Miracle-dz/UniFAR-FTUs huggingface dataset:
Anesthesia care provider sedation versus conscious sedation for endoscopic ultrasound–guided tissue acquisition: a retrospective cohort study

Background/Aims We aimed to study the effects of sedation on endoscopic ultrasound–guided tissue acquisition. Methods We conducted a retrospective study evaluating the role of sedation in endoscopic ultrasound–guided tissue acquisition by comparing two groups: anesthesia care provider (ACP) sedation and endoscopist-directed conscious sedation (CS). Results Technical success was achieved in 219/233 (94.0%) in the ACP group and 114/136 (83.8%) in the CS group (p=0.0086). In multivariate analysis, the difference in technical success between the two groups was not significant (adjusted odds ratio [aOR], 0.5; 95% confidence interval [CI], 0.234–1.069; p=0.0738). A successful diagnostic yield was present in 146/196 (74.5%) in the ACP group and 66/106 (62.3%) in the CS group, respectively (p=0.0274). In multivariate analysis, the difference in diagnostic yield between the two groups was not significant (aOR, 0.643; 95% CI, 0.356–1.159; p=0.142). A total of 33 adverse events (AEs) were observed. The incidence of AEs was significantly lower in the CS group (5/33 CS vs. 28/33 ACP; OR, 0.281; 95% CI, 0.095–0.833; p=0.022). Conclusions CS provided equivalent technical success and diagnostic yield for malignancy in endoscopic ultrasound–guided tissue acquisition. Increased AEs were associated with anesthesia for the endoscopic ultrasound–guided tissue acquisition.
Output tracking of stochastic nonlinear systems with unstable linearization

This paper studies the output tracking problem for a class of stochastic nonlinear systems whose linearization parts may have unstable modes via output‐feedback control. This is in contrast with most of the existing results where only state‐feedback control is considered. On the basis of the homogeneous domination technique, an output tracking controller is designed. It is shown that the expectation of tracking error can be made arbitrarily small while all the states of the closed‐loop system remain to be bounded in probability. Finally, a simulation example is given to illustrate the effectiveness of the tracking controller.
Optimized Replication of Arrayed Bacterial Mutant Libraries Increases Access to Biological Resources

Arrayed mutant collections drive robust genetic screens, but few protocols exist for replication of these resources and subsequent quality control. Increasing the distribution of arrayed biological collections will increase the accessibility and use of these resources. Developing standardized techniques for replication of these resources is essential for ensuring their quality and usefulness to the scientific community. ABSTRACT Biological collections, including arrayed libraries of single transposon (Tn) or deletion mutants, greatly accelerate the pace of bacterial genetic research. Despite the importance of these resources, few protocols exist for the replication and distribution of these materials. Here, we describe a protocol for creating multiple replicates of an arrayed bacterial Tn library consisting of approximately 6,800 mutants in 96-well plates (73 plates). Our protocol provides multiple checkpoints to guard against contamination and minimize genetic drift caused by freeze/thaw cycles. This approach can also be scaled for arrayed culture collections of various sizes. Overall, this protocol is a valuable resource for other researchers considering the construction and distribution of arrayed culture collection resources for the benefit of the greater scientific community. IMPORTANCE Arrayed mutant collections drive robust genetic screens, but few protocols exist for replication of these resources and subsequent quality control. Increasing the distribution of arrayed biological collections will increase the accessibility and use of these resources. Developing standardized techniques for replication of these resources is essential for ensuring their quality and usefulness to the scientific community.
Challenges in conducting fractional polynomial and standard parametric network meta-analyses of immune checkpoint inhibitors for first-line advanced renal cell carcinoma

Aim: Network meta-analyses (NMAs) increasingly feature time-varying hazards to account for non-proportional hazards between different drug classes. This paper outlines an algorithm for selecting clinically plausible fractional polynomial NMA models. Methods: The NMA of four immune checkpoint inhibitors (ICIs) + tyrosine kinase inhibitors (TKIs) and one TKI therapy for renal cell carcinoma (RCC) served as case study. Overall survival (OS) and progression free survival (PFS) data were reconstructed from the literature, 46 models were fitted. The algorithm entailed a-priori face validity criteria for survival and hazards, based on clinical expert input, and predictive accuracy against trial data. Selected models were compared with statistically best-fitting models. Results: Three valid PFS and two OS models were identified. All models overestimated PFS, the OS model featured crossing ICI + TKI versus TKI curves as per expert opinion. Conventionally selected models showed implausible survival. Conclusion: The selection algorithm considering face validity, predictive accuracy, and expert opinion improved the clinical plausibility of first-line RCC survival models.
Profile, Tissue Distribution, and Time Trend of Bisphenol Plastic Additives in Freshwater Wildlife of the Pearl River Ecosystem, China

