Miracle-dz/UniFAR-FTUs huggingface dataset:
Surgical pleth index monitoring in perioperative pain management: usefulness and limitations

Surgical pleth index (SPI) monitoring is a representative, objective nociception-monitoring device that measures nociception using photoplethysmographic signals. It is easy to apply to patients and the numerical calculation formula is intuitively easy to understand; therefore, its clinical interpretation is simple. Several studies have demonstrated its efficacy and utility. Compared with hemodynamic parameters, the SPI can detect the degree of nociception during surgery under general anesthesia with greater accuracy, and therefore can provide better guidance for the administration of various opioids, including remifentanil, fentanyl, and sufentanil. Indeed, SPI-guided analgesia is associated with lower intraoperative opioid consumption, faster patient recovery, and comparable or lower levels of postoperative pain and rates of adverse events compared with conventional analgesia. In addition, SPI monitoring allows for the degree of postoperative pain and analgesic requirements to be predicted through the SPI values immediately before patient arousal. However, because patient age, effective circulating volume, position, concomitant medication and anesthetic regimen and level of consciousness may be confounding factors in SPI monitoring, clinicians must be careful when interpreting SPI values. In addition, as SPI values can differ depending on anesthetic and analgesic regimens and the underlying disease, an awareness of the effects of these variables with an understanding of the advantages and disadvantages of SPI monitoring compared to other nociception monitoring devices is essential. Therefore, this review aimed to help clinicians perform optimal SPI-guided analgesia and to assist with the establishment of future research designs through clarifying current usefulness and limitations of SPI monitoring in perioperative pain management.
GLP-1/GIP analogs: potential impact in the landscape of obesity pharmacotherapy

ABSTRACT Introduction Obesity is recognized as a major healthcare challenge. Following years of slow progress in discovery of safe, effective therapies for weight management, recent approval of the glucagon-like peptide 1 receptor (GLP-1R) mimetics, liraglutide and semaglutide, for obesity has generated considerable excitement. It is anticipated these agents will pave the way for application of tirzepatide, a highly effective glucose-dependent insulinotropic polypeptide receptor (GIPR), GLP-1R co-agonist, recently approved for management of type 2 diabetes mellitus. Areas covered Following promising weight loss in obese individuals in Phase III clinical trials, liraglutide and semaglutide were approved for weight management without diabetes. Tirzepatide has attained Fast Track designation for obesity management by the US Food and Drug Association. This narrative review summarizes experimental, preclinical, and clinical data for these agents and related GLP-1R/GIPR co-agonists, prioritizing clinical research published within the last 10 years where possible. Expert Opinion GLP-1R mimetics are often discontinued within 24 months meaning long-term application of these agents in obesity is questioned. Combined GIPR/GLP-1R agonism appears to induce fewer side effects, indicating GLP-1R/GIPR co-agonists may be more suitable for enduring obesity management. After years of debate, this GIPR-biased GLP-1R/GIPR co-agonist highlights the therapeutic promise of including GIPR modulation for diabetes and obesity therapy.
Disparate statin prescribing following hospital discharge for stroke or transient ischemic attack: Findings from COMPASS.

BACKGROUND Published guidelines recommend high-intensity statins following an ischemic stroke or transient ischemic attack (TIA). The authors examined the potential for disparate patterns of statin prescribing in a cluster randomized trial of transitional care following acute stroke or TIA. METHODS Medications taken before hospitalization and statins prescribed at discharge among stroke and TIA patients at 27 participating hospitals were examined. Any statin and intensive statin prescribed at discharge were compared by age (<65, 65-75, >75 years), racial category (White vs. Black), sex (male vs. female), and rurality (urban vs. non-urban) using logistic mixed models. RESULTS Among 3211 patients (mean age 67 years; 47% female; 29% Black), 90% and 55%, respectively, were prescribed any statin or intensive statin therapy at discharge. White (vs. Black) patients (0.71, 0.51-0.98) less commonly received any statin prescription, while stroke (vs. TIA) patients (1.90, 1.38-2.62) and those residing in urban areas (1.66, 1.07-2.55) more commonly received any statin prescription. Among those prescribed a statin, only 42% of White and 51% of Black patients >75 years. were prescribed an intensive statin; the OR for intensive statin prescribing was 0.44 for patients >75 years and was similar in a subgroup not on a statin previously. CONCLUSION/RELEVANCE Following stroke or TIA, statin prescribing remains lower in White patients, in those with TIA, and in those in non-urban areas. Intensive statin prescribing remains limited, particularly in patients >75 years. These data may inform efforts to improve guideline concordant prescribing for post-stroke patients.
Blood pressure measurement modalities and indexed left ventricular mass in men with low-risk hypertension confirmed by ambulatory monitoring

