Miracle-dz/UniFAR-FTUs huggingface dataset:
Educational Interventions to Improve Advance Care Planning Discussions, Documentation and Billing

Background/Objectives: To determine the impact of educational interventions, clinic workflow redesign, and quality improvement coaching on the frequency of advance care planning (ACP) activities for patients over the age of 65. Design: Nonrandomized before-and-after study. Setting: 13 ambulatory care clinics with 81 primary care providers in eastern and central North Carolina. Participants: Patients across 13 primary care clinics staffed by 66 physicians, 8 physician assistants and 7 family nurse practitioners. Interventions: Interprofessional, interactive ACP training for the entire interprofessional team and quality improvement project management with an emphasis on workflow redesign. Measurements: From July 2017 through June 2018—number of ACP discussions, number of written ACP documents incorporated into the electronic medical record (EMR), number of ACP encounters billed. Results: Following the interventions, healthcare providers were more than twice as likely to conduct ACP discussions with their patients. Patients were 1.4 times more likely to have an ACP document included in their electronic medical record. Providers were significantly (p < 0.05) more likely to bill for an ACP encounter in only one clinic. Conclusions: Implementing ACP education for all clinic staff, planning for workflow changes to involve the entire interprofessional team and supporting ACP activities with quality improvement coaching leads to statistically significant improvements in the frequency of ACP discussions, the number of ACP documents included in the electronic medical record and number of ACP encounters billed.
Diagnosis of pancreatic solid pseudopapillary neoplasms using cell‐blocks and immunohistochemical evaluation of endoscopic ultrasound‐guided fine needle aspiration biopsy specimens

Preoperative diagnostic imaging of pancreatic solid pseudopapillary neoplasms (SPNs) is challenging. A few studies have investigated the role of endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) for the diagnosis of SPN. We investigated the diagnostic yield of cell‐blocks and immunohistochemistry (IHC) for SPN using EUS‐FNA specimens without cytological evaluation.
High School Students’ Knowledge, Attitude and Preventive Practice of Dementia Care in Macao

Objective: To investigate knowledge, attitude and preventive practice of dementia care among high school students in Macao. Methods: Questionnaires was developed and distributed to 10 randomly selected high schools in Macao and 586 valid questionnaires were returned. Results: Knowledge, attitude and preventive practice of dementia care were 56.27 ± 24.90, 73.97 ± 7.72 and 68.34 ± 14.05. There were positive relationships between preventive practice and attitude, and knowledge. The students of 2 high schools had participated or organized lectures or events related to dementia scored higher knowledge, attitude and preventive practice than those hadn’t. Knowledge and attitude of female students were significantly higher than male students. Knowledge and preventive practice of the high school students were significantly lower than primary health professionals in Macao. Conclusion: Most high school students in Macao had insufficient knowledge and inappropriate preventive practice of dementia care. Enhanced dementia education should be a strong agenda for high school students in Macao.
Temperament and Character Profiles of Ankylosing Spondylitis Patients Compared With Major Depression Patients and Healthy Controls

Background/Objective Depressive disorder is common in patients with ankylosing spondylitis (AS), who exhibit specific brain imaging abnormalities resembling those in major depression (MD). We compared temperament and character profiles between patients with AS and MD. Methods The study involved 36 patients with AS, 40 with MD, and 36 healthy controls (HCs). The participants were age-, sex-, and education-matched. Depression, anxiety, temperament, and character were evaluated using the Temperament and Character Inventory and physician-rated Hamilton Depression and Anxiety Scales. Disease severity was assessed using the Bath Ankylosing Spondylitis Disease Activity, Radiology, Metrology, and Functionality Indexes; erythrocyte sedimentation rate; and C-reactive protein. Results Depression and anxiety scores were highest in MD, lowest in HCs, and intermediate in AS (p < 0.001). Harm avoidance was significantly higher in MD and AS than HCs (p = 0.01). Reward dependency was lower (p = 0.011) and self-transcendence higher in AS only (p = 0.034). Bath Ankylosing Spondylitis Radiology Index was negatively correlated with depression (p = 0.020). Bath Ankylosing Spondylitis Radiology Index and Bath Ankylosing Spondylitis Metrology Index were negatively correlated with harm avoidance (p < 0.05). Disease duration was negatively correlated with self-transcendence (p = 0.027). Harm avoidance was correlated with depression score (p = 0.029). Patients under tumor necrosis factor α inhibitor treatment had lower cooperativeness score (p = 0.022). Conclusions Patients with AS had a specific Temperament and Character Inventory pattern. Harm avoidance was common in both AS and MD. In AS, harm avoidance and depression decreased in patients with progression, probably because progressive fusion of the spinal segments causes decrease in pain. Harm avoidance (fear of pain) seemed to be an acting factor for occurrence of depressive symptoms in AS.
The roles of chloroplast membrane lipids in abiotic stress responses

