Miracle-dz/UniFAR-FTUs huggingface dataset:
Resource Use and Outcomes for Children Hospitalized With Severe Sepsis or Septic Shock

Objective: To describe patient and hospital characteristics associated with in-hospital mortality, length of stay (LOS), and charges for children with severe sepsis or septic shock who often require specialized organ-supportive technology to enhance outcomes, availability of which might vary across hospitals. Design: Retrospective study among children hospitalized for severe sepsis or septic shock, using the 2012 Kids’ Inpatient Database. Multivariate regression methods identified factors associated with mortality, LOS, and charges. Measurements and Main Results: Of an estimated 11 972 hospitalizations for pediatric severe sepsis or septic shock, most hospitalizations (85%) were to urban teaching hospitals. Hospitalizations were more frequent among neonates and older adolescents than other age groups. Mortality was 17%, average LOS was 24 days, and average hospital charges were US$314 950. Higher mortality was associated with neonates, cumulative organ dysfunction, more comorbidities, and cardiopulmonary resuscitation. Longer hospitalization and higher charges were associated with neonates, more comorbidities, higher illness severity, invasive medical technology, and urban hospitals. Conclusions: Efforts to mitigate the substantial in-hospital mortality and resource use observed in pediatric severe sepsis or septic shock should be age-specific and focused on the influence of comorbidities and organ dysfunction on outcomes. Future research should elucidate reasons for higher resource use at urban hospitals.
Tigecycline-non-susceptible hypervirulent Klebsiella pneumoniae strains in Taiwan.

OBJECTIVES Emergent antimicrobial-resistant hypervirulent Klebsiella pneumoniae (hvKp) is an important public health issue. We aimed to investigate resistance mechanisms and hypervirulent traits among tigecycline-non-susceptible (TNS) K. pneumoniae clinical strains, focusing on one hvKp strain with in vivo evolution of tigecycline resistance. METHODS TNS K. pneumoniae strains causing invasive diseases in a medical centre in Taiwan between July 2015 and April 2018 were collected. Resistance mechanisms were determined and hvKp strains were defined as rmpA/rmpA2-carrying strains. Isogenic strains with and without tigecycline resistance were subjected to WGS and in vivo virulence testing. Further, site-directed mutagenesis was used to confirm the resistance mechanism. RESULTS In total, 31 TNS K. pneumoniae strains were isolated, including six hypervirulent strains. Tigecycline resistance mechanisms were mostly caused by overexpression of AcrAB and OqxAB together with up-regulation of RamA or RarA, respectively. One TNS hypervirulent strain (KP1692; MIC = 6 mg/L) derived from its tigecycline-susceptible counterpart (KP1677; MIC = 0.75 mg/L) showed acrAB overexpression. WGS revealed four genetic variations between KP1677 and KP1692. In addition, using site-directed mutagenesis, we confirmed that a 1 bp insertion in the ramA upstream region (RamR-binding site), leading to ramA and acrAB overexpression in KP1692, was responsible for tigecycline resistance. The in vivo virulence experiment showed that the TNS hvKp strain KP1692 still retained its high virulence compared with KP1677. CONCLUSIONS hvKp strains accounted for 19.4% among TNS strains. We identified alterations in the ramA upstream region as a mechanism of in vivo tigecycline resistance development in an hvKp strain.
Experience of sexual harassment and coping strategies among students of the school of nursing of a tertiary hospital in Southwest Nigeria

