Miracle-dz/UniFAR-FTUs huggingface dataset:
Factors Associated With Antiretroviral Therapy Adherence and Medication Errors Among HIV-Infected Injection Drug Users

Background:Active drug use is often associated with poor adherence, but few studies have determined psychosocial correlates of adherence in injection drug users (IDUs). Methods:Of 1161 Intervention for Seropositive Injectors-Research and Evaluation study enrollees, 636 were taking antiretrovirals. We assessed self-reported adherence to self-reported antiretroviral regimens and medication errors, which we defined as daily doses that were inconsistent with standard or alternative antiretroviral prescriptions. Results:Most subjects (75%, n = 477) self-reported good (≥90%) adherence, which was strongly associated with an undetectable viral load. Good adherence was independently associated with being a high school graduate, not sharing injection equipment, fewer depressive symptoms, positive attitudes toward antiretrovirals, higher self-efficacy for taking antiretrovirals as prescribed, and greater sense of responsibility to protect others from HIV. Medication errors were made by 54% (n = 346) and were strongly associated with a detectable viral load and fewer CD4 cells. Errors were independently associated with nonwhite race and with depressive symptoms, poorer self-efficacy for safer drug use, and worse attitudes toward HIV medications. Conclusions:Modifiable factors associated with poor adherence, including depressive symptoms and poor self-efficacy, should be targeted for intervention. Because medication errors are prevalent and associated with a detectable viral load and fewer CD4 cells, interventions should include particular efforts to identify medication taking inconsistent with antiretroviral prescriptions.
The development of mediadriven clinical skills through using the 'e-skills portfolio'

Background: The‘e-skills portfolio’ has been developed to give students the opportunity to engage in a creative approach to learning the distinctive core skills of: electrotherapy, manual therapy and therapeutic exercise. This paper aims to review the development and implementation of this e-skills portfolio within a pre-registration MSc physiotherapy programme. Content: Students work in small groups, and capture (through film or images) practice of clinical skills through simulation in the university setting. The analysis of the e-skills portfolio involved a pluralistic approach to: analysing data collected from two student discussion groups (n=21); reviewing submitted portfolio content; and teaching team reflections. Findings were then coded, and the emergent themes identified. Emergent themes from the data included assessment of skills and feedback, reflective practice, employment, continuing professional development through peer and self-coaching, and resource access. Conclusions: Engagement in compil.
Safety and immunogenicity of modified vaccinia Ankara (ACAM3000): effect of dose and route of administration.

BACKGROUND We conducted a clinical trial of the safety and immunogenicity of modified vaccinia Ankara (MVA) to examine the effects of dose and route of administration. METHODS Seventy-two healthy, vaccinia virus-naive subjects received 1 of 6 regimens of MVA (ACAM3000) or placebo consisting of 2 administrations given 1 month apart. RESULTS MVA was generally well tolerated at all dose levels and by all routes. More pronounced local reactogenicity was seen with the intradermal and subcutaneous routes than with intramuscular administration. Binding antibodies to whole virus and neutralizing antibodies to the intracellular mature virion and extracellular enveloped virion forms of vaccinia virus were elicited by all routes of MVA administration and were greater for the higher dose by each route. Similar levels of neutralizing antibodies were seen at a 10-fold-lower dose given intradermally (1 x 10(7) median tissue culture infective doses [TCID(50)]), compared with responses after 1 x 10(8) TCID(50) given intramuscularly or subcutaneously. T cell immune responses to vaccinia virus were detected by an interferon gamma enzyme-linked immunospot assay but had no clear relationship to dose or route. CONCLUSIONS These data suggest that intradermal immunization with MVA provides a dose-sparing effect by eliciting antibody responses similar in magnitude and kinetics to those elicited by the intramuscular or subcutaneous routes but at a 10-fold-lower dose.
Rapid diagnosis of tuberculous meningitis by T cell-based assays on peripheral blood and cerebrospinal fluid mononuclear cells.

