Miracle-dz/UniFAR-FTUs huggingface dataset:
Exploring Ketamine Analgosedation Use and Its Effect on Incident Delirium in Critically Ill Adults

OBJECTIVES: Ketamine is increasingly being used for analgosedation, but its effect on delirium remains unclear. We compared delirium risk variables and ketamine analgosedation use between adults who developed incident delirium and those who did not, evaluated whether ketamine analgosedation increases delirium risk, and compared ICU delirium characteristics, treatments, and outcomes between ketamine and nonketamine patients with delirium. DESIGN: Secondary, subgroup analysis of a cohort study. SETTING: Single, 36-bed mixed medical-surgical ICU in the Netherlands from July 2016 to February 2020. PATIENTS: Consecutive adults were included. Patients admitted after elective surgery, not expected to survive greater than or equal to 48 hours, admitted with delirium, or where delirium occurred prior to ketamine use were excluded. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Trained ICU nurses evaluated patients without coma (Richmond Agitation Sedation Scale. –4/–5) every 8 hours with the Confusion Assessment Method ICU; a delirium day was defined by greater than or equal to1 + Confusion Assessment Method ICU and/or scheduled antipsychotic use. Among 11 variables compared between the delirium and nondelirium groups (Baseline: age, Charlson Comorbidity score, cognitive impairment, admission type, and Acute Physiology and Chronic Health Evaluation-IV score, daily ICU [until delirium occurrence or discharge]: Sequential Organ Failure Assessment score, coma, benzodiazepine, opioid, and ketamine use) and total ICU days, 7 (age, Charlson score, Sequential Organ Failure Assessment score, coma, benzodiazepine, opioid, and ketamine use) were significantly different and were entered, along with delirium occurrence, in a logistic regression model. A total of 332 of 925 of patients (36%) developed delirium. Ketamine use was greater in patients with delirium (54 [16%] vs 4 [0.7%]; p < 0.01). Ketamine use (adjusted odds ratio, 5.60; 95% CI, 1.09–29.15), age (adjusted odds ratio, 1.03; 95% CI, 1.01–1.06), coma (adjusted odds ratio, 2.10; 95% CI, 1.15–3.78), opioid use (adjusted odds ratio, 171.17; 95% CI, 66.45–553.68), and benzodiazepine use (adjusted odds ratio, 34.07; 95% CI, 8.12–235.34) were each independently and significantly associated with increased delirium. Delirium duration, motoric subtype, delirium treatments, and outcomes were not different between the ketamine and nonketamine groups. CONCLUSIONS: Ketamine analgosedation may contribute to increased ICU delirium. The characteristics of ketamine and nonketamine delirium are similar. Further prospective research is required to evaluate the magnitude of risk for delirium with ketamine use.
Cross-cultural adaptation and validation of the Infant Feeding Style Questionnaire in Brazil

We cross-culturally adapted and validated the Infant Feeding Style Questionnaire (IFSQ) in Brazil. The cross-cultural adaptation and content validity assessment was conducted in five steps: translation, synthesis of translations, back-translation, evaluation by experts, and pre-test. To evaluate reliability, construct validity, and floor and ceiling effects, interviews were conducted with 465 mother-infant pairs at Primary Health Centers in the Federal District, Brazil. The mothers answered the Brazilian Portuguese version of the IFSQ (IFSQ-Br), which evaluated four feeding styles (laissez-faire, pressuring, restrictive, and responsive) from 9 sub-constructs. The indulgent style was not evaluated due to time limitation. We performed reliability analysis using Cronbach’s alpha coefficient and construct validity was evaluated through Confirmatory Factor Analysis. Higher means were found in the sub-constructs of the responsive and restrictive styles. The IFSQ-Br presented adequate reliability (α = 0.73) with values for the Cronbach’s alpha coefficient of the sub-constructs ranging from 0.42 to 0.75. In the Confirmatory Factor Analysis, the final models presented good fit, with the Comparative Fit Indices (CFI) ranging from 0.86 to 1.0 and the Root-Mean Squared Error of Approximation (RMSEA) between 0.0 and 0.09. The IFSQ-Br was shown to be a valid and reliable questionnaire to evaluate maternal feeding beliefs and behaviors in Brazil. Future studies should evaluate the psychometric properties of the indulgent style and include mother-infant pairs from different cultural contexts in Brazil.
Comparison of methods for pre-processing, exosome isolation, and RNA extraction in unpasteurized bovine and human milk

