Miracle-dz/UniFAR-FTUs huggingface dataset:
"A Critical Examination of Length of Stay in Autologous Breast Reconstruction: A NSQIP Analysis".

BACKGROUND This study aims to use the National Surgical Quality Improvement Program (NSQIP) database to identify factors associated with extended postoperative length of stay (LOS) after breast reconstruction with free tissue transfer (FTT). METHODS Consecutive cases of breast reconstruction with free tissue transfer were retrieved from the NSQIP (2005-2017) database using Current Procedural Terminology (CPT) code 19364. Extended LOS (dependent variable) was defined as > 5 days. RESULTS 9,686 cases were analyzed; extended LOS was noted in 34%. On regression, patient factors independently associated with extended LOS were BMI (OR 1.5, 95% CI 1.2-1.9, p<0.001), diabetes (OR 1.3, 95% CI 1.1-1.6, p=0.003), and malignancy history (OR 1.9, 95% CI 1.22.-3.02, p=0.005). Operation time > 500 minutes (OR 3, 95% CI 2.73-3.28, p<0.001) and immediate postmastectomy reconstruction (OR 1.7, 95% CI 1.16-2.48, p<0.001) conferred risk for extended LOS. Bilateral FTT was not significant. Operations performed in 2017 were at lower risk (OR 0.2, 95% CI 0.06-0.81, p=0.02) for extended LOS. Reoperation is more likely following operative transfusion and bilateral FTTs, but less likely following concurrent alloplasty. Given a known operation time (minutes), postoperative LOS (days) can be calculated using the equation: LOS = 2.559 + 0.003*operation time. CONCLUSION This study characterizes the risks for extended length of stay after free tissue transfer breast reconstruction using a prospective multicenter national database. The result of this study can be used to risk-stratify patients during surgical planning to optimize perioperative decision making.
Empirical Investigation of Ethical Challenges Related to the Use of Biological Therapies

The aim of this study was to investigate the ethical dilemma of prioritising financial resources to expensive biological therapies. For this purpose, the four principles of biomedical ethics formulated by ethicists Tom Beauchamp and James Childress were used as a theoretical framework. Based on arguments of justice, Beauchamp and Childress advocate for a health care system organised in line with the Danish system. Notably, our study was carried out in a Danish setting.
Viability-PCR Allows Monitoring Yeast Population Dynamics in Mixed Fermentations Including Viable but Non-Culturable Yeasts

The use of controlled mixed inocula of Saccharomyces cerevisiae and non-Saccharomyces yeasts is a common practice in winemaking, with Torulaspora delbrueckii, Lachancea thermotolerans and Metschnikowia pulcherrima being the most commonly used non-Saccharomyces species. Although S. cerevisiae is usually the dominant yeast at the end of mixed fermentations, some non-Saccharomyces species are also able to reach the late stages; such species may not grow in culture media, which is a status known as viable but non-culturable (VBNC). Thus, an accurate methodology to properly monitor viable yeast population dynamics during alcoholic fermentation is required to understand microbial interactions and the contribution of each species to the final product. Quantitative PCR (qPCR) has been found to be a good and sensitive method for determining the identity of the cell population, but it cannot distinguish the DNA from living and dead cells, which can overestimate the final population results. To address this shortcoming, viability dyes can be used to avoid the amplification and, therefore, the quantification of DNA from non-viable cells. In this study, we validated the use of PMAxx dye (an optimized version of propidium monoazide (PMA) dye) coupled with qPCR (PMAxx-qPCR), as a tool to monitor the viable population dynamics of the most common yeast species used in wine mixed fermentations (S. cerevisiae, T. delbrueckii, L. thermotolerans and M. pulcherrima), comparing the results with non-dyed qPCR and colony counting on differential medium. Our results showed that the PMAxx-qPCR assay used in this study is a reliable, specific and fast method for quantifying these four yeast species during the alcoholic fermentation process, being able to distinguish between living and dead yeast populations. Moreover, the entry into VBNC status was observed for the first time in L. thermotolerans and S. cerevisiae during alcoholic fermentation. Further studies are needed to unravel which compounds trigger this VBNC state during alcoholic fermentation in these species, which would help to better understand yeast interactions.
Discriminant analysis of the spatial distribution of plant species occurences : II. Distribution of major tree communities in Paraguay