Background: Blood pressure (BP) measurement modalities such as ambulatory monitoring (ABPM) and noninvasive central aortic systolic pressure (CASP), have been reported to improve prediction of hypertension-mediated organ damage (HMOD) compared with conventional clinic BP. However, clinic BP is often confounded by poor measurement technique and ‘white-coat hypertension’ (WCH). We compared prediction of cardiac MRI (cMRI)-derived left ventricular mass index (LVMI) by differing BP measurement modalities in young men with elevated BP, confirmed by ABPM. Methods: One hundred and forty-three treatment-naive men (<55 years) with hypertension confirmed by ABPM and no clinical evidence of HMOD or cardiovascular disease (37% with masked hypertension) were enrolled. Relationships between BP modalities and cMRI-LVMI were evaluated. Results: Men with higher LVMI (upper quintile) had higher clinic, central and ambulatory SBP compared with men with lower LVMI. Regression coefficients for SBP with LVMI did not differ across BP modalities (r = 0.32; 0.3; 0.31, for clinic SBP, CASP and 24-h ABPM, respectively, P < 0.01 all). Prediction for high LVMI using receiver-operated curve analyses was similar between measurement modalities. No relationship between DBP and LVMI was seen across measurement modalities. Conclusion: In younger men with hypertension confirmed by ABPM and low cardiovascular risk, clinic SBP and CASP, measured under research conditions, that is, with strict adherence to guideline recommendations, performs as well as ABPM in predicting LVMI. Prior reports of inferiority for clinic BP in predicting HMOD and potentially, clinical outcomes, may be due to poor measurement technique and/or failure to exclude WCH.
Relationships of habitual daily alcohol consumption with all-day and time-specific average glucose levels among non-diabetic population samples

Background Alcohol consumption is a prevalent behavior that is bi-directionally related to the risk of type 2 diabetes. However, the effect of daily alcohol consumption on glucose levels in real-world situations in the general population has not been well elucidated. This study aimed to clarify the relationship between alcohol consumption and all-day and time-specific glucose levels among non-diabetic individuals. Methods We investigated 913 non-diabetic males and females, aged 40–69 years, during 2018–2020 from four communities across Japan. The daily alcohol consumption was assessed using a self-report questionnaire. All-day and time-specific average glucose levels were estimated from the interstitial glucose concentrations measured using the Flash glucose monitoring system for a median duration of 13 days. Furthermore, we investigated the association between all-day and time-specific average glucose levels and habitual daily alcohol consumption levels, using never drinkers as the reference, and performed multiple linear regression analyses after adjusting for age, community, and other diabetes risk factors for males and females separately. Results All-day average glucose levels did not vary according to alcohol consumption categories in both males and females. However, for males, the average glucose levels between 5:00 and 11:00 h and between 11:00 and 17:00 h were higher in moderate and heavy drinkers than in never drinkers, with the difference values of 4.6 and 4.7 mg/dL for moderate drinkers, and 5.7 and 6.8 mg/dL for heavy drinkers. Conversely, the average glucose levels between 17:00 and 24:00 h were lower in male moderate and heavy drinkers and female current drinkers than in never drinkers; the difference values of mean glucose levels were −5.8 for moderate drinkers, and −6.1 mg/dL for heavy drinkers in males and −2.7 mg/dL for female current drinkers. Conclusions Alcohol consumption was associated with glucose levels in a time-dependent biphasic pattern.
Impact of Socio-demographic Characteristics on Time in Outpatient Cardiology Clinics: A Retrospective Analysis