Milk is a highly complex, heterogeneous biological fluid that contains non-nutritive, bioactive extracellular vesicles called exosomes. Characterization of milk-derived exosomes (MDEs) is challenging due to the lack of standardized methods that are currently being used for milk pre-processing, storage, and exosome isolation. In this study, we tested: 1) three pre-processing methods to remove cream, fat, cellular debris, and casein proteins from bovine milk to determine whether pre-processing of whole milk prior to long-term storage improves MDE isolations, 2) the suitability of two standard exosome isolation methods for MDE fractionation, and 3) four extraction protocols for obtaining high quality RNA from bovine and human MDEs. MDEs were characterized via Transmission Electron Microscopy (TEM), Nanoparticle Tracking Analysis (NTA), and western immunoblotting for CD9, CD63, and Calnexin protein markers. We also present an optimized method of TEM sample preparation for MDEs. Our results indicate that: 1) Removal of cream and fat globules from unpasteurized bovine milk, prior to long-term storage, improves the MDE yield but not purity, 2) Differential ultracentrifugation (DUC) combined with serial filtration is better suited for bovine MDE isolation compared to ExoQuick (EQ) combined with serial filtration, however both methods were comparable for human milk, and 3) TRIzol LS is better suited for RNA extraction from bovine MDEs isolated by EQ and DUC methods. 4) TRIzol LS, TRIzol+RNA Clean and Concentrator, and TRIzol LS+RNA Clean and Concentrator methods can be used for RNA extractions from human MDEs isolated by EQ, yet the TRIzol LS method is better suited for human MDEs isolated by DUC. The QIAzol + miRNeasy Mini Kit produced the lowest RNA yield for bovine and human MDEs.
People’s naïve belief about curiosity and interest: A qualitative study

The purpose of this study was to critically examine how people perceive the definitions, differences and similarities of interest and curiosity, and address the subjective boundaries between interest and curiosity. We used a qualitative research approach given the research questions and the goal to develop an in-depth understanding of people’s meaning of interest and curiosity. We used data from a sample of 126 U.S. adults (48.5% male) recruited through Amazon’s Mechanical Turk (Mage = 40.7, SDage = 11.7). Semi-structured questions were used and thematic analysis was applied. The results showed two themes relating to differences between curiosity and interest; active/stable feelings and certainty/uncertainty. Curiosity was defined as an active feeling (more specifically a first, fleeting feeling) and a child-like emotion that often involves a strong urge to think actively and differently, whereas interest was described as stable and sustainable feeling, which is characterized as involved engagement and personal preferences (e.g., hobbies). In addition, participants related curiosity to uncertainty, e.g., trying new things and risk-taking behaviour. Certainty, on the other hand, was deemed as an important component in the definition of interest, which helps individuals acquire deep knowledge. Both curiosity and interest were reported to be innate and positive feelings that support motivation and knowledge-seeking during the learning process.
Effectiveness of a Fully Impregnated Hydroxyapatite Polyetheretherketone Cage on Fusion in Anterior Cervical Spine Surgery

