Miracle-dz/UniFAR-FTUs huggingface dataset:
Clozapine Combination and Augmentation Strategies in Patients With Schizophrenia -Recommendations From an International Expert Survey Among the Treatment Response and Resistance in Psychosis (TRRIP) Working Group.

BACKGROUND Evidence for the management of inadequate clinical response to clozapine in treatment-resistant schizophrenia is sparse. Accordingly, an international initiative was undertaken with the aim of developing consensus recommendations for treatment strategies for clozapine-refractory patients with schizophrenia. METHODS We conducted an online survey among members of the Treatment Response and Resistance in Psychosis (TRRIP) working group. An agreement threshold of ≥75% (responses "agree" + "strongly agree") was set to define a first-round consensus. Questions achieving agreement or disagreement proportions of >50% in the first round, were re-presented to develop second-round final consensus recommendations. RESULTS Forty-four (first round) and 49 (second round) of 63 TRRIP members participated. Expert recommendations at ≥75% agreement included raising clozapine plasma levels to ≥350 ng/ml for refractory positive, negative, and mixed symptoms. Where plasma level-guided dose escalation was ineffective for persistent positive symptoms, waiting for a delayed response was recommended. For clozapine-refractory positive symptoms, combination with a second antipsychotic (amisulpride and oral aripiprazole) and augmentation with ECT achieved consensus. For negative symptoms, waiting for a delayed response was recommended, and as an intervention for clozapine-refractory negative symptoms, clozapine augmentation with an antidepressant reached consensus. For clozapine-refractory suicidality, augmentation with antidepressants or mood-stabilizers, and ECT met consensus criteria. For clozapine-refractory aggression, augmentation with a mood-stabilizer or antipsychotic medication achieved consensus. Generally, cognitive-behavioral therapy and psychosocial interventions reached consensus. CONCLUSIONS Given the limited evidence from randomized trials of treatment strategies for clozapine-resistant schizophrenia (CRS), this consensus-based series of recommendations provides a framework for decision making to manage this challenging clinical situation.
Ultrasound‐guided serratus anterior plane block combined with parasternal block in subcutaneous implantable cardioverter defibrillator implantation: Results of a pilot study

The standard approach to subcutaneous defibrillator (S‐ICD) implantation often requires general anesthesia or anesthesiologist‐delivered deep sedation. Ultrasound‐guided serratus anterior plane block (SAPB) combined with parasternal block (PSB) has been proposed in order to provide anesthesia/analgesia and to reduce the need for sedation during S‐ICD implantation. In this pilot study, we compared the double‐block approach (SAPB + PSB) with the single‐block approach (SAPB only) and with the standard approach involving local anesthesia and sedation.
Bacterial disease of coriander

SUMMARY A Pseudomonas sp. , which on serological and biochemical characters falls in Pseudomonas Group IA (similar to P. syringae van Hall), infected the inflorescences and caused seed decay of coriander in Britain. The pathogen was seed transmitted. Seed infection was reduced by slurry treatments with the antibiotics streptomycin at 2–5 g/kg seed or kasugamycin at 0–25 g/kg seed.
Assignment of the Y17 Locus to Classical Soybean Linkage Group 14

The classical genetic map of soybean [Glycine max (L.) Merr. ] remains at a primitive stage of development relative to the maps of other crops. This study was undertaken to augment the information base needed for a more comprehensive classical map. The cultivar Minsoy, which carries the dominant allele Pb that conditions a sharp pubescence tip, was crossed to the genetic type T162, which carries the recessive allele y17 that conditions chlorotic foliage. The F2 seedlings were classified for sharp vs. blunt pubescence tip and green vs. chlorotic foliage. The chi-square for linkage partitioned from the total chi-square was significant and a recombination value of 27% was calculated for the y17 and Pb loci. Because a recombination value of 27% had previously been reported for Pb and the y9 gene, which also conditions foliar chlorosis, an allelism test was conducted to test for the allelism of y1 7 and y9 by hybridizing genetic type T135, which carries the recessive allele y9, with T162, which carries the recessive allele y17. The F1 hybrids had normal green foliage indicating that y17 and y9 were separate loci. To determine whether y9 and y17 were on the same side or opposite sides of the Pb locus, the F2 of the T135 × T162 cross was tested with chi-square for fit to a 9:7 ratio or a 1:1 ratio for green:chlorotic foliage. The F2 segregation data fit the 1:1 ratio indicating that the Y17 and Y9 loci were both on the same side of the Pb locus and in close proximity.
Ramipril pretreatment worsened renal injury and survival despite a reduction in renal inflammation in experimentally induced sepsis in mice

