Miracle-dz/UniFAR-FTUs huggingface dataset:
Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus

Expanded use of nurse practitioners (NPs) and physician assistants (PAs) is a potential solution to workforce issues, but little is known about how NPs and PAs can best be used. Our study examines whether medical and social complexity of patients is associated with whether their primary care provider (PCP) type is a physician, NP, or PA. In this national retrospective cohort study, we use 2012-2013 national Veterans Administration (VA) electronic health record data from 374 223 veterans to examine whether PCP type is associated with patient, clinic, and state-level factors representing medical and social complexity, adjusting for all variables simultaneously using a generalized logit model. Results indicate that patients with physician PCPs are modestly more medically complex than those with NP or PA PCPs. For the group having a Diagnostic Cost Group (DCG) score >2.0 compared with the group having DCG <0.5, odds of having an NP or a PA were lower than for having a physician PCP (NP odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.79-0.88; PA OR = 0.85, CI: 0.80-0.89). Social complexity is not consistently associated with PCP type. Overall, we found minor differences in provider type assignment. This study improves on previous work by using a large national dataset that accurately ascribes the work of NPs and PAs, analyzing at the patient level, analyzing NPs and PAs separately, and addressing social as well as medical complexity. This is a requisite step toward studies that compare patient outcomes by provider type.
The Effect of Newer Drugs on Health Spending: Do They Really Increase the Costs?

We analyze the influence of technological progress on pharmaceuticals on rising health expenditures using US State level panel data. Improvements in medical technology are believed to be partly responsible for rapidly rising health expenditures. Even if the technological progress in medicine improves health outcomes and life quality, it can also increase the expenditure on health care. Our findings suggest that newer drugs increase the spending on prescription drugs since they are usually more expensive than their predecessors. However, they lower the demand for other types of medical services, which causes the total spending to decline. We estimate that a 1-year decrease in the average age of prescribed drugs causes per capita health expenditures to decrease by $45.43. The biggest decline occurs in spending on hospital care due to newer drugs.
Associations between Mycoplasma genitalium, Chlamydia trachomatis, and pelvic inflammatory disease

Objective: To evaluate the association between Mycoplasma genitalium, Chlamydia trachomatis, and pelvic inflammatory disease (PID) Methods: A case-control methodology was used. Swab eluates were processed using the QIAamp DNA mini kit. Polymerase chain reaction (PCR) for M genitalium was carried out using a real time in-house 16S based assay. An endocervical swab was taken and tested for the presence of C trachomatis (ligase chain reaction, Abbott Laboratories), and a high vaginal swab was taken and tested for the presence of Neisseria gonorrhoeae and bacterial vaginosis. Results: Of the PID cases 13% (6/45) had evidence of M genitalium infection compared to none of the controls (0/37); 27% (12/45) of the cases had C trachomatis infection compared to none of the controls; and 16% (7/45) of cases only had serological evidence of C trachomatis infection compared to 5% (2/37) of controls. Cases were more likely to present with M genitalium and/or C trachomatis than controls (p<0.001). Conclusions: This study indicates that there may be an association between M genitalium and PID, and that this relation is largely independent of C trachomatis. Future studies need to investigate the pathological basis of the relation between M genitalium and PID using samples from women with PID diagnosed using laparoscopy and endometrial biopsy. Little is known about the epidemiology of M genitalium: large scale epidemiological investigations are needed to determine the prevalence, incidence, and factors associated with this emerging infection.
Eating disorders, substance use disorders, and impulsiveness among disordered gamblers in a community sample.

