Miracle-dz/UniFAR-FTUs huggingface dataset:
Association between intensification of metformin treatment with insulin vs sulfonylureas and cardiovascular events and all-cause mortality among patients with diabetes.

IMPORTANCE Preferred second-line medication for diabetes treatment after metformin failure remains uncertain. OBJECTIVE To compare time to acute myocardial infarction (AMI), stroke, or death in a cohort of metformin initiators who added insulin or a sulfonylurea. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort constructed with national Veterans Health Administration, Medicare, and National Death Index databases. The study population comprised veterans initially treated with metformin from 2001 through 2008 who subsequently added either insulin or sulfonylurea. Propensity score matching on characteristics was performed, matching each participant who added insulin to 5 who added a sulfonylurea. Patients were followed through September 2011 for primary analyses or September 2009 for cause-of-death analyses. MAIN OUTCOMES AND MEASURES Risk of a composite outcome of AMI, stroke hospitalization, or all-cause death was compared between therapies with marginal structural Cox proportional hazard models adjusting for baseline and time-varying demographics, medications, cholesterol level, hemoglobin A1c level, creatinine level, blood pressure, body mass index, and comorbidities. RESULTS Among 178,341 metformin monotherapy patients, 2948 added insulin and 39,990 added a sulfonylurea. Propensity score matching yielded 2436 metformin + insulin and 12,180 metformin + sulfonylurea patients. At intensification, patients had received metformin for a median of 14 months (IQR, 5-30), and hemoglobin A1c level was 8.1% (IQR, 7.2%-9.9%). Median follow-up after intensification was 14 months (IQR, 6-29 months). There were 172 vs 634 events for the primary outcome among patients who added insulin vs sulfonylureas, respectively (42.7 vs 32.8 events per 1000 person-years; adjusted hazard ratio [aHR], 1.30; 95% CI, 1.07-1.58; P = .009). Acute myocardial infarction and stroke rates were statistically similar, 41 vs 229 events (10.2 and 11.9 events per 1000 person-years; aHR, 0.88; 95% CI, 0.59-1.30; P = .52), whereas all-cause death rates were 137 vs 444 events, respectively (33.7 and 22.7 events per 1000 person-years; aHR, 1.44; 95% CI, 1.15-1.79; P = .001). There were 54 vs 258 secondary outcomes: AMI, stroke hospitalizations, or cardiovascular deaths (22.8 vs 22.5 events per 1000 person-years; aHR, 0.98; 95% CI, 0.71-1.34; P = .87). CONCLUSIONS AND RELEVANCE Among patients with diabetes who were receiving metformin, the addition of insulin vs a sulfonylurea was associated with an increased risk of a composite of nonfatal cardiovascular outcomes and all-cause mortality. These findings require further investigation to understand risks associated with insulin use in these patients.
Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial.

IMPORTANCE For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. OBJECTIVE To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture. INTERVENTIONS The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education. MAIN OUTCOMES AND MEASURES Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0-12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range, 23-85 and 9-101, higher score indicates better function). RESULTS Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.2 [SD, 2.7] at baseline, 7.2 [SD, 3] at 6 months; control group: 6.0 [SD, 2.8] at baseline, 6.2 [SD, 3] at 6 months; and between-group differences: 0.8 [95% CI, 0.4 to 1.2], P < .001; mean AM-PAC mobility scores for intervention group: 56.2 [SD, 7.3] at baseline, 58.1 [SD, 7.9] at 6 months; control group: 56 [SD, 7.1] at baseline, 56.6 [SD, 8.1] at 6 months; and between-group difference, 1.3 [95% CI, 0.2 to 2.4], P = .03; and mean AM-PAC daily activity scores for intervention group: 57.4 [SD, 13.7] at baseline, 61.3 [SD, 15.7] at 6 months; control group: 58.2 [SD, 15.2] at baseline, 58.6 [SD, 15.3] at 6 months; and between-group difference, 3.5 [95% CI, 0.9 to 6.0], P = .03). In multiple imputation analyses, between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. Significant between-group differences persisted at 9 months for all functional measures with and without imputation. CONCLUSIONS AND RELEVANCE Among patients who had completed standard rehabilitation after hip fracture, the use of a home-based functionally oriented exercise program resulted in modest improvement in physical function at 6 months after randomization. The clinical importance of these findings remains to be determined. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00592813.
First clinical evaluation of an atrial haemodynamic sensor lead for automatic optimization of cardiac resynchronization therapy

