Miracle-dz/UniFAR-FTUs huggingface dataset:
Continuing Medical Education in an On-Demand World: Is Podcasting the Netflix of Medical Education?

Podcasting, like many new technologies, provides the opportunity to make learning more convenient and efficient. Since gaining popularity as a medium in the early 2000s, there is a growing number of podcasts in the medical field that target the lay public, patients, and health care professionals.1 In 2018, the Edison Report stated that 44% of Americans had listened to a podcast in their lifetime, and 26% listened in the past month.2 These percentages have consistently risen since 2008.2 Regular podcast listeners tend to have an advanced degree, full-time employment, and a higher annual household income than the general US population.2 The Edison Report also states that podcasting takes advantage of commute time, and as per the US Census Bureau, the average American commute is 26 minutes each way.2 Given this reported average listener profile, physicians seem ideal targets for podcast-based education. Podcasts are currently used in a variety of ways for medical education. The earliest adopters of medical education podcasting were emergency physicians and intensivists.3 Residents have been quick to adopt podcasts as part of their medical education toolbox because they tend to be younger and more likely to use technology. Mallin et al4 showed that …
Age and sex-related upper body performance differences in competitive young tennis players

Objective The aims of this study were to analyze the shoulder functional profile of young male and female tennis players and to establish the relationship among physical variables and serve speed. Methods A total of 128 Spanish tennis players (Under-13 (n = 32/32 males/females) and Under-15 (n = 36/28 males/females), were tested during National training camps. Tests included passive shoulder range of motion (ROM) for both internal (IR) and external rotation (ER) and isometric strength (i.e., IR and ER) of the dominant/non-dominant shoulders, medicine ball throws (MBT), and serve speed. Age and sex pairwise comparisons were carried using the Hedges’ g index (dg). Results Results showed age and sex effects on serve speed and all MBT, with males showing greater changes (1.51≤dg≤1.98) with age than females (0.92≤dg≤1.35; p<0.05). U15 males showed higher (p<0.05) absolute shoulder IR and ER strength than U13, with only significant differences between males and females in the U15. Regarding ROM, U15 males showed a decreased IR ROM compared to U13 (dg = -0.84; p<0.05) and higher significant IR bilateral deficit (dg = 0.51; p<0.05). The distances obtained in the different MBT were the variables more correlated to serve speed. Conclusion The present results suggest that shoulder strength, medicine ball throws and serve speed increased along with age in young elite tennis players of both sexes. However, a decreased range of motion and bilateral deficit for glenohumeral internal rotation is evident in male under-15 tennis players. Muscle strength, power and shoulder range of motion are key factors for serve speed in young tennis players.
Gene flow and genetic drift in urban environments

Evidence is growing that human modification of landscapes has dramatically altered evolutionary processes. In urban population genetic studies, urbanization is typically predicted to act as a barrier that isolates populations of species, leading to increased genetic drift within populations and reduced gene flow between populations. However, urbanization may also facilitate dispersal among populations, leading to higher genetic diversity within, and lower differentiation between, urban populations. We reviewed the literature on nonadaptive urban evolution to evaluate the support for each of these urban fragmentation and facilitation models. In a review of the literature with supporting quantitative analyses of 167 published urban population genetics studies, we found a weak signature of reduced within‐population genetic diversity and no evidence of consistently increased between‐population genetic differentiation associated with urbanization. In addition, we found that urban landscape features act as barriers or conduits to gene flow, depending on the species and city in question. Thus, we speculate that dispersal ability of species and environmental heterogeneity between cities contributes to the variation exhibited in our results. However, >90% of published studies reviewed here showed an association of urbanization with genetic drift or gene flow, highlighting the strong impact of urbanization on nonadaptive evolution. It is clear that species biology and city heterogeneity obscure patterns of genetic drift and gene flow in a quantitative analysis. Thus, we suggest that future research makes comparisons of multiple cities and nonurban habitats, and takes into consideration species' natural history, environmental variation, spatial modelling and marker selection.
Fluorescence Lifetime-Based Tumor Contrast Enhancement Using an EGFR Antibody–Labeled Near-Infrared Fluorophore

