Miracle-dz/UniFAR-FTUs huggingface dataset:
Barriers and facilitators to participating in cardiac rehabilitation and physical activity in a remote and rural population: A cross-sectional survey

Background Cardiac disease requires ongoing active management which may include attendance at formal cardiac rehabilitation (CR) and increased physical activity (PA). However, uptake rates are sub-optimal. This study aimed to identify factors associated with attendance at CR and PA in a rural Scottish population. Methods A cross-sectional postal survey assessing factors potentially associated with attending CR and participating in PA. Data were also collected from hospital electronic medical records. Binary logistic and ordinal regressions were used to identify barriers and facilitators to participation. Results The cohort consisted of 840 participants referred to the CR department of a regional Scottish hospital. After applying the inclusion/exclusion criteria, 567 patients were sent a questionnaire. The number of returned questionnaires was 295 (52.0%). Responders were predominantly male (75.9%), with a mean age of 68.7 years. At the multivariate level, the only factor associated with CR attendance was a lack of perceived need (odds ratio [OR] 0.02, 95% confidence interval [CI] 0.01–0.06). Analyses of PA associations identified self-efficacy as the only significant facilitator (OR 1.29, 95% CI 1.05–1.59), and a lack of willpower as the only barrier (OR 0.42, 95% CI 0.18–0.97). Other factors were linked to CR attendance and PA at a univariate level only. Conclusions This study characterised CR and PA participation, and explored demographic, medical, and psychological factors associated with both activities — with the most important being perceived need, self-efficacy and willpower. These findings may be beneficial in clinical practice by targeting these factors to increase CR attendance and PA levels.
Remedies for Polysulfide Dissolution in Room‐Temperature Sodium–Sulfur Batteries

Rechargeable room‐temperature sodium–sulfur (RT‐NaS) batteries represent one of the most attractive technologies for future stationary energy storage due to their high energy density and low cost. The S cathodes can react with Na ions via two‐electron conversion reactions, thus achieving ultrahigh theoretical capacity (1672 mAh g−1) and specific energy (1273 Wh kg−1). Unfortunately, the sluggish reaction kinetics of the nonconductive S, severe polysulfide dissolution, and the use of metallic Na are causing enormous challenges for the development of RT‐NaS batteries. Fatal polysulfide dissolution is highlighted, important studies toward polysulfide immobilization and conversion are presented, and the reported remedies in terms of intact physical confinement, strong chemical interaction, blocking layers, and optimization of electrolytes are summarized. Future research directions toward practical RT‐NaS batteries are summarized.
A systematic analysis of the optimization of computerized physician order entry and clinical decision support systems: A qualitative study in English hospitals

This article analyzes the range of system optimization activities taking place over an extended period following the implementation of computerized physician order entry and clinical decision support systems. We undertook 207 qualitative semi-structured interviews, 24 rounds of non-participant observations of meetings and system use, and collected 17 organizational documents in five hospitals over three time periods between 2011 and 2016. We developed a systematic analysis of system optimization activities with eight sub-categories grouped into three main categories. This delineates the range of system optimization activities including resolving misalignments between technology and clinical practices, enhancing the adopted system, and improving user capabilities to utilize/further optimize systems. This study highlights the optimization efforts by user organizations adopting multi-user, organization-spanning information technologies. Hospitals must continue to attend to change management for an extended period (up to 5 years post-implementation) and develop a strategy for long-term system optimization including sustained user engagement, training, and broader capability development to ensure smoother and quicker realization of benefits.
Abaloparatide exhibits greater osteoanabolic response and higher cAMP stimulation and β‐arrestin recruitment than teriparatide

