Miracle-dz/UniFAR-FTUs huggingface dataset:
Design Strategies for Biocontainment Units to Reduce Risk During Doffing of High-level Personal Protective Equipment

Abstract Background Few data exist to guide the physical design of biocontainment units, particularly the doffing area. This can impact the contamination risk of healthcare workers (HCWs) during doffing of personal protective equipment (PPE). Methods In phase I of our study, we analyzed simulations of a standard patient care task with 56 trained HCWs focusing on doffing of high-level PPE. In phase II, using a rapid cycle improvement approach, we tested different balance aids and redesigned doffing area layouts with 38 students. In phase III, we tested 1 redesigned layout with an additional 10 trained HCWs. We assessed the effectiveness of design changes on improving the HCW performance (measured by occurrence and number of risky behaviors) and reducing the physical and cognitive load by comparing the results from phase I and phase III. Results The physical load was highest when participants were removing their shoe covers without any balance aid; the use of a chair required the lowest physical effort, followed by horizontal and vertical grab bars. In the revised design (phase III), the overall performance of participants improved. There was a significant decrease in the number of HCW risky behaviors (P = .004); 5 risky behaviors were eliminated and 2 others increased. There was a significant decrease in physical load when removing disposable shoe covers (P = .04), and participants reported a similar workload in the redesigned doffing layout (P = .43). Conclusions Through optimizing the design and layout of the doffing space, we reduced risky behaviors of HCWs during doffing of high-level PPE.
Healthcare Workers’ Strategies for Doffing Personal Protective Equipment

Abstract Background Personal protective equipment (PPE) helps protect healthcare workers (HCWs) from pathogens and prevents cross-contamination. PPE effectiveness is often undermined by inappropriate doffing methods. Our knowledge of how HCWs approach doffing PPE in practice is limited. In this qualitative study, we examine HCWs’ perspectives about doffing PPE. Methods Thirty participants at a Midwestern academic hospital were recruited and assigned to 1 of 3 doffing simulation scenarios: 3 mask designs (n = 10), 2 gown designs (n = 10), or 2 glove designs (n = 10). Participants were instructed to doff PPE as they would in routine practice. Their performances were video-recorded and reviewed with participants. Semistructured interviews about their doffing approaches were conducted and audio-recorded, then transcribed and thematically analyzed. Results Three overarching themes were identified in interviews: doffing strategies, cognitive processes, and barriers and facilitators. Doffing strategies included doffing safely (minimizing self-contamination) and doffing expediently (eg, ripping PPE off). Cognitive processes during doffing largely pertained to tracking contaminated PPE surfaces, examining PPE design cues (eg, straps), or improvising based on prior experience from training or similar PPE designs. Doffing barriers and facilitators typically related to PPE design, such as PPE fit (or lack of it) and fastener type. Some participants also described personal barriers (eg, glasses, long hair); however, some PPE designs helped mitigate these barriers. Conclusions Efforts to improve HCWs’ doffing performance need to address HCWs’ preferences for both safety and expediency when using PPE, which has implications for PPE design, training approaches, and hospital policies and procedures.
Physiological Correlates of Moral Decision-Making in the Professional Domain

Moral decision-making is central to guide our social behavior, and it is based on emotional and cognitive reasoning processes. In the present research, we investigated the moral decision-making in a company context by the recording of autonomic responses (skin conductance response, heart rate frequency, and variability), in three different moral conditions (professional fit, company fit, social fit) and three different offers (fair, unfair, neutral). In particular, the first professional fit condition required participants to accept or reject some offers proposing the money subdivision for a work done together with a colleague. The second company fit condition required participants to evaluate offers regarding the investment of a part of the money in the introduction of some company’s benefits. Finally, the third social fit condition required participants to accept or refuse a money subdivision to support a colleague’s relative with health problems financially. Results underlined the significant effect of both the condition, with increased autonomic effects more for personal and social than company fit, and the offer type, with differences for fair and neutral offers compared to unfair ones. This research shows how individual, situational, and contextual factors influence moral decision-making in a company context.
Aged Mice Demonstrate Greater Muscle Degeneration of Chronically Injured Rotator Cuff