ABSTRACT Plant chloroplasts have complex membrane systems. Among these, thylakoids serve as the sites for photosynthesis and photosynthesis-related adaptation. In addition to the photosynthetic membrane complexes and associated molecules, lipids in the thylakoid membranes, are predominantly composed of MGDG (monogalactosyldiacylglycerol), DGDG (digalactosyldiacylglycerol), SQDG (sulfoquinovosyldiacylglycerol) and PG (phosphatidylglycerol), play essential roles in shaping the thylakoid architecture, electron transfer, and photoregulation. In this review, we discuss the effect of abiotic stress on chloroplast structure, the changes in membrane lipid composition, and the degree of unsaturation of fatty acids. Advanced understanding of the mechanisms regulating chloroplast membrane lipids and unsaturated fatty acids in response to abiotic stresses is indispensable for improving plant resistance and may inform the strategies of crop breeding.
Bacterial community dynamics across fungal fruiting body developmental stages.

Increasing evidence suggest that bacteria form diverse communities in various eukaryotic hosts, including fungi. However, little is known about their succession and the functional potential at different host development stages. Here we examined the effect of fruiting body parts and developmental stages on the structure and function of fungus-associated bacterial communities. Using high-throughput sequencing, we characterized bacterial communities and their associated potential functions in fruiting bodies from ten genera belonging to four major mushroom-forming orders and three different developmental stages of a model host species Cantharellus cibarius. Our results demonstrate that bacterial community structure differs between internal and external parts of the fruiting body but not between inner tissues. The structure of the bacterial communities also showed significant variation across fruiting body developmental stages. We provide evidence that certain functional groups, such as those related to nitrogen fixation, persist in fruiting bodies during the maturation, but are replaced by putative parasites/pathogens afterwards. These data suggest that bacterial communities inhabiting fungal fruiting bodies may play important roles in their growth and development.
Structured reflection on shared decision making

Shared decision making (SDM), whereby patients and clinicians work collaboratively to make health care decisions, brings multiple benefits. It has, however, been slow to integrate into clinical practice. There are some examples of SDM being embedded and evaluated within medical undergraduate curricula but, despite role models being important in promoting students’ patient‐centred attitudes, these examples do not involve students reflecting on clinicians’ use of SDM in practice.
Atherogenic Index of Plasma Is an Independent Risk Factor for Coronary Artery Disease and a Higher SYNTAX Score

We aimed to identify the best diagnostic cutoff value of the atherogenic index of plasma (AIP) for coronary artery disease (CAD) and its correlation with the SYNTAX score (SS). From January 2016 to December 2019, 2253 patients with CAD and 1347 non-CAD patients with complete data were included in the study. Coronary angiography was performed using the Judkins technique, and the SS was calculated using network software. There were differences in age, body mass index, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol levels, and AIP between groups (all P < .01). Multivariate logistic regression analysis showed that AIP was an independent risk factor for CAD and a high SS (SS ≥ 23) with adjusted odds ratios of 2.248 (95% CI: 1.666-3.032, P < .01) and 1.623 (95% CI: 1.118-2.358, P < .01) per standard deviation increase. Receiver operating characteristic curve analysis revealed that the best diagnostic cutoff value of AIP for the prediction of CAD and SS ≥ 23 was 2.035 and 2.23, the specificity was 61.8% and 65.7%, the sensitivity was 76.4% and 54.9%, the Youden index was 0.382 and 0.206, and the area under the curve was 0.733 (95% CI: 0.717-0.750, P < .01) and 0.653 (95% CI: 0.630-0.676, P < .01). Atherogenic index of plasma, as a biomarker, may assist in the prevention of CAD in the Chinese population.
COVID‐19 and eating disorders during confinement: Analysis of factors associated with resilience and aggravation of symptoms

