Miracle-dz/UniFAR-FTUs huggingface dataset:
The Association of Practice Type and the Scope of Care of Family Physicians

Introduction: Comprehensiveness is a defining principle of primary care and Family Medicine but is declining in some settings. This study explores the relationship between practice setting and comprehensiveness among family physicians (FPs). Methods: Using 2014 to 2016 American Board of Family Medicine survey data to generate scope of practice (SOP) scores (0 to 30) for FPs. We ran univariate and bivariate analyses for services by practice organization type. Our principal independent variable was practice organization type and dependent variable, the SOP score. Results: Among 25,117 total respondents, FPs at rural health centers (RHC) had the widest scope of practice (SOP score of 17.7) whereas FPs in federal, urgent care and other safety net clinics had the narrowest with mean SOP score of 14.0 or less. Higher rates of FPs practicing in Federally Qualified Health Centers and academic health centers were providing a women’s health service, except for deliveries, whereas FPs in rural health centers were providing obstetric services (24%). The proportion of FPs providing newborn care was highest in RHCs and lowest in the urgent care setting (85%, vs 26%). A higher proportion of FPs in RHCs provided joint injections and skin procedures than FPs in other practice organizations. Conclusions: Significant variation in FP comprehensiveness exists across different practice types. FPs in practice types commonly associated with large health systems had narrower breadth of practice, concerning amid increasing practice consolidation. Given associations between comprehensiveness and desirable health care outcomes, policy makers should encourage payment/accountability models that incentivize broader SOP.
Steady‐state chemoreflex drive captures ventilatory acclimatization during incremental ascent to high altitude: Effect of acetazolamide

Ventilatory acclimatization (VA) is important to maintain adequate oxygenation with ascent to high altitude (HA). Transient hypoxic ventilatory response tests lack feasibility and fail to capture the integrated steady‐state responses to chronic hypoxic exposure in HA fieldwork. We recently characterized a novel index of steady‐state respiratory chemoreflex drive (SSCD), accounting for integrated contributions from central and peripheral respiratory chemoreceptors during steady‐state breathing at prevailing chemostimuli. Acetazolamide is often utilized during ascent for prevention or treatment of altitude‐related illnesses, eliciting metabolic acidosis and stimulating respiratory chemoreceptors. To determine if SSCD reflects VA during ascent to HA, we characterized SSCD in 25 lowlanders during incremental ascent to 4240 m over 7 days. We subsequently compared two separate subgroups: no acetazolamide (NAz; n = 14) and those taking an oral prophylactic dose of acetazolamide (Az; 125 mg BID; n = 11). At 1130/1400 m (day zero) and 4240 m (day seven), steady‐state measurements of resting ventilation (V̇I; L/min), pressure of end‐tidal (PET)CO2 (Torr), and peripheral oxygen saturation (SpO2; %) were measured. A stimulus index (SI; PETCO2/SpO2) was calculated, and SSCD was calculated by indexing V̇I against SI. We found that (a) both V̇I and SSCD increased with ascent to 4240 m (day seven; V̇I: +39%, p < 0.0001, Hedges' g = 1.52; SSCD: +56.%, p < 0.0001, Hedges' g = 1.65), (b) and these responses were larger in the Az versus NAz subgroup (V̇I: p = 0.02, Hedges' g = 1.04; SSCD: p = 0.02, Hedges' g = 1.05). The SSCD metric may have utility in assessing VA during prolonged stays at altitude, providing a feasible alternative to transient chemoreflex tests.
Complementary water and nutrient utilization of perianth structural units help maintain long floral lifespan in Dendrobium

Abstract Most orchids have high ornamental value with long-lived flowers. However, the mechanisms by which orchids maintain floral longevity are poorly understood. Here, we hypothesized that floral longevity in Dendrobium is maintained by high resource investment and complementary water and nutrient utilization in different structural units of the perianth. To test this hypothesis, we determined which water- and nutrient-related traits are correlated with flower longevity in 23 Dendrobium species or cultivars, and examined variations of the related traits during flower development of one long-lived cultivar. We found that floral longevity was correlated with dry mass per unit area of perianths and total flower biomass, which indicates that maintaining floral longevity requires increased resource investment. During development of long-lived flowers, labella showed a high capacity for water storage and nutrient reutilization, which could partly remedy high water demand and biomass investment. Sepals and petals, in contrast, had stronger desiccation avoidance and higher metabolic activity with lower biomass investment. These findings indicate that Dendrobium flowers maintain longevity by complementary water and nutrient utilization strategies in the sepals, petals and labella, with labella consuming more water and nutrients to extend flower display, and sepals and petals using a more conservative strategy.
The Character of Physical Law

