Miracle-dz/UniFAR-FTUs huggingface dataset:
Neither Norepinephrine Nor Epinephrine Is Best!

Shock, the failure of the circulatory system to supply sufficient blood to peripheral tissues to meet basic metabolic requirements for oxygen and nutrients, frequently requires resuscitation with pharmacologic intervention. A wide range of potent vasoactive agents is available to the clinician including sympathomimetics (including the catecholamines), vasopressin analogs, angiotensin, angiotensin II, and nitric oxide blockers. As yet the optimal agents for resuscitation of the critically ill has not been identified. Current recommendations have epinephrine as first-line pressor for cardiac arrest, and for anaphylaxis, yet for septic shock, and other forms of prolonged support for shock, norepinephrine is recommended (1–3). Norepinephrine received a “perfect” consensus of 34 experts as the vasopressor of first choice in septic shock and considered the recommendation “Strong” (4). This recent study found that 97% of experts preferred noradrenaline as the first-line vasopressor in the treatment of hypotension, an increased popularity over historical reports (4, 5). In this issue of Critical Care Medicine, a systematic review and meta-analysis of randomized controlled trials by Belletti et al (6) could find no difference in mortality or of any surrogate marker of benefit—neither renal replacement therapy, myocardial ischemia, arrhythmias, nor length of ICU was different between patients receiving epinephrine and those receiving any other adrenergic and nonadrenergic vasoactive drugs (including norepinephrine). Evidence of superior clinical outcomes that would support norepinephrine as the exclusive first-line agent of choice in septic shock is meager at best. Surprisingly, for agent such as epinephrine, with so much potential, and historically so commonly used on critically ill patients, there are so few well-constructed randomized head-to-head comparative trials against other agents. Thus far included just over 1,200 patients appear to have been studied. Given the diversity of need for inotropic, pressor, and chronotropic support, the clinical potential of epinephrine’s unique profile has been grossly understudied. Faced with lack of high-quality evidence, why would norepinephrine be considered more desirable than epinephrine?
Ductal Carcinoma In Situ Progression in Dog Model of Breast Cancer

The mechanisms that drive ductal carcinoma in situ (DCIS) progression to invasive cancer are not clear. Studying DCIS progression in humans is challenging and not ethical, thus necessitating the characterization of an animal model that faithfully resembles human disease. We have characterized a canine model of spontaneous mammary DCIS and invasive cancer that shares histologic, molecular, and diagnostic imaging characteristics with DCIS and invasive cancer in women. The purpose of the study was to identify markers and altered signaling pathways that lead to invasive cancer and shed light on early molecular events in breast cancer progression and development. Transcriptomic studies along the continuum of cancer progression in the mammary gland from healthy, through atypical ductal hyperplasia (ADH), DCIS, and invasive carcinoma were performed using the canine model. Gene expression profiles of preinvasive DCIS lesions closely resemble those of invasive carcinoma. However, certain genes, such as SFRP2, FZD2, STK31, and LALBA, were over-expressed in DCIS compared to invasive cancer. The over-representation of myoepithelial markers, epithelial-mesenchymal transition (EMT), canonical Wnt signaling components, and other pathways induced by Wnt family members distinguishes DCIS from invasive. The information gained may help in stratifying DCIS as well as identify actionable targets for primary and tertiary prevention or targeted therapy.
Geospatial Monitoring of Body Mass Index: Use of Electronic Health Record Data Across Health Care Systems

Objectives: The Colorado BMI Monitoring System was developed to assess geographic (ie, census tract) patterns of obesity prevalence rates among children and adults in the Denver-metropolitan region. This project also sought to assess the feasibility of a surveillance system that integrates data across multiple health care and governmental organizations. Materials and Methods: We extracted data on height and weight measures, obtained through routine clinical care, from electronic health records (EHRs) at multiple health care sites. We selected sites from 5 Denver health care systems and collected data from visits that occurred between January 1, 2013, and December 31, 2015. We produced shaded maps showing observed obesity prevalence rates by census tract for various geographic regions across the Denver-metropolitan region. Results: We identified clearly distinguishable areas by higher rates of obesity among children than among adults, with several pockets of lower body mass index. Patterns for adults were similar to patterns for children: the highest obesity prevalence rates were concentrated around the central part of the metropolitan region. Obesity prevalence rates were moderately higher along the western and northern areas than in other parts of the study region. Practice Implications: The Colorado BMI Monitoring System demonstrates the feasibility of combining EHRs across multiple systems for public health and research. Challenges include ensuring de-duplication across organizations and ensuring that geocoding is performed in a consistent way that does not pose a risk for patient privacy.
Sex and gender differences in Alzheimer’s disease: current challenges and implications for clinical practice

