Miracle-dz/UniFAR-FTUs huggingface dataset:
The impact of a patient-directed activity program on functional outcomes and activity participation after stroke during inpatient rehabilitation—a randomized controlled trial

Objective: Individuals post stroke are inactive, even during rehabilitation, contributing to ongoing disability and risk of secondary health conditions. Our aims were to (1) conduct a randomized controlled trial to examine the efficacy of a “Patient-Directed Activity Program” on functional outcomes in people post stroke during inpatient rehabilitation and (2) examine differences three months post inpatient rehabilitation discharge. Design: Randomized control trial. Setting: Inpatient rehabilitation facility. Subjects: Patients admitted to inpatient rehabilitation post stroke. Interventions: Patient-Directed Activity Program (PDAP) or control (usual care only). Both groups underwent control (three hours of therapy/day), while PDAP participants were prescribed two additional 30-minute activity sessions/day. Main measures: Outcomes (Stroke Rehabilitation Assessment of Movement Measure, Functional Independence Measure, balance, physical activity, Stroke Impact Scale) were collected at admission and discharge from inpatient rehabilitation and three-month follow-up. Results: Seventy-three patients (PDAP (n = 37); control (n = 36)) were included in the primary analysis. Patients in PDAP completed a total of 23.1 ± 16.5 sessions (10.7 ± 8.5 upper extremity; 12.4 ± 8.6 lower extremity) during inpatient rehabilitation. No differences were observed between groups at discharge in functional measures. PDAP completed significantly more steps/day (PDAP = 657.70 ± 655.82, control = 396.17 ± 419.65; P = 0.022). The Stroke Impact Scale showed significantly better memory and thinking (PDAP = 86.2 ± 11.4, control = 80.8 ± 16.7; P = 0.049), communication (PDAP = 93.6 ± 8.3, control = 89.6 ± 12.4; P = 0.042), mobility (PDAP = 62.2 ± 22.5, control = 53.8 ± 21.8; P = 0.038), and overall recovery from stroke (PDAP = 62.1 ± 19.1, control = 52.2 ± 18.7; P = 0.038) for PDAP compared to control. At three months post discharge, PDAP (n = 11) completed significantly greater physical activity (P = 0.014; 3586.5 ± 3468.5 steps/day) compared to control (n = 10; 1760.9 ± 2346.3 steps/day). Conclusion: Functional outcome improvement was comparable between groups; however, PDAP participants completed more steps and perceived greater recovery.
Inhaled Hypertonic Saline (7%) improves the Lung Clearance Index in CF Paediatric Patients with FEV1% predicted ≥ 80%

Objective: To determine if inhaled Hypertonic Saline (7%) improves the Lung Clearance Index in paediatric Cystic Fibrosis patients with FEV1 ≥80% predicted. Methods: In a blinded crossover trial, twenty CF patients received 4 weeks of hypertonic saline (7%) (HS) and 4 weeks of isotonic saline (0.9%) (IS) separated by a 4 week washout period. The primary endpoint was the change in LCI in the HS versus the IS treatment periods. Results: Four weeks of twice daily inhalation of HS significantly improved the LCI as compared to IS by 1.16, 95% CI [0.26, 2.05]; p=0.016. Baseline LCI before IS, 8.71+/-2.10, was not significantly different from baseline LCI before HS inhalation, 8.84+/-1.95 (p=0.73). Randomization order had no significant impact on the treatment effect (p=0.61). Conclusions: Four weeks of twice daily Hypertonic Saline (7%) inhalations improved the LCI and may be a suitable early intervention therapy for CF patients with mild disease.
Meroterpene-Like α-Glucosidase Inhibitors Based on Biomimetic Reactions Starting from β-Caryophyllene

