Rationale, aims and objectives: Increased incidence of chronic illnesses coupled with physician shortages have yielded strain on primary care providers (PCP) to meet care demands. Interdisciplinary providers such as nurse practitioners and physician assistants have increasingly been embedded into primary care teams to alleviate some workload demand. Little evidence exists about the impact of interdisciplinary PCP care delivery models on provider outcomes. The objective of this study was to investigate the impact of interdisciplinary PCP care delivery on provider burnout, job satisfaction and intention to leave current position. Methods: We conducted a cross sectional mail survey using Dillman methodology of primary care practices (e.g., internal medicine) across New York State. A random sample of interdisciplinary PCPs (physicians, nurse practitioners, and physician assistants) (n=333) responded. The Provider Co-management Index (α = .85) was used to measure how well interdisciplinary dyads co-management care delivery attributes (effective communication; mutual respect and trust; shared philosophy of care). Provider outcomes were measured with validated AHRQ and HRSA items for burnout, job satisfaction and intention to leave position. Descriptive statistics, logistic regression models, crude and adjusted odds ratios were calculated, controlling for participant and practice characteristics. Results: Almost 30% of participants reported burnout with three times the odds of intending to leave their current position within one year. With each unit increase in effective co-management between interdisciplinary dyads there was 15% less burnout and 10% less odds of intention to leave position. Conclusion: Incorporating interdisciplinary specialties in primary care appears promising to alleviate some adverse provider outcomes. Organizations contemplating delivery models to promote well-being and retention may consider co-management. Cost effectiveness research is needed to determine financial sustainability of interdisciplinary care delivery.

Background & Aim Cardiogenic shock (CS) withholds a significantly high mortality rate between 40-60% despite advances in diagnosis and medical/surgical intervention. To-date, machine learning(ML) is being implemented to integrate numerous data to optimize early diagnostic predictions and suggest clinical courses. This systematic review summarizes the area under the curve (AUC) receiver operating characteristics (ROC) accuracy for the early prediction of CS. Methods A systematic review was conducted within databases of PubMed, ScienceDirect, Clinical Key/MEDLINE, Embase, GoogleScholar, and Cochrane. Cohort studies that assessed accuracy of early detection of CS using ML software were included. Data extraction was focused on AUC-ROC values directed towards early detection of CS. Results A total of 943 studies were included for systematic review. From the reviewed studies, 2.2% (N=21) evaluated patient outcomes, of which 14.3% (N=3) were assessed. The collective patient cohort (N=698) consisted of 314(45.0%) females, with an average age and body mass index (BMI) of 64.1years and 28.1kg/m2, respectively. Collectively, 159 (22.8%) mortalities were reported following early CS detection. Altogether, the AUC-ROC value was 0.82 (alfa=0.05), deeming it of superb sensitivity and specificity. Conclusions From the present comprehensively gathered data, this study accounts the use of ML software for the early detection of CS in a clinical setting as a valid tool to predict patients at risk of CS. The complexity of ML and its parallel lack of clinical evidence implies that further prospective randomized control trials are needed to draw definitive conclusions prior to standardizing use of these technologies.

The present perspective is a synthesis of 80 published investigations in the setting of a retroaortic left brachiocephalic vein, described in 250 patients. Clinical presentation, radiographic findings, ultrasonographic findings, saline contrast echocardiography, computed-tomographic angiocardiography, magnetic resonance imaging, and angiocardiography provided the diagnostic information used to define the disease entity prior to considering the surgical approach to the associated cardiac anomalies. We have also addressed several issues concerning the influence of isomerism, the establishment of diagnosis, and its importance in various surgical and interventional procedures. Although the retroaortic left brachiocephalic vein is asymptomatic, its recognition during clinical investigation should raise the possibility of an association with other malformations, especially right aortic arch, ventricular septal defect, and anomalies of the outflow tracts. We submit that an increased appreciation of this venous anomaly may facilitate surgical planning, endovascular procedures, placement of central venous lines, and transvenous pacemakers.

