Miracle-dz/UniFAR-FTUs huggingface dataset:
Natural History of Colonization with Gram-Negative Multidrug-Resistant Organisms among Hospitalized Patients

Objective. To determine the anatomic sites and natural history of colonization with gram-negative multidrug-resistant organisms (MDROs). Design. Prospective, longitudinal cohort study. Setting. Walter Reed Army Medical Center, a 236-bed tertiary care center in Washington, DC. Patients. Deployed subjects (ie, inpatients medically evacuated from Iraq or Afghanistan) or nondeployed subjects admitted to the same hospital. Methods. Consenting patients had 6 anatomic sites cultured every 3 days for 2 weeks and then weekly. Gram-negative organisms resistant to 3 or more classes of antibiotics were considered MDROs. Isolates were genotyped using pulsed-field gel electrophoresis. Clinical data, data on antibiotic use, and clinical culture results were collected. Results. Of 60 deployed subjects, 14 (23%) were colonized with an MDRO at admission, and 13 (22%) had incident colonization during hospitalization. The groin was the most sensitive anatomic site for detecting MDRO colonization, and all but one subject remained colonized for the duration of their hospitalization. Sixty percent of subjects with incident Acinetobacter colonization and 25% of subjects with incident Klebsiella colonization had strains that were related to those isolated from other subjects. Of 60 nondeployed subjects, 5 (8%) were colonized with an MDRO at admission; all had recent healthcare contact, and 1 nondeployed subject had an isolate related to a strain recovered from a deployed subject. Conclusions. Colonization with gram-negative MDROs is common among patients with war-related trauma admitted to a military hospital and also occurs among nondeployed patients with recent healthcare contact. The groin is the most sensitive anatomic site for active surveillance, and spontaneous decolonization is rare.
Ethnic Considerations in Facial Aesthetic Surgery.

We may not be able to make you love reading, but ethnic considerations in facial aesthetic surgery will lead you to love reading starting from now. Book is the window to open the new world. The world that you want is in the better stage and level. World will always guide you to even the prestige stage of the life. You know, this is some of how reading will give you the kindness. In this case, more books you read more knowledge you know, but it can mean also the bore is full.
Plaque accumulation and Streptococcus mutans levels around self-ligating bracket clips and elastomeric modules: A randomized controlled trial

Aim: To determine the effect of two different ligating systems that is, elastomeric modules and self-ligating (SL) bracket systems (Smartclip - 3M Unitek) with respect to harboring bacterial plaque in fixed orthodontic treatment. Objectives: To assess, evaluate, and compare the amount of plaque accumulation and Streptococcus mutans colonization around elastomeric ligation and SL clips in the smart clip appliance. Materials and Methods: A total of 111 orthodontic patients scheduled for fixed orthodontic treatments were selected for this split maxillary arch study. All the patients were bonded with smart-clip (3M Unitek) SL brackets, and the wire was placed into the bracket slots, on the randomly selected hemi arch, elastomeric modules were placed for the study to be conducted. Microbial and periodontal plaque accumulation was recorded at 3-time intervals post ligation. Plaque index-by Silness and Loe, modified Quigely Hein index, bleeding on probing were evaluated, and biofilm was collected from the tooth surface after 30 days and placed in petri dishes containing Mitis Salivarius agar for bacterial culturing. Result: It was observed that the side where ligation was done with elastomeric modules accumulated more plaque and increase in S. mutans colony forming units as compared to the side without external ligation (P < 0.05). Conclusion: Reduced bacterial colonization and better plaque control was seen with SL orthodontic bracket appliance system as compared to conventional ligation method.
Application of Self-Report Scales in Balance Function Handicap Assessment and Management

