Miracle-dz/UniFAR-FTUs huggingface dataset:
Operative trauma volume is not related to risk-adjusted mortality rates among Pennsylvania trauma centers

Center-level operative trauma volume is not related to risk-adjusted mortality rates among Pennsylvania trauma centers. Supplemental digital content is available in the text. BACKGROUND Higher center-level operative volume is associated with lower mortality after complex elective surgeries, but this relationship has not been robustly demonstrated for operative trauma. We hypothesized that trauma centers in Pennsylvania with higher operative trauma volumes would have lower risk-adjusted mortality rates than lower volume institutions. METHODS We queried the Pennsylvania Trauma Outcomes Study database (2017–2019) for injured patients 18 years or older at Level I and II trauma centers who underwent an International Classification of Diseases, Tenth Revision (ICD-10), procedure code–defined operative procedure within 6 hours of admission. The primary exposure was tertile of center-level operative volume. The primary outcome of interest was inpatient mortality. We entered factors associated with mortality in univariate analysis (age, injury severity, mechanism, physiology) into multivariable logistic regression models with tertiles of volume accounting for center-level clustering. We conducted secondary analyses varying the form of the association between the volume and mortality to including dichotomous and fractional polynomial models. RESULTS We identified 3,650 patients at 29 centers meeting the inclusion criteria. Overall mortality was 15.9% (center-level range, 6.7–34.2%). Operative procedure types were cardiopulmonary (7.3%), vascular (20.1%), abdominopelvic (24.3%), and multiple (48.3%). The mean annual operative volume over the 3 years of data was 10 to 21 operations for low-volume centers, 22 to 47 for medium-volume centers, and 47 to 158 for high-volume centers. After controlling for patient demographics, physiology, and injury characteristics, there was no significant difference in mortality between highest and lowest tertile centers (odds ratio, 0.92; confidence interval, 0.57–1.49). Secondary analyses similarly demonstrated no relationship between center operative volume and mortality in key procedure subgroups. CONCLUSION In a mature trauma system, we found no association between center-level operative volume and mortality for patients who required early operative intervention for trauma. Efforts to standardize the care of seriously injured patients in Pennsylvania may ensure that even lower-volume centers are prepared to generate satisfactory outcomes. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
A population pharmacokinetic-pharmacodynamic model of navtemadlin, its glucuronide metabolite (M1) and serum macrophage inhibitory cykokine-1 (MIC-1)

Abstract Navtemadlin is a potent, selective, orally available inhibitor of murine double minute 2 that restores p53 activity to induce apoptosis in TP53 wild-type malignancies. Using richly sampled pharmacokinetic (PK) and pharmacodynamic (PD) data from healthy volunteers, a population PK/PD model was developed. A population PK (PPK) model described the PK characteristics of navtemadlin and its major metabolite acyl glucuronide (M1) and quantified enterohepatic recirculation (EHR). Post hoc individual PK parameters from this model were coupled with PD data for serum macrophage inhibitory cytokine-1 (MIC-1, GDF15), a cytokine biomarker of p53 activation, to construct a population PK/PD model that described plasma concentration-driven MIC-1 excursions and enabled simulation of the extent and duration of navtemadlin PD effects. The median apparent clearance (CL/F) and apparent central volume (V2/F) of navtemadlin were 36.4 L/hr and 159 L. The typical maximum stimulatory effect (Smax) was close to the median maximum MIC-1 ratio to baseline of 7.29 in observed data. Simulation revealed a dose-dependent increase of MIC-1 with steady state attained in approximately 7 days, in a 7-day-on/21-day-off dose regimen. Elevated MIC-1 concentrations persist through 17–19 days, leaving about 9-11 PD-free days in a 28-day cycle.
The impact of the demographic shift on limb amputation incidence in Saskatchewan, Canada, 2006–2019