This descriptive cross-sectional study documented the experience of sexual harassment (SH) and coping strategies among 250 consenting students of University College Hospital, Ibadan school of nursing, using a pre-tested questionnaire.Descriptive statistics and Chi-square test were used to analyze the data at 5% level of significance. Mean age was 23.0 ± 4.1 years, 78.8% were females and 91.2% perceived SH to be common in the school. Fifty-eight percent of respondents (20.0% males, 80.0% females) had ever been sexually harassed. Main perpetrators of SH against females were male resident doctors (24.5%) and male patients (11.3%) while female colleagues (44.8%) and female patients (20.7%) were for males. Types of SH experienced were unwanted body contact (79.3%), breast contact (67.6%), enticement (45.5%), attempted rape (39.3%) and unwanted kiss (26.3%). Attending parties and mode of dressing were positively associated with experience of SH. Main coping strategies employed were reporting to school authority, ignoring the perpetrator, confrontation and breaking up the relationship. Sexual harassment is prevalent among the students studied, with females more affected. Coping strategies adopted were adjudged ineffective. Institutional based interventions such as sensitization, capacity building on coping strategy skills, legislation and policy reviews are needed to address these concerns. Key words: Sexual harassment, nursing students, coping strategies.
New insights into irritable bowel syndrome: from pathophysiology to treatment

Irritable bowel syndrome (IBS) is the most common reason to visit a gastroenterologist. IBS was believed to be a functional disease, but many possible pathophysiologic mechanisms can now explain the symptoms. IBS patients are classified into subtypes according to their predominant bowel habit, based on the Rome IV criteria. These include diarrhea-predominant and constipation-predominant IBS, as well as the mixed type, a combination of the two. Usually, IBS treatment is based on the predominant symptoms, with many options for each subtype. A new promising treatment option, fecal microbiota transplantation, seems to have beneficial effects on IBS. However, treating the pathophysiological causative agent responsible for the symptoms is an emerging approach. Therefore, before the appropriate therapeutic option is chosen for treating IBS, a clinical evaluation of its pathophysiology should be performed.
What Can We Quantify About Carer Behavior?

In many species, individuals must contribute extensively to offspring care to reproduce successfully. Within species, variation in care is driven by local social, physiological, and environmental contexts, and this relationship has been a major focus of behavioral ecology since the inception of the field. The majority of existing studies on care, both theoretical and empirical, have focused on measuring the amount of care delivered by each carer as a proxy for individual investment, linking this investment to the local context, and investigating outcomes for offspring. However, more recently interest has grown in the finer-scale details of care, including how individuals respond to each other’s behavior, and temporal variation in care both within and between stages. Simultaneously, advances in remote monitoring methods, such as video cameras and passive integrated transponder (PIT) tag systems, have vastly increased the ease of collecting large amounts of care data, providing opportunities to study carer behavior in much greater detail than previously possible. In this mini-review we provide an overview of the dimensions of carer behavior that can be quantified, illustrated using recent studies from a variety of taxa. We classify these analyses into three broad groups: (a) how parental care is distributed in time, (b) variation within care events, and (c) how carers interact when jointly providing care. Our aim is to encourage more in-depth analyses of parental care, to build a more complete picture of how animals rear their offspring.
Physical Fitness and Long-Term Blood Pressure Variability of Young Male Military Personnel.

AIM To investigate the association of physical fitness with long-term blood pressure variability (BPV) in young male adults. METHODS We included 1,112 healthy military males, ages 18-40 years (mean age, 32 years) in Taiwan for the current analysis. Resting blood pressures were measured over right upper arm in a sitting position every two-year interval from 2012 to 2018 (2012-14, 2014-15, 2015-16, 2016-18). We assessed long-term BPV by standard deviation (SDSBP and SDDBP) and average real variability (ARVSBP and ARVDBP) across 4 visits during the study period. Aerobic fitness was evaluated by time for a 3000-meter run test, and anaerobic fitness was evaluated by numbers of 2-minute sit-ups and 2-minute push-ups, respectively. RESULTS After adjusting for systolic and diastolic blood pressure, time for a 3000-meter run was associated with ARVSBP, SDSBP, and SDDBP (β [SE]: 0.007 [0.002], 0.004 [0.002], and 0.005 [0.002], respectively, all p <0.05) but not with ARVDBP. In addition, numbers of 2-minute sit-ups were inversely associated with ARVSBP (β [SE]: -0.041 [0.017], p =0.01) but not with ARVDBP, SDSBP, and SDDBP. There was no association of numbers of 2-minute push-ups with the BPV indexes. After additionally adjusting for age, body mass index, and other covariates, all the associations were not significant. CONCLUSION We found that there was no association of physical fitness with long-term BPV in young male military personnel. Previous studies have shown no association with cardiorespiratory fitness in the elderly. This study further extended the knowledge of a null association between anaerobic fitness and long-term BPV.
Combustion Performance and Thermal Stability of Basalt Fiber-Reinforced Polypropylene Composites

