Miracle-dz/UniFAR-FTUs huggingface dataset:
A theory-based meta-regression of factors influencing clinical decision support adoption and implementation

OBJECTIVE The purpose of the study was to explore the theoretical underpinnings of effective clinical decision support (CDS) factors using the comparative effectiveness results. MATERIALS AND METHODS We leveraged search results from a previous systematic literature review and updated the search to screen articles published from January 2017 to January 2020. We included randomized controlled trials and cluster randomized controlled trials that compared a CDS intervention with and without specific factors. We used random effects meta-regression procedures to analyze clinician behavior for the aggregate effects. The theoretical model was the Unified Theory of Acceptance and Use of Technology (UTAUT) model with motivational control. RESULTS Thirty-four studies were included. The meta-regression models identified the importance of effort expectancy (estimated coefficient = -0.162; P = .0003); facilitating conditions (estimated coefficient = 0.094; P = .013); and performance expectancy with motivational control (estimated coefficient = 1.029; P = .022). Each of these factors created a significant impact on clinician behavior. The meta-regression model with the multivariate analysis explained a large amount of the heterogeneity across studies (R2 = 88.32%). DISCUSSION Three positive factors were identified: low effort to use, low controllability, and providing more infrastructure and implementation strategies to support the CDS. The multivariate analysis suggests that passive CDS could be effective if users believe the CDS is useful and/or social expectations to use the CDS intervention exist. CONCLUSIONS Overall, a modified UTAUT model that includes motivational control is an appropriate model to understand psychological factors associated with CDS effectiveness and to guide CDS design, implementation, and optimization.
SUMOylation of RepoMan during late telophase regulates dephosphorylation of lamin A

ABSTRACT Dephosphorylation of lamin A, which triggers nuclear lamina reconstitution, is crucial for the completion of mitosis. However, the specific phosphatase and regulatory mechanism that allow timely lamin A dephosphorylation remain unclear. Here, we report that RepoMan (also known as CDCA2), a regulatory subunit of protein phosphatase 1γ (PP1γ) is transiently modified with SUMO-2 at K762 during late telophase. SUMOylation of RepoMan markedly enhanced its binding affinity with lamin A. Moreover, SUMOylated RepoMan contributes to lamin A recruitment to telophase chromosomes and dephosphorylation of the mitotic lamin A phosphorylation. Expression of a SUMO-2 mutant that has a defective interaction with the SUMO-interacting motif (SIM) resulted in failure of the lamin A and RepoMan association, along with abrogation of lamin A dephosphorylation and subsequent nuclear lamina formation. These findings strongly suggest that RepoMan recruits lamin A through SUMO–SIM interaction. Thus, transient SUMOylation of RepoMan plays an important role in the spatiotemporal regulation of lamin A dephosphorylation and the subsequent nuclear lamina formation at the end of mitosis.
A Systematic Review and Pooled Prevalence of Delirium in Critically Ill Children*

Supplemental Digital Content is available in the text. OBJECTIVES: Pediatric delirium is a neuropsychiatric disorder with disrupted cerebral functioning due to underlying disease and/or critical care treatment. Pediatric delirium can be classified as hypoactive, hyperactive, and mixed. This systematic review was conducted to estimate the pooled prevalence of pediatric delirium using validated assessment tools in children (Cornell Assessment of Pediatric Delirium, Pediatric Confusion Assessment Method for the ICU, PreSchool Confusion Assessment Method for the ICU, Pediatric Confusion Assessment Method for the ICU Severity Scale, and Sophia Observation Withdrawal Symptoms Pediatric Delirium scale), identify modifiable and nonmodifiable risk factors, and explore the association of pediatric delirium with clinical outcomes. Data Sources: A systematic search of PubMed, EMBASE, and CINAHL databases was undertaken for full articles pertaining to pediatric delirium prevalence. Study Selection: No language or date barriers were set. Studies were included where the following eligibility criteria were met: study design aimed to estimate pediatric delirium prevalence arising from treatment in the intensive care setting, using a validated tool. Only randomized controlled trials, cross-sectional studies, or cohort studies allowing an estimate of the prevalence of pediatric delirium were included. Data Extraction: Data were extracted by the primary researcher (D.S.) and accuracy checked by coauthors. Data Synthesis: A narrative synthesis and pooled prevalence meta-analysis were undertaken. CONCLUSIONS: Pediatric delirium, as determined by the Cornell Assessment of Pediatric Delirium score, is estimated to occur in 34% of critical care admissions. Eight of 11 studies reporting on subtype identified hypoactive delirium as most prevalent (46–81%) with each of the three remaining reporting either hyperactive (44%), mixed (57%), or equal percentages of hypoactive and mixed delirium (43%) as most prevalent. The development of pediatric delirium is associated with cumulative doses of benzodiazepines, opioids, the number of sedative classes used, deep sedation, and cardiothoracic surgery. Increased time mechanically ventilated, length of stay, mortality, healthcare costs, and associations with decreased quality of life after discharge were also found. Multi-institutional and longitudinal studies are required to better determine the natural history, true prevalence, long-term outcomes, management strategies, and financial implications of pediatric delirium.
Hepatitis E virus RNA‐dependent RNA polymerase is involved in RNA replication and infectious particle production

