Miracle-dz/UniFAR-FTUs huggingface dataset:
Factores limitantes y potenciadores en la adherencia al tratamiento de antirretrovirales en personas que viven con VIH/SIDA

Este trabajo tuvo como proposito explicar los factores limitantes y potenciadores en la adherencia al tratamiento antirretroviral de pacientes VIH residentes en Caracas. En un estudio descriptivo, transversal y de campo se utilizo un cuestionario donde fueron considerados factores como las dificultades de dosificacion e ingesta de medicamentos, efectos biofisiologicos, factores psicologicos, socio ambientales, conductuales, y asociados al sistema de salud, los cuales se midieron utilizando escalas dicotomicas verdadero y falso y Likert. Los datos se procesaron con estadisticos de tendencia central de media aritmetica y correlacion simple de Pearson. Los resultados mostraron que el conocimiento sobre el VIH/Sida no incide significativamente sobre la adherencia al tratamiento. Ninguno de los factores estudiados por si solos limita o potencia la adherencia. No obstante, en este estudio concluimos que los factores emocionales y socioafectivos en conjunto con la operatividad del sistema de salud si tienen un impacto directo en la adherencia. Limiting factors and inducers in adherence to antiretroviral treatment in people living with HIV/AIDS Abstract This work had intended to explain the limiting factors and inducers related to the adherence to antiretroviral HIV treatment, in Caracas resident patients. A descriptive, field transversal study using a questionnaire considering environmental factors such as Dosage difficulties , medicine intakes, bio-physiological effects, psychological issues, behaviour, and those related to the health system, all above were measured using a dichotomous pattern true and false and Likert scale. data were processed statistically, and Pearson´s simple correlation was applied . Results showed that knowledge about HIV/AIDS does not significantly affect treatment adherence . None of the studied factors by itself limit or potentiate adherence to treatment. We conclude that several factors specially emotional and socio affective, in conjunction with the health system have a direct impact in adherence.
Ethics review for international data-intensive research

Ad hoc approaches mix and match existing components Historically, research ethics committees (RECs) have been guided by ethical principles regarding human experimentation intended to protect participants from physical harms and to provide assurance as to their interests and welfare. But research that analyzes large aggregate data sets, possibly including detailed clinical and genomic information of individuals, may require different assessment. At the same time, growth in international data-sharing collaborations adds stress to a system already under fire for subjecting multisite research to replicate ethics reviews, which can inhibit research without improving the quality of human subjects' protections (1, 2). “Top-down” national regulatory approaches exist for ethics review across multiple sites in domestic research projects [e.g., United States (3, 4), Canada (5), United Kingdom, (6), Australia (7)], but their applicability for data-intensive international research has not been considered. Stakeholders around the world have thus been developing “bottom-up” solutions. We scrutinize five such ef orts involving multiple countries around the world, including resource-poor settings (table S1), to identify models that could inform a framework for mutual recognition of international ethics review (i.e., the acceptance by RECs of the outcome of each other's review).
Cellular Underwater Wireless Optical CDMA Network: Performance Analysis and Implementation Concepts

In this paper, we introduce and investigate a cellular underwater wireless optical code division multiple-access (OCDMA) network based on optical orthogonal codes (OOC). The structures, principles, and performance of the underwater wireless OCDMA network in various water types are presented. Since underwater wireless optical links are considered for high-bandwidth underwater communications at short ranges, we will place a set of optical base transceiver stations (OBTS) each in the center of a hexagonal cell to cover a larger underwater area. The OBTSs are connected via fiber optic to an optical network controller (ONC) which operates as the core of the network. An integral expression for system error probability is obtained for both uplink and downlink schemes under a specific channel model expressed in this paper, among many channel models in underwater optical communication systems. Furthermore, an experimental prototype of underwater an OCDMA system including the OBTS, ONC, transmitters, and receivers are implemented using field programmable gate arrays (FPGA).
Impact of A Collaborative Strategy to Reduce the Inappropriate Use of Acid Suppressive Therapy in Non–Intensive Care Unit Patients

