Miracle-dz/UniFAR-FTUs huggingface dataset:
Implementation of a complex intervention to improve care for patients whose situations are clinically uncertain in hospital settings: A multi-method study using normalisation process theory

Purpose To examine the use of Normalisation Process Theory (NPT) to establish if, and in what ways, the AMBER care bundle can be successfully normalised into acute hospital practice, and to identify necessary modifications to optimise its implementation. Method Multi-method process evaluation embedded within a mixed-method feasibility cluster randomised controlled trial in two district general hospitals in England. Data were collected using (i) focus groups with health professionals (HPs), (ii) semi-structured interviews with patients and/or carers, (iii) non-participant observations of multi-disciplinary team meetings and (iv) patient clinical note review. Thematic analysis and descriptive statistics, with interpretation guided by NPT components (coherence; cognitive participation; collective action; reflexive monitoring). Data triangulated across sources. Results Two focus groups (26 HPs), nine non-participant observations, 12 interviews (two patients, 10 relatives), 29 clinical note reviews were conducted. While coherence was evident, with HPs recognising the value of the AMBER care bundle, cognitive participation and collective action presented challenges. Specifically: (1) HPs were unable and unwilling to operationalise the concept of ‘risk of dying’ intervention eligibility criteria (2) integration relied on a ‘champion’ to drive participation and ensure sustainability; and (3) differing skills and confidence led to variable engagement with difficult conversations with patients and families about, for example, nearness to end of life. Opportunities for reflexive monitoring were not routinely embedded within the intervention. Reflections on the use of the AMBER care bundle from HPs and patients and families, including recommended modifications became evident through this NPT-driven analysis. Conclusion To be successfully normalised, new clinical practices, such as the AMBER care bundle, must be studied within the wider context in which they operate. NPT can be used to the aid identification of practical strategies to assist in normalisation of complex interventions where the focus of care is on clinical uncertainty in acute hospital settings.
Neuropathies and vitamin D deficiency

1. Do SS, Kay FU, Abbara S, et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. 24. Radiology: Cardiothoracic Imaging 2020; 2:e200152. Published online: March 25, 2020. https://pubs.rsna. org/doi/full/10.1148/ryct.2020200152. 2. American College of Radiology. Recommendations for the use of chest radiography and computed tomography (CT) for suspected COVID-19 infection. 2020. https://www.acr. org/advocacy-and-economics/acrposition-statements/recommendations-for-chest-radiography-and-ctfor-suspected-covid19-infection. Accessed August 27, 2020. 3. US Centers for Disease Control and Prevention. Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). 2020. https://www.cdc. gov/coronavirus/2019-ncov/hcp/ clinical-guidance-management-patients.html. Accessed August 27, 2020. 4. Drake MG. High-flow nasal cannula oxygen in adults: an evidencebased assessment. Ann Am Thorac Soc. 2018;15:145-155. 5. National Institutes of Health. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. 2020. https:// www.covid19treatmentguidelines. nih.gov/. Accessed August 27, 2020 6. Fan E, Beitler JR, Brochard L, et al. COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted? Lancet Respir Med. 2020;8:816-821. 7. Morales-Quinteros L, Camprubí-Rimblas M, Bringué J, Bos LD, Schultz MJ, Artigas A. The role of hypercapnia in acute respiratory failure. Intensive Care Med Exp. 2019;7:39. 8. Jonville S, Delpech N, Denjean A. Contribution of respiratory acidosis to diaphragmatic fatigue at exercise. Eur Respir J. 2002;19:1079-1086.
Muscle, Ageing and Temperature Influence the Changes in Texture, Cooking Loss and Shrinkage of Cooked Beef

