Miracle-dz/UniFAR-FTUs huggingface dataset:
Effects of Ethanol Lock Therapy on Central Line Infections and Mechanical Problems in Children With Intestinal Failure

Objectives: Although use of 70% ethanol lock therapy (ELT) has been shown to decrease the rate of catheter-related bloodstream infections (CRBSIs) in patients with intestinal failure and central venous catheters (CVCs), concerns have been raised about its association with higher rates of mechanical problems and CVC replacements (CVC-Rs). We sought to compare the rates of CRBSI, mechanical problems, and CVC-Rs in a cohort of pediatric patients with intestinal failure, with and without ELT (ELT+ and ELT−, respectively). Methods: Data were collected in a retrospective chart review from February 2007 to May 2014. Mann-Whitney and Wilcoxon signed-rank tests were used to compare nonparametric and paired data, respectively. Results: Twenty-nine children had 9033 catheter days (CDs). The ELT+ group (vs ELT−) had lower rate of infection and significantly fewer CVC-Rs due to infection but significantly more mechanical events and related CVC-Rs with significantly shorter mean CVC survival. In 13 children who had a pre-ELT and post-ELT period, ELT was associated with a decrease in the rate of CVC-Rs due to infection (0.36 vs 4.74/1000 CDs, P = .046) and an increase in the rate of CVC-Rs due to mechanical problems (5.05 vs 0/1000 CDs, P = .018). Conclusions: While ELT+ is associated with a lower rate of CRBSIs and related CVC-Rs, it is also associated with higher rates of mechanical problems and related CVC-Rs. In addition to investigating the ideal concentration, duration, and timing of ELT to preserve the integrity of the CVC, alternatives to exclusively ethanol-based lock solutions should be developed.
Lipedema: friend and foe

Abstract Background Lipedema is a chronic disorder presenting in women during puberty or other times of hormonal change such as childbirth or menopause, characterized by symmetric enlargement of nodular, painful subcutaneous adipose tissue (fat) in the limbs, sparing the hands, feet and trunk. Healthcare providers underdiagnose or misdiagnose lipedema as obesity or lymphedema. Materials and methods The benefits (friend) and negative aspects (foe) of lipedema were collected from published literature, discussions with women with lipedema, and institutional review board approved evaluation of medical charts of 46 women with lipedema. Results Lipedema is a foe because lifestyle change does not reduce lipedema fat, the fat is painful, can become obese, causes gait and joint abnormalities, fatigue, lymphedema and psychosocial distress. Hypermobility associated with lipedema can exacerbate joint disease and aortic disease. In contrast, lipedema fat can be a friend as it is associated with relative reductions in obesity-related metabolic dysfunction. In new data collected, lipedema was associated with a low risk of diabetes (2%), dyslipidemia (11.7%) and hypertension (13%) despite an obese average body mass index (BMI) of 35.3 ± 1.7 kg/m2. Conclusion Lipedema is a painful psychologically distressing fat disorder, more foe than friend especially due to associated obesity and lymphedema. More controlled studies are needed to study the mechanisms and treatments for lipedema.
Multi-Target Anti-Alzheimer Activities of Four Prenylated Compounds from Psoralea Fructus

Alzheimer’s disease (AD) is an age-related neurodegenerative disease that is mediated by multiple signaling pathways. In recent years, the components of Psoralea Fructus (PF) have demonstrated some anti-Alzheimer effects both in vitro and in vivo. To further reveal the active compounds of PF and their mechanisms regulating key targets of AD, in this study, we identified four prenylated compounds from the 70% ethanolic aqueous extract of PF, namely bavachin, bavachinin, bavachalcone, and isobavachalcone. Multi-target bioactivity analysis showed that these compounds could differentially inhibit neuroinflammation, oxidative damage, and key AD-related protein targets, such as amyloid β-peptide 42, β-secretase, glycogen synthase kinase 3β, and acetylcholinesterase. These compounds may generate beneficial effects in AD prevention and treatment.
Systems thinking in public health: a bibliographic contribution to a meta-narrative review

