Miracle-dz/UniFAR-FTUs huggingface dataset:
Past, present and future of university hospitals

ABSTRACT Objectives: Health care systems worldwide are changing and taking new forms. The old, more hierarchically oriented, model with individual institutional and bilateral interactions between primary, secondary, tertiary and quaternary care is being replaced by an integrated and dynamic network model. We aim to look at what role university hospitals will play in this future organization of health care. Method: In this paper, we look at the relevant literature on the history of academic medicine and university hospitals. Subsequently, we look at the challenges university hospitals are facing according to contemporary literature on the topic. Results: Our current model of academic medicine with its university hospitals finds its origin in the institutionalization of the academic mission in the late 18th century. Currently, the sustainability of the model is under immense pressure. University hospitals are facing economic challenges, teaching challenges and research challenges. However, there is reason to believe that they can continue to play a role of importance in tomorrow’s medicine. The organization of health care is undergoing two important changes. The first is the evolution towards a more dynamic and integrated network model. University hospitals can become an important hub within this network. The second change is an evolution towards evidence based medicine and translational research. Conclusion: Due to their unique tripartite mission, we argue that university hospitals can continue to play an important and critical role in promoting evidence-based medicine and speedy translation of new evidence.
Causality of energy-containing eddies in wall turbulence

Turbulent flows in the presence of walls may be apprehended as a collection of momentum- and energy-containing eddies (energy-eddies), whose sizes differ by many orders of magnitude. These eddies follow a self-sustaining cycle, i.e. existing eddies are seeds for the inception of new ones, and so forth. Understanding this process is critical for the modelling and control of geophysical and industrial flows, in which a non-negligible fraction of the energy is dissipated by turbulence in the immediate vicinity of walls. In this study, we examine the causal interactions of energy-eddies in wall-bounded turbulence by quantifying how the knowledge of the past states of eddies reduces the uncertainty of their future states. The analysis is performed via direct numerical simulation of turbulent channel flows in which time-resolved energy-eddies are isolated at a prescribed scale. Our approach unveils, in a simple manner, that causality of energy-eddies in the buffer and logarithmic layers is similar and independent of the eddy size. We further show an example of how novel flow control and modelling strategies can take advantage of such self-similar causality.
Ultrasound guidance in difficult radial artery puncture for blood gas analysis: A prospective, randomized controlled trial

Background Ultrasound (US) guidance has yet to prove its applicability in radial arterial blood gas analysis (ABGA) punctures. The main objective of our study was to compare the number of first-attempt successes (NFAS) for radial arterial puncture in difficult patients with or without US guidance. The Secondary aims were to compare the number of punctures (NOP), puncture time, and patient pain. Methods In this single-center, randomized controlled trial, patients who required a radial ABGA and in whom the arterial puncture was assessed as difficult (because of non-palpable radial arteries or two previous puncture failures by a nurse) were assigned to the US group or no-US (NUS) group (procedure performed by a trained physician). Results Thirty-six patients were included in the US group and 37 in the NUS groups. The NFAS was 7 (19%) in the NUS group and 19 (53%) in the US group. The relative risk of success in the US group was 2.79 (95% CI,1.34 to 5.82), p = 0.01. In the NUS and US groups, respectively, the median NOP was 3 [2; 6] vs. 1 [1; 2], estimated difference −2.0 (95%CI, −3.4 to −0.6), p < 0.01; the respective puncture time was 3.1 [1.6; 5.4] vs. 1.4 [0.6; 3.1] min, estimated difference −1.45 (95%CI, −2.57 to −0.39), p = 0.01; the respective median patient pain was 6 [4; 8] vs. 2 [1; 4], estimated difference −4.0 (95%CI, −5.8 to −2.3); p < 0.01. Conclusion US guidance by a trained physician significantly improves the rate of success in difficult radial ABGA patients.
Immunomodulatory effect of oleoylethanolamide in dendritic cells via TRPV1/AMPK activation