This study aimed to quantify the effect of muscle, ageing and cooking temperature on the texture, cooking loss and shrinkage of cooked beef. Cuboids from unaged (1 day post mortem) and aged (14 days post mortem) semitendinosus, biceps femoris and psoas major muscles, from both sides of five beef carcasses, were cooked at four different cooking temperatures (50, 60, 70 and 80 °C) for 30 min. and their Warner–Bratzler shear force (WBSF), cooking loss and shrinkage (longitudinal and transverse) were quantified. The WBSF was reduced by ageing in the muscles at the specific cooking temperatures: psoas major (cooked at 50, 60 and 80 °C), semitendinosus (70 and 80 °C) and biceps femoris (80 °C). The cooking loss was 3% greater in aged compared to unaged muscles. The longitudinal shrinkage was greatest in psoas major at 80 °C amongst the muscle types and it was reduced by ageing in psoas major (70 and 80 °C) and biceps femoris (80 °C). The transverse shrinkage was reduced by ageing only in biceps femoris, across all temperatures; and the diameter of homogenized fibre fragments from semitendinosus and biceps femoris was reduced more by cooking at 50 °C in unaged compared to aged condition. WBSF was related to transverse shrinkage, and cooking loss was related to longitudinal shrinkage. The effect of muscle type on the physical changes occurring during cooking of beef is dependent on ageing and cooking temperature.
Maternal obesity influences placental nutrient transport, inflammatory status and morphology in human term placenta.

CONTEXT Maternal obesity has a significant impact on placental development. However, this impact on placenta's structure and function (i.e. nutrient transport, and hormone and cytokine production) is a controversial subject. OBJECTIVE We hypothesized that maternal obesity is associated with morphologic, secretory and nutrient-related changes and elevated levels of inflammation in the placenta. DESIGN We collected samples of placental tissue from two well-defined groups of pregnant women from 2017 to 2019. We compared the two groups regarding the placental cytokine and hormone secretion, immune cell content, morphology, and placental nutrient transporter expressions. SETTING Placenta were collected after caesarean section performed by experienced clinicians at CHI of Poissy-Saint-Germain-en-Laye. PATIENTS The main inclusion criterion was an age between 27 and 37, no complications of pregnancy and a first-trimester BMI of 18-25 kg/m² for the non-obese (control) group and 30-40 kg/m² for the obese group. RESULTS In contrast to our starting hypothesis, we observed that maternal obesity was associated with (i) lower placental IL-6 expression and macrophage/leukocyte infiltration, (ii) lower placental expression of GLUT1 and SNAT1-2, (iii) a lower placental vessel density, and (iv) lower levels of placental leptin and hCG production. CONCLUSION These results suggest that placenta is a plastic organ and could optimize fetal growth. A better understanding of placental adaptation is required because these changes may partly determine the fetal outcome in cases of maternal obesity.
Beneficial Effects of Newly Isolated Akkermansia muciniphila Strains from the Human Gut on Obesity and Metabolic Dysregulation

The identification of new probiotics with anti-obesity properties has attracted considerable interest. In the present study, the anti-obesity activities of Akkermansia muciniphila (A. muciniphila) strains isolated from human stool samples and their relationship with the gut microbiota were evaluated using a high fat-diet (HFD)-fed mice model. Three strains of A. muciniphila were chosen from 27 isolates selected based on their anti-lipogenic activity in 3T3-L1 cells. The anti-lipogenic, anti-adipogenic and anti-obesity properties of these three strains were evaluated further in HFD-induced obese mice. The animals were administered these strains six times per week for 12 weeks. The treatment improved the HFD-induced metabolic disorders in mice in terms of the prevention of body weight gain, caloric intake and reduction in the weights of the major adipose tissues and total fat. In addition, it improved glucose homeostasis and insulin sensitivity. These effects were also associated with the inhibition of low-grade intestinal inflammation and restoration of damaged gut integrity, prevention of liver steatosis and improvement of hepatic function. These results revealed a difference in the distribution pattern of the gut microbial communities between groups. Therefore, the gut microbial population modulation, at least in part, might contribute to the beneficial impact of the selected A. muciniphila strains against metabolic disorders.
Survival and Injury of Listeria monocytogenes , Listeria innocua and Listeria ivanovii in Ground Pork Following Electron Beam Irradiation †.