There has been an increasing interest in the medical community not in physical effects of treatment of medical conditions, but instead in the effect that the condition has on the general well-being of the patient. This new philosophy may have evolved from the holistic approach to medicine. Part of this change in philosophy has resulted from the realization that despite the "objective" effects of treatment (e.g., removal of an vestibular schwannoma, stability of a spine following instrumentation, improvement in hearing sensitivity after the fitting of amplification), if the patient does not feel that his or her general condition has improved, then the true effects of treatment may be less than that observed objectively (i.e., with an audiogram or x-ray). Implicit in the term general condition is the patients' perception of their ability to function in daily life. The spheres of interest include the emotional, functional (how well a patient can carry out necessary daily activities) and social-situational effects imposed by the condition and treatment of the condition. Nowhere has the need to index the effect of a medical condition on daily life been greater than in the case of the dizzy or balance-disordered patient. Frank spells of vertigo in public may cause patients to change their occupation (e.g., a painter who must climb tall ladders), restrict their mobility (a person may stop driving a car for fear of endangering the life of another due to the unpredictability of the onset of dizzy episodes), cease leisure activities with friends or family (e.g., for fear of ruining an otherwise pleasurable activity by becoming suddenly and violently ill), stop necessary household activities such as food shopping (e.g., due to the possibility of becoming ill and incapacitated in a public place), and become housebound in the most severe cases. It has been our observation that unlike other disorders (such as hearing loss) that might require numerous negative experiences to cause a change in behavior, dizziness and vertigo attacks may need only occur a few times before a patient might change his or her normal daily routines. Unlike other disorders such as tinnitus and hearing loss that are more or less constant, vertigo usually is unpredictable and when it occurs leaves a patient with a feeling of helplessness. The lack of a psychometrically strong measuring device to quantify the effects of dizziness and imbalance on daily life led the present authors to develop a self-perceived balance handicap scale
The Combined Effect of Modern Highly Active Antiretroviral Therapy Regimens and Adherence on Mortality Over Time

Objective:To characterize the impact of longitudinal adherence on survival in drug-naive individuals starting currently recommended highly active antiretroviral therapy (HAART) regimens. Methods:Eligible study participants initiated HAART between January 2000 and November 2004 and were followed until November 2005 (N = 903). HAART regimens contained efavirenz, nevirapine, or ritonavir-boosted atazanavir or lopinavir. Marginal structural modeling was used to address our objective. Results:The all-cause mortality was 11%. Individual adherence decreased significantly over time, with the mean adherence shifting from 79% within the first 6 months of starting HAART to 72% within the 24- to 30-month period (P value <0.01). Nonadherence over time (<95%) was strongly associated with higher risk of mortality (hazard ratio: 3.13; 95% confidence interval (CI): 1.95 to 5.05). Nonadherent (<95%) patients on nonnucleoside reverse transcriptase inhibitor (NNRTI)-based and boosted protease inhibitor-based regimens were, respectively, 3.61 times (95% CI: 2.15 to 6.06) and 3.25 times (95% CI: 1.63 to 6.49) more likely to die than adherent patients. Within the NNRTI-based regimens, nonadherent individuals on efavirenz were at a higher risk of mortality. Conclusions:Incomplete adherence to modern HAART over time was strongly associated with increased mortality, and patients on efavirenz-based NNRTI therapies were particularly at a higher risk if nonadherent. These results highlight the need to develop further strategies to help sustain high levels of adherence on a long-term basis.
The Impact of Needle and Syringe Programs on HIV and HCV Transmissions in Injecting Drug Users in Australia: A Model-Based Analysis

Objectives:We aim to estimate how changes in sterile syringe distribution through needle-syringe programs (NSPs) may affect HIV and hepatitis C virus (HCV) incidence among injecting drug users (IDUs) in Australia. Methods:We develop a novel mathematical model of HIV and HCV transmission among IDUs who share syringes. It is calibrated using biological and Australian epidemiological and behavioral data. Assuming NSP syringe distribution affects the number of times each syringe is used before disposal, we use the model to estimate the relationship between incidence and syringe distribution. Results:HIV is effectively controlled through NSP distribution of sterile syringes {with the effective reproduction ratio below 1 [0.66 median, interquartile range (0.63-0.70)] under current syringe distribution}. In contrast, HCV incidence is expected to remain high and its control is not feasible in the foreseeable future. The proportion of injections that are shared and the number of times each syringe is used before disposal are the driving factors of HCV incidence. The frequency in which each syringe is used can potentially be influenced by changes in syringe distribution. We estimate that if syringe distribution or coverage doubled, then annual incidence is likely to reduce by 50%. However, if it was decreased to one third of the current level, then ∼3 times the incidence could be expected. Conclusions:This research highlights the large benefits of NSPs, puts forward a quantitative relationship between incidence and syringe distribution, and indicates that increased coverage could result in significant reductions in viral transmissions among IDUs.
Clinical Updates on Substance-P Antagonist in Pain Management