Background: Natural meroterpenes derived from phloroglucinols and β-caryophyllene have shown high inhibitory activity against α-glucosidase or cancer cells, however, the chemical diversity of this type of skeletons in Nature is limited. Methods: To expand the chemical space and explore their inhibitory activities against α-glucosidase (EC 3.2.1.20), we employed β-caryophyllene and some natural moieties (4-hydroxycoumarins, lawsone or syncarpic acid) to synthesize new types of meroterpene-like skeletons. All the products (including side products) were isolated and characterized by NMR, HR-MS, and ECD. Results: In total, 17 products (representing seven scaffolds) were generated through a one-pot procedure. Most products (12 compounds) showed more potential activity (IC50 < 25 μM) than the positive controls (acarbose and genistein, IC50 58.19, and 54.74 μM, respectively). Compound 7 exhibited the most potent inhibition of α-glucosidase (IC50 3.56 μM) in a mixed-type manner. The CD analysis indicated that compound 7 could bind to α-glucosidase and influence the enzyme’s secondary structure. Conclusions: Compound 7 could serve as a new type of template compound to develop α-glucosidase inhibitors. Full investigation of a biomimic reaction can be used as a concise strategy to explore diverse natural-like skeletons and search for novel lead compounds.
Learning Mathematics from Procedural Instruction: Externally Imposed Goals Influence What Is Learned.

Do externally imposed achievement goals influence what children learn from procedural instruction? Third- and 4th-grade children's goals were manipulated toward either learning or performance. All children were then taught a procedure for solving mathematical equivalence problems (e.g., a + b + c = a + __). Children who were given learning goals were initially more likely to gain conceptual knowledge from the procedural lesson than were children who were given performance goals. After a 2-week period, however, children who were given performance goals exhibited the same conceptual gains as children who were given learning goals. Both initially and after the 2-week period, children who were given either goal were more likely to extend their knowledge beyond the taught procedure than were children who were not given goals. External sources such as teachers and parents may have the potential to foster children's learning by shaping children's goals. When children learn a problem-solving procedure, they may not necessarily gain the corresponding conceptual knowledge. Further, children may not be able to transfer their procedural skills to novel problems. Both of these learning processes, gaining conceptual knowledge from procedural instruction and transferring newly acquired knowledge to novel problems, challenge children to go beyond an instructed procedure. The purpose of the present study is to examine whether externally imposed achievement goals influence children's ability to extend their knowledge beyond an instructed mathematical procedure.
External Validation Is Required for Comparisons of the Diagnostic Performance of Several Predictive Scores.

Critical Care Medicine www.ccmjournal. org e153 urine output. They further found that such a multivariable model showed a comparable predictive performance (area under the curve [AUC], 0.74; 95% CI, 0.71–0.78) with conventional predictive scores such as the Simplified Acute Physiology Score II (AUC, 0.76; 95% CI, 0.73–0.79; p = 0.29) and Acute Physiology and Chronic Health Evaluation (APACHE)–IV (AUC, 0.77; 95% CI, 0.74–0.80; p = 0.16) and was significantly better than the Sequential Organ Failure Assessment (SOFA) (AUC, 0.67; 95% CI, 0.64–0.71; p < 0.001). The net reclassification index consistently showed that the new model based on simple variables was not inferior than above mentioned conventional scores. However, it is unclear on which cohort did the authors compared the AUCs for these scores. From the descriptions in the results section, all these AUCs might be calculated from The Simple Intensive Care Studies (SICS)–I cohort. Although the authors validated the model with hold-out samples that were not used for model training, such validation cohort is similar to the training cohort because they were collected in the same way and from the same institutions. However, other scores such as SOFA and APACHE-IV scores were developed in other cohorts that were significantly different from the validation cohort (2). Thus, it may not be surprising that the model with simple variables were comparable or even better than predictive scores developed in external cohorts (3). It is very likely that the present result does not indicate that the simple model is better than conventional ones, but can be explained by the inappropriate use of validation cohort. There are two approaches to solve this issue. The first one is to validate the model in external cohort that were created differently from the current cohort (4). However, this method is usually not applicable because data are not available. The other approach is to build a regression model by using variables included in SOFA and/or APACHE-IV scores in the same cohort as that for the model based on simple physical examination variables. Then their predictive performances were compared in the same validation cohort. In this way, the coefficients (weights) assigned to each variable can be slightly different from the original one (e.g., a 5-point is given for a subject with age older than 75 yr. It can be 4-point in the newly fitted model) (5). In conclusion, the reported predictive performance of SICS-I had a bit of an unfair advantage over the established scores. More work needs to be done to reliably demonstrate that the SICS-I score is really comparable (not inferior) to that of the externally validated scores such as APACHE and SOFA. Dr. Chen disclosed that he does not have any potential conflicts of interest.
Association of Health Record Visualizations With Physicians’ Cognitive Load When Prioritizing Hospitalized Patients

