Miracle-dz/UniFAR-FTUs huggingface dataset:
Development and Results of an Implementation Plan for High-Intensity Gait Training

Supplemental Digital Content is Available in the Text. Background and Purpose: High-intensity gait training is recommended in stroke rehabilitation to improve gait speed, walking distance, and balance. However, identifying effective and efficient implementation methods is a challenge for rehabilitation providers. This article describes the development of an implementation plan, presents findings of each implementation phase, and identifies the project's impact on clinicians and the health system. Methods: Two inpatient rehabilitation facilities, including 9 physical therapists, collaborated with a knowledge translation center to implement this program. We developed an implementation plan using the Knowledge-to-Action Framework and utilized the Consolidated Framework for Implementation Research to identify barriers and select implementation strategies. Using mix-methods research, including surveys and informal discussions, we evaluated current practice, barriers, outcomes, and the sustainability of high-intensity gait training in practice. Results: A multicomponent implementation plan that targeted barriers was developed. Before implementation, clinicians reported providing several balance, strength training, and gait interventions to improve walking. Barriers to using high-intensity gait training included knowledge, beliefs, adaptability of high-intensity gait training, resources, culture, and others. Twenty-six implementation strategies were selected to target the barriers. Surveys and informal discussions identified significant changes in perceived practice, adoption of high-intensity gait training, and positive impacts on the health system. The 2-year follow-up survey indicated that the new practice was sustained. Discussion and Conclusions: Using a multicomponent implementation plan that targeted barriers, we successfully implemented high-intensity gait training in clinical practice. Contributors to successful implementation may include the implementation methods, usual care interventions, and clinicians' readiness for this change. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A352.)
Dolutegravir in the long term in children and adolescents: frequent virological failure but rare acquired genotypic resistance

Although widely recommended, data about dolutegravir efficacy in HIV‐1‐infected children/adolescents are scarce, limited to short‐term follow‐up and mainly extrapolated from studies in adults with good adherence to treatment. This study aimed to provide long‐term data about the risk of virological failure (VF) and acquired genotypic resistance in children and adolescents receiving dolutegravir.
The effect of physical therapy and exercise on pain and functional capacity according to the radiological grade of knee osteoarthritis.

BACKGROUND Physical therapy and exercise programs are frequently used in the treatment of knee osteoarthritis (OA). However, it is not known at what stage of knee OA it is more effective. OBJECTIVE The purpose of this work was to determine the relationship between the effectiveness of the physical therapy and exercise programs and the radiological findings presence/grade of knee OA. MATERIAL AND METHODS Overall, 92 patients (65F, 27M) with knee OA were enrolled in the retrospective study. Standard knee radiographs were graded according to Kellgren-Lawrence. Pain and functional status were evaluated using a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, at the end of the physical therapy program (first month), and at third-month control visits. The demographic characteristics and VAS/WOMAC scores of the subjects were obtained from patient files. RESULTS We analyzed 131 knees of 92 patients with knee OA (65F, 27M, mean age 53.02 ± 11.13 years). The mean total VAS and WOMAC scores on the first and third months were significantly lower than the initial values (all p< 0.001). The mean VAS scores on the first and third months were significantly lower than the initial values in the group without radiological damage, but WOMAC scores were similar between the evaluations (p= 0.009, p 50 = 0.003, respectively). The mean VAS and WOMAC scores on the first and third months were significantly lower than the initial values in the grade 1 according to the Kellgren-Lawrence radiological grades (all p< 0.001). CONCLUSIONS According to the results of our study, physical therapy and exercise was effective on pain in all patients with knee OA, but only effective on knee functional capacity in the group with radiological findings, and especially more effective in patients with Kellgren-Lawrence grade 1.
Improved survival for young acute leukemia patients following a new donor hierarchy for allogeneic hematopoietic stem cell transplantation: A phase III randomized controlled study

