Miracle-dz/UniFAR-FTUs huggingface dataset:
Development of a measure of the patient–provider relationship in antenatal care and its importance in PMTCT

The prevention of mother-to-child HIV transmission (PMTCT) is a complex challenge in heavily affected and resource-limited settings such as South Africa. Management of PMTCT requires a cascade of interventions that need to be addressed to effectively decrease the risk of HIV transmission to infants. This PMTCT cascade includes incremental components that can be shaped and influenced by the patient–provider relationship. The relationship that a pregnant woman has with her care providers may possibly affect decisions that she makes concerning her antenatal care and may, in turn, influence the quality of the care provided. A patient–provider relationship scale (PPRS) was developed in Pretoria, South Africa with two aims: first, to quantify the patient–provider relationship in an antenatal population in a resource-limited setting and provide preliminary evidence of its reliability and validity; and second, to determine whether the patient–provider relationship has an effect on PMTCT. The instrument was administrated in a cross-sectional pilot study to a group of women at discharge after delivery (n=192) at two major hospitals in South West Tshwane. Statistical analysis of the instrument showed high reliability (α=0.91) and preliminary evidence of its validity including significant associations with participants' attitudes regarding the functioning of the clinics and a single statement (the clinic staff “know me as a person,” R=0.47, p<0.001) that has been shown previously to have a significant association with adherence to antiretroviral treatment. For HIV-positive participants, the PPRS was significantly associated with statements related to important components of the PMTCT cascade. In addition, those with substantially inadequate antenatal care (≤2 visits) and those who did not initiate highly active antiretroviral therapy, although eligible, had significantly poorer PPRS scores. The PPRS is a potentially useful, context-appropriate instrument that could have an important role in future research focused on improving PMTCT and decreasing the risk of HIV infection in children.
Visualization of gene expression in the live subject using the Na/I symporter as a reporter gene: applications in biotherapy

Biotherapies involve the utilization of antibodies, genetically modified viruses, bacteria or cells for therapeutic purposes. Molecular imaging has the potential to provide unique information that will guarantee their biosafety in humans and provide a rationale for the future development of new generations of reagents. In this context, non‐invasive imaging of gene expression is an attractive prospect, allowing precise, spacio‐temporal measurements of gene expression in longitudinal studies involving gene transfer vectors. With the emergence of cell therapies in regenerative medicine, it is also possible to track cells injected into subjects. In this context, the Na/I symporter (NIS) has been used in preclinical studies. Associated with a relevant radiotracer (123I‐, 124I‐, 99mTcO4‐), NIS can be used to monitor gene transfer and the spread of selectively replicative viruses in tumours as well as in cells with a therapeutic potential. In addition to its imaging potential, NIS can be used as a therapeutic transgene through its ability to concentrate therapeutic doses of radionuclides in target cells. This dual property has applications in cancer treatment and could also be used to eradicate cells with therapeutic potential in the case of adverse events. Through experience acquired in preclinical studies, we can expect that non‐invasive molecular imaging using NIS as a transgene will be pivotal for monitoring in vivo the exact distribution and pharmacodynamics of gene expression in a precise and quantitative way. This review highlights the applications of NIS in biotherapy, with a particular emphasis on image‐guided radiotherapy, monitoring of gene and vector biodistribution and trafficking of stem cells.
Role of channel activation in cognitive enhancement mediated by α7 nicotinic acetylcholine receptors

Background and purpose: Several agonists of the α7 nicotinic acetylcholine receptor (nAChR) have been developed for treatment of cognitive deficits. However, agonist efficacy in vivo is difficult to reconcile with rapid α7 nAChR desensitization in vitro; and furthermore, the correlation between in vitro receptor efficacy and in vivo behavioural efficacy is not well delineated. The possibility that agonists of this receptor actually function in vivo as inhibitors via desensitization has not been finally resolved.
A randomized control trial of personalized cognitive counseling to reduce sexual risk among HIV-infected men who have sex with men