Inequitable access to health services influences health outcomes. Some studies have found patients of lower socio-economic status (SES) wait longer for surgery, but little data exist on access to outpatient services. This study analyzed patient-level data from outpatient public cardiology clinics and assessed whether low SES patients spend longer accessing ambulatory services. Retrospective analysis of cardiology clinic encounters across 3 public hospitals between 2014 and 2019 was undertaken. Data were linked to age, gender, Indigenous status, country of birth, language spoken at home, number of comorbidities, and postcode. A cox proportional hazards model was applied adjusting for visit type (new/follow up), clinic, and referral source. Higher hazard ratio (HR) indicates shorter clinic time. Overall, 22 367 patients were included (mean [SD] age 61.4 [15.2], 14 925 (66.7%) male). Only 7823 (35.0%) were born in Australia and 8452 (37.8%) were in the lowest SES quintile. Median total clinic time was 84 min (IQR 58-130). Visit type, clinic, and referral source were associated with clinic time (R2 = 0.23, 0.35, 0.20). After adjusting for these variables, older patients spent longer in clinic (HR 0.94 [0.90-0.97]), though there was no difference according to SES (HR 1.02 [0.99-1.06]) or other variables of interest. Time spent attending an outpatient clinic is substantial, amplifying an already significant time burden faced by patients with chronic health conditions. SES was not associated with longer clinic time in our analysis. Time spent in clinics could be used more productively to optimize care, improve health outcomes and patient experience.
Kinematics of Optical Outflows in the Orion Nebula. I. The Giant Outflow HH 400 and the Irradiated Jet HH 502

We present narrowband filter and high-resolution, velocity-resolved Fabry-Perot images of outflows in the southern portion of the Orion Nebula. HH 400 is a giant, low-velocity, redshifted bow shock located about 10′ south of the core of the Orion Nebula. Its axis of symmetry passes close to the Trapezium cluster 1.5 pc to the north. The most likely point of origin is a young stellar object in the OMC-1 cloud core. HH 400 may be the remnant of a parsec-scale bipolar outflow powered by one of the young stars forming within this region. The radial velocity of gas in the limb-brightened rim of HH 400 is low, with redshifted speeds ranging from 8 to 20 km s-1 with respect to the emission from the Orion Nebula. The shape of the bow indicates that it lies close to the plane of the sky. For an inclination angle of 30° to the plane of the sky and assuming that the plasma is flowing mostly along the axis of symmetry, the visible gas at the rim of HH 400 has a mean velocity of about 30 km s-1, a mass of about 3 × 10-2 M⊙, and a dynamical age of about 5 × 104 yr, assuming the source lies in the OMC-1 cloud core. The estimated mass flux in the HH 400 bow is about 10-6 M⊙ yr-1. The bent bipolar irradiated jet HH 502 is superposed on the western rim of HH 400. We resolve the spatial and velocity structure of the jet and its multiple bow shocks. The jet consists of a chain of photoionized segments separated by wide gaps; bow shocks lie at the leading edges of these jet segments. The mean radial velocities of the jet segments decrease with increasing distance from the source. The large radial velocity dispersions of the gas at the tips of the HH 502 internal working surfaces and the small spreading angles of the HH 502 jet segments, combined with their low radial velocities, indicate that this flow lies close to the plane of the sky. Assuming that the jet is fully ionized, that it spreads at the Mach angle, and that the internal sound speed in the photoionized gas is about 10 km s-1, the jet must have a space velocity of about 400 km s-1. Finally, we present velocity-resolved images of the bow shocks in HH 540, a flow that may originate from the large protoplanetary disk 181-826. Several additional high-velocity features identified in the Fabry-Perot data trace additional jets and outflows in this portion of the Orion Nebula.
World Trade Center psychological exposures and trauma related disorders: PTSD and adjustment disorders

