Miracle-dz/UniFAR-FTUs huggingface dataset:
Absolute Lymphocyte Count: A Predictor of Recurrent Cytomegalovirus Disease in Solid Organ Transplant Recipients

Background Recurrent cytomegalovirus (CMV) disease in solid organ transplant recipients frequently occurs despite effective antiviral therapy. We previously demonstrated that patients with lymphopenia before liver transplantation are more likely to develop posttransplant infectious complications including CMV. The aim of this study was to explore absolute lymphocyte count (ALC) as a predictor of relapse following treatment for CMV disease. Methods We performed a retrospective cohort study of heart, liver, and kidney transplant recipients treated for an episode of CMV disease. Our primary outcome was time to relapse of CMV within 6 months. Data on potential predictors of relapse including ALC were collected at the time of CMV treatment completion. Univariate and multivariate hazard ratios (HRs) were calculated with a Cox model. Multiple imputation was used to complete the data. Results Relapse occurred in 33 of 170 participants (19.4%). Mean ALC in relapse-free patients was 1.08 ± 0.69 vs 0.73 ± 0.42 × 103 cells/μL in those who relapsed, corresponding to an unadjusted hazard ratio of 1.11 (95% confidence interval, 1.03-1.21; P = .009, n = 133) for every decrease of 100 cells/μL. After adjusting for potential confounders, the association between ALC and relapse remained significant (HR, 1.11 [1.03-1.20]; P = .009). Conclusions Low ALC at the time of CMV treatment completion was a strong independent predictor for recurrent CMV disease. This finding is biologically plausible given the known importance of T-cell immunity in maintaining CMV latency. Future studies should consider this inexpensive, readily available marker of host immunity.
Head to Head: Semantic Similarity of Multi–Word Terms

Terms are linguistic signifiers of domain–specific concepts. Semantic similarity between terms refers to the corresponding distance in the conceptual space. In this paper, we use lexico-syntactic information to define a vector space representation in which cosine similarity closely approximates semantic similarity between the corresponding terms. Given a multi–word term, each word is weighed in terms of its defining properties. In this context, the head noun is given the highest weight. Other words are weighed depending on their relations to the head noun. We formalized the problem as that of determining a topological ordering of a direct acyclic graph, which is based on constituency and dependency relations within a noun phrase. To counteract the errors associated with automatically inferred constituency and dependency relations, we implemented a heuristic approach to approximating the topological ordering. Different weights are assigned to different words based on their positions. Clustering experiments performed on such a vector space representation showed considerable improvement over the conventional bag–of–word representation. Specifically, it more consistently reflected semantic similarity between the terms. This was established by analyzing the differences between automatically generated dendrograms and manually constructed taxonomies. In conclusion, our method can be used to semi–automate taxonomy construction.
The impact of peripheral nerve blocks on perioperative outcome in hip and knee arthroplasty—a population-based study

Abstract The role of anesthesia techniques on perioperative outcomes on a population level has recently gained widespread interest. Although mainly neuraxial vs general anesthesia has been addressed, population-level data on the impact of peripheral nerve blocks (PNBs) are still lacking. Therefore, we investigated the association between PNB use and outcomes using retrospective data on 1,062,152 recipients of hip and knee arthroplasties (total hip arthroplasty [THA]/total knee arthroplasty [TKA]) from the national Premier Perspective database (2006-2013). Multilevel multivariable logistic regression models measured associations between PNB use and outcomes. Complications included cardiac, pulmonary, gastrointestinal and renal complications, cerebrovascular events, infections, wound complications, thromboembolic complications, inpatient falls, and mortality. Resource utilization variables included blood transfusions, intensive care unit admissions, opioid consumption, cost, and length of stay. Overall, 12.5% of patients received a PNB, with an increase over time particularly among TKAs. Peripheral nerve block use was associated with lower odds for most adverse outcomes mainly among patients with THA. Notable beneficial effects were seen for wound complications (odds ratio 0.60 [95% confidence interval, 0.49-0.74]) among THA recipients and pulmonary complications (odds ratio 0.83 [95% confidence interval, 0.72-0.94]) in patients with TKA. Peripheral nerve block use was significantly (P < 0.0001) associated with a −16.2% and −12.7% reduction in opioid consumption for patients with THA and TKA, respectively. In conclusion, our results indicate that PNBs might be associated with superior perioperative population-level outcomes. In light of the inability to establish a causal relationship and the presence of residual confounding, we strongly advocate for further prospective investigation, ideally in multicenter, randomized trials, to establish the potential impact of PNBs on outcomes on a population level.
Modeling atmospheric CO2 concentration profiles and fluxes above sloping terrain at a boreal site

