Miracle-dz/UniFAR-FTUs huggingface dataset:
Cost-Effectiveness of a Team-Based Integrative Medicine Approach to the Treatment of Back Pain.

OBJECTIVES To report the results of health economic analyses comparing two treatment approaches for chronic low back pain (CLBP). DESIGN Observational prospective cohort study comparing effectiveness and cost-effectiveness of CLBP care provided at an integrative care clinic with that provided in other clinics within the same hospital. CLBP-related medical utilization, function, quality of life, and days of work incapacity were self-reported at baseline, 3, 6, and 12 months. SETTINGS/LOCATION Osher Clinical Center (OCC) based at a tertiary academic hospital (Brigham and Women's Hospital [BWH]) and other clinics at BWH. SUBJECTS CLBP patients seeking care at OCC or non-OCC BWH clinics. INTERVENTIONS Integrative or conventional care for CLBP as prescribed by the treating clinician(s). OUTCOME MEASURES Quality-adjusted life years (QALYs) were estimated per treatment approach based on the SF-12. Cost per QALY gained was evaluated using an incremental cost-effectiveness ratio (ICER). ICERs based on CLBP-specific effectiveness measures (Roland Disability Questionnaire [RDQ] and bothersomeness of pain [BOP]) were exploratory outcomes. RESULTS Total adjusted annual CLBP-related costs per patient were greater in the OCC versus non-OCC group ($11,526.73 vs. $6,810.63). Between group differences in QALYs were small and ICER estimate of cost per QALY gained was high ($436,676). However, unadjusted mean direct costs per patient decreased over time in the OCC group. Savings in direct costs of $391 (95% confidence interval: -1,078 to 1,861) were observed in the OCC group for the 6- to 12-month period, driven primarily by reduced medication usage. ICERs based on adjusted RDQ and BOP group differences showed cost of $2,073 and $4,203 for a one-point reduction per respective scale. CONCLUSIONS When adjusted for baseline differences, self-reported costs were higher in the OCC group with only small effects on QALYs. However, trends toward decreased direct expenditures and medication usage over time warrant further investigation. Future studies evaluating potential benefits of integrative care models for the management of CLBP should employ randomized designs, longer observational periods, and explore multiple metrics of cost-effectiveness.
On the automaticity of attentional orienting to threatening stimuli.

Attention is biased toward stimuli that have been associated with aversive outcomes in the past. This bias has previously been interpreted as reflecting automatic orienting toward threat signals. However, in many prior studies, either the threatening stimulus provided valuable predictive information, signaling the possibility of an otherwise unavoidable punishment and thereby allowing participants to brace themselves, or the aversive event could be avoided with fast and accurate task performance. Under these conditions, monitoring for threat could be viewed as an adaptive strategy. In the present study, fixating a color stimulus immediately resulted in a shock on some trials, providing a direct incentive not to look at the stimulus. Nevertheless, this contingency resulted in participants fixating the shock-associated stimulus more frequently than a neutral distractor matched for physical salience. Our findings demonstrate that threatening stimuli are automatically attended even when attending such stimuli is actually responsible for triggering the aversive event, providing compelling evidence for automaticity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
High-resolution Mapping of Hyperglycemia-induced Gastric Slow Wave Dysrhythmias

