Miracle-dz/UniFAR-FTUs huggingface dataset:
Simplified seismic performance assessment and implications for seismic design

The last decade or so has seen the development of refined performance-based earthquake engineering(PBEE) approaches that now provide a framework for estimation of a range of important decision variables,such as repair costs,repair time and number of casualties. This paper reviews current tools for PBEE,including the PACT software,and examines the possibility of extending the innovative displacement-based assessment approach as a simplified structural analysis option for performance assessment. Details of the displacement-based s+eismic assessment method are reviewed and a simple means of quickly assessing multiple hazard levels is proposed. Furthermore,proposals for a simple definition of collapse fragility and relations between equivalent single-degree-of-freedom characteristics and multi-degree-of-freedom story drift and floor acceleration demands are discussed,highlighting needs for future research. To illustrate the potential of the methodology,performance measures obtained from the simplified method are compared with those computed using the results of incremental dynamic analyses within the PEER performance-based earthquake engineering framework,applied to a benchmark building. The comparison illustrates that the simplified method could be a very effective conceptual seismic design tool. The advantages and disadvantages of the simplified approach are discussed and potential implications of advanced seismic performance assessments for conceptual seismic design are highlighted through examination of different case study scenarios including different structural configurations.
Persistence of Attitude Changes After Near-Death Experiences

Abstract The aim of this study was to compare attitude changes reported by people who described near-death experiences (NDEs) at two periods two decades apart, to ascertain whether the attitude changes persisted over time. Participants completed the Life Changes Inventory (LCI) upon entry into the study and again two decades later, and the NDE Scale to quantify depth of the experience. Sixty-three participants (mean age at entry into study, 46 ± 10 years) had scores on the NDE Scale typical of other near-death experiencers. Scores on the LCI showed significant changes in attitudes toward life and death both on entry into the study and two decades later. LCI scores showed no significant change over that period, nor was there a significant correlation between change in LCI scores and time elapsed between the two administrations. NDEs appear to be unusual in the long-term persistence of attitude changes.
Relationship of concomitant anti-diabetic drug administration with sodium-glucose co-transporter 2 inhibitor-related ketosis

Objective The use of sodium-glucose co-transporter 2 inhibitors (SGLT2is) may be associated with ketoacidosis. Therefore, the associated risk factors should be identified. In particular, information regarding the effects of the co-administration of anti-diabetic drugs is lacking. Methods We performed a retrospective study of 68 consecutive patients with diabetes who were taking an SGLT2i and attending a single medical center. After a period of treatment (median 78 days), their circulating ketone concentrations were measured. The concomitant use of other anti-diabetic drugs was analyzed to identify independent risk factors associated with ketosis. Results Twenty-five participants were taking empagliflozin, 23 were taking dapagliflozin, and 20 were taking canagliflozin. During the treatment period, no ketoacidotic events were recorded and their mean circulating ketone concentrations at the end of the study period were similar (0.3 mmol/L in the empagliflozin group, 0.26 mmol/L in the dapagliflozin group, and 0.25 mmol/L in the canagliflozin group). After adjustment for the use of anti-diabetic drugs, pioglitazone was found to be independently associated with a risk of high circulating ketone concentration (B value: 0.361, 95% confidence interval: 0.181–0.541). Conclusion SGLT2i-associated ketoacidosis was found to be infrequent, but the concomitant use of pioglitazone was associated with a higher risk of ketosis.
Measurements and determinants of children’s exposure to background gamma radiation in Switzerland