Teriparatide and abaloparatide are parathyroid hormone receptor 1 (PTHR1) analogs with unexplained differential efficacy for the treatment of osteoporosis. Therefore, we compared the effects of abaloparatide and teriparatide on bone structure, turnover, and levels of receptor activator of nuclear factor‐kappa B ligand (RANKL) and osteoprotegerin (OPG). Wild‐type (WT) female mice were injected daily with vehicle or 20–80 µg/kg/day of teriparatide or abaloparatide for 30 days. Femurs and spines were examined by microcomputed tomography scanning and serum levels of bone turnover markers, RANKL, and OPG, were measured by ELISA. Both analogs similarly increased the distal femoral fractional trabecular bone volume, connectivity, and number, and reduced the structure model index (SMI) at 20–80 µg/kg/day doses. However, only abaloparatide exhibited a significant increase (13%) in trabecular thickness at 20 µg/kg/day dose. Femoral cortical evaluation showed that abaloparatide caused a greater dose‐dependent increase in cortical thickness than teriparatide. Both teriparatide and abaloparatide increased lumbar 5 vertebral trabecular connectivity but had no or modest effect on other indices. Biochemical analysis demonstrated that abaloparatide promoted greater elevation of procollagen type 1 intact N‐terminal propeptide, a bone formation marker, and tartrate‐resistant acid phosphatase 5b levels, a bone resorption marker, and lowered the RANKL/OPG ratio. Furthermore, PTHR1 signaling was compared in cells treated with 0–100 nmol/L analog. Interestingly, abaloparatide had a markedly lower EC50 for cAMP formation (2.3‐fold) and β‐arrestin recruitment (1.6‐fold) than teriparatide. Therefore, abaloparatide‐improved efficacy can be attributed to enhanced bone formation and cortical structure, reduced RANKL/OPG ratio, and amplified Gs‐cAMP and β‐arrestin signaling.
Prolyl oligopeptidase inhibition reduces PolyQ aggregation and improves cell viability in cellular model of Huntington’s disease

Unlike several other neurodegenerative diseases, Huntington's disease (HD) has clear genetic background where huntingtin gene (HTT) has an abnormally expanded CAG repeat near the N terminus. This causes production of mutant huntingtin (mHtt) protein with polyglutamine‐expanded (polyQ) tail, and over 36 CAG repeats cause aggregation‐prone polyQ tail. This leads to accumulation of intracellular aggregates of mHtt in the cell producing toxicity with deleterious effects on gene transcription, protein processing and cell signalling cascades ultimately leading to neuronal death (for review, see Ref.1). Clinically, HD is characterized by severe symptoms such as impaired movement and chorea as well as declined cognitive, and there are currently no rational treatments. Recently, great interests have been devoted to the possibility to reduce mHtt burden by lowering the expression levels of mHtt using DNA‐ or RNA‐targeted therapies. However, these approaches are in their infancy and may bear risks related to complete loss of Htt that may have toxic effects.2 An alternative way to interfere with the aggregates would be to increase the degradation rate of mHtt. As a background to this is the finding that mHtt aggregates are known to impair the ubiquitin‐proteasome system causing a further increase in the intracellular protein load in cells. In addition, autophagy inducers can produce beneficial effects in cell culture and animal models of HD (for review, see Ref.3). However, the potential toxicity and adverse effects of such autophagy inducers may also cause serious drawbacks that has to be taken into account.4 Prolyl oligopeptidase (PREP) is mainly cytosolic enzyme involved in peptide bond cleavage that was recently shown to negatively regulate autophagy.5 KYP‐2047 is a small‐molecule inhibitor of PREP having a disease‐modifying effect in the alpha‐synuclein (aSyn) models of Parkinson´s disease (for review, see Ref.6). We have shown that KYP‐2047 reduced the amount of aSyn‐aggregates in in vitro and in vivo by activating autophagy, while PREP directly interacts with aSyn and colocalizes with aSyn in Parkinsonian brain.6, 7 Interestingly, we observed that PREP is also expressed in the striatum and particularly in the medium spiny neurons8 that preferentially degenerate in HD.1 This prompted us to study whether the inhibition of PREP could interfere with mHtt and reduce its aggregation in cell models of HD.
Community-Based, Caregiver-Implemented Early Language Intervention in High-Risk Families: Lessons Learned