In this study, the thermal stability and combustion performance of basalt fiber reinforced polypropylene (BFRPP) composite and pure polypropylene (PP) were compared. The results show that the basalt fiber has no positive effect on increasing the initial decomposition temperature of PP, but it could reduce the maximum thermal decomposition rate and increase the temperature of the maximum thermal decomposition rate. Adding basalt fiber to PP could slightly reduce the limiting oxygen index. At the same oxygen concentration, the BFRPP burned significantly more slowly than the PP. In addition, during the combustion, it was observed that the BFRPP showed a better anti-melt dripping effect than the PP. The results from the cone calorimeter test show that, under the same external heat flux, the time-to-ignition (TTI) of BFRPP was less than that of PP. This indicated that BFRPP was easier to ignite than PP. It was also found that the reciprocal of the square root of the TTI of both has a linear relationship with external heat flux. BFRPP has a lower peak heat release rate and total heat release than PP. Moreover, BFRPP produced less smoke than PP when burned.
Vascular Malformation of the Tongue Treated With Transmucosal Nd:YAG Laser

We describe an interesting case of a 62-year-old white female who presented to our clinic with a vascular malformation of her tongue that had been clinically apparent for approximately 30 years. The area had been surgically excised twice, with recurrence following both procedures; however, surgical treatment was limited owing to fear of potential functional impairment. After obtaining magnetic resonance imaging of the affected area, the patient was treated with one session of transmucosal Nd:YAG laser. The affected area appeared to resolve almost immediately following treatment. The patient had continued resolution at her 5-month follow-up visit and at 18 months by telephone follow-up. This case illustrates an excellent outcome from transmucosal treatment of a vascular malformation of the tongue with Nd:YAG laser. We discuss the various available treatment modalities for vascular malformations of the tongue as well as the risks and benefits of each. We also present a recent review of the literature pertaining to Nd:YAG laser treatment of these lesions.
Effects of tetracycline on myocardial infarct size in obese rats with chemically-induced colitis

Background Recent evidence suggests that antibiotic-induced changes in the composition of intestinal microflora, as well as the systemic immunoendocrine effects that result from them, can modulate myocardial tolerance to ischemia-reperfusion injury. The aim of this study was to investigate the effects of tetracycline (TTC) on myocardial infarct size in the isolated hearts obtained from obese rats with chemically-induced colitis (CIC). The association between TTC-induced changes in infarct size and intestinal microbiome composition as well as plasma levels of cytokines and short-chain fatty acids (SCFAs) was also studied. Methods Obesity was induced in Wistar rats by feeding them a high-fat, high-carbohydrate diet for five weeks. A single rectal administration of 3% acetic acid (2 mL) to the rats resulted in CIC. Healthy rats as well as obese rats with CIC received TTC (15 mg daily for 3 days) via gavage. The rats were euthanized, after which isolated heart perfusion with simulated global ischemia and reperfusion was performed. Infarct size was determined histochemically. Lipopolysaccharide (LPS) and cytokine levels in plasma were measured by enzyme-linked immunosorbent assay, whereas SCFA levels in plasma were measured by gas chromatography/mass spectrometry. The intestinal microbiome was analyzed using reverse transcription polymerase chain reaction. Results The treatment with TTC resulted in significant infarct size limitation (50 ± 7 vs. 62 ± 4% for the control mice, p < 0.05) in the hearts from intact animals. However, infarct size was not different between the control rats and the obese rats with CIC. Furthermore, infarct size was significantly larger in TTC-treated obese rats with CIC than it was in the control animals (77 ± 5%, p < 0.05). The concentrations of proinflammatory cytokines and LPS in serum were elevated in the obese rats with CIC. Compared to the control rats, the rats with both obesity and CIC had lower counts of Lactobacillus and Bifidobacterium spp. but higher counts of Escherichia coli. The effects of TTC on infarct size were not associated with specific changes in SCFA levels. Conclusions TTC reduced infarct size in the healthy rats. However, this effect was reversed in the obese animals with CIC. Additionally, it was associated with specific changes in gut microbiota and significantly elevated levels of cytokines and LPS.
Acquisition of Medical Immunology Knowledge: A Preliminary Study of the Knowledge Structures of Medical Students