Abstract Objectives To assess the level of deterioration in functioning of ED patients during confinement, due to COVID‐19, and examine potential contributing factors (coping strategies, anxiety‐depressive symptomatology and personality traits). Methods A total of 74 ED patients in treatment before the COVID‐19 outbreak, contributed to this study. Baseline pre‐treatment evaluation included the SCL‐90R, TCI‐R, EDI‐2 and Y‐FAS 2.0 questionnaires for general psychopathology, personality and ED severity indexes. ED symptoms, coping strategies, socio‐demographic data and COVID‐19 concerns were collected by clinicians through a semi‐structured telephone survey during lockdown. Results A deterioration in ED symptoms and general psychopathology (anxiety and depression), during lockdown, was associated with low self‐directedness. Higher ED symptomatology during confinement was associated with less‐adaptive coping strategies to deal with lockdown situation leading to an increase in weight. Conclusions These specific vulnerability factors to further confinement or stressful situations may help design personalized preventive and therapeutic approaches.
Nonclinical Safety Assessment of an Inhaled Formulation of Serelaxin: A Recombinant Human Protein in Rats and Cynomolgus Monkeys (Macaca fascicularis)

Serelaxin is a recombinant human relaxin-2 intended for cardiovascular indications. Inhalation was chosen as alternative route to intravenous to allow daily administration for chronic applications and home treatment. A total of 4 short-term studies were conducted in rats and cynomolgus monkeys with inhaled formulation of serelaxin at dose up to 10 mg/kg/d. All rats and cynomolgus macaques receiving serelaxin were exposed to the test item. One rat and approximately 50% of macaques developed immunogenicity, which did not appear to affect exposure. No adverse effect on respiratory function or systemic changes was noted. Both species developed similar microscopic lesions characterized by eosinophilic cell infiltration around bronchi; however, in the rat, this was more pronounced and extended to a perivascular location. In addition, in the rat, serelaxin showed eosinophilic crystalline material associated with macrophages in the alveoli and bronchioles. In macaques, serelaxin induced minimal macrophage infiltrates in alveoli and perivascular/peribronchiolar mononuclear cell infiltrations. The minimal airway eosinophilic/mononuclear inflammatory cell infiltrations were considered to be nonadverse in macaques due to the minimal severity and the lack of any other alterations in the lung parenchyma. In the rat, the presence of eosinophilic crystalline material and macrophage response, characterized as precipitated test article, was considered adverse.
Unusual oak leaf galls from the middle Miocene of northwestern Nevada

Distinctive galls have been found on a fossil oak leaf from the Miocene Gillam Springs Flora of Washoe County, Nevada. The described galls are located on the leaf surface of Quercus hannibali Dorf, an analogue of the modern species Q. chrysolepis Liebmann. Similar galls are found on extant Quercus, but the fossils seem distinctive enough to warrant description as Antronoides schorni new genus and species. The occurrence of Antronoides schorni coincides with a rapid episode of change from a mesic to a more xeric habitat, with a concomitant shift from an oak-dominated to a conifer-dominated paleoflora. Recent work suggests that speciation and radiation of galling insects is highest in xeric environments, possibly due to decreases in rates of parasitism and disease. This pattern has been documented for modern galling insects and fits the qualitative fossil evidence we present. These galls also support the hypothesis that cynipids in the Antron group originated in Nevada or eastern California and migrated from their point of origin to their current range in the Sierra Nevada and Coast Ranges.
Differential Role of Psychosocial, Health Care System and Neighborhood Factors on the Retention in HIV Care of Women and Men in the Ryan White Program