Introduction: The angiotensin converting enzyme inhibitor ramipril is a standard antihypertensive therapy for many patients. Because angiotensin II may promote inflammation, we were interested in whether basal pretreatment with ramipril may modify renal function and inflammation as well as systemic outcome in experimentally induced sepsis in mice. Material and methods: Ramipril (10 mg/kg/day) pretreatment or placebo (NaCl) was given intraperitoneally for 5 days to C57BL6/J mice, followed by either sham operation or cecal ligation and puncture sepsis induction. Real-time polymerase chain reaction and immunological stains were used to evaluate renal gene and protein expression, respectively. Plasma creatinine, neutrophil-gelatinase associated lipocalin, and blood urea nitrogen were used as markers for renal function. A clinical severity score was determined. Results: Administration of ramipril before cecal ligation and puncture surgery was associated with reduced renal inflammation but did not improved renal function and structure and even worsened the clinical status of septic mice. Conclusions: The data suggest that the effects of ramipril pretreatment are complex. Additional studies including monitoring of hemodynamic parameters are necessary to elucidate the exact mechanism(s) of this observation. In addition, the timing of the ramipril administration could be of importance.
Objective Structured Clinical Examination: From Exam Room to Zoom Breakout Room.

Objective Structured Clinical Examinations (OSCEs) in United States Medical Schools traditionally involve students interviewing and examining standardized patients (SP) in clinical skills labs. Our medical students complete 2-station OSCEs at the end of each clerkship. We suspended in-person curricular activities during the COVID-19 pandemic. Our dilemma: administer OSCEs upon return to in-person curriculum, release final grades without OSCEs, or convert to remote OSCEs.
The pedigree analysis and prenatal diagnosis of Hong Kongαα Thalassemia and the sequence analysis of Hong Kongαα Allele

Thalassemia is one of the most common monogenic hemolytic disorders in the world. Hong Kongαα (HKαα) thalassemia was initially found among the people of southern China. Because of the complexity of genetic changes in HKαα thalassemia, we lack a precise sequence analysis of the HKαα allele. Here we aim to detect the specific genotype and trace the law of inheritance of this rare genotype.
Altered spontaneous activity and effective connectivity of the anterior cingulate cortex in obsessive–compulsive disorder

Obsessive–compulsive disorder (OCD) is a disabling neuropsychiatric disorder whose neurobiological basis remains unclear. Magnetic resonance imaging (MRI) studies have reported functional and structural alterations of the anterior cingulate cortex (ACC) in OCD. In this study, we explored the functional activity of subregions of the ACC and effective connectivity (EC) between ACC subregions and the whole brain in OCD. We used a Granger causality analysis (GCA) to identify the direction of information flow and whether the impact of that flow was excitatory or inhibitory. We performed resting‐state functional MRI in 31 patients with OCD and 36 healthy controls and analyzed the amplitude of low‐frequency fluctuation (ALFF) and coefficient‐based GCA. The left pregenual ACC (pACC) in patients with OCD showed decreased ALFF relative to controls. There was significantly decreased excitatory output from the left pACC to both right dorsal superior frontal gyrus (dSFG) and left precuneus in patients compared with controls. Patients also had decreased inhibitory input to left pACC from left ventral SFG and left thalamus and caudate relative to controls. Results were similar in drug‐naive patients and those with prior but not current psychopharmacological treatment. In patients, path coefficients of GCA from left pACC to right dSFG showed significant negative correlations with obsession and anxiety ratings. Decreased spontaneous neural activity and altered EC of pACC with widely distributed cortical circuitry, and associations with clinical ratings highlight the importance of pACC functional alteration in OCD.
Vertical behavior of bigeye tuna (Thunnus obesus) in the northwestern Pacific Ocean based on archival tag data