Background Changing demographics in a population may have an inevitable influence on disease incidence including limb amputation. However, the extent to which these changes affect limb amputation (LA) is unknown. Understanding the impact of changing demographics on LA would provide the best opportunity to plan for the future. We assessed the impact of changes in age and sex on limb amputation in Saskatchewan between 2006 and 2019. Methods Retrospective linked Saskatchewan’s LA cases, and demographic characteristics and residents population from 2006–2019 was used. The amputation rate was calculated by dividing the total number of LA cases recorded each year by the annual Saskatchewan resident population and the results expressed per 100,000 populations. Furthermore, decomposition analysis was used to assess the impact of changes in age and sex on LA in a decade (2008–2017) and the Generalized Additive Model (GAM) was employed to examine the linear and non-linear effect of age. Results We found that in the ten years (2008–2017), the absolute LA rate difference was 9.0 per 100,000 population. Changes in age structure alone contributed 7.7% to the LA rate increase and 92.3% to changes in age-specific LA rates. The decade witnessed a marginal population difference between males and females, but the LA rate was 2.1–2.2 times higher in males than in females. The GAM revealed a non-linear relationship between LA and age, and further indicates that the risk of LA significantly increased as age increases. Conclusions In a decade, we found that changes in age distribution and age-specific rate substantially impacted the increase in the LA rate observed in the province. This highlights the urgent need for strategized programs to respond to these changes as both the population and diabetes, which is age-dependent and a leading cause of LA, are expected to increase in the province by 2030. As changes in population and demographic factors are inevitable, this study provides data for policy makers on the need for continuous incorporation of the shift in population in the design of future health services.
Electronic Connectivity Among US Hospitals Treating Shared Patients

Background: Increasing electronic health information exchange (HIE) between provider organizations is a top policy priority that has been pursued by establishing varied types of networks. Objectives: To measure electronic connectivity enabled by these networks, including community, electronic health record vendor, and national HIE networks, across US hospitals weighted by the volume of shared patients and identify characteristics that predict connectivity. Research Design: Cross-sectional analysis of 1721 hospitals comprising 16,344 hospital pairs and 6,492,232 shared patients from 2018 CareSet Labs HOP data and national hospital surveys. Subjects: Pairs of US acute care hospitals that delivered care to 11 or more of the same fee-for-service Medicare beneficiaries in 2018. Measures: Whether a patient was treated by a pair of hospitals connected through participation in the same HIE network (“connected hospitals”) or not connected because the hospitals participated in different networks, only 1 participated, or both did not participate. Results: Sixty-four percent of shared patients were treated by connected hospitals. Of the remaining shared patients, 14% were treated by hospital pairs that participated in different HIE networks, 21% by pairs in which only 1 hospital participated in an HIE network, and 2% by pairs in which neither participated. Patients treated by pairs with at least 1 for-profit hospital, and by pairs located in competitive markets, were less likely to be treated by connected hospitals. Conclusions: While the majority of shared patients received care from connected hospitals, remaining gaps could be filled by connecting HIE networks to each other and by incentivizing certain types of hospitals that may not participate because of competitive concerns.
Health-related quality of life and associated factors among adult podoconiosis patients in Debre Elias district Northwest, Ethiopia

Background Podoconiosis is endemic non-filarial elephantiasis and non-infective neglected tropical disease. It has a wide impact on the physical, social and psychological aspects of the well-being of a person. However, limited information is available about the disease burden on health-related quality of life and associated factors in Ethiopia. Objective This study aimed is to determine health-related quality of life and associated factors among adult podoconiosis patients in Debre Elias district, Northwest, Ethiopia. Methods A community-based cross-sectional study was conducted from February 1 to March 30, 2020 in the Debre Elias district. A multi-stage stratified; systematic random sampling technique was employed to select 403 podoconiosis patients. The data were collected through an interviewer-administered questionnaire. Data were entered into Epi data version 4.6 and exported to STATA version 14 for analysis. After the assumption check for the linear regression model, simple and multiple regression was done to see the association between the predictor and outcome variables. Predictor variables that had p-value <0.2 at simple linear regression were taken into multiple linear regression. β coefficient with 95% CI and p-value of <0.05 was considered as statistically significant variables in multiple linear regression analysis. Result The overall mean quality of life score among podoconiosis patients was 61.93±17.14. The mean quality of life score for the physical, psychological, social, and environmental domains were 75.57±21.86, 60.43±18.58, 30.34±10.46, and 81.38±22.77 respectively. Foot care had a statically significant association with all domains. Higher quality of life podoconiosis patients was associated with foot care. Lower quality of life was associated with the presence of anxiety, advanced stage of the disease, and frequent adenolymphangitis attack. Conclusion Social and psychological domains of quality of life were lowest as compared to physical and environmental domains of quality of life. Early medical treatment, psychosocial support, and home-based foot care should be encouraged to improve the quality of life in podoconiosis patients.
Advancing theorizing about fast-and-slow thinking