In these Messenger Lectures, originally delivered at Cornell University and recorded for television by the BBC, Richard Feynman offers an overview of selected physical laws and gathers their common features into one broad principle of invariance. He maintains at the outset that the importance of a physical law is not "how clever we are to have found it out, but.how clever nature is to pay attention to it," and tends his discussions toward a final exposition of the elegance and simplicity of all scientific laws. Rather than an essay on the most significant achievements in modern science, The Character of Physical Law is a statement of what is most remarkable in nature. Feynman's enlightened approach, his wit, and his enthusiasm make this a memorable exposition of the scientist's craft.The Law of Gravitation is the author's principal example. Relating the details of its discovery and stressing its mathematical character, he uses it to demonstrate the essential interaction of mathematics and physics. He views mathematics as the key to any system of scientific laws, suggesting that if it were possible to fill out the structure of scientific theory completely, the result would be an integrated set of mathematical axioms. The principles of conservation, symmetry, and time-irreversibility are then considered in relation to developments in classical and modern physics, and in his final lecture Feynman develops his own analysis of the process and future of scientific discovery.Like any set of oral reflections, The Character of Physical Law has special value as a demonstration of the mind in action. The reader is particularly lucky in Richard Feynman. One of the most eminent and imaginative modern physicists, he was Professor of Theoretical Physics at the California Institute of Technology until his death in 1988. He is best known for his work on the quantum theory of the electromagnetic field, as well as for his later research in the field of low-temperature physics. In 1954 he received the Albert Einstein Award for his "outstanding contribution to knowledge in mathematical and physical sciences"; in 1965 he was appointed to Foreign Membership in the Royal Society and was awarded the Nobel Prize.
Association Between Serum Lipids and Survival in Patients With Amyotrophic Lateral Sclerosis

Background and Objective To explore the association between lipids, polygenic profile scores (PPS) for biomarkers of lipid metabolism, markers of disease severity, and survival in patients with amyotrophic lateral sclerosis (ALS). Methods We meta-analyzed the current literature on the prognostic value of lipids in patients with ALS. Subsequently, we evaluated the relationship between lipid levels at diagnosis, clinical disease stage, and survival in all consecutive patients diagnosed in the Netherlands. We determined the hazard ratio (HR) of each lipid for overall survival, defined as death from any cause. A subset of patients was matched to a previous genome-wide association study; data were used to calculate PPS for biomarkers of lipid metabolism and to determine the association between observed lipid levels at diagnosis and survival. Results Meta-analysis of 4 studies indicated that none of the biomarkers of the lipid metabolism were statistically significantly associated with overall survival; there was, however, considerable heterogeneity between study results. Using individual patient data (N = 1,324), we found that increased high-density lipoprotein (HDL) cholesterol was associated with poorer survival (HR of 1.33 (95% CI 1.14–1.55, p < 0.001)). The correlation between BMI and HDL cholesterol (Pearson r −0.26, 95% CI −0.32 to −0.20) was negative and between BMI and triglycerides (TG) positive (Pearson r 0.18, 95% CI 0.12–0.24). Serum concentrations of total cholesterol and LDL cholesterol were lower in more advanced clinical stages (both p < 0.001). PPS for biomarkers of lipid metabolism explained 1.2%–13.1% of their variance at diagnosis. None of the PPS was significantly associated with survival (all p > 0.50). Discussion Lipids may contain valuable information about disease severity and prognosis, but their main value may be driven as a consequence of disease progression. Our results underscore that gaining further insight into lipid metabolism and longitudinal data on serum concentrations of the lipid profile could improve the monitoring of patients and potentially further disentangle ALS pathogenesis.
Dynein intermediate chains DYCI‐1 and WDR‐60 have specific functions in Caenorhabditis elegans