The sensitivity of five strains of Listeria to electron beam irradiation in ground pork as well as the extent of sublethal radiation injury exhibited by each were investigated. Ground pork was inoculated with one of five strains of Listeria and irradiated with from 0 to 1.25 kGy at 0.25 kGy intervals. Listeria innocua NADC 2841 was more radiation-resistant (D10 = 0.638 kGy) than L. monocytogenes NADC 2045 Scott A (D10 = 0.447 kGy), L. monocytogenes NADC 2783 (a hamburger isolate) (D10 = 0.424 kGy), L. monocytogenes ATCC 15313 (D10 = 0.445 kGy), and L. ivanovii NADC 3518 (D10 = 0.372 kGy), when recovered on tryptic soy agar supplemented with 0.6% yeast extract. D10 values for L. innocua , L. ivanovii , and L. monocytogenes ATCC 15313 were lower when cells were recovered on modified Oxford medium. These three strains were susceptible to radiation-induced sublethal injury, with the numbers of injured organisms increasing with irradiation dose. The two pathogenic strains of L. monocytogenes were not injured significantly at the dose levels used. The results show that the dose range currently being considered by the Food and Drug Administration for the irradiation of beef and pork (1.5 to 4.5 kGy) is adequate for the elimination of L. monocytogenes from pork.
Pengendalian Hayati Afid pada Tanaman Cabai Merah dengan Menochilus sexmaculatus

A field trial on biological control of aphids (Homoptera: Aphididae) with Menochilus sexmaculatus (Coleoptera: Coccinellidae) was conducted at red chilli field in Sleman, Yogyakarta, in the planting season of 2010. Second instar was released at rate of 1 larva/250 aphids. The number of predator per plant varied depending on aphid-population density. The effectiveness of the predator was compared with application of sihalotrin 25 g/l at concentration rate of 2 cc/l as much as 500 l/ha. The results showed that effectiveness of the predator application was equal with the insecticide application. Percobaan lapangan pengendalian hayati Aphis spp. (Homoptera: Aphididae) dengan Menochilus sexmaculatus (Coleoptera: Coccinellidae) dilakukan di lahan cabai merah di daerah Sleman, Yogyakarta, pada musim tanam tahun 2010. Satu ekor larva instar II dilepas pada populasi 250 ekor afid. Banyaknya predator per tanaman bervariasi tergantung kepadatan populasi afid. Keefektifan aplikasi predator dibandingkan dengan perlakuan sihalotrin 25 g/l, konsentrasi 2 cc/l sebanyak 500 l/ha. Hasil kajian menunjukkan bahwa keefektifan aplikasi predator setara dengan aplikasi insektisida
Clinical Utility of the Meal Tolerance Test in the Care of Patients with Type 2 Diabetes Mellitus

Objective The measurement of C-peptide immunoreactivity (CPR) is essential for evaluating the pancreatic β-cell function and selecting appropriate therapeutic agents in patients with diabetes mellitus. The meal tolerance test (MTT) is simple to administer physiological insulin-stimulating test. Previous studies have reported that several CPR-related indices are useful markers for predicting insulin requirement in type 2 diabetes. In the present study, we investigated the serum CPR response during the MTT in hospitalized patients with type 2 diabetes mellitus in order to clarify the clinical utility of the MTT. Methods We performed the MTT using a test meal with timed measurements of the serum CPR level based on the oral glucose tolerance test over 180 minutes and tested the correlation of various CPR-related indices and clinical factors in patients with type 2 diabetes mellitus. Patients The subjects were patients with type 2 diabetes mellitus who had been admitted to our hospital for diabetes management and education. The final study population consisted of 68 patients. Results The fasting CPR level was correlated with the 24-hour urinary CPR excretion and body mass index. The serum CPR level at 120 minutes in the MTT was strongly correlated with the area under the curve of CPR during the MTT. The patients who needed insulin therapy at 6 months after hospitalization showed a significant lower incremental CPR value from 0 to 120 minutes in the MTT than those who did not need insulin therapy. Conclusion The plasma C-peptide levels at 0 and 120 minutes in the MTT provide essential information for the clinical management of patients with type 2 diabetes mellitus.
Nephrotoxicity of calcineurin inhibitors as a risk factor for BK polyomavirus replication after kidney transplantation