Purpose: Imaging techniques for highly specific detection of cancer cells in vivo can have applications ranging from preclinical drug discovery studies to clinical cancer diagnosis and surgical therapy. Although fluorescence imaging using cancer-targeted antibodies has shown promise, nonspecific probe accumulation in tissue results in significant background fluorescence, reducing detection sensitivity using traditional intensity–based continuous-wave (CW) fluorescence imaging. Here we demonstrate that fluorescence lifetime (FLT) imaging can provide significant tumor contrast enhancement over CW intensity in preclinical models of human breast cancer. Experimental Design: Mice bearing MDA-MB-231 tumors were injected with anti-EGFR antibody conjugated to the fluorescent dye IRDye 800CW (anti-EGFR-800). Time domain fluorescence imaging was performed in vivo and in situ up to 48 hours after dye injection. Results: Mice injected with anti-EGFR-800 showed a significantly longer FLT (0.7 ± 0.03 ns) compared with the FLT of nonspecific probe uptake in liver (0.63 ± 0.05 ns), providing a dramatic improvement in sensitivity and specificity compared with CW intensity. IgG antibody–conjugated IRDye 800CW did not show an increased FLT compared with normal tissue, suggesting that the FLT increase of anti-EGFR-800 in tumors was associated with receptor expression. Using serial surgery, we show that FLT allows the detection of smaller residual tumors in the surgical bed than possible using CW intensity. Conclusions: Our data suggest that FLT can significantly enhance tumor contrast using fluorescently labeled antibodies, thereby accelerating the efficient clinical application of these probes for margin assessment in image-guided surgery and for highly specific detection of tumor receptors in vivo.
A Practical Guide to Source and Receiver Locations for Surface Wave Transmission Measurements across a Surface-Breaking Crack in Plate Structures

The main objectives of this study are to investigate the interference of multiple bottom reflected waves in the surface wave transmission (SWT) measurements in a plate and to propose a practical guide to source-and-receiver locations to obtain reliable and consistent SWT measurements in a plate. For these purposes, a series of numerical simulations, such as finite element modelling (FEM), are performed to investigate the variation of transmission coefficient of surface waves across a surface-breaking crack in various source-to-receiver configurations in plates. Main variables in this study include the crack depths (0, 10, 20, 30, 40 and 50 mm), plate thicknesses (150, 200, 300, 400 and 800 mm), source-to-crack distances (100, 150, 200, 250 and 300 mm) and receiver-to-crack distances. The validity of numerical simulation results was verified by comparison with results from experiments using Plexiglas specimens using two types of noncontact sensors (laser vibrometer and air-coupled sensor) in the laboratory. Based on simulation and experimental results in this study, practical guidelines for sensor-to-receiver locations are proposed to reduce the effects of the interference of bottom reflected waves on the SWT measurements across a surface-breaking crack in a plate. The findings in this study will help obtain reliable and consistent SWT measurements across a surface-breaking crack in plate-like structures.
American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis.

DESCRIPTION The purpose of this AGA Institute Clinical Practice Update is to review the available evidence and expert recommendations regarding the clinical care of patients with pancreatic necrosis and to offer concise best practice advice for the optimal management of patients with this highly morbid condition. METHODS This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology. This review is framed around the 15 best practice advice points agreed upon by the authors, which reflect landmark and recent published manuscripts in this field. This expert review also reflects the experiences of the authors who are advanced endoscopists or hepatopancreatobiliary surgeons with extensive experience in managing and teaching others to care for patients with pancreatic necrosis.
Factors associated with vision-related quality of life in Brazilian patients with glaucoma.