BACKGROUND The role of the new Myocbacterium tuberculosis-specific enzyme-linked immunosorbent spot (ELISPOT) assay for diagnosis of tuberculous meningitis (TBM) has not yet been fully assessed. Here, we conducted a prospective, blinded, observational study to evaluate the diagnostic accuracy of this assay, compared with the conventional tests, for diagnosing TBM. METHODS All adult patients with suspected TBM were enrolled at a tertiary care hospital (Seoul, South Korea) during a 12-month period. ELISPOT assays were performed on peripheral mononuclear cells and mononuclear cells from cerebrospinal fluid (CSF). RESULTS Eighty-nine patients with suspected TBM were enrolled. Of these, 31 (35%) were classified as having TBM (10 confirmed, 6 highly probable, and 15 probable cases), and 55 (62%) were classified as not having active tuberculosis. The remaining 3 (3%) with possible TBM were excluded from the final analysis. The sensitivities and specificities, respectively, of the tested methods for diagnosing TBM were as follows: CSF adenosine deaminase level >5.8 U/L, 89% (95% confidence interval [CI], 69%-98%) and 73% (95% CI, 58%-84%); peripheral mononuclear cells ELISPOT, 71% (95% CI, 51%-86%) and 57% (95% CI, 42%-70%); and CSF mononuclear cells ELISPOT assay, 59% (95% CI, 36%-79%) and 89% (95% CI, 72%-98%). The combined sensitivity of an adenosine deaminase level >5.8 U/L or a positive peripheral mononuclear cells ELISPOT assay result was 94% (95% CI, 79%-99%), conferring a negative likelihood ratio of 0.14 (95% CI, 0.03-0.55) when both test results were negative. CONCLUSION ELISPOT assays using peripheral mononuclear cells and CSF mononuclear cells are useful adjuncts to the current tests for diagnosing TBM, particularly when used in combination with the assessment of adenosine deaminase level in CSF.
The oral management of oncology patients requiring radiotherapy, chemotherapy and/or bone marrow transplantation

Patients undergoing cancer therapy may experience unwanted side-effects involving the oral cavity and more evidence is emerging regarding the management of these complications. These oral effects have both short and long-term implications. Dentists need to be aware of these implications and liaise closely with the oncology teams to establish pathways of oral care. This enables patients to have appropriate dental support in place before, during and after cancer therapy. This article is an executive summary of a review undertaken for a national clinical guideline, The Oral Management of Oncology Patients following Radiotherapy, Chemotherapy and/or Bone Marrow Transplanation. The full text is available on the FDS website: www.rcseng. ac.uk/fds/publications-clinical-guidelines/clinical_guidelines/
Modelling the Effects of Pollution on a Population and a Resource in a Polluted Environment

A model for the effect of pollution on an animal population partially dependent on a plant resource is examined. Using a system of ordinary differential equations, the model tracks and relates changes in an animal population and its internal pollution levels, a plant population and its internal pollution levels, and the overall environmental pollution level. The model system is analysed using standard mathematical techniques, including the direct Lyapunov method and numerical simulations. Criteria for the stability of the system are found and numerically tested. Three inequalities are sufficient to establish global stability, and a parameter range exists in which these criteria are satisfied. The stability criteria dictate that the system will be globally stable provided that the removal rate of the pollution from the environment, the intrinsic growth rate of the plant population, and the rate the animal population relieves itself of its pollution are all sufficiently large.
Antibody persistence after serogroup C meningococcal conjugate immunization of United Kingdom primary-school children in 1999-2000 and response to a booster: a phase 4 clinical trial.