Disordered gambling and many eating disorders (EDs) involve recurrent loss of impulse control. We examined rates of specific EDs, ED psychopathology, substance use disorders, and their interrelationships with impulsiveness among community members with disordered gambling. Community-recruited adults with pathological (n = 95) or problem (n = 9) gambling (N = 104; 51% female) completed structured interviews and questionnaires. We observed high rates of substance dependence, lifetime EDs, and current ED psychopathology; 20.8% of women (vs 1.9% of men) had a DSM-IV ED, and 37.8% (vs 3.9%) had an ED according to proposed DSM-5 criteria. Although disordered gambling severity was not associated with ED diagnosis or severity of ED psychopathology, greater disordered gambling severity and an ED diagnosis were both associated with increased impulsiveness. These findings suggest that impulsiveness might constitute a common personality characteristic that underlies disordered gambling and EDs.
Crohn's Disease in Children 10 Years Old and Younger: Comparison with Ulcerative Colitis

SummaryIn order to examine the presentation and course of Crohn's disease (CD) versus those of ulcerative colitis (UC) in children ±10 years of age, a retrospective review of children ±10 years old with inflammatory bowel disease singled out 40 patients and compared their findings with those of 38 children with UC. The mean age at onset was 7.5 years for CD, as compared with 5.9 years for UC. A family history of inflammatory bowel disease was present in 13 patients (32%). Abdominal pain (97%), diarrhea (78%), and weight loss (88%) were the major initial complaints, with growth retardation present in 12 (30%) children. At onset, four children had diffuse small-bowel disease, nine had terminal ileal disease, 15 had ileocolitis, and 12 had colitis; at the end of the study two had diffuse small-bowel disease, four had terminal ileal disease, 25 had ileocolitis, and seven had colitis. Extraintestinal manifestations increased with duration of disease. Although the number of recurrences did not differ greatly between groups, those with ileocolitis and colitis needed longer steroid therapy and more days in hospital than did those with only small-bowel disease. Operation was required in 42.5% of children with CD, as compared with 5% of those with UC, with six CD children (35%) requiring later reoperation for recurrent disease or fistula and abscess. Two children died from causes unrelated to their disease (gastric volvulus, carcinoma of the breast). The number of operations, duration of steroid therapy in the course of a year, and days in hospital for children with CD exceeded those for a similar group of children with UC. The quality of life noted at the end of the study period was considered only fair in the majority (70%) of CD patients, in contrast to those with UC, 75% of whom considered life good after 2 years of illness.
Antinatriuretic effect of vasopressin in humans is amiloride sensitive, thus ENaC dependent.

BACKGROUND AND OBJECTIVES Acute infusion of the potent V2 receptor agonist 1-desamino-8-d-arginine vasopressin (dDAVP) reduces sodium excretion in humans, through an effect attributed to the stimulation of the amiloride sensitive epithelial sodium channel, ENaC, in ex vivo/in vivo experiments. We investigated in humans whether the antinatriuretic effect of dDAVP is sensitive to amiloride, a specific blocker of ENaC. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Forty-eight healthy normotensive adult men were assigned to a high Na/low K (250/40 mmol/d) diet, to suppress aldosterone secretion. dDAVP (4-μg intravenous bolus followed by 4 μg over 2 hours) was administrated before and after a 7-day administration of 20 mg/d amiloride. Urine and blood samples were collected before and at the end of the dDAVP infusion, to measure Na, K, creatinine, and osmolality concentrations. RESULTS dDAVP alone decreased the urinary flow rate by 75% and the sodium excretion rate by 19% despite an increase in creatinine clearance by 38 ml/min. Potassium excretion rate was unchanged and the urinary Na/K ratio decreased by 18%. Seven-day amiloride administration had no effect on the dDAVP-induced decrease in the urinary flow rate (-71%) nor on the dDAVP-induced increase in creatinine clearance (+35 ml/min), but it fully prevented the dDAVP-induced decrease in both urinary sodium excretion (+1%) and urinary Na/K ratio (+21%). CONCLUSIONS The antinatriuretic effect of dDAVP in humans is amiloride sensitive, and thus is related to the stimulatory effect on ENaC-mediated sodium reabsorption. This test provides a new tool to investigate ENaC function in a clinical setting.
Utility of island populations in re‐introduction programmes – relationships between Arabian gazelles (Gazella arabica) from the Farasan Archipelago and endangered mainland populations