Introduction Anterior cervical discectomy and fusion (ACDF) is the gold standard for the treatment of cervical spondylosis. However, new techniques, technologies, and improved implants have aided surgeons in reducing operative time with enhanced patient outcomes. Impregnated hydroxyapatite polyetheretherketone (HA PEEK) cages (Arena-C HA®, LESspine Inc. Malden, MA) are one such option that has aimed to increase the fusion rate. The authors herein aimed to assess the use of HA PEEK interbody cages by looking at outcomes, complications, and radiographic fusion. Methods The medical records of 41 consecutive patients undergoing single-level ACDF with impregnated HA PEEK cages (group 1) were compared to the control group of 47 patients who had single-level ACDF without impregnated HA PEEK cages (group 2). Outcomes assessed included Visual Analog Scale (VAS) neck, Neck Disability Index (NDI) scores, radiographic fusion, and complication rates. Results Of the 41 patients in group 1 (HA PEEK), 48% were female population with a mean age of 58.5+/- 1.7 years and BMI 29.7+/-1.2 kg/m2. Of the 47 patients in group 2 (non-HA PEEK), 53% were female with a mean age of 54.3+/- 1.2 years and BMI 27.8+/-0.8 kg/m2. Using t-test, there was a statistically significant intergroup difference in two-year VAS neck and NDI scores, p=0.007, and p=0.001, respectively. Radiographic fusion occurred as early as three months in the HA PEEK group. Conclusions This study has demonstrated the equivalence of impregnated HA PEEK cages in single-level ACDF. Significant improvements were seen in VAS and NDI scores in the HA PEEK group. There was no incidence of heterotopic bone formation or reaction to HA PEEK cages. Additionally, a trend toward fusion was seen in HA PEEK patients as early as three to five months compared to seven to eight months for the ACDF group. We conclude that HA PEEK cages can be safely placed with excellent outcomes. However, further studies are required to look at added benefits.
The Application of Buccal Fat Pad to Cover Lateral Palatal Defect Causes Early Mucolization

Introduction Cleft lip and cleft palate are among the most common birth defects. These deformities lead to profound psychosocial and functional effects on cleft palate patients. Several surgical techniques have been described for the repair of the cleft. The defects lateral to mucoperiosteal flaps closure are sometimes covered with sterile gauze soaked with soft paraffin or tincture of benzoin or are left open for mucolization by means of secondary intention. The buccal fat pad (BFP) is used as a pedicled graft to cover the exposed bone of the lateral palatal defect, and it is associated with proposed benefits of early healing and fewer effects on transverse growth of the maxilla. Materials and methods This was a prospective study involving 42 cleft palate patients who underwent cleft palate repair; 21 patients received BFP as an additional step to cover lateral palatal defect while the rest of the patients (n=21) underwent conventional surgical cleft palate repair and the defect was covered with Surgicel (Ethicon, Inc., Bridgewater, NJ). Postoperative follow-up was conducted at first, second, and third weeks postoperatively to assess the time required for mucolization. Results Our cohort of 42 patients included an equal number of complete and incomplete cleft palate patients. Follow-up at the first postoperative week showed an equal number (n=21, 100%) patients with incomplete mucolization on both groups, while at the second postoperative follow-up, only one (4.8%) of the patients who underwent conventional cleft palate repair had complete mucolization while 20 (95.2%) among the patients who underwent BFP had complete mucolization. At the third-week postoperative follow-up, three (14.3%) patients from the conventional group had complete mucolization, while 18 (85.7%) had incomplete mucolization. Only two patients (4.8%) developed recipient area complications, and they were managed conservatively. Conclusion BFP is a good source of vascularized tissue to cover the hard palate bones after primary cleft repair. It is easy to harvest as a local tissue with a low learning curve. The epithelialization rate is faster than conventional methods with minimal complication rates.
Effects on annual income changes after radical radiotherapy versus after prostatectomy in patients with localized prostate cancer with a specific employment status: A web-based pilot study

Men with localized prostate cancers are insured for undergoing radical radiotherapy or prostatectomy. However, limited information is available on the influence of cancer treatments on patients’ employment status in Japan. Therefore, in this web-based survey, we aimed to compare the effects of post-treatment changes on the annual income of patients with prostate cancer after undergoing radical radiotherapy and prostatectomy and to identify the risk factors associated with the decrease in annual income. We investigated the clinical characteristics and demographics including pre-treatment working status, self-employment, non-regular employment, working for wage or salary, and joblessness of patients with localized prostate cancer. Multivariable logistic regression was performed to analyze the effects of various factors on the change in the annual income of self-employed and non-regularly employed workers. Seventy-eight eligible patients with localized prostate cancer had undergone radiotherapy, and 128 patients had undergone prostatectomy. Among self-employed and non-regularly employed workers, post-treatment income decline rates in those who underwent radiotherapy were smaller but not significant (12% vs. 42%, P = 0.074). Multivariable logistic regression analysis revealed that initial treatment for prostate cancer was the only significant risk factor for the post-treatment income decline among self-employed and non-regularly employed workers. Radiotherapy was associated with a smaller decrease in income (odds ratio, 0.22; 95% confidence interval, 0.052–0.95; P = 0.042). Our novel results implied the effectiveness of radiotherapy in preventing post-treatment income decline among patients with prostate cancer based on specific employment status: self-employed or non-regularly employed.
Accessing Healthcare Services for People with Physical Disabilities in Hawassa City Administration, Ethiopia: A Cross-Sectional Study