Hepatitis E virus (HEV) is one of the most common causes of acute hepatitis worldwide. Its positive‐strand RNA genome encodes three open reading frames (ORF). ORF1 is translated into a large protein composed of multiple domains and is known as the viral replicase. The RNA‐dependent RNA polymerase (RDRP) domain is responsible for the synthesis of viral RNA.
Biochemical insights into Paf1 complex–induced stimulation of Rad6/Bre1-mediated H2B monoubiquitination

Significance PAF1C is a highly conserved multiprotein complex composed of five core subunits (Paf1, Leo1, Ctr9, Cdc73, and Rtf1) and is required for Rad6/Bre1-mediated H2B monoubiquitination (H2Bub). This study involves a mechanistic analysis of the contributions of the PAF1C subunits to H2Bub. The results from an established in vitro ubiquitination assay clearly suggest that PAF1C might stimulate H2Bub through multivalent interactions with Rad6 and nucleosomal substrates to facilitate ubiquitin transfer and indicate that intact PAF1C is required to efficiently stimulate Rad6/Bre1-mediated H2Bub. The highly conserved multifunctional polymerase-associated factor 1 (Paf1) complex (PAF1C), composed of five core subunits Paf1, Leo1, Ctr9, Cdc73, and Rtf1, participates in all stages of transcription and is required for the Rad6/Bre1-mediated monoubiquitination of histone H2B (H2Bub). However, the molecular mechanisms underlying the contributions of the PAF1C subunits to H2Bub are not fully understood. Here, we report that Ctr9, acting as a hub, interacts with the carboxyl-terminal acidic tail of Rad6, which is required for PAF1C-induced stimulation of H2Bub. Importantly, we found that the Ras-like domain of Cdc73 has the potential to accelerate ubiquitin discharge from Rad6 and thus facilitates H2Bub, a process that might be conserved from yeast to humans. Moreover, we found that Rtf1 HMD stimulates H2Bub, probably through accelerating ubiquitin discharge from Rad6 alone or in cooperation with Cdc73 and Bre1, and that the Paf1/Leo1 heterodimer in PAF1C specifically recognizes the histone H3 tail of nucleosomal substrates, stimulating H2Bub. Collectively, our biochemical results indicate that intact PAF1C is required to efficiently stimulate Rad6/Bre1-mediated H2Bub.
Histological and Ultrastructural Study on the Effect of Celery Juice on Ethylene Glycol Induced Urolithiasis in Male Albino Rats