Background/Aims It is now recognised that gastric dysrhythmias are best characterised by their spatial propagation pattern. Hyperglycemia is an important cause of gastric slow wave dysrhythmia, however, the spatiotemporal patterns of dysrhythmias in this context have not been investigated. This study aims to investigate the relationship between hyperglycemia and the patterns of dysrhythmias by employing high-resolution (multi-electrode) mapping simultaneously at the anterior and posterior gastric serosa. Methods High-resolution mapping (8 × 16 electrodes per serosal) was performed in 4 anesthetized hounds. Baseline recordings (21 ± 8 minutes) were followed by intravenous injection of glucagon (0.5 mg per dose) and further recordings (59 ± 15 minutes). Blood glucose levels were monitored manually using a glucose sensing kit at regular 5-minute intervals. Slow wave activation maps, amplitudes, velocity, anisotropic ratio, and frequency were calculated. Differences were compared between baseline and post glucagon injection. Results Baseline slow waves propagated symmetrically and antegrade. The blood glucose levels were increased by an average of 112% compared to the baseline by the end of the recordings. All subjects demonstrated elevated incidence of slow wave dysrhythmias following injection compared to the baseline (48 ± 23% vs 6 ± 4%, P < 0.05). Dysrhythmias arose simultaneously or independently on anterior and posterior serosa. Spatial dysrhythmias occurred before and persisted after the onset and disappearance of temporal dysrhythmias. Conclusions Infusion of glucagon induced gastric slow wave dysrhythmias, which occurred across a heterogeneous range of patterns and frequencies. The spatial dysrhythmias of gastric slow waves were shown to be more prevalent and persisted over a longer period of time compared to the temporal dysrhythmias.
Framing IPE. Exploring meanings of interprofessional education within an academic health professions institution

ABSTRACT This paper reports a qualitative study that explored the meanings of interprofessional education (IPE) by comparing and contrasting educational leaders’ perceptions with educational policy documents at an academic health professions education institution in Scandinavia. The study used Goffman’s frame analysis to identify two frames of IPE by illuminating issues related to the definition, rationale, and presentation of IPE. A directed content analysis to identify these three aspects of IPE was conducted on semi-structured interviews with nine educational leaders who were overseeing the development of IPE, as well as on the institution’s regulatory IPE documentation. Differences regarding definition, rationale, and presentation of IPE between the institutional regulatory IPE frame and the IPE frame of the educational leaders were found which implied difficulties for the educational leaders regarding the implementation of IPE. Based on the study’s findings, the paper argues that creating awareness of the differences in meanings of IPE between different perspectives within an academic education institution is an important factor to consider when creating future organisational structures and faculty development programmes in connection to IPE.
Effect of Low-Intensity Pulsed Ultrasound After Autologous Adipose-Derived Stromal Cell Transplantation for Bone-Tendon Healing in a Rabbit Model

Background: Low-intensity pulsed ultrasound (LIPUS), as a safe biophysiotherapy, can enhance bone-tendon (B-T) healing in vivo and induce osteogenic or chondrogenic differentiation of mesenchymal stromal cells in vitro. This study aimed to determine whether LIPUS can improve the efficacy of transplanted mesenchymal stromal cells on B-T healing. Hypothesis: LIPUS can induce lineage-specific differentiation of transplanted adipose-derived stromal cells (ASCs) at the B-T healing site, thus resulting in superior healing quality when compared with LIPUS or ASCs alone. Study Design: Controlled laboratory study. Methods: A total of 112 mature rabbits with partial patellectomy in the hindlimb were randomly assigned into mock sonication without ASCs (control), ultrasonication without ASCs (LIPUS), mock sonication with ASCs (ASCs), and ultrasonication with ASCs (LIPUS + ASCs). The treatment time of the mock sonication or ultrasonication was 20 minutes per day. Autologous ASCs were transplanted to the healing site by fibrin glue during the operation, and LIPUS was delivered daily starting at postoperative day 3 until euthanasia. The patella–patellar tendon junctions were postoperatively harvested at 8 and 16 weeks for radiological, histological, and mechanical evaluations. Additionally, 9 animals were used for ASC tracking with mCherry protein. Results: Radiologically, there was more new bone formation and remodeling in the LIPUS + ASCs group as compared with the other groups. Synchrotron radiation micro–computed tomography showed that the LIPUS + ASCs group significantly increased bone volume fraction, trabecular thickness, and trabecular number at the healing site as compared with the other groups at postoperative 8 weeks (P < .05 for all). Histologically, immunohistochemical staining confirmed that the transplanted mCherry-ASCs can differentiate into osteoblasts and fibrochondrocytic-like cells. Meanwhile, as compared with the other groups, the LIPUS + ASCs group showed more formation and maturity of the fibrocartilage layer and new bone at postoperative weeks 8 and 16 (P < .05 for all). Biomechanically, the LIPUS + ASCs group showed significantly higher failure load and stiffness versus the other groups at postoperative weeks 8 and 16 (P < .05 for all). Conclusion: Autologous ASC transplantation stimulated with LIPUS can result in superior B-T healing quality when compared with LIPUS or ASCs alone. Clinical Relevance: This study demonstrates the effectiveness of using ASC transplantation stimulated with LIPUS for B-T healing and provides a foundation for future clinical studies.
Pediatric Abdominal Pain in Children Presenting to the Emergency Department

