Miracle-dz/UniFAR-FTUs huggingface dataset:
Efficacy and safety of infliximab: A comparison with other biological disease-modifying anti-rheumatic drugs

Abstract Objectives: The intensification of infliximab (IFX) treatment, involving escalation of the dose and shortening of interval, was approved in Japan in July 2009. We consider IFX intensification therapy to be preferable for patients with treatment-resistant active rheumatoid arthritis (RA). We retrospectively compared the efficacy of IFX with that of other bDMARDs in methotrexate (MTX)-resistant patients. Methods: Patients who satisfied the following criteria were enrolled: (i) those who started bDMARDs between February 2011 and December 2016, and (ii) those who required bDMARDs after 180 d of MTX treatment. We compared 33 patients who had been treated with IFX (IFX group) and 146 who had received other bDMARDs treatment (non-IFX group). Results: IFX was administered at a dose of 6.98 mg/kg/8-week equivalent at 52 weeks. Clinical disease activity index clinical remission (CDAI-CR) was achieved in 49 of the 179 patients at 52 weeks and 13 of these 49 patients received IFX. Logistic regression analysis showed that treatment with IFX was an important variable for the achievement of CDAI-CR at 52 weeks (odds ratio 2.69, 95% confidence interval 1.13–6.42). The severity and frequency of adverse events did not differ. Conclusion: Intensification of IFX was effective and well tolerated for MTX resistant patients.
Overcoming Resistance: Virologic Response to a Salvage Regimen with the Combination of Ritonavir plus Indinavir

Abstract Purpose: To explore the possibility of overcoming resistance to protease inhibitors (PIs) and to determine the resistance cutoff values that continue to predict treatment failure with a dual PI regimen. Method: We performed a prospective study of 53 patients who had failed in several PIs and who were included in a ritonavir (RTV) plus indinavir (IDV) salvage regimen. Median HIV RNA level decrease was evaluated according to resistance assays and indinavir trough levels. Results: Eighty-seven percent of patients had previously failed on an IDV-containing regimen. Overall, median HIV RNA decrease was –1.25 log10 copies/mL after 3 months on therapy. A significant blunted virologic response was observed only in isolates with more than 12 substitutions including the V82A (–0.75 vs. –1.3 log10 copies/mL; p = .04), or in isolates with more than 30 fold-increase in the IC50 (–0.43 vs. –1.2 log10 copies/mL). Higher drug levels were observed in patients with resistant isolates who achieved an HIV RNA decrease greater than 1 log (1742 vs. 1100 ng/mL). Conclusion: Our preliminary data suggest the possibility of overcoming resistance with the combination of RTV plus IDV. They also suggest the need for establishing new resistance cutoff values when using PIs in combination.
Testosterone levels and fecundity in the hermaphroditic aquatic snail Lymnaea stagnalis exposed to testosterone and endocrine disruptors

Endocrine disruptors are known to alter endogenous free and esterified levels of androgenic and estrogenic steroid hormones in aquatic mollusks. The origin of steroids in these animals, however, remains controversial. In the present study, free and esterified testosterone concentrations were measured in the hermaphroditic aquatic gastropod Lymnaea stagnalis exposed to molecules known for their androgenic (testosterone and tributyltin), anti‐androgenic (cyproterone‐acetate), and estrogenic (chlordecone) properties, by reference to their mode of action in vertebrates. In parallel, snail oviposition and fecundity were followed over a 21‐d exposure period. Testosterone exposure resulted in increased esterified testosterone levels, whereas free testosterone concentrations remained stable. In contrast, cyproterone‐acetate significantly increased the free form of testosterone with no changes in the esterified form, whereas chlordecone showed a tendency to reduce (though not significantly) esterified testosterone concentrations without changing free testosterone levels. Finally, tributyltin did not alter testosterone homeostasis. The production of egg clutches and eggs was significantly reduced only in the snails exposed to the highest concentrations of chlordecone (19.6 µg/L) and tributyltin (94.2 ng Sn/L). Overall, the present study demonstrates that uptake of testosterone from the exposure medium occurs in L. stagnalis. Moreover, it shows that cyproterone‐acetate and, to a lesser extent, chlordecone can alter endogenous testosterone levels in this freshwater snail. However, the relationship between hormonal changes and snail reproduction has not been established. Environ Toxicol Chem 2013;32:1740–1745. © 2013 SETAC
Nickel allergy in Spain needs active intervention