BK polyomavirus‐associated nephropathy (PyVAN) is responsible for a significant percentage of transplanted kidneys prematurely terminating their function. Its occurrence is closely related to the intensity of immunosuppressive therapy. In a group of 161 newly transplanted patients, we prospectively evaluated 457 protocol renal biopsies performed within the first year after transplantation. Using the calcineurin inhibitors (CI) nephrotoxicity score, the incidence of nephrotoxicity was monitored as a manifestation of excessive immunosuppression. Findings were correlated with clinical evidence of active BK polyomavirus (BKPyV) replication and PyVAN. Compared to the normal histology, nephrotoxicity was associated with more frequent BKPyV viremia and viruria (p = .01 and p < .01, respectively) and more common occurrence of PyVAN. The persistence of toxicity in the subsequent biopsy proved to be a negative risk factor of viremia and viruria (p = .03 and p < .01, respectively), independently of the initial BKPyV status. Toxicity could also be used as a predictor of viremia and viruria (p = .04 and p < .01, respectively) even in the absence of viral replication at the time of initial biopsy. The early histological manifestation of CI nephrotoxicity was associated with significant BKPyV reactivation in the risky first posttransplant year.
It Takes Time to Unravel the Ecology of War in Gaza, Palestine: Long-Term Changes in Maternal, Newborn and Toddlers’ Heavy Metal Loads, and Infant and Toddler Developmental Milestones in the Aftermath of the 2014 Military Attacks

Toxicant, teratogen and carcinogen metal war remnants negatively affect human health. The current study analyzes, first, the persistence of heavy metal contamination in newborn hair in four cohorts across time in Gaza Palestine; second, the change in mothers’ and infants’ heavy metal contamination from birth to toddlerhood; and third, the impact of heavy metal contamination on infants’ and toddlers’ growth and development. The hair of newborns was analyzed for twelve heavy metals by Inductively Coupled Plasma Mass Spectrometry (ICP/MS) in cohorts recruited at delivery in 2011, 2015, 2016, and 2018–2019. In the 2015 cohort, mothers’ hair samples were taken at delivery, and toddlers and mothers hair were also analyzed 18 months later. Growth levels of infants at six months and toddlers at 18 months were assessed according to World Health Organization (WHO) standards according to a mother report and pediatric check-up, respectively. 1. The level of metal contamination in utero was persistently high across 8 years, 2011, 2015, 2016, 2019, following three major military attacks (2009, 2012, 2014). 2. The 2015 cohort babies exposed in utero to attacks in 2014 at six months showed association of high load at birth in mother of arsenic and in newborn of barium with underweight, of barium and molybdenum in newborn with stunting. 3. Eighteen months after birth, toddlers had a higher level of metals in hairs than when they were born, while, in their mothers, such levels were similar to those at delivery, confirming persistence in the environment of war remnants. Underweight and stunting, both in infants and toddlers, were higher than reported for previous years, as well as being progressive within the cohort. Severe environmental factors, metal contamination and food insecurity put Gaza’s infant health at risk.
Updated size index valid for both neurogenic and myogenic changes

Size index (SI) is a motor unit potential (MUP) parameter in concentric needle electromyography calculated from amplitude and area/amplitude, which can sensitively discriminate between control and neurogenic MUPs. In this study, we investigated the application of SI to myogenic MUPs based on expanded data.
Polymers for Melt Electrowriting

Melt electrowriting (MEW) is an emerging high‐resolution additive manufacturing technique based on the electrohydrodynamic processing of polymers. MEW is predominantly used to fabricate scaffolds for biomedical applications, where the microscale fiber positioning has substantial implications in its macroscopic mechanical properties. This review gives an update on the increasing number of polymers processed via MEW and different commercial sources of the gold standard poly(ε‐caprolactone) (PCL). A description of MEW‐processed polymers beyond PCL is introduced, including blends and coated fibers to provide specific advantages in biomedical applications. Furthermore, a perspective on printer designs and developments is highlighted, to keep expanding the variety of processable polymers for MEW.
Bone Health or Performance? Adaptation Response of Genetically Divergent Chicken Layer Lines to a Nutritive Calcium Depletion

