Miracle-dz/UniFAR-FTUs huggingface dataset:
Prospective payment systems and discretionary coding—Evidence from English mental health providers

Abstract Reimbursement of English mental health hospitals is moving away from block contracts and towards activity and outcome‐based payments. Under the new model, patients are categorised into 20 groups with similar levels of need, called clusters, to which prices may be assigned prospectively. Clinicians, who make clustering decisions, have substantial discretion and can, in principle, directly influence the level of reimbursement the hospital receives. This may create incentives for upcoding. Clinicians are supported in their allocation decision by a clinical clustering algorithm, the Mental Health Clustering Tool, which provides an external reference against which clustering behaviour can be benchmarked. The aims of this study are to investigate the degree of mismatch between predicted and actual clustering and to test whether there are systematic differences amongst providers in their clustering behaviour. We use administrative data for all mental health patients in England who were clustered for the first time during the financial year 2014/15 and estimate multinomial multilevel models of over, under, or matching clustering. Results suggest that hospitals vary systematically in their probability of mismatch but this variation is not consistently associated with observed hospital characteristics.
Minding the Baby®: Enhancing parental reflective functioning and infant attachment in an attachment-based, interdisciplinary home visiting program

Abstract In this article, we describe the results of the second phase of a randomized controlled trial of Minding the Baby (MTB), an interdisciplinary reflective parenting intervention for infants and their families. Young first-time mothers living in underserved, poor, urban communities received intensive home visiting services from a nurse and social worker team for 27 months, from pregnancy to the child's second birthday. Results indicate that MTB mothers' levels of reflective functioning was more likely to increase over the course of the intervention than were those of control group mothers. Likewise, infants in the MTB group were significantly more likely to be securely attached, and significantly less likely to be disorganized, than infants in the control group. We discuss our findings in terms of their contribution to understanding the impacts and import of intensive intervention with vulnerable families during the earliest stages of parenthood in preventing the intergenerational transmission of disrupted relationships and insecure attachment.
Induction of the BIM Short Splice Variant Sensitizes Proliferating NK Cells to IL-15 Withdrawal

Adoptive transfer of allogeneic NK cells holds great promise for cancer immunotherapy. There is a variety of protocols to expand NK cells in vitro, most of which are based on stimulation with cytokines alone or in combination with feeder cells. Although IL-15 is essential for NK cell homeostasis in vivo, it is commonly used at supraphysiological levels to induce NK cell proliferation in vitro. As a result, adoptive transfer of such IL-15–addicted NK cells is associated with cellular stress because of sudden cytokine withdrawal. In this article, we describe a dose-dependent addiction to IL-15 during in vitro expansion of human NK cells, leading to caspase-3 activation and profound cell death upon IL-15 withdrawal. NK cell addiction to IL-15 was tightly linked to the BCL-2/BIM ratio, which rapidly dropped during IL-15 withdrawal. Furthermore, we observed a proliferation-dependent induction of BIM short, a highly proapoptotic splice variant of BIM in IL-15–activated NK cells. These findings shed new light on the molecular mechanisms involved in NK cell apoptosis following cytokine withdrawal and may guide future NK cell priming strategies in a cell therapy setting.
Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association