Background Persons with disabilities experience significant barriers to accessing health care. These barriers may be more serious in countries such as Ethiopia. In this study, we aimed to assess the prevalence of accessibility and associated factors among physically disabled people visiting physical disability associations in Hawassa. Methods A cross-sectional study was conducted among 345 randomly selected physically disabled people who visited disability associations in Hawassa. Data were collected from February 1 to 28, 2020 through face-to-face interview using a semi-structured questionnaire. Data analysis was done by SPSS version 23. Statistically significant test was declared using statistical cut-off point of P-value < 0.05. Results Accessibility to healthcare services among respondents was 83 (25.4%). About three-quarters of these respondents (74.6%) experienced at least one access barrier to healthcare services; 61.5% experienced physical barriers, 62.7% reported barriers related to medical equipment and 59.3% had communication barriers. Male participants (AOR = 3.19, 95% CI: 1.70, 6.99), married individuals (AOR = 2.95, 95% CI: 1.59, 5.49), people whose costs for healthcare services was covered by NGOs (AOR = 3.23, 95% CI: 1.39, 7.51) and participants with no experience of discrimination when accessing healthcare services (AOR = 5.84, 95% CI: 3, 11, 10.95) had more access to healthcare services. Conclusion Accessibility to healthcare services among people with disabilities was poor in the study. It is related with various factors. Therefore, it is important to strengthen inter-sectoral collaboration, promote community health insurance and strengthen the economic capacity of persons with physical disabilities in order to overcome barriers.
Comparison of Kirschner Wire Versus Screw Fixation in 1,2 Inter-Compartment Supra Retinaculum Artery Pedicle-Vascularized Bone Graft for Scaphoid Fractures

Introduction: The purpose of the study was to compare the outcomes of the Kirschner wires (k-wires) versus screw fixation in 1,2 inter-compartment supra retinaculum artery (ICSRA) pedicle-vascularized bone graft for scaphoid non-union treatment. Method: A retrospective study that included all patients with scaphoid nonunion underwent pedicle-vascularized bone graft and fixated with either k-wire or screw from 2010 through 2019 in the Department of Plastic and Reconstructive Surgery at Liaquat National Hospital and Medical College. Clinical outcomes were compared between k-wire and screw fixation, which were measured in terms of union rate, time of healing, pre and post-operative Disabilities of the Arm, Shoulder, and Hand (DASH) scores, range of motion at wrist, and grip strength of hand. Results: A total of 33 patients were included in the study. All of them had scaphoid non-union and were treated with 1,2 ICSRA pedicle-vascularized bone graft; 20 patients had a fixation with k-wire and 13 with a screw. Radiological healing was achieved in 18 patients with k-wire and 11 patients with screw fixation, with healing rates of 90% and 84.6%, respectively. There was a significant decrease in DASH score postoperatively in both groups. Although no significant difference between the outcomes of both groups whether on union rate, DASH score, or range of motion at the wrist. Conclusion: Hence, there is no significant difference in outcome between k-wire and screw fixation methods. We concluded k-wire as a more acceptable option with vascularized bone graft fixation as less technically demanding and low cost as compared to screw fixation.
Can fingernail quality predict bone damage in Type 2 diabetes mellitus? a pilot study