Key Points Question Can information visualization tools within electronic health records reduce the cognitive workload for physicians when identifying which patients have the highest-priority care needs? Findings In this cross-sectional study of 29 physicians, information visualization tools that identified and highlighted clinically meaningful patterns were associated with a significantly lower cognitive workload compared with tools that required physicians to spend more time searching for similar information. Meaning Electronic health records that use well-designed information visualization tools have the potential to reduce cognitive workload among physicians.
SIRT3 Acts as a Positive Autophagy Regulator to Promote Lipid Mobilization in Adipocytes via Activating AMPK

Obesity is increasing at an alarming rate worldwide, which is characterized by the excessive accumulation of triglycerides in adipocytes. Emerging evidence has demonstrated that macroautophagy and chaperone-mediated autophagy (CMA) regulate lipid mobilization and play a key role in energy balance. Sirtuin 3 (SIRT3) is an NAD+-dependent deacetylase, which is important in regulating macroautophagy and lipid metabolism. It is still unknown whether SIRT3 modulates macroautophagy and CMA in adipocytes. The current study found that macroautophagy was dynamically regulated during 3T3-L1 adipocyte differentiation, which coincided with SIRT3 expression. In mature adipocytes, overexpression of SIRT3 activated macroautophagy, mainly on lipid droplets (LDs), through activating the AMP-activated protein kinase (AMPK)-unc-51-like kinase 1 (ULK1) pathway, which in turn resulting in smaller LD size and reduced lipid accumulation. Moreover, SIRT3 overexpression induced the formation of perilipin-1 (PLN1)-heat shock cognate 71 kDa protein (HSC70)-lysosome-associated membrane protein 2 (LAMP2) complex, to activate CMA and cause the instability of LDs in adipocytes. In summary, we found SIRT3 is a positive regulator of macroautophagy and CMA in adipocytes, which might be a promising therapeutic target for treatment of obesity and its related metabolic dysfunction.
Design, Synthesis and In Vitro Characterization of Novel Antimicrobial Agents Based on 6-Chloro-9H-carbazol Derivatives and 1,3,4-Oxadiazole Scaffolds

In this paper, we aimed to exploit and combine in the same molecule the carbazole and the 1,3,4-oxadiazole pharmacophores, to obtain novel carprofen derivatives, by using two synthesis pathways. For the first route, the following steps have been followed: (i) (RS)-2-(6-chloro-9H-carbazol-2-yl)propanonic acid (carprofen) treatment with methanol, yielding methyl (RS)-2-(6-chloro-9H-carbazol-2-yl)propanoate; (ii) the resulted methylic ester was converted to (RS)-2-(6-chloro-9H-carbazol-2-yl)propane hydrazide (carprofen hydrazide) by treatment with hydrazine hydrate; (iii) reaction of the hydrazide derivative with acyl chlorides led to N-[(2RS)-2-(6-chloro-9H-carbazol-2-yl)propanoil]-N′-R-substituted-benzoylhydrazine formation, which; (iv) in reaction with phosphorus oxychloride gave the (RS)-1-(6-chloro-9H-carbazol-2-yl)-1-(1,3,4-oxadiazol-2-yl)ethane derivatives. In the second synthesis pathway, new 1,3,4-oxadiazole ring compounds were obtained starting from carprofen which was reacted with isoniazid, in the presence of phosphorus oxychloride to form (RS)-1-(6-chloro-9H-carbazol-2-yl)-1-[5-(4-pyridyl)-1,3,4-oxadiazol-2-yl]ethane. The synthesized compounds were characterized by IR, 1H-NMR and 13C-NMR, screened for their drug-like properties and evaluated for in vitro cytotoxicity and antimicrobial activity. The obtained compounds exhibited a good antimicrobial activity, some of the compounds being particularly active on E. coli, while others on C. albicans. The most significant result is represented by their exceptional anti-biofilm activity, particularly against the P. aeruginosa biofilm. The cytotoxicity assay revealed that at concentrations lower than 100 μg/mL, the tested compounds do not induce cytotoxicity and do not alter the mammalian cell cycle. The new synthesized compounds show good drug-like properties. The ADME-Tox profiles indicate a good oral absorption and average permeability through the blood brain barrier. However, further research is needed to reduce the predicted mutagenic potential and the hepatotoxicity.
Dental clinic: Potential source of high-risk screening for prediabetes and type 2 diabetes

