Miracle-dz/UniFAR-FTUs huggingface dataset:
The Impact of High-Frequency Chest Wall Oscillation on Healthcare Use in Patients with Neuromuscular Diseases.

RATIONALE People with neuromuscular disease frequently have difficulty clearing pulmonary secretions, which leads to pneumonia and respiratory failure. High-frequency chest wall oscillation (HFCWO) is one intervention used to facilitate secretion clearance. OBJECTIVES The objective of this study was to determine if HFCWO therapy leads to improved outcomes as measured by lower healthcare use for patients who have a chronic neuromuscular disease. METHODS We performed a cohort study comparing healthcare claims before and after initiation of HFCWO. Data were obtained from two large databases of commercial insurance claims. Study subjects were commercial insurance members with an International Classification of Diseases, Ninth Revision, code for a neuromuscular disease and a claim for HFCWO between 2007 and 2011. The study included both children and adults. MEASUREMENTS AND MAIN RESULTS There were 426 patients in this study. Their mean age was 29.9 ± 22 years. Total medical costs per member per month decreased by $1,949 (18.6%) after initiation of HFCWO (P = 0.002). Inpatient admission costs decreased by $2,392 (41.7%) (P = 0.001), and pneumonia costs decreased by $514 (18.1%) (P = 0.015). To account for the possibilities of misclassification based on diagnosis and bias due to loss to follow-up, we compared outcomes between those lost to follow-up and those not, and we found similar results. CONCLUSIONS Total medical costs, hospitalizations, and pneumonia claims were less after than before initiation of HFCWO in a broad group of patients with neuromuscular disease. Subject to the limitations that administrative data did not capture how HFCWO was used and that HFCWO may be a marker of generally better care, our findings lend support to the routine use of this intervention in the care of patients with neuromuscular diseases.
The Psychosocial Effects of Bone Marrow Transplantation in Children

It is a problem in a rapidly advancing field such as immunology that for fear of being controversial or out of date authors fail to set down aspects of new research which are of great potential relevance to clinical practice for the benefit of practitioners. It is therefore not only timely but also courageous that two specialists should set down their personal clinical practice in a format designed to be accessible to the clinician with broader interests than immunology alone. The book is a pocket sized manual which opens with a resume of basic immunology and the investigation of primary immunodeficiency, then covers the immunological aspects of investigation of diseases ofeach of the major organ systems in a series of 11 concise chapters and concludes with a very useful summary chapter of the major laboratory immunological investigations in clinical use, complete with paediatric normal ranges and types of specimen required. It is well referenced throughout to major easily accessible sources of further information, and the text is well supported by numerous figures and tables. For the most part chapters are divided into sections on each major disease or group. This layout makes the book, as the tide states, a handbook of investigations and not of diagnosis. A typical section opens with some comments on the immunopathogenesis of the condition, lists the investigations of potential relevance, and then enlarges on each of them in turn, discussing the value of the test and the likely significance of possible results. This makes access to information easy for the reader using the book as a quick reference, although a little familiarity with the contents, or use of the index, is necessary to know that, for example, asthma is dealt with under allergic disease rather than respiratory disorders and sudden infant death syndrome under respiratory disorders rather than infections. To a large extent the authors have overcome these inevitable classification problems by the judicious use of repetition and cross referencing. Reasons a paediatrician may have for performing immunological investigations on a child vary between the extremes of elucidating the underlying defect in a rare and untreatable disorder and detecting a well defined abnormality which indicates an established treatment. In addition, most of us must at some time have experienced the frustration of receiving a result of an immunological test which no-one seems to be able to interpret! This book treads a useful middle path in providing a fairly comprehensive guide to the current repertoire of investigations while emphasising the diagnostic value of some and the uncertain significance of others. It will constitute a considerable improvement on relying on occasional review articles in clinical journals and the ancient edition of Roitt's Essential Immunology most of us have lurking on our shelves from medical school days.
Cytomegalovirus (CMV) Epitope–Specific CD4+ T Cells Are Inflated in HIV+ CMV+ Subjects