Novel drug designing and development is the need and the decisive target of pharmaceutical industry, as the active life of a drug is not very extensive. Substance P (SP) is considered as the prototypic neuropeptide of the more than 50 known neuroactive molecules, and is also the member of a new neurotransmitter system that belongs to the family of three related peptides known as neurokinins and a member of the seven-transmembrane G-protein coupled family of receptors and is primarily associated with sensory neurons in the periphery and specific areas of the CNS [1,2]. The other two members are simply called neurokinin A and neurokinin B. Modulation of SP activity offered a radical new approach to the management of depression, anxiety, stress and is involved in several physiologic activities, including the vomiting reflex, defensive behavior, change in cardio-vascular tone, stimulation of salivary secretion, smooth muscle contraction and vasodilatation [3,4].
Loss of Bone Mineral Density After Antiretroviral Therapy Initiation, Independent of Antiretroviral Regimen

Background:Decreased bone mineral density (BMD) has been described in HIV-infected patients initiating antiretroviral therapy (ART), but the contributions of ART and immunologic and/or virologic factors remain unclear. Methods:We compared total BMD changes over 96 weeks in 106 ART-naive HIV-infected subjects who were randomized to receive efavirenz (EFV) + zidovudine/lamivudine (n = 32) or lopinavir/ritonavir (LPV/r) + zidovudine/lamivudine induction (n = 74) for 24-48 weeks followed by LPV/r monotherapy. We also sought to identify factors associated with BMD loss, including markers of systemic inflammation [soluble tumor necrosis factor-α receptors (sTNFR I and II)]. Results:After 96 weeks, the mean percent change from baseline in total BMD was −2.5% (LPV/r) and −2.3% (EFV) (P < 0.01 for within-group changes in either arm; P = 0.86 for between-group differences). No alteration in the rate of BMD change was observed upon simplification to LPV/r monotherapy. Although soluble tumor necrosis factor-α receptor II concentrations at baseline and 24 weeks were at least marginally associated with subsequent changes in BMD (P = 0.06 and P = 0.028, respectively), these associations were no longer significant after adjustment for CD4+ T cell count. Subjects with lower baseline CD4+ T cell count, non-black race, and higher baseline glucose demonstrated a higher risk for >5% decrease in BMD. Conclusions:Similar decreases in BMD over 96 weeks occurred in ART-naive subjects receiving either EFV-based regimen or LPV/r-based regimen, which was not altered by simplification to LPV/r monotherapy and was unrelated to markers of tumor necrosis factor-α activity.
Influenza Virus—Cytokine-Protease Cycle in the Pathogenesis of Vascular Hyperpermeability in Severe Influenza

Abstract Background. Severe influenza is characterized by cytokine storm and multiorgan failure with edema. The aim of this study was to define the impact of the cytokine storm on the pathogenesis of vascular hyperpermeability in severe influenza. Methods. Weanling mice were infected with influenza A WSN/33(H1N1) virus. The levels of proinflammatory cytokines, tumor necrosis factor (TNF) α, interleukin (IL) 6, IL-1β, and trypsin were analyzed in the lung, brain, heart, and cultured human umbilical vein endothelial cells. The effects of transcriptional inhibitors on cytokine and trypsin expressions and viral replication were determined. Results. Influenza A virus infection resulted in significant increases in TNF-α, IL-6, IL-1β, viral hemagglutininprocessing protease trypsin levels, and viral replication with vascular hyperpermeability in lung and brain in the first 6 days of infection. Trypsin upregulation was suppressed by transcriptional inhibition of cytokines in vivo and by anti-cytokine antibodies in endothelial cells. Calcium mobilization and loss of tight junction constituent, zonula occludens-1, associated with cytokine- and trypsin-induced endothelial hyperpermeability were inhibited by a protease-activated receptor-2 antagonist and a trypsin inhibitor. Conclusions. The influenza virus-cytokine-protease cycle is one of the key mechanisms of vascular hyperpermeability in severe influenza.
Incomplete Reversibility of Tenofovir-Related Renal Toxicity in HIV-Infected Men