The genes MECP2, CDKL5, FOXG1, UBE3A, SLC9A6, and TCF4 present unique challenges for current ACMG/AMP variant interpretation guidelines. To address those challenges, the Rett and Angelman-like Disorders Variant Curation Expert Panel (Rett/AS VCEP) drafted gene-specific modifications. A pilot study was conducted to test the clarity and accuracy of using the customized variant interpretation criteria. Multiple curators obtained the same interpretation for 78 out of the 87 variants (~90%), indicating appropriate usage of the modified guidelines the majority of times by all the curators. The classification of 13 variants changed using these criteria specifications compared to when the variants were originally curated and as present in ClinVar. Many of these changes were due to internal data shared from laboratory members however some changes were because of changes in strength of criteria. There were no two step classification changes and only 1 clinically relevant change (Likely pathogenic to VUS). The Rett/AS VCEP hopes that these gene-specific variant curation rules and the assertions provided help clinicians, clinical laboratories, and others interpret variants in these genes but also other fully penetrant, early-onset genes associated with rare disorders.

Aims Primary hyperparathyroidism (PHPT) is common disorder in which parathyroid hormone (PTH) is excessively secreted from one or more of four parathyroid glands. Primary hyperparathyroidism (PHPT) is an endocrinological disorder associated with increased systemic inflammation, endothelial dysfunction. The systemic inflammation may cause subclinical decrease in cardiac function. Our aim in our study is to compare the markers of systemic inflammation in preoperative, postoperative period with PHPT, to show that PDW (platelet distribution width) value may be a predictive value for the development of cardiovascular (CVO), thromboembolic events (TBO) in patients with primary hyperparathyroidism. Results In this study, patients who underwent parathyroidectomy for primary hyperparathyroidism between 2014 - 2021 were retrospectively screened. A total of 56 patients who underwent parathyroidectomy for PHPT were included in the study. In addition to demographic and clinical information; PTH, corrected calcium, phosphate, white blood cell (WBC) count, platelet counts and PDW of the patients were recorded before and three months after parathyroidectomy. Systemic inflammatory index (SII) was calculated according to appropriate formula. Discussion The preoperative PDW value of the patients was found to be significantly higher when compared with the postoperative period and control groups. Preoperative platelet value, on the other hand, was statistically significantly higher when compared with control group. PDW values were found to be statistically significantly decreased in the postoperative period compared to the preoperative period in patients. Conclusion Increased PDW value before parathyroidectomy may be a predictive value of inflammatıon and the development of CVO ,TBO. Keywords: primary hyperparathyroidism, PDW (platelet distribution width), platelets, parathyroidectomy It is known to cause subclinical inflammation and subclinical cardiac dysfunction in primary hyperparathyroidism. There are conflicting studies on inflammation markers. Our article is the first to study PDW in primary hyperparathyroidism. High preoperative PDW indicates that PHPT may be a risk factor for cardiovascular events.

The trade-off between cognitive capacity and developmental costs drive brain size and morphology across fish species, but this pattern is less explored at intraspecific level. Physical habitat complexity has been proposed as a selection pressure on cognitive capacity that shapes brain morphology of fishes, but development of brain is also inherently linked to supply of energy and nutrients, particularly of omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFA). In this study, we compared brain morphology of brown trout Salmo trutta from stream, lake, and hatchery environments, which differ in physical complexity and availably of dietary n-3 LC-PUFA ranging from low habitat complexity and high n-3 LC-PUFA availability in hatchery to high habitat complexity and low n-3 LC-PUFA availability in streams. We found that brain size, and size of optic tectum and telencephalon differed across the three habitats, being largest in lake fish. We suggest that these differences appeared to associate with diet quality and habitat specific behavioural adaptations rather than physical habitat complexity.