Abstract:Background: High-quality, early caregiver-child interaction facilitates language, cognitive, and health outcomes. Children in low socioeconomic status households experience less frequent and lower-quality language interactions on average than their middle to high socioeconomic status peers. Early caregiver-implemented intervention may help to improve outcomes for these children.Objectives: This article describes how we used community-based participatory research (CBPR) to develop and implement a community-based, caregiver-implemented early language intervention, including the challenges, solutions, and lessons learned in the process of CBPR.Methods: We adopted an ethnographic approach to document and analyze our CBPR experiences in multiple phases of the project, including intervention design, training, implementation, and evaluation.Lessons Learned: Developing the CBPR partnership, co-designing and implementing the study, and managing systems- level concerns like obtaining funding were central challenges for the researcher–community team.Conclusions: The CBPR model enhances early language intervention research by facilitating understanding of families in underserved communities and increasing the cultural relevancy of intervention materials.
Trisomy 13 and 18—Prevalence and mortality—A multi‐registry population based analysis

The aim of the study is to determine the prevalence, outcomes, and survival (among live births [LB]), in pregnancies diagnosed with trisomy 13 (T13) and 18 (T18), by congenital anomaly register and region. Twenty‐four population‐ and hospital‐based birth defects surveillance registers from 18 countries, contributed data on T13 and T18 between 1974 and 2014 using a common data‐reporting protocol. The mean total birth prevalence (i.e., LB, stillbirths, and elective termination of pregnancy for fetal anomalies [ETOPFA]) in the registers with ETOPFA (n = 15) for T13 was 1.68 (95% CI 1.3–2.06), and for T18 was 4.08 (95% CI 3.01–5.15), per 10,000 births. The prevalence varied among the various registers. The mean prevalence among LB in all registers for T13 was 0.55 (95%CI 0.38–0.72), and for T18 was 1.07 (95% CI 0.77–1.38), per 10,000 births. The median mortality in the first week of life was 48% for T13 and 42% for T18, across all registers, half of which occurred on the first day of life. Across 16 registers with complete 1‐year follow‐up, mortality in first year of life was 87% for T13 and 88% for T18. This study provides an international perspective on prevalence and mortality of T13 and T18. Overall outcomes and survival among LB were poor with about half of live born infants not surviving first week of life; nevertheless about 10% survived the first year of life. Prevalence and outcomes varied by country and termination policies. The study highlights the variation in screening, data collection, and reporting practices for these conditions.
I n vitro and in vivo studies of Cucurbita pepo L. flowers: chemical profile and bioactivity

Abstract Edible flowers consumption has increased in recent years due to their rich content of healthy phytochemicals. The aim of this study was to analyse the chemical profile of Cucurbita pepo L. flowers, and to explore their antioxidant and hypoglycaemic properties. Moreover, in order to assess in vivo effects, biochemical analysis, Reactive Oxygen Metabolites (d-ROMs) and Biological Antioxidant Potential (BAP) tests were performed on mice serum. High Performance Liquid Chromatography-Diode Array Detection (HPLC-DAD) analyses revealed the presence of (+)-catechin, (−)-epicatechin, rutin, and syringic acid as main constituents. 2,2′-Azino-bis (3-ethylbenzothiazoline-6-sulphonic acid) (ABTS) and Ferric Reducing Antioxidant Power (FRAP) tests showed interesting results. The extract exhibited the strongest inhibitory effect on α-glucosidase (IC50 of 144.77 μg/mL). In vivo results confirmed the hypoglycaemic effects, also affecting lipid metabolism but did not revealed benefits on ROS production. These results may add some information supporting the use of C. pepo flowers as functional foods and/or nutraceuticals.
Nintedanib in Progressive Fibrosing Interstitial Lung Diseases.