Understanding local adaptation and population differentiation is vital to the success of re‐introduction initiatives. As other mammals living on islands, Arabian gazelles (G. arabica) show reduced body size on the Farasan archipelago, which we corroborated in this study through morphometric analyses of skulls. In the light of the steep population decline on the Arabian Peninsula – but stable population development on the archipelago – we tested the potential suitability of Farasan gazelles as a source for re‐introductions on the mainland. We therefore investigated genetic differentiation between Farasan and mainland populations using eleven nuclear microsatellite loci and detected a distinct genetic cluster exclusively present on the archipelago, which we inferred to be separated from the mainland cluster for less than 2000 years. About 30% of sampled individuals from Farasan Islands showed assignment to a mainland cluster with signs of ongoing introgression. Analyses using the isolation‐with‐migration model confirmed recent (probably human‐induced) bidirectional exchange of gazelles between mainland and island populations. Hence, the surprisingly uniform island dwarfism most likely reflects phenotypic plasticity, that is, altered morphology as a direct consequence of harsh environmental conditions and resource limitation on the archipelago. Should a further decline of Arabian gazelles on the mainland necessitate restocking in the future, Farasan gazelles may thus become an additional source for captive breeding programmes.
Myeloproliferative neoplasms, thrombosis and paroxysmal nocturnal hemoglobinuria: Is this triad more frequent than we thought?

Background: Chronic myeloproliferative neoplasms (MPN) are clonal disorders characterized by an increased risk of thrombosis and of leukemic evolution. Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease whose characteristic traits are intravascular hemolysis and thrombophilia. The PNH clone is classically associated with bone marrow failure syndromes and, accordingly, it is thought to expand because the remaining hematopoiesis is suppressed. Conversely, here we report the detection of a PNH population in 2 MPN patients presenting with thrombosis. Case presentation: The first case is a 72-year-old woman presenting with a portal vein thrombosis associated with leukothrombocytosis and anemia; additional investigations diagnosed a JAK2-mutated essential thrombocythemia in myelofibrotic evolution and a significant PNH population. The second case is a 75-year-old man with JAK2-mutated polycythemia vera and a long history of thrombosis, who was found to carry a small PNH clone. Both our patients have experienced severe thrombotic events, while neither of them has ever reported signs of overt hemolysis. Conclusions: These cases defy the most accepted etiopathogenetic theory for PNH, challenge the classical indications for PNH screening and raise several practical questions, such as the clinical significance of small PNH clones and the management of patients with two pro-thrombotic factors with different etiologies. Correspondence to: Alessandro Cignetti, University Division of Hematology and Cell Therapy, AO Ordine Mauriziano, Largo Turati 62, 10128, Turin, Italy, Tel: +39 011 5085322; Fax: +39 011 5085374; E-mail: acignetti@mauriziano.it
Anti-Müllerian Hormone Attenuates the Effects of FSH on Follicle Development in the Mouse Ovary.

Although ovarian follicle growth is under the influence of many growth factors and hormones of which FSH remains one of the most prominent regulators. Therefore, factors affecting the sensitivity of ovarian follicles to FSH are also important for follicle growth. The aim of the present study was to investigate whether anti-Mullerian hormone (AMH) has an inhibitory effect on follicle growth by decreasing the sensitivity of ovarian follicles to FSH. Furthermore, the combined action of AMH and FSH on ovarian follicle development was examined. Three different experiments were performed. Using an in vitro follicle culture system it was shown that FSH-stimulated preantral follicle growth is attenuated in the presence of AMH. This observation was confirmed by an in vivo experiment showing that in immature AMH-deficient females, more follicles start to grow under the influence of exogenous FSH than in their wild-type littermates. In a third experiment, examination of the follicle population of 4-month-old wild-ty.
Pseudorabies Virus EP0 Protein Counteracts an Interferon-Induced Antiviral State in a Species-Specific Manner