Abstract Epidemiological studies of children’s cancer risks associated with background gamma radiation exposure have used geographic exposure models to estimate exposure at their locations of residence. We measured personal exposure to background gamma radiation, and we investigated the extent to which it was associated with children’s whereabouts. We collected data on whereabouts and exposure to background gamma radiation over a 5-day period among children aged 4–15 years in Switzerland. We used D-Shuttle dosimeters to measure children’s exposure, and we asked parents to write their children’s activities in diaries. We used Poisson mixed-effects and linear regression models to investigate the association of hourly and overall doses, respectively, with children’s reported whereabouts. During the observed time, 149 participating children spent 66% indoors at home; 19% indoors away from home; and 15% outdoors. The mean personal exposure was 85.7 nSv/h (range 52.3 nSv/h–145 nSv/h). Exposure was 1.077 (95% CI 1.067, 1.087) times higher indoors than outdoors and varied by building material and (predicted) outdoor dose rates. Our study provides detailed information about children’s patterns of exposure to background gamma radiation in Switzerland. Dwelling building materials and outdoor dose rates are important determinants of children’s exposure. Future epidemiological studies may benefit from including information about building materials.
Enhanced recovery after surgery multimodality pain regimen performs similar to PRN narcotics on outcomes and pain control after cardiac surgery: A quality improvement project

While enhanced recovery after surgery (ERAS) pathways have been successfully applied for cardiac surgery, there has been limited research directly comparing ERAS protocols to ad hoc narcotic use after surgery. We hypothesized that a standardized ERAS protocol would provide similar pain management and psychoemotional outcomes while decreasing the use of opioids in the hospital and after discharge.
Immunogenicity and safety of a bivalent, adjuvant system 04–adjuvanted human papillomavirus vaccine in healthy female volunteers aged 15–25: a randomized, double-blind, phase III, noninferiority clinical trial

Objective Vaccination is proven to significantly reduce the risk of human papillomavirus (HPV)–related complications, especially cervical cancer. This study aimed to assess the immunogenicity and safety of the investigational bivalent HPV vaccine (16/18), named Papilloguard (Noyan Pajouhan Biopharma, Tehran, Iran), in comparison with the reference product (Cervarix, bivalent HPV vaccine (16/18) manufactured by GlaxoSmithKline, Rixensart, Belgium) in a three-dose regimen. Methods This trial was a randomized, controlled, double-blind, phase III study of two HPV vaccines in healthy female volunteers aged 15–25. The primary endpoint was to test the noninferiority of Papilloguard (Noyan Pajouhan Biopharma) to Cervarix (GlaxoSmithKline) as measured by the geometric mean titer (GMT) ratios of HPV-16 and HPV-18 7 months after the first vaccination. Secondary endpoints were the proportion of local and systemic solicited and unsolicited events, and the number of females with seroconversion against HPV-16 and HPV-18 7 months after the first vaccination. Results Out of 504 screened women, 218 were enrolled. Seven months after the first vaccination, GMT ratios of HPV-16 and HPV-18 were 0.59 and 0.93, respectively. The seroconversion rates of both Papilloguard (Noyan Pajouhan Biopharma) and Cervarix (GlaxoSmithKline) were more than 96%. Both vaccinated groups had a generally good profile of solicited and unsolicited adverse events (AEs). The most common AE was discomfort at the injection site, which was well tolerated. Conclusion The result analysis of this study supports the noninferiority of Papilloguard (Noyan Pajouhan Biopharma) to Cervarix (GlaxoSmithKline) in terms of safety and immunogenicity based on the GMT ratio. However, long-term comparative studies to evaluate the sustainability of GMT response and risk of cervical intraepithelial neoplasia grades 2–3 are needed.
Clinical and Serological Characterization of Orf-Induced Immunobullous Disease.