Background Research across the formal, natural and social sciences has greatly expanded our knowledge about complex systems in recent decades, informing a broadly inclusive, cross-disciplinary conceptual framework referred to as Systems Thinking (ST). Its use in public health is rapidly increasing, although there remains a poor understanding of how these ideas have been imported, adapted and elaborated by public health research networks worldwide. Method This review employed a mixed methods approach to narrate the development of ST in public health. Tabulated results from a literature search of the Web of Science Core Collection database were used to perform a bibliometric analysis and literature review. Annual publication counts and citation scores were used to analyse trends and identify popular and potential 'landmark' publications. Citation network and co-authorship network diagrams were analysed to identify groups of articles and researchers in various network roles. Results Our search string related to 763 publications. Filtering excluded 208 publications while citation tracing identified 2 texts. The final 557 publications were analysed, revealing a near-exponential growth in literature over recent years. Half of all articles were published after 2010 with almost a fifth (17.8%) published in 2014. Bibliographic analysis identified five distinct citation and co-authorship groups homophilous by common geography, research focus, inspiration or institutional affiliation. As a loosely related set of sciences, many public health researchers have developed different aspects of ST based on their underlying perspective. Early studies were inspired by Management-related literature, while later groups adopted a broadly inclusive understanding which incorporated related Systems sciences and approaches. Conclusion ST is an increasingly popular subject of discussion within public health although its understanding and approaches remain unclear. Briefly tracing the introduction and development of these ideas and author groups in public health literature may provide clarity and opportunities for further learning, research and development.
Is Subdissociative Ketamine As Safe and Effective As Morphine for Pain Management in the Emergency Department?

&NA; Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for “Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial. ” This prospective, randomized controlled inquiry enrolled 90 patients into 2 groups (ketamine vs. morphine) for patients seeking care in an emergency department with acute pain. Data regarding pain scores were collected at baseline, 15, 30, 60, 90, and 120 min. Study subjects reporting persistent pain could receive rescue analgesia with fentanyl. Initial pain scores for the subjects in each of the groups were comparable (ketamine: 8.6; morphine: 8.5). Pain management for the 2 groups revealed similar average doses (ketamine: 21.8 mg; morphine: 7.7 mg). Although subjects in both groups reported reduction in pain scores at 15 and 30 min, no clinical significance was found. Subjects experienced greater pain relief (pain score = 0) in the ketamine group at 15 min (percentage difference 31%; 95% confidence interval [13, 49]), yet this was not sustained at the 30-min interval. There were no serious or life-threatening adverse effects in either group. This study highlights the important role of the APN in providing quality care, communication about pain management, and related follow-up care.
Chameleon: Versatile and practical near-DRAM acceleration architecture for large memory systems

The performance of computer systems is often limited by the bandwidth of their memory channels, but further increasing the bandwidth is challenging under the stringent pin and power constraints of packages. To further increase performance under these constraints, various near-DRAM acceleration (NDA) architectures, which tightly integrate accelerators with DRAM devices using 3D/2.5D-stacking technology, have been proposed. However, they have not prevailed yet because they often rely on expensive HBM/HMC-like DRAM devices which also suffer from limited capacity, whereas the scalability of memory capacity is critical for some computing segments such as servers. In this paper, we first demonstrate that data buffers in a load-reduced DIMM (LRDIMM), which is originally developed to support large memory systems for servers, are supreme places to integrate near-DRAM accelerators. Second, we propose Chameleon, an NDA architecture that can be realized without relying on 3D/2.5D-stacking technology and seamlessly integrated with large memory systems for servers. Third, we explore three microarchitectures that abate constraints imposed by taking LRDIMM architecture for NDA. Our experiment demonstrates that a Chameleon-based system can offer 2.13 χ higher geo-mean performance while consuming 34% lower geo-mean data transfer energy than a system that integrates the same accelerator logic within the processor.
Previous land use alters plant allocation and growth in forest herbs