Dynein is a microtubule‐dependent motor protein required for cell division, retrograde intracellular transport, and intraflagellar transport (IFT). Dynein 1 and dynein 2 serve as molecular motors in the cytoplasm and cilia, respectively. Each dynein consists of multiple subunits. Although the components of dynein 1 and dynein 2 are different and specific in most species, a previous study has suggested that dynein intermediate chain subunit DYCI‐1 is shared by both dynein 1 and 2 in Caenorhabditis elegans (C. elegans). Here, we show that C. elegans has two dynein intermediate chains—DYCI‐1 and WDR‐60—and their functions are different. Mutational analysis showed that dyci‐1 is essential for the retrograde axonal transport of synaptic vesicles. In the same mutant allele, IFT is not affected at all. Instead, wdr‐60 is essential for IFT. Thus, we suggest that dynein 1 and dynein 2 have specific intermediate chains in C. elegans as in other organisms.
Dissipational galaxy formation. II - Effects of star formation

Numerical simulations of hierarchical galaxy formation, including gasdynamics, star formation, and supernova feedback, are presented. The simulations model the collapse of isolated constant-density perturbations, initially in solid-body rotation and in Hubble flow. The perturbations are made of dark and baryonic matter in a 10:1 ratio. Small-scale power is added using the Zel'dovich approximation, assuming a power-law slope of -2.5. We are successful in making a three-component system that resembles a spiral galaxy: a thin disk made of stars and gas, a spheroidal component made of stars, and a dark matter halo
An experimental investigation of the equilibrium and stability of long towed cable systems

The dynamics of towed objects in a fluid environment is of interest for many practical situations. We investigate experimentally the equilibrium and stability of the trajectory of a sphere towed at constant velocity at the tip of a cable with an unprecedented large length-to-diameter aspect ratio, exceeding 104. The towing configuration is artificially obtained by considering a steady cable (with one fixed end and a free end to which a sphere is eventually attached) in a low-turbulence wind tunnel. We consider three different configurations: (i) the cable towed by itself; (ii) a light millimetric towed sphere made of expanded polystyrene; and (iii) a denser millimetric towed sphere made of lead. The trajectory of the cable tip is monitored using high-speed Lagrangian tracking, which allows one to characterize the average position and the dynamical fluctuations of the towed object. We show that the mean equilibrium position is well predicted by a simple model including the aerodynamical forces acting along the cable and on the towed sphere (when present). Concerning stability issues, we find that the heavy lead particle is always towed in stable conditions (within the accessible range of velocities) with only very low energy oscillations related to a weak pendulum-like motion. In contrast, the free end and light sphere cases are shown to become unstable when the towing velocity exceeds a certain threshold. Spectral analysis shows a flutter-type instability for the sphere, with a dominant oscillatory motion, while the cable alone develops a divergence-type instability with random fluctuations.
Prostate magnetic resonance imaging‐targeted biopsy global grade correlates better than highest grade with prostatectomy grade

Magnetic resonance imaging (MRI)‐targeted prostate biopsy has become an increasingly common method of diagnosing prostate cancer. A previous study from our institution demonstrated that the biopsy global Grade Group (gGG, aggregate GG of all positive cores) and highest Grade Group (hGG in any core) both show substantial concordance with the Grade Group at radical prostatectomy (RPGG) while the discordance predominantly consists of upgrading in gGG and downgrading in hGG. We performed a larger cohort study focused on biopsy cases in which gGG and hGG differ, to determine their relative concordance with RPGG.
Automated adjustment of dialysate sodium by the hemodialysis monitor: Rationale, implementation, and clinical benefits