Massive tears of the rotator cuff (RC) are often associated with progressive and irreversible muscle degeneration due to fibrosis, fatty infiltration, and muscle atrophy. RC tears are common in individuals older than 60 years and the repair of these tears is amongst the most prevalent of orthopedic procedures. However, most current models of this injury are established in young animals, which may not accurately recapitulate the clinical condition. In this study, we used a murine model of massive RC tears to evaluate age‐related muscle degeneration following chronic injury. The expression of the fibro‐adipogenic genes encoding collagen type III and leptin was higher in aged RC compared with matched injured young tissue at 2 weeks post‐injury, and development of fibrosis was accelerated in aged mice within 5 days post‐injury. Furthermore, the synthesis of collagens type I and III and fat tissue accumulation were significantly higher in injured RCs of aged mice. Similar frequency of fibro‐adipogenic PDGFRβ+PDGFRα+ progenitor cells was measured in non‐injured RC of aged and young mice, but PDGFRβ+PDGFRα+ cells contributed to significantly larger fibrotic lesions in aged RCs within 2 weeks post‐injury, implying a more robust fibrotic environment in the aged injured muscle. Altogether, these findings demonstrate age‐dependent differences in RC response to chronic injury with a more profound fibro‐adipogenic change in aged muscles. Clinically, cell therapies for muscular pathologies should not only consider the cell type being transplanted but also the recipient milieu into which these cells are seeded. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:320‐328, 2020
Response to Anti-EGFR Therapy in Patients with BRAF non-V600–Mutant Metastatic Colorectal Cancer

Purpose: While mutations in BRAF in metastatic colorectal cancer (mCRC) most commonly occur at the V600 amino acid, with the advent of next-generation sequencing, non-V600 BRAF mutations are increasingly identified in clinical practice. It is unclear whether these mutants, like BRAF V600E, confer resistance to anti-EGFR therapy. Experimental Design: We conducted a multicenter pooled analysis of consecutive patients with non-V600 BRAF-mutated mCRCs identified between 2010 and 2017. Non-V600 BRAF mutations were divided into functional classes based on signaling mechanism and kinase activity: activating and RAS-independent (class 2) or kinase-impaired and RAS-dependent (class 3). Results: Forty patients with oncogenic non-V600 BRAF–mutant mCRC received anti-EGFR antibody treatment [n = 12 (30%) class 2 and n = 28 (70%) class 3]. No significant differences in clinical characteristics were observed by mutation class. In contrast, while only 1 of 12 patients with class 2 BRAF mCRC responded, 14 of 28 patients with class 3 BRAF responded to anti-EGFR therapy (response rate, 8% and 50%, respectively, P = 0.02). Specifically, in first- or second-line, 1 of 6 (17%) patients with class 2 and 7 of 9 (78%) patients with class 3 BRAF mutants responded (P = 0.04). In third- or later-line, none of 6 patients with class 2 and 7 of 19 (37%) patients with class 3 BRAF mutants responded (P = 0.14). Conclusions: Response to EGFR antibody treatment in mCRCs with class 2 BRAF mutants is rare, while a large portion of CRCs with class 3 BRAF mutants respond. Patients with colorectal cancer with class 3 BRAF mutations should be considered for anti-EGFR antibody treatment. See related commentary by Fontana and Valeri, p. 6896
On field vaccine effectiveness in three periods of 2018/2019 influenza season in Emilia-Romagna Region

