Miracle-dz/UniFAR-FTUs huggingface dataset:
Patient Outcomes at 26 Months in the Patient-Centered Medical Home National Demonstration Project

PURPOSE The purpose of this study was to evaluate patient outcomes in the National Demonstration Project (NDP) of practices’ transition to patient-centered medical homes (PCMHs). METHODS In 2006, a total of 36 family practices were randomized to facilitated or self-directed intervention groups. Progress toward the PCMH was measured by independent assessments of how many of 39 predominantly technological NDP model components the practices adopted. We evaluated 2 types of patient outcomes with repeated cross-sectional surveys and medical record audits at baseline, 9 months, and 26 months: patient-rated outcomes and condition-specific quality of care outcomes. Patient-rated outcomes included core primary care attributes, patient empowerment, general health status, and satisfaction with the service relationship. Condition-specific outcomes were measures of the quality of care from the Ambulatory Care Quality Alliance (ACQA) Starter Set and measures of delivery of clinical preventive services and chronic disease care. RESULTS Practices adopted substantial numbers of NDP components over 26 months. Facilitated practices adopted more new components on average than self-directed practices (10.7 components vs 7.7 components, P=.005). ACQA scores improved over time in both groups (by 8.3% in the facilitated group and by 9.1% in the self-directed group, P <.0001) as did chronic care scores (by 5.2% in the facilitated group and by 5.0% in the self-directed group, P=.002), with no significant differences between groups. There were no improvements in patient-rated outcomes. Adoption of PCMH components was associated with improved access (standardized beta [Sβ]=0.32, P = .04) and better prevention scores (Sβ=0.42, P=.001), ACQA scores (Sβ=0.45, P = .007), and chronic care scores (Sβ=0.25, P =.08). CONCLUSIONS After slightly more than 2 years, implementation of PCMH components, whether by facilitation or practice self-direction, was associated with small improvements in condition-specific quality of care but not patient experience. PCMH models that call for practice change without altering the broader delivery system may not achieve their intended results, at least in the short term.
Exposição múltipla a agrotóxicos e efeitos à saúde: estudo transversal em amostra de 102 trabalhadores rurais, Nova Friburgo, RJ

Um estudo transversal foi realizado em uma comunidade agricola localizada em Nova Friburgo, RJ, para conhecer os aspectos epidemiologicos, clinicos e laboratoriais da exposicao multipla a agrotoxicos em uma amostra representativa de 102 pequenos agricultores, de ambos os sexos. Os trabalhadores foram submetidos a um extenso protocolo que incluia aplicacao de questionario ocupacional, coleta de amostras biologicas para exame toxicologico e avaliacao clinica - geral e neurologica. Os resultados dos exames toxicologicos revelaram episodios leves a moderados de intoxicacao aguda aos organofosforados descritos pelos agricultores ou observados durante o exame clinico. Foram tambem diagnosticados 13 (12,8 %) quadros de neuropatia tardia e 29 (28,5%) quadros de sindrome neurocomportamental e disturbios neuropsiquiatricos associados ao uso cronico de agrotoxicos. Os resultados apontam para a ocorrencia de episodios recorrentes de sobre-exposicao multipla, a elevadas concentracoes de diversos produtos quimicos, com grave prejuizo para as funcoes vitais desses trabalhadores, especialmente por se encontrarem em uma faixa etaria jovem (media = 35 ± 11anos) e periodo produtivo da vida. Estes dados demonstram a importância do monitoramento da multipla exposicao a agrotoxicos, uma cadeia de eventos de grande repercussao na saude publica e para o meio ambiente.
Contribution of Organized Sports Participation to Estimated Daily Energy Expenditure in Youth

The contribution of organized sport participation to the total daily energy expenditure (TDEE) of youth was estimated in a sample of 90 males and 93 females, 12-14 years of age. TDEE and moderate-to-vigorous energy expenditure (MVEE) were estimated using a 3-day activity record. Males expended 20.4% of TDEE in youth sports; the corresponding estimate for females was 16.3%. Males and females expended 55% and 64.6%, respectively, of MVEE in youth sports. Youth who participated in organized sports had greater TDEE and MVEE, and spent less time watching television than those who did not participate. Thus, organized sport participation appears to be a significant component of daily energy expenditure among youth.
Relationship Between Clinical Quality and Patient Experience: Analysis of Data From the English Quality and Outcomes Framework and the National GP Patient Survey