One in 4 Americans >40 years of age takes a statin to reduce the risk of myocardial infarction, ischemic stroke, and other complications of atherosclerotic disease. The most effective statins produce a mean reduction in low-density lipoprotein cholesterol of 55% to 60% at the maximum dosage, and 6 of the 7 marketed statins are available in generic form, which makes them affordable for most patients. Primarily using data from randomized controlled trials, supplemented with observational data where necessary, this scientific statement provides a comprehensive review of statin safety and tolerability. The review covers the general patient population, as well as demographic subgroups, including the elderly, children, pregnant women, East Asians, and patients with specific conditions such as chronic disease of the kidney and liver, human immunodeficiency viral infection, and organ transplants. The risk of statin-induced serious muscle injury, including rhabdomyolysis, is <0.1%, and the risk of serious hepatotoxicity is ≈0.001%. The risk of statin-induced newly diagnosed diabetes mellitus is ≈0.2% per year of treatment, depending on the underlying risk of diabetes mellitus in the population studied. In patients with cerebrovascular disease, statins possibly increase the risk of hemorrhagic stroke; however, they clearly produce a greater reduction in the risk of atherothrombotic stroke and thus total stroke, as well as other cardiovascular events. There is no convincing evidence for a causal relationship between statins and cancer, cataracts, cognitive dysfunction, peripheral neuropathy, erectile dysfunction, or tendonitis. In US clinical practices, roughly 10% of patients stop taking a statin because of subjective complaints, most commonly muscle symptoms without raised creatine kinase. In contrast, in randomized clinical trials, the difference in the incidence of muscle symptoms without significantly raised creatinine kinase in statin-treated compared with placebo-treated participants is <1%, and it is even smaller (0.1%) for patients who discontinued treatment because of such muscle symptoms. This suggests that muscle symptoms are usually not caused by pharmacological effects of the statin. Restarting statin therapy in these patients can be challenging, but it is important, especially in patients at high risk of cardiovascular events, for whom prevention of these events is a priority. Overall, in patients for whom statin treatment is recommended by current guidelines, the benefits greatly outweigh the risks.
Mutational Analysis of 472 Urothelial Carcinoma Across Grades and Anatomic Sites

Purpose: The purpose of this study is to characterize the mutational landscape across the spectrum of urothelial carcinoma (UC) to identify mutational features and potential therapeutic targets. Experimental Design: Using targeted exome sequencing (n = 237 genes), we analyzed the mutation spectra of 82 low-grade nonmuscle-invasive bladder cancers (LG-NMIBC), 126 high-grade (HG) NMIBC, 199 muscle-invasive bladder cancers (MIBC), 10 LG-upper tract urothelial cancers (LG-UTUC), and 55 HG-UTUC. Results: FGFR3 and KDM6A mutations were significantly more common in LG-NMIBC (72% and 44%, respectively) versus other bladder subtypes. FGFR3 alterations were also enriched in LG-UTUC versus HG-UTUC tumors (80% vs. 16%). In contrast, TP53 and RB1 mutations were significantly more frequent in all 3 HG urothelial carcinoma subtypes than in LG-NIMBC (45%–58% vs. 4%; 9%–22% vs. 0; respectively). Among LG-NMIBC tumors, KDM6A mutations were more common in women than in men (71% vs. 38%). HG-NMIBC and MIBC had higher tumor mutational burden (TMB) than LG-NMIBC (P = 0.001 and P < 0.01, respectively). DNA-damage repair (DDR) alterations were associated with a higher TMB in HG-NMIBC and MIBC tumors, and these two tumor types were also enriched for an APOBEC mutational signature compared with LG-NMIBC and HG-UTUC. Alterations in FGFR3, PIK3CA, and EP300 correlated with worse overall survival in HG-UTUC and occurred concurrently. Conclusions: Our analysis suggests that a fraction of MIBCs likely arise from precursor lesions other than LG-NMIBC. KDM6A mutations are twice as common in women with LG-NIMBC than those in men. DDR gene mutations and APOBEC mutagenesis drive mutations in HG-NMIBC and MIBC. UTUC has a distinct mutation profile from bladder cancer.
The clinical impact of Pseudomonas aeruginosa eradication in bronchiectasis in a Dutch referral centre

About one-third of the patients with bronchiectasis is likely to develop a chronic infection with Pseudomonas aeruginosa [1, 2]. The available evidence to date suggest that P. aeruginosa colonisation in bronchiectasis may be associated with poorer outcome in terms of hospital admissions, exacerbation frequency and mortality [3–5]. The place of Pseudomonas eradication regimens is well defined in cystic fibrosis and supported by a Cochrane review, which showed that early detection of P. aeruginosa and subsequent early eradication treatment, consisting of nebulised antibiotics with or without oral antibiotics, could reduce the risk of chronic P. aeruginosa infection [6]. Recently published guidelines by the European Respiratory Society (ERS) suggested that adults with bronchiectasis and a new isolation of P. aeruginosa should also be offered eradication antibiotic treatment [7]. The aim of this study was to investigate the effectiveness of different P. aeruginosa eradication strategies and the clinical outcome after eradication. An antibiotic approach directed at eradication of a new isolate of Pseudomonas aeruginosa can result in a significant reduction in exacerbation frequency in bronchiectasis patients http://ow.ly/L1Zl30nv1WS
Trajectories of Resting Heart Period and Shyness in Adolescent Females Exposed to Child Maltreatment