BACKGROUND Preclinical data have suggested that nintedanib, an intracellular inhibitor of tyrosine kinases, inhibits processes involved in the progression of lung fibrosis. Although the efficacy of nintedanib has been shown in idiopathic pulmonary fibrosis, its efficacy across a broad range of fibrosing lung diseases is unknown. METHODS In this double-blind, placebo-controlled, phase 3 trial conducted in 15 countries, we randomly assigned patients with fibrosing lung disease affecting more than 10% of lung volume on high-resolution computed tomography (CT) to receive nintedanib at a dose of 150 mg twice daily or placebo. All the patients met criteria for progression of interstitial lung disease in the past 24 months despite treatment and had a forced vital capacity (FVC) of at least 45% of the predicted value and a diffusing capacity of the lung for carbon monoxide ranging from 30 to less than 80% of the predicted value. Randomization was stratified according to the fibrotic pattern (a pattern of usual interstitial pneumonia [UIP] or other fibrotic patterns) on high-resolution CT. The primary end point was the annual rate of decline in the FVC, as assessed over a 52-week period. The two primary populations for analysis were the overall population and patients with a UIP-like fibrotic pattern. RESULTS A total of 663 patients were treated. In the overall population, the adjusted rate of decline in the FVC was -80.8 ml per year with nintedanib and -187.8 ml per year with placebo, for a between-group difference of 107.0 ml per year (95% confidence interval [CI], 65.4 to 148.5; P<0.001). In patients with a UIP-like fibrotic pattern, the adjusted rate of decline in the FVC was -82.9 ml per year with nintedanib and -211.1 ml per year with placebo, for a difference of 128.2 ml (95% CI, 70.8 to 185.6; P<0.001). Diarrhea was the most common adverse event, as reported in 66.9% and 23.9% of patients treated with nintedanib and placebo, respectively. Abnormalities on liver-function testing were more common in the nintedanib group than in the placebo group. CONCLUSIONS In patients with progressive fibrosing interstitial lung diseases, the annual rate of decline in the FVC was significantly lower among patients who received nintedanib than among those who received placebo. Diarrhea was a common adverse event. (Funded by Boehringer Ingelheim; INBUILD ClinicalTrials.gov number, NCT02999178.).
Trends in Stroke Incidence Rates in Older US Adults: An Update From the Atherosclerosis Risk in Communities (ARIC) Cohort Study.

Importance Determining whether the previously reported decreased stroke incidence rates from 1987 to 2011 among US adults 65 years and older in the Atherosclerosis Risk in Communities (ARIC) study continued to decrease subsequently can help guide policy and planning efforts. Objective To evaluate whether stroke incidence declines among older adults in the ARIC study continued after 2011. Design, Setting, and Participants ARIC is a community-based prospective cohort study including 15 792 individuals aged 45 to 64 years at baseline (1987-1989), selected by probability sampling from residents of Forsyth County, North Carolina; Jackson, Mississippi (black individuals only); the northwestern suburbs of Minneapolis, Minneapolis; and Washington County, Maryland (ie, center). The present study included ARIC participants free of stroke at baseline, followed up through December 31, 2017. Data were collected through personal interviews and physical examinations during study visits, annual/semiannual telephone interviews, and active surveillance of discharges from local hospitals. Stroke events were adjudicated by study-physicians reviewers. Analysis began September 2018. Main Outcomes and Measures The main outcome was stroke incidence rates, which were computed with 95% CIs stratifying the analysis by age and calendar time. Trends in adjusted incidence rates were assessed using Poisson regression incidence rate ratios. Models included calendar time, age, sex, race/center, and time-varying risk factors (hypertension, diabetes, coronary heart disease, cholesterol-lowering medication use, and smoking). Results Of 14 357 ARIC participants with 326 654 person-years of follow-up, the mean (SD) age at baseline was 54.1 (5.8) years and 7955 (55.4%) were women. From 1987 to 2017, a total of 1340 incident strokes occurred among ARIC participants, and among them, 1028 (76.7%) occurred in participants 65 years and older. Crude incidence rates of stroke for participants 65 years and older decreased progressively from 1987 to 2017. Incidence rates, adjusted for age, sex, race/center, and time-varying risk factors, decreased by 32% (95% CI, 23%-40%) per 10 years in participants 65 years and older. Findings were consistent across decades, sex, and race. Conclusions and Relevance Validated total stroke incidence rates in adults 65 years and older decreased over the last 30 years in the ARIC cohort. The decrease in rates previously reported for 1987 to 2011 extends for the subsequent 6 years in men and women as well as in white and black individuals.
The role of the spinal cyclooxygenase (COX) for incisional pain in rats at different developmental stages

Cyclooxygenase enzymes (COX)‐1 and COX‐2 are important targets for pain relief after surgery, but the spinal contribution of both isoforms is still unclear, e.g., from a developmental point of view. Here, we studied changes of spinal COX‐1 and COX‐2 expression and their functional relevance in rats of different ages for pain‐related behaviour after incision.
Two cases of pheochromocytoma in pregnancy: a multidisciplinary challenge.