PURPOSE Clinical quality and patient experience are both widely used to evaluate the quality of health care, but the relationship between these 2 domains remains uncertain. The aim of this study was to examine this relationship using data from 2 established measures of quality in primary care in England. METHODS Practice-level analyses (N = 7,759 practices in England) were conducted on measures of patient experience from the national General Practice Patient Survey (GPPS), and measures of clinical quality from the national pay-for-performance scheme (Quality and Outcomes Framework). Spearman’s rank correlation and multiple linear regression were used on practice-level estimates. RESULTS Although all the correlations between clinical quality summary scores and patient survey scores are positive, and most are statistically significant, the strength of the associations was weak, with the highest correlation coefficient reaching 0.18, and more than one-half were 0.11 or less. Correlations with clinical quality were highest for patient-reported access scores (telephone access 0.16, availability of urgent appointments 0.15, ability to book ahead 0.18, ability to see preferred doctor 0.17) and overall satisfaction (0.15). CONCLUSION Although there are associations between clinical quality and measures of patient experience, the 2 domains of care quality remain predominantly distinct. The strongest correlations are observed between practice clinical quality and practice access, with very low correlations between clinical quality and interpersonal aspects of care. The quality of clinical care and the quality of interpersonal care should be considered separately to give an overall assessment of medical care.
Cannabis and Young Users—A Brief Intervention to Reduce Their Consumption (CANABIC): A Cluster Randomized Controlled Trial in Primary Care

PURPOSE Brief intervention to reduce cannabis is a promising technique that could be adapted for use in primary care, but it has not been well studied in this setting. We tested the efficacy of a brief intervention conducted by general practitioners among cannabis users aged 15 to 25 years. METHODS We performed a cluster randomized controlled trial with 77 general practitioners in France. The intervention consisted of an interview designed according to the FRAMES (feedback, responsibility, advice, menu, empathy, self-efficacy) model, while the control condition consisted of routine care. RESULTS The general practitioners screened and followed up 261 young cannabis users. After 1 year, there was no significant difference between the intervention and control groups in the median number of joints smoked per month among all users (17.5 vs 17.5; P = .13), but there was a difference in favor of the intervention among nondaily users (3 vs 10; P = .01). After 6 months, the intervention was associated with a more favorable change from baseline in the number of joints smoked (−33.3% vs 0%, P = .01) and, among users younger than age of 18, smoking of fewer joints per month (12.5 vs 20, P = .04). CONCLUSIONS Our findings suggest that a brief intervention conducted by general practitioners with French young cannabis users does not affect use overall. They do, however, strongly support use of brief intervention for younger users and for moderate users.
‘Be Gentle and Be Sincere About It’: A Story About Community-Based Primary Care Research

Practice-based researchers in primry care have increasingly recognized the need to include community members in research efforts. In this reflective vignette, the importance of community engagement is realized through the researcher’s ability to elicit and interpret an alternative story told by a respected local resident in a focus group. The focus group was part of a study examining communication between patients and clinicians about traditional medicine in New Mexico. During this session, yerba mansa, a plant used in traditional medicine, became a powerful cultural metaphor for expressing concerns about the intentions of outside researchers. This story shows how creating opportunities for sustained engagement with the people we serve can lead to more sensitive ways to establish research partnerships.
The Effects of Barley-Derived Soluble Fiber on Serum Lipids

PURPOSE We wanted to determine the association between consumption of barley and changes in plasma lipids in healthy and hypercholesterolemic men and women. METHODS A systematic literature search was conducted from the earliest possible date through January 2008. Trials were included in the analysis if they were randomized controlled trials of barley that reported efficacy data on at least 1 lipid endpoint. A DerSimonian and Laird random-effects model was used in calculating the weighted mean difference (WMD) and its 95% confidence interval (CI). Statistical heterogeneity was addressed using the I2 statistic. Visual inspection of funnel plots, Egger’s weighted regression statistics, and the trim and fill method were used to assess for publication bias. RESULTS We found 8 trials (n = 391 patients) of 4 to 12 weeks’ duration evaluating the lipid-reducing effects of barley. The use of barley significantly lowered total cholesterol (weighted mean difference [WMD], −13.38 mg/dL; 95% CI, −18.46 to −8.31 mg/dL), low-density lipoprotein (LDL) cholesterol (WMD, −10.02 mg/dL; 95% CI, −14.03 to −6.00 mg/dL) and triglycerides (WMD, −11.83 mg/dL; 95% CI, −20.12 to −3.55 mg/dL) but did not appear to significantly alter high-density lipoprotein (HDL) cholesterol (P=.07). CONCLUSION Barley-derived β-glucan appears to beneficially affect total cholesterol, LDL-cholesterol, and triglycerides, but not HDL-cholesterol.
Robust Unidirectional Airflow through Avian Lungs: New Insights from a Piecewise Linear Mathematical Model