Select CMV epitopes drive life-long CD8+ T cell memory inflation, but the extent of CD4 memory inflation is poorly studied. CD4+ T cells specific for human CMV (HCMV) are elevated in HIV+ HCMV+ subjects. To determine whether HCMV epitope–specific CD4+ T cell memory inflation occurs during HIV infection, we used HLA-DR7 (DRB1*07:01) tetramers loaded with the glycoprotein B DYSNTHSTRYV (DYS) epitope to characterize circulating CD4+ T cells in coinfected HLA-DR7+ long-term nonprogressor HIV subjects with undetectable HCMV plasma viremia. DYS-specific CD4+ T cells were inflated among these HIV+ subjects compared with those from an HIV− HCMV+ HLA-DR7+ cohort or with HLA-DR7–restricted CD4+ T cells from the HIV-coinfected cohort that were specific for epitopes of HCMV phosphoprotein-65, tetanus toxoid precursor, EBV nuclear Ag 2, or HIV gag protein. Inflated DYS-specific CD4+ T cells consisted of effector memory or effector memory–RA+ subsets with restricted TCRβ usage and nearly monoclonal CDR3 containing novel conserved amino acids. Expression of this near-monoclonal TCR in a Jurkat cell–transfection system validated fine DYS specificity. Inflated cells were polyfunctional, not senescent, and displayed high ex vivo levels of granzyme B, CX3CR1, CD38, or HLA-DR but less often coexpressed CD38+ and HLA-DR+. The inflation mechanism did not involve apoptosis suppression, increased proliferation, or HIV gag cross-reactivity. Instead, the findings suggest that intermittent or chronic expression of epitopes, such as DYS, drive inflation of activated CD4+ T cells that home to endothelial cells and have the potential to mediate cytotoxicity and vascular disease.
Innate Immune Activation by cGMP-AMP Nanoparticles Leads to Potent and Long-Acting Antiretroviral Response against HIV-1

HIV-1 evades immune detection by the cGAS-STING cytosolic DNA-sensing pathway during acute infection. STING is a critical mediator of type I IFN production, and STING agonists such as cGMP-AMP (cGAMP) and other cyclic dinucleotides elicit potent immune and antitumor response. In this article, we show that administration of cGAMP, delivered by an ultra–pH-sensitive nanoparticle (NP; PC7A), in human PBMCs induces potent and long-acting antiretroviral response against several laboratory-adapted and clinical HIV-1 isolates. cGAMP-PC7A NP requires endocytosis for intracellular delivery and immune signaling activation. cGAMP-PC7A NP-induced protection is mediated through type I IFN signaling and requires monocytes in PBMCs. cGAMP-PC7A NPs also inhibit HIV-1 replication in HIV+ patient PBMCs after ex vivo reactivation. Because pattern recognition receptor agonists continue to show more clinical benefits than the traditional IFN therapy, our data present important evidence for potentially developing cGAMP or other STING agonists as a new class of immune-stimulating long-acting antiretroviral agents.
Possible False Negative Results in Conditioned Place Preference Induced by Low-dose Morphine in Mice

Conditioned Place Preference (CPP) is an easy-to-run experiment that is widely used to detect the reinforcing property of drugs. Most CPP experiments have employed post-training tests without drug injection. Here, a post-training test with drug injection was employed. C57/BL6 mice received CPP training with 0.3 mg/Kg or 3.0 mg/Kg morphine and were then tested three times: without morphine, with 0.3 mg/Kg morphine, and with 3.0 mg/Kg morphine. The mice trained with 0.3 mg/Kg did not show a significant increase in staying time at the drug-associated compartment in the drug-free test, but a significant increase was found in tests with the drug. The mice trained with 3.0 mg/Kg morphine showed conditioned preference in all tests and displayed enhancement of the conditioned preference in tests with the drug. The animals experienced environmental cues under the influence of the drug during the CPP training but were exposed to cues without the drug in the drug-free test. Thus negative results obtained in the post-training drug-free test may have been caused by differences in the stimuli the animals experienced.
IL-1α and IL-1β Are Endogenous Mediators Linking Cell Injury to the Adaptive Alloimmune Response1