Abstract The increased life expectancy and well-being of HIV-infected persons presents the need for effective prevention methods in this population. Personalized cognitive counseling (PCC) has been shown to reduce unprotected anal intercourse (UAI) with a partner of unknown or different serostatus among HIV-uninfected men who have sex with men (MSM). We adapted PCC for use among HIV-infected MSM and tested its efficacy against standard risk-reduction counseling in a randomized clinical trial in San Francisco. Between November 2006 and April 2010, a total of 374 HIV-infected MSM who reported UAI with two or more men of negative or unknown HIV serostatus in the previous 6 months were randomized to two sessions of PCC or standard counseling 6 months apart. The primary outcome was the number of episodes of UAI with a non-primary male partner of different or unknown serostatus in the past 90 days, measured at baseline, 6, and 12 months. Surveys assessed participant satisfaction with the counseling. The mean number of episodes of UAI at baseline did not differ between PCC and control groups (2.97 and 3.14, respectively; p=0.82). The mean number of UAI episodes declined in both groups at 6 months, declined further in the PCC group at 12 months, while increasing to baseline levels among controls; these differences were not statistically significant. Episode mean ratios were 0.76 (95% confidence interval [CI] 0.25–2.19, p=0.71) at 6 months and 0.48 (95% CI 0.12–1.84, p=0.34) at 12 months. Participants in both groups reported a high degree of satisfaction with the counseling. The findings from this randomized trial do not support the efficacy of a two-session PCC intervention at reducing UAI among HIV-infected MSM and indicate the continued need to identify and implement effective prevention methods in this population.
Delayed initiation of antiretroviral therapy among HIV-discordant couples in Kenya

Abstract Timely initiation of antiretroviral therapy (ART) is particularly important for HIV-discordant couples because viral suppression greatly reduces the risk of transmission to the uninfected partner. To identify issues and concerns related to ART initiation among HIV-discordant couples, we recruited a subset of discordant couples participating in a longitudinal study in Nairobi to participate in in-depth interviews and focus group discussions about ART. Our results suggest that partners in HIV-discordant relationships discuss starting ART, yet most are not aware that ART can decrease the risk of HIV transmission. In addition, their concerns about ART initiation include side effects, sustaining an appropriate level of drug treatment, HIV/AIDS-related stigma, medical/biological issues, psychological barriers, misconceptions about the medications, the inconvenience of being on therapy, and lack of social support. Understanding and addressing these barriers to ART initiation among discordant couples is critical to advancing the HIV “treatment as prevention” agenda.
Frequency, patterns, and preferences of lubricant use during anal intercourse within male sexual partnerships in Lima, Peru: Implications for a rectal microbicide HIV prevention intervention

Abstract Understanding current practices of lubricant use during anal intercourse can help to assess the contexts for the introduction of topical rectal microbicides as an HIV prevention tool for men who have sex with men (MSM). We used quantitative and qualitative methods to assess: current patterns of lubricant use; preferred characteristics of commercial lubricant formulations; and social and behavioral contexts of lubricant use within male sexual partnerships in Lima, Peru. Between 2007 and 2008, we conducted a quantitative behavioral survey with 547 MSM followed by qualitative individual and group interviews with 36 MSM from Lima, Peru. Approximately half of all participants in the quantitative survey (50.3%) reported using commercial lubricant during intercourse occasionally or consistently during the preceding two months, with lack of availability at the time of intercourse the most commonly reported reason for non-use. No clear preferences regarding the color, smell, taste, or viscosity of commercial lubricants were identified, and all participants who reported using a commercial lubricant used the same product (“Love-Lub”). In the qualitative analysis, participants characterized lubricant use as a sexual practice consistently controlled by the receptive partner, who typically obtained and applied lubricant independently, with or without the consent of the insertive partner. Quantitative findings supported this differential pattern of lubricant use, with men who reported sexual identities or roles consistent with receptive anal intercourse, including unprotected receptive intercourse, more likely to report lubricant use than MSM who claimed an exclusively insertive sexual role. Given the social, behavioral, and biological factors contributing to increased vulnerability for HIV and STI acquisition by the receptive partner in anal intercourse, delivery of a topical rectal microbicide as a lubricant formulation could provide an important HIV prevention resource for at-risk MSM in Lima, Peru.
Condom use among female sex workers in Uganda