Supplemental digital content is available in the text. Background Undifferentiated abdominal pain is a common pediatric presentation to the emergency department (ED). Objectives The objective of this study was to describe the prevalence of clinically significant abdominal pathology (CSAP) including appendicitis, patterns of imaging and pathology tests, and management and outcomes of children with abdominal pain in ED. Methods A prospective multicenter observational cohort pilot study of children under the age of 16 years presenting to 4 Australian EDs with abdominal pain was performed for a 1-month period at each site. The primary outcome was to describe the prevalence of CSAP and appendicitis. Age, sex, length of stay, surgery or interventional procedure, investigations, and analgesia use were recorded. Results There were 555 presentations with abdominal pain during the study period with a median age of 9 years (interquartile range, 6–12 years). Eighty-two patients (14.8%; 95% confidence interval, 11.8–17.7) had CSAP, of which 41 (7.4%, 5.2–9.6) had appendicitis. Three hundred forty-eight (62.7%, 58.7–66.7) were discharged directly from ED, and 207 (37.3%, 33.2–41.3) were admitted. Two hundred fifty-five (45.9%, 41.8–50.1) had pathology tests, and 173 (31.2%, 27.3–35.1) had imaging tests in ED. Of those contacted for telephone follow-up, 100 (50.5%, 43.5–57.5) of 198 reported ongoing pain after discharge, and 13.1% (8.4–17.8) had missed over a week of school due to abdominal pain. Conclusions The prevalence of CSAP and appendicitis in our study was 14.8% (11.8–17.7) and 7.4% (5.2–9.6), respectively. Fewer than half of patients received blood tests, and a third received imaging during their ED attendance. The presentation of abdominal pain conveys a significant health burden on families with time off school and ongoing symptoms of pain.
An updated measure for investigating basic knowledge of Alzheimer’s disease in underserved rural settings

Abstract Objective: Older rural adults face a higher burden of Alzheimer's disease (AD) and delayed detection. This risk is heightened in rural populations that are ethnically diverse. Patients and providers are often hesitant to participate in screening, partially due to gaps in knowledge of the current science. The purpose of this paper is to describe the results of administering the revised version of the Basic Knowledge of Alzheimer's Disease (BKAD) measure in small rural communities in five different states. Methods: The BKAD measure was revised after first being tested in rural Appalachia. Revisions including eliminating non-discriminating items and adding questions regarding early detection, sleep, head injury, and vision changes. Reliability and validity testing included Cronbach's alpha and Rasch item analysis, test-retest, and predictive validity. Descriptive measures and independent sample t-tests were used to analyze knowledge gaps and sociodemographics. Results: Tests for reliability and validity were highly favorable, including Cronbach's alpha = . 85 and overall Rasch item analysis of . 94. Three-fourths of participants knew that annual cognitive screening was recommended for older adults, but only one-fourth had been previously screened. Sociodemographic findings revealed that a majority of participants (86%) would participate in annual memory screening if offered, regardless of education or health literacy level. Conclusion: The BKAD measure is a good fit for use in rural and underserved populations. BKAD results can inform the design of culturally relevant programs for raising awareness of the importance of early AD detection and treatment.
What'S New in Shock, April 2019?