Relatively little is known about the psychophysiological processes underlying the development of socioemotional vulnerabilities that are common among adolescents exposed to child maltreatment. Using a prospective, longitudinal design, we investigated whether trajectories of resting heart period (HP; a physiological correlate of stress vulnerability) across three visits (separated by 6 months) was associated with shyness (a type of socioemotional vulnerability) in adolescent females exposed to child maltreatment (N = 55; Mage = 14.07 years). Adolescents’ resting HP across visits was best characterized by two latent trajectories: a stable high class (25.5%) and a stable low class (74.5%). The stable low HP trajectory was associated with higher shyness at Time 1 (T1), and HP trajectory moderated the association between T1 and Time 3 (T3) shyness. Females in the stable low HP trajectory demonstrated stability of shyness from T1 to T3, whereas T1 and T3 shyness were unrelated for females in the stable high HP trajectory. We also found that shyness at T1 and T3 was associated with greater levels of anxiety at T3. These findings illustrate heterogeneity in the developmental patterns of resting autonomic activity in adolescent females exposed to child maltreatment; such differences may influence the continuity of some traits linked with socioemotional vulnerability such as shyness.
Bacillus thuringiensis Maize Expressing a Fusion Gene Cry1Ab/Cry1AcZM Does Not Harm Valued Pollen Feeders

The ladybird Propylea japonica, adults of the green lacewing Chrysoperla nipponensis and the honey bee Apis mellifera are common pollen feeders in many crop systems. They could therefore be directly exposed to Cry proteins in Bacillus thuringiensis (Bt)-transgenic crop fields by ingestion of pollen. They, or closely related species, are therefore often selected as surrogate test species in non-target risk assessment of Bt plants. In the current study, we evaluated the potential effects of the ingestion of Bt maize pollen containing the Cry1Ab/Cry1Ac fusion protein on various life-table parameters of the three pollen-feeding non-target species in laboratory feeding assays. The results showed that pupation rate and male adult fresh weight of P. japonica were significantly increased when fed pollen from Bt maize compared to control maize pollen, but other test life-table parameters were not affected. For the other two species, none of the tested life-table parameters (survival, pre-oviposition period, fecundity and adult fresh weight for C. nipponensis; survival and mean acinus diameter of hypopharyngeal glands for A. mellifera) differed between non-Bt and Bt maize pollen treatments. ELISA measurements confirmed the stability and uptake of the Cry protein by all three species during the feeding bioassays. In addition, a sensitive insect bioassay confirmed the bioactivity of the Cry1Ab/Cry1Ac protein in the Bt maize pollen used. Overall, the results suggested that the three pollen feeders are not sensitive to the Cry1Ab/Cry1Ac protein, and planting of the Bt maize variety will pose a negligible risk to P. japonica, adult C. nipponensis and adult A. mellifera.
Medir o cérebro, para quê?

Varias sao as “janelas” da Ressonância Magnetica (RM) que hoje tem aplicacao na clinica1-2. Servem para fundamentar o diagnostico (p.e., da encefalopatia microvascular do idoso), o prognostico (p.e., do declinio cognitivo), a terapeutica (p.e., da desmielinizacao primaria). Com elas tambem poderemos aceder ao estudo fiavel da substância branca aparentemente normal (T2 convencional), o que sera importante para prever a evolucao. Havendo, agora, uma outra contrastizacao quantificavel – sem T1 nem T2 –, a designacao generica dos metodos sera RMq3.
Enfermería infantil y disfemia: Evolución y marcadores de cronicidad. Una revisión sistemática = Child nursing and stuttering: Evolution and chronicity markers. A systematic review