Oleoylethanolamide (OEA) is an endogenous lipid mediator involved in the control of feeding, body weight, and energy metabolism. However, whether OEA modulates maturation of dendritic cells (DCs) has never been addressed. Hence, we evaluated the effect of OEA on DCs maturation in bone marrow‐derived DCs (BMDCs) in four aspects: (a) Cell surface markers were determined using flow cytometric analysis; (b) cell mobile ability was testified with the transwell assay; (c) stimulation of T cells proliferation was performed in a coculture system; and (d) cytokine production was measured using polymerase chain reaction (PCR). The result showed that, in mature BMDCs induced by lipopolysaccharides (LPS), the OEA treatment decreased expressions of cell surface markers, reduced cell migration, diminished the proliferation of cocultured T cells, and regulated cytokine production of BMDCs, indicating the modulatory effect of OEA on DCs maturation. Furthermore, to explore the underlying mechanism of the immunomodulatory effect of OEA, we used antagonists of transient receptor potential vanilloid‐1 (TRPV1) and AMP‐activated protein kinase (AMPK), determined the protein expressions of TRPV1/AMPK and Toll‐like receptor 4 (TLR4)/nuclear factor‐kappa B (NF‐κB) using western blot, and measured the intracellular calcium concentration using calcium imaging. The result illustrated that OEA downregulated TLR4/NF‐κB, the classical pathway leading to DCs maturation induced by LPS, through the activation of TRPV1 and AMPK. Collectively, the present study suggests that OEA suppresses DCs maturation through the activation of TRPV1/AMPK. These findings increase our understanding of this endogenous lipid OEA.
Electricity and Firm Productivity: A General-Equilibrium Approach

Many policymakers view power outages as a major constraint on firm productivity in developing countries. Yet empirical studies find modest short-run effects of outages on firm performance. This paper builds a dynamic macroeconomic model to study the long-run general-equilibrium effects of power outages on productivity. Outages lower productivity in the model by creating idle resources, depressing the scale of incumbent firms and reducing entry of new firms. Consistent with the empirical literature, the model predicts small short-run effects of eliminating outages. However, the long-run general-equilibrium effects are much larger, supporting the view that eliminating outages is an important development objective. (JEL D22, D24, G32, L94, O13, O14)
Faculty stressors and their relations to teacher efficacy, engagement and teaching satisfaction

ABSTRACT This study investigated faculty-perceived stressors and their relationships with teacher efficacy, engagement and teaching satisfaction in mainland China. The results of a survey of 2758 faculty members from 25 public institutions showed a generally high level of stress, and the stress varied among different types of institution and demographic groups. In a series of bivariate analyses and structural equation models, we found no compelling evidence that faculty stressors were associated with efficacy, engagement, or satisfaction. Instead, our findings show that efficacy is a key factor in explaining the variation in teaching outcomes. These findings suggest a need to elaborate our theoretical models on faculty development and stress to include processes of stress appraisal and coping.
Diagnostic tests for Crimean-Congo haemorrhagic fever: a widespread tickborne disease

Crimean-Congo haemorrhagic fever (CCHF) is a widespread tickborne disease that circulates in wild and domestic animal hosts, and causes severe and often fatal haemorrhagic fever in infected humans. Due to the lack of treatment options or vaccines, and a high fatality rate, CCHF virus (CCHFV) is considered a high-priority pathogen according to the WHO R&D Blueprint. Several commercial reverse transcriptase PCR (RT-PCR) and serological diagnostic assays for CCHFV are already available, including febrile agent panels to distinguish CCHFV from other viral haemorrhagic fever agents; however, the majority of international laboratories use inhouse assays. As CCHFV has numerous amplifying animal hosts, a cross-sectoral ‘One Health’ approach to outbreak prevention is recommended to enhance notifications and enable early warning for genetic and epidemiological shifts in the human, animal and tick populations. However, a lack of guidance for surveillance in animals, harmonisation of case identification and validated serodiagnostic kits for animal testing hinders efforts to strengthen surveillance systems. Additionally, as RT-PCR tests tend to be lineage-specific for regional circulating strains, there is a need for pan-lineage sensitive diagnostics. Adaptation of existing tests to point-of-care molecular diagnostic platforms that can be implemented in clinic or field-based settings would be of value given the potential for CCHFV outbreaks in remote or low-resource areas. Finally, improved access to clinical specimens for validation of diagnostics would help to accelerate development of new tests. These gaps should be addressed by updated target product profiles for CCHFV diagnostics.
Short Versus Long InterTAN Fixation for Geriatric Intertrochanteric Hip Fractures: A Multicentre Head-to-Head Comparison

Objective: To determine if geriatric intertrochanteric hip fracture patients achieve equivalent postoperative functional status after management with either a short (180-200 mm) or a long (260-460 mm) InterTAN intramedullary device. Design: Retrospective review of a prospective randomized control trial. Setting: Four Level I Trauma Centers. Patients/Participants: One hundred eight patients with OTA/AO classification 31A-1 and 31A-2 intertrochanteric hip fractures were included in the study. Intervention: Internal fixation using an IT device. Main Outcomes Measures: Primary outcomes included Functional Independence Measure and Timed Up and Go. Secondary outcomes included blood loss, surgical time, length of stay, adverse events, and mortality. Results: Seventy-one short and 37 long IT patients met study inclusion criteria. Demographics were similar between groups. There was no difference in Functional Independence Measure or Timed Up and Go scores between the 2 IT groups at any of the time points collected. Mean operative time was lower in the short IT group than in the long IT group (60 vs. 73 minutes; P = 0.021). A higher proportion of long IT patients had reamed constructs (95% vs. 48% short IT, P < 0.001). Postoperative blood loss was significantly higher in the long IT group without a significant influence on the number of patients requiring transfusion (P = 0.582) or average units transfused (P = 0.982). There was no significant difference in the proportion of postoperative adverse events between the 2 cohorts despite a higher number of peri-implant femur fractures in the short IT group than in the long IT group (5 vs. 1, P = 0.350). Conclusions: Postoperative functional status was not influenced by the length of IT device in the management of geriatric intertrochanteric hip fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Mediation of the Effect of Glycemia on the Risk of CVD Outcomes in Type 1 Diabetes: The DCCT/EDIC Study