Background and aim of the work: Epidemic influenza is associated with significant morbidity and mortality, particularly in people at risk. The vaccine reduces complications, hospitalization and mortality excess, as well as health care and social costs. Aim of the study was to estimate the influenza vaccine effectiveness (VE) in Emilia-Romagna Region during the 2018/2019 season. Methods: Within the context of virological surveillance conducted at the Regional Reference Laboratory of Parma, nasal/throat swabs were performed by sentinel practitioners and clinicians, on patients with ILI (Influenza-like illness). VE estimates, overall and against subtype A(H1N1)pdm09 and A(H3N2), were evaluated in three periods of the season, using a test-negative case-control design. Results: From November 2018 to April 2019, 2,230 specimens were analyzed: 1,674 (75.1%) performed by clinicians and 556 (24.9%) by sentinel practitioners of the regional network. The season was characterized by the predominant circulation of influenza type A viruses: 57.4% belonged to subtype A(H3N2), 41.2% to subtype A(H1N1)pdm09. 23.5% of patients was vaccinated against influenza with quadrivalent or adjuvate vaccine. The overall VE was -5% (95% CI -33% - 18%) with a decreasing trend during the season. The overall VE against subtype A(H1N1)pdm09 was 39% (95% CI 11% - 58%) and remained stable during the season. The overall VE against subtype A(H3N2) was -43% (95% CI -89% - -9%), and showed an important decreasing trend. Conclusions: The possibility to make accurate and continuous VE estimates during the season will help to better define the composition of the vaccine for the following season. (www.actabiomedica.it)
Health and Illness at the Age of 90

The oldest-old population is expanding rapidly. Currently in 2009, 0.6% of the population in Finland is 90 years old or older. There is a need for clinical information about this group that actively uses the social and health care but as a marginal population has not been systematically studied. This thesis work studied the health and illnesses of the 90-year-olds with an aim to obtain population level information from several perspectives. The target population was all people born in 1907-1910 and living in the city of Tampere at the age 90. Sources of information used were medical records, city hospitals patient register and discharge database, a mailed questionnaire, testing for mobility and cognition, and finally population register data for mortality. Four of five 90-year-olds were women (79%). More than two-thirds of the 90-yearolds lived in the community (72%). One-year mortality was nearly 20%. Morbidity was higher than in younger populations. Though women were more numerous, the few surviving 90-year-olds men appeared healthier. The most common diagnosis groups in the patient history were cardiovascular diseases (78%), gastrointestinal diseases (59%), infections (54%), and injuries (50%). An average of eight chronic or severe diseases were mentioned in the patient history indicating multiple co-morbidities. The diagnosis of dementia was mentioned in every fourth case (27%); most of the demented 90-year-olds were living in institutions. Of all 90-year-olds, one third (38%) were able to move using no or a light support, 8% were bedridden. Of the community-living 90-year-olds, 78% reported their current health as good or average, which result is similar to reports from younger generations. Poor self-rated or depression. The agreement of self-reported and medical records data was relatively good. As expected, many of the diagnosed diseases were underreported in the mailed
The Development and Validation of the Compassion Scale

This article presents a measure of compassion for others called the Compassion Scale (CS), which is based on Neff’s theoretical model of self-compassion. Compassion was operationalized as experiencing kindness, a sense of common humanity, mindfulness, and lessened indifference toward the suffering of others. Study 1 (n = 465) describes the development of potential scale items and the final 16 CS items chosen based on results from analyses using bifactor exploratory structural equation modeling. Study 2 (n = 510) cross-validates the CS in a second student sample. Study 3 (n = 80) establishes test–retest reliability. Study 4 (n = 1,394) replicates results with a community sample, while Study 5 (n = 172) replicates results with a sample of meditators. Study 6 (n = 913) examines the finalized version of the CS in a community sample. Evidence regarding reliability, discriminant, convergent, construct, and known-groups validity for the CS is provided.
Self-care in women with breast cancer

This secondary data analysis of the Self-Help Intervention Project pilot study was conducted to determine the relationships among Enabling Skills, Nursing Interventions, Symptom distress, and Self-Care in 23 women with breast cancer. This study was based upon Orem's (1985) Framework of Self-Care. Results indicated Enabling Skills as positively related to Symptom Distress (r=.55, p=.007) and Self-Care (r=.55, p=.007). Self-Care was positively related to pattern of Symptom Distress (r=.36, p=.099), and negatively related to numbers of Symptom Distress (r=-.55, p=.007). Self-Help Class intervention was positively related to Symptom Distress (r=.44, p=.037). Results of the study demonstrated women with breast cancer can benefit from nursing, interventions that increase their self-control, or reduce the distress from cancer treatment's side effects. Findings emphasize the need for nurses to become more active in promoting patients' Enabling Skills and consequent increase of patients' Self-Care level. 11 CHAPTER
A Comprehensive Review of Outcome Predictors in Low MELD Patients

