Miracle-dz/UniFAR-FTUs huggingface dataset:
Evaluation of simulation debriefing methods with interprofessional learning

ABSTRACT Interprofessional education (IPE) using simulations provides a rich environment for mastery learning and deliberate practice. The debriefing phase is identified as the most valuable by learners, yet investigation into the most effective format for debriefing interprofessional (IP) groups has largely gone unexplored. To determine the best practices in IP simulation debriefing, we compared perceived effectiveness of in-person versus teledebriefing, and single versus IP co-debriefer models according to 404 Debriefing Assessment for Simulation in Healthcare Student-Version (DASH-SV) scores from students in medicine, nursing, and respiratory therapy (n = 135) following three critical care simulations. All calculated total mean scores were in the acceptable range (above 4.0), indicating a positive experience for all methods. We found statistically significantly higher scores for in-person (M = 5.79) compared to teledebriefing (M = 4.96, p < .001). Single debriefer (M = 6.09) compared to IP co-debriefer DASH scores (M = 5.93) for all scenarios were not significantly different (p = .059). Our results suggest that teledebriefing may provide a solution for simulation programs with off-site or rural learners, and that a single in-person debriefing can be equally effective as co-debriefing for IP students.
Pharmacokinetics of Salicylic Acid Following Intravenous and Oral Administration of Sodium Salicylate in Sheep

Simple Summary Scarcity of non-steroidal anti-inflammatory drugs (NSAID) to minimise the pain in sheep instigated the current study. The aim of this study was to know the pharmacokinetic parameters of salicylic acid in New Zealand sheep after administration of multiple intravenous and oral doses of sodium salicylate (sodium salt of salicylic acid). Results of the study suggest that the half-life of the drug was shorter and clearance was faster after intravenous administration as compared to that of the oral administration. The minimum effective concentration required to produce analgesia in humans (16.8 µL) was achieved in sheep for about 0.17 h in the current study after intravenous administration of 100 and 200 mg/kg body weight of sodium salicylate. However, oral administration of these doses failed to achieve the minimum effective concentration as mentioned above. This study is of significance as it adds valuable information on pharmacokinetics and its variation due to breed, species, age, gender and environmental conditions. As per the authors’ knowledge, this is the only study showing detailed information about absorption, distribution and elimination of salicylic acid in New Zealand Sheep. An intravenous administration of sodium salicylate at 100 and 200 mg/kg dose may produce analgesia in sheep, which requires further investigation using pharmacokinetic–pharmacodynamic (PKPD) integration or modelling techniques. Abstract The pharmacokinetics of salicylic acid (SA) in sheep was evaluated following intravenous (IV) and oral administration of sodium salicylate (sodium salt of salicylic acid) at different doses. Six healthy sheep were administered sodium salicylate (SS) IV at doses of 10, 50, 100 and 200 mg/kg body weight and another six sheep were drenched with 100 and 200 mg/kg of SS orally. Both studies were randomised crossover trials. A one-week washout period between each treatment was allowed in both studies. Blood samples were collected at 0, 15, 30 min and 1, 2, 4 and 6 h after IV and oral SS administrations. Plasma SA concentrations were determined using high-performance liquid chromatography (HPLC) with diode array detection method. Pharmacokinetic variables were calculated in a non-compartmental model. The elimination half-life (T1/2 el) of SA after IV administration of 200 mg/kg SS was 1.16 ± 0.32 h. Mean bioavailability of SA was 64%, and mean T1/2 el was 1.90 ± 0.35 h, after 200 mg/kg of oral SS. The minimum plasma SA concentration (16.8 µg/mL) reported to produce analgesia in humans was achieved after IV administration of 100 and 200 mg/kg SS in sheep for about 0.17 h in this study. Experiments on pharmacokinetic–pharmacodynamics modelling are required to determine the actual effective plasma concentration range of SA in sheep.
[Predictive value of red blood cell distribution width for acute kidney injury in children with sepsis].