Avian lungs are remarkably different from mammalian lungs in that air flows unidirectionally through rigid tubes in which gas exchange occurs. Experimental observations have been able to determine the pattern of gas flow in the respiratory system, but understanding how the flow pattern is generated and determining the factors contributing to the observed dynamics remains elusive. It has been hypothesized that the unidirectional flow is due to aerodynamic valving during inspiration and expiration, resulting from the anatomical structure and the fluid dynamics involved, however, theoretical studies to back up this hypothesis are lacking. We have constructed a novel mathematical model of the airflow in the avian respiratory system that can produce unidirectional flow which is robust to changes in model parameters, breathing frequency and breathing amplitude. The model consists of two piecewise linear ordinary differential equations with lumped parameters and discontinuous, flow-dependent resistances that mimic the experimental observations. Using dynamical systems techniques and numerical analysis, we show that unidirectional flow can be produced by either effective inspiratory or effective expiratory valving, but that both inspiratory and expiratory valving are required to produce the high efficiencies of flows observed in avian lungs. We further show that the efficacy of the inspiratory and expiratory valving depends on airsac compliances and airflow resistances that may not be located in the immediate area of the valving. Our model provides additional novel insights; for example, we show that physiologically realistic resistance values lead to efficiencies that are close to maximum, and that when the relative lumped compliances of the caudal and cranial airsacs vary, it affects the timing of the airflow across the gas exchange area. These and other insights obtained by our study significantly enhance our understanding of the operation of the avian respiratory system.
Effects of Darwinian Selection and Mutability on Rate of Broadly Neutralizing Antibody Evolution during HIV-1 Infection

Accumulation of somatic mutations in antibody variable regions is critical for antibody affinity maturation, with HIV-1 broadly neutralizing antibodies (bnAbs) generally requiring years to develop. We recently found that the rate at which mutations accumulate decreases over time, but the mechanism governing this slowing is unclear. In this study, we investigated whether natural selection and/or mutability of the antibody variable region contributed significantly to observed decrease in rate. We used longitudinally sampled sequences of immunoglobulin transcripts of single lineages from each of 3 donors, as determined by next generation sequencing. We estimated the evolutionary rates of the complementarity determining regions (CDRs), which are most significant for functional selection, and found they evolved about 1.5- to 2- fold faster than the framework regions. We also analyzed the presence of AID hotspots and coldspots at different points in lineage development and observed an average decrease in mutability of less than 10 percent over time. Altogether, the correlation between Darwinian selection strength and evolutionary rate trended toward significance, especially for CDRs, but cannot fully explain the observed changes in evolutionary rate. The mutability modulated by AID hotspots and coldspots changes correlated only weakly with evolutionary rates. The combined effects of Darwinian selection and mutability contribute substantially to, but do not fully explain, evolutionary rate change for HIV-1-targeting bnAb lineages.
Magnetic Resonance Cell-Tracking Studies: Spectrophotometry-Based Method for the Quantification of Cellular Iron Content after Loading with Superparamagnetic Iron Oxide Nanoparticles