PURPOSE To evaluate the impact of visual acuity, visual field damage, and other factors on the quality of life in Brazilian patients with glaucoma. METHODS This cross-sectional prospective study involved 49 patients with glaucoma enrolled based on the presence of reproducible standard automated perimetry defects in at least one eye at the time of evaluation. A detailed ophthalmologic examination was performed on each patient. All patients had reproducible standard automated perimetry and completed an NEI VFQ-25 questionnaire. The associations of the quality of life scores to the best-corrected visual acuity and the visual field loss of the better and worse eyes were investigated. RESULTS The mean quality of life score of the patients was 58.8 ± 18.7 units. The highest and lowest mean values (85.0 ± 24.2 and 37.5 ± 36.5 units) were observed in the "Social Functioning Subscale" and "Driving Subscale," respectively. Patients with advanced glaucoma (mean deviation <-12 dB) in the worse eye had significantly lower quality of life scores (p=0.007). There was a significant correlation between the quality of life scores and the visual acuity of the better and worse eyes (r2=13%, p=0.010 and r2=32%, p<0.001, respectively). There was also a significant correlation between the quality of life scores and standard automated perimetry mean deviation of the better and worse eyes (r2=13%, p=0.023 and r2=47%, p<0.001, respectively). In a multivariate model containing so-cioeconomic and comorbidity indices, quality of life remained significantly related to the standard automated perimetry mean deviation of the better and worse eyes (r2=23%, p=0.29 and r2=49%, p<0.001, respectively) as well as to the visual acuity of the better and worse eyes (r2=18%, p=0.017 and r2=40%, p<0.001, respectively). CONCLUSION The standard automated perimetry mean deviation and the visual acuity of the better and worse eyes were associated with lower quality of life in Brazilian patients with glaucoma. Quality of life was mostly highly associated with the standard automated perimetry mean deviation of the worse eye.
Microencapsulation Curcuminoids for Effective Delivery in Pharmaceutical Application

Curcuminoids have been long proven to possess antioxidant, anti-inflammatory and antibacterial properties which are crucial in their role as a pharmacological active agent. However, its poor solubility, high oxidative degradation, light sensitivity and poor bioavailability have been huge hurdles that need to be overcome for it to be administered as an oral or even a topical medication. In this present study, a complex coacervation microencapsulation approach was used to encapsulate the curcuminoids using both gelatin B and chitosan (at the optimum ratio of 30:1% w/w) for a more efficient drug delivery system. Curcuminoids microcapsules (CPM) were developed to be spherical in shape, discrete and free flowing with a reduced color staining effect. The thick wall of the CPM contributes directly to its integrity and stability. Cross-linking increases the density of polymers’ wall network, hence, further increasing the decomposition temperature of curcuminoids microcapsules. Microencapsulation demonstrated an increment in curcuminoids solubility, while chemical cross-linking allowed for sustained release of the drug from the microcapsules by lowering the swelling rate of the available polymer networks. Thus, the microcapsules complied with the zero order release kinetics with super case-II transport mechanism. On the basis of all that was discussed above, it can be safely concluded that CPM should be incorporated in delivery system of curcuminoid, especially in its topical delivery for controlled drug release purposes, for not only a more efficient drug delivery system design but also a more efficacious optimization of the pharmacological benefits of curcuminoids.
GLIM Criteria Using Hand Grip Strength Adequately Predict Six-Month Mortality in Cancer Inpatients

Protein-calorie malnutrition is very frequent in cancer patients and is associated with an increase in morbidity and mortality. Recently, the Global Leadership Initiative on Malnutrition (GLIM) criteria were proposed to standardize the diagnosis of malnutrition. Nevertheless, these criteria were not validated in prospective studies. Our objective is to determine the prevalence of malnutrition in cancer inpatients using different diagnostic classifications, including GLIM criteria, and to establish their association with length of stay and mortality. Hence, we designed a prospective study. Within the first 24 hours of admission to the Inpatient Oncology Unit, subjective global assessment (SGA) was carried out, and anthropometric data (body mass index (BMI), mid-arm circumference (MAC), arm muscle circumference (AMC), fat-free mass index (FFMI)) and hand grip strength (HGS) were obtained to assess the reduction of muscle mass according to GLIM criteria. Length of stay, biomarkers (albumin, prealbumin, C-reactive protein (CRP)), and in-hospital and six-month mortality were evaluated. Regarding the 282 patients evaluated, their mean age was 60.4 ± 12.6 years, 55.7% of them were male, and 92.9% had an advanced-stage tumor (17.7% stage III, 75.2% stage IV). According to SGA, 81.6% of the patients suffered from malnutrition (25.5% moderate malnutrition, and 56.1% severe malnutrition), and, based on GLIM criteria, malnutrition rate was between 72.2 and 80.0% depending on the used tool. Malnourished patients (regardless of the tool used) showed significantly worse values concerning BMI, length of stay, and levels of CRP/albumin, albumin, and prealbumin than normally nourished patients. In logistic regression, adjusted for confounding variables, the odds ratio of death at six months was significantly associated with malnutrition by SGA (odds ratio 2.73, confidence interval (CI) 1.35–5.52, p = 0.002), and by GLIM criteria calculating muscle mass with HGS (odds ratio 2.72, CI 1.37–5.40, p = 0.004) and FFMI (odds ratio 1.87, CI 1.01–3.48, p = 0.047), but not by MAC or AMC. The prevalence of malnutrition in advanced-stage cancer inpatients is very high. SGA and GLIM criteria, especially with HGS, are useful tools to diagnose malnutrition and have a similar predictive value regarding six-month mortality in cancer inpatients.
Plasma Disappearance Rate of Indocyanine Green for Determination of Liver Function in Three Different Models of Shock