Background:Significant nephrotoxicity develops in 1%-2% of HIV-infected adults receiving tenofovir (TDF). This nephrotoxicity is said to resolve rapidly, but this assessment is based on short follow-up, very few patients and use of serum creatinine, an insensitive measure of renal function. Methods:We determined the reversibility of TDF-related nephrotoxicity in 24 HIV-infected male outpatients who ceased TDF for renal impairment by retrospective assessment of estimated glomerular filtration rate (eGFR) using the Modified Diet in Renal Disease equation. Results:Median (interquartile range) eGFR pre-TDF was 74 (61-88) mL·min−1·1.73 m−2, fell to 51 (39-61) mL·min−1·1.73 m−2 at TDF cessation and increased to 58 (48-70) mL·min−1·1.73 m−2 a median 13 months after TDF cessation (most recent vs pre-TDF eGFR; P = 0.0008). Results were similar with the Cockcroft-Gault equation and after exclusion of patients who had shorter follow-up after TDF cessation. Only 10 (42%) patients reached their pre-TDF eGFR. Greater eGFR improvement was significantly associated with more rapid decline in eGFR on TDF therapy and in those who received TDF with a protease inhibitor, with a trend for shorter duration of TDF therapy. Discussion:In this population, TDF-related renal toxicity was not always fully reversible.
Drug-Drug Interactions Between Raltegravir and Pravastatin in Healthy Volunteers

Background:To evaluate the potential drug-drug interaction between raltegravir and pravastatin. Methods:This was an open-label, randomized, 3-period, cross-over, single-centre trial in 24 healthy volunteers. Subjects received the following treatments: pravastatin 40 mg every day for 4 days, raltegravir 400 mg twice a day for 4 days, and pravastatin 40 mg every day + raltegravir 400 mg twice a day for 4 days. The treatments were separated by washout periods of 10 days. On day 4 of each treatment period, blood samples for pharmacokinetics were collected throughout a 24-hour period. Results:Geometric mean ratios (90% confidence interval) for pravastatin + raltegravir versus pravastatin alone were 0.96 (0.83 to 1.11) for AUC0-24 and 1.04 (0.85 to 1.26) for Cmax. The mean low-density lipoprotein cholesterol decrease after 4 days of pravastatin was 0.42 mmol/L both in the presence and the absence of raltegravir. The geometric mean ratio (90% confidence interval) AUC0-12, Cmax, and C12 for raltegravir + pravastatin versus raltegravir alone were 1.13 (0.77 to 1.65), 1.31 (0.81 to 2.13), and 0.59 (0.39 to 0.88), respectively. Conclusions:Raltegravir did not influence the pharmacokinetics or the short-term lipid-lowering effects of pravastatin, whereas pravastatin increased the Cmax but decreased the C12 of raltegravir. The effects of pravastatin on raltegravir pharmacokinetics are not likely to be clinically relevant.
Hypertext Computer-Assisted Instruction for Geriatric Physical Therapists

The American long-term care industry is being challenged to care for increasing numbers of more acutely ill patients. To meet that challenge, health care providers must possess adequate skills and knowledge related to geriatric patients. Physical therapists provide care to geriatric patients, but professional training programs may lack adequate course work in geriatric evaluation and treatment procedures. This study investigated the use of computer-assisted instruction (CAI) for physical therapists working in geriatric treatment facilities owned by a long-term care company. A hypertext CAI program on wound physiology/care was developed. Using an equivalent- group, posttest only study design, fourteen randomly assigned physical therapists received experimental treatment (CAI), while 19 other therapists served as controls. Both groups were administered a posttest instrument; the experimental group also completed an opinionnaire. The experimental group mean score was significantly higher (p < .004) than the .
Recovery of a multidrug-resistant strain of pandemic influenza A 2009 (H1N1) virus carrying a dual H275Y/I223R mutation from a child after prolonged treatment with oseltamivir.

A/Pennsylvania/30/2009 H275Y, I223R 4.72 0.43 (21) 8.57 0.75 (22) 3093.49 44.99 (12,374) 9324.21 119.08 (9053) 978.88 119.08 (7530) 3142.10 441.99 (13,092) Control A/West Virginia/11/2009 Wild type 0.22 0.02 (1) 0.39 0.02 (1) 0.25 0.12 (1) 1.03 0.22 (1) 0.13 0.03 (1) 0.24 0.06 (1) A/California/38/2009 H275Y 0.35 0.03 (2) 0.76 0.07 (2) 125.62 37.26 (502) 1305.66 125.02 (1268) 10.87 2.35 (84) 96.89 16.63 (404) A/Chile/1579/2009 I223K 1.05 0.28 (5) 2.32 0.34 (6) 2.98 0.78 (12) 40.06 8.03 (39) 0.17 0.08 (1) 1.06 0.08 (4)
Introduction: Paving the Way for Biomedical HIV Prevention Interventions in Youth