Cet article est le second d'une serie de deux articles decrivant les aspects theoriques et pratiques de la discrimination spatiale des distributions de plusieurs especes sur une zone donnee. Nous presentons ici un cas d'etude pratique utilisant des donnees d'herbier. Nous avons etudie la zonation geographique des especes arborees au Paraguay, afin d'identifier les communautes vegetales et leur organisation spatiale dans ce pays. Des donnees sur la distribution spatiale de ces especes ont ete rassemblees dans les bases de donnees des herbiers de Geneve (Suisse) et de Saint Louis (Missouri, USA). Nous avons choisi de travailler sur les 32 especes les plus communes au Paraguay (especes "ballasts"), pour homogeneiser l'echantillon analyse. Nous avons ensuite utilise une Analyse Discriminante sur Vecteurs Propres du Graphe de Voisinage (ADVPGV) pour identifier les principales structures vegetales rencontrees dans ce pays. Suivant l'echelle adoptee, cette etude souligne que l'ecotone paraguayen est caracterise par plusieurs communautes, et non par un changement continu de la composition de la vegetation. Nous avons mis en lumiere deux types vegetaux principaux au Paraguay, le Chaco et le Parana, eux-memes constitues de plusieurs «sous-structures». A l'extreme ouest du Chaco, une premiere communaute correspond a la flore xeromorphique typique, dont Aspidosperma quebrachoblanco Schitdl. est une espece caracteristique. Le centre du Chaco paraguayen est occupe par une communaute plus psammophile, avec Schinopsis quebracho-colorado (Schitdl.) F. A. Barkley & T. Mey. comme espece arboree dominante. La derniere communaute chaqueenne mise en evidence dans cette etude est formee des forets xeromesophiles du «Chaco humide», caracterisees par des sols temporairement inondes et un climat plus humide. Deux communautes paraneennes ont egalement ete mises en evidence, sur la rive orientale du Rio Paraguay: (i) les forets paraneennes typiques, principalement constituees par des representants de la famille des Lauraceae, et (ii) a l'extreme nord du Paraguay, un melange d'especes paraneennes et d'especes liees aux «cerrados» (especes de savane). Cette mosaique constitue une zone de transition entre les forets paraneennes et les cerrados du Sud-Bresil. Le Chaco et les formations typiques paraneennes sont separes par un autre ecotone caracterise par une diversite tres importante, sur la rive orientale du Rio Paraguay. La relation entre le concept d'echelle et celui d'heterogeneite est un probleme essentiel en phytosociologie. L'accord entre ces resultats et ceux de la litterature constitue un argument fort en faveur de l'utilisation des donnees d'herbiers dans les etudes de biogeographie.
Silage Fermentation, Bacterial Community, and Aerobic Stability of Total Mixed Ration Containing Wet Corn Gluten Feed and Corn Stover Prepared with Different Additives