OBJECTIVE To study the clinical value of red blood cell distribution width (RDW) in the early prediction of acute kidney injury (AKI) in children with sepsis. METHODS A total of 126 children with sepsis were divided into an AKI group (n=66) and a non-AKI group (n=60) according to the presence or absence of AKI. These patients were also classified into high-RDW and low-RDW groups according to the mean RDW. The groups were compared in terms of age, male-to-female ratio, body mass index (BMI), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, serum blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), serum C-reactive protein (CRP), and routine blood test results. Independent factors associated with RDW were analyzed by multiple linear regression. RESULTS Age, male-to-female ratio, BMI, CRP, SOFA score, and APACHE II score did not differ significantly between the AKI and non-AKI groups (P>0.05), but the AKI group had significantly higher BUN, Cr, UA, and RDW levels than the non-AKI group (P<0.05). Age, male-to-female ratio, and BMI did not differ significantly between the high-RDW and low-RDW groups (P>0.05), but the high-RDW group had significantly higher BUN, Cr, UA, CRP, SOFA score, APACHE II score, Hb, and mean corpuscular volume (MCV) than the low-RDW group (P<0.05). The multiple linear regression analysis showed that age, sex, APACHE II score, Cr, Hb, and MCV were independent factors associated with RDW. CONCLUSIONS RDW has a certain clinical value in the early prediction of AKI in children with sepsis.
New Morbidity and Discharge Disposition of Pediatric Acute Respiratory Distress Syndrome Survivors*

Objectives: Much of the research related to pediatric acute respiratory distress syndrome has focused on inhospital mortality and interventions affecting this outcome. Limited data exist on survivors’ morbidity, hospital disposition, and 1-year survival. The aim of this study was to determine new morbidity rate, discharge disposition, and 1-year mortality for survivors of pediatric acute respiratory distress syndrome. Design: Secondary analysis of prospective cohort study. Setting: Quaternary children’s hospital. Patients: Three-hundred sixteen mechanically ventilated children with pediatric acute respiratory distress syndrome (Berlin and Pediatric Acute Lung Injury Consensus Conference criteria) between July 2011 and December 2014. Interventions: None. Measurements and Main Results: We performed secondary analysis of a prospectively recruited cohort of 316 mechanically ventilated children with pediatric acute respiratory distress syndrome between July 2011, and December 2014. Preillness and hospital discharge Functional Status Scale score were determined via chart review, and factors associated with new morbidity, defined as an increase of Functional Status Scale score of 3 or more, were analyzed. Demographic variables, pediatric acute respiratory distress syndrome characteristics, and ventilator management were tested for association with development of new morbidity, discharge disposition, and 1-year mortality. Inhospital mortality of pediatric acute respiratory distress syndrome was 13.3% (42/316). Of 274 survivors to hospital discharge, new morbidity was seen in 63 patients (23%). Discharge to rehabilitation rate was 24.5% (67/274) and associated with development of new morbidity. One- and 3-year mortality of survivors was 5.5% (15 deaths) and 8% (22 deaths) and was associated with baseline Functional Status Scale, immunocompromised status, Pediatric Risk of Mortality III, and organ failures at pediatric acute respiratory distress syndrome onset, but not with pediatric acute respiratory distress syndrome severity. Conclusions: New morbidity was common after pediatric acute respiratory distress syndrome and appears to be intermediate phenotype between survival without morbidity and death, making it a useful metric in future interventional and outcome studies in pediatric acute respiratory distress syndrome.
Meta-Analysis of 89 Structural MRI Studies in Posttraumatic Stress Disorder and Comparison With Major Depressive Disorder.