The aim of our study was to evaluate the most optimal donor for young acute leukemia (AL) patients with multiple donors available for allogeneic hematopoietic stem cell transplantation (allo‐HSCT), including HLA‐matched sibling donors (MSDs), HLA‐matched unrelated donors (URDs), haploidentical parental donors (HPDs), and haploidentical sibling donors (HSDs). From March 2008 to December 2016, 430 AL patients ≤ 35 years of age were included in the discovery, retrospective study. Patients who received transplantation from a MSD or a HSD had better 5‐year OS rates compared with patients who received transplantation from a URD or a HPD. A superior graft‐versus‐leukemia effect was observed for high‐risk patients undergoing HSD‐HSCT with a lower relapse rate (p = 0.014) and a higher disease‐free survival (DFS) rate (p = 0.029) compared with those undergoing MSD‐HSCT. Outcomes of high‐risk patients receiving an URD or HPD were equivalent. For intermediate/standard‐risk patients, either a MSD or HSD may be the front‐line donor selection with comparable outcomes. HLA‐matched unrelated donors were preferred over HPDs with reduced non‐relapse mortality and higher overall survival (OS) and DFS rates. We further conducted an independent prospective randomized study to evaluate the survival advantage with the new donor hierarchy. Two hundred and fifty patients were randomly assigned to follow our new donor hierarchy or the traditional donor hierarchy at a 2:1 ratio. The new donor hierarchy contributed to significantly superior 2‐year OS and DFS rates (OS: 76.2% vs. 67.8%, p = 0.046; DFS: 71.8% vs. 64.5%, p = 0.039).
Morpho‐anatomical characterization of Eryngium yuccifolium ('Rattlesnake‐master')

This paper provides detailed morpho‐anatomical and histochemical characteristics of the leaves, peduncles, stems, and roots of Eryngium yuccifolium Michx. (Apiaceae) by bright‐field light and scanning electron microscopy. Noteworthy morpho‐anatomical features include the monocot‐like leaves with parallel venation and distant marginal bristles, amphistomatic leaves with paracytic or anisocytic stomata and heterogenous isobilateral mesophyll, the presence of epicuticular wax crystalloids on both leaf surfaces, calcium oxalate druses and secretory canals in all the studied plant parts, presence of hypodermis, stem and peduncle with longitudinal ribs containing collenchyma, presence of aerenchyma in the peduncle and root, and absence of sclerenchyma in all the plant parts analyzed. These characteristics would aid in the taxonomy, species identification as well as quality control of the botanical.
N1 neuraminidase of H5N1 avian influenza A virus complexed with sialic acid and zanamivir – A study by molecular docking and molecular dynamics simulation

Abstract Development of antiviral drugs is an urgent need to control and prevent the presently circulating H5N1 avian influenza virus which is affects the human respiratory tract. The complex crystal structure of N1–N–acetylneuranamic acid (sialic acid, SIA) is not available as complex and hence SIA and zanamivir (ZMR) are docked into the binding site of N1 neuraminidase. Based on the analysis, the initial complex structures have been simulated for 120 ns to get insight into the binding modes and interaction between protein–ligand complex systems. NAMD pair interaction energy and MM–PBSA binding free energy are calculated and show that there are two possible binding modes (BM1 and BM2) for N1–SIA and a single binding mode (BM1) for and N1–ZMR complex structures respectively. BM1 of N1–SIA is the most preferred binding mode. On contrary to the currently available drugs in which the chair conformation is distorted, in both the binding modes of N1–SIA, the binding pocket of N1 neuraminidase is able to accommodate SIA in 2C5 chair conformation which is the preferred conformation of SIA in solution state. In N1–ZMR complex, ZMR is bind in a distorted chair conformation. The neuraminidase binding pocket is also able to accommodate galactose of SIAα(2→3)GAL and SIAα(2→6)GAL. RMSD, RMSF and hydrogen bonding analyses have been carried out to identify the conformational flexibility and structural stability of each complex system. All the analyses show that SIA can be used as an inhibitor for N1 neuraminidase of H5N1 influenza viral infection. Communicated by Ramaswamy H. Sarma
Investigation of the Formation and Photo-activity of Titanium Dioxide and Polyelectrolytes