Plastic‐related contaminants in the environment have attracted increasing attention, with plastic pollution becoming a serious issue globally. The present study investigated the potential bioaccumulation and biotransfer of bisphenol (BP) compounds that are widely added in various products such as plastics and other products in a freshwater ecosystem, China. Among commonly applied 14 BP analogues, bisphenol A (BPA), bisphenol F (BPF), and bisphenol S (BPS) were predominant, representing 64%–100% of the total concentrations of BPs (ΣBPs) in freshwater wildlife. Both the concentrations and analogue profiles in the fish showed seasonal differences and species dependence. Higher BP concentrations were observed in fish collected during the dry season than the wet season. Higher percentages of non‐BPA analogues (e.g., BPS and BPF) were observed in fish collected during the wet season. Pelagic species accumulated notably higher levels of BPs than midwater and bottom species. The liver generally contained the highest ΣBPs, followed successively by the swim bladder, belly fat, and dorsal muscle. The analogue profile also showed some differences among tissues, varying by species and season. Lower ΣBPs but higher percentages of non‐BPA analogues were observed in female than male common carp. Time trends of the BPA concentration in fish varied by species, probably related to habitats and diets of the fish. Habitats, feeding behaviors, and trophic transfer may have significant impacts on exposure of wildlife to BPs in natural ecosystems. The BPs did not demonstrate strong potential for bioaccumulation. More research is warranted about metabolism and transgenerational transfer of BPs in wildlife to fully reveal the bioaccumulation and consequently ecological risks of these chemicals in the environment. Environ Toxicol Chem 2023;42:2130–2142. © 2023 SETAC
Perspectives of health workers engaging in task shifting to deliver health care in low-and-middle-income countries: a qualitative evidence synthesis

ABSTRACT Background Low- and middle-income countries (LMICs) are experiencing growing demand for healthcare services yet face a persistent shortage in access to specialist health workers (SHWs). Task shifting is an approach used to address this gap in service provision. Specific healthcare tasks are shifted to other, larger cadres of non-specialist health workers (NSHWs), including lay health workers with SHWs potentially taking on supervisory roles. Previous studies demonstrate that task shifting is both clinically and economically effective, however the impact of task shifting on health workers (HWs) is not fully understood. Objective The aim of this synthesis is to generate new knowledge about what influences HWs perspectives of benefits and costs of engaging in task shifting. Methods A qualitative evidence synthesis (QES) of peer-reviewed literature using databases CINAHL, the Cochrane Database of Systematic Reviews, Psych INFO, MEDLINE, EMBASE, Epistimonikos, Web of Science (science and social science citation index), Scopus LILACS, the African Index Medicus and Google Scholar. Eligible studies were those that included qualitative data about HWs perspectives of task shifting in LMICs. Information from eligible studies was extracted into a Google Sheet, and the data gathered were analysed thematically. Results Fifty-four studies were included in the QES. Results were organised under three themes, ‘the cultural environment in which task shifting is employed’, ‘access to resources for task shifting’ and ‘alignment with personal values and beliefs, self-efficacy and personal emotional resilience’. Conclusion This is the first review bringing together views about task shifting from the perspective of different cadres of HWs drawn from diverse healthcare, geographical and country settings in LMICs. Task shifting is a complex process which relies upon the active engagement of HWs. Taking into consideration factors that influence HWs perspectives, such as their personal characteristics, preparatory training, and ongoing access to resources, is important for informing how task shifted healthcare initiatives are designed and delivered to successfully widen access to healthcare in LMICs.
Coordinated observations of two types of diffuse auroras near magnetic local noon by Magnetospheric Multiscale mission and ground all‐sky camera

Structured diffuse auroras are often observed near magnetic local noon (MLN), but their generation mechanisms are poorly understood. We have found that two types of structured diffuse auroras with obviously different dynamical properties often coexist near MLN. One type usually drifts from low to high latitude with higher speed and shows pulsation. The other type is always adjacent to the discrete aurora oval and drifts together with nearby discrete aurora with much lower speed. Using coordinated observations from MMS and ground all‐sky imagers, we found that the two types of diffuse auroras are well correlated with number density increase of O+ (from the ionosphere) and of He2+ (from magnetosheath) ions, respectively. These observations indicate that mangetosheath particles penetrated into the magnetosphere also can play an important role for producing the dayside diffuse aurora. In addition, for the first time, electron cyclotron harmonic waves are observed associated with dayside diffuse aurora.
Properties of hadrons from a non-perturbative approach