We investigated potential differential impact of barriers to HIV care retention among women relative to men. Client intake, health assessment, service, and laboratory information among clients receiving medical case management during 2017 in the Miami-Dade County Ryan White Program (RWP) were obtained and linked to American Community Survey data by ZIP code. Cross-classified multilevel logistic regression analysis was conducted. Among 1609 women and 5330 men, 84.6% and 83.7% were retained in care. While simultaneously controlling for all demographic characteristics, vulnerable/enabling factors, and neighborhood indices in the model, younger age, being US born, not working, and having a medical provider with low volume (<10) of clients remained associated with non-retention in care among women and men; while having ≥3 minors in the household and being perinatally infected were additionally associated with retention only for women. Both gender-specific and gender-non-specific barriers should be considered in efforts to achieve higher retention rates.
In a search for efficient treatment for amyotrophic lateral sclerosis: Old drugs for new approaches

Recent progress in understanding the pathological changes in the nervous system and in certain other body systems (e.g., immune system) that lead to the development and progression of amyotrophic lateral sclerosis (ALS) revealed a number of molecular and cellular processes that can potentially be used as therapeutic targets. Many of these processes are compromised not only in ALS but also in other diseases and a repertoire of drugs able to restore, at least partially, their functionality has been developed. In this review, we briefly describe current approaches to the repurposing of such “old” drugs for treatment of patients with ALS.
Allovalency observed by transferred NOE: interactions of sulfated tyrosine residues in the N‐terminal segment of CCR5 with the CCL5 chemokine

The N‐terminal segment of the chemokine receptor Human CC chemokine receptor 5 (CCR5), Nt‐CCR5, contains four tyrosine residues, Y3, Y10, Y14, and Y15. Sulfation of at least two of these tyrosine residues was found to be essential for high‐affinity binding of CCR5 to its chemokine ligands. Here, we show that among the monosulfated Nt‐CCR5(8‐20) peptide surrogates (sNt‐CCR5) those sulfated at Y15 and Y14 have the highest affinity for the CC chemokine ligand 5 (CCL5) chemokine in comparison with monosulfation at position Y10. Sulfation at Y3 was not investigated. A peptide sulfated at both Y14 and Y15 has the highest affinity for CCL5 by up to a factor of 3, in comparison with the other disulfated (sNt‐CCR5) peptides. Chemical shift perturbation analysis and transferred nuclear Overhauser effect measurements indicate that the sulfated tyrosine residues interact with the same CCL5‐binding pocket and that each of the sulfated tyrosines at positions 10, 14, and 15 can occupy individually the binding site on CCL5 in a similar manner, although with somewhat different affinity, suggesting the possibility of allovalency in sulfated Nt‐CCR5 peptides. The affinity of the disulfated peptides to CCL5 could be increased by this allovalency and by stronger electrostatic interactions.
Validamycin A induces broad-spectrum resistance involving in salicylic acid, and jasmonic acid/ ethylene signaling pathways.

Validamycin A (VMA) is an aminoglycoside antibiotic used to control rice sheath blight. Although it has been reported that VMA can induce the plant defense responses, the mechanism remains poorly understood. Here we found that reactive oxygen species (ROS) bursts and callose deposition in Arabidopsis thaliana, rice (Oryza sativa L.) and wheat (Triticum aestivum L.) were induced by VMA and were most intense with 10 μg mL-1 of VMA at 24 h. Moreover, we showed that VMA induced resistance against Pseudomonas syringae, Botrytis cinerea, and Fusarium graminearum in Arabidopsis leaves, indicating that VMA induces broad-spectrum disease resistance in both dicots and monocots. Furtherly, VMA-mediated resistance against P. syringae was not induced in NahG transgenic plants, partially decreased in npr1 mutants, and VMA-mediated resistance to B. cinerea was not induced in npr1, jar1, and ein2 mutants. These results strongly indicated that VMA triggers plant defense responses to both biotrophic and necrotrophic pathogens involving in salicylic acid (SA), jasmonic acid/ ethylene (JA/ET) signaling pathway and dependent on NPR1. In addition, transcriptome analysis further revealed that VMA regulated the expressions of genes involved in SA, JA/ET, abscisic acid (ABA) and Auxin signal pathways. Taken together, VMA induces systemic resistance involving in SA, and JA/ET signaling pathways, and also exerts a positive influence on ABA and Auxin signaling pathways. Our study highlighted the creative application of VMA in triggering plant defense responses against plant pathogens, providing a valuable insight into applying VMA to enhance plant resistance and reduce the use of chemical pesticides.
Comparing the Effects of Reading Intervention Versus Reading and Mindset Intervention for Upper Elementary Students With Reading Difficulties