The purpose of this article is to present a user-friendly tool for quantifying the iron content of superparamagnetic labeled cells before cell tracking by magnetic resonance imaging (MRI). Iron quantification was evaluated by using Prussian blue staining and spectrophotometry. White blood cells were labeled with superparamagnetic iron oxide (SPIO) nanoparticles. Labeling was confirmed by light microscopy. Subsequently, the cells were embedded in a phantom and scanned on a 3 T magnetic resonance tomography (MRT) whole-body system. Mean peak wavelengths Λpeak was determined at A720nm (range 719–722 nm). Linearity was proven for the measuring range 0.5 to 10 μg Fe/mL (r = .9958; p = 2.2 × 10−12). The limit of detection was 0.01 μg Fe/mL (0.1785 mM), and the limit of quantification was 0.04 μg Fe/mL (0.714 mM). Accuracy was demonstrated by comparison with atomic absorption spectrometry. Precision and robustness were also proven. On T2-weighted images, signal intensity varied according to the iron concentration of SPIO-labeled cells. Absorption spectrophotometry is both a highly sensitive and user-friendly technique that is feasible for quantifying the iron content of magnetically labeled cells. The presented data suggest that spectrophotometry is a promising tool for promoting the implementation of magnetic resonance-based cell tracking in routine clinical applications (from bench to bedside).
Neuroimagem do transportador de dopamina na doença de Parkinson: primeiro estudo com [99mTc]-TRODAT-1 e SPECT no Brasil

BACKGROUND: Dopamine transporter (DAT) neuroimaging radiotracers were developed to estimate dopamine neuronal loss in vivo in Parkinsons disease (PD). OBJECTIVE: To evaluate DAT density in vivo using [99mTc]-TRODAT-1 and single photon computerized tomography (SPECT) in a population of Brazilian PD. METHOD: Fifteen PD patients and 15 matched healthy controls scanned with [99mTc]-TRODAT-1 (INER-Taiwan) and SPECT. Estimates of striatum DAT density were calculated using binding potential (BP). Patients were assessed with PD scales. RESULTS: PD patients had significantly lower striatal DAT-BP (mean±SD) (0.38±0.12) compared to controls (BP=0.84±0.16; p<0.01). A 100% sensitivity and 100% specificity was obtained to discriminate PD cases from controls. Negative correlations between striatal DAT-BP and PD severity (rho= -0.7, p<0.001) and motor scales (rho= -0.80, p<0.001) were found. CONCLUSION: [99mTc]TRODAT-1 SPECTs scanning was able to discriminate PD patients from controls. The technique is a powerful instrument to measure DAT density that can be used in clinical and research settings in Brazil.
Correlation of diagnostic efficacy of unhealthy cervix by cytology, colposcopy and histopathology in women of rural areas -

Background: The objective was to assess the sensitivity and specificity of pap smear and colposcopy and to study the socio demographic parameters of women with unhealthy cervix. Methods: This was a prospective observational study conducted from August 2011 – August 2013 in the Department of Obstetrics and Gynaecology. Pap smear was performed by the conventional method and colposcopy was done for all 200 sexually active women who came with complaints of discharge per vagina, inter menstrual or post coital bleeding. Colposcopy results were analysed. Final correlation of pap smear and colposcopy were based on histopathology. Results: There were 200 samples that were suitable for statistical analysis. The sensitivity of colposcopy was 79.37%, specificity 81.02%, positive predictive value 65.79%, negative predictive value 89.52% respectively and accuracy was 80.5%. Pap smear had a sensitivity of 25.4%, specificity of 99.27%, positive predictive value of 94.12%, negative predictive value of 74.32%, and accuracy of 76.0% respectively. Conclusions: Pap smear had a poorer sensitivity compared to Colposcopy but a better specificity than colposcopy. Hence it may be better to utilise both tests as they complement each other in screening of premalignant lesions of cervix.
Review of Phase II and Phase III clinical trials for Duchenne muscular dystrophy

Introduction: Evidence-based therapeutics in Duchenne muscular dystrophy (DMD) has been limited to corticosteroids for the past 30 years. There have been a host of other therapeutic interventions studied in mice, canines and more recently humans, but they are yet to show effectiveness in clinical trials. Newer genetic approaches are in early stages of clinical trials. Areas covered: In this paper, the authors review evidence-based studies for corticosteroids as well as other Phase II and Phase III clinical trials involving potential pharmacologic treatments: myostatin and phosphodiesterase inhibitors, insulin-like growth factor 1 and replenishment of nutritional deficiencies. Finally, the authors briefly review the current status of treatments specific for genetic mutations and gene therapy. Expert opinion: Since the identification of corticosteroids as an effective treatment for DMD, there has not yet been another pharmacologic intervention that has shown as much benefit, although further investigation is needed for some of the mentioned therapeutics. New therapies will need to show a significantly greater sustained benefit for our DMD patients with cost effectiveness, in order for them to supplant or reduce the use of long-term corticosteroid treatment. While studying new therapeutics, further study and trials in corticosteroids should not be lost.
Role of MicroRNA 1207-5P and Its Host Gene, the Long Non-Coding RNA Pvt1, as Mediators of Extracellular Matrix Accumulation in the Kidney: Implications for Diabetic Nephropathy