The behavior of bigeye tuna (Thunnus obesus) in the northwestern Pacific Ocean was investigated using archival tag data for 28 fish [49–72 cm fork length (FL) at release, 3–503 days] released in Japanese waters around the Nansei Islands (24–29°N, 122–132°E) and east of central Honshu (Offshore central Honshu, 32–36°N, 142–148°E). Vertical behavior was classified into three types based on past studies: ‘characteristic’ (non-associative), ‘associative’ (associated with floating objects) and ‘other’ (behavior not fitting into these two categories). The proportion of fish showing associative behavior decreased and that of characteristic behavior increased as fish grew, and this shift was pronounced at 60–70 cm FL. The fish usually stayed above the 20°C isotherm during the daytime and nighttime when showing associative behavior and below the 20°C isotherm during daytime for characteristic behavior. A higher proportion of characteristic behavior was seen between December and April around the Nansei Islands, and between September and December for offshore central Honshu. Seasonal changes in vertical position were also observed in conjunction with changes in water temperature. In this study, ‘other’ behavior was further classified into five types, of which ‘afternoon dive’ behavior, characterized by deep dives between around noon and evening, was the most frequent. The present study indicated that in the northwestern Pacific Ocean, the vertical behavior of bigeye tuna changes with size, as well as between seasons and regions.
Nivolumab resulting in persistently elevated troponin levels despite clinical remission of myocarditis and myositis in a patient with malignant pleural mesothelioma: case report

Malignant pleural mesothelioma (MPM) remains a deadly disease with limited therapeutic options beyond platinum/pemetrexed chemotherapy. Immune checkpoint inhibitors have demonstrated modest benefit in the second to later-line settings. An MPM patient from our institute developed myocarditis and myositis after 2 cycles of second-line nivolumab. Despite immunosuppression with corticosteroids and mycophenolate mofetil, there was ongoing rise in troponin levels which remained elevated for months. The patient developed an impressive but brief response following cessation of nivolumab. Myocarditis and myositis are rare complications of immune checkpoint inhibitors. Clinicians should be aware of these possible complications as myocarditis can result in mortality.
Dietary intake and processes of behaviour change in a nutrition education intervention for pregnant women in rural Malawi: a cluster-randomised controlled trial

Abstract Objective: To examine if increased intake of locally available nutrient-dense foods among pregnant women improved the quality of their dietary intake and if use of the Theory of Planned Behaviour could explain changes in their dietary behaviour. Design: We used data from a randomised controlled trial where the intervention group received nutrition education and dietary counselling. We promoted the use of recipes that utilised powders to enhance dietary diversity. We examined how the intervention achieved changes in dietary intakes and used mixed effects logistic regression models with random effects at village level to explore changes over time of the outcomes, adjusted for selected explanatory variables. Setting: The study was conducted in twenty villages in rural Malawi. Participants: Data from 257 pregnant women who were enrolled during late first trimester and followed until birth. Results: The intervention achieved improvements in the Dietary Diversity Score (DDS) and the Six Food Group Pyramid (SFG) score, especially in intakes of micronutrient-rich foods. A third of the women in the intervention group attained optimal DDS, whereas about 50 % attained optimal SFG. The theorised behaviour mediators (i.e. nutrition attitudes, nutrition behaviour control and subjective norm) that had improved were also significantly associated with high DDS. Conclusions: Improved dietary intakes were achieved through promoting the use of locally available nutrient-dense foods. Attainment of high DDS was a consequence of the women’s belief in the effectiveness of the proposed nutrition recommendations. We identified critical personal and environmental constraints related to dietary intakes during pregnancy in a low-resource setting.
Clinical outcome of coronavirus disease 2019 in haemato‐oncology patients

Since being identified in China in December 2019, coronavirus disease 2019 (Covid-19) has rapidly evolved into a global pandemic with over 4 million cases and more than 270,000 deaths. (1) Following the first reported cases in the United Kingdom (UK) in late January 2020, numbers have continued to rise with 223,060 cases and 32,065 deaths reported as of 11th May 2020. (2) Initial reports from China have indicated that Covid-19 has an overall mortality rate of 1.4%. However, the prognosis varies widely between groups, with age over 60 years and underlying conditions including hypertension, diabetes, cardiovascular disease and cancer identified as risk factors for severe disease and death. (3) The initial reports from China show that patients with cancer are over-represented among individuals who develop severe Covid-19 after contracting the virus. (4) Patients with haematological malignancies are expected to be at increased risk of adverse outcomes from this viral infection, due being immunosuppressed as a consequence of the underlying cancer, and from the effects of therapy.
The morphology and affinities of Geranium sections Lucida and Unguiculata