Abstract Aims One option to improve cardiac resynchronization therapy (CRT) responder rates lies in the optimization of pacing intervals. A haemodynamic sensor embedded in the SonRtip atrial lead measures cardiac contractility and provides a systematic automatic atrioventricular and interventricular delays optimization. This multi-centre study evaluated the safety and performance of the lead, up to 1 year. Methods and results A total of 99 patients were implanted with the system composed of the lead and a CRT-Defibrillator device. Patients were followed at 1, 3, 6, and 12 months post-implant. The primary safety objective was to demonstrate that the atrial lead complication free rate was superior to 90% at 3-months follow-up visit. A lead handling questionnaire was filled by implanting investigators. Lead electrical performances and the performance of the system to compute AV and VV delays were evaluated at each study visit over 1 year. The complication free rate at 3 months post-implant was 99.0% [95%CI 94.5–100.0%], P < 0.001. Electrical performances of the lead were adequate whatever the atrial lead position and remained stable over the study period. The optimization algorithm was able to compute AV and VV delays in 97% of patients, during >75% of the weeks. Conclusion The atrial lead is safe to implant and shows stable electrical performance over time. It therefore offers a promising tool for automatic CRT optimization to further improve responder rates to CRT.
Antithrombotic management in patients undergoing electrophysiological procedures: a European Heart Rhythm Association (EHRA) position document endorsed by the ESC Working Group Thrombosis, Heart Rhythm Society (HRS), and Asia Pacific Heart Rhythm Society (APHRS).

Since the advent of the non-vitamin K antagonist oral anticoagulant (NOAC) agents, which act as direct thrombin inhibitors or inhibitors of Factor Xa, clinicians are provided with valuable alternatives to vitamin K antagonists (VKAs). At the same time, electrophysiologists frequently perform more invasive procedures, increasingly involving the left chambers of the heart. Thus, they are constantly faced with the dilemma of balancing the risk for thromboembolic events and bleeding complications. These changes in the rapidly evolving field mandate an update of the European Heart Rhythm Association (EHRA) 2008 consensus document on this topic.1 The present document covers the antithrombotic management during different ablation procedures, implantation or exchange of cardiac implantable electronical devices (CIEDs), as well as the management of peri-interventional bleeding complications. The document is not a formal guideline and due to the lack of prospective randomized controlled trials (RCTs) for many of the clinical situations encountered, the recommendations are often ‘expert opinion’. The document strives to be practical for which reason we subdivided it in the three main topics: ablation procedure, CIED implantation or generator change, and issues of peri-interventional bleeding complications on concurrent antiplatelet therapy. For quick reference, every subchapter is followed by a short section on consensus recommendations. Many RCTs are ongoing in this field and it is hoped that this document will help to prompt further well-designed studies. ### Ablation of atrial fibrillation, left atrial arrhythmias and right sided atrial flutter In patients with symptomatic paroxysmal or even persistent atrial fibrillation (AF), catheter ablation is indicated when antiarrhythmic drugs have failed in controlling recurrences or even as a first-line therapy in selected patients.2–4 Patients with AF have an increased risk of thromboembolic events, which varies according to the presence of several risk factors.5,6 Apart from their intrinsic thromboembolic risks, ablation in these patients increases thromboembolic risk due to the introduction and manipulation …
Reducing the effects that cumulative maternal allostatic load poses on mother-infant interactions through mindfulness based family therapy in African American women