Juan Garcı́a-Gavı́n1 , José Carlos Armario-Hita2 , Virginia Fernández-Redondo1, José Manuel Fernández-Vozmediano3, Javier Sánchez-Pérez4, Juan Fco. Silvestre5, Wolfgang Uter6 and Ana M Giménez-Arnau7 1Faculty of Medicine, Department of Dermatology, University Hospital Complex, Santiago de Compostela, La Coruña 15706, Spain, 2Department of Dermatology, Hospital Punta de Europa (Algeciras), University of Cádiz, Cádiz 11207, Spain, 3Department of Dermatology, Hospital Universitario de Puerto Real, University of Cádiz, Cádiz 11510, Spain, 4Department of Dermatology, Hospital Universitario la Princesa, Madrid 28006, Spain, 5Department of Dermatology, Hospital General Universitario de Alicante, Alicante 03010, Spain, 6Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nüremberg, Erlangen 91054, Germany, and 7Department of Dermatology, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona 08003, Spain
Do Hospitals Measure up to the National Culturally and Linguistically Appropriate Services Standards?

Background:Federal regulations require that health care organizations provide language services to patients with limited English proficiency. The National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS standards) provide guidance on how to fulfill these regulations. It is not known how US hospitals have incorporated them into practice. Objectives:To assess how US hospitals are meeting federal regulations requiring provision of language services using CLAS as a measure of compliance. Research Design:Cross-sectional survey. Subjects:Hospital interpreter services managers (or equivalent position). Measures:Degree of meeting each of the 4 language-related CLAS standards. Results:Many hospitals are not meeting federal regulations. The majority reported providing language assistance in a timely manner in their first, but not their third, most commonly requested language. Although hospitals reported that they informed patients of their right to receive language services, many did so only in English. A majority of hospitals reported the use of family members or untrained staff as interpreters. Few reported providing vital documents in non-English languages. Overall, 13% of hospitals met all 4 of the language-related CLAS standards, whereas 19% met none. Conclusions:Our study documents that many hospitals are not providing language services in a manner consistent with federal law. Enforcement of these regulations is inconsistent, and thus does not motivate hospitals to comply. Compliance will likely come with new guidelines, currently being written, by many of the regulatory organizations. Our study reinforces the importance of these efforts and helps target interventions to improve the delivery and safety of care to limited English proficient patients.
Avoidance and reproduction tests with the predatory mite Hypoaspis aculeifer: Effects of different chemical substances

Few toxicity data exist in the literature on the toxicity of chemicals to the predatory mite Hypoaspis aculeifer, but no information is available on its avoidance response. To assess the relevance of the avoidance behavior of H. aculeifer and the relative sensitivity of the mite in comparison with other invertebrates, avoidance and reproduction tests were conducted with 7 chemicals using standardized guidelines. The chemicals (deltamethrin, chloropyrifos, dimethoate, Cu, NaCl, phenanthrene, and boric acid) were selected so as to cover varying chemical classes. For all 3 pesticides tested, avoidance response showed lower sensitivity than reproduction and survival (avoidance median effective concentration [EC50] > reproduction EC50/median lethal concentration [LC50] values). However, for Cu, NaCl, and phenanthrene, the avoidance response showed similar sensitivity as reproduction (avoidance EC50 ≤ reproduction EC50 values), whereas for boric acid, similar sensitivity as survival (avoidance EC50 ≤ LC50 values). Although the mite H. aculeifer appears less sensitive to some of the chemicals tested than most other soil invertebrates, its status as the only predator among organisms for which standardized tests are available affirms its inclusion in routine ecotoxicity assessment. The results of the avoidance test with H. aculeifer suggest its potential usefulness as a rapid screening test for risk assessment purposes. Environ Toxicol Chem 2014;33:230–237. © 2013 SETAC
Improving the Quality of Pressure Ulcer Care With Prevention: A Cost-Effectiveness Analysis