Renal stones is the third prevalent problem in urinary system, affecting mankind for centuries. The present study was designed to find out the effect of celery juice on ethylene glycol (EG) induced urolithiasis in male albino rats from histological and ultrastructural points of view. Twenty one rats were divided into three groups randomly. The first group represented control group which received normal diet only. The other two groups were received 0.75% Ethylene glycol in drinking water ad libitum . The second group represented the calcium oxalate crystal model. The third group was received 0.3 ml celery juice by gavage. The investigation was conducted for four weeks. Histological and ultrastructral investigations of model group have shown numerous crystal deposition in kidney tubules in addition to inflammatory cells, kidney tubules and glomerulus injury, dilation of capillaries, podocytes destruction, mitochondrial swelling and cell death. Both Light and electron microscopy examination of rat kidneys belong to third group showed obvious protective effect by celery juice when compared to model group: few numbers of crystals deposited, renal tubules and glomeruli have appeared approximately normal and healthy but some blood capillaries dilation and mitochondrial swelling were still seen.
West Nile Virus and Other Domestic Nationally Notifiable Arboviral Diseases — United States, 2019

Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the United States (1). Other arboviruses, including La Crosse, Jamestown Canyon, Powassan, eastern equine encephalitis, and St. Louis encephalitis viruses, cause sporadic disease and occasional outbreaks. This report summarizes surveillance data for nationally notifiable domestic arboviruses reported to CDC for 2019. For 2019, 47 states and the District of Columbia (DC) reported 1,173 cases of domestic arboviral disease, including 971 (83%) WNV disease cases. Among the WNV disease cases, 633 (65%) were classified as neuroinvasive disease, for a national incidence of 0.19 cases per 100,000 population, 53% lower than the median annual incidence during 2009-2018. More Powassan and eastern equine encephalitis virus disease cases were reported in 2019 than in any previous year. Health care providers should consider arboviral infections in patients with aseptic meningitis or encephalitis, perform recommended diagnostic testing, and promptly report cases to public health authorities. Because arboviral diseases continue to cause serious illness, and annual incidence of individual viruses continues to vary with sporadic outbreaks, maintaining surveillance is important in directing prevention activities. Prevention depends on community and household efforts to reduce vector populations and personal protective measures to prevent mosquito and tick bites such as use of Environmental Protection Agency-registered insect repellent and wearing protective clothing. *,†.
Akt Regulates Sox10 Expression to Control Oligodendrocyte Differentiation via Phosphorylating FoxO1

Sox10 is a well known factor to control oligodendrocyte (OL) differentiation, and its expression is regulated by Olig2. As an important protein kinase, Akt has been implicated in diseases with white matter abnormalities. To study whether and how Akt may regulate OL development, we generated OL lineage cell-specific Akt1/Akt2/Akt3 triple conditional knock-out (Akt cTKO) mice. Both male and female mice were used. These mutants exhibit a complete loss of mature OLs and unchanged apoptotic cell death in the CNS. We show that the deletion of Akt three isoforms causes downregulation of Sox10 and decreased levels of phosphorylated FoxO1 in the brain. In vitro analysis reveals that the expression of FoxO1 with mutations on phosphorylation sites for Akt significantly represses the Sox10 promoter activity, suggesting that phosphorylation of FoxO1 by Akt is important for Sox10 expression. We further demonstrate that mutant FoxO1 without Akt phosphorylation epitopes is enriched in the Sox10 promoter. Together, this study identifies a novel FoxO1 phosphorylation-dependent mechanism for Sox10 expression and OL differentiation. SIGNIFICANCE STATEMENT Dysfunction of Akt is associated with white matter diseases including the agenesis of the corpus callosum. However, it remains unknown whether Akt plays an important role in oligodendrocyte differentiation. To address this question, we generated oligodendrocyte lineage cell-specific Akt1/Akt2/Akt3 triple-conditional knock-out mice. Akt mutants exhibit deficient white matter development, loss of mature oligodendrocytes, absence of myelination, and unchanged apoptotic cell death in the CNS. We demonstrate that deletion of Akt three isoforms leads to downregulation of Sox10, and that phosphorylation of FoxO1 by Akt is critical for Sox10 expression. Together, these findings reveal a novel mechanism to regulate Sox10 expression. This study may provide insights into molecular mechanisms for neurodevelopmental diseases caused by dysfunction of protein kinases.
Clinical Characteristics, Management, and In-Hospital Outcomes in Patients With Stroke or Transient Ischemic Attack in China

