Miracle-dz/UniFAR-FTUs huggingface dataset:
A national study of medical care expenditures for musculoskeletal conditions: the impact of health insurance and managed care.

OBJECTIVE To provide estimates of all medical care expenditures on behalf of persons with musculoskeletal conditions in the United States in 1996, to estimate the increment in expenditures attributable to the musculoskeletal conditions among such persons, and to ascertain the impact of the presence or absence of health insurance and/or managed care on such expenditures. METHODS The estimates were derived from the Medical Expenditure Panel Survey (MEPS), a national probability sample of 9,488 households, which includes responses from 21,571 persons. In the MEPS, respondents are surveyed every 6 months to report on medical care utilization and health care expenditures. Of the 21,571 persons surveyed, 4,161 reported having 1 or more musculoskeletal conditions. After weighting the data, these 4,161 individuals were inferred to represent 53.935 million persons in the nation as a whole. We tabulated all medical care expenditures of these individuals, stratified by comorbidity status, and then compared their expenditures with those among persons with chronic conditions other than musculoskeletal disease or with no chronic conditions. We then used regression techniques to estimate the increment of health care expenditures attributable to the musculoskeletal conditions. Finally, we used regression to estimate the impact of health insurance status and managed care status on the health care expenditures of the persons with musculoskeletal conditions. RESULTS Per capita medical care expenditures in 1996 averaged $3,578 among persons with musculoskeletal conditions, for a national total of $193 billion, the equivalent of 2.5% of the Gross Domestic Product in that year. The largest components were hospital admissions (37%), physician visits (23%), and prescriptions (16%). Estimates of the per capita increment in total medical care expenditures attributable to musculoskeletal conditions ranged from a high of $723 when controlling for the other medical conditions present, to $364 when controlling for these variables and demographics. Persons with musculoskeletal conditions ages 16-64 who lacked health insurance reported total expenditures of $793, versus $3,249 among those with insurance (P < 0.0001). Among such persons with insurance, expenditures did not differ significantly between those in fee-for-service plans and those in managed care health plans. CONCLUSION Persons with musculoskeletal conditions and health insurance experienced high total expenditures for medical care and high expenditures attributable to the musculoskeletal conditions. Insurance coverage under a managed care plan had no effect on the magnitude of these total expenditures, but lack of insurance coverage did have a significant effect among persons with musculoskeletal conditions.
Enzyme replacement therapy improves joint motion and outcome of the 12‐min walk test in a mucopolysaccharidosis type VI patient previously treated with bone marrow transplantation

Mucopolysaccharidosis type VI (MPS VI; Maroteaux–Lamy syndrome, OMIM #253200) is a rare disorder involving multiple organs and manifested particularly by severe skeletal abnormalities. Bone marrow transplantation (BMT) improves cardiopulmonary function and facial features, but has limited success in ameliorating skeletal abnormalities and short stature. Here, we report the outcome of enzyme replacement therapy (ERT) with recombinant human arylsulfatase‐B (ASB, Naglazyme®, BioMarin, Novato, CA) in an MPS VI patient who received BMT 10 years prior to ERT induction. Administration of weekly Naglazyme® for 18 months was effective in improving range of motion in several joints [shoulders (improvement of flexion (Right/Left): 40°/55°; improvement of extension 30°/40°; improvement of abduction 10°/10°), elbows (improvement of flexion 25°/25°; improvement of extension 10°/15°), hips (improvement of flexion 25°/10°), and knees (improvement of flexion 45°/40°; improvement of extension 50°/60°)]. Improvement in the outcome of the 12‐min walk test (70% increase) and 3‐min stair‐climbing test (29% increase) was also noted after ERT. Because ERT improved clinical features in an MPS VI patient who had undergone prior BMT, the role of ERT post successful BMT in MPS VI needs further investigation. © 2012 Wiley Periodicals, Inc.
Pharmacokinetics of propetamphos following intravenous administration in the F344 rat.