Background: Stress ulcer prophylaxis (SUP) is inappropriately prescribed in more than 30% of non–intensive care unit (ICU) patients, leading to unnecessary adverse events as well as increases in economic burden. Objective: There was an increasing trend in the prophylactic use of acid suppressive therapy (AST) in non–critically ill patients at our institution, which prompted this initiative aimed at reducing the inappropriate use of AST in non-ICU patients. Methods: This was a retrospective interventional study that consisted of formulation of a guideline, education to the hospitalist service, and intervention by clinical pharmacists. All adult non-ICU patients admitted to the hospitalist service who were newly initiated on AST were considered for inclusion. The primary outcome was a comparison of the proportion of inpatient days with inappropriate AST. Secondary outcomes included a comparison of patients discharged on inappropriate AST and drug acquisition costs, successful pharmacy interventions, hospitalist interventions, incidence of Clostridium difficile infection (CDI) or gastrointestinal (GI) bleeding, and drug costs averted through pharmacy intervention. Results: There were 61 patients in the historical group and 81 patients in the interventional group. This intervention resulted in a 31% absolute reduction in inappropriate patient days of AST and a 24% absolute reduction in patients discharged on inappropriate AST. There were 23 successful interventions. There were no cases of CDI and 1 GI bleed. This intervention resulted in an 87% reduction in drug acquisition costs per patient. Conclusions: A collaboration between clinical pharmacists and a hospitalist service can significantly reduce the inappropriate use of AST in non-ICU patients.
The screams of a star being ripped apart

A star being devoured by a black hole provides a route to study accretion and jet formation [Also see Report by van Velzen et al.] Closely coupled, ubiquitous, and complex, accretion and outflow are the yin and yang of astrophysics (1). The processes occur on all length and time scales, from the formation of the first galaxies in the early universe to the formation of stars in our Milky Way. Compact objects such as white dwarfs, neutron stars, and black holes provide some of the most spectacular examples of these entangled phenomena. Quasars, for instance, are supermassive black holes with masses as large as 10 billion times that of the Sun that lurk in the centers of galaxies and are extraordinarily efficient accretors as revealed through luminous x-ray emission as well as producers of narrowly collimated relativistic jets that can extend millions of light years away from the black hole (see the figure). On page 62 of this issue, van Velzen et al. (2) report the discovery of a transient relativistic jet flowing from a supermassive black hole system that captured and destroyed a passing star. The discovery further confirms the coupled nature of accretion and outflow. Most important, the discovery shows that these events short-circuit the extraordinarily long evolutionary time scale of quasars, creating a laboratory for the study of accretion and outflow physics.
Sparsity Enhanced Mismatch Model for Robust Intercell Interference Management in Heterogeneous Networks With Doubly-Selective Fading Channels

Transmission over doubly-selective fading (DSF) interference channel often relies on the use of robust precoder due to a lack of accurate channel state information, with performance often depending on the conservativeness of the mismatch model. Previously proposed mismatch models either have been deemed too conservative (deterministic models) or are prone to error due to inaccuracy in the probability density function (pdf) and corresponding parameters (stochastic models). A deterministic mismatch model called Sparsity Enhanced Mismatch Model - Reverse discrete prolate spheroidal sequence, or SEMMR, is proposed herein in an attempt to alleviate this problem. Different from all previously deterministic models, the proposed model exploits the inherent sparse characteristics of DSF interference channels which lead to a two-stage robust transceiver design that outperforms precoding only strategy incorporating conventional norm ball mismatch model (NBMM). The inherent sparsity in the channel is brought forth by modeling the channel using a basis expansion model (BEM) where discrete prolate spheroidal sequence (DPSS) is used as a basis. Analytical and simulation results are provided to validate the performance gains of the SEMMR transceiver over the NBMM precoder.
Can Paris pledges avert severe climate change?