Preoperative or perioperative ischemic injury of allografts predisposes to graft arteriosclerosis, the major cause of late graft failure. We hypothesize that injured tissues release mediators that increase the production of pathogenic cytokines by alloreactive T cells. We find that freeze-thaw lysates of human endothelial cells (EC) increase both IFN-γ and IL-17 production by human CD4+ T cells activated by HLA-DR+ allogeneic EC. Immunoadsorption of high-mobility group box 1 protein (HMGB1) reduces this activity in the lysates by about one-third, and recombinant HMGB1 increases T cell cytokine production. HMGB1 acts by inducing IL-1β secretion from contaminating monocytes via TLR4 and CD14. Upon removal of contaminating monocytes, the remaining stimulatory activity of EC lysates is largely attributable to IL-1α. Recombinant IL-1 directly augments IFN-γ and IL-17 production by activated memory CD4+ T cells, which express IL-1R1. Furthermore, IL-1 increases the frequency of alloreactive memory CD4+ T cells that produce IL-17, but not those that produce IFN-γ, in secondary cultures. Our results suggest that IL-1, released by injured EC or by HMGB1-stimulated monocytes, is a key link between injury and enhanced alloimmunity, offering a new therapeutic target for preventing late graft failure.
Planning the mode of delivery for twin pregnancies: A web-based questionnaire

Using orthogonal design, we created a questionnaire containing 16 cases of twin pregnancies. For each case, respondents indicated whether they would plan a vaginal delivery (VD) or a caesarean section (CS). We assessed the association between each variable (maternal age, parity, mode of conception, gestational age, chorionicity, body mass index, foetal growth, foetal presentation and wish for additional children) and the planned mode of delivery. A VD was planned mostly for vertex presentation of twin A (vertex–vertex vs. non-vertex–vertex, odds ratio [OR]: 0.002, 95% confidence interval [CI]: 0.001–0.003, p < 0.001). For vertex– non-vertex (vs. vertex–vertex) presentation, chances on planning a VD decreased threefold (OR: 0.29, 95% CI: 0.018–0.46, p < 0.001), although the majority of respondents would still plan a VD. In multiparous (vs. nulliparous) women, VD was chosen more often (OR: 3.24, 95% CI: 2.50–4.18, p < 0.001). Vertex presentation of twin A and multiparity were the main reasons for planning a VD.
Gene Expression Profiling of Bronchoalveolar Lavage Cells Preceding a Clinical Diagnosis of Chronic Lung Allograft Dysfunction.

Background Chronic Lung Allograft Dysfunction (CLAD) is the main limitation to long-term survival after lung transplantation. Although CLAD is usually not responsive to treatment, earlier identification may improve treatment prospects. Methods In a nested case control study, 1-year post transplant surveillance bronchoalveolar lavage (BAL) fluid samples were obtained from incipient CLAD (n = 9) and CLAD free (n = 8) lung transplant recipients. Incipient CLAD cases were diagnosed with CLAD within 2 years, while controls were free from CLAD for at least 4 years following bronchoscopy. Transcription profiles in the BAL cell pellets were assayed with the HG-U133 Plus 2.0 microarray (Affymetrix). Differential gene expression analysis, based on an absolute fold change (incipient CLAD vs no CLAD) > 2.0 and an unadjusted p-value (cid:20) 0.05, generated a candidate list containing 55 differentially expressed probe sets (51 up-regulated, 4 down-regulated). These findings suggest that a pathobiology, similar to AR, precedes a clinical diagnosis of CLAD. A larger prospective investigation of the BAL cell pellet transcriptome as a biomarker for CLAD risk stratification is warranted.
Management of female urinary incontinence: A survey of urogynaecologists’ view on the NICE guideline

We conducted a survey to obtain the opinions of urogynaecologists regarding the National Institute for Health and Care Excellence or NICE 2013 urinary incontinence guideline and whether it would change their current practice. A closed format questionnaire was sent electronically to all members of the British Society of Urogynaecology or BSUG between January and March 2014. There were three major areas of disagreement. First, 70.2% of respondents disagreed that a multidisciplinary team review was necessary before invasive treatment for urinary incontinence. Second, 53.8% of respondents disagreed that preoperative urodynamic studies were not required in stress urinary incontinence diagnosed clinically. Third, 58.6% of respondents disagreed that oxybutynin, tolterodine and darifenacin should be used as first-line drug therapy for overactive bladder. The questionnaire demonstrates that there are significant concerns leading to more than a third of respondents not altering their current practice in line with the entire guideline.
Key Findings from the 2005 Illicit Drug Monitoring System (IDMS)