Background: It is predicted that by 2030 diabetes may affect 79.4 million individuals in India. Early diagnosis and prompt treatment of diabetes are essential to prevent or delay its acute or chronic complications. It is observed that the number of patients visiting dentists is significantly increased. This opportunity can be used for early identification of diabetes in dental office. This study assesses the feasibility of high-risk screening for diabetes and prediabetes in private dental care center. Materials and Methods: A cross-sectional study was conducted among patients reporting to the dental clinic. A total of 1150 patients above 40 years of age having one or more risk factors such as family history of diabetes, hypertension, smoking, loss of teeth, and periodontitis were included in the study. Patients were subjected to high-risk screening by random blood sugar (RBS) test. American Diabetes Association criteria indicating normal (RBS 79–140 mg/dL), prediabetic (RBS 140–200 mg/dL), and diabetic (RBS >200 mg/dL) was considered for screening. Results: Among 1150 participants, 64.69% had RBS level within normal range and 20.69% had prediabetic range while 14.60% had RBS level above 200 mg/dL, suggestive of having diabetes. A total of 35.29% patients had hyperglycemia based on random blood glucose level. Conclusion: The study concluded that patients who are unaware about their diabetic status visiting a dental clinic having one or more risk factors of diabetes can be used as potential sources for high-risk screening for diabetes using a simple RBS test and oral examination.
Immunological Differences Between Right-Sided and Left-Sided Colorectal Cancers: A Comparison of Embryologic Midgut and Hindgut

Purpose There are known differences in embryology, clinical symptoms, incidences, molecular pathways involved, and oncologic outcomes of right-sided and left-sided colorectal cancers. However, immunologic study has only been characterized for healthy adults. The present study was designed to identify differences in immune cell populations in patients with right-sided and left-sided colorectal cancers. Methods A total of 35 patients who underwent colorectal resection for cancer between November 2016 and August 2017 at a tertiary teaching hospital were enrolled in this study. Patients were excluded if they had a disease affecting their immune system. Populations of immune cells, including mucosal-associated invariant T (MAIT), gamma delta T, invariant natural killer T, T, natural killer, and B cells, were measured in the peripheral blood and cancer tissues using flow cytometry, and then assessed based on the origin of the colorectal cancer. Results Fifteen had right-side and 20 had left-side colorectal cancer. There were no significant differences between the 2 cohorts for patient characteristics including pathologic stage. Peripheral blood from patients with right-side colon cancers contained fewer MAIT (0.87% right-side vs. 1.74% left-side, P = 0.028) and gamma delta T cells (1.10% right-side vs. 3.05% left-side, P = 0.002). Although the group with right-side colorectal cancer had more MAIT cells in cancer tissues (1.71% vs. 1.00%), this difference was not statistically significant. Conclusion There is a difference in population sizes of immune cells in blood between patients with right-sided and leftsided colon cancers. The immune cell composition was determined to be distinct based on embryologic origin.
Oxidative Stress Parameters in the Liver of Growing Male Rats Receiving Various Alcoholic Beverages