Abstract Human reasoning is often conceived as an interplay between a more intuitive and deliberate thought process. In the last 50 years, influential fast-and-slow dual-process models that capitalize on this distinction have been used to account for numerous phenomena – from logical reasoning biases, over prosocial behavior, to moral decision making. The present paper clarifies that despite the popularity, critical assumptions are poorly conceived. My critique focuses on two interconnected foundational issues: the exclusivity and switch feature. The exclusivity feature refers to the tendency to conceive intuition and deliberation as generating unique responses such that one type of response is assumed to be beyond the capability of the fast-intuitive processing mode. I review the empirical evidence in key fields and show that there is no solid ground for such exclusivity. The switch feature concerns the mechanism by which a reasoner can decide to shift between more intuitive and deliberate processing. I present an overview of leading switch accounts and show that they are conceptually problematic – precisely because they presuppose exclusivity. I build on these insights to sketch the groundwork for a more viable dual-process architecture and illustrate how it can set a new research agenda to advance the field in the coming years.
A Prediction Model Based on the Risk Factors Associated with Pathological Upgrading in Patients with Early-Stage Gastric Neoplasms Diagnosed by Endoscopic Forceps Biopsy

Background/Aims The discrepancies between the diagnosis of preoperative endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) in patients with early gastric neoplasm (EGN) exist objectively. Among them, pathological upgrading directly influences the accuracy and appropriateness of clinical decisions. The aims of this study were to investigate the risk factors for the discrepancies, with a particular focus on pathological upgrading and to establish a prediction model for estimating the risk of pathological upgrading after EFB. Methods We retrospectively collected the records of 978 patients who underwent ESD from December 1, 2017 to July 31, 2021 and who had a final histopathology determination of EGN. A nomogram to predict the risk of pathological upgrading was constructed after analyzing subgroup differences among the 901 lesions enrolled. Results The ratio of pathological upgrading was 510 of 953 (53.5%). Clinical, laboratorial and endoscopic characteristics were analyzed using univariable and binary multivariable logistic regression analyses. A nomogram was constructed by including age, history of chronic atrophic gastritis, symptoms of digestive system, blood high density lipoprotein concentration, macroscopic type, pathological diagnosis of EFB, uneven surface, remarkable redness, and lesion size. The C-statistics were 0.804 (95% confidence interval, 0.774 to 0.834) and 0.748 (95% confidence interval, 0.664 to 0.832) in the training and validation set, respectively. We also built an online webserver based on the proposed nomogram for convenient clinical use. Conclusions The clinical value of identifying the preoperative diagnosis of EGN lesions is limited when using EFB separately. We have developed a nomogram that can predict the probability of pathological upgrading with good calibration and discrimination value.
Use of 99mTc‐sestamibi SPECT/CT for indeterminate renal tumours: a pilot diagnostic accuracy study

The increase in cross-sectional imaging across medical disciplines has led to a rise in incidentally-detected renal tumours worldwide [1]. Contemporary imaging cannot reliably distinguish benign from malignant tumours. Renal tumour biopsy is a relatively safe, albeit invasive test with good diagnostic accuracy [2]; however, there is a lack of consensus on its role in the renal tumour diagnostic paradigm [3]. Surgical resection of renal tumours remains the current standard of care, which is considered both diagnostic and therapeutic. However, up to 30% of renal tumours in surgical series are found to be benign [4]. Surgery, with its associated risks, morbidity and costs may represent significant overtreatment of benign tumours [5]. The radiotracer Tc-sestamibi (MIBI) combined with single-photon emission computed tomography/computed tomography (SPECT/CT) (MIBI-kidney) is an emerging imaging test for non-invasive characterisation of renal tumours [6].
Acoustic Force Elastography Microscopy