Introduction This research briefing presents the key trends in illicit drug use in New Zealand from the combined samples of the 2005 Illicit Drug Monitoring System (IDMS). The aim of the IDMS is to provide timely information on trends in illicit drug use and drug related harm in New Zealand. This is the first year that the IDMS has been conducted, with future waves planned annually from this point on. The findings presented in this report focus on the key trends in illicit drug prices, availability and perceptions of risk. The IDMS consists of three modules based on the type of frequent illicit drug user interviewed: (i) the Methamphetamine Module, which interviews frequent methamphetamine users; (ii) the Hallucinogen Module, which interviews frequent ecstasy (MDMA) and LSD users; and (iii) the Cannabis Module, which interviews frequent cannabis users. The detailed findings for each of these three modules are presented in separate reports. Each module of the IDMS draws on three types of data: (1) interviews with frequent drug users; (2) interviews with key experts (KE) who have regular contact with drug users through their work; and (3) the collation and examination of secondary data sources on drug trends. The combined information from these three sources is used to identify emerging trends in drug use and drug related harm. Frequent drug users are considered a sentinel group who can provide accurate information on patterns of drug use and trends in illicit drug markets. The validity of the IDMS comes from the ‘expert’ status of the people interviewed, and hence the high quality of information they can provide, rather than from the statistical rigour of the sampling methodology. The survey of frequent drug users is not intended to be statistically representative of drug use in the general population.
Multiple‐Breath Washout Outcomes Are Sensitive to Inflammation and Infection in Children with Cystic Fibrosis

Rationale: The lung clearance index is a measure of ventilation distribution derived from the multiple‐breath washout technique. The lung clearance index is increased in the presence of lower respiratory tract inflammation and infection in infants with cystic fibrosis; however, the associations during the preschool years are unknown. Objectives: We assessed the ability of the lung clearance index to detect the presence and extent of lower respiratory tract inflammation and infection in preschool children with cystic fibrosis. Methods: Ventilation distribution outcomes were assessed at 82 visits with 58 children with cystic fibrosis and at 38 visits with 31 healthy children aged 3‐6 years. Children with cystic fibrosis also underwent bronchoalveolar lavage fluid collection for detection of lower respiratory tract inflammation and infection. Associations between multiple‐breath washout indices and the presence and extent of airway inflammation and infection were assessed using linear mixed effects models. Results: Lung clearance index was elevated in children with cystic fibrosis (mean [SD], 8.00 [1.45]) compared with healthy control subjects (6.67 [0.56]). In cystic fibrosis, the lung clearance index was elevated in individuals with lower respiratory tract infections (difference compared with uninfected [95% confidence interval], 0.62 [0.06, 1.18]) and correlated with the extent of airway inflammation. Conclusions: These data suggest that the lung clearance index may be a useful surveillance tool for monitoring the presence and extent of lower airway inflammation and infection in preschool children with cystic fibrosis.
Health status and Medical Care-Seeking Behaviour of the poorest 20% in Jamaica