Resumen : La disfemia es un trastorno de la comunicacion cuyo origen es aun muy difuso. Teorias neuroambientales o de articulacion de la palabra inundan una literatura que en la mayoria de los casos esta escrita por logopedas, neurologos o pedagogos. Aun cuando enfermeria cuida y aborda todos los dias ninos con esta dificultad, es escasa la literatura escrita por este gremio profesional, que, en la mayoria de los casos, tiene que acceder a informacion en bases de datos afines, no garantizandose siempre el acceso a las mismas. El trabajo descriptivo sobre la evolucion de la disfemia y sus marcadores de cronicidad, se ha realizado mediante una exhaustiva revision sistematica en la Biblioteca Virtual del Sistema de Salud Publico Andaluz, con el objetivo de acercar la tartamudez a la realidad de la profesion enfermera, aumentar la bibliografia escrita por profesionales que se acercan y cuidan dia a dia a ninos disfemicos y con la conclusion de que se puede mejorar la calidad de vida de nuestros pacientes al saber derivarlos en el momento adecuado, asi como mejorar la comunicacion interprofesional y los registros enfermeros. Palabras clave : Desarrollo de la Disfemia, Enfermeria, Evolucion, Marcadores Abstract : Stuttering is a communication disorder whose origin is still not clarified. Literature about neuroambiental or speech theories are recorded by speech therapists, neurologists and educators in most cases. Although nurses look after and address patients with this difficulty daily, there is little literature written by this professional group which in most cases, get difficult and not guarantee access to related databases. The descriptive job regarding develop, chronicity and stuttering markers, was performe using a exhaustive systematic review in the Virtual Library of Andalusian Public Health System, with the aim of closing stuttering reality to nursing, to increase written literature by professionals and carers who look after children with stuttering every day and concluding that it could improve our patients life quality referring them to another professionals on time and also improving interprofessional communication and nursing records. Keywords : Developmental Stuttering. Evolution, Markers, Nursing
Classification of von willebrand disease

The term “von Willebrand disease” (1) defines a bleeding disorder that is heterogeneous in its modalities of genetic transmission, clinical and laboratory manifestations, and underlying pathogenetic mechanisms. Common to the different forms of the disease is that they all represent a genetic disorder, transmitted in an autosomal manner, which alters the structure, function, and/or synthesis or release of von Willebrand factor (2). The purpose of a classification of von Willebrand disease is to recognize and define the symptoms and laboratory abnormalities that characterize the different subtypes, so that all the patients ascribed to a certain group can be expected to benefit from the same kind of treatment. A correct classification should be based on the understanding of the pathophysiological mechanisms underlying each form of the disease. In achieving this aim we are still limited by our incomplete knowledge of the processes that regulate the structure, function and biosynthesis of von Willebrand factor. To date, several independent investigators have published a collection of reports describing patients affected by different forms of von Willebrand disease, with supposedly distinctive characteristics. In some cases, patients with similar features have been reported independently under different designations, thus adding to the confusion of the many existing subtypes. At this point, therefore, the clinician involved in the diagnosis and treatment of these patients may find useful a classification that aims at grouping all the known forms of von Willebrand disease into categories identified by well defined parameters and, presumably, common pathogenetic mechanisms. In this article, the reader will find an attempt to provide such a classification. In order to avoid new, confusing terminology, the nomenclature proposed by the authors who have originally described each new subtype of von Willebrand disease has been retained. The description of the different forms of von Willebrand disease is preceded by a brief outline of the current knowledge on von Willebrand factor biosynthesis, structure, and function, in order to provide some concepts that may help in understanding the pathogenesis of the disease. VON WILLEBRAND FACTOR
Architecture Patterns for a Ubiquitous Identity Management System

The design of an Identity Management System (IdM) must strike a balance between protocol overhead, software footprint and security level in order to operate successfully under the resource constraints found in mobile and wireless systems. But, what is good for a constrained system is also good for everyone else, in the sense that reduced overhead benefits all business application processing. This paper contributes to the discussion of IdM construction by suggesting patterns that preserves existing investments, maintains adaptability, scalability and modularity of the IdM. It also provides a discussion where security level is balanced with other non-functional requirements, which is seen less often in security research. A prototypical IdM systems built upon the proposed principles is also presented to some detail.
Isolation and Absolute Configurations of Diversiform C17, C21 and C25 Terpenoids from the Marine Sponge Cacospongia sp.