Simple Summary Wet corn gluten feed (WCGF) is a feed containing high moisture and rapidly digestible, non-forage fiber and protein for dairy cows, that is difficult to preserve. The use of corn stover as roughage by ruminants is limited by its poor digestibility. Total mixed ration (TMR) silage is an ensiling mixed feed that can fully mix forage and concentrate in a specific ratio to satisfy the nutritional needs of dairy cows, which has become an effective method of preservation of high-moisture byproducts. The objective of this study was to investigate the effects of different additives on the fermentation quality, bacterial community, and aerobic stability of TMR silage containing WCGF and corn stover. Inoculation with lactic acid bacteria (LAB) + fibrolytic enzyme (EN) and LAB improved aerobic stability of TMR silages indicated by higher and more stable LA and AA contents, a smaller rise in pH, and yeast count than other silages. Total mixed ration silage inoculated the LAB + EN and LAB can become an effective method of preserving high-moisture WCGF and corn stover with poor digestibility. Abstract The objective of this study was to investigate the effects of different additives on the fermentation quality, bacterial community, and aerobic stability of total mixed ration (TMR) silage containing wet corn gluten feed (WCGF) and corn stover. The TMR was ensiled with four treatments: (1) no additive (control); (2) lactic acid bacteria (LAB); (3) fibrolytic enzyme (EN); (4) LAB + EN. The EN and LAB + EN decreased the neutral detergent fiber and acid detergent fiber contents. Additives led to a higher lactic acid (LA) content (p < 0.0001) compared to control at all ensiling times. Silages inoculated with LAB and LAB + EN had higher dry matter (p = 0.0007), LA (p < 0.0001) and acetic acid (AA) contents (p < 0.0001) compared to control. The LAB and LAB + EN had significantly lowest ammonia nitrogen among the treatments, while no significant difference occurred after days 7 of ensiling. Silages treated with LAB and LAB + EN had a higher LAB count (p < 0.0001) and a lower pH, yeast, and mold counts compared to other silages. The LAB and LAB + EN greatly increased the portions of Firmicutes and Lactobacillus (p < 0.0001, and p < 0.0001, respectively) and reduced undesirable bacteria. Inoculation with LAB + EN and LAB improved aerobic stability of TMR silages indicated by higher and more stable LA and AA contents, smaller rise in pH, and yeast count than other silages. The LAB + EN and LAB reduced microbial diversity and improved the fermentation quality and aerobic stability of TMR silage containing WCGF and corn stover.
Integrating Models of Self-Regulation.

Self-regulation is a core aspect of human functioning that helps facilitate the successful pursuit of personal goals. There has been a proliferation of theories and models describing different aspects of self-regulation both within and outside of psychology. All of these models provide insights about self-regulation, but sometimes they talk past each other, make only shallow contributions, or make contributions that are underappreciated by scholars working in adjacent areas. The purpose of this article is to integrate across the many different models in order to refine the vast literature on self-regulation. To achieve this objective, we first review some of the more prominent models of self-regulation coming from social psychology, personality psychology, and cognitive neuroscience. We then integrate across these models based on four key elements-level of analysis, conflict, emotion, and cognitive functioning-specifically identifying points of convergence but also points of insufficient emphasis. We close with prescriptions for future research. Expected final online publication date for the Annual Review of Psychology, Volume 72 is January 5, 2021. Please see http://www.annualreviews. org/page/journal/pubdates for revised estimates.
Cerebral venous sinus thrombosis associated with spontaneous heparin-induced thrombocytopenia syndrome after total knee arthroplasty

Abstract Spontaneous heparin-induced thrombocytopenia (HIT) syndrome, characterized by clinical and serologic features of HIT despite the absence of proximate heparin exposure, can be triggered by total knee arthroplasty (TKA). A 56-year-old female receiving aspirin thromboprophylaxis post-TKA presented with aphasia and thrombocytopenia on post-operative day 11. Imaging studies revealed cerebral venous sinus thrombosis (CVST) and intravenous bivalirudin was initiated. Her serum tested strong-positive for IgG anti-PF4/polyanion complexes and serotonin-release assay in the presence and absence of heparin; strong-positive IgG-specific chemiluminescent immunoassay; and moderate-positive latex immunoturbidimetric assay. Two 65 g doses of IVIG were administered. With the improvement of her platelet count, she was transitioned from bivalirudin to warfarin. At one-year follow-up, she remained free of recurrent thrombosis and neurologically stable with a normal platelet count. Previous reports of post-TKA spontaneous HIT syndrome include venous/arterial thrombosis and adrenal hemorrhage, and this report of CVST expands the clinical spectrum of this rare complication of orthopedic surgery.
Pharmacological management of dementia with Lewy bodies with a focus on zonisamide for treating parkinsonism