The measurement of the liver function via the plasma disappearance rate of indocyanine green (PDRICG) is a sensitive bed-side tool in critical care. Yet, recent evidence has questioned the value of this method for hyperdynamic conditions. To evaluate this technique in different hemodynamic settings, we analyzed the PDRICG and corresponding pharmacokinetic models after endotoxemia or hemorrhagic shock in rats. Male anesthetized Sprague-Dawley rats underwent hemorrhage (mean arterial pressure 35 ± 5 mmHg, 90 min) and 2 h of reperfusion, or lipopolysaccharide (LPS) induced moderate or severe (1.0 vs. 10 mg/kg) endotoxemia for 6 h (each n = 6). Afterwards, PDRICG was measured, and pharmacokinetic models were analyzed using nonlinear mixed effects modeling (NONMEM®). Hemorrhagic shock resulted in a significant decrease of PDRICG, compared with sham controls, and a corresponding attenuation of the calculated ICG clearance in 1- and 2-compartment models, with the same log-likelihood. The induction of severe, but not moderate endotoxemia, led to a significant reduction of PDRICG. The calculated ICG blood clearance was reduced in 1-compartment models for both septic conditions. 2-compartment models performed with a significantly better log likelihood, and the calculated clearance of ICG did not correspond well with PDRICG in both LPS groups. 3-compartment models did not improve the log likelihood in any experiment. These results demonstrate that PDRICG correlates well with ICG clearance in 1- and 2-compartment models after hemorrhage. In endotoxemia, best described by a 2-compartment model, PDRICG may not truly reflect the ICG clearance.
Elevated serum alkaline phosphatase in epilepsy: effect of age and treatment

Purpose: The major goal of epilepsy management using antiepileptic drug therapy is to attain seizure freedom without any adverse effects. However, the reported adverse effects of antiepileptic drugs on the hematological and biochemical profiles are subject of considerable debate in clinical practice. The objective of the present study was to investigate the effect of antiepileptic drug therapy on the hematobiochemical parameters in patients with epilepsy and to investigate the association of altered parameters with different demographic and clinical variables. Methods: A cross-sectional study involving 567 patients with epilepsy (drug-naive, N=223; phenytoin, N=85; carbamazepine, N=114; valproate, N=100; and multitherapy, N=45) and 37 healthy controls, aged 5-60 years, from North India was conducted. Hematological and biochemical profiling of all the subjects was performed at a single center. Results: Of all the parameters evaluated, only alkaline phosphatase (ALP) levels were found to be elevated in drug-free as well as patients on antiepileptic drug therapy. Early age and higher pretreatment seizure frequency were significantly associated with higher ALP levels (p<0.0001) while prolonged treatment duration and higher doses of antiepileptic drugs were inversely related to them (p<0.01). Though preliminary analysis demonstrated the involvement of epilepsy type, multivariate logistic regression eliminated the possibility. Conclusions: Our findings, for the first time, suggested that elevated ALP levels in patients with epilepsy are attributed to the disease, epilepsy itself and not antiepileptic drug therapy.
Analysis of Potential Conflicts of Interest among Otolaryngologic Patient Advocacy Organizations in 2016