Sadea Shahan William Fifer Infant Development Seminar 3 May 2013 Reducing the effects that cumulative maternal allostatic load poses on mother-infant interactions through mindfulness based family therapy in African American women Aim: In the United States, there is a significant disparity in birth outcomes between African American and White American mothers due to various factors such as socioeconomic status (SES), prenatal care, and exposure to risk factors during pregnancy among many others. But more importantly, it is the cumulative allostatic load that the African American mother faces over her lifetime that leads to this outcome. 1 Allostasis is a concept that describes the relationship between the biological, psychological and physiological responses to stress. 2 High allostatic load increases the risk of adverse birth outcomes such as preterm birth, perinatal death and low birth weight 2 . Often times, professional support can be more than valuable and necessary for proper treatment and care in reducing the effects of allostatic load. However, research has supported that the benefits of family support can often outweigh that of professional support during pregnancy. This has been clearly shown in a study where low income women were more likely to engage in adequate prenatal care if they received support from their partners and family. Interestingly, these women did not view professionals such as therapists and counselors as a form of social support,
Safety of gastrointestinal endoscopic biopsy in patients taking antithrombotics

Current Japanese gastrointestinal (GI) endoscopic guidelines permit endoscopic biopsy without cessation of antiplatelet agents and warfarin in patients with a therapeutic range of prothrombin time–international normalized ratio (PT‐INR) levels, although the evidence levels are low. We evaluated the safety of endoscopic biopsy in patients currently taking antithrombotics.
Effect of optional home initiation of HIV care following HIV self-testing on antiretroviral therapy initiation among adults in Malawi: a randomized clinical trial.

IMPORTANCE Self-testing for HIV infection may contribute to early diagnosis of HIV, but without necessarily increasing antiretroviral therapy (ART) initiation. OBJECTIVE To investigate whether offering optional home initiation of HIV care after HIV self-testing might increase demand for ART initiation, compared with HIV self-testing accompanied by facility-based services only. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized trial conducted in Blantyre, Malawi, between January 30 and November 5, 2012, using restricted 1:1 randomization of 14 community health worker catchment areas. Participants were all adult (≥16 years) residents (n = 16,660) who received access to home HIV self-testing through resident volunteers. This was a second-stage randomization of clusters allocated to the HIV self-testing group of a parent trial. INTERVENTIONS Clusters were randomly allocated to facility-based care or optional home initiation of HIV care (including 2 weeks of ART if eligible) for participants reporting positive HIV self-test results. MAIN OUTCOMES AND MEASURES The preplanned primary outcome compared between groups the proportion of all adult residents who initiated ART within the first 6 months of HIV self-testing availability. Secondary outcomes were uptake of HIV self-testing, reporting of positive HIV self-test results, and rates of loss from ART at 6 months. RESULTS A significantly greater proportion of adults in the home group initiated ART (181/8194, 2.2%) compared with the facility group (63/8466, 0.7%; risk ratio [RR], 2.94, 95% CI, 2.10-4.12; P < .001). Uptake of HIV self-testing was high in both the home (5287/8194, 64.9%) and facility groups (4433/8466, 52.7%; RR, 1.23; 95% CI, 0.96-1.58; P = .10). Significantly more adults reported positive HIV self-test results in the home group (490/8194 [6.0%] vs the facility group, 278/8466 [3.3%]; RR, 1.86; 95% CI, 1.16-2.97; P = .006). After 6 months, 52 of 181 ART initiators (28.7%) and 15 of 63 ART initiators (23.8%) in the home and facility groups, respectively, were lost from ART (adjusted incidence rate ratio, 1.18; 95% CI, 0.62-2.25, P = .57). CONCLUSIONS AND RELEVANCE Among Malawian adults offered HIV self-testing, optional home initiation of care compared with standard HIV care resulted in a significant increase in the proportion of adults initiating ART. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01414413.
How does becoming and being a professional counsellor affect one’s personal life : a qualitative exploration