Propetamphos [(E)-1-methylethyl 3-[[(ethylamino)methoxyphosphinothioyl]oxy]-2-butenoate], the active ingredient in Safrotin, is an organophosphate developed by Sandoz, Ltd. (Switzerland) as an insecticide (1). Although metabolism of propetamphos has been previously investigated (2,3), there is no pharmacokinetic data available in the literature. The current studies were undertaken to investigate the pharmacokinetics of propetamphos following intravenous administration in male and female Fischer 344 (F344) rats. Rats were dosed via an indwelling jugular cannula at a dose of 12 mg/kg (one-tenth the oral LD-50). Blood samples were withdrawn via the cannula at predetermined timepoints to quantitate plasma concentrations of propetamphos over time. Propetamphos is highly bound to plasma proteins (free fraction = 0.06). Free propetamphos concentration in plasma vs. time data were analyzed by noncompartmental methods. The terminal elimination rate constant, lambda, was significantly different for males versus females (0.015 min-1 for males and 0.037 min-1 for females, p = 0.001). Plasma was cleared of unbound propetamphos at rates of 0.559 +/- 0.069 and 0.828 +/- 0.181 L/min/kg for males and females (mean +/- standard error). Mean residence times (MRTs) for propetamphos in the body for males and females were 28.3 +/- 5.7 and 14.4 +/- 3.5 min, and the volume of distribution at steady state (Vss) was 14.7 +/- 2.6 and 12.3 +/- 4.5 L/kg. The differences in these parameters, clearance (CI), MRT, and Vss, were not statistically significant at the p < 0.05 level for males versus females, but MRT was nearly significantly different (p = 0.08). (ABSTRACT TRUNCATED AT 250 WORDS)
A new process for the continuous production of succinic acid from glucose at high yield, titer, and productivity

A novel three stages continuous fermentation process for the bioproduction of succinic acid at high concentration, productivity and yield using A. succiniciproducens was developed. This process combined an integrated membrane‐bioreactor‐electrodialysis system. An energetic characterization of A. succiniciproducens during anaerobic cultured in a cell recycle bioreactor was done first. The very low value of YATP obtained suggests that an ATP dependent mechanism of succinate export is present in A. succiniciproducens. Under the best culture conditions, biomass concentration and succinate volumetric productivity reach values of 42 g/L and 14.8 g/L·h. These values are respectively 28 and 20 times higher compared to batch cultures done in our laboratory. To limit end‐products inhibition on growth, a mono‐polar electrodialysis pilot was secondly coupled to the cell recycle bioreactor. This system allowed to continuously remove succinate and acetate from the permeate and recycle an organic acids depleted solution in the reactor. The integrated membrane‐bioreactor‐electrodialysis process produced a five times concentrated succinate solution (83 g/L) compared to the cell recycle reactor system, at a high average succinate yield of 1.35 mol/mol and a slightly lower volumetric productivity of 10.4 g/L·h. The process combined maximal production yield to high productivity and titer and could be economically viable for the development of a biological route for succinic acid production. Biotechnol. Bioeng. 2008;99: 129–135. © 2007 Wiley Periodicals, Inc.
Schistosoma mansoni Phosphoenolpyruvate Carboxykinase, a Novel Egg Antigen: Immunological Properties of the Recombinant Protein and Identification of a T-Cell Epitope

ABSTRACT In schistosomiasis mansoni, hepatic granulomatous inflammation surrounding parasite eggs is mediated by CD4+ T helper (Th) cells sensitized to schistosomal egg antigens (SEA). We previously showed that a prominent lymphoproliferative response of CD4+ Th cells from schistosome-infected C57BL/6 (BL/6) mice was directed against a 62-kDa component of SEA. A partial amino acid sequence of the 62-kDa component was found to be identical with one present in the enzyme phosphoenolpyruvate carboxykinase (PEPCK). Based on this sequence, a cDNA clone containing the entire coding region of PEPCK was identified, and the full recombinant Schistosoma mansoni PEPCK (rSm-PEPCK) of 626 amino acids was purified from a prokaryotic expression system. rSm-PEPCK strongly stimulated a specific T-cell hybridoma, 4E6, as well as CD4+ Th cells from SEA-immunized BL/6 mice and from infected BL/6, CBA, and BALB/c mice. In the infected mice, rSm-PEPCK elicited significant gamma interferon production as well as, to a lesser extent, production of interleukin-2 and -5. In BL/6 and BALB/c mice, the CD4+ Th cell response to rSm-PEPCK was greater than that directed against the egg antigen Sm-p40; conversely, CBA mice responded better to Sm-p40 than to Sm-PEPCK. A 12-amino-acid region (residues 398 to 409: DKSKDPKAHPNS) was demonstrated to contain a T-cell epitope; synthetic peptides containing this epitope significantly stimulated specific hybridoma 4E6 and polyclonal CD4+ Th cells. The identification and characterization of immunogenic egg components will contribute to the understanding and possible control of T-cell-mediated schistosomal disease.
Maternal smoking during pregnancy and primary headache in school-aged children: a cohort study