Abstract The relationship between exposure to the World Trade Center (WTC) disaster and elevated rates of trauma related psychiatric illnesses in 9/11 responders and survivors has been well documented. This paper is part of a series to promote the practice of evidence-based medicine when managing persons with WTC-related conditions and focuses on “Trauma and Stressor Related Disorders,” a diagnostic category that includes posttraumatic stress disorder (PTSD) and adjustment disorder. It offers background on 9/11-related trauma exposure, a summary of research findings from this cohort, and is followed by brief diagnostic and treatment information from selected clinical practice guidelines.
Reproductive variance can drive behavioral dynamics

Significance The question of how cooperation might evolve by natural selection, famously posed by Darwin, has since been answered many times over. Most explanations boil down to some form of population structure, either physical or social, so that cooperative partnerships arise more often than expected in a well-mixed community. Here, we report a qualitatively different mechanism that can favor cooperation, without any population structure whatsoever. The simple fact that reproduction or social contagion involves randomness can alone reverse the evolutionary outcome for cooperation and for many other social behaviors. This account of evolution shows that stochasticity during reproduction can be as strong a force as fitness, when interacting types compete in a population.
Atmospheric and Fuel Moisture Characteristics Associated with Lightning-Attributed Fires

AbstractA systematic examination is presented of the relationship between lightning occurrence and fires attributed to lightning ignitions. Lightning occurrence data are matched to a database of fires attributed to lightning ignition over southeastern Australia and are compared with atmospheric and fuel characteristics at the time of the lightning occurrence. Factors influencing the chance of fire per lightning stroke are examined, including the influence of fuel moisture and weather parameters, as well as seasonal and diurnal variations. The fuel moisture parameters of the Canadian Fire Weather Index System are found to be useful in indicating whether a fire will occur, given the occurrence of lightning. The occurrence of “dry lightning” (i.e., lightning that occurs without significant rainfall) is found to have a large influence on the chance of fire per lightning stroke. Through comparison of the results presented here with the results of studies from other parts of the world, a considerable degree of .
Motion estimation/compensated compressed sensing using patch-based low rank penalty

In this paper, a novel patch-based signal processing algorithm for motion estimated/compensated compressed sensing dynamic MR imaging is proposed. More specifically, we impose a non-convex patch-based low-rank penalty that exploits self-similarities within the images. This penalty is shown to favor capturing geometric features such as edges rather than reconstructing the background noises. To solve the resulting non-convex optimization problem, we propose a globally convergent concave-convex procedure (CCCP) using convex conju- gate, which has closed form solution at each sub-iteration. Experimental results demonstrate that the proposed algorithm outperforms the existing ones.
Calibrated Ensemble Forecasts Using Quantile Regression Forests and Ensemble Model Output Statistics

AbstractEnsembles used for probabilistic weather forecasting tend to be biased and underdispersive. This paper proposes a statistical method for postprocessing ensembles based on quantile regression forests (QRF), a generalization of random forests for quantile regression. This method does not fit a parametric probability density function (PDF) like in ensemble model output statistics (EMOS) but provides an estimation of desired quantiles. This is a nonparametric approach that eliminates any assumption on the variable subject to calibration. This method can estimate quantiles using not only members of the ensemble but any predictor available including statistics on other variables.The method is applied to the Meteo-France 35-member ensemble forecast (PEARP) for surface temperature and wind speed for available lead times from 3 up to 54 h and compared to EMOS. All postprocessed ensembles are much better calibrated than the PEARP raw ensemble and experiments on real data also show that QRF performs better t.
Model and parameter identification for nonlinear ice-structure interaction

