Miracle-dz/UniFAR-FTUs huggingface dataset:
Burnout within UK surgical specialties: a systematic review.

INTRODUCTION Burnout is of growing concern within the surgical workforce, having been shown to result in reduced job satisfaction, decreased patient satisfaction and higher rates of medical errors. Determining the extent of burnout and identifying its risk factors within UK surgical practice is essential to ensure appropriate interventions can be implemented to improve mental wellbeing. MATERIALS A systematic search of PubMed, Medline, Embase, PsychINFO and Cochrane databases was performed, following PRISMA guidelines. Studies published between January 2000 and October 2019 that reported prevalence data or risk factors on burnout for surgeons working within the UK and/or the Republic of Ireland were included. FINDINGS Ten papers met the inclusion criteria. The overall prevalence of burnout amongst surgeons in the UK was 32.0% (IQR 28.9-41.0%), with surgical trainees having the highest prevalence (59.0%) of burnout documented for any subgroup. The most common risk factors identified for burnout were younger surgeon age and lower clinical grade. Being married or living with a partner was found to be protective. CONCLUSIONS Burnout is highly prevalent in UK surgical specialties, mostly amongst surgical trainees. Targeted pre-emptive interventions based upon relevant risk factors for burnout should be prioritised, at both individual and institutional levels.
Causal mediation of semicompeting risks

The semi‐competing risks problem arises when one is interested in the effect of an exposure or treatment on both intermediate (e.g., having cancer) and primary events (e.g., death) where the intermediate event may be censored by the primary event, but not vice versa. Here we propose a nonparametric approach casting the semi‐competing risks problem in the framework of causal mediation modeling. We set up a mediation model with the intermediate and primary events, respectively as the mediator and the outcome, and define an indirect effect as the effect of the exposure on the primary event mediated by the intermediate event and a direct effect as that not mediated by the intermediate event. A nonparametric estimator with time‐varying weights is proposed for direct and indirect effects where the counting process at time t of the primary event N2n1(t) and its compensator An1(t) are both defined conditional on the status of the intermediate event right before t, N1(t−)=n1 . We show that N2n1(t)−An1(t) is a zero‐mean martingale. Based on this, we further establish theoretical properties for the proposed estimators. Simulation studies are presented to illustrate the finite sample performance of the proposed method. Its advantage in causal interpretation over existing methods is also demonstrated in a hepatitis study.
Temporal dynamics of trematode intermediate snail host environmental DNA in small water body habitats

Abstract Abstract Environmental DNA (eDNA) surveying has potential to become a powerful tool for sustainable parasite control. As trematode parasites require an intermediate snail host that is often aquatic or amphibious to fulfil their lifecycle, water-based eDNA analyses can be used to screen habitats for the presence of snail hosts and identify trematode infection risk areas. The aim of this study was to identify climatic and environmental factors associated with the detection of Galba truncatula eDNA. Fourteen potential G. truncatula habitats on two farms were surveyed over a 9-month period, with eDNA detected using a filter capture, extraction and PCR protocol with data analysed using a generalized estimation equation. The probability of detecting G. truncatula eDNA increased in habitats where snails were visually detected, as temperature increased, and as water pH decreased (P < 0.05). Rainfall was positively associated with eDNA detection in watercourse habitats on farm A, but negatively associated with eDNA detection in watercourse habitats on farm B (P < 0.001), which may be explained by differences in watercourse gradient. This study is the first to identify factors associated with trematode intermediate snail host eDNA detection. These factors should be considered in standardized protocols to evaluate the results of future eDNA surveys.
Perioperative Intravenous Lidocaine Infusion for Post-operative Analgesia in Patients undergoing Surgery of the Spine Systematic Review and Meta-analysis.