Alzheimer’s disease (AD) is characterized by high heterogeneity in disease manifestation, progression and risk factors. High phenotypic variability is currently regarded as one of the largest hurdles in early diagnosis and in the design of clinical trials; there is therefore great interest in identifying factors driving variability that can be used for patient stratification. In addition to genetic and lifestyle factors, the individual’s sex and gender are emerging as crucial drivers of phenotypic variability. Evidence exists on sex and gender differences in the rate of cognitive deterioration and brain atrophy, and in the effect of risk factors as well as in the patterns of diagnostic biomarkers. Such evidence might be of high relevance and requires attention in clinical practice and clinical trials. However, sex and gender differences are currently seldom appreciated; importantly, consideration of sex and gender differences is not currently a focus in the design and analysis of clinical trials for AD. The objective of this position paper is (i) to provide an overview of known sex and gender differences that might have implications for clinical practice, (ii) to identify the most important knowledge gaps in the field (with a special regard to clinical trials) and (iii) to provide conclusions for future studies. This scientific statement is endorsed by the European Academy of Neurology.
Investigating the Super Paramagnetic Limits of Ferromagnetic Nanowires

Highly sensitive focused magneto optical Kerr effect magnetometer (MOKE) has been used to explore the nanoscale limit of state of the art electron beam lithography (EBL) patterned permalloy (NiFe) nanowires. The nanowires are 20 Âµm long arranged in 20 Âµm Ã— 20 Âµm arrays. Permalloy of different thicknesses, which includes 10, 8, 6, 4 and 3.5 nm were deposited on 5 different samples containing these arrays. Results from 10 nm thick permalloy nanowires shows superparamagnetic transition at 85 Â± 5 nm wire width. For 6 nm thick array, superparamagnetic transition occurs at 125 Â± 25 nm. We therefore show that with 10 nm thickness, instead of 6 nm thickness, more miniaturisation of nanowire width can be achieved before the onset of superparamagnetism. This may be seen as very efficient in achieving increased storage density in memory devices.
Effects of Planting Time and Cultivar on Leaf Physiology and Seed Yield of Soybean (Glycine max. (L.) Merr)

The use of adaptive soybean cultivars with appropriate planting time on dry land can enhance the improvement of soybean growth and yield. This study aimed to determine changes in leaf physiological character and soybean yield as affected by different planting time and superior soybean cultivars. The experiment was conducted on the dry land of Inceptisol in Gunungkidul from November 2018 to March 2019. The experiment was arranged in a Split Plot Design with the main plot arranged in a Randomized Complete Block Design (RCBD) with three (3) replications. The main plots consisted of three planting times, i.e. early planting time–Pranoto Mongso, midldle planting time–Farmer Method and late planting–Katam Terpadu. The subplots consisted of four soybean cultivars, namely Anjasmoro, Argomulyo, Grobogan and Dega-1. The fertilizers used were organic fertilizer (2 t ha-1), Urea (50 kg ha-1) and KCl (50 kg ha-1). The results showed that the treatment of planting time and cultivar could increase leaf physiological activity, particularly the number of leaves, total leaf area, leaf area index and plant growth rate. Early planting time–Pranoto Mongso and middle planting time–Farmers Method produced higher plant dry weight (20.11 g; 24.21 g) and seed yields per plant (29.11 g; 26.75 g) than late planting (Katam Terpadu) did (20.30 g). Meanwhile, cultivar Dega-1 had higher seed yields per plant (30.11 g) than cultivar Grobogan (28.39 g), Argomulyo (23.35 g) and Anjasmoro (19.79 g) did.
Effect of Curing Light and Exposure Time on the Polymerization of Bulk-Fill Resin-Based Composites in Molar Teeth.

OBJECTIVES This study examined the influence of different light-curing units (LCUs) and exposure times on the microhardness across bulk-fill resin-based composite (RBC) restorations in a molar tooth. METHODS AND MATERIALS Tip diameter, radiant power, radiant exitance, emission spectra, and light beam profile were measured on two single-emission-peak LCUs (Celalux 3 and DeepCure-S) and two multiple-peak LCUs (Bluephase 20i and Valo Grand). A mold was made using a human molar that had a 12-mm mesial-distal length, a 2.5-mm deep occlusal box, and two 4.5-mm deep proximal boxes. Two bulk-fill RBCs (Filtek Bulk Fill Posterior and Tetric EvoCeram Bulk Fill) were photoactivated for 10 seconds and for 20 seconds, with the light guide positioned at the center of the occlusal surface. Microhardness was then measured across the transverse surface of the restorations. The light that reached the bottom of the proximal boxes was examined. Data were statistically analyzed with the Student t-test, two-way analysis of variance, and the Tukey post hoc test (α=0.05). RESULTS The four LCUs were different regarding all the tested characteristics. Even when using LCUs with wide tips and a homogeneous beam profile, there were significant differences in the microhardness results obtained at the central and proximal regions of the RBCs (p<0.05). LCUs with wider tips used for 20 seconds produced higher microhardness values (p<0.05). The multiple-peak LCUs produced greater hardness values in Tetric EvoCeram Bulk Fill than did the single-emission-peak LCUs (Celalux 3 and DeepCure-S). Results for the light measured at the bottom of proximal boxes showed that little light reached these regions when the light tip was positioned at the center of restorations. CONCLUSIONS Curing lights with wide tips, homogeneous light beam profiles, and longer exposure times are preferred when light-curing large MOD restorations. Light curing from more than one position may be required for adequate photopolymerization.
The impacts of unstructured nature play on health in early childhood development: A systematic review

