Miracle-dz/UniFAR-FTUs huggingface dataset:
Thinking globally to improve care locally: A Delphi study protocol to achieve international clinical consensus on best-practice end-of-life communication with adolescents and young adults with cancer

For the sizeable subset of adolescents and young adults whose cancer is incurable, developmentally appropriate end-of-life discussions are critical. Standards of care for adolescent and young adult end-of-life communication have been established, however, many health-professionals do not feel confident leading these conversations, leaving gaps in the implementation of best-practice end-of-life communication. We present a protocol for a Delphi study informing the development and implementation of clinician training to strengthen health-professionals’ capacity in end-of-life conversations. Our approach will inform training to address barriers to end-of-life communication with adolescents and young adults across Westernized Adolescent and Young Adult Cancer Global Accord countries. The Adolescent and Young Adult Cancer Global Accord team involves 26 investigators from Australia, New Zealand, the United States, Canada and the United Kingdom. Twenty-four consumers, including adolescents and young adults with cancer history and carers, informed study design. We describe methodology for a modified Delphi questionnaire. The questionnaire aims to determine optimal timing for end-of-life communication with adolescents and young adults, practice-related content needed in clinician training for end-of-life communication with adolescents and young adults, and desireability of evidence-based training models. Round 1 involves an expert panel of investigators identifying appropriate questionnaire items. Rounds 2 and 3 involve questionnaires of international multidisciplinary health-professionals, followed by further input by adolescents and young adults. A second stage of research will design health-professional training to support best-practice end-of-life communication. The outcomes of this iterative and participatory research will directly inform the implementation of best-practice end-of-life communication across Adolescent and Young Adult Cancer Global Accord countries. Barriers and training preferences identified will directly contribute to developing clinician-training resources. Our results will provide a framework to support further investigating end-of-life communication with adolescents and young adults across diverse countries. Our experiences also highlight effective methodology in undertaking highly collaborative global research.
Cellular microRNAs correlate with clinical parameters in multiple injury patients

In a large multicenter prospectively collected database, the Surgical Critical Care Initiative's microRNA team characterize novel changes in microRNA expression in response to severe trauma. Systemic levels of microRNAs were associated with recovery complications. #microRNA INTRODUCTION The pathophysiology of the inflammatory response after major trauma is complex, and the magnitude correlates with severity of tissue injury and outcomes. Study of infection-mediated immune pathways has demonstrated that cellular microRNAs may modulate the inflammatory response. The authors hypothesize that the expression of microRNAs would correlate to complicated recoveries in polytrauma patients (PtPs). METHODS Polytrauma patients enrolled in the prospective observational Tissue and Data Acquisition Protocol with Injury Severity Score of >15 were selected for this study. Polytrauma patients were divided into complicated recoveries and uncomplicated recovery groups. Polytrauma patients' blood samples were obtained at the time of admission (T0). Established biomarkers of systemic inflammation, including cytokines and chemokines, were measured using multiplexed Luminex-based methods, and novel microRNAs were measured in plasma samples using multiplex RNA hybridization. RESULTS Polytrauma patients (n = 180) had high Injury Severity Score (26 [20–34]) and complicated recovery rate of 33%. MicroRNAs were lower in PtPs at T0 compared with healthy controls, and bivariate analysis demonstrated that variations of microRNAs correlated with age, race, comorbidities, venous thromboembolism, pulmonary complications, complicated recovery, and mortality. Positive correlations were noted between microRNAs and interleukin 10, vascular endothelial growth factor, Acute Physiology and Chronic Health Evaluation, and Sequential Organ Failure Assessment scores. Multivariable Lasso regression analysis of predictors of complicated recovery based on microRNAs, cytokines, and chemokines revealed that miR-21-3p and monocyte chemoattractant protein-1 were predictive of complicated recovery with an area under the curve of 0.78. CONCLUSION Systemic microRNAs were associated with poor outcomes in PtPs, and results are consistent with previously described trends in critically ill patients. These early biomarkers of inflammation might provide predictive utility in early complicated recovery diagnosis and prognosis. Because of their potential to regulate immune responses, microRNAs may provide therapeutic targets for immunomodulation. LEVEL OF EVIDENCE Diagnostic Tests/Criteria; Level II.
Power Flow and Stability Analyses of a Multifunctional Distributed Generation System Integrating a Photovoltaic System With Unified Power Quality Conditioner