Prescribing dialysate sodium is the responsibility of the physician, but there are currently no clear guidelines for this prescription. Furthermore, there is quite frequently a significant difference between prescribed and measured dialysate sodium. Several arguments, both theoretical and experimental, suggest that dialysate sodium should be adjusted individually in such a way as to result in a decreasing sodium profile that takes into account the patient's predialytic natremia. The generalization in clinical routine of this strategy requires the integration into the hemodialysis monitor of software making the machine capable to automatically adjust the dialysate sodium at each session. The only three such softwares that have been integrated into hemodialysis machines for routine clinical use are discussed. All three work with conductivity measurements as a surrogate for sodium concentrations. Although there are only a few publications on the use of these softwares in clinical practice, they appear to result in improved intradialytic tolerance to the dialysis treatment, better control of hypertension, and reduced thirst, leading to decreased interdialytic weight gain.
Out of Asia? Expansion of Eurasian Lyme borreliosis causing genospecies display unique evolutionary trajectories

Vector‐borne pathogens exist in obligate transmission cycles between vector and reservoir host species. Host and vector shifts can lead to geographic expansion of infectious agents and the emergence of new diseases in susceptible individuals. Three bacterial genospecies (Borrelia afzelii, Borrelia bavariensis, and Borrelia garinii) predominantly utilize two distinct tick species as vectors in Asia (Ixodes persulcatus) and Europe (Ixodes ricinus). Through these vectors, the bacteria can infect various vertebrate groups (e.g., rodents, birds) including humans where they cause Lyme borreliosis, the most common vector‐borne disease in the Northern hemisphere. Yet, how and in which order the three Borrelia genospecies colonized each continent remains unclear including the evolutionary consequences of this geographic expansion. Here, by reconstructing the evolutionary history of 142 Eurasian isolates, we found evidence that the ancestors of each of the three genospecies probably have an Asian origin. Even so, each genospecies studied displayed a unique substructuring and evolutionary response to the colonization of Europe. The pattern of allele sharing between continents is consistent with the dispersal rate of the respective vertebrate hosts, supporting the concept that adaptation of Borrelia genospecies to the host is important for pathogen dispersal. Our results highlight that Eurasian Lyme borreliosis agents are all capable of geographic expansion with host association influencing their dispersal; further displaying the importance of host and vector association to the geographic expansion of vector‐borne pathogens and potentially conditioning their capacity as emergent pathogens.
Mathematical contributions to the theory of evolution.—On the law of reversion

(1) Introductory. —In a memoir recently presented to the Royal Society, I have endeavoured to emphasise the importance of distinguishing between three diverse types of heredity, namely (i), Blended Inheritance, (ii) Exclusive Inheritance, and (iii) Particulate Inheritance.
Impact of facemasks on psychotherapy: Clinician's confidence and emotion recognition

Abstract Objectives Facial emotion recognition is a key component of human interactions, and in clinical relationships contributes to building and maintaining the therapeutic alliance with patients. The introduction of facemasks has reduced the availability of facial information in private and professional relationships. This study aimed to assess the impact of facemasks on clinicians' perception of clinical interactions as well as their ability to read facial expressions. Methods In this cross‐sectional study, a purposive sample of 342 clinical psychologists or psychotherapists completed an online survey including the assessment of burnout, alexithymia, emotion dysregulation, and self‐perceived ability to build effective relationships and communication with patients with/without facemasks. Participants were randomly assigned to the standardized facial emotion recognition task Diagnostic Analysis of Nonverbal Accuracy FACES 2‐Adult Faces including 24 faces representing anger, fear, sadness, and happiness. Results Facemasks impaired the self‐perceived ability of clinicians to build effective relationships and communicate with patients and reduced satisfaction in clinical encounters. The ability of clinicians to recognize facial emotions is significantly reduced for masked happy and angry faces, but not for sad and afraid ones. The perceived difficulty in building good relationships and communication with patients had a positive correlation with alexithymia and emotion dysregulation; higher levels of discomfort when wearing facemasks had a positive correlation with burnout and emotion dysregulation. Conclusion Facemasks reduced clinicians' self‐confidence in clinical encounters with patients wearing facemasks, but their facial emotion recognition performance was only partially impaired.
Effect of using a structured pacing protocol on post‐exertional symptom exacerbation and health status in a longitudinal cohort with the post‐COVID‐19 syndrome