Investigation of the Formation and Photo-activity of Titanium Dioxide and Polyelectrolytes Scott McAuley Master of Science Graduate Department of Chemistry University of Toronto 2010 Anatase titanium dioxide was synthesized using a hydrothermal treatment of bis(ammonium lactato) titanium dihydroxide (ALT) under a variety conditions. Heating the precursor produces highly crystalline particles that do not undergo a crystal phase transition upon calcination; however, it does remove a layer of surface adsorbed lactate. Three titanium-polyelectrolyte composites (PAA, PAH, and PEI) were formed through electrostatic polymer chain collapse. In order to gain a measure of the relative photo-activity of these various samples the interaction and de-colouration of methylene blue (MB) was investigated. The composite particles were not active whereas the non-composite titanium dioxide and solution phase PAA were individually active. MB was found to form dimers with anionic PAA through electrostatic interaction; however, there was no difference in the de-colouration rate of these dimers versus the monomers. Finally, it was found that pre-irradiating the polyelectrolyte prior to combining with MB decreases the de-colouration rate.
An AMPK-ULK1-PIKFYVE signaling axis for PtdIns5P-dependent autophagy regulation upon glucose starvation

ABSTRACT Glucose deprivation induces macroautophagy/autophagy primarily through AMPK activation. However, little is known about the exact mechanism of this signaling. A recent study from Dr. David C. Rubinsztein’s lab showed that ULK1 is activated by AMPK upon glucose starvation, resulting in the phosphorylation of the lipid kinase PIKFYVE on S1548. The activated PIKFYVE consequently enhances the formation of phosphatidylinositol-5-phosphate (PtdIns5P)-containing autophagosomes, and therefore drives autophagy upregulation. The novel discovery of how ULK1 regulates the non-canonical autophagy signaling (PtdIns5P-dependent autophagy), not only expands our knowledge of autophagy, but also sheds light on therapeutic strategies for curing human disorders, where glucose-induced starvation can play an important role.
Vulnerability of personality disorder during COVID-19 crises: a multicenter survey of mental and social distress among patients referred to treatment

Abstract Background Relational and emotional problems, dysregulation, self-harming or substance abuse often characterize personality disorders (PD). In Norway, COVID-19 restrictions led to an abrupt shutdown of services from 12 March 2020 also including specialized PD treatments. Aims The objective of this study was to investigate social and mental distress among patients with PDs during the first COVID-19 wave. Design A survey was distributed after the first COVID-19 wave (June–October 2020) among 1120 patients from 12 PD treatment units. Results The response rate was 12% (N = 133). The survey reflected impairment of occupational activity (53% <50% activity last 6 months), life quality (EQ-5D-VAS: 56, SD 19), and personality functioning (LPFS-BF ≥12: 81%, 35% avoidant PD, 44% borderline PD) and high levels of depression and anxiety (PHQ-9 ≥ 10: 84%, GAD-7 ≥ 10: 68%), 49% with health-related anxiety. Problem increase was reported for anxiety (28%), depression (24%), aggression (23%), substance use (14%), and 70% of parents had more child-care difficulties. Self-destructive behaviors (26%) did not increase. The majority (78%) reported increased or unchanged social isolation and loneliness. Occupational activity declined with negative effects on part-time jobs/rehabilitation. Therapist contact was mainly telephone-based (63% ≥ weekly contact). More severe personality problems, current depressive symptoms, and self-harming before 12 March were associated with more frequent consultations. Conclusion The survey confirms severe, enhanced levels of mental distress among patients receiving telephone-based consultations as the main alternative to specialized PD treatment during the COVID-19 shutdown. The most vulnerable patients received more frequent consultations and self-destructive actions did not increase.
A Slight Increase in Reverberation Time in the Classroom Affects Performance and Behavioral Listening Effort