Consistent condom use can prevent HIV infection, yet levels of condom use are low in many settings. This paper examines determinants of inconsistent condom use among 905 women enrolled in a high-risk cohort in Kampala, Uganda, who reported sexual intercourse with paying clients in the last month. Among these, 40% participants reported using condoms inconsistently with paying clients in the past month. The most common reason for inconsistent condom use was client preference. Factors independently associated with inconsistent condom use included: sex work not being the sole source of income [adjusted odds ratio (aOR) = 1.54; 95% confidence interval (CI): 1.13–2.09], sexual debut before 14 years (aOR = 1.46; 95% CI: 1.09–1.96), daily consumption of alcohol (aOR = 1.90; 95% CI: 1.26–2.88) and being currently pregnant (aOR = 2.11; 95% CI: 1.25–3.57). Being currently married (aOR = 0.36; 95% CI: 0.18–0.73) and a higher number of sexual partners per month (p-trend = 0.001) were associated with a lower risk of inconsistent condom use. Targeted programmes should be developed to promote consistent condom use in high-risk women, alongside interventions to reduce alcohol use.
How Well Do We Understand the Long-Term Health Implications of Childhood Bullying?

Abstract Once dismissed as an innocuous experience of childhood, bullying is now recognized as having significant psychological effects, particularly with chronic exposure. Victims of bullying are at risk for a number of psychiatric disturbances, and growing evidence suggests that the pathophysiological effects of bullying, as with other forms of trauma and chronic stress, create additional health risks. We review the literature on the known sequelae of bullying, including psychiatric and physiological health effects, with a focus on implications for the victim. In addition, since it is now well established that early and chronic exposure to stress has a significant negative impact on health outcomes, we explore the implications of this research in relation to bullying and victimization in childhood. In particular, we examine how aspects of the stress response, via epigenetic, inflammatory, and metabolic mediators, have the capacity to compromise mental and physical health, and to increase the risk of disease. Research on the relevant mechanisms associated with bullying and on potential interventions to decrease morbidity is urgently needed.
Mechanisms of multimodal sensing by extracellular Ca2+‐sensing receptors: a domain‐based survey of requirements for binding and signalling

In this article we consider the molecular basis of sensing and signalling by the extracellular calcium‐sensing receptor. We consider the nature of its ligands and sensing modalities, the identities of its major protein domains and their roles in sensing, signalling and trafficking as well as the significance of receptor homo‐ and hetero‐dimerization. Finally, we consider the current, incomplete, state of knowledge regarding the requirements for ligand‐specific signalling.
Rate‐related left bundle branch block and cardiac memory in a patient with bradycardia: Case report and literature review

Rate‐related left bundle branch block (LBBB) is a well‐studied phenomenon. Cardiac memory is another physiologic phenomenon in which T‐wave abnormalities occur in the absence of ischemia. The association between these 2 phenomena has been described in several case reports. A literature review was performed through Ovid and PubMed, where at total of 93 cases of rate‐related LBBB were identified. Cases were reviewed, and data were collected on rates of appearance and disappearance as well as the presence or absence of cardiac memory. There is some overlap in the rate at which LBBB appears. Cardiac memory is associated with rate‐related LBBB in several cases, but its true prevalence is unknown. Cardiac memory is a phenomenon that is well described in the literature but is often underrecognized in clinical practice. As a consequence of overlooking this phenomenon and not including cardiac memory in the differential when T‐wave abnormalities are observed, patients may be subjected to unnecessary invasive diagnostic testing.
Factor structure of the Beck Depression Inventory-II among South Africans receiving antiretroviral therapy