This paper presents detailed studies involving sizing, stability analysis, and power flow through the series and parallel power converters in a multifunctional three-phase distributed generation (DG) system composed of a single-stage photovoltaic (PV) system integrated into a unified power quality conditioner (UPQC). The UPQC operates as a bidirectional interface when the DG system is placed between the grid and either generic loads or ac microgrid. In the grid-connected mode, the DG system performs active power-line conditioning, while injecting the energy produced by the PV array into the grid. In islanded operation, the system can act as ac grid forming via a parallel inverter, whether there is the presence of an energy storage system. A complete study involving the power flow through the PV-UPQC is mandatory to achieve the overall understanding of the system operation and designing the power converters properly. For this purpose, sizing curves are presented and discussed. Furthermore, two strategies aimed at limiting and/or decreasing the power processed by the series and parallel inverters are presented and discussed in detail. Both simulation and experimental results are presented to evaluate the static and dynamic performances of the PV-UPQC system operating grid connected and grid islanded.
High Impedance Fault Detection Method Based on Variational Mode Decomposition and Teager–Kaiser Energy Operators for Distribution Network

The focus of the paper is the difficulty of high impedance fault (HIF) detection in distribution network, and its ease to be confused with capacitor switching (CS) and load switching (LS). Based on the intermittent reignition and extinction characteristics of HIF current, this paper proposes a novel HIF detection method, which combines variational mode decomposition (VMD) and Teager–Kaiser energy operators (TKEOs). The HIF detection method is as follows: First, perform the VMD on transient zero sequence currents to obtain the intrinsic mode functions (IMFs) and select the IMFs with the largest kurtosis value as the characteristic IMFs. Second, calculate the characteristic IMFs to obtain TKEOs and divide into subintervals of TKEOs waveform to calculate the time entropy values. Finally, construct HIF detection criterion as follows: when time entropy value is 0, it is judged as CS or LS. When the entropy value is not 0, it is judged as HIF. A large number of simulations and field data tests show that the method is accurate and stable, and under the interference of 1 dB strong noise, it can accurately judge. Compared with other methods, the method has higher feature extraction accuracy, less calculation time, and better judgment accuracy.
Development of a Novel Bilosomal System for Improved Oral Bioavailability of Sertraline Hydrochloride: Formulation Design, In Vitro Characterization, and Ex Vivo and In Vivo Studies

This study was proposed to develop an optimized sertraline hydrochloride (SER)–loaded bilosomal system and evaluate its potential for enhancement of drug oral bioavailability. A full 23 factorial design was used to prepare SER-loaded bilosomal dispersions by thin film hydration using span 60, cholesterol (CHL), and sodium deoxycholate (SDC). The investigated factors included the total concentration of span 60 and CHL (X1), span 60:CHL molar ratio (X2), and SER:SDC molar ratio (X3). The studied responses were entrapment efficiency (EE%) (Y1), zeta potential (Y2), particle size (Y3), and in vitro % drug released at 2 (Y4), 8 (Y5), and 24 h (Y6). The selected optimal bilosomal dispersion (N1) composition was 0.5% w/v (X1), 1:1 (X2), and 1:2 (X3). Then, N1 was freeze dried into FDN1 that compared with pure SER for in vitro drug release, ex vivo permeation through rabbit intestine, and in vivo absorption in rats. Moreover, storage effect on FDN1 over 3 months was assessed. The optimal dispersion (N1) showed 68 ± 0.7% entrapment efficiency, − 41 ± 0.78 mV zeta potential, and 377 ± 19 nm particle size. The freeze-dried form (FDN1) showed less % drug released in simulated gastric fluids with remarkable sustained SER release up to 24 h compared to pure SER. Moreover, FDN1 showed good stability, fivefold enhancement in SER permeation through rabbit intestine, and 222% bioavailability enhancement in rats’ in vivo absorption study compared to pure SER. The SER-loaded bilosomal system (FDN1) could improve SER oral bioavailability with minimization of gastrointestinal side effects.
A phenomenological study identifying facilitators and barriers to Black and Latinx youth's engagement in hospital‐based violence intervention programs