Descriptions of the external morphology of six species of Geranium are presented to match those published by the author previously for the six species of the related sections Anemonifolia and Ruberta. It is proposed to merge Anemonifolia with Ruberta and to re-define sections Lucida and Unguiculata, the first containing G. lucidum, G. glaberrimum and G. lasiopus, and the second G. macrorrhizum and G. dalmaticum, while G. cataractarum is placed in Ruberta. G. lasiopus is a plant of vertical and overhanging cliffs and has adaptations to keep the seeds within the habitat, whereas G. glaberrimum, from the same area of Turkey, occurs on step-crevice and lacks these arrangements. For the species covered earlier, additional notes are provided for most, including reports on variation in G. robertianum in England, Taiwan and China. Attention is drawn to the informal term tangle-strands for bundles of long clinging hairs borne by dormant stages of some plants and animals. Scanning electron micrographs of the mericarp surface of all 12 species and a list of specimen citations of interspecific hybrids are presented. © 2004 The Linnean Society of London, Botanical Journal of the Linnean Society, 2004, 144, 409–429.
Assessing Self-Reported Competence Among Registered Nurses Working as a Culturally Diverse Work Force in Public Hospitals in the Kingdom of Saudi Arabia

Introduction: Nurses in the Kingdom of Saudi Arabia (KSA) represent a multicultural workforce who are educated in different countries from around the world. The purpose was to assess professional competence among a multicultural workforce of registered nurses in KSA in relation to individual and work-related factors. Method: The Nurse Professional Competence Scale was used in a cross-sectional design. Results: Registered nurses (N = 541) reported highest scores for “nursing care,” and “value-based nursing care,” and lowest scores for “care pedagogics,” and “development, leadership, and organization of nursing care. ” All CAs achieved 0.80 or more Cronbach’s alpha. Known-group validity was verified by comparing nurse managers and staff nurses competence in organization, administration, and leadership of nursing care (p = .000). Discussion: There is room for competence development in care pedagogics, and development, leadership, and organization of nursing care. Assessing registered nurses competence is of importance for planning and implementing cultural congruent nursing care.
The Effect of Leaf-Pruning on Nutrient Intake and In Vivo Digestibility of Soybean Stovers by Sheep

ABSTRACT Nutrients of soybean stovers (SBS) from three soybean varieties: TGx 923-2E (SBS1), TGx 1660–19F (SBS2) and TGx 1019–2EN (SBS3) whole plant (WP) and leaf-pruned stem (LPS) were compared, and these SBS (WP and LPS) were offered to West African dwarf sheep to measure voluntary dry matter (DM) intake (VDMI) and apparent crude protein (CP) and cell wall constituent digestibility coefficients. Average DM, CP, ash and cell wall phenolics concentrations in WP were higher than in LPS by 1.53, 33.65, 1.47 and 96.15%, respectively. In contrast, average NDF, ADF, ADL, cellulose and hemicellulose concentrations of LPS were higher than in WP by 1.73, 1.87, 2.93, 1.19 and 1.44%, respectively. Daily DM intake by sheep fed SBS2 (WP; 36.2 g kg BW) was lower (P < 0.05) than other tested stovers with a similar (P >: 0.05) average intake value of 41.8 kg BW0.75. Corresponding (P > 0.05) average daily CP intake by sheep fed SBS1, SBS2 and SBS3 (WP; 5.1 g kg BW0.75) was higher (P < 0.05) than the CP intake of sheep fed SBS1, SBS2 and SBS3 (LPS). Neutral detergent fibre digestibility values of 3 SBS (WP) and N-retention coefficient of 3 SBS (WP) were significantly (P < 0.05) higher than the values obtained from the 3 SBS (LPS). It is concluded that leaf-pruning has no significant beneficial effect on the feeding of soybean stovers to sheep.
Desorbed terpenes and sesquiterpenes from forages and cheeses