The composition and structure of matter remains a fundamental problem in physics. The closest theory that tries to deal with this problem is the Standard Model of particle physics, which encodes the electromagnetic, weak and strong interactions. The strong interaction is the main ingredient in the description of hadronic properties such as their masses, distribution of charge and magnetisation, decay parameters, and interactions between them. These properties have the common feature that they are modelled at low four momentum transfer. At those conditions the theory of the strong interactions becomes impossible to use and the best approach is to calculate the hadronic properties using expensive numerical simulations called lattice QCD. Because lattice QCD requires a lot of computational resources, models close to the theory of strong interactions are still of great importance. The work presented in this thesis uses different quark models (in particular the NJL model), in the calculation of the masses, electromagnetic form factors and weak decay properties of some light mass hadrons. In addition, it explores (in the context of the NJL model and others) the consequences that possible changes in fundamental constants could have for the binding energies of certain nuclei. Throughout the whole thesis the results are compared with other models, existing experimental data, and extrapolations of the lattice QCD simulations. In general terms, the agreement in those comparisons is outstanding. In some cases the quark models give predictions for and insights into what is expected for future experiments and lattice calculations. The main thrust of this thesis is to investigate the validity of the NJL model and the other models used here, because they can be crucial in the computation of physical properties of more complex structures such as many hadron systems or systems at very extreme conditions. Lattice QCD in those cases will still require a lot of work, time and computational resources. So far, it is fair to say that the models used here are to a very good extent, a good approximation to first principle calculations in the properties that were calculated in this thesis.
Do we really need two sessions?: The use of a structured interview as a trauma cue reactivity paradigm

Abstract Objectives Derived from classical conditioning theory and rooted in motivational mechanisms, cue reactivity paradigms (CRPs) are used in addictions research to measure participants' propensities for substance‐relevant responses (e.g., craving) during exposure to substance‐relevant cues (e.g., drug paraphernalia). CRPs are also useful in PTSD‐addiction comorbidity research, allowing the study of affective and substance‐relevant responses to trauma cues. However, studies using traditional CRPs are time‐consuming with high attrition rates due to repeat testing. Thus, we sought to test whether a single session semi‐structured trauma interview could serve as a CRP in terms of eliciting theorized cue exposure effects on craving and affect measures. Method Fifty regular cannabis users with trauma histories provided detailed descriptions of their most traumatic lifetime experience, and a neutral experience, according to an established interview protocol. Linear mixed models examined the effect of cue type (trauma vs. neutral) on affective and craving responses. Results As hypothesized, the trauma interview elicited significantly greater cannabis craving (and alcohol craving among the drinkers), and, greater negative affect among those with more severe PTSD symptoms, compared to the neutral interview. Conclusion Results suggest an established semi‐structured interview may function effectively as a CRP for use in trauma and addictions research.
Non‐Medical Switching from Tocilizumab to Sarilumab in Rheumatoid Arthritis Patients with Low Disease Activity, an Observational Study

Tocilizumab and sarilumab are IL‐6‐receptor antagonists registered for rheumatoid arthritis (RA), with equal effectiveness and safety. Switching from tocilizumab to sarilumab could be a strategy to reduce injection burden, in case of drug shortages, and to reduce costs. This study therefore aims to investigate the effectiveness and safety of switching patients with RA with well‐controlled disease under tocilizumab treatment to sarilumab. Patients with RA with low Disease Activity Score 28 (DAS28;‐CRP < 2.9 or < 3.5 with clinical judgment), on stable dose tocilizumab (> 6 months) were offered to switch to sarilumab. Patients who switched and consented were followed for 6 months. Sarilumab was started at 200 mg and double the last tocilizumab interval. Co‐primary outcomes at 6 months were (i) the 90% confidence interval (CI) of DAS28‐CRP change from baseline compared with the non‐inferiority margin of 0.6 and (ii) the 90% CI of the proportion of patients persisting with sarilumab, compared with a prespecified minimum of 70%. Of 50 invited patients, 25 agreed to switch to sarilumab, and 23 patients switched and were included. One patient was lost to follow‐up immediately after inclusion, therefore 22 patients are included in the analyses. At 6 months, mean change in DAS28‐CRP was 0.48 (90% CI: 0.11–0.87), compared with the non‐inferiority margin of 0.6. Sarilumab persistence was 68% (90% CI: 51–82%, 15 out of 22 patients), compared with the prespecified minimum of 70%. Non‐medical switching from tocilizumab to sarilumab in patients doing well on tocilizumab failed to show non‐inferiority regarding disease activity and drug persistence.
Phenylpropionic acid produced by gut microbiota alleviates acetaminophen-induced hepatotoxicity