Type 2 diabetes mellitus (T2DM) adversely affects the normal functioning, intrinsic material properties, and structural integrity of many tissues, including bone. It is well known that the clinical utility of areal bone mineral density (aBMD) is limited to assess bone strength in individuals with T2DM. Therefore, there is a need to explore new diagnostic techniques that can better assist and improve the accuracy of assessment of bone tissue quality. The present study investigated the link between bone and fingernail material/compositional properties in type 2 diabetes mellitus (T2DM). For that, femoral head and fingernail samples were obtained from twenty-five adult female patients (with/without T2DM) with fragility femoral neck fractures undergoing hemi/total hip arthroplasty. Cylindrical cores of trabecular bone were subjected to micro-CT, and lower bone volume fraction was observed in the diabetic group than the non-diabetic group due to fewer and thinner trabeculae in individuals with T2DM. The material and compositional properties of bone/fingernail were estimated using nanoindentation and Fourier Transform Infrared Spectroscopy, respectively. Both bone/fingernails in T2DM had lower reduced modulus (Er), hardness (H), lower Amide I and Amide II area ratio (protein content), higher sugar-to-matrix ratio, and relatively high carboxymethyl-lysine (CML) content compared with non-diabetic patients. Sugar-to-matrix ratio and relative CML content were strongly and positively correlated with HbA1c for both bone/fingernail. There was a positive correlation between bone and fingernail glycation content. Our findings provide evidence that the degradation pattern of bone and fingernail properties go hand-in-hand in individuals with T2DM. Hence, the fingernail compositional/material properties might serve as a non-invasive surrogate marker of bone quality in T2DM; however, further large-scale studies need to be undertaken.
Is the Future Bright or Bleak? Assessing Past and Future Outlooks Across the Adult Lifespan

An individual’s outlook on society can change over time and can be related to both their physical and mental health. Here, we developed an instrument to measure outlooks on the past and future in relation to the present in 413 adults ranging in age from 18 to 80 years. Exploratory and confirmatory factor analyses were conducted on independent samples and test–retest reliability was assessed in a subset of participants. Construct validity of the two past and future scales was assessed by relating them to 1) pre-existing scales measuring related constructs, and 2) beliefs and safety behaviors during the COVID-19 pandemic. The final Bright or Bleak Scale (BOBS) consists of a past and future scale, each with two factors measuring societal and personal outlooks. Brighter future societal and personal outlooks were positively associated with longer future time perspectives, while self-reporting a higher likelihood of already having contracted COVID-19 was related to bleaker past societal and personal outlooks.
Identification and Analysis of GhEXO Gene Family Indicated That GhEXO7_At Promotes Plant Growth and Development Through Brassinosteroid Signaling in Cotton (Gossypium hirsutum L.)

Brassinosteroids (BRs), an efficient plant endogenous hormone, significantly promotes plant nutrient growth adapting to biological and abiotic adversities. BRs mainly promote plant cell elongation by regulating gene expression patterns. EXORDIUM (EXO) genes have been characterized as the indicators of BR response genes. Cotton, an ancient crop, is of great economic value and its fibers can be made into all kinds of fabrics. However, EXO gene family genes have not been full identified in cotton. 175 EXO genes were identified in nine plant species, of which 39 GhEXO genes in Gossypium hirsutum in our study. A phylogenetic analysis grouped all of the proteins encoded by the EXO genes into five major clades. Sequence identification of conserved amino acid residues among monocotyledonous and dicotyledonous species showed a high level of conservation across the N and C terminal regions. Only 25% the GhEXO genes contain introns besides conserved gene structure and protein motifs distribution. The 39 GhEXO genes were unevenly distributed on the 18 At and Dt sub-genome chromosomes. Most of the GhEXO genes were derived from gene duplication events, while only three genes showed evidence of tandem duplication. Homologous locus relationships showed that 15 GhEXO genes are located on collinear blocks and that all orthologous/paralogous gene pairs had Ka > Ks values, indicating purifying selection pressure. The GhEXO genes showed ubiquitous expression in all eight tested cotton tissues and following exposure to three phytohormones, IAA, GA, and BL. Furthermore, GhEXO7_At was mainly expressed in response to BL treatment, and was predominantly expressed in the fibers. GhEXO7_At was found to be a plasma membrane protein, and its ectopic expression in Arabidopsis mediated BR-regulated plant growth and development with altered expression of DWF4, CPD, KCS1, and EXP5. Additionally, the functions of GhEXO7_At were confirmed by virus-induced gene silencing (VIGS) in cotton. This study will provide important genetic resources for future cotton breeding programs.