1 Former human practices can persistently influence forest ecosystems, particularly by altering the distribution and abundance of vegetation. Previous research has focused on the role of colonization success in governing plant community patterns in abandoned forests, but few studies have explored how changes in the performance of adult plants may contribute to changes in plant populations. 2 We examined patterns of biomass allocation and growth of 12 herbaceous plant species in southern Appalachian forest stands that have developed after agricultural abandonment or logging at least 55 years ago, to determine whether plant performance varied with land‐use history. Soil nutrient availability and canopy closure were also investigated. 3 Adult plant biomass allocation varied appreciably among stands with different histories. Herbs in farmed stands generally allocated the most to leaves and the least to stems, while reference stands showed the opposite pattern. Plants in previously farmed sites had the highest rate of growth, although we observed considerable interspecific variation in plant performance. Stem allocation and relative growth rate were positively correlated in reference stands, but not in farmed or logged stands. Similarly, the growth of plants was clearly associated with soil nutrient concentration in reference stands but not in farmed or logged stands. 4 Differences in understorey density and soil nutrient availability may account for the observed patterns. Total herbaceous cover was appreciably lower in farmed and logged stands (58% and 51%) than in reference stands (78%), and soil phosphorus was higher in farmed stands than in logged and reference stands. Thus, competition for light and nutrients may be lower in farmed and logged stands than in reference stands, despite there being no difference in canopy closure with land‐use history. 5 Overall, these results suggest that land‐use history may influence environmental variables in ways that can enhance the performance of some herbaceous species. However, not all species may respond similarly to these changes.
The Benefit of Web- and Computer-Based Interventions for Stress: A Systematic Review and Meta-Analysis

Background Stress has been identified as one of the major public health issues in this century. New technologies offer opportunities to provide effective psychological interventions on a large scale. Objective The aim of this study is to investigate the efficacy of Web- and computer-based stress-management interventions in adults relative to a control group. Methods A meta-analysis was performed, including 26 comparisons (n=4226). Cohen d was calculated for the primary outcome level of stress to determine the difference between the intervention and control groups at posttest. Analyses of the effect on depression, anxiety, and stress in the following subgroups were also conducted: risk of bias, theoretical basis, guidance, and length of the intervention. Available follow-up data (1-3 months, 4-6 months) were assessed for the primary outcome stress. Results The overall mean effect size for stress at posttest was Cohen d=0.43 (95% CI 0.31-0.54). Significant, small effects were found for depression (Cohen d=0.34, 95% CI 0.21-0.48) and anxiety (Cohen d=0.32, 95% CI 0.17-0.47). Subgroup analyses revealed that guided interventions (Cohen d=0.64, 95% CI 0.50-0.79) were more effective than unguided interventions (Cohen d=0.33, 95% CI 0.20-0.46; P=.002). With regard to the length of the intervention, short interventions (≤4 weeks) showed a small effect size (Cohen d=0.33, 95% CI 0.22-0.44) and medium-long interventions (5-8 weeks) were moderately effective (Cohen d=0.59; 95% CI 0.45-0.74), whereas long interventions (≥9 weeks) produced a nonsignificant effect (Cohen d=0.21, 95% CI –0.05 to 0.47; P=.006). In terms of treatment type, interventions based on cognitive behavioral therapy (CBT) and third-wave CBT (TWC) showed small-to-moderate effect sizes (CBT: Cohen d=0.40, 95% CI 0.19-0.61; TWC: Cohen d=0.53, 95% CI 0.35-0.71), and alternative interventions produced a small effect size (Cohen d=0.24, 95% CI 0.12-0.36; P=.03). Early evidence on follow-up data indicates that Web- and computer-based stress-management interventions can sustain their effects in terms of stress reduction in a small-to-moderate range up to 6 months. Conclusions These results provide evidence that Web- and computer-based stress-management interventions can be effective and have the potential to reduce stress-related mental health problems on a large scale.
Alendronate Use and the Risk of Nonvertebral Fracture During Glucocorticoid Therapy: A Retrospective Cohort Study