Known elicitors of plant defenses against eggs of herbivorous insects are low-molecular-weight organic compounds associated with the eggs. However, previous studies provided evidence that also proteinaceous compounds present in secretion associated with eggs of the herbivorous sawfly Diprion pini can elicit defensive responses in Pinus sylvestris. Pine responses induced by the proteinaceous secretion are known to result in enhanced emission of (E)-β-farnesene, which attracts egg parasitoids killing the eggs. Here, we aimed to identify the defense-eliciting protein and elucidate its function. After isolating the defense-eliciting protein from D. pini egg secretion by ultrafiltration and gel electrophoresis, we identified it by MALDI-ToF mass spectrometry as an annexin-like protein, which we named “diprionin”. Further GC-MS analyses showed that pine needles treated with heterologously expressed diprionin released enhanced quantities of (E)-β-farnesene. Our bioassays confirmed attractiveness of diprionin-treated pine to egg parasitoids. Expression of several pine candidate genes involved in terpene biosynthesis and regulation of ROS homeostasis was similarly affected by diprionin and natural sawfly egg deposition. However, the two treatments had different effects on expression of pathogenesis related genes (PR1, PR5). Diprionin is the first egg-associated proteinaceous elicitor of indirect plant defense against insect eggs described so far.

The Euler-Poisson equations can be used to describe the important physical phenomena in many areas, such as semiconductor modeling and plasma physics. In this paper, we show the singularity formation mechanism for the solutions of the pressureless Euler-Poisson equations with time-dependent damping for the attractive forces in R^n (n ≧1) and the repulsive forces in R. We obtain the blow up of the derivative of the velocity under the appropriate assumptions.

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Background: We previously demonstrated better inflow cannula (IFC) position and reduced pump thrombosis with a centrifugal-flow LVAD (CF-LVAD) compared to an axial-flow device. We hypothesized that implant technique and patient anatomy would affect CF-LVAD IFC positioning and that malposition would impact LV unloading and outcomes. Methods: Pre- and postoperative computed tomography (CT) scans were reviewed for patients with six-month follow-up. Malposition was quantified using angular deviation from an ideal line in two planes. IFC position was compared between conventional sternotomy (CS) and lateral thoracotomy-hemisternotomy (LTHS). The influence of LV end-diastolic dimension (LVEDD), body mass index (BMI), and CT-derived anatomy was determined. LV unloading was assessed by LVAD flow index (FI) and pre- to post-LVAD decrement in mitral regurgitation (MR) and LVEDD. Outcome measures were pump thrombus or stroke (PT/eCVA); 30-day and total heart failure-related readmissions (HFRAs); and survival free of surgery for LVAD dysfunction. Results: One hundred fourteen patients met criteria. Total malposition magnitude was higher for CS than LTHS (p=0.04). Midline-LV apex distance predicted lateral-plane malposition (p=0.04), while apex-LVOT angle predicted both anterior- (p=0.01) and lateral-plane (p=0.04) malposition. Lateral-plane malposition predicted decreased LVAD FI at three (p=0.03) and six (p=0.01) months. Total malposition magnitude predicted increased 30-day HFRAs (p=0.04), while lateral-plane malposition predicted more overall HFRAs (p=0.01). Malposition was not associated with PT/eCVA, changes in MR or LVEDD, or survival free of surgical revision. Conclusions: Patient anatomy and surgical technique were associated with CF-LVAD IFC malposition. In turn, malposition was associated with increased readmissions and decreased LVAD FI.

Introduction: The aim of this study was to construct and validate a nomogram and risk stratification model for predicting cancer-specific survival (CSS) of pediatric brainstem glioma patients. Methods: Cases of pediatric brainstem glioma patients (<12 years) from 1998 to 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and demographic, clinicopathologic characteristics, treatments, and survival outcomes were analyzed. The total cohort was randomly divided into training and validation sets, followed by univariate and multivariate Cox regression analyses. A nomogram was constructed and risk stratification analysis incorporated using the selected variables from the multivariate analysis. The accuracy of the model was assessed using C-index and calibration curves. Results: A total of 806 pediatric cases with histologically confirmed diagnosis of brainstem glioma were selected and analyzed. Multivariate analysis showed that age, race, tumor size, grade and radiotherapy (P<0.05) were independent prognostic indicators of pediatric gliomas. For prediction of CSS, the C-index of the nomogram was 0.75, which shows a good predictive probability. Conclusion: The nomogram developed in this study for predicting survival of pediatric patients with histologically confirmed stem gliomas is the first to incorporate risk stratification. Combining nomogram and risk stratification system is a convenient tool to aid clinicians in the identification of high-risk patients and to perform targeted adjuvant treatment.