BackgroundIn October 2008, Centers for Medicare and Medicaid Services discontinued reimbursement for hospital-acquired pressure ulcers (HAPUs), thus placing stress on hospitals to prevent incidence of this costly condition. ObjectiveTo evaluate whether prevention methods are cost-effective compared with standard care in the management of HAPUs. Research Design and SubjectsA semi-Markov model simulated the admission of patients to an acute care hospital from the time of admission through 1 year using the societal perspective. The model simulated health states that could potentially lead to an HAPU through either the practice of “prevention” or “standard care. ” Univariate sensitivity analyses, threshold analyses, and Bayesian multivariate probabilistic sensitivity analysis using 10,000 Monte Carlo simulations were conducted. MeasuresCost per quality-adjusted life-years (QALYs) gained for the prevention of HAPUs. ResultsPrevention was cost saving and resulted in greater expected effectiveness compared with the standard care approach per hospitalization. The expected cost of prevention was $7276.35, and the expected effectiveness was 11.241 QALYs. The expected cost for standard care was $10,053.95, and the expected effectiveness was 9.342 QALYs. The multivariate probabilistic sensitivity analysis showed that prevention resulted in cost savings in 99.99% of the simulations. The threshold cost of prevention was $821.53 per day per person, whereas the cost of prevention was estimated to be $54.66 per day per person. ConclusionThis study suggests that it is more cost effective to pay for prevention of HAPUs compared with standard care. Continuous preventive care of HAPUs in acutely ill patients could potentially reduce incidence and prevalence, as well as lead to lower expenditures.
Intranasal administration of oxytocin modulates behavioral and amygdala responses to infant crying in females with insecure attachment representations

ABSTRACT The current study examined the effects of oxytocin administration on the response to infant crying in individuals with secure or insecure attachment representations as assessed with the Adult Attachment Interview. We measured feelings of irritation and the use of excessive force as indicated by grip strength using a handgrip dynamometer during exposure to infant crying in 42 women without children who were administered intranasal oxytocin or a placebo. In addition, amygdala responses to infant crying and control sounds were measured with functional magnetic resonance imaging (fMRI). The effects of oxytocin on reactivity to crying were moderated by attachment security. Oxytocin decreased the use of excessive handgrip force and amygdala reactivity in response to crying in individuals with insecure attachment representations. Our findings indicate that insecure individuals, who show emotional, behavioral, and neural hyperreactivity to crying, benefit the most from intranasal oxytocin.
Identificación de los determinantes de la estadía en Unidades de Cuidados Intensivos usando redes neuronales artificiales

The prediction of the length of stay at the moment of hospital admission is of outmost importance. Many studies have used lineal models to predict this variable, but there are inherent limitations to these models. The use of non lineal models has been scarce. Aim: To develop a non lineal model to predict length of stay in intensive care units. Material and methods: Retrospective analysis of 294 patients admitted to two intensive care units in Santiago, Chile. The severity of the disease motivating the admission was nominally quantified. This and other physiological variables were included in the model. The length of stay was modeled using Artificial Neural Networks. Results: The model yielded an error of 8.7% (3.6 ± 0.4 days, CI 95%) and a correlation coefficient of 0.9 (p <0.001) for the prediction of length of stay. Using net sensitivity analysis, the model determined that gastrointestinal diseases, infections and respiratory problems were the main causes of prolongation of intensive care unit stay. Conclusions: Intensive care units should have, in the future, computer systems that gather vital information to predict length of stay (Rev Med Chile 2002; 130: 71-78)
Risk adjustment for primary care: an essential tool for health system reform.