Background Nature play is growing in popularity as children’s play spaces are transforming from traditional playgrounds into more nature-based play spaces with considerable financial and resource investment from government bodies. This has resulted in the re-development of children’s play spaces to incorporate more natural elements such as trees, plants and rocks. Despite this, it is unclear whether there is empirical evidence to support claims that play in nature is beneficial for child health and development. Aim To conduct a systematic review examining the impacts of nature play on the health and developmental outcomes of children aged 2–12 years. Methods Seven electronic databases were searched (MEDLINE, ERIC, Embase, PsycINFO, The Cochrane Library, The Joanna Briggs Institute and Emcare) from inception to July/August 2018 (search updated July/August 2019). The Inclusion criteria were children aged 2–12 years with no health/developmental conditions. The exposure/intervention of interest was unstructured, free play in nature. Critical appraisal of included studies was conducted using the McMaster Critical Appraisal Tool. Descriptive synthesis was then undertaken using the NHMRC FORM Framework. Results Out of 2927 articles identified, 16 studies met the inclusion criteria. The nature play exposure/intervention was heterogeneously described, and a plethora of outcome measures were used. Nature play had consistent positive impacts on physical activity outcomes and cognitive play behaviours (imaginative and dramatic play). However, there remain some concerns regarding the quality of the evidence base, heterogeneity in intervention description and parameters in the outcome measures used. Conclusions While the positive impacts of nature play were encouraging in terms of physical activity and cognitive development, nature play stakeholders should focus on producing a universal definition for nature play, the development of standardised outcome measures and the conduct of robust research designs. Implications of these findings suggest the need for the development of standardised guidelines to inform practice and policy in the design of children’s play spaces in different contexts.
The stressful tumour environment drives plasticity of cell migration programmes, contributing to metastasis

Tumours evolve to cope with environmental stresses or challenges such as nutrient starvation, depletion of survival factors, and unbalanced mechanical forces. The uncontrolled growth and aberrant deregulation of core cell homeostatic pathways induced by genetic mutations create an environment of stress. Here, we explore how the adaptations of tumours to the changing environment can drive changes in the motility machinery of cells, affecting migration, invasion, and metastasis. Tumour cells can invade individually or collectively, or they can be extruded out of the surrounding epithelium. These mechanisms are thought to be modifications of normal processes occurring during development or tissue repair. Therefore, tumours may activate these pathways in response to environmental stresses, enabling them to survive in hostile environments and spread to distant sites. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
The ability to learn new written words is modulated by language orthographic consistency

Introduction It is well known that a difficulty in forming lexical representations is a strong predictor of reading and spelling difficulties even after controlling for the effects of other cognitive skills. Our study had two main interrelated aims. First, we wanted to examine whether the ability to learn new written words (lexical learning) varies as a function of the orthographic consistency of the language of the learner. Second, we wanted to evaluate the cognitive abilities involved in orthographic lexical learning and whether they differed as a function of language consistency. Method 163 Italian children and 128 English children performed a lexical learning task as well as tasks assessing several cognitive skills potentially related to the ability to establish orthographic representations. Results We found that children learning an orthographic inconsistent orthography (English) were better able to learn novel written words presented in association with pictures than children learning a consistent orthography (Italian). This was true for both younger and older primary school children and also when children were matched for school grade. Lexical learning may be better in English children because the many irregularities of this language promote storing in memory whole-word representations and processing larger orthographic units. In Italian, instead, reading can be accomplished successfully on the basis of grapheme-phoneme conversion rules and on processing smaller orthographic units. This interpretation was supported by the pattern of cognitive skills associated with lexical learning skills in the two languages. Variations in lexical learning were explained by spatial visual memory and phonological awareness tasks in both languages, but phonological STM explained further variance in Italian, while a task tapping visuo-attentional capacity explained further variance in English. Conclusion Learning a language with inconsistent orthography is associated with better lexical learning skills in children at different stages of primary school; the pattern of cognitive skills associated with lexical learning skills is also partially modulated by orthographic consistency.
Treatment outcome of acute coronary syndrome patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia; A retrospective cross-sectional study