OBJECTIVE We conducted a systematic review and meta-analysis to examine the impact of perioperative intravenous lidocaine infusion on pain management scores, opioid consumption, adverse events and hospital length of stay in patients undergoing spinal surgery. METHODS We included randomized controlled trials (RCT's) evaluating the use of perioperative intravenous lidocaine in adult and paediatric patients undergoing spinal surgery. Primary outcomes were post-operative pain scores at rest, at two, four- six, twenty-four and forty-eight hours and adverse events attributable to lidocaine administration. We searched electronic databases from inception to present. We used Cochrane's standard methods. We used a random-effects model to synthetize data. We conducted three subgroup analysis: major versus minor surgery, patients with chronic pain conditions versus patients without, and adult versus paediatric. RESULTS A total of eight studies were included comparing patients having intravenous lidocaine (n = 349) to controls (n = 343). Intravenous lidocaine administration was associated with significantly reduced visual analogue pain scores at two MD= -1.13, four-six MD =-0.79 and twenty-four hours MD= -0.50 post-operatively. In the adults, efficacy of treatment was extended to forty-eight hours MD= -0.72. Perioperative intravenous lidocaine administration was associated with reduced peri-operative opioid consumption at twenty-four and forty-eight as well as decreased hospital length of stay. CONCLUSION Perioperative intravenous lidocaine infusion consistently improves analgesic measures in adult and paediatric population in the first twenty-four hours, with an effective decrease in opioid consumption noted to forty-eight hours. These results are most generalizable in the adult population in the first four-six to twenty four post-operative hours.
Is there a problem with modular dual mobility acetabular components in revision total hip arthroplasty at mid-term follow-up?

AIMS Modular dual mobility (MDM) acetabular components are often used with the aim of reducing the risk of dislocation in revision total hip arthroplasty (THA). There is, however, little information in the literature about its use in this context. The aim of this study, therefore, was to evaluate the outcomes in a cohort of patients in whom MDM components were used at revision THA, with a mean follow-up of more than five years. METHODS Using the database of a single academic centre, 126 revision THAs in 117 patients using a single design of an MDM acetabular component were retrospectively reviewed. A total of 94 revision THAs in 88 patients with a mean follow-up of 5.5 years were included in the study. Survivorship was analyzed with the endpoints of dislocation, reoperation for dislocation, acetabular revision for aseptic loosening, and acetabular revision for any reason. The secondary endpoints were surgical complications and the radiological outcome. RESULTS The overall rate of dislocation was 11%, with a six-year survival of 91%. Reoperation for dislocation was performed in seven patients (7%), with a six-year survival of 94%. The dislocations were early (at a mean of 33 days) in six patients, and late (at a mean of 4.3 years) in four patients. There were three intraprosthetic dissociations. An outer head diameter of ≥ 48 mm was associated with a lower risk of dislocation (p = 0.013). Lumbrosacral fusion was associated with increased dislocation (p = 0.004). Four revision THAs (4%) were further revised for aseptic acetabular loosening, and severe bone loss (Paprosky III) at the time of the initial revision was significantly associated with further revision for aseptic acetabular loosening (p = 0.008). Fourteen acetabular components (15%) were re-revised for infection, and a pre-revision diagnosis of reimplantation after periprosthetic joint infection (PJI) was associated with subsequent PJI (p < 0.001). Two THAs had visible metallic changes on the backside of the cobalt chromium liner. CONCLUSION When using this MDM component in revision THA, at a mean follow-up of 5.5 years, there was a higher rate of dislocation (11%) than previously reported. The size of the outer bearing was related to the risk of dislocation. There was a low rate of aseptic acetabular loosening. Longer follow-up of this MDM component and evaluation of other designs are warranted. Cite this article: Bone Joint J 2021;103-B(7 Supple B):66-72.
Delayed diagnosis of diabetic ketoacidosis and associated mortality during the COVID‐19 pandemic

To the Editor, A recent editorial in the Journal of Diabetes commented on the potentially negative impacts of the coronavirus disease 2019 (COVID-19) pandemic on our healthcare system. Rates of diabetic ketoacidosis (DKA) at type 1 diabetes (T1D) diagnosis have increased during the COVID-19 pandemic. This is likely due to decreased healthcare access during the pandemic vs actual COVID-19 infection as limited access to care is a risk factor for DKA. This notion is also supported by the small minority of new-onset T1D patients with concomitant COVID-19, the knowledge that the development of autoimmunity in T1D precedes presentation by months to years, and the absence of detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) proteins in the endocrine cells of pancreata from people with COVID-19. The Network for Pancreatic Organ Donors with Diabetes (nPOD) is a program developed to procure and study pancreata and other tissues from cadaveric organ donors in different stages of T1D. During the pandemic, nPOD has received two COVID-19 negative donors where the initial presentation of DKA was delayed, resulting in devastating outcomes.
Does Quantitative Sensory Testing Improve Prediction of Chronic Pain Trajectories? A Longitudinal Study of Youth With Functional Abdominal Pain Participating in a Randomized Controlled Trial of Cognitive Behavioral Treatment