Background and Objectives: Data for the last 2-decades (1988-2007) in Jamaica have shown a gradual decline in the percentage of people in the lowest 20 th income quintile category. Despite this reality, statistics from WHO for 2005 revealed that 80 percent of chronic diseases are in low-to-middle income nations. Poverty is undoubtedly correlated with ill-health; but no study has ever been done in the Caribbean in particular Jamaica that examines health status, health care-seeking behaviour, health insurance coverage and the typology of illness influencing those people in the poorest categorization. This study bridges the gap in the literature by evaluating how recurring illness influences the poorest, health status and health care-seeking behaviour of this group as well as ascertaining factors that account for their good health status and medical care-seeking behaviour. Methods: Data from the Jamaica Survey of Living Conditions (JSLC) for 2007 commissioned by the Planning Institute of Jamaica and the Statistical Institute of Jamaica were used to provide the analyses for this study. The sample for this study was 1,343 respondents who are classified as receiving 20 th lowest percentile of the income in Jamaica (or the poorest 20%). Descriptive statistics were used to provide background information on the sample; Chi-square and F-statistic were used for bivariate analyses and logistic regression was performed to determine the factors for the model. Data was stored, retrieved and processed using SPSS for windows 16.0 and a 5 percent level of significance was used to test significance. Results: The sample was 1,343 respondents (671 males and 672 females). Majority of the sample did not have health insurance coverage (93.2%) compared to 5.6% with public coverage and 1.2% private. A substantial percentage of the sample had at most basic schooling (71.5%); 17.5% primary or preparatory; 10.6% secondary and 0.4% tertiary. Only 14.7% of respondents indicated that they had an illness. Of those who indicated an illness, 93.2% of them reported that this was diagnosed by a medical practitioner. The self-reported diagnosed ailments were asthma, 11.9%; hypertension, 24.2%; arthritis, 7.7%; diabetes mellitus, 10.8%; diarrhoea, 1.5%; influenza, 13.4% and 24.2% did not specify. Four variables emerged as statistically significant correlates of good health status. These are age (OR = 0.956, 95% CI = 0.945 – 0.968); illness (OR = 0.125, 95% CI = 0.085 – 0.185); male (OR = 1.543, 95% CI = 1.107 – 2.151) and per capita consumption (OR = 1.152, 95% CI = 0.741 – 1.790). The model (good health status) had statistically predictive power [χ 2 (df = 10) = 354.269, p < 0.001]; Hosmer and Lemeshow goodness of fit χ 2 = 6.086, P = 0.638, correctly classify 85.4% of the sample (correctly classified 96.1% of those who had good
Gendered Physiotherapy in Transition - the Swedish Case

In order to determine gender distributions in Swedish physiotherapy, mail questionnaires were sent to approximately 1100 physiotherapists (77.5% response rate) in 1996 inquiring about male-female differences in professional strategies, focusing on two questions regarding power structure in the workplace and relation to the professional knowledge base. Some findings support the idea that there are male-female differences, specific to different specialities. A generational pattern is also visible, possibly related to external changes in the composition of patient groups, the social insurance system, the healthcare system and the labour market. Younger female physiotherapists work with elderly care more often than their older colleagues do. In addition, the younger group works more closely with its horizontal neighbours, as do female physiotherapists compared to males. The younger ones are not so bound to physicians as their older colleagues were. One possible explanation is that younger physiotherapists are.
Maximal exercise electrocardiographic responses and coronary heart disease mortality among men with metabolic syndrome.

OBJECTIVE To examine the association between abnormal exercise electrocardiographic (E-ECG) test results and mortality (all-cause and that resulting from coronary heart disease [CHD] or cardiovascular disease [CVD]) in a large population of asymptomatic men with metabolic syndrome (MetS). PATIENTS AND METHODS A total of 9191 men (mean age, 46.9 years) met the criteria of having MetS. All completed a maximal E-ECG treadmill test (May 14, 1979, through April 9, 2001) and were without a previous CVD event or diabetes at baseline. Main outcomes were all-cause mortality, mortality due to CHD, and mortality due to CVD. Cox regression analysis was used to quantify the mortality risk according to E-ECG responses. RESULTS During a follow-up of 14 years, 633 deaths (242 CVD and 150 CHD) were identified. Mortality rates and hazard ratios (HRs) across E-ECG responses were the following: for all-cause mortality: HR, 1.36; 95% confidence interval (CI), 1.09-1.70 for equivocal responses and HR, 1.41; 95% CI, 1.12-1.77 for abnormal responses (P(trend)<. 001); for mortality due to CVD: HR, 1.29; 95% CI, 0.88-1.88 for equivocal responses and HR, 2.04; 95% CI, 1.46-2.84 for abnormal responses (P(trend)<. 001); and for mortality due to CHD: HR, 1.62; 95% CI, 1.02-2.56 for equivocal responses and HR, 2.45; 95% CI, 1.62-3.69 for abnormal responses (P(trend)<. 001). A positive gradient for CHD, CVD, and all-cause mortality rates across E-ECG categories within 3, 4, or 5 MetS components was observed (P<.001 for all). CONCLUSION Among men with MetS, an abnormal E-ECG response was associated with higher risk of all-cause, CVD, and CHD mortality. These findings underscore the importance of E-ECG tests to identify men with MetS who are at risk of dying.