INTRODUCTION Pheochromocytoma in pregnancy is an extremely rare condition with prevalence of 1 in 54 000 pregnancies. It is also extremely difficult to handle, as when treated improperly, it poses a great risk to both the mother and the fetus. Early diagnosis and treatment are crucial for keeping both of the patients safe, but its recognition can become a challenge, as the main symptoms are not specific, with sustained or paroxysmal hypertension being the most prominent one. CASES PRESENTATION In this paper, we report two cases of pheochromocytoma in pregnancy. The first is a 29-year-old woman with recently diagnosed MEN2A syndrome whose tests revealed bilateral pheochromocytomas of the adrenal glands and medullary thyroid cancer. She did not consent to surgery during pregnancy and was treated conservatively during that time. Due to risk of hypertensive crisis, cesarean section was performed in the 33rd week of pregnancy. The procedure was successful, after which the patient underwent adrenalectomy and thyroidectomy. The second case is a 29-year-old woman with history of MEN2A syndrome, whose pregnancy was discovered during preparation for adrenalectomy due to pheochromocytoma. She was treated with transabdominal adrenalectomy in the 21st week of pregnancy. The subsequent childbirth was uneventful. CONCLUSIONS Due to extreme rarity of pheochromocytoma in pregnancy, its impact on the mother and the fetus remains poorly understood. Official guidelines for treatment are not established, which, combined with the complex nature of the disease itself, demands a multidisciplinary and individualized approach.
An Implementation of Robust Image Fingerprinting Based on DCT

Abstract. As a new technology of copyright protection, digital fingerprinting has played an important role in multimedia piracy tracking. In this paper, a new image fingerprinting scheme was presented. Including an embedding algorithm based on image dividing and DCT coefficients, an extracting algorithm based on image registration. In the algorithm implementation we enhance the robustness by skipping the smaller coefficients and improve the extracting accuracy by optimizing the transformation matrix of image registration. The experimental results show that our image fingerprinting scheme has good invisibility and robustness against noise, low-pass filtering and geometric attacks such as scaling, rotation and cropping.
The pragmatic role of FEF25-75 in asymptomatic subjects, allergic rhinitis, asthma, and in military setting

ABSTRACT Introduction: The forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75) is a spirometry parameter that may be useful in many clinical settings. Values <65% of predicted have been defined as abnormal. Areas covered: The current report discusses the clinical value of FEF25-75 in different settingv, namely military medicine, primary care, and specialized clinic. Moreover, the predictive role of FEF25-75 was discussed considering different patients’ populations, including patients suffering from allergic rhinitis and/or asthma, as well as normal subjects. The most recent literature concerning the assessment of FEF25-75 in these covered areas was searched. Expert opinion: In clinical practice, impaired values have been defined as a reliable surrogate marker for bronchial airflow limitation associated with early onset of asthma, bronchial hyperresponsiveness, lower airway inflammation, reversibility to bronchodilation testing, allergic sensitization, and uncontrolled asthma. In the military medicine setting, simple spirometry, including FEF25-75, may suggest a series of fruitful information.
An Institutional Approach to Fostering Inclusion and Addressing Racial Bias: Implications for Diversity in Academic Medicine

Abstract Issue: While an increasingly diverse workforce of clinicians, researchers, and educators will be needed to address the nation’s future healthcare challenges, underrepresented in medicine (UIM) perspectives remain relatively absent from academic medicine. Evidence: Prior studies have identified differential experiences within the learning environment, lack of social supports, and implicit bias in evaluations as barriers to the academic interests and successes of UIM learners. The UCSF Differences Matter initiative has shown that interventions focused on recruiting diverse academic faculty, building strong social communities, facilitating cross-cultural communication and understanding, and mitigating disparities in summative assessments can positively affect the educational experience for UIM learners and contribute to their academic success. Implications: Institution-level initiatives are needed to foster a culture of inclusion, teach cultural humility, and build a culture of trust within academic medicine. Such initiatives should aim to teach a common language to discuss diversity issues and place the responsibility of fostering inclusion on all members of the academic community. Our own institutional experience with systemic cultural reform challenges others to develop novel approaches toward fostering inclusion in academic medicine.