OBJECTIVE: The authors conducted a comprehensive meta-analysis of MRI region-of-interest and voxel-based morphometry (VBM) studies in posttraumatic stress disorder (PTSD). Because patients have high rates of comorbid depression, an additional objective was to compare the findings to a meta-analysis of MRI studies in depression. METHOD: The MEDLINE database was searched for studies from 1985 through 2016. A total of 113 studies met inclusion criteria and were included in an online database. Of these, 66 were selected for the region-of-interest meta-analysis and 13 for the VBM meta-analysis. The region-of-interest meta-analysis was conducted and compared with a meta-analysis of major depressive disorder. Within the region-of-interest meta-analysis, three subanalyses were conducted that included control groups with and without trauma. RESULTS: In the region-of-interest meta-analysis, patients with PTSD compared with all control subjects were found to have reduced brain volume, intracranial volume, and volumes of the hippocampus, insula, and anterior cingulate. PTSD patients compared with nontraumatized or traumatized control subjects showed similar changes. Traumatized compared with nontraumatized control subjects showed smaller volumes of the hippocampus bilaterally. For all regions, pooled effect sizes (Hedges' g) varied from -0.84 to 0.43, and number of studies from three to 41. The VBM meta-analysis revealed prominent volumetric reductions in the medial prefrontal cortex, including the anterior cingulate. Compared with region-of-interest data from patients with major depressive disorder, those with PTSD had reduced total brain volume, and both disorders were associated with reduced hippocampal volume. CONCLUSIONS: The meta-analyses revealed structural brain abnormalities associated with PTSD and trauma and suggest that global brain volume reductions distinguish PTSD from major depression.
A Cluster-Analytic Approach to Determining Drinking Motives and Personality Typologies: Trauma Group Differences and Respective Relations to PTSD and Problematic Alcohol Use

Veterans with posttraumatic stress disorder (PTSD) are at elevated risk for alcohol use problems, a relationship commonly explained by using alcohol to cope with unpleasant symptoms of PTSD. However, patterns of alcohol use motives, more broadly, have not been well characterized in veteran samples, nor have they been evaluated in the context of other relevant factors, such as normative personality traits. The aims of the present study were to identify empirically derived drinking motive and personality typologies to determine whether these typologies differ as a function of PTSD status (i.e., nontrauma control, trauma exposed−no PTSD, and PTSD) and to evaluate associations between typology and PTSD symptom severity and alcohol consumption, respectively. Cluster analyses identified a 4-cluster solution. Results indicated that these typologies differed significantly according to trauma group as well as across levels of PTSD symptom severity and alcohol use. Specifically, Cluster 4 represented individuals at highest risk for both PTSD symptom severity and alcohol use compared to all the other typologies; Cluster 1 demonstrated lowest risk for PTSD symptom severity and alcohol use compared to all other typologies; and although Clusters 2 and 3 did not differ according to PTSD symptom severity, individuals in Cluster 2 had significantly higher alcohol use. These results represent certain “at risk” versus “protective” typologies that may facilitate the identification of individuals at risk for comorbid PTSD and problematic alcohol use.
Stress-testing the relationship between T cell receptor/peptide-MHC affinity and cross-reactivity using peptide velcro

Significance T cells recognize their targets through the T cell receptor (TCR). The affinity of a typical receptor for an agonist peptide-major histocompatibility complex (pMHC) molecule is extremely weak, and TCRs are known to be cross-reactive for related peptides. However, there are known TCR/pMHC interactions that occur at weaker affinities, such as in thymic selection and recognition of self-antigens, yet little is known about the identity of these peptides. We show that TCR/pMHC interactions of extremely low affinities remain highly specific, which informs of the nature of extremely weak affinity ligands. We also show that a peptide “velcro” can induce peptide-dependent T cell activation, providing a method for increasing the potency of a target, which is useful in immunotherapy. T cell receptors (TCRs) bind to peptide-major histocompatibility complex (pMHC) with low affinity (Kd ∼ μM), which is generally assumed to facilitate cross-reactive TCR “scanning” of ligands. To understand the relationship between TCR/pMHC affinity and cross-reactivity, we sought to engineer an additional weak interaction, termed “velcro,” between the TCR and pMHC to probe the specificities of TCRs at relatively low and high affinities. This additional interaction was generated through an eight-amino acid peptide library covalently linked to the N terminus of the MHC-bound peptide. Velcro was selected through an affinity-based isolation and was subsequently shown to enhance the cognate TCR/pMHC affinity in a peptide-dependent manner by ∼10-fold. This was sufficient to convert a nonstimulatory ultra-low-affinity ligand into a stimulatory ligand. An X-ray crystallographic structure revealed how velcro interacts with the TCR. To probe TCR cross-reactivity, we screened TCRs against yeast-displayed pMHC libraries with and without velcro, and found that the peptide cross-reactivity profiles of low-affinity (Kd > 100 μM) and high-affinity (Kd ∼ μM) TCR/pMHC interactions are remarkably similar. The conservation of recognition of the TCR for pMHC across affinities reveals the nature of low-affinity ligands for which there are important biological functions and has implications for understanding the specificities of affinity-matured TCRs.
A Novel Squirrel Respirovirus with Putative Zoonotic Potential