Over the past few decades, the rapid democratization of high-throughput sequencing and the growing emphasis on open science practices have resulted in an explosion in the amount of publicly available sequencing data. This opens new opportunities for combining datasets to achieve unprecedented sample sizes, spatial coverage, or temporal replication in population genomic studies. However, a common concern is that non-biological differences between datasets may generate batch effects that can confound real biological patterns. Despite general awareness about the risk of batch effects, few studies have examined empirically how they manifest in real datasets, and it remains unclear what factors cause batch effects and how to best detect and mitigate their impact bioinformatically. In this paper, we compare two batches of low-coverage whole genome sequencing (lcWGS) data generated from the same populations of Atlantic cod (Gadus morhua). First, we show that with a “batch-effect-naive” bioinformatic pipeline, batch effects severely biased our genetic diversity estimates, population structure inference, and selection scan. We then demonstrate that these batch effects resulted from multiple technical differences between our datasets, including the sequencing instrument model/chemistry, read type, read length, DNA degradation level, and sequencing depth, but their impact can be detected and substantially mitigated with simple bioinformatic approaches. We conclude that combining datasets remains a powerful approach as long as batch effects are explicitly accounted for. We focus on lcWGS data in this paper, which may be particularly vulnerable to certain causes of batch effects, but many of our conclusions also apply to other sequencing strategies.

Primary pulmonary synovial sarcoma (SS) is a rare neoplasm. Its clinicoradiologic attributes are not yet well defined. We report the observation of a patient followed for primary pulmonary synovial sarcoma. we report the radio-clinical features of this rare tumor.

Adversity early in life can shape the reproductive potential of individuals through negative effects on health and lifespan. However, long-lived populations with multiple reproductive events may present alternative life history strategies to optimize reproductive schedules and compensate for shorter lifespans when experiencing adversities early in life. Here, we quantify the effects of major hurricanes and density-dependence as sources of early-life ecological adversity on the mean age-specific fertility, reproductive pace, and lifetime reproductive success (LRS) of Cayo Santiago rhesus macaque females, and explored demographic mechanisms for reproductive schedule optimization later in life. Females experiencing major hurricanes early in life exhibit a delayed reproductive debut, but maintain inter-birth intervals and show a higher mean fertility during prime reproductive ages relative to females experiencing no hurricanes. Increasing density at birth is associated to a decrease in mean fertility and LRS. When combined, our study reveals that early-life ecological adversities predict a delay-overshoot pattern in mean age-specific fertility that supports the maintenance of LRS. In contrast to predictive adaptive response models of accelerated reproduction, the long-lived Cayo Santiago population presents a novel reproductive strategy where females who experience major natural disasters early in life ultimately overcome their initial reproductive penalty with no overall negative fitness outcomes. Such strategy suggests that investing more energy into development and maintenance at younger ages allows long-lived females experiencing early-life ecological adversity to reproduce at a mean rate equivalent to that of a typical female cohort later in life.

Prompted by the centenary of Alfred Landé’s g-factor, we reconstruct Landé’s path to his discovery of half-integer angular momentum quantum numbers and of vector coupling of atomic angular momenta - both encapsulated in the g-factor - as well as point to reverberations of Landé’s breakthroughs in the work of other pioneers of quantum physics.