O ur nation’s disappointing experience with the performance of its health care system necessitates serious consideration of how health care services are paid for. Under our largely fee-for-service (FFS) payment system (based on Medicare’s Resource-Based Relative Value Scale model), we richly reimburse procedures and pay little for evaluation and management services. 1,2 It should come as no surprise that “we get what we pay for”: too many procedures and too little doctoring. 3 The consequences include the world’s highest per capita health care expenditures, poor rankings in health status and health outcomes, 4 and a distorted physician workforce (too many procedural specialists and a shortage of primary care physicians). 5,6 The situation persists despite the preponderance of evidence ﬁnding access to primary care signiﬁcantly associated with lower per capita costs, better health status, and fewer health disparities. 7 The poster child for this state of affairs is McAllen, TX, exhibiting twice the per capita Medicare expenditures as El Paso, TX (same demographics), with no difference in the measures of health quality. 8 Such disappointing outcomes indicate poor value for each health care dollar spent and pose serious economic and social challenges. Nevertheless, the current health care debate continues obsessed with how we pay for health insurance rather than how we pay for health care services, the key to unlocking value. focus to proceed Those doing
Person centred dementia care: problems and possibilities

PurposeDementia care is an issue of increasing policy focus, with person centred approaches becoming synonymous with quality provision in this area. However, the implementation and efficacy of this approach is difficult to measure and there are still huge variations in working practices, with task centred approaches traditionally predominating over more holistic forms of care. In order to address these issues the procedure of dementia care mapping has been developed, which aims to assess the wellbeing of people with dementia and other vulnerable groups through the observation of communal activities. This article aims to critically assess the implementation of a person centred approach.Design/methodology/approachWith the use of dementia care mapping, this article assesses the implementation of a person centred approach with a group of care home residents. All were female, their ages ranged from 77 to 92.FindingsIt is shown that while participants potentially experienced many benefits from person centred approaches and the social engagement and integration that derived from this, its efficacy and impact was undermined by contextual factors such as staff shortages.Originality/valueIn order that contextual factors are recognised and addressed, practice should transcend its focus on the promotion of individual wellbeing and address the wider group and social contexts which can facilitate or prevent its fulfilment.
Development and Dissemination of a Statewide System to Minimize Use of Potentially Inappropriate Medications (PIMs)

Background:Drug safety and adverse drug reactions in the community are of concern in the geriatric population. To help decrease the number of adverse drug reactions, the New Mexico Prescription Improvement Coalition created a consensus panel, the Potentially Inappropriate Medications (PIMs) Advisory Board. Objective:To develop consensus guidelines that would promote decreasing the use of PIMs, as defined by the Beers’ criteria, through the promotion of safer alternative therapies and strategies. Methods:A consensus panel of clinical pharmacists, geriatricians, nurses, managed care specialists, and consumers evaluated the Beers’ criteria and created clinical guidelines addressing the use of PIMs in older adults and disease state alternative treatment recommendations and strategies. The guidelines were distributed and made available electronically to health care providers. In addition, educational sessions were provided to health care providers throughout the state. Since development of the guidelines in 2009, they have been distributed to over 7500 practitioners and 140 pharmacists throughout New Mexico. Results:The PIMs clinical guidelines were endorsed by 27 state-level health care organizations and have been promoted through several managed care organizations. The Web-based version of the guidelines have been viewed an average of 163 times per month and the alternative treatment recommendations and strategies was viewed an average of 407 times per month. Conclusions:Use of a consensus process to develop and promote guidelines that include alternative treatment recommendations and strategies can increase awareness of the use of medications that require caution in the elderly and promote safer prescribing practices.
Körperliche Belastung, Ernährung und Sonnenexposition zur Prävention der Osteoporose