The April 2019 issue of Shock provides a fresh mixture of clinical observational and preclinical translational studies centered on important aspects of sepsis, inflammation, organ injury, and critical illness. The main theme of the clinical studies in this issue of Shock is the quest for biomarkers to predict outcomes in critical illness. In a single-center prospective observational study, Kastl et al. (1) evaluated whether systemic levels of intestinal fatty acid-binding protein (iFABP, also known as fatty acid-binding protein 2 (FABP2)) could serve as outcomes biomarker in patients with acute heart failure or cardiogenic shock. The authors observed in 90 consecutive patients that high iFABP levels on the day of intensive care unit admission were associated with low 30-day survival, thus suggesting potential predictive value of iFABP in these patient populations. Because iFABP expression is limited to the intestine and released into the systemic circulation from injured or hypoxic enterocytes, the authors conclude that early intestinal hypoperfusion might be associated with mortality in patients with acute heart failure or cardiogenic shock (1). In another prospective observational study Barnaby et al. (2) enrolled 1,247 patients to derive and evaluate a predictive model containing clinical, laboratory, and heart rate variability measures to quantify risk of deterioration in patients with sepsis admitted to the emergency department. The authors show that the combination of laboratory values and heart rate variability metrics improves prediction of clinical deterioration, suggesting that such a model could facilitate risk stratification for sepsis patients in the emergency department. In two retrospective observational studies, changes in leukocyte counts and morphology were associated with outcomes (3,4). Chung et al. (3) performed a retrospective analysis of prospectively collected data to evaluate the associations of circulating monocyte counts with mortality, bacteremia and organ dysfunction in sepsis and septic shock patients. Furthermore, the authors were able to compare monocyte counts at the manifestation of sepsis with monocyte counts that were obtained 3 months to 2 weeks prior to the manifestation of sepsis. Chung et al. report that monocyte counts were independently associated with mortality in multivariate logistic regression analyses and that sepsis patients with low initial monocyte
Psychosocial Factors Associated With Irritable Bowel Syndrome Development in Chinese College Freshmen

Background/Aims The role of psychosocial factors on irritable bowel syndrome (IBS) in adolescents is incompletely understood. The aim of this study is to investigate the association between the psychosocial factors and the risk of developing IBS in college freshmen. Methods A cross-sectional survey was conducted in a randomly selected freshmen population in Wuhan China (n = 2449). Questionnaire evaluated demographics and psychosocial risks. The population was divided into 3 groups: non-discomfort, chronic abdominal discomfort and IBS. The association between the development of IBS and psychosocial factors was analyzed by ordinal and multiple logistic regression analysis. Results A total of 2053 (83.8%) completed this survey (mean age, 18.2 ± 0.9 years; female, 35.6%). Among them, 82 (4.0%) fulfilled the Rome III criteria for IBS. Female (odds ratio [OR], 3.31; 95% confidence interval [CI], 2.47–4.45), experience of abuse (OR, 2.44; 95% CI, 1.10–5.56), and suicidal intention (OR, 2.17; 95% CI, 1.15–4.17) were more likely to have IBS. Compared with chronic abdominal discomfort, however, depression (OR, 5.55; 95% CI, 1.36–22.71) was the only dependent risk factor for IBS. Conclusion The prevalence of IBS in college freshmen is 4.0%, and to the freshmen, psychosocial factors such as experience of abuse, depression, and suicidal intention were associated with high risk of developing IBS.
Distributed Algorithm Design for Nonsmooth Resource Allocation Problems

This paper investigates resource allocation problems, where the cost functions of agents are nonsmooth and the decisions of agents are constrained by heterogeneous local constraints and network resource constraints. We design a distributed subgradient-based algorithm to achieve the optimal resource allocation. Moreover, we analyze the convergence of the algorithm to the optimal solution. The algorithm can solve resource allocation problems with strongly convex cost functions and weight-balanced digraphs, as well as resource allocation problems with strictly convex cost functions and connected undirected graphs. With the algorithm, the decisions of all agents asymptotically converge to the optimal allocation. Simulation examples verify the effectiveness of the algorithm.
Influence of Human Parameters on Labor Productivity in the Construction Industry