The primary purpose of this study was to examine the effects of providing mindset intervention in addition to reading intervention compared with only reading intervention for fourth graders with reading difficulties. Reading intervention was provided daily in 45 min sessions throughout the school year. Mindset intervention occurred in small groups for 24–30 min lessons. Multilevel structural equation modeling (SEM) via n-level SEM was used to account for the latent variable representation of constructs, and the complex nesting and cross-classification structure of the data. Students in the reading intervention plus mindset condition significantly outperformed the business as usual condition on nonword reading (d = 0.35) as did students in the reading intervention condition (d = 0.20), who also outperformed the business as usual condition on phonological processing (d = 0.28). There were no significant differences among students in the three conditions on nonword reading, word reading, phonological processing, reading comprehension, or growth mindset. Initial reading achievement, mindset, and problem behavior did not generally moderate these findings.
Factor Structure and Construct Validity of the Proposed Specifiers for Conduct Disorder (PSCD) Scale in Chinese Adolescents

The Proposed Specifiers for Conduct Disorder (PSCD) Scale is a new measure to assess psychopathic traits and symptoms of conduct disorder (CD) in children and adolescents. The current study examined the psychometric properties of the self-report version of the PSCD in a sample of community adolescents in mainland China (N = 1,683; mean age = 13.60, SD = 1.14; 54.1% boys). The new instrument showed good internal consistency (alpha) for the 24-item total scale and good mean interitem correlations for each of the six-item subscales. Confirmatory factor analyses (CFAs) were conducted on all 24 items, and also a subset of 13 items that demonstrated strong item-level reliabilities. Using all 24 items, CFA results supported a four-factor bifactor model indicating the total score reflects a broad syndrome with four factors. The four factors included grandiose–manipulative traits (GM traits), callous–unemotional traits (CU traits), daring–impulsive traits (DI traits), and CD traits. The 13-item CFA results provided further support for a four-factor conceptualization of the PSCD and evidence of strong measurement invariance across gender. Finally, the PSCD exhibited the expected relations with other psychopathy measures, anxiety and depression, and aggression, supporting the PSCD scores convergent, discriminant, and criterion related validity. The findings provide preliminary evidence for the four-factor structure of the PSCD and support for the utility of the self-report PSCD for measuring psychopathic traits and CD in Chinese adolescents.
A history of smoking does not reduce long-term benefits of cardiac rehabilitation on cardiorespiratory fitness in men and women with cardiovascular disease.

Smoking is an important risk factor for cardiovascular disease and all-cause mortality. Cardiac rehabilitation (CR) is effective for reducing the risk of recurrent cardiac events through improving cardiorespiratory fitness (CRF). Little is known about the influence of smoking on CRF throughout long-term CR. The purpose of this analysis was to compare CRF trajectories among individuals with positive and negative smoking history enrolled in long-term CR. Participants had a positive smoking history if they currently smoke or formerly smoked (Smoke+, n=55, mean age=64.9 ± 9.0 years) and had a negative history if they never smoked (Smoke-, n=34, mean age=61.4 ± 9.0 years). CRF (VO2peak) was measured at baseline and annually thereafter for 6 years. The Smoke+ group had lower CRF compared to the Smoke- group over enrollment (β=-3.29 (SE=1.40), 95% CI -6.04, -0.54, p=0.02), but there was no interaction of smoking history and enrollment (β=0.35 (SE=0.21), 95% CI -0.06, 0.77, p=0.10). Moreover, trajectories were not influenced by pack-years (β=0.01 (SE=0.01), 95% CI -0.01, 0.04, p=0.23) or time smoke-free (β=-0.002 (SE=0.01), 95% CI -0.02, 0.02, p=0.80). Although the trajectories of CRF do not appear to be affected by smoking behaviour, individuals without a history of smoking maintained higher CRF throughout enrollment. Novelty bullets: • The benefits of long-term exercise-based cardiac rehabilitation on cardiorespiratory fitness are similar between those who have smoked and those who have never smoked. • Neither the number of pack-years nor the length of time spent smoke-free influence cardiorespiratory fitness trajectories following long-term cardiac rehabilitation.