CO2 fluxes and concentrations were simulated in the planetary boundary layer above subarctic hilly terrain us- ing a three dimensional model. The model solves the trans- port equations in the local scale and includes a vegetation sub-model. A WMO/GAW background concentration mea- surement site and an ecosystem flux measurement site are located inside the modeled region at a hilltop and above a mixed boreal forest, respectively. According to model re- sults, the concentration measurement at the hill site was rep- resentative for continental background. However, this was not the case for the whole model domain. Concentration at few meters above active vegetation represented mainly local variation. Local variation became inseparable from the re- gional signal at about 60-100 m above ground. Flow over hills changed profiles of environmental variables and height of inversion layer, however CO2 profiles were more affected by upwind land use than topography. The hill site was above boundary layer during night and inside boundary layer dur- ing daytime. The CO2 input from model lateral boundaries dominated in both cases. Daily variation in the CO2 assimila- tion rate was clearly seen in the CO2 profiles. Concentration difference between the hill site and the forest site was about 5 ppm during afternoon according to both model and mea- surements. The average modeled flux to the whole model region was about 40% of measured and modeled local flux at the forest site.
Reaction products of hexamethylene diisocyanate vapors with “self” molecules in the airways of rabbits exposed via tracheostomy

Abstract 1. Hexamethylenediisocyanate (HDI) is a widely used aliphatic diisocyanate and a well-recognized cause of occupational asthma. 2. “Self” molecules (peptides/proteins) in the lower airways, susceptible to chemical reactivity with HDI, have been hypothesized to play a role in asthma pathogenesis and/or chemical metabolism, but remain poorly characterized. 3. This study employed unique approaches to identify and characterize “self” targets of HDI reactivity in the lower airways. Anesthetized rabbits free breathed through a tracheostomy tube connected to chambers containing either, O2, or O2 plus ∼200 ppb HDI vapors. Following 60 minutes of exposure, the airways were lavaged and the fluid was analyzed by LC-MS and LC-MS/MS. 4. The low-molecular weight (<3 kDa) fraction of HDI exposed, but not control rabbit bronchoalveolar lavage (BAL) fluid identified 783.26 and 476.18 m/z [M+H]+ ions with high energy collision-induced dissociation (HCD) fragmentation patterns consistent with bis glutathione (GSH)-HDI and mono(GSH)-HDI. Proteomic analyses of the high molecular weight (>3 kDa) fraction of exposed rabbit BAL fluid identified HDI modification of specific lysines in uteroglobin (aka clara cell protein) and albumin. 5. In summary, this study utilized a unique approach to chemical vapor exposure in rabbits, to identify HDI reaction products with “self” molecules in the lower airways.
“You’ve Got to Love Yourself”: Photovoice Stories From African Americans and Hispanic/Latinos Living With Diabetes

Introduction: Health disparities persist among African Americans (AAs) and Latino adults with type 2 diabetes. The purpose of this research was to use PhotoVoice to examine AAs and Latinos’ daily experiences of managing diabetes. Method: An exploratory, descriptive study using PhotoVoice and focus groups was conducted over a 3-week period: Week 1 orientation session, Week 2 photo taking and returning cameras, and Week 3 focus group to share and discuss photos. Results: Ten AAs and nine Latino adults were enrolled, forming four focus groups. Four categories emerged: (1) daily life living with type 2 diabetes mellitus, (2) negative and positive emotions, (3) supports and barriers, and (4) needs. The social determinants of health influencing diabetes self-care were observed in discussions and photos—this included the built environment to promote a healthy lifestyle, social support, and education. Implications: PhotoVoice promotes culturally congruent care to better understand AA and Latinos’ experience living with type 2 diabetes mellitus.
Do Thiopurines Reduce the Risk of Surgery in Elderly Onset Inflammatory Bowel Disease? A 20-Year National Population-Based Cohort Study