The multi-store model developed in the 1970s suggests that information gained by a learner flows in through a defined set of states (Atkinson & Shiffrin, 1968). First, sensory stores capture visual and auditory information. A small amount of that information is then transferred to the short-term memory compartment. Here, a great deal of work has been performed to suggest we can retain anywhere between five to seven discrete chunks of information at any given time (Simon, 1979). The information that is transferred from the sensory stores to short-term memory stores is often dependent on repetition. However, a fraction of that information can then be transferred to long-term memory stores and is dependent on encoding, visualising and experiencing that occur during the learning process. Finally, working memory is the result of accessing information from the short-term and long-term memory stores and is thought to rely heavily on visual-spatial patterning, etc. This is controlled by the central executive that integrates written and spoken material as well as visual and spatial information, and is at the core of problem solving. This multi-store model as originally defined by Atkinson and Shiffrin has now been replaced by an alternative model which has the same components but organises them in different ways and suggests that each component has limited capacity for storage and is independent of one another (Baddeley & Hitch, 1974).
Common flow cytometry pitfalls in diagnostic hematopathology

Flow cytometry (FC) has proven to be an extremely versatile and useful tool in the diagnosis and monitoring of hematological diseases in addition to numerous other applications. Major advances in electronics, software, and reagents over the past years have simplified some aspects of FC, while at the same time the ability to combine 8–10 antibodies in a single tube can create both technical and interpretation issues that are more difficult to detect when using only 3–4 color combinations. Use of multiparameter panels can facilitate identification of abnormal populations; however, characteristics of the neoplastic population may create potential diagnostic pitfalls. An understanding of normal immunophenotypic patterns in states of rest, recovery, and activation is a critical first step in order to appropriately identify the abnormal populations that characterize hematopoietic neoplasms. Additionally, incorporation of newer therapeutic strategies, in particular targeted therapies, can confound standard methods for flow cytometric data analysis and knowledge of the impact of therapy on flow cytometric data is critical for accurate data interpretation. This manuscript will review preanalytical, instrument, and interpretation issues that may lead to incorrect interpretation of results.
Interrelationships Among Physical Health, Health-Related, and Psychosocial Characteristics of Persons Receiving Integrated Care in Community Mental Health Settings

ABSTRACT Integrated primary and behavioral health care (PBHC) programs in community mental health (CMH) settings seek to address the health disparities and excess mortality of persons with serious mental illness (SMI) and comorbid medical disorders. The current cross-sectional, descriptive study utilized an integrated health data set to examine interrelationships among physical health, health-related, and psychosocial characteristics of 125 clients receiving integrated PBHC services in a CMH setting. Using baseline data collected by nurse care managers, researchers sought to develop a comprehensive, person-centered profile of adults in CMH agencies. Results showed that participants reported fair overall health, with mean scores on four of eight health indicators in the at-risk range. Disparities on some measures emerged for women, African Americans, and clients with a family history of cardiometabolic disorders. Participants reported moderate levels of functioning and psychological distress and moderately high levels of social connectedness. Approximately 27% of the variance in overall health was explained by five predictors in the model. Blood glucose levels and daily functioning were the strongest predictors of health status. Results are consistent with research on comorbidity that emphasizes the multidimensionality of health. Future social work research should employ multivariate approaches to identify disparities and clarify treatment needs of diverse CMH clients.
Intrapleural urokinase directly under medical thoracoscopy for the diagnosis of tuberculous pleurisy

