An intrinsic S/G2 checkpoint enforced by ATR

An additional cell cycle checkpoint Cell division is controlled by checkpoints that regulate the temporal order of the cell cycle phases, including the G1/S, G2/M, and metaphase/anaphase transitions. Yet there are no known control mechanisms for a fourth fundamental transition—the S/G2 transition. Saldivar et al. report a switchlike control mechanism that regulates the S/G2 transition. The checkpoint kinase ATR senses ongoing DNA replication in S phase and represses the mitotic transcriptional network, ensuring that DNA replication in S phase is completed before mitosis. Science, this issue p. 806 ATR represses FOXM1-dependent expression of a mitotic gene network until the S/G2 transition, ensuring completion of DNA replication. The cell cycle is strictly ordered to ensure faithful genome duplication and chromosome segregation. Control mechanisms establish this order by dictating when a cell transitions from one phase to the next. Much is known about the control of the G1/S, G2/M, and metaphase/anaphase transitions, but thus far, no control mechanism has been identified for the S/G2 transition. Here we show that cells transactivate the mitotic gene network as they exit the S phase through a CDK1 (cyclin-dependent kinase 1)–directed FOXM1 phosphorylation switch. During normal DNA replication, the checkpoint kinase ATR (ataxia-telangiectasia and Rad3-related) is activated by ETAA1 to block this switch until the S phase ends. ATR inhibition prematurely activates FOXM1, deregulating the S/G2 transition and leading to early mitosis, underreplicated DNA, and DNA damage. Thus, ATR couples DNA replication with mitosis and preserves genome integrity by enforcing an S/G2 checkpoint.
Feelings of insecurity regarding organized crime in Tamaulipas, Mexico.

OBJECTIVE To understand the meanings, feelings and practices associated with insecurity in a context with the presence of organized crime. MATERIALS AND METHODS The study was conducted in a municipality of Tamaulipas, México, with high levels of violence. Semi-structured interviews were conducted with a purposive sample of thirty indirect victims. Interview transcriptions underwent computer-assisted qualitative analysis using the MAXQDA program. RESULTS Threatening situations and perceived causes of insecurity in the local context were identified. Various psychosocial consequences of insecurity and coping strategies are also described. CONCLUSIONS Although the strategies used attempt to reduce the impact of insecurity on mental health, a transformation of mobility in public space and social relations is observed. Citizens handle insecurity at the individual level, even when it is attributed to structural causes.
How online media synergy influences consumers' purchase intention: A perspective from broadcast and interactive media

Purpose The purpose of this paper is to examine the synergistic effects of online multimedia by categorizing it into online broadcast media (OBM) and online interactive media (OIM). Design/methodology/approach The authors used an online experiment method to manipulate the online message stimuli level (online media synergy and online single media repetition). Findings The results revealed that participants exposed to message stimuli of online media synergy reported greater source credibility, cognitive responses (brand credibility and positive thoughts about the brand), attitude toward the brand and purchase intention. In online multimedia, source credibility influences attitude toward the brand through brand credibility and positive thoughts about the brand; in online single media repetition, source credibility influences attitude toward the brand through only brand credibility. Research limitations/implications In addition, the relationship between online media synergy and marketing outcomes might be moderated by consumers’ goals and thought patterns, and future research could further explore the moderating effects of these variables. Practical implications This study contributes to media synergy research, assists marketing planners in their understanding of the importance of online media synergy and serves as a reference for marketing planners considering an integrated online marketing plan. Originality/value The current study investigated how the synergy of OBM and OIM influences message persuasiveness for consumers (cognitive responses, attitude toward the brand and purchase intention).
NSAID induced gastrointestinal damage and designing GI-sparing NSAIDs