Background: It is not known whether smoking by mothers during pregnancy is associated with headache in their offspring. Methods: Two prospective cohorts of 869 children aged 10–11 years from Ribeirão Preto (RP) and 805 children aged 7–9 years from São Luís (SL) were studied. Data on maternal smoking were collected at birth. Primary headache was defined as a reporting of ≥2 episodes of headache in the past 2 weeks, without any associated organic symptoms. Results: Prevalence of headache was 28.1% in RP and 13.1% in SL as reported by the mothers and 17.5% in RP and 29.4% in SL as reported by the children. Agreement between mothers’ report and children’s self-report of primary headache in the child was poor. After adjustment, children whose mothers smoked ≥10 cigarettes per day during pregnancy presented higher prevalence of primary headache than their counterparts in both cohorts, as reported by the mother and in RP as reported by the children. Conclusions: Maternal smoking during pregnancy was associated with headache in 7- to 11-year-olds. With one exception, the consistency of the results, despite poor agreement between maternal and children reports of headache, indicates that maternal smoking during pregnancy may contribute to headaches in their children.
Trajectory design for aircraft taxi automation to benefit trajectory-based operations

Trajectory-based operations constitute a key mechanism considered by the Joint Planning and Development Office (JPDO) of the U.S. for managing traffic in high-density or highly complex airspace in the Next-Generation Air Transportation System (NextGen). With this concept applied to surface operations at major airports, current research has been exploring the use of surface 4-dimensional (4D) trajectories, which require the taxiing aircraft to meet required times of arrival (RTAs) at selected locations along the taxi route. Observing these RTAs as constraints along the taxi route, the flight still has many degrees of freedom in adjusting its state profiles (i.e., position, velocity, etc. as functions of time) to achieve the timing constraints. Previous research has applied the trajectory control freedom to assure passenger comfort by keeping the accelerations and decelerations within prespecified limits. This paper explores untapped flexibility in the trajectory design problem to achieve additional desirable behaviors, beginning with the consideration of fuel burn, emissions, and noise. A flight-deck automation experimental prototype serves as the platform for evaluating the designs. The findings will benefit future designs of flight-deck automation systems, as well as tower automation systems which rely on accurate understanding of the flight deck's operational behaviors to plan efficient and safe operations for the entire surface traffic.
Optimized provisioning of SDN-enabled virtual networks in geo-distributed cloud computing datacenters

Cloud computing provides on-demand IT services via large distributed datacenters over high-speed networks. Virtualization, a key cloud computing technology, allows service providers to offer computing services in cloud environments without platform compatibility discrepancies. The recent proliferation of cloud computing has rekindled interest in network virtualization. Thus, network virtualization is emerging as a polymorphic approach for the future Internet that will facilitate the use of shared resources. Virtual network provisioning is considered to be a main resource allocation challenge in any virtualized network environment. Software-defined networking (SDN) imparts flexibility to a network by removing the control layer from the data transfer layer of the network and moving it to the control plane. Network virtualization is further employed to share physical infrastructure to enable multiple service providers to access the network. Flexible access requires efficient management of network resources; the SDN control plane can be used for efficient management of virtual networks. In this study, we formulate virtual network provisioning in SDN-enabled, geographically distributed cloud computing datacenters as a mixed integer linear programming (MILP) problem. The formulation of the proposed optimized virtual network provisioning (OVNP) model is studied by means of simulations. The performance of the proposed approach is measured against enhanced network cloud provisioning (ENCP), our previous research, and other recognized research focused on the ratio of successfully provisioned requests and the efficiency of resource utilization The results verify the effectiveness of the proposed approach.
Assessing health related quality of life in diabetic patients.