Objectives: The purpose of this study was to investigate the effect of a small change in reverberation time (from 0.57 to 0.69 s) in a classroom on children’s performance and listening effort. Aiming for ecological listening conditions, the change in reverberation time was combined with the presence or absence of classroom noise. In three academic tasks, the study examined whether the effect of reverberation was modulated by the presence of noise and depended on the children’s age. Design: A total of 302 children (aged 11–13 years, grades 6–8) with normal hearing participated in the study. Three typical tasks of daily classroom activities (speech perception, sentence comprehension, and mental calculation) were administered to groups of children in two listening conditions (quiet and classroom noise). The experiment was conducted inside real classrooms, where reverberation time was controlled. The outcomes considered were task accuracy and response times (RTs), the latter taken as a behavioral proxy for listening effort. Participants were also assessed on reading comprehension and math fluency. To investigate the impact of noise and/or reverberation, these two scores were entered in the statistical model to control for individual child’s general academic abilities. Results: While the longer reverberation time did not significantly affect accuracy or RTs under the quiet condition, it had several effects when in combination with classroom noise, depending on the task measured. A significant drop in accuracy with a longer reverberation time emerged for the speech perception task, but only for the grade 6 children. The effect on accuracy of a longer reverberation time was nonsignificant for sentence comprehension (always at ceiling), and depended on the children’s age in the mental calculation task. RTs were longer for moderate than for short reverberation times in the speech perception and sentence comprehension tasks, while there was no significant effect of the different reverberation times on RTs in the mental calculation task. Conclusions: The results indicate small, but statistically significant, effects of a small change in reverberation time on listening effort as well as accuracy for children aged 11 to 13 performing typical tasks of daily classroom activities. Thus, the results extend previous findings in adults to children as well. The findings also contribute to a better understanding of the practical implications and importance of optimal ranges of reverberation time in classrooms. A comparison with previous studies underscored the importance of early reflections as well as reverberation times in classrooms.
Editorial: Updates from the World Health Organization (WHO) on Global Treatment Recommendations for Drug-Susceptible and Multidrug-Resistant Tuberculosis

The World Health Organization (WHO) estimated that in 2019, 10.0 million people worldwide developed tuberculosis (TB), with 1.4 million deaths from TB in that year. Infection with Mycobacterium tuberculosis that is resistant to at least isoniazid and rifampin and an additional chemotherapeutic agent is known as multidrug-resistant TB (MDR TB). Until recently, the prevalence of drug resistance in patients with TB has been poorly understood due to a lack of infection surveillance and molecular testing. Countries with the highest prevalence of TB, including MDR TB, are also those most affected by the COVID-19 pandemic. The identification of MDR TB requires careful monitoring and resources for molecular testing. Previous treatment regimens have required intravenous treatments of long duration and high cost. The 2020 and 2021 recommendations from the WHO for the management of drug-susceptible TB and MDR TB have included oral treatment regimens and reduced treatment duration. This Editorial aims to present the rationale for the 2020 and 2021 recommendations from the WHO for the management of drug-susceptible TB and MDR TB.
Complications and adverse effects related to surgical and medical treatment in patients with inflammatory bowel disease in a prospectively recruited population-based cohort

Abstract Background Medical adverse effects and surgical complications have been reported during treatment of patients with inflammatory bowel diseases (IBDs). There is however a shortage of studies describing these in the same cohort of patients. Aim To describe medical adverse effects and surgical complications in a prospectively followed population-based cohort of patients followed for at least 10 years. Methods All newly diagnosed patients with ulcerative colitis (UC) and Crohn’s disease (CD) in the county of Uppsala between 2005 and 2009 were prospectively followed. At the end of 2019, the medical notes were scrutinised and all medical adverse effects and postoperative surgical complications were registered. Results A total of 330 patients with UC and 153 patients with CD in all age groups were included in the cohort. Four hundred and forty-two of these (91.5%) could be followed for 10 years or until death. One hundred and twenty-two patients (26.9%) experienced one or more adverse effects during the pharmacological treatment, and 25 of these could be classified as serious. Fifty-seven malignancies were diagnosed during the observation time. Surgery was performed in 16/330 UC and 33/153 CD patients. Frequency of early postoperative complications was 31% for UC patients and 36% for CD patients. Most complications were minor but two patients were re-operated, two needed intensive care and one patient died postoperatively. Conclusions Adverse effects related to medical therapy were experienced by approximately every fourth patient, and by every third patient that was operated.
Significantly favourable outcome for patients with non-small-cell lung cancer stage IIIA/IIIB and single-station persistent N2 (skip or additionally N1) disease after multimodality treatment.