The composition and sensory characteristics of matured cheeses are controlled by a number of factors, among which the type of feed is important. The influence of feeding can be reflected by the presence in cheeses of terpenes and sesquiterpenes, compounds typically indicating their vegetable origin (Mariaca et al. 1997). Indeed, several investigators have already established that these compounds could characterize the forage even to a specific geographical location. Dumont & Adda (1978), Dumont et al. (1981), Guichard et al. (1987), Bosset et al. (1994) and Moio et al. (1996) were thus able to distinguish cheeses from lowland and upland regions. In most of these studies, the conditions under which milk was produced and processed were not completely controlled. Furthermore, all these studies analysed only the volatile fraction of cheeses and did not examine the volatile compounds in the forages used. Recently Bosset et al. (1994), in one part of the project described by Jeangros et al. (1997), showed that highland grass with a highly diversified botanical composition produces milk and cheeses with significantly different chemical compositions from those from lowland grass. To improve our understanding of the relationship between animal feed and cheese composition, we have investigated under controlled experimental conditions both the composition of the terpene and sesquiterpene fractions of four forages with different botanical diversities and the influence of those forages on the terpene fraction of cheeses.
Non-walled spherical Acinetobacter baumannii is an important type of persister upon β-lactam antibiotic treatment

ABSTRACT Bacterial persistence is one of the major causes of antibiotic treatment failure and the step stone for antibiotic resistance. However, the mechanism by which persisters arise has not been well understood. Maintaining a dormant state to prevent antibiotics from taking effect is believed to be the fundamental mechanistic basis, and persisters normally maintain an intact cellular structure. Here we examined the morphologies of persisters in Acinetobacter baumannii survived from the treatment by three major classes of antibiotics (i.e. β-lactam, aminoglycoside, and fluoroquinolone) with microcopy and found that a fraction of enlarged spherical bacteria constitutes a major sub-population of bacterial survivors from β-lactam antibiotic treatment, whereas survivors from the treatment of aminoglycoside and fluoroquinolone were less changed morphologically. Further studies showed that these spherical bacteria had completely lost their cell wall structures but could survive without any osmoprotective reagent. The spherical bacteria were not the viable-but-non-culturable cells and they could revive upon the removal of β-lactam antibiotics. Importantly, these non-walled spherical bacteria also persisted during antibiotic therapy in vivo using Galleria mellonella as the infection model. Additionally, the combinational treatment on A. baumannii by β-lactam and membrane-targeting antibiotic significantly enhanced the killing efficacy. Our results indicate that in addition to the dormant, structure intact persisters, the non-wall spherical bacterium is another important type of persister in A. baumannii. The finding suggests that targeting the bacterial cell membrane during β-lactam chemotherapy could enhance therapeutic efficacy on A. baumannii infection, which might also help to reduce the resistance development of A. baumannii.
Coldzyme® Mouth Spray reduces duration of upper respiratory tract infection symptoms in endurance athletes under free living conditions

Abstract Upper respiratory tract infection (URTI) can compromise athlete preparation and performance, so countermeasures are desirable. The aim of this study was to assess the effects of ColdZyme® Mouth Spray (ColdZyme) on self-reported upper respiratory tract infection in competitive endurance athletes under free-living conditions. One hundred and twenty-three endurance-trained, competitive athletes (recruited across 4 sites in England, UK) were randomised to control (no treatment, n = 61) or ColdZyme (n = 62) for a 3-month study period (between December 2017 and March 2018; or December 2018 and April 2019). They recorded daily training and illness symptoms (Jackson common cold questionnaire) during the study period. A total of 130 illness episodes were reported during the study with no difference in incidence between groups (episodes per person: 1.1 ± 0.9 Control, 1.0 ± 0.8 ColdZyme, P = 0.290). Episode duration was significantly shorter in ColdZyme compared to Control: Control 10.4 ± 8.5 days vs. ColdZyme 7.7 ± 4.0 days, P = 0.016). Further analysis to compare episodes with poor vs. good compliance with ColdZyme instructions for use (IFU) within the ColdZyme group showed a greater reduction in duration of URTI when compliance was good (9.3 ± 4.5 days in ColdZyme poor IFU compliance vs. 6.9 ± 3.5 days in ColdZyme good IFU compliance, P = 0.040). ColdZyme may be an effective countermeasure to reduce URTI duration, which was significantly lower (by 26-34%) in the ColdZyme treatment group (with no influence on incidence). This may have implications for athlete performance.