Key Points Question What are the contemporary clinical characteristics, management, and in-hospital outcomes in patients with acute stroke and transient ischemic attack in China? Findings In this quality improvement study that included more than 1 million admissions, in-hospital management measures and outcomes varied by type of cerebrovascular event and hospital level of care. Temporal improvements from 2015 to 2019 were also observed. Meaning Although improvements were seen over time, these findings suggest that ongoing support for evidence-based care is needed.
Epidemiology of Acute Leukemia among Children with Down Syndrome in Korea

Purpose Children with Down syndrome (DS) show a higher risk of acute leukemia than those without DS. In this study, we investigated the nationwide incidence of acute leukemia among children with DS and compared their epidemiologic characteristics with those of children with acute leukemia but without DS. Materials and Methods Using the National Health Insurance Service database, we selected patients with acute leukemia aged 0–19 years at diagnosis between 2007 and 2016. Results Among the 4,697 children with acute leukemia, 54 (1.1%) had DS. The median incidence rate of leukemia with DS by year was 1.3% (range, 0.2% to 2.0%). Sixteen patients with acute lymphoblastic leukemia (ALL; 29.6%) and 36 with acute myeloid leukemia (AML; 66.7%) had DS. The DS group showed younger age at diagnosis than the non-DS group, and diagnosis of AML was more frequent in the DS group than in the non-DS group (3 years vs. 9 years, p < 0.001; 66.7% vs. 32.4%, p < 0.001, respectively). The 5-year overall survival was comparable between the DS and non-DS groups (88.0% vs. 81.9%, p=0.375). Among all the Koreans born between 2007 and 2008, the incidences of acute leukemia, ALL, and AML were 49.25, 20.75, and 163.38 times higher, respectively, in the DS group than in the non-DS group. Conclusion Our findings support the fact that the incidence of acute leukemia is higher among patients with DS than among those without DS in Korea. However, the DS and non-DS groups in this study had a comparable overall survival rate.
Zooming in on T cell clones: Are we heading to personalized treatment of allergy?

Single-cell RNA and TCR sequencing analysis of peripheral blood and esophageal cells from patients with eosinophilic esophagitis uncovers evidence for an antigen-restricted set of TH2 cells detected in the blood and enriched in the esophagus (see the related Research Article by Morgan et al.). Single-cell RNA and TCR sequencing of peripheral blood and esophageal cells of human eosinophilic esophagitis uncovers antigen-restricted TH2 cells.
Group Counseling for Southeast Asian Refugee Children with Trauma Symptoms: Pilot Study Results and Practical Guidelines

ABSTRACT Southeast Asian (SEA) refugee children tend to have numerous mental health problems such as trauma symptoms, depression, and low self-esteem. Yet, many SEA refugee children do not receive the counseling help they need due to barriers such as access and limited resources. One counseling intervention that overcomes these barriers is Cognitive Behavioral Interventions for Trauma in Schools (CBITS). In this article, the authors identify the unique needs of SEA refugee children and describe a pilot study of implementing CBITS with 20 SEA refugee children, who were primarily from the Myanmar Chin population. Research questions were (1) is there a significant difference between the Child PTSD Symptom Scale (CPSS) pretest and posttest measures of SEA refugee children’s trauma symptoms after they receive CBITS, and (2) what are guidelines for counselors implementing CBITS with SEA refugee children. The study method was a one group pretest–posttest research design with a convenience sample. Results were based on a paired samples t-test of CPPS pretest and posttest scores. Results showed statistically significant reductions in participants’ trauma symptoms as well as clinically significant reductions with a large effect size. The authors discuss practical guidelines for implementing CBITS with SEA refugee children including increasing awareness of the specific SEA subculture, not requiring identification of a specific traumatic event, recognizing vicarious learning from children to parents, and providing social justice advocacy for SEA refugee children.
Hyperbolicity of delay equations via cocycles

We characterize the existence of an exponential dichotomy for a nonautonomous linear delay equation via the hyperbolicity of an appropriate cocycle. An important advantage of this approach is that the base is compact under mild additional assumptions. Moreover, we give a few applications of the equivalence of the two notions of hyperbolicity. In particular, we consider the robustness and the admissibility of the equation, and we obtain stable and unstable invariant manifolds.
Surface gas exchange determined from an aquatic eddy covariance floating platform