ABSTRACT Pseudorabies virus (PRV), an alphaherpesvirus related to herpes simplex virus type 1 and varicella-zoster virus, infects a broad host range of mammals. A striking characteristic of PRV infection is the different symptoms and outcomes of infection in natural and nonnatural hosts. Adult pigs, the natural hosts of PRV, survive infection with only mild respiratory symptoms, while nonnatural hosts, including rodents and cattle, invariably die after exhibiting neurological symptoms. Here, we show that the PRV EP0 protein is necessary to overcome an interferon-mediated antiviral response in primary cells from the natural host of PRV but is not necessary in nonnatural-host cells.
Modulation of immune cell proliferation by glycerol monolaurate

Previous studies have shown that glycerol monolaurate (GML), a surfactant commonly used in a wide variety of food and cosmetic products, inhibits the production of a variety of exotoxins by group A streptococci and staphylococci. Given the highly lipophilic nature of the structure of GML, it is suspected that the surfactant exerts its toxin inhibition effects via interaction with the cell membrane. The present study attempted to characterize some of the potential targets of GML action using the model system of lymphocyte activation. Results from murine splenocytes show that GML stimulates proliferation at concentrations between 10(-5) and 5 micrograms/ml/5 x 10(5) splenocytes. At concentrations greater than 5 micrograms/ml, GML inhibited lymphocyte proliferation and blocked the proliferative effects of the lymphocyte mitogens phorbol myristate acetate and concanavalin A and the potent T-cell mitogen toxic shock syndrome toxin-1. Studies using purified immune cell subsets indicated that GML at a concentration of 0.1 microgram/ml optimally induced proliferation of T cells but did not affect B cells. At higher concentrations, GML inhibited the toxic shock syndrome toxin-1 mitogenic effects on T cells, but did not inhibit the lipopolysaccharide-induced stimulation of B cells, suggesting that GML preferentially affects the T-cell population. GML-induced proliferation was blocked by the immunosuppressive drug cyclosporin A, suggesting that GML may be exerting its T-cell-proliferative effects along the calcium-dependent inositol phospholipid signal transduction pathway.
The influence of different anticoagulants and time‐delayed sample processing and measurements on human monocyte subset and monocyte‐platelet aggregate analyses

Measuring human monocyte subsets (CD14++CD16−, CD14++CD16+, and CD14 + CD16++) and subset‐specific monocyte‐platelet aggregates (MPA) is vulnerable to analytical bias due to unavailability of a standardized methodology. We aimed to address this issue by focusing on the impacts of time‐delayed sample processing and measurement between two commonly used anticoagulants.
Correlations between progression of coronary artery disease and circulating endothelial progenitor cells

The pathophysiology of coronary artery disease (CAD) progression is not well understood. Endothelial progenitor cells (EPCs) may have an important role. In the present observational cohort study we assessed the number of circulating EPCs in 136 patients undergoing elective percutaneous coronary intervention and who had at least one major epicardial vessel with a nonsignificant stenosis [<50% diameter stenosis (DS)], and the relationship between plasma EPC levels and the 24‐mo progression of the nonsignificant coronary artery lesion. The following cell populations were analyzed: CD34+, CD133+, CD34+/KDR+, CD34+/VE cadherin+, and endothelial cell colony‐forming units (CFU‐ECs). Progression was defined as a >15% DS increase of the objective vessel at follow‐up. At 24 mo, 57 patients (42%) experienced significant progression. Independent predictors of disease progression were LDL cholesterol > 100 mg/dl (OR=1.03; 95% CI 1.01–1.04; P=0.001), low plasma levels of CFU‐ECs (OR=3.99; 95% CI 1.54–10.37; P= 0.005), and male sex (OR=3.42; 95% CI 1.15–10.22; P=0.027). Circulating levels of EPCs are significantly lower in patients with angiographic CAD progression. —Briguori, C. , Testa, U. , Riccioni, R, Colombo, A. , Petrucci, E. , Condorelli, G. , Mariani, G. , D’Andrea, D. , De Micco, F. , Rivera, N. V. , Puca, A. A. , Peschle, C. , Condorelli, G. Correlations between progression of coronary artery disease and circulating endothelial progenitor cells, FASEB J. 24, 1981–1988 (2010). www.fasebj. org
The effect of heating the scrotum of the ram on respiration and body temperature.