BACKGROUND After immunization with serogroup C meningococcal (MenC) conjugate vaccine, antibody responses and vaccine effectiveness are sustained in adolescents, in contrast to rapid waning in young children. We investigated the persistence of serum bactericidal antibody (SBA) titers in children 6 years after immunization with MenC vaccine (primed between 2 months and 6 years of age). The response to a Haemophilus influenzae type b-MenC conjugate (Hib-MenC) booster was also measured. METHODS A phase 4 clinical trial was conducted among 250 healthy 6-12-year-old children. SBA titers were measured before, 1 month after, and 1 year after Hib-MenC administration. The correlate of protection was an SBA titer of 8. RESULTS An SBA titer of 8 was observed in 61 (25% [95% confidence interval {CI}, 20%-30%]) of 244 participants (mean age, 9.1 years; mean interval since MenC immunization, 6.75 years). The proportion with an SBA titer of 8 and the SBA geometric mean titer increased with age, from 12% (95% CI, 4%-23%) to 48% (95% CI, 29%-67%) and from 2.90 (95% CI, 2.11-3.99) to 17.20 (95% CI, 6.80-43.5), respectively, from a mean age of 7.0 to 12.1 years. One month after the Hib-MenC booster, all participants had an SBA titer of 8, which was sustained in 99.6% at 1 year. CONCLUSIONS As a result of waning antibody, the majority of 6-12-year-old children in the United Kingdom have inadequate serological protection against MenC. The persistence of MenC immunity and the response to a Hib-MenC booster is dependent on age at priming. A booster was highly effective in this cohort and could sustain population immunity against MenC disease. Trial registration. Current Controlled Trials ( http://www.controlled-trials.com ) identifier: ISRCTN72858898 .
Dual chamber pacemaker implantation in dogs with atrioventricular block.

BACKGROUND Pacemaker implantation is the treatment of choice for symptomatic bradyarrhythmias. In dogs, a single chamber system is commonly used. In human patients with high-grade 2nd- or 3rd-degree atrioventricular (AV) block, physiologic pacing is recommended, because it improves cardiac output, blood pressure, exercise tolerance, and quality of life. In dogs, this type of pacing is seldom used. HYPOTHESIS The implantation of a dual chamber pacemaker in dogs with AV block is a feasible procedure for restoring AV synchrony. ANIMALS Thirty-three privately owned dogs with high-grade 2nd- or 3rd-degree AV block were included. METHODS Patient data of all dogs with AV block presented for pacemaker implantation between December 1997 and November 2004 were reviewed. RESULTS Dual chamber pacemaker implantation with AV synchronous stimulation was successfully performed in 33/33 dogs (100%). In 9/33 (27%) major and in 12/33 (36%) minor complications were observed. Mean survival time for the patients discharged from hospital (n = 32) was 33.6 +/- 20.4 months (range, 3.9-83.5 months). CONCLUSION AND CLINICAL IMPORTANCE Dual chamber pacing is a feasible procedure in dogs with 2nd- or 3rd-degree AV block and is not associated with a higher complication rate compared with single chamber pacemaker systems. A major advantage over ventricular demand pacemaker systems is the restoration of AV synchrony for a substantial period of time.
Safety of Switching Nevirapine Twice Daily to Nevirapine Once Daily in Virologically Suppressed Patients

Background:The strategy of switching nevirapine (NVP) twice daily to once daily was evaluated. Methods:Forty-eight-week randomized, open, multicenter trial. Stable HIV-infected patients on NVP twice daily for >12-18 weeks with alanine aminotransferase (ALT) <2.5, the upper normal limit were randomized to continue their regimen or switch to NVP 400 mg once daily. Primary end point was the proportion of ALT/aspartate transaminase (AST) ≥grade 3. Results:Two hundred eighty-nine patients were included, mean CD4 620 cells per microliter. Noninferiority was demonstrated in the per protocol analysis, with 97.9% (once daily) and 99.3% (twice daily) of patients event free (difference, 1.4%; 95% confidence interval, −1.95% to 5.4%), whereas 81.8% vs. 93.8% were event free by intent-to-treat switch = toxicity analysis (difference, 12%; 95% confidence interval, 4.6% to 19.4%). Only 4 patients (3 once daily, 1 twice daily) had NVP-related grade 3/4 ALT/AST increases, but in 2 of them (once daily), transaminases decreased despite continuation with NVP. Two other once daily patients presented grade 3/4 ALT/AST increase due to well-documented acute hepatitis A virus or hepatitis C virus infection. Grade 2 ALT/AST increases occurred in 11.2% (once daily) vs. 10.3% (twice daily) of patients (P = 0.80). A larger number of once daily patients were lost to follow-up/violated protocol (15% vs. 5%). Conclusions:In patients on standard twice daily NVP-containing regimens for at least 12-18 weeks, per protocol analysis showed that switching to once daily NVP was not inferior to continued twice daily NVP in terms of the predefined noninferiority margin of 10% for hepatotoxicity.
Epidemiological study of pestiviruses in South American camelids in Switzerland.