Considerable evidence suggests that mood disturbance is common among patients living with HIV and may be an important barrier to anti-retroviral therapy (ART) adherence. Thus the assessment of depressed mood is an important and necessary aspect of the experience of persons living with HIV as it may impact the health status of individuals directly and indirectly. We sought to determine the factor structure of the Beck Depression Inventory (BDI) among a sample of 185 South Africans living with HIV and receiving ART. The mean BDI score was 16.5 (SD 12.15) with a range from 0–50 (out of a possible 63), indicating on average moderate levels of depression. Cronbach's alpha for the total scale was 0.90. Although the four factors had eigenvalues that were technically above 1.0, only three factors could logically be extracted, the combination of which accounted for 47.29% of the variance. These three factors were Cognitive, Affective and Somatic. The results indicate that the BDI-II is a reliable measure of symptoms of depression among persons living with HIV. The factor structure among South Africans receiving ART is similar to that of other samples, although surprisingly, the item assessing appetite disturbance did not load on any factor. The results of the study suggest that the BDI-II is a useful measure among South Africans living with HIV. In the context of the need to rapidly identify depressed mood among persons receiving ART in public health clinics, the BDI may be a useful instrument. We end the paper with certain cautions associated with routine screening.
Return to Work Following Mild Traumatic Brain Injury

Objective:To examine factors relating to return to work (RTW) following mild traumatic brain injury (mTBI). Participants:One hundred and nine patients (Age: M = 37.4 years, SD = 13.2; 52.3% women) who sustained an mTBI. Design:Inception cohort design with questionnaires and neuropsychological testing completed approximately 3 to 4 weeks postinjury. Setting:Emergency Department of Tampere University Hospital, Finland. Main Outcome Measures:Self-report (postconcussion symptoms, depression, fatigue, and general health) and neurocognitive measures (attention and memory). Results:The cumulative RTW rates were as follows: 1 week = 46.8%, 2 weeks = 59.6%, 3 weeks = 67.0%, 4 weeks = 70.6%, 2 months = 91.7%, and 1 year = 97.2%. Four variables were significant predictors of the number of days to RTW: age, multiple bodily injuries, intracranial abnormality at the day of injury, and fatigue ratings (all P < .001). The largest amount of variance accounted for by these variables in the prediction of RTW was at 30 days following injury (P < .001, R2 = 0.504). Participants who returned to work fewer than 30 days after injury (n = 82, 75.2%) versus more than 30 days (n = 27, 24.8%) did not differ on demographic or neuropsychological variables. Conclusions:The vast majority of this cohort returned to work within 2 months. Predictors of slower RTW included age, multiple bodily injuries, intracranial abnormality at the day of injury, and fatigue.
Pioglitazone improves lipid and insulin levels in overweight rats on a high cholesterol and fructose diet by decreasing hepatic inflammation

Background and purpose: Nutrient overload leads to obesity and insulin resistance. Pioglitazone, a selective peroxisome proliferator‐activated receptor (PPAR)γ agonist, is currently used to manage insulin resistance, but the specific molecular mechanisms activated by PPARγ are not yet fully understood. Recent studies suggest the involvement of suppressor of cytokine signalling (SOCS)‐3 in the pathogenesis of insulin resistance. This study aimed to investigate the hepatic signalling pathway activated by PPARγ activation in a non‐genetic insulin‐resistant animal model.
Absence of Differences Between Male and Female Adolescents With Prior Sport Concussion