Reducing risks of severe outcomes and improving chances of limiting warming to 2°C Current international climate negotiations seek to catalyze global emissions reductions through a system of nationally determined country-level emissions reduction targets that would be regularly updated. These “Intended Nationally Determined Contributions” (INDCs) would constitute the core of mitigation commitments under any agreement struck at the upcoming Paris Conference of the Parties to the United Nations Framework Convention on Climate Change (UNFCCC) (1). With INDCs now reported from more than 150 countries and covering around 90% of global emissions, we can begin to assess the role of this round of INDCs in facilitating or frustrating achievement of longer-term climate goals. In this context, it is important to understand what these INDCs collectively deliver in terms of two objectives. First, how much do they reduce the probability of the highest levels of global mean surface temperature change? Second, how much do they improve the odds of achieving the international goal of limiting temperature change to under 2°C relative to preindustrial levels (2)? Although much discussion has focused on the latter objective (3–5), the former is equally important when viewing climate mitigation from a risk-management perspective.
Distributed Collaborative Beamforming Design for Maximized Throughput in Interfered and Scattered Environments

In this paper, we consider a dual-hop communication from a source surrounded by MI interferences to a receiver, through a wireless network comprised of K independent terminals. In the first time slot, all sources send their signals to the network, whereas in the second time slot, the terminals multiply the received signal by their respective beamforming weights and forward the resulting signals to the receiver. We design these weights so as to minimize the interferences plus noises' powers while maintaining the received power from the source to a constant level. We show, however, that they are intractable in closed form due to the complexity of the polychromatic channels arising from the presence of scattering. By resorting to a two-ray channel approximation proved valid at relatively low angular spread (AS) values, we are able to derive the new optimum weights and prove that they could be locally computed at each terminal, thereby complying with the distributed feature of the network of interest. The so-obtained bichromatic distributed collaborative beamforming (B-DCB) is then analyzed and compared in performance to the monochromatic CB (MCB), whose design does not account for scattering, and the optimal CSI-based CB (OCB). Comparisons are made under both ideal and real-world conditions where we account for implementation errors and the overhead incurred by each CB solution. They reveal that the proposed B-DCB always outperforms MCB in practice; and that it approaches OCB in lightly to moderately scattered environments under ideal conditions and outperforms it under real-world conditions even in highly scattered environments. In such conditions, indeed, the B-DCB operational regions in terms of AS values over, which it is favored against OCB could reach until 50° and hence cover about the entire span of AS values.
The 3.8 Å structure of the U4/U6.U5 tri-snRNP: Insights into spliceosome assembly and catalysis

Structure of a key spliceosomal complex In eukaryotes, when DNA is transcribed into RNA, the primary transcript has protein-coding sequences interrupted by noncoding sequences called introns. Introns are removed by a complex molecular machine, the spliceosome. Wan et al. determined the structure of a key subcomplex, the tri-SNP, that comprises three small nuclear RNAs and more than 30 proteins. The structure, determined by electron microscopy at 3.8 Å resolution, unexpectedly shows a primary RNA transcript bound in the tri-SNP. Further analysis revealed how the spliceosome assembles to achieve its complex functions. Science, this issue p. 466 A key spliceosomal subcomplex reveals how the spliceosome assembles for activity. Splicing of precursor messenger RNA is accomplished by a dynamic megacomplex known as the spliceosome. Assembly of a functional spliceosome requires a preassembled U4/U6.U5 tri-snRNP complex, which comprises the U5 small nuclear ribonucleoprotein (snRNP), the U4 and U6 small nuclear RNA (snRNA) duplex, and a number of protein factors. Here we report the three-dimensional structure of a Saccharomyces cerevisiae U4/U6.U5 tri-snRNP at an overall resolution of 3.8 angstroms by single-particle electron cryomicroscopy. The local resolution for the core regions of the tri-snRNP reaches 3.0 to 3.5 angstroms, allowing construction of a refined atomic model. Our structure contains U5 snRNA, the extensively base-paired U4/U6 snRNA, and 30 proteins including Prp8 and Snu114, which amount to 8495 amino acids and 263 nucleotides with a combined molecular mass of ~1 megadalton. The catalytic nucleotide U80 from U6 snRNA exists in an inactive conformation, stabilized by its base-pairing interactions with U4 snRNA and protected by Prp3. Pre-messenger RNA is bound in the tri-snRNP through base-pairing interactions with U6 snRNA and loop I of U5 snRNA. This structure, together with that of the spliceosome, reveals the molecular choreography of the snRNAs in the activation process of the spliceosomal ribozyme.
Utility of the Advanced Chronic Kidney Disease Patient Management Tools: Case Studies