BACKGROUND In the context of the ongoing eradication campaign for bovine viral diarrhea virus (BVDV) in cattle in Switzerland, the role of South American camelids (SAC) as a possible virus reservoir needed to be evaluated. OBJECTIVE To assess and characterize the prevalence of pestivirus infections in SAC in Switzerland. ANIMALS Serum samples collected from 348 animals (40 herds) in 2008 and from 248 animals (39 herds) in 2000 were examined for antibodies against pestiviruses and for the presence of BVDV viral RNA. METHODS Cross-sectional study using stratified, representative herd sampling. An indirect BVDV-ELISA was used to analyze serum samples for pestivirus antibodies, and positive samples underwent a serum neutralization test (SNT). Real-time RT-PCR to detect pestiviral RNA was carried out in all animals from herds with at least 1 seropositive animal. RESULTS In 2008, the overall prevalence of animals positive for antibodies (ELISA) and pestiviral RNA or was 5.75 and 0%, respectively. In 2000, the corresponding prevalences were 3.63 and 0%, respectively. The seroprevalences (SNT) for BVDV, border disease virus or undetermined pestiviruses were estimated to be 0, 1.73, and 4.02% in 2008, and 0.40, 1.21, and 2.02% in 2000, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE At the present time, SAC appear to represent a negligible risk of re-infection for the BVDV eradication program in cattle in Switzerland.
Plasma corticosteroid profiling: brief opinion of its current status in clinical diagnosis and research

Adrenal steroid biosynthesis comprises a series of dynamically interrelated, enzyme-catalyzed reactions in two separate compartments, the zona glomerulosa and the zona fasciculata/reticularis. End products (cortisol, aldosterone and androgens), together with a proportion of the intermediate compounds, appear in the circulation as a characteristic profile. Rare deficiencies of individual enzymes modify this profile in a recognizable way. Previous exhaustive profiling suggests that their diagnosis can now often be made on the basis of single-compound analyses with concomitant genetic tests. However, high-capacity liquid chromatography coupled with tandem mass spectrometry-based methods are facilitating profiling of large population samples, revealing that smaller differences in enzyme efficiency, indicated by potentially more complex corticosteroid patterns, may be related to clinical wellbeing in a much larger proportion of the population.
Ontogenetic Diet Shifts Result in Niche Partitioning between Two Consumer Species Irrespective of Competitive Abilities

Tilman’s theory predicts the outcome of competition between two consumers sharing two resources on the basis of the shape of zero net‐growth isoclines (ZNGIs). In his theory, intraspecific differences in resource use are not accounted for. Here we extend this theory to include situations where organisms undergo ontogenetic diet shifts, as these characterize the life histories of many species. In a situation that without diet shifts would lead to neutral coexistence of consumer species, we investigate whether ontogenetic diet shifts lead to niche partitioning. We analyze a model describing competition for two resources between two competitors with distinctive diets over ontogeny, using copepods (showing ontogenetic diet shifts) and daphnids (not showing ontogenetic diet shifts) as appropriate representatives. We show that an ontogenetic diet shift affects the shape of the ZNGI, changing it from reflecting perfectly substitutable resources to reflecting essential resources. Furthermore, we show that resource supply determines population stage structure and stage‐dependent resource consumption in copepods and influences the competitive outcome with daphnids. In particular, we show that in itself, an ontogenetic diet shift can provide a competitive advantage if the supply of the adult resource is lower than the supply of the juvenile resource but that it always causes a disadvantage if the supply of the adult resource exceeds that of the juvenile resource.
Youth-Specific Considerations in the Development of Preexposure Prophylaxis, Microbicide, and Vaccine Research Trials

Preventing HIV infection in adolescents and young adults will require a multimodal targeted approach, including individual-directed behavioral risk reduction, community-level structural change, and biomedical interventions to prevent sexual transmission. Trials testing biomedical interventions to prevent HIV transmission will require special attention in this population due to the unique psychosocial and physiologic characteristics that differentiate them from older populations. For example, microbicide research will need to consider acceptability, dosing requirements, and coinfection rates that are unique to this population. Preexposure prophylaxis studies also will need to consider potential unique psychosocial issues such as sexual disinhibition and acceptability as well as unique pharmacokinetic parameters of antiretroviral agents. Vaccine trials also face unique issues with this population, including attitudes toward vaccines, risks related to false-positive HIV tests related to vaccine, and different immune responses based on more robust immunity. In this article, we will discuss issues around implementing each of these biomedical prevention modalities in trials among adolescents and young adults to help to guide future successful research targeting this population.
The Future of HIV Testing