Context Glucocorticoids increase the risk of nonvertebral fracture, but no clinical trial has shown that nonvertebral fractures can be prevented by coadministration of an antiosteoporotic drug. Objective To estimate the effect of alendronate on the risk of nonvertebral fracture in older adults taking oral glucocorticoids. Design Retrospective cohort study using national Swedish registers. Setting Hospitalized care and ambulatory specialist care. Patients Among adults aged ≥50 years (N = 3,347,959), we identified those who initiated oral glucocorticoid therapy from 2006 through 2011 (≥2.5 mg/d of prednisone or equivalent for ≥91 days). The final analysis included 16,890 alendronate users and 16,890 nonusers, who were matched using time-dependent propensity scores. Main Outcome Measure Nonvertebral fracture. This was not prespecified. Results Over a median follow-up of 14.5 months, the incidence rate of nonvertebral fracture was 2.0 cases/100 person-years in alendronate users and 2.4 cases in nonusers. This difference corresponded to a 16% lower rate in users (hazard ratio 0.84; 95% confidence interval, 0.75 to 0.94). For hip fractures specifically, the rate was 34% lower in alendronate users relative to nonusers (hazard ratio 0.66; 95% confidence interval, 0.55 to 0.78). The association of alendronate use with a lower risk of nonvertebral fracture was strongest in patients who received high doses of glucocorticoid. Conclusion Alendronate use was associated with a lower risk of nonvertebral fracture, including hip fracture. Similar, but not statistically significant, associations have been reported in meta-analyses of clinical trials.
The Potential Value of the Disappearance of the Lateral Spread Response During Microvascular Decompression for Predicting the Clinical Outcome of Hemifacial Spasms: A Prospective Study

BACKGROUND: Hemifacial spasm (HFS) is a benign, chronic, involuntary movement of the muscles involved in facial expressions that typically begins in the orbicularis oculi and spreads to the other expression muscles over several years. OBJECTIVE: To clarify the effectiveness of intraoperative electromyogram during microvascular decompression (MVD) for HFS. METHODS: Two hundred ninety-nine consecutive patients with HFS underwent continuous intraoperative monitoring during MVD. The patients were divided into 2 groups based on whether the lateral spread response (LSR) disappeared before or after decompression RESULTS: In 276 of 299 patients (92.3%), the LSR was observed during intraoperative facial electromyogram monitoring. The mean follow-up period was 17.9 months (range, 12-27 months). Three patients in whom the LSR persisted despite decompression were not included in this study. In 183 of the 273 patients (67%), the LSR disappeared after decompression (group A); in the remaining 90 (33%), the LSR disappeared at dural opening or after drainage of the cerebrospinal fluid before decompression (group B). At the postoperative 3-month and 2-year follow-up visits, there were significant differences in the clinical outcomes between the 2 groups (P < .05). CONCLUSION: The disappearance of the LSR before and after MVD may predict clinical outcomes. This must be considered together with the disappearance or persistence of LSR after decompression as a prognostic factor for HFS after MVD.
Sepsis Incidence: A Population-Based Study

Background. Although sepsis is a major health problem, data on sepsis epidemiology are scarce. The aim of this study was to assess the incidence of sepsis, based on clinical findings in all adult patients treated with intravenous antibiotic in all parts of all hospitals in an entire population. Methods. This is a retrospective chart review of patients ≥18 years, living in 2 regions in Sweden, who were started on an intravenous antibiotic therapy on 4 dates, evenly distributed over the year of 2015. The main outcome was the incidence of sepsis with organ dysfunction. The mean population ≥18 years at 2015 in the regions was 1275753. Five hundred sixty-three patients living in the regions were started on intravenous antibiotic treatment on the dates of the survey. Patients who had ongoing intravenous antibiotic therapy preceding the inclusion dates were excluded, if sepsis was already present. Results. Four hundred eighty-two patients were included in the study; 339 had a diagnosed infection, of those, 96 had severe sepsis according to the 1991/2001 sepsis definitions, and 109 had sepsis according to the sepsis-3. This is equivalent to an annual incidence of traditional severe sepsis of 687/100000 persons (95% confidence interval [CI], 549–824) or according to the sepsis-3 definition of 780/100000 persons (95% CI, 633–926). Seventy-four patients had sepsis according to both definitions. Conclusions. The incidence of sepsis with organ dysfunction is higher than most previous estimates independent of definition. The inclusion of all inpatients started on intravenous antibiotic treatment of sepsis in a population makes an accurate assessment of sepsis incidence possible.
Impaired voluntary neuromuscular activation limits muscle power in mobility-limited older adults.