Risk scoring for patients with cirrhosis has evolved greatly over the past several decades. However, patients with low Model for End-Stage Liver Disease–Sodium scores still suffer from liver-related morbidity and mortality. Unfortunately, it is not clear which of these low Model for End-Stage Liver Disease–Sodium score patients would benefit from earlier consideration of liver transplantation. This article reviews the literature of risk prediction in patients with cirrhosis, identifies which patients may benefit from earlier interventions, such as transplantation, and proposes directions for future research.
MRI findings in posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is a psychiatric condition that develops after a person experiences one or more traumatic events, characterized by intrusive recollection, avoidance of trauma‐related events, hyperarousal, and negative cognitions and mood. Neurophysiological evidence suggests that the development of PTSD is ascribed to functional abnormalities in fear learning, threat detection, executive function and emotional regulation, and contextual processing. Magnetic resonance imaging (MRI) plays a primary role in both structural and functional neuroimaging for PTSD, demonstrating focal atrophy of the gray matter, altered fractional anisotropy, and altered focal neural activity and functional connectivity. MRI findings have implicated that brain regions associated with PTSD pathophysiology include the medial and dorsolateral prefrontal cortex, orbitofrontal cortex, insula, lentiform nucleus, amygdala, hippocampus and parahippocampus, anterior and posterior cingulate cortex, precuneus, cuneus, fusiform and lingual gyri, and the white matter tracts connecting these brain regions. Of these, alterations in the anterior cingulate, amygdala, hippocampus, and insula are highly reproducible across structural and functional MRI, supporting the hypothesis that abnormalities in fear learning and reactions to threat play an important role in the development of PTSD. In addition, most of these structures have been known to belong to one or more intrinsic brain networks regulating autobiographical memory retrieval and self‐thought, salience detection and autonomic responses, or attention and emotional control. Altered functional brain networks have been shown in PTSD. Therefore, in PTSD MRI is expected to reflect disequilibrium among functional brain networks, malfunction within an individual network, and impaired brain structures closely interacting with the networks.
Characterizing Consumer Behavior in Leveraging Social Media for E-Patient and Health-Related Activities

The emergence of e-patients has encouraged consumers, people who are non-medical experts, to be more engaged in healthcare needs by utilizing online sources via social media. However, the nature of social media and regulation issues have caused concerns for the reliability and validity of the shared information. These phenomena shape consumers behavior in leveraging social media for e-patient activities. This study investigates consumer behavior using an integrated model based on the Unified Theory of Acceptance and Use of Technology (UTAUT) and the Protection Motivation Theory (PMT). The data collected from the participants (N = 312) was analyzed using partial least square structural equation modelling. The results showed that behavioral intention to use social media for e-patient activities was significantly affected by performance expectancy, effort expectancy, perceived severity, perceived susceptibility, and response efficacy; and that behavioral intention corresponded positively to usage intention. In addition, the results also indicate that the intention to use social media for health-related purposes is driven by awareness of preventing health problems and attempts to reduce the risk of developing an illness. Based on findings, this study recommends strategies and initiatives to optimize social media for promoting a healthy lifestyle and educating society about public health and healthcare management.
Hearing loss in police K9 handlers and non-K9 handlers