Abstract Black and Latinx youth are disproportionately affected by violence in the United States. Hospital‐based violence intervention programs (HVIPs) have emerged as an effective response to this epidemic; however, participation rates remain low. This study aimed to identify facilitators and barriers to recruitment and engagement amongst black and Latinx youth from the perspective of HVIP staff. Employing a phenomenological approach, a purposive sample of key informants was recruited. Focus groups and semi‐structured interviews lasting approximately 90 min were conducted with representatives (N = 12) from five HVIPs in U.S. cities across the Midwest and Northeast, making up 15% of all HVIPs in the United States. Each interview was recorded and transcribed verbatim. The research team employed rigorous content analysis of the data. Three themes and subsequent categories resulted from the analysis: (1) Interpersonal/Relational Facilitators (building rapport; connecting with youth; enhancing the teachable moment; building relational health); (2) Structural/Systemic Barriers (lack of reinforcement; difficulties connecting after discharge from the hospital; hospital workflow; institutional challenges); (3) Structural/Systemic Facilitators (embedding the HVIP; trauma‐informed practices and policies). Given the limited research on black and Latinx youth and the disproportionate rate of violent injuries amongst these groups, an evidence‐based systematic approach to engage youth is essential to promote health equity. The findings from this study suggest that there are several steps that HVIPs and hospitals can take to enhance their recruitment and engagement of youth and their families.
RNA‐sequencing reveals genes linked with oocyte developmental potential in bovine cumulus cells

Cumulus cells provide an interesting biological material to perform analyses to understand the molecular clues determining oocyte competence. The objective of this study was to analyze the transcriptional differences between cumulus cells from oocytes exhibiting different developmental potentials following individual in vitro embryo production by RNA‐seq. Cumulus cells were allocated into three groups according to the developmental potential of the oocyte following fertilization: (1) oocytes developing to blastocysts (Bl+), (2) oocytes cleaving but arresting development before the blastocyst stage (Bl−), and (3) oocytes not cleaving (Cl−). RNAseq was performed on 4 (Cl−) or 5 samples (Bl+ and Bl−) of cumulus cells pooled from 10 cumulus‐oocyte complexes per group. A total of 49, 50, and 18 differentially expressed genes (DEGs) were detected in the comparisons Bl+ versus Bl−, Bl+ versus Cl− and Bl‐ versus Cl−, respectively, showing a fold change greater than 1.5 at an adjusted p value <0.05. Focussing on DEGs in cumulus cells from Bl+ group, 10 DEGs were common to both comparisons (10/49 from Bl+ vs. Bl−, 10/50 from Bl+ vs. Cl−). These DEGs correspond to 6 upregulated genes (HBE1, ITGA1, PAPPA, AKAP12, ITGA5, and SLC1A4), and 4 downregulated genes (GSTA1, PSMB8, FMOD, and SFRP4) in Bl+ compared to the other groups, from which 7 were validated by quantitative PCR (HBE1, ITGA1, PAPPA, AKAP12, ITGA5, PSMB8 and SFRP4). These genes are involved in critical biological functions such as integrin‐mediated cell adhesion, oxygen availability, IGF and Wnt signaling or PKA pathway, highlighting specific biological processes altered in incompetent in vitro maturation oocytes.
Recurrent Myocarditis Treated with Intravenous Immune Globulin and Steroids