Objective: Hydrogel scaffolds have attracted attention to develop cellular therapy and tissue engineering platforms for regenerative medicine applications. Among factors, local mechanical properties of scaffolds drive the functionalities of cell niche. Dynamic mechanical analysis (DMA), the standard method to characterize mechanical properties of hydrogels, restricts development in tissue engineering because the measurement provides a single elasticity value for the sample, requires direct contact, and represents a destructive evaluation preventing longitudinal studies on the same sample. We propose a novel technique, acoustic force elastography microscopy (AFEM), to evaluate elastic properties of tissue engineering scaffolds. Results: AFEM can resolve localized and two-dimensional (2D) elastic properties of both transparent and opaque materials with advantages of being non-contact and non-destructive. Gelatin hydrogels, neat synthetic oligo[poly(ethylene glycol)fumarate] (OPF) scaffolds, OPF hydroxyapatite nanocomposite scaffolds and ex vivo biological tissue were examined with AFEM to evaluate the elastic modulus. These measurements of Young's modulus range from approximately 2 kPa to over 100 kPa were evaluated and are in good agreement with finite element simulations, surface wave measurements, and DMA tests. Conclusion: The AFEM can resolve localized and 2D elastic properties of hydrogels, scaffolds and thin biological tissues. These materials can either be transparent or non-transparent and their evaluation can be done in a non-contact and non-destructive manner, thereby facilitating longitudinal evaluation. Significance: AFEM is a promising technique to quantify elastic properties of scaffolds for tissue engineering and will be applied to provide new insights for exploring elastic changes of cell-laden scaffolds for tissue engineering and material science.
Physical exertion as a risk factor for perimesencephalic nonaneurysmal subarachnoid hemorrhage

Perimesencephalic and nonperimesencephalic nonaneurysmal subarachnoid hemorrhage (PM‐naSAH and NPM‐naSAH) have a different bleeding pattern and clinical course. The etiology and risk factors for PM‐naSAH and NPM‐naSAH are unclear. The objective of this study was to compare risk factors and triggering events between PM‐naSAH and NPM‐naSAH.
The effect of green coffee and/or endurance exercise on sperm function in pre‐diabetic mice

This study aimed to investigate the effect of green coffee (GC), chlorogenic acid (CA) as an active ingredient of GC and exercise, alone or in a combination with exercise, on spermatogenesis and sperm function in pre‐diabetic mice. Results revealed that pre‐diabetic status can have a significant adverse effect on spermatogenesis (Johnson score), and sperm concentration, motility, DNA damage and persistent histone in compared to the control group. Although lipid peroxidation, intracellular ROS production, and persistent histones in sperm were high in pre‐diabetic mice, exercise only can improve sperm motility. GC alone only improved sperm motility in pre‐diabetic mice while CA alone, even did not have this beneficial effect. However, GC along with exercise, did not improve motility but reduce DNA damage, while CA with exercise, significantly improved motility compared to pre‐diabetic stage and to the level comparable to control. Therefore, based on this result in individuals with high DNA damage, GC supplementation and exercise could be useful approach while in asthenozoospermia, CA supplementation and exercise should be considered as an alternative approach. However, such an interpretation awaits validation.
An exploratory descriptive cohort study of 90-day prognosis after acute ischaemic stroke with mechanical thrombectomy