Importance Ecthyma contagiosum, or orf, is a viral zoonotic infection caused by Poxviridae. Although human orf infection is considered to follow a self-limited course, various immunological reactions may be triggered, including immunobullous diseases. In the majority of the latter cases, the antigenic target remained enigmatic. Objective To characterize the predominant autoantigen in orf-induced immunobullous disease and further describe this clinical entity. Design, Setting, and Participants This multicenter case series sought to provide detailed clinical, histopathological and immunological characteristics of a patient with orf-induced pemphigoid. Based on this index patient, serological analyses were conducted of 4 additional patients with previously reported orf-induced immunobullous disease. Immunoblotting with extracellular matrix and a recently established indirect immunofluorescence assay for detection of serum anti-laminin 332 IgG were performed. Exposures The disease course and clinical characteristics of orf-induced immunobullous disease were observed. Main Outcomes and Measures Orf-induced immunobullous disease is primarily characterized by anti-laminin 332 autoantibodies, predominant skin involvement, and a self-limiting course. The study provides further details on epidemiological, clinical, immunopathological, diagnostic, and therapeutic aspects of orf-induced immunobullous disease. Results In all 5 patients, IgG1 and/or IgG3 autoantibodies against laminin 332 were identified. The α3, β3, and γ2 chains were recognized in 2, 4, and 1 patient(s), respectively. Conclusions and Relevance In this case series, laminin 332, a well-known target antigen in mucous membrane pemphigoid, was a major autoantigen in orf-induced immunobullous disease, even though predominant mucosal lesions were lacking in this autoimmune blistering disease. Orf-induced anti-laminin 332 pemphigoid is proposed as distinct clinical entity.
Prevalence of lateral violence in nurse workplace: a systematic review and meta-analysis

Background The prevalence of inter-nurse lateral violence (LV) reported in current studies is inconsistent, ranging from 7% to 83%. The purpose of this study is to quantify the prevalence of LV in nurses’ workplaces. Methods Systematic review and meta-analysis. Cochrane, PubMed, Embase, CINAHL, CNKI and Wanfang databases were searched for relevant studies (up to 27 January 2021). We included cross-sectional, case–control or cohort studies in which both abusers and victims were nurses. Studies that did not provide specific data on abusers were excluded. Stata V.16. 0 was used for statistical analysis. Fixed-effect or random-effect model was adopted according to heterogeneity, which was evaluated by Cochran’s Q and I2 values. The main indicator was LV prevalence. Sensitivity analysis, subgroup analysis and meta-regression were performed to investigate the sources of heterogeneity. Results A total of 14 studies with 6124 nurses were included. Further, 13 articles with 5745 nurses were included in the meta-analysis, and the pooled prevalence of LV among nurses was 33.08% (95% CI: 23.41% to 42.75%, p<0.05; I2=99.0%). The remaining one study containing 370 samples reported that the prevalence of inter-nurse LV was 7.92%. Subgroup analysis showed that region, sample size, sampling, study’s quality, response rate and publication time might not be the sources of heterogeneity. Meta-regression indicated that sample size had the main influence on model heterogeneity. Egger’s test showed the existence of publication bias (p=0.03). Discussion The prevalence of inter-nurse LV is high in nurse workplace. It is suggested that scholars pay more attention to the cultural differences of inter-nurse LV between regions in the future. This study has the following limitations: there is a lack of studies on LV prevalence in many countries; lack of standard assessment tools; no grey literature was searched.
Role of dalbavancin as combination therapy: evidence from the literature and clinical scenarios

ABSTRACT Introduction The off-label use of dalbavancin in patients with infections other than acute bacterial skin and skin structure infections (ABSSSI) represents an interesting therapeutic option. Its use as monotherapy or in combination with other antibiotics should be better defined. Areas covered The aim of this review is to summarize evidence about the potential role of dalbavancin in combination with other antibiotics and describe clinical scenarios in which combination regimens including dalbavancin are useful. The studies were retrieved from PubMed using different combinations of keywords (‘dalbavancin,’ ‘combination,’ and ‘synergy’). Expert opinion Limited data about the use of dalbavancin in monotherapy or combined with other antibiotics are available. In vitro assays showed a synergistic effect of dalbavancin when combined with beta-lactam antibiotics. The use of dalbavancin as a combination therapy in patients with ABSSSI did not demonstrate superiority compared to monotherapy. Conversely, combination regimens including dalbavancin may be useful in specific infection types, such as bone and prosthetic joint infections or subacute/chronic intravascular infections with no possibility of device removal. Potential partner drugs might be rifampin, beta-lactams, fluoroquinolones, doxycycline, and trimethoprim/sulfamethoxazole. The choice of the companion drug should be tailored on in vitro results of synergistic tests, patient’s profile, and type of infection.
Psychometric properties of the Kessler psychological scales in a Swiss young‐adult community sample indicate poor suitability for community screening for mental disorders