Post‐exertional symptom exacerbation (PESE) is a characteristic symptom of post‐COVID syndrome (PCS). This prospective study investigated the effect of a 6‐week structured World Health Organization (WHO) Borg CR‐10 5‐phase pacing protocol on PESE episodes and quality of life in a cohort of individuals with long‐standing PCS (average duration of symptoms was 17 months). Participants received weekly telephone calls with a clinician to complete the Leeds PESE questionnaire (LPQ) and identify the appropriate phase of the pacing protocol. EQ‐5D 5L was completed at the intervention's beginning and end to measure overall health. Thirty‐one participants completed the 6‐week protocol, with a statistically and clinically significant reduction in the average number of PESE episodes (from 3.4 episodes in Week 1 to 1.1 in Week 6), with an average decrease of 16% (95% CI: 9%−24%; p < 0.001) each week, and reduction across all three exertional triggers (physical, cognitive, and emotional). Physical activity levels showed moderate improvements during the intervention period. Mean EQ‐5D 5L scores improved from 51.4 to 60.6 points (paired difference of 9.2 points, 95% CI: 3.2−15.2 points; p = 0.004). A structured pacing protocol significantly reduces PESE episodes and improves overall health in PCS.
Macrophage colony‐stimulating factor potentially induces recruitment and maturation of macrophages in recurrent pituitary neuroendocrine tumors

Although pituitary neuroendocrine tumors (PitNETs) are usually benign, some are highly invasive and recurrent. Recurrent PitNETs are often treatment‐resistant and there is currently no effective evidence‐based treatment. Tumor‐associated macrophages (TAMs) promote tumor growth in many cancers, but the effect of TAMs on PitNETs remains unclear. This study investigated the role of TAMs in the incidence of recurrent PitNETs. Immunohistochemical analysis revealed that the densities of CD163‐ and CD204‐positive TAMs tended to increase in recurrent PitNETs. Compared with TAMs in primary lesions, those in recurrent lesions were enlarged. To clarify the cell–cell interactions between TAMs and PitNETs, in vitro experiments were performed using a mouse PitNET cell line AtT20 and the mouse macrophage cell line J774. Several cytokines related to macrophage chemotaxis and differentiation, such as M‐CSF, were elevated significantly by stimulation with macrophage conditioned medium. When M‐CSF immunohistochemistry analysis was performed using human PitNET samples, M‐CSF expression increased significantly in recurrent lesions compared with primary lesions. Although no M‐CSF receptor (M‐CSFR) expression was observed in tumor cells of primary and recurrent PitNETs, flow cytometric analysis revealed that the mouse PitNET cell line expressed M‐CSFR. Cellular proliferation in mouse PitNETs was inhibited by high concentrations of M‐CSFR inhibitors, suggesting that cell‐to‐cell communication between PitNETs and macrophages induces M‐CSF expression, which in turn enhances TAM chemotaxis and maturation in the tumor microenvironment. Blocking the M‐CSFR signaling pathway might be a novel therapeutic adjuvant in treating recurrent PitNETs.
Modified scarf osteotomy for hallux valgus: From a finite element model to clinical results

Purpose Finite element (FE) analysis and clinical follow-up were used to evaluate the efficacy of modified scarf osteotomy for moderate-to-severe hallux valgus (HV). Method We retrospectively evaluated 42 patients (44 feet) who underwent modified rotational scarf osteotomy for moderate-to-severe HV at our institution between January 2010 and January 2019. Radiological indicators and subjective scores were recorded at different time points. To compare the results and elemental characteristics, a FE model of the metatarsophalangeal (MTP) joint that included anatomically realistic geometrical and structural characteristics was built. The biomechanical features and correction differences in dynamic loads as well as the incidence of troughing were estimated. Results Both the hallux valgus angle (HVA) and intermetatarsal angle (IMA) showed significant improvement 6 weeks postoperatively (p < 0.05); additionally, the HVA increased from 6 weeks postoperatively to the last follow-up, while the IMA showed no significant changes (p > 0.05). The subjective scores significantly improved from the preoperative period to the last follow-up. The percentages of troughing and recurrence were remarkably low in our pilot study because of the innate stability of the modified rotated fixation. Conclusion Our preliminary findings suggest that modified rotational scarf osteotomy offers sufficient stability, correct HV deformity effectively, and good clinical outcomes for moderate to severe HV.