Typical alcohol consumption begins in the adolescence period, increasing the risk of alcoholic liver disease (ALD) in adolescents and young adults, and while the pathophysiology of ALD is still not completely understood, it is believed that oxidative stress may be the major contributor that initiates and promotes the progression of liver damage. The aim of the present study was to assess the influence of alcohol consumption on the markers of oxidative stress and liver inflammation in the animal model of prolonged alcohol consumption in adolescents using various alcoholic beverages. In a homogenic group of 24 male Wistar rats (4 groups—6 animals per group), since 30th day of life, in order to mimic the alcohol consumption since adolescence, animals received (1) no alcoholic beverage (control group), (2) ethanol solution, (3) red wine, or (4) beer (experimental groups) for 6 weeks. Afterwards, the activities of alcohol dehydrogenase (ADH), alanine aminotransferase (ALT), and aspartate aminotransferase (AST), as well as levels of cytochrome P450-2E1 (CYP2E1), thiobarbituric acid-reactive substances (TBARS), protein carbonyl groups, tumor necrosis factor-α (TNF-α), and interleukine-10 (IL-10) were measured in liver homogenates. The difference between studied groups was observed for CYP2E1 and protein carbonyl groups levels (increased levels for animals receiving beer compared with control group), as well as for ALT activity (decreased activity for animals receiving beer compared with other experimental groups) (p < 0.05). The results suggested that some components of beer, other than ethanol, are responsible for its influence on the markers of oxidative stress and liver inflammation observed in the animal model of prolonged alcohol consumption in adolescents. Taking this into account, beer consumption in adolescents, which is a serious public health issue, should be assessed in further studies to broaden the knowledge of the progression of liver damage caused by alcohol consumption in this group.
Medication Adherence, Burden and Health-Related Quality of Life in Adults with Predialysis Chronic Kidney Disease: A Prospective Cohort Study

This study examines the associations between medication adherence and burden, and health-related quality of life (HRQOL) in predialysis chronic kidney disease (CKD). A prospective study targeting adults with advanced CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2) and not receiving renal replacement therapy was conducted in Tasmania, Australia. The actual medication burden was assessed using the 65-item Medication Regimen Complexity Index, whereas perceived burden was self-reported using a brief validated questionnaire. Medication adherence was assessed using a four-item Morisky-Green-Levine Scale (MGLS) and the Tool for Adherence Behaviour Screening (TABS). The Kidney Disease and Quality of Life Short-Form was used to assess HRQOL. Of 464 eligible adults, 101 participated in the baseline interview and 63 completed a follow-up interview at around 14 months. Participants were predominantly men (67%), with a mean age of 72 (SD 11) years and eGFR of 21 (SD 6) mL/min/1.73 m2. Overall, 43% and 60% of participants reported medication nonadherence based on MGLS and TABS, respectively. Higher perceived medication burden and desire for decision-making were associated with nonadherent behaviour. Poorer HRQOL was associated with higher regimen complexity, whereas nonadherence was associated with a decline in physical HRQOL over time. Medication nonadherence, driven by perceived medication burden, was prevalent in this cohort, and was associated with a decline in physical HRQOL over time.
Analytical Bias in the Measurement of Plasma 25-Hydroxyvitamin D Concentrations in Infants

Hypovitaminosis D is prevalent worldwide; however, analytical bias in the measurement of circulating 25-hydroxyvitamin D (25(OH)D) concentrations may affect clinical treatment decisions and research. We performed parallel plasma 25(OH)D analyses using the Abbott Architect i2000 chemiluminescent immunoassay (CIA) and liquid chromatography–tandem mass spectrometry (LC–MS/MS) for paired samples from the same infants at 3 (n = 69), 6 (n = 79) and 12 months (n = 73) of age. To test agreement, we used Lin’s concordance correlation coefficient and corresponding 95% confidence interval, Bland–Altman’s limits of agreement, and Bradley–Blackwood (BB) test. Agreement was high at 3 months (coefficient between difference and mean −0.076; BB F = 0.825; p = 0.440), good at 12 months (−0.25; BB F = 2.41; p = 0.097) but missing at 6 months of age (−0.39; BB F = 12.30; p < 0.001). Overall, 18 infants had disparate results based on the cut-off point for vitamin D deficiency (25(OH)D < 50 nmol/L), particularly at three months, with seven (10%) infants deficient according to CIA but not LC–MS/MS, and four (6%) deficient by LC–MS/MS but not CIA. To our knowledge, this is the first study to show that the reported 25(OH)D concentration may be influenced by both age and assay type. Physicians and researchers should be aware of these pitfalls when measuring circulating 25(OH)D concentrations in infants and when developing treatment plans based on measured vitamin D status.