The Kessler psychological distress scales (K10 and K6) are used as screening tools to assess psychological distress related to the likely presence of a mental disorder. Thus, we studied the psychometric properties of their German versions in a Swiss community sample to evaluate their potential usefulness to screen for mental disorders or relevant mental problems in the community and, relatedly, for low threshold transdiagnostic German‐speaking services.
Endotracheal lactate reflects lower respiratory tract infections and inflammation in intubated patients

The aim of this study was to assess L‐lactate and D‐lactate in endotracheal aspirate from intubated patients hospitalized at the intensive care unit and explore their use as diagnostic biomarkers for inflammation and lower respiratory tract infections (LRTI). Tracheal aspirates from 91 intubated patients were obtained at time of intubation and sent for microbiological analyses, neutrophil count, and colorimetric lactate measurements. We compared the concentration of lactate from patients with microbiological verified LRTI or clinical/radiological suspicion of LRTI with a control group. In addition, associations between inflammation and the lactate isomers were examined by correlating L‐lactate and D‐lactate with sputum neutrophils and clinical assessments. The concentration of L‐lactate was increased in aspirates with verified or suspected LRTI (p < 0.001) relative to the control group at Day 0. Connections between L‐lactate and inflammation were indicated by the correlation between neutrophils and L‐lactate (p < 0.001). We found no increase in sputum D‐lactate from patients with verified or suspected LRTI relative to the control group and D‐lactate was not correlated with neutrophils. L‐lactate was found to be a potential indicator for inflammation and LRTI at the time of intubation. An association was found between neutrophil count and L‐lactate. Interestingly, the increase of L‐lactate in the control group after intubation may suggest that intubation challenges the host response by inflicting tissue damage or by introducing infectious microbes.
Oropharyngeal Rehabilitation for Patients With Moderate to Severe Obstructive Sleep Apnea After Transoral Robotic Surgery

Objective To determine whether combined transoral robotic surgery and postoperative oropharyngeal rehabilitation are effective for reducing the severity of obstructive sleep apnea. Study Design A quasi-experimental study enrolled participants without blinding between May 2019 and April 2021. Setting Single-center study at National Cheng Kung University Hospital. Methods Patients with moderate to severe obstructive sleep apnea who were otherwise healthy were recruited from the ear, nose, and throat department at National Cheng Kung University Hospital. The group undergoing transoral robotic surgery with oropharyngeal rehabilitation (n = 18) received a 12-week intervention consisting of home-based rehabilitation exercises following surgery; the transoral robotic surgery group (n = 17) received surgery only; and the control group (n = 15) received conservative treatment, such as continuous positive airway pressure therapy or other oral appliance therapy. Polysomnography data and tongue muscle performance were measured before and after the interventions. Results The group that underwent transoral robotic surgery with oropharyngeal rehabilitation exhibited significantly improved tongue protrusion strength as compared with the transoral robotic surgery–only group, as well as significantly improved apnea-hypopnea index in the supine position vs the control group. Conclusion In this study, we demonstrated the synergistic effects of transoral robotic surgery and postoperative oropharyngeal rehabilitation for adult patients with obstructive sleep apnea. Objective records should be used to monitor home-based rehabilitation exercises and examine the lasting synergistic effects.
Modeling total predation to avoid perverse outcomes from cat control in a data‐poor island ecosystem