Supplemental Digital Content is available in the text. Objectives: Youth with functional abdominal pain (FAP) experience significant pain-related distress and functional impairment. Although quantitative sensory testing protocols have identified alterations in pain modulatory systems that distinguish youth with FAP from healthy controls, the extent to which evoked pain responses predict subsequent trajectories of pain symptoms and disability over and above established psychosocial risk factors is unclear. Methods: The present study included 183 adolescents with FAP who were enrolled in a randomized controlled trial comparing an 8-week, internet-delivered program of cognitive behavior therapy (n=90) or pain education (n=93). Participants completed a quantitative sensory testing protocol before the intervention and were followed for 12-month posttreatment. Results: Whereas adolescents with FAP who exhibited stronger baseline conditioned pain modulation (CPM) reported decreases in pain-related interference over follow-up (b=−0.858, SE=0.396, P=0.032), those with weaker CPM exhibited high, relatively stable levels of pain-related interference over time (b=−0.642, SE=0.400, P=0.110). CPM status predicted changes in pain-related interference after controlling for the effects of treatment condition and psychosocial risk factors. Static measures of pain sensitivity (ie, pain threshold, pain tolerance) and temporal summation of second pain were not associated with changes in measures of abdominal pain, gastrointestinal symptom severity, or pain-related interference over follow-up. Discussion: The present findings contribute to a growing literature on the predictive utility of quantitative sensory testing indices and suggest that CPM may complement existing psychosocial risk measures in determining individualized pain-related risk profiles.
Measurements and observations of movements at work for warehouse forklift truck operators

Inclinometry and video analyses can provide objective measures of physical workloads. The study aim was to measure and observe arm, back and head postures and movements among forklift truck operators (FLTOs) during a working day, analyzing differences between types of forklift trucks and to assess reported workload and health. Twenty-five male FLTOs in a high-level warehouse were randomly included. The data collected comprised technical measurements, video analyses of postures and movements, and a questionnaire measuring health, pain and workload. On average, the FLTOs rotated their head more than 45°, in total, 232 times/h. Video analysis revealed that FLTOs periodically drive the forklift truck sideways with the head rotated in the direction of travel, and in periods look upwards, in which the head is highly rotated and extended. Inclinometry and observations during the working day has the potential to be a valuable part of risk assessment promoting occupational safety and health.
Predictors of negative psychosocial and health behavior impact of COVID-19 among young adults

Abstract Given the global impact of coronavirus disease 2019 (COVID-19) on mental and physical health, we examined young adults’ changes in mental health, intimate relationship quality, alcohol use and weight-related behaviors during COVID-19 and their correlates (depressive symptoms, resilience, social context and COVID-19-related factors). We analyzed data from a longitudinal study of 1082 young adults across six metropolitan areas (Mage = 24.76 ± 4.70; 51.8% female; 73.6% White and 12.5% Hispanic), using multivariate linear regressions for continuous outcomes (magnitude of mental health impact) and logistic regressions for categorical outcomes (decreased relationship quality, physical activity and nutrition and increased alcohol use and sedentary behavior). Of five negative mental health impacts assessed, participants reported experiencing an average of 3.54 (SD = 5.46), experiencing more correlated with increased childcare responsibilities and lower resilience. Additionally, 23.6% of those in relationships experienced negative relationship impact, 41.3% increased alcohol use, 47.2% decreased physical activity, 74.0% were more sedentary and 34.7% experienced poorer nutrition, all of which was predicted by greater depressive symptoms. Additionally, lower resilience predicted negative relationship impact and poorer nutrition and social context/roles correlated with various outcomes (e.g. relationships and alcohol use). Interventions to reduce negative health behaviors given societal stressors should address key psychosocial and situational factors, including depressive symptoms and resilience.
Computational neuronal correlation with enhanced synchronized activity in the basal ganglia and the slowing of thalamic theta and alpha rhythms in Parkinson's disease