HIV testing is the essential entry point for both treatment and prevention. The need to identify acute HIV infection (the period immediately after HIV acquisition, when persons are most infectious) and HIV-2 infection, which does not respond to many first-line antiretroviral agents, poses challenges for the traditional algorithm of Western blot confirmation after a repeatedly reactive antibody screening test. Immunoassays that detect antibodies earlier, tests for HIV RNA, and combination assays that screen simultaneously for both p24 antigen and HIV antibody are now approved for HIV diagnosis by the Food and Drug Administration. A revised testing algorithm can address the challenges posed by acute infection, HIV-2 infection, and the shortcomings of the Western blot. These new diagnostic strategies will allow earlier more accurate identification of infected persons so that they can benefit from effective treatment and also enhance abilities to focus prevention efforts where HIV transmission is most active.
Electronic Prediction Rules for Methicillin-Resistant Staphylococcus aureus Colonization

Background. Considerable hospital resources are dedicated to minimizing the number of methicillin-resistant Staphylococcus aureus (MRSA) infections. One tool that is commonly used to achieve this goal is surveillance for MRSA colonization. This process is costly, and false-positive test results lead to isolation of individuals who do not carry MRSA. The performance of this technique would improve if patients who are at high risk of colonization could be readily targeted. Methods. Five MRSA colonization prediction rules of varying complexity were derived in a population of 23,314 patients who were consecutively admitted to a US hospital and tested for colonization. Rules incorporated only prospectively collected, structured electronic data found in a patient's record within 1 day of hospital admission. These rules were tested in a validation cohort of 26,650 patients who were admitted to 2 other hospitals. Results. The prevalence of MRSA at hospital admission was 2.2% and 4.0% in the derivation and validation cohorts, respectively. Multivariable modeling identified predictors of MRSA colonization among demographic, admission-related, pharmacologic, laboratory, physiologic, and historical variables. Five prediction rules varied in their performance, but each could be used to identify the 30% of patients who accounted for greater than 60% of all cases of MRSA colonization and approximately 70% of all MRSA-associated patient-days. Most rules could also identify the 20% of patients with a greater than 8% chance of colonization and the 40% of patients among whom colonization prevalence was 2% or less. Conclusions. We report electronic prediction rules that can fully automate triage of patients for MRSA-related hospital admission testing and that offer significant improvements on previously reported rules. The efficiencies introduced may result in savings to infection control programs with little sacrifice in effectiveness.
Strength Training in Adult Elite Tennis Players

T ennis is today one of the most widespread and popular competitive sports (19). As a consequence, strength training and conditioning has become vital in contemporary tennis as the game continues to increase in terms of velocity and power (2, 9, 22). Research has shown that strength training can improve players’ maximal force and power production, reduce the incidence of injuries, and contribute to faster recovery times, thereby minimizing the number of missed practice sessions and competitions (22). The purpose of the current paper is to discuss different approaches towards the design of effective strength training programs in modern tennis in order to develop basic and specific strength efficiently and to prevent injuries. Strength Demands in Tennis The main goals of strength training in tennis are outlined in Table 1 and comprise the development of power, muscular endurance, and maximum strength. Several authors (2, 4, 9, 14, 19, 22) have characterized tennis as a game in which players must respond skillfully to a continuous series of emergencies, such as sprinting to the ball, reaching, jumping, lunging, changing directions, stopping, and starting. Furthermore, because these power skills must be performed over long periods, muscular endurance is also important to maintain high performance. Additionally, it has been suggested that performing strength training with heavy loads will bring about beneficial neuromuscular adaptations (8, 10, 21, 27) that may play an important role in developing powerful movements (23, 26, 27). In fact, maximum strength training efforts result in a higher recruitment of motor units and an increased firing rate of motor neurons (21, 27).