Background: Evidence that thiopurines impact on the risk of surgery in elderly onset inflammatory bowel disease (EO-IBD) is lacking. We aimed to compare the rates of surgery in EO-IBD (>60 years at diagnosis) with adult-onset IBD (18–59 yrs), and examine the impact of thiopurines on surgical risk in EO-IBD. Methods: Using a U.K. database between 1990 and 2010, we compared rates of surgery between adult-onset IBD and EO-IBD using survival analysis. Ulcerative colitis (UC) and Crohn's disease (CD) were analyzed separately. Cox proportional hazard modeling was used to determine the adjusted relative risk of surgery. We further assessed the impact of duration of thiopurine treatment on risk of surgery. Results: We identified 2758 of 9515 patients with UC and 1349 of 6490 patients with CD, with EO-IBD. Cumulative 1, 5, and 10 years risk of colectomy was similar in EO-UC (2.2, 4.5, and 5.8%, respectively) and AO-UC (2.2, 5.0, and 7.3%, respectively; P = 0.15). Cumulative 1, 5, and 10 years risk of first intestinal surgery was lower in EO-CD (9.5, 14.6, and 17.9%, respectively) than AO-CD (12.2, 19.0, and 24.4%, respectively; P < 0.001). Early steroid use, steroid dependency, and thiopurine use was associated with higher risk of colectomy in EO-UC. Among EO-UC receiving thiopurines for >12 months, there was a 70% reduction in risk of colectomy (hazard ratio. 0.30; 95% confidence interval, 0.15–0.58). Thiopurines were not associated with a reduced risk of surgery in EO-CD. Conclusions: Risk of colectomy in EO-UC does not differ from AO-UC, but the risk of surgery in EO-CD is significantly lower than in AO-CD. Sustained thiopurine use of 12 months or more duration in EO-UC reduces the risk colectomy, but does not impact on the risk of surgery in EO-CD. These findings are important given the greater risk of thiopurine-associated lymphoma in the elderly.
A threshold‐free summary index of prediction accuracy for censored time to event data

Prediction performance of a risk scoring system needs to be carefully assessed before its adoption in clinical practice. Clinical preventive care often uses risk scores to screen asymptomatic population. The primary clinical interest is to predict the risk of having an event by a prespecified future time t0. Accuracy measures such as positive predictive values have been recommended for evaluating the predictive performance. However, for commonly used continuous or ordinal risk score systems, these measures require a subjective cutoff threshold value that dichotomizes the risk scores. The need for a cutoff value created barriers for practitioners and researchers. In this paper, we propose a threshold‐free summary index of positive predictive values that accommodates time‐dependent event status and competing risks. We develop a nonparametric estimator and provide an inference procedure for comparing this summary measure between 2 risk scores for censored time to event data. We conduct a simulation study to examine the finite‐sample performance of the proposed estimation and inference procedures. Lastly, we illustrate the use of this measure on a real data example, comparing 2 risk score systems for predicting heart failure in childhood cancer survivors.
Changes in the Gut Microbiota After Early Administration of Oral Synbiotics to Young Infants in India