Appropriate management of advanced chronic kidney disease (CKD) delays or limits its progression. The Advanced CKD Patient Management Toolkit was developed using a process-improvement technique to assist patient management and address CKD-specific management issues. We pilot tested the toolkit in 2 community nephrology practices, assessed the utility of individual tools, and evaluated the impact on conformance to an advanced CKD guideline through patient chart abstraction. Tool use was distinct in the 2 sites and depended on the site champion's involvement, the extent of process reconfiguration demanded by a tool, and its perceived value. Baseline conformance varied across guideline recommendations (averaged 54%). Posttrial conformance increased in all clinical areas (averaged 59%). Valuable features of the toolkit in real-world settings were its ability to: facilitate tool selection, direct implementation efforts in response to a baseline performance audit, and allow selection of tool versions and customizing them. Our results suggest that systematically created, multifaceted, and customizable tools can promote guideline conformance. (Am J Med Qual 2008; 23:105-114)
Phage therapy redux—What is to be done?

Bacteriophage biology should move beyond a model system to support human health Phage therapy is the use of bacteriophages—viruses that infect and replicate within a bacterium—to treat pathogenic bacteria. This approach had a short history in the premolecular era of Western medicine, but it died out before the mid-20th century mainly as a result of justly critical reports from the American Medical Association and the development of chemical antibiotics (1). Now, the global antibiotic resistance crisis and a new appreciation for the importance of the human microbiota have led to a resurgence of interest in phage therapy, not only in the classic sense of treating bacterial infections (2) but also for its potential role in modulating microbiota (3). A landmark 2015 meeting (4) on phage-based therapeutics hosted by the U.S. National Institute of Allergy and Infectious Diseases (NIAID) included not only phage biologists but also participants from private companies, public and governmental research organizations, clinicians, and the federal regulatory community. Opinions on the practicality of phage applications replacing traditional antibiotic regimens ranged from full-speed ahead, mostly from the biotechnology industry, to overt skepticism on the part of some physicians. In any case, participants left the meeting convinced that a “Phage Therapy 2.0” is on its way.
Relationship of a Quality Measure Composite to Clinical Outcomes for Patients With Heart Failure

Background: To determine whether compliance with heart failure performance measures (HFPMs) is associated with short-term outcome benefit. Methods: In a cohort study, 194 patients satisfying all the HFPMs for which they were eligible were compared with 206 controls. Over 6 months, time to death and first all-cause readmission data were collected. Data were adjusted for differences in comorbidities, medications, and demographics in a multivariate model. Results: There was no difference in 6-month mortality between the 2 groups. Adjusted time to death or all-cause hospitalization (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.58-0.97; P = .03) and all-cause hospitalization (HR, 0.74; 95% CI, 0.57-0.97; P = .03) were shorter for the study group compared with control, whereas there was no difference in time to death (HR, 0.86; 95% CI, 0.66-1.11; P = .24). Conclusions: Adherence to a composite of HFPM appears to be related to a reduction in all-cause readmissions for patients with HF but not short-term mortality. (Am J Med Qual 2008;23:168-175)
In the wake of collision