Chemical investigation of MeOH extract of a South China Sea sponge Cacospongia sp. yielded 15 terpenoids belonging to three different skeleton-types, including the unusual C17 γ-lactone norditerpenoids (1–3), the rare C21 pyridine meroterpenoid (7), and the notable C25 manoalide-type sesterterpenoids (4–6, 8–10). Compounds 1–5 were initially obtained as enantiomers, and were further separated to be optically pure compounds (1a, 1b, 2a, 2b, 3a-r, 3b-r, 4a, 4b, 5a and 5b) by chiral HPLC, with a LiAlH4 reduction aid for 3. Compounds 3a/3b (a pair of inseparable enantiomers), 4a, 5a, 6, and 7 were identified as new compounds, while 1a/1b and 2a/2b were obtained from a natural source and were determined for their absolute configurations for the first time. This is also the first time to encounter enantiomers of the well-known manoalide-type sesterterpenoids from nature. The structures with absolute configurations of the new compounds were unambiguously determined by comprehensive methods including HR-ESI-MS and NMR data analysis, optical rotation comparison, experimental and calculated electronic circular dichroism (ECD), and Mo2(OAc)4 induced circular dichroism (ICD) methods. The cytotoxicity of the isolates against selected human tumor cell lines was evaluated, however, the tested compounds showed no activity against selected cell lines.
Gender differences in physical activity are partially explained by anxiety sensitivity in post-secondary students

Abstract Objective: Female post-secondary students typically engage in less physical activity than their male counterparts. Given that women have greater anxiety sensitivity (ie, fear of arousal-based body sensations) and anxiety sensitivity is inversely related to physical activity participation, this study sought to determine if anxiety sensitivity mediates gender differences in self-reported physical activity. Participants and methods: A sample of 802 post-secondary students completed the Anxiety Sensitivity Index-3 and a Lifestyles Questionnaire in September 2017. Results: Women reported significantly less physical activity and significantly greater anxiety sensitivity. Anxiety sensitivity was significantly and inversely related to self-reported physical activity. A significant indirect effect of gender on physical activity via anxiety sensitivity was shown (B = 5.56, SE = 2.81, p < .05, 95% CI [1.31, 12.78], PM = .0843). Conclusions: Results suggest that anxiety sensitivity partially explains gender differences in physical activity. Anxiety sensitivity reduction interventions might increase physical activity participation and reduce the existing gender gap.
Sexual Conflict and Sexually Transmitted Infections (STIs): Coevolution of Sexually Antagonistic Host Traits with an STI

In many taxa, there is a conflict between the sexes over mating rate. The outcome of sexually antagonistic coevolution depends on the costs of mating and natural selection against sexually antagonistic traits. A sexually transmitted infection (STI) changes the relative strength of these costs. We study the three-way evolutionary interaction among male persistence, female resistance, and STI virulence for two types of STIs: a viability-reducing STI and a reproduction-reducing STI. A viability-reducing STI escalates conflict between the sexes. This leads to increased STI virulence (i.e., full coevolution) if the costs of sexually antagonistic traits occur through viability but not through reproduction. In contrast, a reproduction-reducing STI de-escalates the sexual conflict, but STI virulence does not coevolve in response. We also investigated the establishment probability of STIs under different combinations of evolvability. Successful invasion by a viability-reducing STI becomes less likely if hosts (but not parasites) are evolvable, especially if only the female trait can evolve. A reproduction-reducing STI can almost always invade because it does not kill its host. We discuss how the evolution of host and parasite traits in a system with sexual conflict differs from a system with female mate choice.
Neurotoxicity of Nanomaterials: An Up-to-Date Overview

The field of nanotechnology, through which nanomaterials are designed, characterized, produced, and applied, is rapidly emerging in various fields, including energy, electronics, food and agriculture, environmental science, cosmetics, and medicine. The most common biomedical applications of nanomaterials involve drug delivery, bioimaging, and gene and cancer therapy. Since they possess unique properties which are different than bulk materials, toxic effects and long-term impacts on organisms are not completely known. Therefore, the purpose of this review is to emphasize the main neurotoxic effects induced by nanoparticles, liposomes, dendrimers, carbon nanotubes, and quantum dots, as well as the key neurotoxicology assays to evaluate them.