Background Acute coronary syndrome (ACS) is increasingly becoming a common cause of cardiovascular mortality in developing countries. Even though, there is an introduction of limited percutaneous coronary intervention and thrombolytic therapies, in-hospital mortality due to ACS still remains high in sub-Saharan countries. Objective The aim of the study was to assess treatment outcome of ACS patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia. Methods A retrospective cross-sectional study was done by collecting data from patients’ medical records using a data abstraction tool. Data were analyzed using logistic regression to determine crude and adjusted odds ratio. At 95% confidence interval, p-value<0.05 was considered as statistically significant. Results Of the total 151 patients, in-hospital mortality was found to be 24.5%, and hypertension was the most frequent (46.4%) risk factor of ACS. Concerning the management practice, catheterization and primary percutaneous coronary intervention were done in 27.1%, and 3.9% respectively. Additionally, in emergency setting loading dose of aspirin and clopidogrel were used in about 63.8% and 62.8%, respectively. The other frequently used medications were beta-blockers (86.9%), angiotensin converting enzymes/angiotensin receptor blockers (84.1%) and statins (84.1%). Streptokinase was administered in 6.3% of patients with ST-elevated myocardial infarction and heparins in 78.1% of them. The commonly prescribed discharge medications were aspirin (98.2%), statins (94.7%) and clopidogrel (92%). Non-use of beta-blockers (p = 0.014), in-hospital complication of cardiogenic shock (p = 0.001) and left ventricular ejection fraction of ≤ 30% (p = 0.032) were independent predictors of in-hospital mortality. Conclusion The proportion of in-hospital mortality due to ACS was found to be high. Therefore, timely evidence based therapy should be implemented in the setup.
The Effects of Co-Occurring Interpersonal Trauma and Gender on Opioid Use and Misuse

The association between interpersonal trauma (IPT) and opioid misuse is well established. There are important gaps, however, in our understanding of this relationship. Studies often do not account for the co-occurrence of IPT across time (i.e., multiple experiences of the same type of IPT) and contexts (i.e., experiences of different types of IPT). In addition, few studies have examined the relationship between IPT and prescription opioid use or gender differences. To address these gaps, this study examines the impact of IPT co-occurrence and gender on prescription opioid use and opioid misuse. Data were collected through a cross-sectional online survey of 235 adults with a self-reported history of IPT (i.e., intimate partner violence, sexual assault, adverse childhood experiences). IPT co-occurrence and interactions between IPT, as continuous scales, were assessed as correlates of opioid use and misuse using multinomial regression models. IPT was associated with opioid misuse, but not use, adjusting for gender. The relationship between sexual assault and opioid misuse was confounded by exposure to other types of IPT. Intimate partner violence was associated with opioid misuse among men. Adverse childhood experiences were associated with misuse among women. The interaction between intimate partner violence and sexual assault increased odds of opioid use among women. This study highlights the importance of accounting for IPT co-occurrence and examining gender differences in clinical practice and research related to opioid use/misuse. These approaches are important for understanding the relationship between IPT and opioid use/misuse by more accurately representing the complexity of the lives of survivors.
Patient‐based experiences with the use of an ambulatory electromyographic device for the assessment of masticatory muscle activity during sleep

Abstract Background It is important to know how easy or difficult it is to use an ambulatory electromyographic (EMG) device for sleep bruxism assessment, and how this might affect its future utilisation. Objective To explore the experience of individuals using an EMG device that pairs with a smartphone app, in order to detect factors that could facilitate and/or hamper its utilisation in future scientific research. Methods Fifteen adults were recruited in the Orofacial Pain and Dysfunction Clinic of the Academic Centre for Dentistry Amsterdam (ACTA). Overnight recordings were performed in the home setting during one week. Time investment, feelings and thoughts, encountered difficulties and reasons for not using the device were assessed in a diary through open‐ended questions and 5‐point Likert scales. Content analysis of textual data was performed, and descriptives of quantitative data were calculated. Results Time investment was low (mean 10.2 minutes in the clinic, and 1.9 minutes per recording at home). Quantitative data showed an overall good experience (median of 4). Qualitative diary data showed that the desire to gain insight into one's masticatory muscle activity formed the main motivation to use the device. Device detachment and difficulty in using the app were the most prominent negative experiences. Conclusion The EMG device was well accepted for multiple overnight recordings. Curiosity for gaining insight into muscle activity was the most important factor that facilitated its use, and the app addressed this need. Device detachment and difficulties in using the app were the main factors that hampered its use.