Abstract Objective: The objective of this study was to assess and compare the hearing of police K9 handlers and non-K9 handlers. Design: Cross-sectional design. Study sample: Hearing was assessed on 30 police officers, 12 K9 handlers and 18 non-K9 handlers, from Northeast Ohio. Results: There were no significant differences in audiologic test results between police K9 handlers and non-K9 handlers. Audiometric results revealed that 66.7% of K9 handlers and 83.3% of non-K9 handlers presented with hearing loss. Noise notches, consistent with noise-induced hearing loss (NIHL), and asymmetric hearing losses were observed for both groups. Subjective questionnaires indicated low awareness regarding the risks and identification of NIHL in this population. Conclusions: This study represents one of the few studies that focus on hearing assessments in police K9 handlers and non-K9 handlers in the United States and internationally. Significant differences between these two groups were not found, suggesting that K9 handlers do not present a higher risk for NIHL than non-K9 handlers. Nonetheless, the high prevalence of hearing loss identified for both groups in this study suggests the need for increased conservation efforts to raise awareness regarding hearing loss prevention and the need for routine audiologic monitoring for this underserved population.
Comparison between Aptima Assays (Hologic) and the Allplex STI Essential Assay (Seegene) for the diagnosis of Sexually transmitted infections

Sexually transmitted infections (STIs) remain a worldwide problem and a severe threat to public health. The purpose of this study was to compare Aptima® Assays (Hologic®) and the Allplex™ STI Essential Assay (Seegene®) for the simultaneous detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium in clinical practice. The Aptima® assays (Hologic®) are based on a transcription-mediated amplification (TMA) method. The Allplex™ STI Essential assay (Seegene®) is based on a multiplex Real-Time PCR (RT-PCR) method. A total of 622 clinical samples from different anatomical sites were tested using both methods. A total of 88 (14.1%) and 66 (10.6%) positive samples were found for any of the TMA assays used and for the RT-PCR assay, respectively. Aptima® assays showed a slightly higher rate of positive results for all pathogens except for T. vaginalis, the results of which were similar to those obtained with Allplex™. The most commonly detected pathogen was C. trachomatis (37 samples; 5.9% using TMA assays) and the anatomical site with the highest prevalence of microorganisms was a non-urogenital site, the pharynx (27 positive samples; 4.3%). Using the Aptima® assays as reference method, the comparison showed that the average specificity of multiplex RT-PCR was 100.0% for the four pathogens. However an average sensitivity of 74.5% was observed, showing 95.2% (CI95%; 93.6–96.9) of overall concordance (κ = 0.80). In conclusion, the Aptima® assays show a higher sensitivity on a wide range of sample types compared to the Allplex™ assay.
Thermalization and possible signatures of quantum chaos in complex crystalline materials

Significance Quantum chaos has been suggested as a framework to understand transport of charge excitations in strongly correlated electron systems exhibiting the “strange metal” state without long-lived quasiparticle excitations. Identifying a characteristic local scrambling time and a velocity by which perturbation propagates into nonlocal degrees of freedom, a chaos diffusivity is identified and related to the measured charge and energy diffusivities. Here we scrutinize the underlying hypothesis that lattice dynamics can be ignored, particularly at high temperatures, where many phonon bands and their interactions dominate the thermal transport in complex materials. We argue that much of the chaotic behavior, which is also identified in complex insulators, originates from phonons, and in equivalent itinerant systems only the thermal (energy) diffusivity describes chaos diffusivity. Analyses of thermal diffusivity data on complex insulators and on strongly correlated electron systems hosted in similar complex crystal structures suggest that quantum chaos is a good description for thermalization processes in these systems, particularly in the high-temperature regime where the many phonon bands and their interactions dominate the thermal transport. Here we observe that for these systems diffusive thermal transport is controlled by a universal Planckian timescale τ∼ℏ/kBT and a unique velocity vE. Specifically, vE≈vph for complex insulators, and vph≲vE≪vF in the presence of strongly correlated itinerant electrons (vph and vF are the phonon and electron velocities, respectively). For the complex correlated electron systems we further show that charge diffusivity, while also reaching the Planckian relaxation bound, is largely dominated by the Fermi velocity of the electrons, hence suggesting that it is only the thermal (energy) diffusivity that describes chaos diffusivity.