Diabetic nephropathy is the most common cause of chronic kidney failure and end-stage renal disease in the Western World. One of the major characteristics of this disease is the excessive accumulation of extracellular matrix (ECM) in the kidney glomeruli. While both environmental and genetic determinants are recognized for their role in the development of diabetic nephropathy, epigenetic factors, such as DNA methylation, long non-coding RNAs, and microRNAs, have also recently been found to underlie some of the biological mechanisms, including ECM accumulation, leading to the disease. We previously found that a long non-coding RNA, the plasmacytoma variant translocation 1 (PVT1), increases plasminogen activator inhibitor 1 (PAI-1) and transforming growth factor beta 1 (TGF-β1) in mesangial cells, the two main contributors to ECM accumulation in the glomeruli under hyperglycemic conditions, as well as fibronectin 1 (FN1), a major ECM component. Here, we report that miR-1207-5p, a PVT1-derived microRNA, is abundantly expressed in kidney cells, and is upregulated by glucose and TGF-β1. We also found that like PVT1, miR-1207-5p increases expression of TGF-β1, PAI-1, and FN1 but in a manner that is independent of its host gene. In addition, regulation of miR-1207-5p expression by glucose and TGFβ1 is independent of PVT1. These results provide evidence supporting important roles for miR-1207-5p and its host gene in the complex pathogenesis of diabetic nephropathy.
Associations Between Genetic Variants in Vitamin D Metabolism and Asthma Characteristics in Young African Americans

Introduction Low vitamin D levels have been associated with asthma severity in children. Young, urban African Americans (AAs) have high rates of hypovitaminosis D and asthma. Our objective was to determine associations between variants in vitamin D metabolism genes and asthma characteristics in a pilot study of young urban AAs. Materials and Methods Two urban AA cohorts of subjects aged 6 to 20 years (139 subjects with asthma and 74 subjects without asthma) were genotyped for 12 single nucleotide polymorphisms (SNPs) in 3 vitamin D metabolism genes: VDR (vitamin D receptor), CYP24A1 (cytochrome P450 vitamin D 24-hydroxylase), and CYP2R1 (cytochrome P450 vitamin D 25-hydroxylase). In a case-control analysis, SNPs were studied for associations with an asthma diagnosis. Within the asthmatic cohort, SNPs were analyzed for associations with quantitative asthma characteristics. All analyses were adjusted for age, sex, and body mass index percentile. Results Only the CYP2R1 SNP rs10766197 homozygous minor genotype was associated with asthma (P = 0.044). CYP24A1 SNP rs2248137 was associated with lower vitamin D levels (P = 0.006). Within the asthma cohort, multiple significant associations between SNPs and asthma characteristics were identified; VDR SNP rs2228570 was associated with the higher nighttime asthma morbidity scores (P = 0.04), lower baseline spirometric measures (P < 0.05), 1 or more positive aeroallergen skin test (P = 0.003), and increased immunoglobulin E levels (P < 0.001). Discussion This pilot study demonstrates that variants in vitamin D metabolism genes are associated with quantitative asthma characteristics in young, urban AAs. The collection of these associations provides evidence for the need for a large population-based study of vitamin D-relevant SNPs in this cohort.
Jordanians knowledge and beliefs about cancer

Purpose: This survey aims to describe the knowledge and beliefs toward cancer prevention and care in Jordan. Methods: A representative sample of the population from the three main regions of Jordan was used. The total number of household members was 19,266 individuals, from them, 3,196 participants were interviewed. Results: The results indicated that knowledge gaps and improper practices toward cancer existed among the participants, and if corrected, could facilitate the care, prevention and early detection of cancer. Conclusions: The findings of this study may help in identifying the current KAPs toward cancer among Jordanians. Recommendations: The findings may help in providing high quality care to patients with cancer and their families, and evidence-based recommendations to public health officials in Jordan. Keywords: practices, Jordanians, cancer, beliefs.