Patient: Male, 18-year-old Final Diagnosis: Myocarditis Symptoms: Chest pain • palpitation • shortness of breath Medication: — Clinical Procedure: Angiogram • cardiac MRI • transthoracic echocardiogram Specialty: Cardiology Objective: Unusual clinical course Background: Myocarditis is an inflammatory process that can present as acute or chronic with either focal or diffuse involvement of the myocardium. Its incidence is approximately 1.5 million cases per year worldwide. In the United States, viral infection is the most common cause of myocarditis. Most of the reported cases are singular and self-limiting in nature. We present the case of severe recurrent myocarditis in a young adult who was transferred to the Intensive Care Unit. Case Report: An 18-year-old man presented with chest pressure and troponin I 33 ng/mL. He had presented to another hospital with similar symptoms 3 months prior and was diagnosed with myocarditis that had resolved with colchicine. As part of his workup during this admission, coronary angiogram was normal and biopsy obtained without evidence of an inflammatory process; however, cardiac magnetic resonance imaging (MRI) was consistent with myocarditis and Coxsackie B titers indicated prior infection, leading to a diagnosis of clinically suspected recurrent viral myocarditis. He was treated with intravenous immunoglobulin (IV Ig) and a steroid taper, with rapid improvement in symptoms over the ensuing weeks without evidence of further recurrence or sequelae. Conclusions: We present a case of recurrent Coxsackie B myocarditis based on presentation and imaging. Myocarditis is an important diagnosis to consider when a young, healthy individual presents with chest pain mimicking acute coronary syndrome, especially during the COVID pandemic. If there is evidence of myocarditis on MRI or endomyocardial biopsy, immunosuppressive therapy should be considered in patients with recurrent and severe presentations.
When A Nonnative Accent Lets You Spot All the Errors: Examining the Syntactic Interlanguage Benefit

Abstract In our continuously globalizing world, cross-cultural and cross-linguistic communications are far from exceptional. A wealth of research has indicated that the processing of nonnative-accented speech can be challenging for native listeners, both at the level of phonology. However, few online studies have examined the underpinnings of accented speech recognition from the perspective of the nonnative listener, even though behavioral studies indicate that accented input may be easier to process for such individuals (i.e., the interlanguage speech intelligibility benefit. The current EEG study first examined the phonological and syntactic analysis of nonnative-accented speech among nonnative listeners. As such, 30 English learners of Spanish listened to syntactically correct and incorrect Spanish sentences produced in native and nonnative-accented Spanish. The violation in the incorrect sentences was caused by errors that are typical (i.e., gender errors; *la color) or atypical (i.e., number errors; *los color) for English learners of Spanish. Results indicated that nonnative listeners elicit a phonological mismatch negativity (PMN) when attending to speech produced by a native Spanish speaker. Furthermore, the nonnative listeners showed a P600 for all grammatical violations, indicating that they repair all errors regardless of their typicality or the accent in which they are produced. Follow-up analyses compared our novel data to the data of native listeners from the methodologically identical precursor study. These analyses showed that native and nonnative listeners exhibit directionally opposite PMN effects; whereas natives exhibited a larger PMN for English-accented Spanish, nonnatives displayed a larger PMN in response to native Spanish utterances (a classic interlanguage speech intelligibility benefit). An additional difference was observed at the syntactic level: Whereas natives repaired only atypical number errors when they were English-accented, nonnative participants exhibited a P600 in response to all English-accented syntactic errors, regardless of their typicality (a syntactic interlanguage speech intelligibility benefit). Altogether, these results suggest that accented speech is not inherently difficult to process; in fact, nonnatives may benefit from the presence of a nonnative accent. Thus, our data provide some of the first electrophysiological evidence supporting the existence of the classic interlanguage speech intelligibility benefit and its novel syntactic counterpart.
Standalone Containment Analysis of Four Phébus Tests with the ASTEC and the MELCOR Codes