At ambient temperatures of 18 ± 2° C. , heating the scrotumn of the fullyfleeced ram to above 36° C. evoked a polypnœa which immediately stopped when the scrotum was cooled again. Only small increases of respiratory rate occurred when an identical area of flank skin was similarly heated. The responses to heating the scrotum started before intra-carotid temperatures changed and were maintained despite falls in deep body temperature of up to 2·2° C. Deneirvation of the scrotum abolished the reflex. When rams were shorn and flank skin temperatures were in the range 30·0-34·3° C. , the rams no longer panted when the scrotum was heated. A second, unidentified channel of heat loss was then evoked and body temperature again fell.
Current and Future Perspectives for Levofloxacin in Severe Pseudomonas aeruginosa Infections

Abstract The question of whether levofloxacin includes Pseudomonas aeruginosa in its spectrum of clinical activity is discussed by reviewing the major findings on this issue, mainly those published in Italy. The in vitro activity of levofloxacin against P. aeruginosa is now documented on thousands of strains worldwide. The pharma-codynamic properties of levofloxacin allow for the treatment of pseudomonal infections. The levofloxacin clinical results extrapolated from published studies document the efficacy of levofloxacin in the treatment of infections sustained by P. aeruginosa.
Variations in Mortise Anatomy

Background Variations in ankle mortise anatomy may be a predisposing factor to ankle instability. Hypothesis A posteriorly positioned fibula associated with ankle instability may not be a true pathologic entity but rather the result of measuring off an internally rotated talus. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods The authors reviewed 60 ankle computed tomography scans performed on patients from their institution for reasons unrelated to ankle instability. They also reviewed ankle computed tomography scans on 21 patients surgically treated for clinical ankle instability. The position of the fibula in relation to the talar articular surface was calculated and expressed as the axial malleolar index, as described by Scranton et al. They also calculated the intermalleolar index, a new method that references the medial malleolus, not the talus. Results Using the method of Scranton et al, the axial malleolar index in the control and instability patients was similar to values previously described, and there was a significant difference between control and instability patients (P <. 01). However, using the intermalleolar index method referencing the medial malleolus, there was not a significant difference between control and instability patients (P =. 43). Conclusion The new method of referencing the medial malleolus assesses fibular position independent of talar rotation. The data, when referencing the medial malleolus, do not show significant variation in fibular position in patients with and without ankle instability.
Rule-Based Query Optimization in Extensible Database Systems

This thesis presents the problems of query optimization in extensible database systems and proposes a solution. It describes the design and an initial evaluation of the query optimizer generator developed for the EXODUS extensible database system. The goal of the EXODUS system is to provide software tools and libraries to structure and to ease the task of implementing or extending a database system for a new data model. Our basic model of optimization is to map a query tree, which consists of operators at the nodes and stored data at the leaves, to an access plan, which is a tree with implementation methods at the nodes and scans at the leaves. The optimizer generator translates algebraic equivalence rules into an executable optimizer. The equivalence rules are specific to the data model. The generated optimizer reorders query trees and selects implementation methods according to cost functions associated with the methods. The search strategy of the optimizer avoids exhaustive search by learning from past experience. We report on two operational optimizers. Experiments with a restricted relational system show that the generated optimizer produces access plans of almost the same anticipated execution cost as those produced by exhaustive search, with the search time cut to a small fraction. Another set of experiments shows that a generated optimizer is able to handle large queries. An optimizer currently under development for a new query evaluation method shows the power and flexibility of the approach. Other researchers have decided to use the optimizer generator for their database implementation work. Independently from the EXODUS project, the optimizer generator proved to be a valuable tool for exploring the trade-offs between left-deep execution trees and general execution trees in relational database systems. Our experiments show that for bushy trees, the higher optimization cost and the cost for creating and reading temporary files can be more than compensated by the reduction in processing cost.