In a globalized world, the threat of emerging pathogens plays an increasing role, especially if their zoonotic potential is unknown. In this study, a novel respirovirus, family Paramyxoviridae, was isolated from a Sri Lankan Giant squirrel (Ratufa macroura), which originated in Sri Lanka and deceased with severe pneumonia in a German zoo. The full-genome characterization of this novel virus, tentatively named Giant squirrel respirovirus (GSqRV), revealed similarities to murine (71%), as well as human respiroviruses (68%) with unique features, for example, a different genome length and a putative additional accessory protein. Congruently, phylogenetic analyses showed a solitary position of GSqRV between known murine and human respiroviruses, implicating a putative zoonotic potential. A tailored real-time reverse transcription-polymerase chain reaction (RT-qPCR) for specific detection of GSqRV confirmed a very high viral load in the lung, and, to a lesser extent, in the brain of the deceased animal. A pilot study on indigenous and exotic squirrels did not reveal additional cases in Germany. Therefore, further research is essential to assess the geographic distribution, host range, and zoonotic potential of this novel viral pathogen.
Risk Factors for Antibiotic-Associated Diarrhea in Critically Ill Patients

Background We analyzed the factors related to AAD to inform the rational use of antibiotics in critically ill patients and to reduce the incidence of AAD by providing a reference for antibiotic use in the clinical setting. Material/Methods This study was a retrospective analysis of the clinical data of patients who were hospitalized in the ICU of the First Teaching Hospital of Xi’an Jiaotong University from January 1, 2015 to December 31, 2016. Patients with AAD were assigned to the case group, and all others were assigned to the control group. Basic data were collected for all the selected patients. All the relevant data were analyzed with univariate or multivariate regression analyses, and P<0.05 was considered statistical significance. Results A total of 293 patients were enrolled. Statistical analyses showed that gender (OR 1.915; 95% [CI] 1.061–3.455; P=0.031), parenteral nutrition (OR 1.877; 95% [CI] 1.043–3.377; P=0.036), preventive use of probiotics (OR 0.497; 95% [CI] 0.285–0.866; P=0.014), APACHE II score upon admission to the ICU (OR 0.961; 95% [CI] 0.927–0.998; P=0.037) and use of enzyme-inhibitor antibiotics (OR 1.899; 95% [CI] 1.044–3.420; P=0.016) were associated with AAD. Further subgroup analysis by gender showed that parenteral nutrition (OR 2.144; 95% [CI] 1.064–4.322; P=0.033), preventive use of probiotics (OR 0.367; 95% [CI] 0.186–0.722; P=0.004), and APACHE II score upon admission to the ICU (OR 1.055; 95% [CI] 1.011–1.101; P=0.014) were associated with AAD in critically ill male patients. Age (OR 0.975; 95% [CI] 0.951–0.999; P=0.041) and use of carbapenem antibiotics (OR 4.826; 95% [CI] 1.011–23.030; P=0.048) were associated with AAD in critically ill female patients. Conclusions Parenteral nutrition, prophylactic use of probiotics, use of enzyme-inhibitor antibiotics, and use of combinations of antibiotics were associated with AAD in critically ill patients. The prophylactic use of probiotics may be a protective factor in AAD.
Acute Effects of Battle Rope Exercise on Performance, Blood Lactate Levels, Perceived Exertion, and Muscle Soreness in Collegiate Basketball Players.