When atoms collide with metal surfaces, electron-hole pair excitations dissipate the adsorption energy [Also see Report by Bünermann et al.] When a metal atom with thermal kinetic energy hits a metal surface, it adsorbs on it with a probability of one. Moreover, it sticks to its impact site and makes not even a single jump to neighboring lattice sites (1). The mechanism behind this observation is not fully understood. On page 1346 of this issue, Bünermann et al. study a simpler system that can help to elucidate the metal/metal case. In their study, energetic hydrogen atoms impact on a gold surface. Only a fraction of the H atoms adsorb on the surface (see the figure), but the reflected atoms still lose a substantial fraction of their incident kinetic energy. The authors unequivocally identify electron-hole pair excitation as the main dissipation mechanism in these collisions (2). Apart from its obvious model character, the H/metal system is important for fields as diverse as heterogeneous catalysis, interstellar H2 production, and H storage.
Muscle Pain from Physical Exercise

SUMMARYMuscle pain during and after exercise can appear as a result of various conditions, both pathophysiologic [e.g., arterial obstructive pathologies, presence of trigger points, occurrence of traumatic events] and physiologic [dynamic concentric, isometric and dynamic eccentric muscle contraction]. Pain from dynamic concentric contraction has been investigated through execution of rectangular and triangular tests on cycloergolmeter. In the rectangular tests, pain never appears for trials performed below a certain workload [critical exertion], while it is always present, and with a latency progressively lower as the exertion increases, for higher workloads. It is oppressive or cramp-like, fairly well discriminated and diffuse. In triangular tests performed up to maximal exertion, pain starts at well-defined work intensities and increases progressively until the trial has to be stopped. Pain occurring during protracted isometric contractions is characteristically burning, increases steadily in intensity.
Sequential transcriptional waves direct the differentiation of newborn neurons in the mouse neocortex

Tracking neuronal transcriptional programs Early in brain development, cortical neurons are born near the ventricles, then migrate to their functional destinations. Telley et al. used a fluorescent labeling technique to see what transcripts characterize these earliest stages of neural development. Waves of transcriptional programs are initiated, then passed by as the neuron progresses from proliferative to migratory and finally to connectivity phases. Science, this issue p. 1443 In vivo fluorescence labeling reveals neuron-specific primordial transcriptional programs as they dynamically unfold. During corticogenesis, excitatory neurons are born from progenitors located in the ventricular zone (VZ), from where they migrate to assemble into circuits. How neuronal identity is dynamically specified upon progenitor division is unknown. Here, we study this process using a high-temporal-resolution technology allowing fluorescent tagging of isochronic cohorts of newborn VZ cells. By combining this in vivo approach with single-cell transcriptomics in mice, we identify and functionally characterize neuron-specific primordial transcriptional programs as they dynamically unfold. Our results reveal early transcriptional waves that instruct the sequence and pace of neuronal differentiation events, guiding newborn neurons toward their final fate, and contribute to a road map for the reverse engineering of specific classes of cortical neurons from undifferentiated cells.
HIV Quality of Care Assessment at an Academic Hospital

Rapid changes in HIV treatment guidelines and antiretroviral therapy drug safety data add to the increasing complexity of caring for HIV-infected patients and amplify the need for continuous quality monitoring. The authors created an electronic HIV database of 642 patients who received care in the infectious disease (ID) and general medicine clinics in their academic center to monitor HIV clinical performance indicators. The main outcome measures of the study include process measures, including a description of how the database was constructed, and clinical outcomes, including HIV-specific quality improvement (QI) measures and primary care (PC) measures. Performance on HIV-specific QI measures was very high, but drug toxicity monitoring and PC-specific QI performance were deficient, particularly among ID specialists. Establishment of HIV QI data benchmarks as well as standards for how data will be measured and collected are needed and are the logical counterpart to treatment guidelines.