Medical thoracoscopy, also called “local anesthetic thoracoscopy” and “pleuroscopy,” is a minimally invasive single‐port endoscopic technique that provides direct visualization of the pleural surfaces and channels to conduct diagnostic and therapeutic procedures. However, this technique is not helpful when substantial fibrous adhesions exist. We reported the first case of intrapleural urokinase directly under medical thoracoscopy for the diagnosis of malignant pleural mesothelioma with severe multiloculated pleural effusions in 2019. This is the second report regarding the efficacy of intrapleural urokinase directly under medical thoracoscopy for the diagnosis of multiloculated pleural effusions. Urokinase‐induced intrapleural fibrinolysis, which removed the fibrous septa, consequently improved the field of view under endoscopy within only 10 min. Fibrinolytic effect appeared very rapidly. This technique is available for tuberculous pleurisy with severe multiloculated pleural effusion.
Promising therapeutic effect of thapsigargin nanoparticles on chronic kidney disease through the activation of Nrf2 and FoxO1

Pathophysiological states cause misfolded protein accumulation in the endoplasmic reticulum (ER). Then, ER stress and the unfolded protein response (UPR) are activated. Targeting ER stress may enhance the adaptive UPR and then protect the cell against pathogenic environments. In the present study, we utilized nanotechnology to synthesize thapsigargin nanoparticles (TG NPs) which induced ER stress and the UPR pathway, to study the role of ER stress and autophagy in chronic kidney disease (CKD). We found that the mRNA levels of ER stress- and autophagy-related molecules were elevated in the renal tissue of CKD patients compared to those of healthy individuals. Furthermore, TG NPs induced the UPR pathway and autophagy in HK-2 human kidney tubular epithelial cells. TG NPs protected HK-2 cells against oxidative stress-induced cell death through the activation of Nrf2 and FoxO1. The siRNA-mediated inhibition of Nrf2 or FoxO1 resulted in enhanced oxidative stress-induced cytotoxicity in HK-2 cells. In a mouse model of adenine diet-induced CKD, TG NPs and KIM-1-TG NPs ameliorated renal injury through the stimulation of ER stress and its downstream pathways. Our findings suggest that the induction of ER stress using pharmacological agents may offer a promising therapeutic strategy for preventing or interfering with CKD progression.
How free-ranging ungulates with differing water dependencies cope with seasonal variation in temperature and aridity

Abstract Large mammals respond to seasonal changes in temperature and precipitation by behavioural and physiological flexibility. These responses are likely to differ between species with differing water dependencies. We used biologgers to contrast the seasonal differences in activity patterns, microclimate selection, distance to potential water source and body temperature of the water-independent gemsbok (Oryx gazella gazella) and water-dependent blue wildebeest (Connochaetes taurinus), free-living in the arid Kalahari region of Botswana. Gemsbok were more active nocturnally during the hot seasons than in the cold-dry season, while wildebeest showed no seasonal difference in their nocturnal activity level. Both species similarly selected shaded microclimates during the heat of the day, particularly during the hot seasons. Wildebeest were further than 10 km from surface water 30% or more of the time, while gemsbok were frequently recorded >20 km from potential water sources. In general, both species showed similar body temperature variation with high maximum 24-h body temperature when conditions were hot and low minimum 24-h body temperatures when conditions were dry, resulting in the largest amplitude of 24-h body temperature rhythm during the hot-dry period. Wildebeest thus coped almost as well as gemsbok with the fairly typical seasonal conditions that occurred during our study period. They do need to access surface water and may travel long distances to do so when local water sources become depleted during drought conditions. Thus, perennial water sources should be provided judiciously and only where essential.