Chen, WH, Yang, WW, Lee, YH, Wu, HJ, Huang, CF, and Liu, C. Acute effects of battle rope exercise on performance, blood lactate levels, perceived exertion, and muscle soreness in collegiate basketball players. J Strength Cond Res XX(X): 000-000, 2018-This study investigated the acute effects of battle rope (BR) exercise on basketball players' performance, blood lactate levels, rating of perceived exertion (RPE), and perceived muscle soreness. Fifteen well-trained Division-I male basketball players underwent the same test procedure at baseline, before BR exercise (30 minutes of rest after the baseline test), and after BR exercise. The 30-minute experimental protocol comprised 6 BR exercises at a work-to-rest ratio of 1:2 (20-second exercise and 40-second rest). Shooting accuracy, basketball chest pass speed, countermovement jump (CMJ) height, blood lactate levels, RPE (Borg Category-Ratio-10 scale), and perceived muscle soreness (visual analog scale, 0-100 mm) were measured in each test. The results indicated no change for any variables between baseline and before BR exercise. After BR exercise, performance decrements (p < 0.05) were recorded in shooting accuracy (16.9%) and basketball chest pass speed (9.1%), but no significant changes were observed for CMJ height. Battle rope exercise caused increases in blood lactate levels (13.6 mmol·L), RPE (9.9), and perceived muscle soreness (upper-limb: 63-67 mm; trunk: 43-68 mm; and lower-limb: 45-52 mm). In conclusion, BR exercise is physically demanding on the upper body, resulting in decreased performance in shooting accuracy and basketball chest pass speed. Battle rope exercise may not be beneficial before a practice or game because it triggers acute exercise-induced performance decrements and fatigue. However, BR exercise may be suitable for basketball training sessions in which the objective is to strengthen technical skills under fatiguing conditions.
Expression of Peroxisome Proliferator-Activated Receptor Alpha (PPARα) in Non-Somatotroph Pituitary Tumours and the Effects of PPARα Agonists on MMQ Cells

Abstract Peroxisome proliferator-activated receptor alpha (PPARα) has been involved in the regulation of somatotroph tumour cells and may be targeted by different drugs, some of them are in current clinical use. The aim of this study was to investigate the expression of PPARα in additional phenotypes of pituitary adenomas (PA), the relationship between PPARα and its potential molecular partner aryl hydrocarbon receptor interacting protein (AIP) in these tumours, and the effects of PPARα agonists on lactotroph cells. Seventy-five human PA – 57 non-functioning (NFPA) and 18 prolactinomas (PRL-PA) – were characterised for PPARα and AIP expression by real time RT-PCR and/or immunohistochemistry (IHC), and the effects of fenofibrate and WY 14 643 on MMQ cells were studied in vitro. PPARα was expressed in a majority of PA. PPARα immunostaining was observed in 93.7% PRL-PA vs. 60.6% NFPA (p=0.016), the opposite being found for AIP (83.3% in NFPA vs. 43.7% in PRL-PA, p=0.003). PPARα expression was unrelated to gonadotroph differentiation in NFPA, but positively correlated with tumour volume in PRL-PA. Both drugs significantly reduced MMQ cell growth at high concentrations (100–200 μM). At the same time, despite modest stimulating effects on PRL secretion were observed, these were overcome by the reduction in cell number. In conclusion, PPARα is commonly expressed by PRL-PA and NFPA, regardless of AIP, and may represent a new target of PPARα agonists.
Sirt1 protects from K‐Ras‐driven lung carcinogenesis

The NAD+‐dependent deacetylase SIRT1 can be oncogenic or tumor suppressive depending on the tissue. Little is known about the role of SIRT1 in non‐small cell lung carcinoma (NSCLC), one of the deadliest cancers, that is frequently associated with mutated K‐RAS. Therefore, we investigated the effect of SIRT1 on K‐RAS‐driven lung carcinogenesis. We report that SIRT1 protein levels are downregulated by oncogenic K‐RAS in a MEK and PI3K‐dependent manner in mouse embryo fibroblasts (MEFs), and in human lung adenocarcinoma cell lines. Furthermore, Sirt1 overexpression in mice delays the appearance of K‐RasG12V‐driven lung adenocarcinomas, reducing the number and size of carcinomas at the time of death and extending survival. Consistently, lower levels of SIRT1 are associated with worse prognosis in human NSCLCs. Mechanistically, analysis of mouse Sirt1‐Tg pneumocytes, isolated shortly after K‐RasG12V activation, reveals that Sirt1 overexpression alters pathways involved in tumor development: proliferation, apoptosis, or extracellular matrix organization. Our work demonstrates a tumor suppressive role of SIRT1 in the development of K‐RAS‐driven lung adenocarcinomas in mice and humans, suggesting that the SIRT1–K‐RAS axis could be a therapeutic target for NSCLCs.