INTRODUCTION The number of people with diabetes mellitus (DM) is increasing. For chronic illnesses such as DM, where there is no cure, it is important to establish that therapy really makes people feel better. The purpose of the study was to analyze the quality of life in a group of diabetic patients without major complications. SUBJECTS AND METHODS The study group consisted of 50 patients, males and females, aged 60 (+/- 6), diagnosed with type 2 DM and followed up at an outpatient clinic. The Romanian version of the SF-36 questionnaire was used as a health survey tool to measure the quality of life (QOL) of patients in the study. RESULTS Validity (coefficient alpha Cronbach) was > 0.7 for all scales except social functioning. QOL scores for study group were significantly lower compared with general population. Examining the effects of insulin use and QOL, there are no significant differences between patients following insulin therapy and patients with other therapeutic protocols. Role limitations due to emotional problems correlate with disease duration. Statistical analysis demonstrates a significant correlation between energy/fatigue scores and HbA1c. There are no other statistically significant correlations between SF-36 scores and other variables analyzed. DISCUSSIONS AND CONCLUSIONS Patients with DM have statistically significant impairment of all aspects of QOL, not simply physical functioning. DM put a substantial burden on affected individuals by influencing physical, psychological and social aspects of QOL. The progressive nature of type 2 DM and the real risk for developing chronic complications certifies that insulin use will be a reality for most diabetic patients, but its use did not seem to have a negative impact upon QOL. Glycemic control becomes an important measurement for preventing long-terms complications and provides a better QOL to diabetic patient. This end-point should be a much more important target for healthcare interventions.
Presenilins Regulate Neurotrypsin Gene Expression and Neurotrypsin-dependent Agrin Cleavage via Cyclic AMP Response Element-binding Protein (CREB) Modulation*

Background: Presenilins regulate multiple cellular pathways by controlling transcription. Results: Presenilins repress neurotrypsin expression by preventing CREB recruitment to its promoter. Conclusion: A new strategy utilized by presenilins to regulate CREB signaling relies on preventing CREB recruitment to gene promoters. Significance: Learning how presenilins control CREB signaling will help understanding their physiological/pathological roles. Presenilins, the catalytic components of the γ-secretase complex, are upstream regulators of multiple cellular pathways via regulation of gene transcription. However, the underlying mechanisms and the genes regulated by these pathways are poorly characterized. In this study, we identify Tequila and its mammalian ortholog Prss12 as genes negatively regulated by presenilins in Drosophila larval brains and mouse embryonic fibroblasts, respectively. Prss12 encodes the serine protease neurotrypsin, which cleaves the heparan sulfate proteoglycan agrin. Altered neurotrypsin activity causes serious synaptic and cognitive defects; despite this, the molecular processes regulating neurotrypsin expression and activity are poorly understood. Using γ-secretase drug inhibitors and presenilin mutants in mouse embryonic fibroblasts, we found that a mature γ-secretase complex was required to repress neurotrypsin expression and agrin cleavage. We also determined that PSEN1 endoproteolysis or processing of well known γ-secretase substrates was not essential for this process. At the transcriptional level, PSEN1/2 removal induced cyclic AMP response element-binding protein (CREB)/CREB-binding protein binding, accumulation of activating histone marks at the neurotrypsin promoter, and neurotrypsin transcriptional and functional up-regulation that was dependent on GSK3 activity. Upon PSEN1/2 reintroduction, this active epigenetic state was replaced by a methyl CpG-binding protein 2 (MeCP2)-containing repressive state and reduced neurotrypsin expression. Genome-wide analysis revealed hundreds of other mouse promoters in which CREB binding is similarly modulated by the presence/absence of presenilins. Our study thus identifies Tequila and neurotrypsin as new genes repressed by presenilins and reveals a novel mechanism used by presenilins to modulate CREB signaling based on controlling CREB recruitment.
Economic evaluation in health care: the point of view of informed physicians.