Objectives: The authors examined the changes in the developing gut microbiota of Indian infants enrolled in a colonization study of an oral synbiotic (Lactobacillus plantarum and fructo-oligosaccharides) preparation. Methods: Frozen stool samples were available from a previously published clinical study of the synbiotic preparation administered daily for 7 days to full-term Indian infants delivered by C-section. 16S rRNA gene sequencing of fecal bacterial community-DNA was done in 11 infants sampled on day 7 and day 60 of life. Results: All infants showed changes in bacterial diversity with age. While Firmicutes and Proteobacteria were predominant in all, Actinobacteria and Bacteroidetes were initially low on day 7. In control infants, we observed a significant increase (P = 0.012) in the proportions of Actinobacteria on day 60. In the treated group, during the 60-day period, there was a 10-fold increase in Bacteroidetes, a somewhat smaller increase in Firmicutes, and a reduction in Proteobacteria. Compared to controls, treated infants were increasingly colonized by different Gram-positive genera including Enterococcus, Lactobacillus, and Bifidobacterium. Relatively less known taxa and some unassigned sequence reads added to enriched diversity observed in the treated group. Conclusions: There was a high level of bacterial diversity among infants examined in the present study. Synbiotic treatment induced an increase in overall taxa and Gram-positive diversity, especially in the first week of life. Changes in the microbiota during early infancy should be used as a rationale for selecting probiotics in diverse clinical settings.
Gestational Alcohol Exposure and Other Factors Associated With Continued Teenage Drinking

Purpose. A longitudinal cohort of adolescents who initiated drinking before age 15 were studied to determine which factors distinguished between early initiators who continued to drink (persisters) from those who stopped drinking (desisters). There were 308 early initiators in the total sample (n = 917); 247 were persisters, and 61 were desisters. Method. A stepwise discriminant analysis identified differences between the two groups. Considered risk/protective factors were parenting practices, peer drinking, child and maternal depression, child behavior, prenatal alcohol exposure, home environment, and demographic factors. Results. Desistence was significantly related to African American race and more parental strictness. Exposure to ≥1 drink/day during pregnancy and high levels of autonomy from parents were significant predictors of persistent drinking. Conclusions. Early initiation places adolescents at risk for continued and heavier drinking. Identifying characteristics of those who start early but do or do not continue drinking can inform education programs to better target the most appropriate adolescents.
Role of the Lymphatic System in the Pathogenesis of Hypertension in Humans.

BACKGROUND Recent studies, mainly on animal models, have suggested that negatively charged glycosaminoglycans, macrophages, and lymph vessels in the skin interstitium may serve as extrarenal control of sodium balance and blood pressure. The aim of the study was to prove the hypothesis that skin interstitium has a role in the pathogenesis of hypertension in humans. METHODS AND RESULTS We have examined skin biopsies in 91 patients from the department of surgery who had elective surgery with abdominal skin incision: 43 were hypertensive, 14 had resistant hypertension, and 34 with normal blood pressure as control group (median patients' age in these groups estimated accordingly 64 vs. 64 vs. 61.5; p > 0.05). We have studied (1) the content of Na+, water, accumulation of macrophages (CD68), and density of lymphatic vessels (D2-40) and blood vessels (CD31) in the specimens of abdominal skin taken at the time of surgery and (2) plasma NT-proANP, vascular endothelial growth factor (VEGF)-C, and VEGF-D concentrations. The study groups differed in skin expression of CD68 (control vs. hypertension vs. resistant hypertension groups were accordingly: 3.33 vs. 4.00 vs. 8.33; p = 0.005) and in serum concentration of VEGF-C (5792 vs. 4348 vs. 3974 pg/mL; p = 0.026). Differences among groups in plasma NT-proANP levels were close to statistical significance (p = 0.056). CONCLUSIONS Our results confirm that skin interstitium may be involved in the pathogenesis of essential hypertension in humans. Lower levels of VEGF-C in hypertensive groups suggest that impairment of lymphangiogenesis and protective function of the skin lymphatic system may play a role in the pathogenesis of hypertension.
Pain chronification: what should a non-pain medicine specialist know?