After the severe accident (SA) occurred at the Three-Miles Island Nuclear Power Plant (NPP), important efforts on the investigation of the different phenomena during this kind of accidents have been started. Several experimental campaigns investigating one phenomenon at time or the combination of two or more phenomena have been performed. Today, the Phébus experimental campaign is probably the most important activity on the evaluation of the coupling among different phenomena. Four out of five tests investigated the degradation of an intact Pressurized Water Reactor (PWR) fuel bundle and the subsequent transport of Fission Products (FP) and Structural Materials (SM) through the primary circuit and into the containment, while the fifth test was only the degradation of a bed of PWR fuel bundle debris. These tests were performed between 1990 and 2010 at the CEA Cadarache laboratories (France) in a 5000:1 scaled facility. The main four tests varied the employed control rod materials, the fuel burn-up, and the oxidizing conditions of the atmosphere (strongly or weakly). The outcomes of this experimental campaign created a solid base for the understanding of the involved phenomena and allowed the development of models and software codes capable of simulating the evolution of a SA in a real NPP. ASTEC and MELCOR were two of the main SA codes profiting from the results of this Phébus campaign. These two codes were further improved in the latest years to account for the findings obtained in more recent experimental campaigns. A continuous verification and validation work is then necessary to check how the newer code’s versions reproduce the tests performed in these older experimental campaigns such as Phébus one. The present work is intended to be the final step of a series of publications covering the activities carried out at University of Pisa with the ASTEC and the MELCOR SA codes on the four Phébus tests employing an intact PWR fuel bundle. Because of the complexity and the extent of these tests, only the containment aspects were considered in the precedent works, i.e., only the thermal-hydraulics transient and its coupling with the FP and SM behavior. Then, general conclusions based on the outcomes of these precedent works are summarized in this work.
Image-Based OA-Style Paper Pop-Up Design via Mixed-Integer Programming

Origami architecture (OA) is a fascinating papercraft that involves only a piece of paper with cuts and folds. Interesting geometric structures ‘pop up’ when the paper is opened. However, manually designing such a physically valid 2D paper pop-up plan is challenging since fold lines must jointly satisfy hard spatial constraints. Existing works on automatic OA-style paper pop-up design all focused on how to generate a pop-up structure that approximates a given target 3D model. This article presents the first OA-style paper pop-up design framework that takes 2D images instead of 3D models as input. Our work is inspired by the fact that artists often use 2D profiles to guide the design process, thus benefited from the high availability of 2D image resources. Due to the lack of 3D geometry information, we perform novel theoretic analysis to ensure the foldability and stability of the resultant design. Based on a novel graph representation of the paper pop-up plan, we further propose a practical optimization algorithm via mixed-integer programming that jointly optimizes the topology and geometry of the 2D plan. We also allow the user to interactively explore the design space by specifying constraints on fold lines. Finally, we evaluate our framework on various images with interesting 2D shapes. Experiments and comparisons exhibit both the efficacy and efficiency of our framework.
Genotoxic potential of different nano-silver halides in cultured human lymphocyte cells

Abstract Most antibacterial applications in nanotechnology are carried out using silver nanoparticles (AgNPs). However, there is a dearth of information on the biological effects of AgNPs on human blood cells. In this study, the cytotoxic and genotoxic potentials of ionic silver (Ag+), AgNP, silver bromide (AgBr), silver chloride (AgCl), and silver iodide (AgI) were evaluated through chromosome aberration (CA) test and cytokinesis-blocked micronucleus (CBMN) test in human cultured lymphocytes in vitro. Furthermore, the potential damages that can cause to DNA were evaluated through alkaline single cell gel electrophoresis (Comet) assay on isolated lymphocytes. The results showed that AgNPs exerted cytotoxic effects by reducing the cytokinesis-block proliferation index and mitotic index at 24 and 48 h. AgNPs also increased micronucleus (MN) formation at both exposure times in the cultured cells. Meanwhile, AgCl had no genotoxic effects on the human lymphocyte cultured cells but had a cytotoxic effect at high doses. AgNP, Ag+, AgBr, and AgI caused substantial DNA damage by forming DNA strand breaks. They may also have clastogenic, genotoxic and cytotoxic effects on human lymphocyte cells. Based on the foregoing findings, silver nanomaterials may have genotoxic and cytotoxic potentials on human peripheral lymphocytes in vitro. Graphical Abstract