BACKGROUND Age-related alterations of neuromuscular activation may contribute to deficits in muscle power and mobility function. This study assesses whether impaired activation of the agonist quadriceps and antagonist hamstrings, including amplitude- and velocity-dependent characteristics of activation, may explain differences in leg extension torque and power between healthy middle-aged, healthy older, and mobility-limited older adults. METHODS Torque, power, and electromyography were recorded during maximal voluntary leg extension trials across a range of velocities on an isokinetic dynamometer. RESULTS Neuromuscular activation was similar between middle-aged and older healthy groups, with differences in torque and power explained predominantly by muscle size. However, the older mobility-limited group demonstrated marked impairment of torque, power, and agonist muscle activation, with the greatest deficits occurring at the fastest movement velocities. Agonist muscle activation was found to be strongly associated with torque output. CONCLUSIONS Similar neuromuscular activation between the middle-aged and older healthy groups indicates that impaired voluntary activation is not an obligatory consequence of aging. However, the finding that the mobility-limited group exhibited impaired activation of the agonist quadriceps and concomitant deficits in torque and power output suggests that neuromuscular activation deficits may contribute to compromised mobility function in older adults.
Identification of a Late Stage of Small Noncycling pTα−  Pre-T Cells as Immediate Precursors of T Cell Receptor α/β+  Thymocytes

During thymocyte development, progression from T cell receptor (TCR)β to TCRα rearrangement is mediated by a CD3-associated pre-TCR composed of the TCRβ chain paired with pre-TCRα (pTα). A major issue is how surface expression of the pre-TCR is regulated during normal thymocyte development to control transition through this checkpoint. Here, we show that developmental expression of pTα is time- and stage-specific, and is confined in vivo to a limited subset of large cycling human pre-T cells that coexpress low density CD3. This restricted expression pattern allowed the identification of a novel subset of small CD3− thymocytes lacking surface pTα, but expressing cytoplasmic TCRβ, that represent late noncycling pre-T cells in which recombination activating gene reexpression and downregulation of T early α transcription are coincident events associated with cell cycle arrest, and immediately preceding TCRα gene expression. Importantly, thymocytes at this late pre-T cell stage are shown to be functional intermediates between large pTα+ pre-T cells and TCRα/β+ thymocytes. The results support a developmental model in which pre-TCR–expressing pre-T cells are brought into cycle, rapidly downregulate surface pre-TCR, and finally become small resting pre-T cells, before the onset of TCRα gene expression.
Fidaxomicin Inhibits Spore Production in Clostridium difficile

Fidaxomicin (FDX) is a novel antimicrobial agent with narrow-spectrum and potent bactericidal activity against Clostridium difficile. In recent clinical trials, FDX was superior to vancomycin in preventing recurrences of C. difficile infection. A possible mechanism of reducing recurrence may be through an inhibitory effect on sporulation. The effect of FDX and its major metabolite, OP-1118, on C. difficile growth and sporulation kinetics was compared with that of vancomycin, metronidazole, and rifaximin. Drugs at subminimum inhibitory concentrations (sub-MICs) were added to cells at an early stationary phase of growth; this was followed by collection of cells at various intervals for quantitation of total viable cell and heat-resistant spore counts on taurocholate-containing media. The effect of the drugs at 2–2.5× MIC on the expression of sporulation genes in C. difficile was also compared using quantitative reverse-transcriptase polymerase chain reaction. Both FDX and OP-1118 (1/4× MIC) inhibited sporulation when added to early-stationary-phase cells in C. difficile strains, including the epidemic NAP1/BI/027 strain. In contrast, vancomycin, metronidazole, and rifaximin (at similar sub-MICs) did not inhibit sporulation. The number of spores following treatment with comparator drugs increased to the same level as the no-drug control treatment. Expression of mother cell–specific (spoIIID) and forespore-specific (spoIIR) sporulation genes also was inhibited by FDX and OP-1118 but not significantly by vancomycin. Both FDX and OP-1118 (unlike vancomycin, rifaximin, and metronidazole) effectively inhibited sporulation by C. difficile. The inhibitory effect of FDX on C. difficile sporulation may contribute to its superior performance in sustaining clinical response and reducing recurrences and may also be beneficial in decreasing shedding and transmission of this pathogen.