OBJECTIVE The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study has demonstrated the major role of hyperglycemia as a risk factor for clinical cardiovascular outcomes in type 1 diabetes (T1D). We assessed whether and to what extent the effect of glycemia is mediated by other established cardiovascular disease (CVD) risk factors. RESEARCH DESIGN AND METHODS In the DCCT, 1,441 participants were randomized to receive either intensive or conventional diabetes therapy. The EDIC observational follow-up study enrolled 96% of the surviving DCCT cohort with 94% of the survivors still actively participating after more than 27 years of follow-up. Mediation of the effect of glycemia, as captured by HbA1c, on the subsequent CVD risk was quantified using the relative change in the CVD risk associated with HbA1c between models without and with the potential mediator. RESULTS Adjusted for age, only a few factors (e.g., pulse, triglycerides, albumin excretion rate) explained more than 10% of the effect of glycemia on CVD risk when considered individually. In multivariable models, these traditional risk factors together mediated up to ∼50% of the effect of glycemia on the risk of CVD. However, the association between HbA1c and the risk of CVD remained highly significant even after adjustment for these risk factors. CONCLUSIONS While HbA1c is associated with many traditional CVD risk factors, its association with these factors alone cannot explain its effects on risk of CVD. Consequently, aggressive management of traditional nonglycemic CVD risk factors, coupled with aggressive glycemic management, is indicated for individuals with type 1 diabetes.
Low guanylyl cyclase activity in Weddell seals: implications for peripheral vasoconstriction and perfusion of the brain during diving.

Nitric oxide (NO) is a potent vasodilator, which improves perfusion and oxygen delivery during tissue hypoxia in terrestrial animals. The vertebrate dive response involves vasoconstriction in select tissues, which persists despite profound hypoxia. Using tissues collected from Weddell seals at necropsy, we investigated whether vasoconstriction is aided by downregulation of local hypoxia signaling mechanisms. We focused on NO-soluble guanylyl cyclase (GC)-cGMP signaling, a well-known vasodilatory transduction pathway. Seals have a lower GC protein abundance, activity, and capacity to respond to NO stimulation than do terrestrial mammals. In seal lung homogenates, GC produced less cGMP (20.1 ± 3.7 pmol·mg protein-1·min-1) than the lungs of dogs (-80 ± 144 pmol·mg protein-1·min-1 less than seals), sheep (-472 ± 96), rats (-664 ± 104) or mice (-1,160 ± 104, P < 0.0001). Amino acid sequences of the GC enzyme α-subunits differed between seals and terrestrial mammals, potentially affecting their structure and function. Vasoconstriction in diving Weddell seals is not consistent across tissues; perfusion is maintained in the brain and heart but decreased in other organs such as the kidney. A NO donor increased median GC activity 49.5-fold in the seal brain but only 27.4-fold in the kidney, consistent with the priority of cerebral perfusion during diving. Nos3 expression was high in the seal brain, which could improve NO production and vasodilatory potential. Conversely, Pde5a expression was high in the seal renal artery, which may increase cGMP breakdown and vasoconstriction in the kidney. Taken together, the results of this study suggest that alterations in the NO-cGMP pathway facilitate the diving response.
Peripheral eye length measurement techniques: a review

Along with the rising myopia epidemic is the increasing interest in any ocular parameter that might inform understanding of myopia progression. The relationship between eye length and myopia has long been established but the recent interest in the central and peripheral retina, eye shape, retinal contour, and refractive error development is attracting more clinical and research interest in peripheral eye length measurements. Therefore, peripheral eye length measurements are an important step in the ongoing research involving the peripheral retina. Since the first measurement of peripheral eye length reported in 1991, many techniques and methods have been developed, which vary in many aspects. These techniques involve custom‐built or modified commercially available instruments, with the use of off‐axis targets and other considerations such as eye or head turn of the subject. The wide range of methods and instruments used for peripheral eye length measurements make it difficult to compare results and may account for some of the variations in the reported results. Specifications of the different methods are presented along with their advantages and disadvantages. Although researchers acknowledge a good agreement between the modified commercially available optical biometers for peripheral eye length measurement, the Lenstar LS 900 appears to offer better results. Nevertheless, the introduction to the market of an instrument specially designed for peripheral eye length might overcome the issues noted with other methods and could allow for more insights in future research involving the peripheral retina. Moreover, future studies may be able to track peripheral eye length changes and its relationship to the progression of myopia and find out if those changes are responsible for or correlated with important eye conditions.
Using Nonexperimental Methods to Address Noncompliance