Physical Exercise, Nutrition and Sunshine Exposure for the Prevention of Osteoporosis Background: Social and economic impact of osteoporosis is growing. Prevention deserves more attention than at present. Since previous reviews on prevention of osteoporosis by the author, many original papers and reviews on the subject have been published. Which interventions are effective? Methods: A MEDLINE search was performed using the search terms ‘osteoporosis’ and ‘calcium’ or ‘vitamin D’ or ‘ultraviolet’ or ‘sunshine’ or ‘nutrition’ or ‘exercise’ or ‘hormone’. Additionally, references of recent publications were searched for significant contributions. Relevant publications as assessed by the author were included into the present review. Results and Conclusions: Regular high-impact physical exercise, a daily allowance of at least 1000 mg calcium, a sufficient supplementation with vitamin D through UVB-exposure of the skin or oral supplementation, and hormonal replacement therapy in deficiency states are the fundamentals of prevention of osteoporosis.
Cheerleaders/booth babes/ Halo hoes: pro-gaming, gender and jobs for the boys

In recent years, a ‘professional’ digital gaming industry has emerged in North America: this interconnected series of organisations and leagues host competitive gaming tournaments (often televised) in which young, mostly male participants compete for increasingly lucrative prize money and sponsorship contracts. Taking up Jo Bryce and Jason Rutter's (2005) challenge to confront the ways girl gamers are rendered ‘invisible’ by gamers, researchers and designers, this paper maps the various ways women participate in a set of practices around the organisation, promotion and performance of competitive gaming, framed as the exclusive domain of (young, straight, middle class) male bodies. Mothers flying their sons' teams to events all over North America, female players participating in tournaments or promotional models operating sponsorship booths, the women who participate in competitive gaming tournaments negotiate different expectations and carry out different kinds of embodied work. Each of these ‘roles’, however, is tenuously maintained within a community that most commonly reads female participation in sexualised terms: mothers at events describe themselves as ‘cheerleaders’, female players risk being labelled as ‘halo hoes’ and promotional models become ‘booth babes’.
An internet of old things

This paper reflects upon the temporal characteristics of the emerging phenomenon known as the ‘Internet of Things’. As objects become individually tagged with unique identities through the addition of small electronic chips or bar codes, their history is recorded and made available to others across a network. The advent of this ever-growing catalogue of histories means that every object will be ‘in touch’ with its current and previous owner at all times and suggests that while we as owners might like to ‘forget’ about an object, we will never truly be detached from them. However the author suggests that there exists a social and cultural inertia that is tied to a teleological perception of time and that the weight of this is hampering opportunities for the Internet of Things to embrace old things. The paper uses a series of cultural coordinates to explore our relationship with personal and social histories including the use of cosmetic surgery to correct hereditary characteristics and films from the last five years that demonstrate a more creative approach to understanding the past. Ultimately the author uses a research project that he is involved in to explore the potential for digital technology to network the past and develop an ‘Internet of Old Things’.
Ante mortem diagnosis of pancreatitis in four cats

The ante mortem detection of pancreatitis in four cats is reported. Clinical findings included vomiting, lethargy and constipation in all the cats, diabetes mellitus in two cats and severe jaundice and a vitamin K responsive coagulopathy in one cat. Serum amylase was normal in all the cats and serum lipase was elevated in one azotaemic cat. Ultrasonography revealed predominantly hypoechoic masses in the right cranial quandrant of the abdomen of each cat. The anatomical location of these masses was consistent with the pancreas. Gross examination supported these ultrasonographic observations. The pancreatic lesions were characterised histologically as acute necrotising pancreatitis, acute necrotising pancreatitis with abscessation, chronic active pancreatitis with cystic dilatation of the pancreatic duct causing bile duct obstruction and chronic active pancreatitis with nodular hyperplasia. This report indicates that pancreatitis is a clinically significant disease in cats that may be diagnosed ante mortem.