The evolutionary direction of gonochorism and hermaphroditism is an intriguing mystery to be solved. The special transient hermaphroditic stage makes the little yellow croaker (Larimichthys polyactis, L. polyactis) an appealing model for studying the formation of hermaphrodites. On the other hand, as the most famous commercial fish species in East Asia, the origin and evolutionary relationship of L. polyactis and Larimichthys crocea remain unclear. Here, we report the genome sequence of L. polyactis, with a size of ~706 Mb (contig N50 = 1.21 Mb and scaffold N50 = 4.52 Mb) and 25,233 protein-coding genes. Phylogenomic analysis suggests that L. polyactis diverged from the common ancestor of Larimichthys crocea ~25.4 million years ago. Our high-quality genome assembly enabled comparative genomic analysis, which revealed a number of within-chromosome rearrangements and translocations without major chromosome fission or fusion events between the two species. The dmrt1 gene was identified as the candidate sex determination gene in L. polyactis. The expression of dmrt1 and its upstream regulatory gene rnf183 were both sexually dimorphic in the transcriptome analysis. Rnf183, unlike its two paralogues rnf223 and rnf225, is only present in Larimichthys but not in other teleost species, suggesting that it originated from a lineage-specific duplication or was lost in other teleosts. Phylogenetic analysis shows that the hermaphrodite stage in male L. polyactis may be explained by the sequence evolution of dmrt1. Decoding the L. polyactis genome not only provides insight into the genetic underpinnings of hermaphrodite evolution but also provides valuable information for enhancing fish aquaculture.

In this study, we give the notions about some new post-quantum partial derivatives and then use these derivatives to prove an integral equality via post-quantum double integrals. We establish some new post-quantum Ostrowski type inequalities for differentiable coordinated functions using the newly established equality. We also show that the results presented in this paper are the extensions of some existing results.

A document by Manh Tuan Hoang. Click on the document to view its contents.

Background: The aim of this study was to assess the effect on short-term outcomes and long-term survival in patients following coronary artery bypass grafting in whom second arterial conduit(right internal thoracic artery-RITA or radial artery-RA) or saphenous vein was grafted and between RITA and RA as second best arterial conduit. Methods: Between January-2006 and June-2018, 7857-patients met the inclusion criteria and were divided into two groups: single internal thoracic artery: SITA+Vein group(n=7140) and 2nd-arterial conduit group(n=717), of these 537-patients received RITA and 180-patients received RA. Short‐term outcomes included: 30-day mortality and Major Adverse Cardiac and Cerebral Events(MACCE), reoperation for bleeding and deep sternal wound infection(DSWI). The long‐term outcome was all‐cause mortality. propensity score(PS) matching was used to match patients between the groups. Results: Before as well as after PS-matching, no significant differences were observed between 2nd-arterial conduit vs SITA+Vein groups and between RITA vs RA groups in terms of 30-day mortality, 30-day MACCE, reoperation for bleeding and incidence of DSWI. The use of 2nd-arterial conduit was associated with a significant reduction in long-term mortality before(HR:0.52;95%CI;0.43-0.64;p<0.001) as well as after PS-matching(HR:0.77;95%CI;0.60-0.99;p=0.04). RA and RITA as second arterial conduit had comparable long-term mortality before(HR:1.22;95%CI;0.82-1.82;p=0.3) as well as after PS-matching(HR:0.96;95%CI;0.58-1.58;p=0.87). Conclusions: The use of 2nd-arterial conduit vs vein is associated with improved long-term survival. As for the 2nd-best arterial conduit, RA and RITA had comparable long-term mortality.

Massive parallel sequencing technology has become the predominant technique for genetic diagnostics and research. Many genetic laboratories have wrestled with the challenges of setting up genetic testing workflows based on a completely new technology. The learning curve we went through as a laboratory was accompanied by growing pains while we gained new knowledge and expertise. Here we discuss some important mistakes that have been made in our laboratory through ten years of clinical exome sequencing but that have given us important new insights on how to adapt our working methods. By providing these examples and the lessons that we learned from them, we hope that other laboratories do not need to make the same mistakes.