The aim of this work is computationally to correlate the synchronized neuronal activity of basal ganglia and slowing in theta and alpha rhythms in electroencephalogram (EEG) signal in thalamic region in case of dopamine depletion and decrease of synaptic connections. The used network topology is a scale‐free network with constant node degree. The dopamine‐modulated type Izikhevich neuron model is used for modeling the striatal region, consisting of fast‐spiking interneurons, D1 and D2 type dopamine expressing medium spiny neurons. On the other hand, the ordinary Izikhevich neuron model is used in the modeling of extrastriatal basal ganglia (BG) regions where globus pallidus (GP) subregion neurons have also dopamine‐dependent parameters. The thalamic region of the network is mass modeled including inhibitory input from basal ganglia. Depending on the decrease of synaptic connections and dopamine level, the synchronization among basal ganglia neuron populations is investigated. The effect of synaptic delay on synchronization is also considered. It is observed that the decrease of dopamine neurotransmitter and decrease in the number of synaptic connections cause an increased synchronous activity in BG. Also, slowing in theta and alpha bands in thalamus EEG signals is observed. This shows the causal relation between synchronization and power shifting to lower frequency components in the case of neurodegenerative diseases such as Parkinson's disease (PD).
Why Does Classroom-Level Victimization Moderate the Association Between Victimization and Depressive Symptoms? The "Healthy Context Paradox" and Two Explanations.

The present longitudinal study examined how and why classroom-level victimization moderates the prospective association between peer victimization and depressive symptoms with 2,643 third- and fourth-graders (Mage = 10.01 years) in China. Multilevel modeling revealed that peer victimization was more strongly associated with increasing depressive symptoms in classrooms with lower classroom-level victimization. Moreover, two mechanisms were identified to explain the moderating effect of classroom-level victimization. First, low classroom-level victimization reduced victimized children's received friendship nominations from peers, thereby leading to increases in depressive affect. Second, low classroom-level victimization affected victimized children's depressive symptoms through damage to their social self-concept. These findings provide support for the "healthy context paradox" in the Chinese culture, and highlight the mechanisms of this phenomenon.
Effectiveness of psychosocial support provided by midwives and family on preventing postpartum depression among first-time adolescent mothers at 3-month follow-up: A randomised controlled trial.

AIMS AND OBJECTIVES To evaluate the effectiveness of a midwife-family provided social support programme (MFPSS programme) for first-time adolescent mothers on preventing postpartum depression (PPD) at 3-month postpartum. BACKGROUND Adolescent mothers with lack of social support are a high-risk group for increasing the development of PPD. Interventions designed to promote social support and provided to mothers following childbirth have a more effective role in preventing PPD. DESIGN The Consolidated Standards of Reporting Trials (CONSORT) guidelines for a single-blinded randomised controlled trial were conducted. METHODS Forty-two adolescent mothers were randomly assigned to 4-week MFPSS programme plus routine care (n = 21) and routine care only (n = 21). PPD was measured using the Edinburgh Postnatal Depression Scale (EPDS), rates and severity at baseline, post-test, 6-week and 3-month postpartum follow-ups. Repeated measures ANOVA and Cohen's d were used to analyse the data. RESULTS At the last follow-up, 20 (95.24%) participants remained in each group. Data were analysed based on 40 adolescent mothers. After the intervention, the mean EPDS scores in the intervention group were significantly lower than the same scores in the control group at post-test, 6-week and 3-month postpartum follow-ups. Similarly, the rates and severity of PPD in the intervention group were also lower than the control group at post-test, 6-week and 3-month postpartum follow-ups. CONCLUSION Psychosocial support interventions designed to incorporate support from midwives and family members is an effective intervention for preventing PPD in first-time adolescent mothers and the preventive effect is sustained for up to 3-month postpartum. RELEVANCE TO CLINICAL PRACTICE Midwives or nurses could apply the MFPSS programme to nursing care for adolescent mothers and family members by adding health information about PPD and promoting social support. CLINICAL TRIAL REGISTRATION The trial was registered with Thai Clinical Trials Registry (TCTR). The trial registration number is TCTR 20190206004.
In vitro and in vivo evaluation of an ionic sensitive in situ gel containing nanotransfersomes for aripiprazole nasal delivery