ABSTRACT Introduction Dementia with Lewy bodies (DLB) has no approved symptomatic or disease-modifying treatments in the US and Europe, despite being the second most common cause of neurodegenerative dementia. Areas covered Herein, the authors briefly review the DLB drug development pipeline, providing a summary of the current pharmacological intervention studies. They then focus on the anticonvulsant zonisamide, a benzisoxazole derivative with a sulfonamide group and look at its value for treating parkinsonism in DLB. Expert opinion Several new compounds are being tested in DLB, the most innovative being those aimed at decreasing brain accumulation of α-synuclein. Unfortunately, new drug testing is challenging in terms of consistent diagnostic criteria and lack of reliable biomarkers. Few randomized controlled trials (RCTs) are well-designed, with enough power to detect significant drug effects. Levodopa monotherapy can treat the parkinsonism in DLB, but it can cause agitation or visual hallucination worsening. Two Phase II/III RCTs of DLB patients recently reported a statistically significant improvement in motor function in those receiving zonisamide as an adjunctive treatment to levodopa. New biomarker strategies and validated outcome measures for DLB or prodromal DLB may enhance clinical trial design for the development of specific disease-modifying treatments.
Early lessons from COVID-19 response and shifts in authority: public trust, policy legitimacy and political inclusion

worthy policies. Once the arguments resulting from these principles are arranged, the questions resulting from the principle of solidarity and reciprocity can be addressed: how much burden can be expected from different groups and who ought to be given some leeway? Finally, given the analysis based on the previous principles, the public needs to be informed to enable their autonomous decision-making about, e.g., supporting or protesting the isolation of people in LTCF. Finally, we want to call upon the public health community not to shy away from openly discussing the moral distress. The Covid-19 pandemic causes. We need to collect the stories about the situations where members of the public health community were hindered in doing what was the ethically appropriate action due to circumstances beyond their control, for example, institutionalized impediments. Sharing these stories is necessary first of all to avoid discouragement on both an individual and organizational level. Secondly, it creates insight into what the public health community deems as ‘ethically appropriate actions’. Thirdly, these situations of moral distress are a treasure trove for an evaluation of where and when systems ‘test our humanity’. Conflicts of interest: None declared.
Goal-Oriented Attention Self-Regulation Training Improves Executive Functioning in Veterans with PTSD and Mild TBI.

Difficulties in executive-control functions are common sequelae of both Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD). The goal of this study was to assess whether a cognitive rehabilitation training that was successfully applied in civilian and military TBI would be effective for military Veterans with comorbid PTSD and mild TBI (mTBI). In the prior study, Veterans with history of mild to severe TBI significantly improved after Goal-Oriented Attentional Self-Regulation (GOALS) training on measures of attention/executive function, functional task performance, and emotional regulation. The objective of this study was to assess effects of GOALS training in Veterans with comorbid PTSD and mTBI. Forty Veterans with current PTSD diagnosis and history of mTBI (6+ months post) were randomized to either five weeks of GOALS or Brain-Health Education (BHE) training matched in time and intensity. Evaluator-blinded assessments at baseline and post-training included neuropsychological and complex functional task performance, and self-report measures of emotional functioning/regulation. After GOALS, but not BHE training, participants significantly improved from baseline on primary outcome measures of: Overall Complex Attention/Executive Function neuropsychological performance composite [F = 12.35, p =. 001; Cohen's d = . 48], and Overall Mood Disturbance -POMS emotional regulation self-report [F=4.29, p=. 05, Cohen's d = . 41]. Additionally, GOALS, but not BHE participants indicated significant decrease in PTSD symptoms (PCL-M Total Score) [F=4.80, p=. 05, Cohen's d =. 60], and demonstrated improvement on complex functional task performance -GPS Learning and Memory [F=5.06, p=. 05, Cohen's d =. 56]. Training in attentional self-regulation applied to participant defined goals may improve cognitive functioning in Veterans with comorbid PTSD and mTBI. Improving cognitive control functioning may also improve functioning in other domains such as emotional regulation and functional performance, potentially making it particularly relevant for Veterans with history of mTBI and co-morbid psychiatric symptoms.
Geographical patterns and effects of human and mechanical factors on road traffic crashes in Nigeria