OBJECTIVES Persistent lymph nodes infiltration after neoadjuvant treatment remains a controversial topic in the treatment of stage III non-small-cell lung cancer (NSCLC). The aim of this study is to identify subgroups with persistent N2 disease, who could experience survival benefit from the addition of surgery. METHODS A retrospective mono-institutional study was conducted to analyse all patients with a final histopathology of NSCLC and persistent mediastinal disease after induction chemotherapy or chemoradiotherapy and surgery from January 1998 to June 2015. RESULTS A total of 145 patients (93 men, 52 women) fulfilled the inclusion criteria. The median age was 60 years (range 38-78). A total of 82 (56.5%) patients received a lobectomy, 48 (33.1%) a pneumonectomy, 11 (7.6%) a bilobectomy and 4 (2.6%) an anatomical segmentectomy; 128 (88.3%) were completely resected (R0). Operative mortality was 2.6% (4 patients), and morbidity was 35.2% (51 patients). Overall survival at 5 years was 47.3% (n = 19) for single N2 (skip), 30.2% (n = 16) for single N2 and N1 lymph nodes and under 5% (n = 1) for multiple mediastinal stations disease. Overall survival at 5 years after lobectomy/bilobectomy was not statistically different than after pneumonectomy (33.5% vs 20.5%, P = 0.082). Disease-free survival at 5 years was 30.6% (n = 6) for ypN2a1, 23.4% (n = 7) for ypN2a2 and under 5% (n = 1) for ypN2b status. CONCLUSIONS Lobectomy or bilobectomy has to be taken into account as a potentially curative option with promising long-term results for patients after induction treatment and persistent single-station N2 involvement (skip or additionally N1 status). TRIAL REGISTRY NUMBER 14-6138-BO.
Large-Scale Fandom-based Gamification Intervention to Increase Physical Activity: A Quasi-experimental Study

Supplemental digital content is available in the text. ABSTRACT Purpose Gamification, the use of game design elements in nongame contexts, in combination with insights from behavioral economics, has been applied increasingly to behavior change interventions. However, little is known about the effectiveness or scalability of this approach, especially in the long term. We tested a large-scale smartphone-based intervention to encourage physical activity among Japanese baseball fans using gamification techniques that leveraged fandom and interteam competition inherent in sports. Methods A quasi-experimental study was conducted among fans of the Japanese Pacific League. The app, Pa-League Walk, included gamification elements, such as competition between opposing teams’ fans based on total daily step counts on game days (>60,000 free downloads since March 2016). We analyzed daily steps of 20,052 app users, supplemented by online survey data of 274 users and 613 matched controls. Difference-in-differences estimators evaluated change in daily steps before and after app installation in users versus matched controls. Results Users’ daily steps increased by 574 (95% confidence interval, 83–1064) steps 3 months after installation, compared with controls. The increase was maintained for up to 9 months (559 (99–1018) more steps per day vs baseline), attenuating over a longer follow-up. Positive effect modification was found by high-frequency of the app use (P < 0.001) but not by other covariables (P ≥ 0.14) such as education or income. Days with 10,000-step achievement increased from 24.4% to 27.5% after the additional introduction of incentives (digital player photographs; P < 0.001). Conclusions Using existing fandom and solidarity, the gamification app increased physical activity at scale among baseball fans, including people with lower socioeconomic status underrepresented in traditional health programs.