Abstract In the current study, a composite in-situ gel formulation containing aripiprazole (APZ) loaded transfersomes (TFS) was developed for the intranasal brain targeting of APZ. APZ loaded TFS were prepared by applying the film hydration method and optimized using an irregular factorial design. The prepared formulations were optimized based on different parameters including particle size, polydispersity index (PdI), zeta potential, encapsulation efficiency (EE) and release efficiency (RE). The optimized APZ-TFS were distributed in an ion-triggered deacetylated gellan gum solution (APZ-TFS-Gel) and evaluated in terms of pH, gelling time, rheological properties and in-vitro release study. The therapeutic efficacy of the best APZ-TFS-Gel was then tested in the mice model of schizophrenia induced by ketamine by evaluating various behavioral parameters. The optimized formulation showed the particle size of 72.12 ± 0.72 nm, the PdI of 0.19 ± 0.07, the zeta potential of −55.56 ± 1.9 mV, the EE of 97.06 ± 0.10%, and the RE of 70.84 ± 1.54%. The in-vivo results showed that compared with the other treatment groups, there was a considerable increase in swimming and climbing time and a decrease in locomotors activity and immobility time in the group receiving APZ-TFS-Gel. Thus, APZ-TFS-Gel was found to have desirable characteristics for therapeutic improvement. Graphical Abstract
Effectiveness of Evidence-Based Telecoaching Delivered Through an Employer-Sponsored Mental Health Benefits Platform

Introduction: Coaches delivering telemental health services as part of an employer-sponsored benefit may increase access to affordable and effective care. We examined the effectiveness of evidence-based telecoaching delivered via videoconferencing to people requesting mental health services during the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: We analyzed data from 1,228 employees (mean age = 35 ± 8 years; 67.2% female) who utilized telecoaching through the Modern Health benefits platform between March 11, 2020 and March 11, 2021. We used paired samples t tests to examine changes in well-being, burnout, absenteeism, and presenteeism before and after telecoaching and moderated regressions to test whether these changes depended on visit utilization. We analyzed rates of clinical improvement for well-being and reduction from entry in symptoms for burnout. We conducted analyses in the full sample and participants presenting with elevated symptoms at baseline. Results: Participants utilized an average of 2.6 visits. Well-being (p = 0.02) significantly increased, while both presenteeism (p < 0.001) and absenteeism (p < 0.001) significantly decreased at follow-up in our full sample, but represented negligible effect sizes. Burnout was not found to have significantly changed at follow-up in our full sample (p = 0.69). In participants beginning care with elevated depressive-related symptoms, well-being significantly increased (p < 0.001) and 46.3% experienced a clinically relevant improvement. In participants beginning care with elevated levels of burnout, burnout significantly decreased (p < 0.001) and 20.9% experienced a reduction in symptoms from entry. Conclusions: Leveraging videoconferencing, telecoaching had positive effects on mental health and workplace outcomes, even during the COVID-19 pandemic. Evidence-based telecoaching represents a promising option for achieving optimal outcomes in people who need mental health services.
Cysteine cross-linking in native membranes establishes the transmembrane architecture of Ire1

The ER is a hotspot of lipid biosynthesis and crucial for the folding of membrane and secretory proteins. The unfolded protein response (UPR) controls the size and folding capacity of the ER. The conserved UPR transducer Ire1 senses both unfolded proteins and aberrant lipid compositions to mount adaptive responses. Using a biochemical assay to study Ire1 in signaling-active clusters, Väth et al. provide evidence that the neighboring transmembrane helices of clustered Ire1 form an X irrespectively of the primary cause of ER stress. Hence, different forms of ER stress converge in a common, signaling-active transmembrane architecture of Ire1.