Abstract Road traffic crashes (RTCs) remain an issue of global concern particularly in Nigeria where over 80 percent of these crashes are accounted by human and mechanical factors (HM). Many geographic studies on RTCs, fatality and injury have largely focused on the spatial clustering and associative analysis of risk factors; with little known about the relative contribution of HM factors within the spatial context. Hence, this study applied a spatial approach to the effect of HM factors on RTCs, fatality and injury across the regions of Nigeria. The data for this study were obtained from the National Bureau of Statistics for the year 2017-2019 and were analysed using spatial analysis techniques such as Global Moran’s I and spatial regression model. There was evidence of geographic clustering of RTCs, fatality and injury in Nigeria. On one hand, route violation and sleeping on steering were significant predictors in southern Nigeria while tyre burst was significant at the national level, in the north and rural areas. The use of mobile phone while driving was a significant predictor at the national level. On the other hand, overloading was associated with RTCs and injuries at the national level and northern Nigeria. Speed violation was a prominent risk factor across the country. The study, based on observed regional differentials, argues that extant laws and regulations on traffic safety should be strictly enforced to curtail RTCs in the country.
Melflufen: A Peptide–Drug Conjugate for the Treatment of Multiple Myeloma

Despite the availability of new therapies that have led to improved outcomes for patients with multiple myeloma, most patients will eventually relapse. With triplet and even quadruplet combination therapies becoming standard in the first and second line, many patients will have few treatment options after second-line treatment. Melflufen (melphalan flufenamide) is a first-in-class peptide–drug conjugate (PDC) that targets aminopeptidases and rapidly releases alkylating agents into tumor cells. Once inside the tumor cells, melflufen is hydrolyzed by peptidases to release alkylator molecules, which become entrapped. Melflufen showed anti-myeloma activity in myeloma cells that were resistant to bortezomib and the alkylator melphalan. In early phase studies (O-12-M1 and HORIZON [OP-106]), melflufen plus dexamethasone has demonstrated encouraging clinical activity and a manageable safety profile in heavily pretreated patients with relapsed/refractory multiple myeloma, including those with triple-class refractory disease and extramedullary disease. The Phase III OCEAN study (OP-104) is further evaluating melflufen plus dexamethasone in patients with relapsed/refractory multiple myeloma. The safety profile of melflufen is characterized primarily by clinically manageable hematologic adverse events. Melflufen, with its novel mechanism of action, has the potential to provide clinically meaningful benefits to patients with relapsed/refractory multiple myeloma, including those with high unmet needs.
Patient characteristics and predictors of completion of a pulmonary rehabilitation programme in Auckland, New Zealand.

AIM Chronic respiratory diseases, such as chronic obstructive pulmonary disease, are a worldwide public health problem. Pulmonary rehabilitation is a gold-standard intervention for these diseases, yet attendance and completion rates are poor. Counties Manukau Health, in Auckland, New Zealand, has a high prevalence of chronic respiratory disease and a culturally diverse population, comprising large numbers of Māori and Pacific Island people, who are known to be disproportionately affected by chronic respiratory disease. The aim of this study was to investigate patient characteristics affecting engagement with the Counties Manukau Health pulmonary rehabilitation programme and identify factors predicting completion of the programme. METHODS Investigators performed a retrospective analysis using routinely collected data of 2,756 patients invited to attend the pulmonary rehabilitation programme at Counties Manukau Health. Data were analysed to compare demographic and clinical outcomes of patients who completed, did not complete or did not attend the programme, and identified factors predicting completion. RESULTS Significant differences were found between groups in demographic and clinical characteristics. Increasing age, higher six-minute walk test distance at programme commencement and European ethnicity were significant predictors of completion of the PR programme. CONCLUSIONS Compared to European people, Māori were 52% less likely and Pacific Island people were 40% less likely to complete the programme. These findings are significant for the Counties Manukau Health population. Further work needs to focus on determining how to make programmes more engaging to different cultures and how we can aim to reduce health inequities in these populations.