Objective:Sex differences following concussion are poorly understood. The purpose of this study was to examine whether male and female adolescent athletes with prior concussions differ regarding neurocognitive function and symptom reporting. Setting:Community-based hockey teams. Participants:Participants included 615 elite hockey players 13 to 17 years old (mean = 15.5, 95% confidence interval [CI] = 15.4-15.6). There were 517 males and 98 females. Players with English as a second language, attention or learning problems, a concussion within 6 months of baseline, or suspected invalid test profiles were excluded from these analyses. Design:Cross-sectional. Main Measure:Domain scores and symptom ratings from the ImPACT computerized battery. Results:There were no significant neurocognitive differences between males and females with (F5,227 = 1.40, P = .227) or without (F5,376 = 1.33, P = 0.252) a prior history of concussion. Male and female athletes with a history of concussion reported higher raw symptom scores than those without a prior concussion; however, sex differences disappear when symptom scores are adjusted for known sex differences in controls (total score, F2,230 = 0.77, P = .46; Cohen d = 0.01 or domain scores (F4,227 = 1.52, P = .197; Cohen d = 0.07-0.18). Conclusions:Although those with prior concussions report more symptoms (but do not differ on neurocognition), this study does not support sex differences with cognition or symptoms in adolescent athletes with prior concussions.
Population Estimates of Undocumented Incident Traumatic Brain Injuries Among Combat-Deployed US Military Personnel

Objective:To estimate the number of undocumented incident traumatic brain injuries (TBIs) among active component US military personnel serving in Iraq and Afghanistan prior to policy changes implemented in late 2006 and 2010 that improved TBI documentation. Methods:Negative binomial regression was used to model monthly incident TBI counts between December 2010 and June 2012 (N = 19) and then estimate expected monthly counts of incident TBIs during 2 periods: January 2003-October 2006 and November 2006-November 2010. Monthly amputation counts from Department of Defense surveillance data were used as a proxy for changing injury rates. Monthly active component deployment estimates derived from the Congressional Research Service, Brookings Institution, and Defense Manpower Data Center were used to estimate the size of the at-risk population each month. The difference between expected monthly incident TBI counts and reported counts is presented as the estimated number of undocumented incident TBIs. Results:The full model estimates that 21 257 active component military personnel experienced undocumented incident TBIs while deployed in Iraq or Afghanistan between January 2003 and October 2006, more than 4 times the 5272 incident TBIs documented during that period. Conclusions:A sizeable majority of Iraq and Afghanistan combat veterans who experienced incident TBI while deployed prior to November 2006 are likely to have had their injuries undocumented, creating challenges for clinical care, disability evaluation, and future research.
Longitudinal Predictors of Criminal Arrest After Traumatic Brain Injury: Results From the Traumatic Brain Injury Model System National Database

Objective:To examine how pre-traumatic brain injury (TBI) variables and TBI-related characteristics predict post-TBI criminal arrest, using longitudinal data from the Traumatic Brain Injury Model System National Database. Settings:Medical hospitals; rehabilitation facilities. Participants:Participants with documented TBI and nonmissing Traumatic Brain Injury Model System data, resulting in N = 6315 at 1 year post-TBI, N = 4982 at 2 years post-TBI, and N = 2690 at 5 years post-TBI. Design:Prospective cohort study with secondary data analysis of the relationship between pre-TBI/TBI factors and post-TBI criminal arrest as measured at 3 time points. Main Measures:Self-report of post-TBI criminal arrest. Results:Post-TBI criminal arrest was associated with gender, age, marital status, educational attainment, pre-TBI felony, pre-TBI drug abuse, pre-TBI alcohol abuse, and violent cause of TBI. Frontal, temporal, parietal, or occipital lobe lesions from computed tomographic scans did not predict post-TBI criminal arrests. Higher numbers of post-TBI arrests were predicted by loss of consciousness (≥24 hours), combined with retention of motor function. Conclusion:Premorbid variables, especially pre-TBI felonies, were strongly linked to post-TBI criminal arrests. The relationship between TBI and arrest was complex, and different brain functions (eg, physical mobility) should be considered when understanding this association. Findings highlight that for post-TBI criminal behavior, many risk factors mirror those of the non-TBI general population.