Structures deployed in arctic and subarctic regions are inevitably subjected to loading tue to floating ice. The failure of the ice at the interaction point can result in complex dynamic behavior of the structure. The ice-induced vibration of structures can be generally categorized into: (1) intermittent crushing, (2) frequency lock-in, and (3) continuous crushing. The aim of this thesis is to estimate the unknown parameters as well as identify the shape of ice crushing strength and stress rate curve in a numerical model proposed by M. Maattanen under low, high and medium ice velocity. Based on measured vibration data, the least squares method and the extended Kalman filter has been used. Using the least squares method for the case of low ice velocity, all of the five unknown model parameters reach their target value when no noise is assumed to be present on the measurements. However, the result obtained under 5% noise level is poor. The reason is the discontinuity in the ice crushing stress rate curve used in the model at ? ̇? = 0MPa/s. Under high ice velocity, the least squares method fails due to the lack of information. While for medium ice velocity, the estimated ice curshing strength curve differs from the original one. On the other hand, the extended Kalman filter, which can estimate both the model parameters and the structural states, works better. For the case of low ice velocity, the estimated parameters converge to the target value for three parameter estimation also in the presence of noise. When estimating more model parameters, the result doesn’t converge to the target value due to nonuniqueness issues. However, the ice crushing strength curve obtained from fitting the ice crushing strength points at each time step is successful. Under high ice velocity, the estimated ice crushing strength curve is constant, reaching the target constant value. Moreover, the estimated curve is close to the original one within 0.4MPa/s < ? ̇? < 1.8MPa/s under medium ice velocity.
Assessment of the relationship between monocyte to high-density lipoprotein ratio and subclavian artery stenosis.

OBJECTIVE Assessment of the monocyte-to-high-density lipoprotein ratio (MHR) is a new tool for predicting inflammation, which plays a major role in atherosclerosis. Subclavian artery stenosis (SAS) is usually asymptomatic, and atherosclerosis is the most common cause of chronic obstruction of the subclavian artery in adults. The aim of this study was to determine the relationship between the MHR and SAS. PATIENTS AND METHODS Between January 2015 and January 2020, 43 patients with SAS and 43 patients without SAS were enrolled in the study. The patients' angiographic, demographic and clinic characteristics were reviewed from their medical records. Monocytes and HDL (high-density lipoprotein) cholesterols were measured through a complete blood count. The MHR was calculated as the ratio of the absolute monocyte count to the HDL cholesterol value. The resulting MHR values were divided into the following three groups: low (7.16 ± 1.59), moderate (11.08 ± 1.53) and high (21.70 ± 5.62). A p-value of less than 0.05 was considered significant. RESULTS MHR was found to be significantly higher in the SAS group compared to the control group with normal subclavian arteries (p<0.001). The frequency of SAS was found to increase with an increase in the MHR tertiles. Sensitivity and specificity values were 69.8% and 95.3%, respectively. The cut-off of the MHR value, taken as 13.39, was found to provide a significantly accurate prediction of the subclavian diagnosis (ROC area under the curve: 0.868, 95% CI: 0.789-0.947, p<0.001). After adjusting for other hematological parameters in the multivariate analysis, MHR (p=0.061) was found to be a predictor of the presence of SAS. CONCLUSIONS This study showed that MHR can be a convenient marker for predicting SAS because of the correlation between MHR and SAS.
Solder reaction-assisted crystallization of electroless Ni-P under bump metallization in low cost flip chip technology

Solder reaction-assisted crystallization of electroless Ni–P under bump metallization in the Si/SiO2/Al/Ni–P/63Sn–37Pb multilayer structure was analyzed using transmission electron microscopy, scanning electron microscopy, energy dispersive x-ray, and electron probe microanalyzer. The electroless Ni–P had an amorphous structure and a composition of Ni85P15 in the as-plated condition. Upon reflow, the electroless Ni–P transformed to Ni3Sn4 and Ni3P. The crystallization of electroless Ni–P to Ni3P was induced by the depletion of Ni from electroless Ni–P to form Ni3Sn4. The interface between electroless Ni–P and Ni3P layer was planar. From the Ni3P thickness-time relationship, the kinetics of crystallization was found to be diffusion controlled. Conservation of P occurs between electroless Ni–P and Ni3P, meaning that little or no P diffuses into the molten solder. Combining the growth rates of Ni3Sn4 and Ni3P, the consumption rate of electroless Ni–P was determined. Based upon microstructural and diffusion r.