ABSTRACT NSAIDs are widely used to treat pain and rheumatic conditions, but they induce adverse events in different body systems, although the major, most frequent events occur in the upper and lower gastrointestinal (GI) tracts. Areas covered: This review is focused on damage caused by NSAIDs in the upper and lower GI tracts, the different mechanisms of damage and the GI-sparing NSAIDs designed to minimize adverse events based on understanding of these mechanisms. Expert commentary: Among the new NSAIDs, COX-2 selective inhibitors have been extensively investigated, and some were approved for human use. Celecoxib demonstrated its safety for the entire GI tract, compared to traditional NSAIDs. However, coxibs, like traditional NSAIDs, are toxic to the cardiovascular (CV) system. Other GI-sparing agents include nitric oxide-NSAIDs and phosphatidylcholine-associated NSAIDs. Testing in animal models and humans they showed GI advantages over the parent NSAID compounds, but none obtained regulatory approval or were further investigated. Hydrogen sulfide-releasing NSAIDs are currently under clinical development, and more data are needed before clinical use. Alternative therapies, such as modulating gut microbiota, are being explored. Currently, clinicians must continue prescribing traditional NSAIDs or coxibs, associated with/without proton pump inhibitor therapy, based on the presence of GI/CV risk factors.
INJURY IDENTIFICATION: THE EFFICACY OF THE FUNCTIONAL MOVEMENT SCREEN™ IN FEMALE AND MALE RUGBY UNION PLAYERS.

Background Rugby union is a collision sport which is associated with a high injury rate and therefore the development of effective injury prevention strategies is required. Purpose This study aimed to determine whether the Functional Movement Screen™ (FMS™) components can predict injury in female and male rugby union players and whether differences exist in the FMS™ scores of injured and non-injured players. Study Design Prospective cohort study. Methods Sixty-four female university rugby union players (age: 20.39 ± 1.91 years) and 55 male university rugby union players (age: 21.05 ± 1.35 years) completed the FMS™ which assesses seven functional movements on a scale of 0 to 3 and provides a total or composite score out of 21. Players were subsequently monitored for injury during the season and injury rates calculated. Results The training injury rates for females were 5.80 injuries/1000 hours and males 5.34 injuries/1000 hours while the match injury rates for females was 55.56 injuries/1000 hours and males 46.30 injuries/1000 hours. FMS™ composite score demonstrated a significant difference between injured females and non-injured males (p = 0.01) and a combined sample comparison of injured and non-injured subjects was significant (p = 0.01). FMS™ composite score was not a good predictor of injury however as FMS™ individual components predicted 37.4% of the variance in total days injured in females. ROC curve analysis revealed an injury cut off score of 11.5 for females and males and provided a sensitivity and specificity of 0.90 and 0.86 and 0.88 and 1.00 respectively. The combined sample FMS™ composite score of 'multiple injuries' participants demonstrated no significant difference between non-injured (p = 0.31) and single injury subjects (p = 0.76). Conclusion Injury rates between female rugby and male rugby were similar with match injury rates higher in females. The FMS™ can be used to identify those players with the potential to develop injury and the FMS™ injury cut off point was 11.5 for both female rugby and male rugby players. Individual components of the FMS™ are a better predictor of injury than FMS™ composite score. Levels of Evidence 2b.
Association Between Hospital Volume and Mortality in Status Epilepticus: A National Cohort Study

Objectives: In various medical and surgical conditions, research has found that centers with higher patient volumes have better outcomes. This relationship has not previously been explored for status epilepticus. This study sought to examine whether centers that see higher volumes of patients with status epilepticus have lower in-hospital mortality than low-volume centers. Design: Cohort study, using 2010–2015 data from the nationwide Case Mix Programme database of the U.K.’s Intensive Care National Audit and Research Centre. Setting: Greater than 90% of ICUs in United Kingdom, Wales, and Northern Ireland. Patients: Twenty-thousand nine-hundred twenty-two adult critical care admissions with a primary or secondary diagnosis of status epilepticus or prolonged seizure. Interventions: Annual hospital status epilepticus admission volume. Measurements and Main Results: We used multiple logistic regression to evaluate the association between hospital annual status epilepticus admission volume and in-hospital mortality. Hospital volume was modeled as a nonlinear variable using restricted cubic splines, and generalized estimating equations with robust SEs were used to account for clustering by institution. There were 2,462 in-hospital deaths (11.8%). There was no significant association between treatment volume and in-hospital mortality for status epilepticus (p = 0.54). This conclusion was unchanged across a number of subgroup and sensitivity analyses, although we lacked data on seizure duration and medication use. Secondary analyses suggest that many high-risk patients were already transferred from low- to high-volume centers. Conclusions: We find no evidence that higher volume centers are associated with lower mortality in status epilepticus overall. It is likely that national guidelines and local pathways in the United Kingdom allow efficient patient transfer from smaller centers like district general hospitals to provide satisfactory patient care in status epilepticus. Future research using more granular data should explore this association for the subgroup of patients with refractory and superrefractory status epilepticus.