Supervisory Committee Dr. Tim Black (Dept. of Educational Psychology & Leadership Studies) Supervisor Dr. Gina Harrison (Dept. of Educational Psychology & Leadership Studies) Departmental Member This study investigates the effects that becoming and being a professional counsellor, including training and professional practice, can have on one‟s personal life. The significance of this study lies in its contribution to a base of research literature that is starting to form on the personal lives of counsellors. Qualitative methodology and thematic analysis were chosen for this study. Semi-structured interviews were conducted with six professional counsellors, asking them how their training and professional practice has affected their personal lives. Findings revealed participants experienced mostly positive effects, which impacted their personal lives in a variety of ways and in a range of areas. It is suggested that the research be used as part of counsellor training and support programs, as well as to inspire future research on how the profession of counselling psychology comes to affect the professionals engaged with this work.
The intention-to-treat principle: how to assess the true effect of choosing a medical treatment.

The intention-to-treat (ITT) principle is a cornerstone in the interpretation of randomized clinical trials (RCTs) conducted with the goal of influencing the selection of medical therapy for well-defined groups of patients. The ITT principle defines both the study population included in the primary efficacy analysis and how the outcomes are analyzed. Under ITT, study participants are analyzed as members of the treatment group to which they were randomized regardless of their adherence to, or whether they received, the intended treatment.1- 3 For example, in a trial in which patients are randomized to receive either treatment A or treatment B, a patient may be randomized to receive treatment A but erroneously receive treatment B, or never receive any treatment, or not adhere to treatment A. In all of these situations, the patient would be included in group A when comparing treatment outcomes using an ITT analysis. Eliminating study participants who were randomized but not treated or moving participants between treatment groups according to the treatment they received would violate the ITT principle.
Telehealth support system for evaluation of continuous positive airway pressure treatment

This paper describes a telehealth system for the support and evaluation of continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea hypopnea (OSAH). The Web-based system supports the patients in the initial months of the CPAP therapy, especially, the patients from remote areas with limited access to specialized clinics. The system has four major functions: (1) to facilitate patient's education and communication with the clinic, (2) to collect and store subjective self-reported data, physiologic information, and objective CPAP usage data, (3) to analyse patient's compliance, and (4) to assess effectiveness of CPAP treatment. The telemedicine system consists of four modules: (1) a Web-based interface for the patients and health practitioners, (2) a database system for self-reported data, physiologic information, objective CPAP usage data (downloaded from the machine), and patient's records, (3) an analytical system for measuring the compliance, and (4) a rule-based system for the evaluation of effectiveness of CPAP treatment.
Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial.

IMPORTANCE The United States has invested substantially in screening and brief intervention for illicit drug use and prescription drug misuse, based in part on evidence of efficacy for unhealthy alcohol use. However, it is not a recommended universal preventive service in primary care because of lack of evidence of efficacy. OBJECTIVE To test the efficacy of 2 brief counseling interventions for unhealthy drug use (any illicit drug use or prescription drug misuse)-a brief negotiated interview (BNI) and an adaptation of motivational interviewing (MOTIV)-compared with no brief intervention. DESIGN, SETTING, AND PARTICIPANTS This 3-group randomized trial took place at an urban hospital-based primary care internal medicine practice; 528 adult primary care patients with drug use (Alcohol, Smoking, and Substance Involvement Screening Test [ASSIST] substance-specific scores of ≥4) were identified by screening between June 2009 and January 2012 in Boston, Massachusetts. INTERVENTIONS Two interventions were tested: the BNI is a 10- to 15-minute structured interview conducted by health educators; the MOTIV is a 30- to 45-minute intervention based on motivational interviewing with a 20- to 30-minute booster conducted by master's-level counselors. All study participants received a written list of substance use disorder treatment and mutual help resources. MAIN OUTCOMES AND MEASURES Primary outcome was number of days of use in the past 30 days of the self-identified main drug as determined by a validated calendar method at 6 months. Secondary outcomes included other self-reported measures of drug use, drug use according to hair testing, ASSIST scores (severity), drug use consequences, unsafe sex, mutual help meeting attendance, and health care utilization. RESULTS At baseline, 63% of participants reported their main drug was marijuana, 19% cocaine, and 17% opioids. At 6 months, 98% completed follow-up. Mean adjusted number of days using the main drug at 6 months was 12 for no brief intervention vs 11 for the BNI group (incidence rate ratio [IRR], 0.97; 95% CI, 0.77-1.22) and 12 for the MOTIV group (IRR, 1.05; 95% CI, 0.84-1.32; P = .81 for both comparisons vs no brief intervention). There were also no significant effects of BNI or MOTIV on any other outcome or in analyses stratified by main drug or drug use severity. CONCLUSIONS AND RELEVANCE Brief intervention did not have efficacy for decreasing unhealthy drug use in primary care patients identified by screening. These results do not support widespread implementation of illicit drug use and prescription drug misuse screening and brief intervention. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00876941.
The study of changes in the serial peak flowmetery test in the workers of car painting workshops in Isfahan.