The HIV epidemic among youth continues to grow at alarming proportions throughout the world. Efficacious and comprehensive biomedical prevention interventions are desperately needed for this vulnerable population if a reduction in global HIV incidence is to be achieved. To succeed at enrolling youth in studies of such modalities, communities whose youth will be participating must be highly engaged throughout the spectrum of research concept development to implementation and later translation into programs. In this process, there are numerous challenges, both intrinsic and extrinsic to the youth themselves. Intrinsic ones include developmental considerations in physiology, pharmacology, and behavior; extrinsic considerations are those in the community, ethical, legal, and regulatory arenas and those in designing clinical trials for youth to feasibly participate. We convened a consultative meeting to deliberate over these considerations among a variety of experts representing youth and their community, advocacy groups, academia, industry, regulators, and others in the federal government. Broad recommendations aimed at many stakeholders in the adolescent HIV prevention research agenda were made and were to improve the timely inclusion of youth in this research to ensure that prevention agents can be used safely by youth as soon as they become available to adults.
The 1540-nm Nonablative Fractional Photothermolysis for Facial Surgical Scars

Introduction: Nonablative fractionated photothermolysis creates microscopic zones of thermal damage extending down into the dermis. The epidermis is left intact, allowing for rapid healing with minimal downtime for the patient. The deep heating of the dermis can help with rejuvenation of the skin by promoting neocollagenesis. The purpose of this study is to evaluate the effectiveness of 1540-nm nonablative fractional photothermolysis for facial surgical scars. Materials and Methods: Four patients with varying Fitzpatrick skin types had facial surgical scars treated with a 1540-nm nonablative fractionated photothermolysis. Results: All patients showed marked improvement in the appearance of their scars with no adverse pigmentary changes. The 1540-nm nonablative fractional resurfacing laser should be considered a first-line treatment for postsurgical scarring. Conclusions: Nonablative fractional photothermolysis with a 1540-nm wavelength is an excellent method to improve the appearance of facial surgical scars. It can be done with a minimum amount of downtime and should be safe for all skin types.
Transmission of Influenza A Pandemic (H1N1) 2009 Virus in a Long-Term Care Facility in Ontario, Canada

From the Division of Infectious Diseases, Department of Pediatrics, Columbia University (S.J.P., E.R., L.S.), and the Department of Infection Control and Prevention, New York-Presbyterian Hospital (L.S.), New York, New York; and the Division of Infectious Diseases, Department of Infection Prevention and Control, the Children's Hospital of Philadelphia (T.Z., P.P.), and the University of Pennsylvania School of Medicine (T.Z., P.P.), Philadelphia, Pennsylvania. Address reprint requests to Sameer J. Patel, MD, Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University, 622 West 168th Street, PH 4W-475, New York, NY 10032 (sp2172@columbia.edu). Received March 31, 2010; accepted June 14, 2010; electronically published October 21, 2010. © 2010 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2010/3112-0015$15.00. DOI: 10.1086/657334
The Cost of Sex and Competition between Cyclical and Obligate Parthenogenetic Rotifers

The ubiquity of sexual reproduction is an evolutionary puzzle because asexuality should have major reproductive advantages. Theoretically, transitions to asexuality should confer substantial benefits in population growth and lead to rapid displacement of all sexual ancestors. So far, there have been few rigorous tests of one of the most basic assumptions of the paradox of sex: that asexuals are competitively superior to sexuals immediately after their origin. Here I examine the fitness consequences of very recent transitions to obligate parthenogenesis in the cyclical parthenogenetic rotifer Brachionus calyciflorus. This experimental system differs from previous animal models, since obligate parthenogens were derived from the same maternal genotype as cyclical parthenogens. Obligate parthenogens had similar fitness compared with cyclical parthenogens in terms of the intrinsic rate of increase (calculated from life tables). However, population growth of cyclical parthenogens was predicted to be much lower: sexual female offspring do not contribute to immediate population growth in Brachionus, since they produce either males or diapausing eggs. Hence, if cyclical parthenogens constantly produce a high proportion of sexual offspring, there is a cost of sex, and obligate parthenogens can invade. This prediction was confirmed in laboratory competition experiments.