Objective: The objective of this article is to investigate the influence of human parameters on qualitative assessment of labor productivity (LP) in the construction industry. Background: The theories involving workers have identified various parameters on physical efficiency, such as heart rate, relative heart rate, and calorie count, so as to improve the safety and social conditions of construction labor, thereby increasing LP. However, there is no direct emphasis on assessment of LP using human parameters related to physical strength. Method: An exploratory study was conducted on 17 construction workers by observing their task-level LP in real time at a construction site. Human parameters, such as age, body mass index (BMI), handgrip strength, and upper body muscle strength of the laborers, were measured at the construction site. Performance levels of these workers were placed in three categories, and each worker was assigned a typical weightage to each category when correlated to physical strength. Results: Labor categories among the human parameters that included middle age, normal-range BMI, and strong muscular strength were shown as having higher LP than others. A quantitative parameter called the Human Parameter Index (HPI) was developed based on the performance categories developed for an individual worker. Human parameters revealed a significant relationship with respect to task-level LP. Conclusion and Application: The study determines the influence of human parameters on LP in construction. Introduction of human parameters in the construction industry will help in assessment of LP for various labor-intensive activities.
Regulation of fiber-specific actin expression by the Drosophila SRF ortholog Blistered

ABSTRACT Serum response factor (SRF) has an established role in controlling actin homeostasis in mammalian cells, yet its role in non-vertebrate muscle development has remained enigmatic. Here, we demonstrate that the single Drosophila SRF ortholog, termed Blistered (Bs), is expressed in all adult muscles, but Bs is required for muscle organization only in the adult indirect flight muscles. Bs is a direct activator of the flight muscle actin gene Act88F, via a conserved promoter-proximal binding site. However, Bs only activates Act88F expression in the context of the flight muscle regulatory program provided by the Pbx and Meis orthologs Extradenticle and Homothorax, and appears to function in a similar manner to mammalian SRF in muscle maturation. These studies place Bs in a regulatory framework where it functions to sustain the flight muscle phenotype in Drosophila. Our studies uncover an evolutionarily ancient role for SRF in regulating muscle actin expression, and provide a model for how SRF might function to sustain muscle fate downstream of pioneer factors. Summary: Drosophila Serum response factor has a fiber-specific role in controlling actin expression in the adult flight muscles, and functions downstream of the putative pioneer factors Extradenticle and Homothorax.
Non-Branded Food Placements in Children’s Entertainment Programs: A Content Analysis

ABSTRACT Food messages transmitted in media are considered to affect children´s eating habits. Depending on the healthiness of the food messages, these food portrayals can be supportive or non-supportive in educational food content, affecting eventually childhood obesity. This study aims to analyze how food references present in children´s animated cartoons are depicted, considering not only their prevalence and prominence but also their educational nature which is measured by the overall message that is being transmitted. A content analysis of non- branded food placements was conducted on the basis of 25 international cartoon series for children (aged 3–12) with 4,790 minutes of viewing. A total of 1,065 food placements occurred with a rate of one placement approximately every five minutes. A balance was found between the frequency of low and highly-recommended consumption foods and the same happened considering the educational nature of the global message. When the target age and the country of origin were considered, the least educational messages predominated in those series aimed at the oldest children group and produced in North America. This study intends to contribute to the problem of childhood obesity by indicating the educational nature of the food messages that children are confronted with. As prevalence and prominence of non-supportive food placements to educational food content is high, policy makers should consider these findings when designing public policies that aim to prevent childhood obesity.
A Correlated Traits, Correlated Methods Model for Thin-Slice Child Personality Assessment

Recent research has illustrated the utility and accuracy of a thin-slice (TS) approach to child personality assessment, whereby unacquainted observers provide personality ratings of children after exposure to brief behavioral episodes. The current study sought to expand on this approach by exploring formal multitrait-multimethod (MTMM) models for child TS data comprising ratings from a comprehensive set of TS situations. Results using data from a sample of 326 community children 9−10 years of age indicated that a correlated traits, correlated methods (CTCM) model can be used to represent individual differences in children’s behavior as manifest across different situations. Indicator variables derived from a CTCM differentially correlated with traditional parental ratings of behavior, moreover, and provide predictive and incremental validity regarding child competencies and behavior. Results illustrate the utility of a TS approach in the assessment of childhood personality and inform understanding of issues encountered in applying different MTMM models to these types of empirical data.