OBJECTIVES We investigated health professionals with a solid background in health-care management and economics to get their opinion and attitude on the use of economic evaluation at the policy, organizational, and professional levels of decision-making. METHODS A 12-item questionnaire was sent to 374 Italian health-care professionals who received training in economic evaluation of health-care programs in the last 10 years at the Bocconi School of Management, Milan, Italy. RESULTS The response rate was 46.8% (175 questionnaires). All respondents stated that the basics of economic evaluation analysis must be part of the overall knowledge of health-care professionals. The usefulness of economic evaluation for professional activities was rated 3.83 (scale 1-5). Respondents stated that economic evaluation is used more for managerial decisions than for clinical ones (mean 2.89 vs. 2.74, P = 0.09). "Decisions are taken according to a short-term perspective" was the most frequently reported barrier for the actual use of economic evaluation studies, particularly by managers (76.7%). "More training in health economics" was indicated as the incentive to expand its use by the majority of both clinicians and managers (64.6%). Significantly more managers than clinicians (74.4% vs. 54.1%, P = 0.005) considered that the maximum benefits of economic evaluation are reaped at organizational level. CONCLUSIONS Informed Italian health professionals have a positive attitude toward the principles and the techniques of economic evaluation. They show appreciation of their potential role and report making some use of them in actual decision making.
Patient care: Is interpersonal trust missing?

Background: Health statistics and studies in the Caribbean have omitted interpersonal trust in their investigations. Aims: This study will examine the effect of interpersonal trust and other conditions on psychosocial subjective wellbeing and self-reported health, in order to assess the significance of interpersonal trust, as well as other socio-demographic factors on health. Materials and Method: The current study utilized primary data commissioned by the Centre of Leadership and Governance, Department of Government, the University of West Indies, Mona, Jamaica, between July and August 2006. It was a nationally representative probability sampling survey. A sample of 1,338 respondents was interviewed with a detailed 166-item questionnaire. Results: Generally, the psychosocial subjective wellbeing of Jamaicans was high (mean = 6.8 ± 1.8), and self-reported health was moderately high (mean = 6.3 ± 2.6). The current study has revealed that income, political system, subjective social class, employment status, and interpersonal trust determine psychosocial subjective wellbeing as well as self-reported health. Interpersonal trust accounted for between 9.4 to 10.4% of the explanatory power of the wellbeing and self-reported health of Jamaicans. Conclusion: The current study highlights that the determinants of health include interpersonal trust. It is critical to point out here that trust must be taken into consideration in any evaluation of health statistics, as it is a factor of subjective wellbeing and health. It is within this context that clinicians need to incorporate interpersonal trust along with other conditions, as it is a part of the psychosocial determinants of health, subjective wellbeing, and health treatment.
ATP-sensitive potassium (K(ATP)) channel openers diazoxide and nicorandil lower intraocular pressure in vivo.

PURPOSE To evaluate the expression of ATP-sensitive potassium (K(ATP)) channel subunits and study the effect of K(ATP) channel openers diazoxide and nicorandil on intraocular pressure (IOP) in an in vivo mouse model. METHODS Expression of K(ATP) channel subunits in normal C57BL/6 mouse eyes was studied by immunohistochemistry and confocal microscopy. Wild-type C57BL/6 mice were treated with K(ATP) channel openers diazoxide (n = 10) and nicorandil (n = 10) for 14 days. Similar treatments with diazoxide were performed on K(ir)6.2((-/-)) mice (n = 10). IOP was recorded with a handheld tonometer 1 hour, 4 hours, and 23 hours following daily treatment. Posttreatment histology was examined by light and transmission electron microscopy. RESULTS The K(ATP) channel subunits SUR2B, K(ir)6.1, and K(ir)6.2 were identified in all tissues within mouse eyes. Treatment with diazoxide in wild-type mice decreased IOP by 21.5 ± 3.2% with an absolute IOP reduction of 3.9 ± 0.6 mm Hg (P = 0.002). Nicorandil also decreased IOP (18.9 ± 1.8%) with an absolute IOP reduction of 3.4 ± 0.4 mm Hg (P = 0.002). Treatment with diazoxide in K(ir)6.2((-/-)) mice had no effect on IOP. No morphological abnormalities were observed in diazoxide- or nicorandil-treated eyes. CONCLUSIONS K(ATP) channel openers diazoxide and nicorandil are effective regulators of IOP in mouse eyes. K(ir)6.2 appears to be a major K(ATP) channel subunit through which IOP is lowered following treatment with diazoxide.