We present a new approach to quantifying air‐water flux and gas transfer velocity (k600) from underwater eddy covariance (EC) of dissolved oxygen. EC fluxes were measured 35 cm below the air‐water interface using an acoustic Doppler velocimeter (ADV) coupled with a fast‐responding dissolved oxygen optode probe, integrated on a floating platform. A micro‐electro‐mechanical system (MEMS)‐based inertial motion unit integrated with the ADV enabled compensation of measured velocities for platform motion and changing sensor orientation. Deployments of 16 h and 30 h were conducted under low to moderate wind conditions in Sage Lot Pond, a small estuarine embayment. We evaluate air‐sea flux parameterizations based on wind speed, current speed, and turbulent kinetic energy dissipation rate compared to our directly measured EC flux. Total kinetic energy was linearly correlated with EC‐determined k600, indicative of a more direct relationship to near surface turbulence compared to wind and current speed based parameterizations, which were subject to biases attributable to directional differences in fetch and low current speed. Our observations, which encompassed a period of low turbulent energy, suggest that existing parameterizations are not well constrained for these conditions. This new aquatic EC technique is highly advantageous for the determination of air‐water exchange, especially in dynamic near‐shore and inland systems. The system presented here has the potential for wide applicability for lake, riverine, and open‐ocean air‐water exchange and the results can be extrapolated for use with a wide range of biogeochemically relevant gases.
Demography of the Appalachian Spotted Skunk (Spilogale putorius putorius)

Abstract Spilogale putorius (Eastern Spotted Skunk) is a small, secretive carnivore that has substantially declined throughout the eastern United States since the mid-1900s. To better understand the current status of Eastern Spotted Skunks, we studied survival and reproduction of the S. p. putorius (Appalachian Spotted Skunk) subspecies across 4 states in the central and southern Appalachian Mountains from 2014 to 2020. Using encounter histories from 99 radio-collared Appalachian Spotted Skunks in a Kaplan–Meier known-fate survival analysis, we calculated a mean annual adult survival rate of 0.58. We did not find support for this survival rate varying by sex, predator cover (canopy cover and topographic ruggedness), or climate. Compared to estimates of survival from previous research, our data suggest that Appalachian Spotted Skunk survival is intermediate to the S. p. interrupta (Plains Spotted Skunk) and S. p. ambarvalis (Florida Spotted Skunk) subspecies of Eastern Spotted Skunk. We located 11 Appalachian Spotted Skunk natal dens and estimated mean litter size to be 2.8 juveniles per female. We used a Lefkovitch matrix to identify the most important demographic rates and found that adult survivorship had the largest impact on the population growth rate. These results provide important demographic information for future Eastern Spotted Skunk population viability analyses and can serve as a baseline for future comparative assessments of the effects of management interventions on the species.
Infectious Diseases of Eastern Spotted Skunks (Spilogale putorius) within a One Health Framework

Abstract Owing to their omnivorous diet, den-site habits, foraging activities, mating behaviors, and other pertinent habitat-use and natural-history traits, Spilogale putorius (Eastern Spotted Skunk [ESS]) are exposed to a wide variety of pathogenic agents. Understanding the diversity of infectious diseases affecting ESS in conjunction with the role this species plays in the disease ecology of these pathogens is crucial not only for devising efficacious management strategies, but also in formulating comprehensive veterinary and public health strategies for combatting zoonotic diseases associated with this species. Herein I review the reported infectious diseases of ESS. I address the implications of these pathogens for current and future population health of the species with reference to the changing dynamics of ESS disease ecology, influenced by increasing habitat fragmentation, exposure to pathogens across the domestic–wildlife interface, fluctuating climatic patterns, antimicrobial-resistant pathogens, and the profusion of immunosuppressant chemicals throughout the environment. Employing a One Health framework to evaluate the role that ESS play in the disease ecology of zoonoses further highlights the interrelationships of ESS health to the health of humans, domestic animals, and other wildlife. The potential for ESS to serve as hosts, “dilutors”, and/or sentinels for zoonoses underscores their importance in public health and provides an opportunity to leverage their potential disease-mitigating attributes for the conservation of ESS aligned with their provision of ecosystem services.