Aim To evaluate the relationship between nursing assessment findings at discharge and acute ischaemic stroke (AIS) patient prognosis after mechanical thrombectomy (MT). Methods We analysed the characteristics of 144 AIS patients with MT treatment admitted to a university affiliated teaching hospital in Chengdu, Sichuan Province China, from January 2020 to December 2020. The modified Rankin Scale (mRS) score was used to assess outcomes 90-days after discharge. Exploratory analyses were undertaken using IBM SPSS Statistics (Version 26.0). Results At 90-days, 47.9% (n = 69) had a good prognosis (mRS ≤ 2) including 22.2% (n = 32) fully recovered patients. There were 5 (3.5%) deceased patients and 48.6% (n = 70) of patients had a poor prognosis (mRS ≥ 3). In univariate analysis, clinical prognosis correlated with the need for inpatient endotracheal intubation (p = 0.02), nasogastric tube (p < 0.001), indwelling urinary catheter (p < 0.001), central venous catheter (p = 0.03), health knowledge needs of pressure injury prevention (p = 0.03), National Institute of Health Stroke Scale (NIHSS) score (p < 0.001) and Activities of Daily Living (ADL) score (p < 0.001) at the time of discharge from hospital. The average hospitalization time of the 144 patients was 12[IQR, 9–25] days, and the average cost of hospitalization was $Y$21291.93 (SD 9165.01). Conclusion Almost half of the surviving patients had a poor prognosis. In our country, this surgery and rehabilitation impose a significant financial burden that needs to be addressed. However, the longer length of hospital stay and higher costs at discharge may be contributing factors to worse outcomes. The outcomes of comprehensive nursing assessment of the patients, including nursing needs, activities of daily living, and neurological function, can predict their outcome. Impact statement We recommend a comprehensive nursing assessment at discharge that predicts patient outcomes and can be used for subsequent targeted interventions. The prognosis of patients with acute ischaemic stroke after mechanical thrombectomy is poor, and the financial burden needs to be considered.
A Closed-Form Formula for the Skewness Estimation of Non-Life Reserve Risk Distribution

In the same spirit as the Mack standard deviation for non-life reserves, which can be estimated with a closed-form formula applied to a loss development triangle (see Mack 1993), this article introduces a closed-form formula to estimate the skewness of non-life reserves which can also be applied to a loss development triangle.This closed-form formula is tested on 41 triangles and estimators of skewness per different lines of business are derived. These estimators are used to calibrate skew-normal and Generalized Extreme Value ("GEV") distributions for a fictitious reinsurance company so that a capital amount related to the reserve risk of this company using an internal model is calculated. This capital amount is then compared to the capital amount which would result from the use of lognormal distributions instead of skew-normal or GEV distributions. An excel sheet developed to estimate the presented closed-form formula is available on the internet.
Crystallography and Surface Structure: An Introduction for Surface Scientists and Nanoscientists

1. Introduction 2. Bulk crystals, 3-dimensional lattices 2.1. Basic definitions 2.2. Representation of bulk lattices 2.3. Periodicity cells of lattices 2.4. Lattice symmetry 2.5. Neighbor shells 2.6. Quasicrystals Exercises 3. Crystal layers, 2-dimensional lattices 3.1. Basic definitions, Miller indices 3.2. Reciprocal lattice 3.3. Netplane-adapted lattice vectors 3.4. Symmetrically appropriate lattice vectors, Minkowski reduction 3.5. Miller indices for cubic lattices 3.6. Alternative definition of Miller indices, hexagonal Miller-Bravais indices 3.7. Symmetry properties of netplanes 3.8 Crystal systems and Bravais lattices in two dimensions 3.9 Crystallographic classification of netplanes Exercises 4. Ideal single crystal surfaces 4.1. Basic definitions, termination 4.2. Morphology of surfaces, stepped and kinked surfaces 4.3. Miller index decomposition 4.4. Chiral surfaces Exercises 5. Real crystal surfaces 5.1. Surface relaxation 5.2. Surface reconstruction 5.3. Facetting Exercises 6. Adsorbate layers 6.1. Definition and classification 6.2. Wood notation of surface geometry 6.3. Symmetry domain formation Exercises 7. Experimental analysis of real crystal surfaces 7.1. Experimental methods 7.2. The NIST Surface Structure Database (SSD) Exercises 8. Nanotubes 8.1. Basic definition 8.2. Nanotubes and symmetry 8.3. Complex nanotubes, examples Exercises Appendices: A Mathematics of the Wood notation B Mathematics of the Minkowski reduction C Some details of number theory D Some details of vector calculus and linear algebra E Parameter tables of crystals F Relevant websites