Abstract Objective: Pain is one of the most common reasons for an individual to consult their primary care physician, with most chronic pain being treated in the primary care setting. However, many primary care physicians/non-pain medicine specialists lack enough awareness, education and skills to manage pain patients appropriately, and there is currently no clear, common consensus/formal definition of “pain chronification”. Methods: This article, based on an international Change Pain Chronic Advisory Board meeting which was held in Wiesbaden, Germany, in October 2016, provides primary care physicians/non-pain medicine specialists with a narrative overview of pain chronification, including underlying physiological and psychosocial processes, predictive factors for pain chronification, a brief summary of preventive strategies, and the role of primary care physicians and non-pain medicine specialists in the holistic management of pain chronification. Results: Based on currently available evidence, we propose the following consensus-based definition of pain chronification which provides a common framework to raise awareness among non-pain medicine specialists: “Pain chronification describes the process of transient pain progressing into persistent pain; pain processing changes as a result of an imbalance between pain amplification and pain inhibition; genetic, environmental and biopsychosocial factors determine the risk, the degree, and time-course of chronification. ” Conclusions: Early intervention plays an important role in preventing pain chronification and, as key influencers in the management of patients with acute pain, it is critical that primary care physicians are equipped with the necessary awareness, education and skills to manage pain patients appropriately.
Understanding the developmental course of the acoustic properties of the human outer and middle ear over the first 6 months of life by using a longitudinal analysis of power reflectance at ambient pressure.

BACKGROUND As shown by tympanometric and wideband acoustic immittance (WAI) measures, developmental changes that occur in the middle ear and the external auditory canal can affect the mechano-acoustic properties of the middle ear system during the first 2 years of life. However, these observed differences and the specific course of maturation have not been fully investigated. PURPOSE The overall goal of the current study was to define the time course and rate at which functional maturation of the middle ear occurs in human infants through wideband acoustic immittance (WAI). It was also within the scope of this study to establish normative data to characterize acoustic properties of the normal middle ear in infants from birth to 6 mo of age. RESEARCH DESIGN Newborns were tested longitudinally at 1-mo intervals up to 6 mo of age for a total of six visits. All babies passed transient evoked otoacoustic emission screening on each visit. Tympanograms and WAI were recorded, and the distributions of WAI patterns were analyzed as a function of age. WAI was measured across a wide range of frequencies from birth to 6 mos of age in a cohort of 31 infants. Test-retest differences for WAI were also evaluated. STUDY SAMPLE Thirty-one newborns were recruited. DATA COLLECTION AND ANALYSIS A repeated-measure analysis of variance was conducted to investigate whether the variations observed in power reflectance at ambient pressure across the six visits were statistically different. All significant findings were subject to Greenhouse-Geisser correction for repeated-measures sphericity and inflated type-I error. RESULTS RESULTS showed that power reflectance increased (closer to 1) at low frequencies (<400 Hz) and decreased (closer to 0) at high frequencies (>2000 Hz) as a function of age. There was very little change in power reflectance from 600 to 1600 Hz across the first 6 mo of life. Most group changes that were observed were also consistently shown in longitudinal changes observed within individual subjects. CONCLUSIONS The overall maturation of the middle ear can result in a lower reflectance at higher frequencies and a higher reflectance at lower frequencies. This could be explained by known changes in ear-canal and/or middle-ear structures across this time period, which could lead to changes in mass and resistance. An increase in volume in the middle-ear cavity, reduction of middle-ear debris, and overall decrease in resistive elements might be contributing to these changes. Significant differences were observed between each visit, which could warrant the use of age-specific norms when applying WAI data to infants less than 6 mo of age.
Measuring the Cost of the Patient-Centered Medical Home: A Cost-Accounting Approach

To explore the cost for individual practices to become more patient-centered, we inventoried and calculated the cost of costly activities involved in implementing the Patient-Centered Medical Home (PCMH) as defined by the National Committee for Quality Assurance. There were 3 key findings. The cost of each PCMH-related clinical activity can be classified in 1 of 3 major categories. Cost offsets can be used to defray part of the cost recognition. The cost of PCMH transformation varied by practice with no clear level or pattern of costs. Our study suggests that small- and medium-sized practices may experience difficulty with the financial burden of PCMH recognition.