Data‐hungry, complex ecosystem models are often used to predict the consequences of threatened species management, including perverse outcomes. Unfortunately, this approach is impractical in the many systems that have insufficient data to parameterize ecosystem interactions or reliably calibrate or validate such models. We devised a different approach composed of a minimum realistic model that guides decisions in data‐ and resource‐scarce systems. We applied our approach to a case study in an invaded ecosystem from Christmas Island, Australia, where there are concerns that cat (Felis catus) eradication to protect native species, including the red‐tailed tropicbird (Phaethon rubricauda), could release mesopredation by invasive rats (Rattus rattus). We used biophysical constraints (metabolic demand) and observable parameters (e.g., prey preferences) to identify the combined cat and rat abundances that could threaten the tropicbird population. The population of tropicbirds was not sustained when predated by 1607 rats (95% credible interval [CI]: 103–5910) in the absence of cats and 21 cats (95% CI: 2–82) in the absence of rats. For every cat removed from the island, the bird's net population growth rate improved, provided rats did not increase by more than 77 individuals (95% CI: 30–174). Thus, in this context, 1 cat is equivalent to 30–174 rats. Our methods are especially useful for on‐the‐ground predator control in the absence of knowledge of predator–predator interactions to determine whether current abundance of predators threatened the prey population of interest; managing only 1 predator species was sufficient to protect the prey species given potential release of another predator; and control of multiple predator species was needed to meet the conservation goal. With our approach limited information can be used for maximum value in data‐poor systems because it shifts the focus from predicting future trajectories to identifying conditions that impede conservation.
Palliative Care Consultation and Cost of Stay in out of Hospital Cardiac Arrest

Background: Cardiac arrest is a critical condition with high clinical, economic, and emotional burden. The role of palliative medicine in the management of critical patients has grown and, in some areas, has shown reduced cost of stay. This study set out to examine the association of palliative care involvement in out of hospital post cardiac arrest patients and cost of stay. Methods: This is a single center retrospective analysis of all patients ≥18 years of age who were admitted at our institution from March 2018 to June 2019 with out of hospital cardiac arrest. Patients who immediately died in the emergency department were excluded. Patients were then classified according to whether palliative care was consulted. Total charges were obtained from the billing records and compared between those with palliative care compared to those without using Mann–Whitney U test. Results: A final sample of 98 patients that were included in the analysis. The mean age was 61.2 ± 17.3, 46% were female, and 61% were African American. Palliative care consultation was present in 27 (28%) of patients. There were no significant differences among age, gender, ethnicity, BMI, SOFA scores, and common comorbidities among those who did and did not have palliative care consultation. While there was a significantly longer ICU length of stay and mechanical ventilation days among patients with palliative care involvement P < . 0001, the charges among patients with palliative care involvement were not statistically significantly different $59,245 ($3744-148,492) (median IQR) compared to those without palliative care $79,521 ($6540-157,952) P = . 762. Conclusion: Length of stay increased with palliative care consultation which may relate more to the inherent clinical scenario. Cost of stay was not statistically significantly different.
Therapeutic hypothermia for acute myocardial infarction: a narrative review of evidence from animal and clinical studies

Myocardial infarction (MI) is the leading cause of death from coronary heart disease and requires immediate reperfusion therapy with thrombolysis, primary percutaneous coronary intervention, or coronary artery bypass grafting. However, myocardial reperfusion therapy is often accompanied by cardiac ischemia/reperfusion (I/R) injury, which leads to myocardial injury with detrimental consequences. The causes of I/R injury are unclear, but are multifactorial, including free radicals, reactive oxygen species, calcium overload, mitochondria dysfunction, inflammation, and neutrophil-mediated vascular injury. Mild hypothermia has been introduced as one of the potential inhibitors of myocardial I/R injury. Although animal studies have demonstrated that mild hypothermia significantly reduces or delays I/R myocardium damage, human trials have not shown clinical benefits in acute MI (AMI). In addition, the practice of hypothermia treatment is increasing in various fields such as surgical anesthesia and intensive care units. Adequate sedation for anesthetic procedures and protection from body shivering has become essential during therapeutic hypothermia. Therefore, anesthesiologists should be aware of the effects of therapeutic hypothermia on the metabolism of anesthetic drugs. In this paper, we review the existing data on the use of therapeutic hypothermia for AMI in animal models and human clinical trials to better understand the discrepancy between perceived benefits in preclinical animal models and the absence thereof in clinical trials thus far.