Background and Aim: Workers working in car painting workshops are exposed to different contaminants including isocyanates. One of the most important sequelae of this exposure is occupational asthma. The aim of this study was to identify alterations in peak expiratory flow test in the workers working in the car painting workshops. Materials and Methods: This was a cross-sectional descriptive study. 43 workers were selected randomly from the car painting workplaces in Isfahan. The peak expiratory flow of the workers was measured by means of a peak flow meter set at the beginning and at the end of the work shift, for one week. Results: The mean percentage of alterations in peak expiratory flow was 6.91% on the first day and 8.11% on the last day of week. The mean percentage of alternation of peak expiratory flow of the workers were 11.2±1.8 and 7.9±1.9 an the day of exposure to the contaminants after painting, and also one day after exposure respectively, which was indicative of pathological changes in the lungs of the workers, as shown by standard tests of pulmonary function. 72% of the workers after exposure to the contaminants showed alternation of more than 10% in the peak expiratory flow. Conclusion: This study showed there is high risk of occupational asthma and other lung diseases in the workers working in car painting workshops and peak flow meter test can be useful for assessment of pulmonary disorders Keywords:Peak Flow, Car Painters, Occupational asthma
On Associations between Housing Characteristics, Dampness and Asthma and Allergies among Children in Northeast Texas

A cross-sectional study on the home environment and children’s health in Northeast Texas was carried out in 2008–2009. Two thousand eight hundred and nineteen (2,819) parents of children (1–8 years) reported their housing characteristics, home interior surface materials, dampness and children’s health status. The response rate was 71%. Health outcomes studied were wheeze, dry cough, rhinitis, eczema in the last 12 months and diagnosed asthma and hay fever. Dampness was significant risk factor for wheeze and rhinitis with adjusted odds ratio (AOR) 1.3–1.7. Mould/damp spot, condensation and suspected moisture problems were more commonly reported in buildings with flat roof and pier/beam foundation in hot and humid Northeast Texas. Compared to single family houses, trailers were associated with more dampness, consequently a significant increased prevalence of asthma (AOR 1.5 with 95% confidence interval (CI) 1.0–2.3), rhinitis (AOR 1.4, 95% CI 1.0–2.0) and hay fever (AOR 1.5, 95% CI 1.1–2.1). Central air-conditioning system, which re-circulates indoor air, was associated with less dampness problems. However, an increment trend of allergic symptoms was found in homes with air-conditioning system, especially for rhinitis (AOR 1.6, 95% CI 1.1–2.2). Carpet as floor covering and laminated panel as wall covering were associated with rhinitis (AOR 1.6, 95% CI 1.0–2.5) and wheezing (AOR 4.7, 95% CI 1.8–12.7), respectively.