Crop wild relatives, the closely related species of crops, may harbor potentially important sources of new allelic diversity for (a)biotic tolerance or resistance. However, to date wild diversity is only poorly characterized and evaluated. Banana has a large wild diversity but only a narrow proportion is currently used in breeding programs. The main objective of this work was to evaluate genotype-dependent transpiration responses in relation to the environment. By applying continuous high-throughput phenotyping, we were able to construct genotype-specific transpiration response models in relation to light, VPD and soil water potential. We characterized and evaluated 6 (sub)species and discerned four phenotypic clusters. Significant differences were observed in leaf area, cumulative transpiration and transpiration efficiency. We confirmed a general stomatal-driven ‘isohydric’ drought avoidance behavior, but discovered genotypic differences in the onset and intensity of stomatal closure. We pinpointed crucial genotype specific environmental conditions when drought avoidance mechanisms were initiated and when stress kicked in. Differences between (sub)species were more pronounced under certain environmental conditions, illustrating the need for high-throughput dynamic phenotyping, modelling and validation. We conclude that the banana wild relatives contain useful drought tolerance traits, emphasizing the importance of their conservation and potential for use in breeding programs.

This paper, which drew on quantitative and qualitative data, was mainly aimed at examining the perceptions of higher institution lecturers in Nigeria concerning the effectiveness, facilitators, and inhibitors of CPD activities provided by their higher institutions and/or the Ministry of Education. The researchers employed and adapted the data collection instrument by Sywelem & Witte (2013) designed to collect data on perceptions of teachers regarding professional development opportunities and activities that exist in Saudi schools. The interview questions were designed by the researchers to access lecturers' evaluation of the professional development programs and activities in their institutions. Research survey was sent to lecturers in 3 representative higher institution in Anambra state, 213 survey responses and 15 interviews were received and analyzed. Results showed that the participants did recognize the importance and usefulness of CPD activities and expressed how CPD activities has impacted them as professionals. Lecturers expressed their expectations with regards to program content, time management, financial and moral sponsorship and support, etc. It was recommended that for lecturers to be effective at their jobs in the higher institution system, their professional development and in-service training programs must be given good attention by the management.

A 46-year-old gentleman had a complicated course of COVID-19 pneumonia. Despite the recovery of the respiratory status, he developed corpus callosum hematoma and critical illness neuropathy/myopathy, the clinical situation became more complicated by developing pulmonary embolism that required anticoagulation. Fortunately, the patient made a good recovery.

Background: Cow’s milk allergy(CMA) is the most common allergy in infants that decreases the quality of life of patients and their families. Standard treatment for CMA is the strict avoidance of milk, new treatment strategies such as oral immunotherapy (OIT) have been sought for patients with CMA . We aimed to assess the clinical efficacy and safety of OIT in the treatment of children with IgE-mediated cow’s milk allergy (IMCMA). Methods: We searched all randomized controlled trials (RCTs) in which OIT is used to treat children with IMCMA from 5 international electronic databases. We estimated a pooled relative ratio (RR) for each outcome using a Mantel-Haenzel fixed-effect model if statistical heterogeneity was low. Results: Eleven studies were chosen for meta-analysis, including a total of 469 children (242 OIT, 227 control). 176 patients (72.7%) in the OIT were desensitized compared to 49 patients in the control group (RR 7.35, 95%CI 2.82-19.13, p<0.0001). The desensitization effect of OIT was particularly significant in children over 3 years old (RR 18.05, 95%CI 6.48-50.26, p<0.00001). Although adverse effects were common, they usually involved mild reactions, but epinephrine use was more common in the OIT group (RR 7.69, 95%CI 2.16-27.33, p<0.002). Conclusion: OIT can lead to desensitization in the majority of individuals with IMCMA, especially in patients over 3-years old. A major problem of OIT is the frequency of adverse events, although most are mild. OIT may be an alternative treatment in the future.