Patient advocacy organizations (PAOs) are nonprofits dedicated to benefiting patients and their families through activities such as education/counseling and research funding. Although medical drug/device companies may serve as important partners, industry donations may bias the efforts of PAOs. We conducted a retrospective cross-sectional analysis of the Kaiser Health News nonprofit database to identify and characterize otolaryngologic PAOs (n = 32) active in 2016. Among these PAOs, half (n = 16, 50.0%) focused on otologic diseases, and mean total annual revenue was $3.1 million. Among the 15 PAOs (46.9%) with publicly available donor lists, 10 (66.7%) received donations from industry. Few PAOs publicly reported the total amount donated by industry (n = 3, 9.4%) or published policies for mitigating potential financial conflicts of interest with donors (n = 3, 9.4%). Requiring drug and device companies to publicly report donations to PAOs may help patients, providers, and policy makers to better understand advocacy by these influential stakeholders.
Mismatch Recognition by Saccharomyces cerevisiae Msh2-Msh6: Role of Structure and Dynamics

The mismatch repair (MMR) pathway maintains genome integrity by correcting errors such as mismatched base pairs formed during DNA replication. In MMR, Msh2–Msh6, a heterodimeric protein, targets single base mismatches and small insertion/deletion loops for repair. By incorporating the fluorescent nucleoside base analog 6-methylisoxanthopterin (6-MI) at or adjacent to a mismatch site to probe the structural and dynamic elements of the mismatch, we address how Msh2–Msh6 recognizes these mismatches for repair within the context of matched DNA. Fluorescence quantum yield and rotational correlation time measurements indicate that local base dynamics linearly correlate with Saccharomyces cerevisiae Msh2–Msh6 binding affinity where the protein exhibits a higher affinity (KD ≤ 25 nM) for mismatches that have a significant amount of dynamic motion. Energy transfer measurements measuring global DNA bending find that mismatches that are both well and poorly recognized by Msh2–Msh6 experience the same amount of protein-induced bending. Finally, base-specific dynamics coupled with protein-induced blue shifts in peak emission strongly support the crystallographic model of directional binding, in which Phe 432 of Msh6 intercalates 3′ of the mismatch. These results imply an important role for local base dynamics in the initial recognition step of MMR.
Poor Postpartum Sleep Quality Predicts Subsequent Postpartum Depressive Symptoms in a High-Risk Sample.

STUDY OBJECTIVES Postpartum depression (PPD) occurs in 15% to 20% of mothers worldwide and is associated with adverse outcomes for mother and child. Prior research has established a relationship between concurrent sleep quality and PPD. We conducted a secondary analysis in 45 women with mood disorders to study overall sleep quality (and individual components of sleep), measured in the early postpartum period, as a predictor of subsequent PPD. METHODS We measured sleep quality using the Pittsburgh Sleep Quality Index (PSQI; subscale and total scores) at 1 month postpartum (and during the third trimester). We measured depressive symptoms using the Inventory of Depressive Symptoms, Self-Report (IDS-SR) at 3 months postpartum. We used bivariate and multivariate linear regression models to study the association between PSQI and IDS scores. RESULTS We found that higher global PSQI scores as well as higher component scores for self-reported sleep quality, sleep latency, sleep efficiency, sleep medication usage, and daytime dysfunction, measured 1 month postpartum, were associated with increased IDS scores (at 3 months postpartum (P = .01, .01, .01, .003, < .001, respectively). We did not find an association between poor sleep quality in the third trimester and PPD. CONCLUSIONS Poor sleep quality in the early postpartum period independently predicts development of later PPD. This is clinically significant and highlights the importance of sleep interventions as an immediate postpartum therapeutic tool. CITATION McEvoy KM, Rayapati D, Washington Cole KO, Erdly C, Payne JL, Osborne LM. Poor postpartum sleep quality predicts subsequent postpartum depressive symptoms in a high-risk sample. J Clin Sleep Med. 2019;15(9):1303-1310.