The analysis compares estimates of the incremental impact for those who receive HPOG with a program enhancement to the standard HPOG program. The experimental benchmark for the incremental impact comes from two-stage least squares with random assignment as an instrumental variable for enhancement take-up. Then, ignoring the randomly assigned conditions, the analysis estimates the counterfactual for those who “take up” the enhancement using ordinary least squares and inverse propensity weighting. The analysis also tests whether adding information that is only available due to the experiment — who complied with their randomization status and who did not — improves the non-experimental estimates. The analysis compares these estimates using statistical tests recommended by the within-study comparison literature.
MYCYC: unravelling the long road ahead in ANCA-associated vasculitis

We read with great interest the article on ‘Mycophenolate mofetil versus cyclophosphamide for remission induction in ANCA-associated vasculitis: a randomized, non-inferiority trial’ by Jones et al . 1 The trials of mycophenolate mofetil (MMF) for induction in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) done previously were single-centre studies mostly restricted to patients with microscopic polyangiitis (MPA), predominantly from South East Asia.2 3 We commend the authors for including a large population of patients with AAV of different age groups, with true representation of both granulomatosis with polyangiitis, and patients with MPA from different countries, thus overcoming the limitations of previous studies and possibly bringing us closer to the true estimate of efficacy of MMF as an induction agent in AAV. However, certain aspects of this study require clarification and discussion. First, median baseline estimated glomerular filtration rate (eGFR) of 51 mL/min/m2 of the trial patients did not improve considerably at 6 or 18 months in either of the two arms (online supplementary figure 1B of the paper). Non-reversibility of renal dysfunction with immunosuppressive therapy raises a suspicion of a component of chronicity to the underlying renal disease. Since patients with recent decline (eGFR …
Determinants of Stunting in Children Aged 12-59 Months

Background: Stunting is one of the priority nutritional issues in Indonesia. It is one of the chronic malnutrition effects in children which will have a long-term impact on the growth and cross-generation of mothers through the cycle of stunting syndrome.Purpose: This study aimed to identify the determinant factors of stunting in children aged 12-59 months.Methods: Quantitative research with a cross-sectional approach was employed in this study, involving 205 respondents recruited using a consecutive sampling technique. Data were collected using the z scores and questionnaires for children aged 12-59 months, food trust questionnaire, feeding practice questionnaire and child eating habits questionnaire. The Chi Square test and multivariable logistic regression were performed for the data analysis.Results: Children who were not exclusively breastfed and had major infectious disease had a higher risk of stunting for 53.8% and 40.9%, respectively. There was a significant relationship between the history of exclusive breastfeeding (p=0.001, OR=2.28), the history of infection (p=0.013, OR= 2.27), and eating habits (p=0.04, OR=1.55) with stunting in children.Conclusion: There is a relationship between the history of exclusive breastfeeding, the history of infection and eating habits of children with stunting. The formation of a peer group community of children aged 12-59 months is expected to prevent and overcome stunting and improve nutritional status and optimal development of the children.
Chronic optogenetic induction of stress granules is cytotoxic and reveals the evolution of ALS-FTD pathology

Stress granules (SGs) are non-membrane-bound RNA-protein granules that assemble through phase separation in response to cellular stress. Disturbances in SG dynamics have been implicated as a primary driver of neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD), suggesting the hypothesis that these diseases reflect an underlying disturbance in the dynamics and material properties of SGs. However, this concept has remained largely untestable in available models of SG assembly, which require the confounding variable of exogenous stressors. Here we introduce a light-inducible SG system, termed OptoGranules, based on optogenetic multimerization of G3BP1, which is an essential scaffold protein for SG assembly. In this system, which permits experimental control of SGs in living cells in the absence of exogenous stressors, we demonstrate that persistent or repetitive assembly of SGs is cytotoxic and is accompanied by the evolution of SGs to cytoplasmic inclusions that recapitulate the pathology of ALS-FTD. Editorial note: This article has been through an editorial process in which the authors decide how to respond to the issues raised during peer review. The Reviewing Editor's assessment is that all the issues have been addressed (see decision letter).