Simple Summary Selection for high egg production in laying hens has led to an increased calcium requirement and consequently to an intensified calcium mobilization from the bones. However, excessive demineralization can lead to osteoporosis, which is manifested by a high incidence of bone-damaged hens. In this study, we characterized the adaptation response of laying hens to a repeated dietary calcium restriction (1.09% instead of 4.26% calcium) by means of egg production, eggshell quality, body weight and bone stability. The animal model included four layer lines differing in performance level (high vs. moderately performing lines) and phylogenetic origin (white-egg vs. brown-egg layers). We assumed that the high performing lines would respond by maintaining egg production level at the expense of eggshell quality and bone health. Egg production and eggshell quality declined considerably and bone demineralization occurred in all lines. Contrary to our hypothesis, there was evidence that phylogeny rather than performance level influenced the hens′ response. The brown-egg lines appeared to be more tolerant to the calcium depletion, while the white-egg lines were more sensitive. Our findings demonstrate the influence of genetics on the adaptive capacity of chickens and underline the importance of preserving genetic variability to cope with potential future environmental challenges. Abstract In modern laying hybrids, calcium (Ca) homeostasis is immensely challenged by daily eggshell calcification. However, excessive mobilization of Ca from bones may lead to osteoporosis, which then manifests in a high incidence of poor bone quality. The aim of this study was to characterize the hens’ adaptation response to an alternating dietary Ca restriction. The animal model consisted of four purebred layer lines, differing in laying performance (high vs. moderately performing lines) and phylogenetic origin (white- vs. brown-egg lines). According to the resource allocation theory, hens selected for high egg production were assumed to show a different response pattern to cope with this nutritive challenge compared to moderately performing lines. Data collected included egg number, egg quality traits, body weight and bone characteristics. The Ca depletion led to a temporary drop in egg production and shell quality and a loss of bone stability due to Ca mobilization. The white-egg lines response was more pronounced, whereas the brown-egg lines were less sensitive towards reduced Ca supply. Our study shows that the hens’ responsiveness to coping with a nutritive Ca depletion is not ultimately linked to genetic selection for increased egg production but rather to phylogenetic origin.
Effect of Intraocular Lens Tilt and Decentration on Visual Acuity, Dysphotopsia and Wavefront Aberrations

Tilt and decentration of intraocular lenses (IOL) may occur secondary to a complicated cataract surgery or following an uneventful phacoemulsification. Although up to 2–3° tilt and a 0.2–0.3 mm decentration are common and clinically unnoticed for any design of IOL, larger extent of tilt and decentration has a negative impact on the optical performance and subsequently, the patients’ satisfaction. This negative impact does not affect various types of IOLs equally. In this paper we review the methods of measuring IOL tilt and decentration and focus on the effect of IOL tilt and decentration on visual function, in particular visual acuity, dysphotopsia, and wavefront aberrations. Our review found that the methods to measure the IOL displacement have significantly evolved and the available studies have employed different methods in their measurement, while comparability of these methods is questionable. There has been no universal reference point and axis to measure the IOL displacement between different studies. A remarkably high variety and brands of IOLs are used in various studies and occasionally, opposite results are noticed when two different brands of a same design were compared against another IOL design in two studies. We conclude that <5° of inferotemporal tilt is common in both crystalline lenses and IOLs with a correlation between pre- and postoperative lens tilt. IOL tilt has been noticed more frequently with scleral fixated compared with in-the-bag IOLs. IOL decentration has a greater impact than tilt on reduction of visual acuity. There was no correlation between IOL tilt and decentration and dysphotopsia. The advantages of aspheric IOLs are lost when decentration is >0.5 mm. The effect of IOL displacement on visual function is more pronounced in aberration correcting IOLs compared to spherical and standard non-aberration correcting aspherical IOLs and in multifocal versus monofocal IOLs. Internal coma has been frequently associated with IOL tilt and decentration, and this increases with pupil size. There is no correlation between spherical aberration and IOL tilt or decentration. Although IOL tilt produces significant impact on visual outcome in toric IOLs, these lenses are more sensitive to rotation compared to tilt.