ABSTRACT The gut microbiota affects hepatic drug metabolism. However, gut microbial factors modulating hepatic drug metabolism are largely unknown. In this study, using a mouse model of acetaminophen (APAP)-induced hepatotoxicity, we identified a gut bacterial metabolite that controls the hepatic expression of CYP2E1 that catalyzes the conversion of APAP to a reactive, toxic metabolite. By comparing C57BL/6 substrain mice from two different vendors, Jackson (6J) and Taconic (6N), which are genetically similar but harbor different gut microbiotas, we established that the differences in the gut microbiotas result in differential susceptibility to APAP-induced hepatotoxicity. 6J mice exhibited lower susceptibility to APAP-induced hepatotoxicity than 6N mice, and such phenotypic difference was recapitulated in germ-free mice by microbiota transplantation. Comparative untargeted metabolomic analysis of portal vein sera and liver tissues between conventional and conventionalized 6J and 6N mice led to the identification of phenylpropionic acid (PPA), the levels of which were higher in 6J mice. PPA supplementation alleviated APAP-induced hepatotoxicity in 6N mice by lowering hepatic CYP2E1 levels. Moreover, PPA supplementation also reduced carbon tetrachloride-induced liver injury mediated by CYP2E1. Our data showed that previously known PPA biosynthetic pathway is responsible for PPA production. Surprisingly, while PPA in 6N mouse cecum contents is almost undetectable, 6N cecal microbiota produces PPA as well as 6J cecal microbiota in vitro, suggesting that PPA production in the 6N gut microbiota is suppressed in vivo. However, previously known gut bacteria harboring the PPA biosynthetic pathway were not detected in either 6J or 6N microbiota, suggesting the presence of as-yet-unidentified PPA-producing gut microbes. Collectively, our study reveals a novel biological function of the gut bacterial metabolite PPA in the gut-liver axis and presents a critical basis for investigating PPA as a modulator of CYP2E1-mediated liver injury and metabolic diseases.
PREPARE: A Stepped-Wedge Cluster-Randomized Trial to Evaluate Whether Risk Stratification Can Reduce Preterm Deliveries Among Patients With Suspected or Confirmed Preterm Preeclampsia

BACKGROUND: Early delivery in preterm preeclampsia may reduce the risks for the patient, but consequences of prematurity may be substantial for the baby. This trial evaluated whether the implementation of a risk stratification model could safely reduce prematurity. METHODS: This was a stepped-wedge cluster-randomized trial in seven clusters. Patients presenting with suspected or confirmed preeclampsia between 20+0 and 36+6 gestational weeks were considered eligible. At the start of the trial, all centers were allocated in the preintervention phase, and patients enrolled in this phase were managed according to local treatment guidance. Subsequently, every 4 months, 1 randomly allocated cluster transitioned to the intervention. Patients enrolled in the intervention phase had sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio and preeclampsia integrated estimate of risk assessments performed. If sFlt-1/PlGF ≤38 and preeclampsia integrated estimate of risk <10%, patients were considered low risk and clinicians received recommendations to defer delivery. If sFlt-1/PlGF >38 and preeclampsia integrated estimate of risk ≥10%, patients were considered not low risk, and clinicians received recommendations to increase surveillance. The primary outcome was the proportion of patients with preterm preeclampsia delivered prematurely out of total deliveries. RESULTS: Between March 25, 2017 and December 24, 2019, 586 and 563 patients were analyzed in the intervention and usual care groups, respectively. The event rate was 1.09% in the intervention group, and 1.37% in the usual care group. After prespecified adjustments for variation between and within clusters over time, the adjusted risk ratio was 1.45 ([95% CI, 1.04–2.02]; P=0.029), indicating a higher risk of preterm deliveries in the intervention group. Post hoc analysis including calculation of risk differences did not show evidence of statistical differences. Abnormal sFlt-1/PlGF was associated with a higher rate of identifying preeclampsia with severe features. CONCLUSIONS: The introduction of an intervention based on biomarkers and clinical factors for risk stratification did not lead to reductions in preterm deliveries. Further training on the interpretation of disease severity in preeclampsia and the development of additional risk stratification is needed before adoption into clinical practice. REGISTRATION: URL: https://www.clinicaltrials. gov; Unique identifier: NCT03073317.
An integrative literature review examining the key elements of bereavement follow-up interventions in critical care

Purpose of review The aim of this review is to examine bereavement follow-up intervention studies in critical care, with the purpose of integrating results on the timing, content, aims and outcomes of interventions. The impact of a death in critical care is well documented, and bereavement follow-up is recognised as an important topic, but there is limited research with little consensus on the content and structure of interventions. Recent findings A total of 18 papers were selected; 11 are intervention studies, with only one randomised control trial. Six papers were from national surveys and are not the focus of this review. Bereavement follow-up mainly consisted of information giving, condolence interventions, telephone calls and meetings with families. The timing, content, aims and outcomes depended on the intervention and were influenced by the design of the study. Summary Overall, bereavement follow-up is acceptable for relatives but outcomes are mixed. Calls for more research are valid, but how do we utilise the current research to better inform the critical care community? Researchers suggest that bereavement follow-up interventions need to be designed with specific aims and outcomes, in collaboration with bereaved families that are appropriate to the intervention.