Miracle-dz/UniFAR-FTUs huggingface dataset:
Uncovering the relation between clinical reasoning and diagnostic accuracy – An analysis of learner's clinical reasoning processes in virtual patients

Background Clinical reasoning is an important topic in healthcare training, assessment, and research. Virtual patients (VPs) are a safe environment to teach, assess and perform research on clinical reasoning and diagnostic accuracy. Our aim was to explore the details of the clinical reasoning process and diagnostic accuracy of undergraduate medical students when working with VPs using a concept mapping tool. Methods Over seven months we provided access to 67 German and 30 English VPs combined with a concept mapping tool to visualize and measure the clinical reasoning process of identifying problems, differential diagnoses, recommended tests and treatment options, and composing a summary statement about a VP. A final diagnosis had to be submitted by the learners in order to conclude the VP scenario. Learners were allowed multiple attempts or could request the correct diagnosis from the system. Results We analyzed 1,393 completed concept maps from 317 learners. We found significant differences between maps with a correct final diagnosis on one or multiple attempts and maps in which learners gave up and requested the solution from the system. These maps had lower scores, fewer summary statements, and fewer problems, differential diagnoses, tests, and treatments. Conclusions The different use patterns and scores between learners who had the correct final diagnosis on one or multiple attempts and those who gave up, indicate that diagnostic accuracy in the form of a correct final diagnosis on the first attempt has to be reconsidered as a sole indicator for clinical reasoning competency. For the training, assessment, and research of clinical reasoning we suggest focusing more on the details of the process to reach a correct diagnosis, rather than whether it was made in the first attempt.
Polar Feature Based Deep Architectures for Automatic Modulation Classification Considering Channel Fading

To develop intelligent receivers, automatic modulation classification (AMC) plays an important role for better spectrum utilization. The emerging deep learning (DL) technique has received much attention in AMC due to its superior performance in classifying data with deep structure. In this work, a novel polar-based deep learning architecture with channel compensation network (CCN) is proposed. Our test results show that learning features from polar domain (r-θ) can improve recognition accuracy by 5% and reduce training overhead by 48%. Besides, the proposed CCN is also robust to channel fading, such as amplitude and phase offsets, and can improve the recognition accuracy by 14% under practical channel environments.
Upgrading of by‐product from beverage industry through solid‐state fermentation with Candida utilis and Bacillus subtilis

Yellow wine lees (YWL) are the main co‐products in yellow wine industry with unbalanced amino acid (AA) profiles. Solid‐state fermentation was employed in this study to upgrade the YWL for ruminant animals. A 3 × 3 orthogonal design was conducted to optimize the fermentation condition for optimal crude protein (CP) yield as follows: ratio of water to total solid medium at 50 : 100 (v/w), temperature of 30°C, and ratio of Candida utilis to Bacillus subtilis at 2 : 1. The contents of CP, peptides and AA of fermented products were 14·5, 40·9 and 26·1% higher than those of the unfermented respectively. In particular, the essential AA were highly improved, especially for lysine and methionine. The fermentation increased the in vitro microbial protein synthesis with higher CP digestibility and dramatically enhanced the ability of scavenging free radicals of the YWL. It is concluded that the microbial pretreatment can greatly improve the nutritional value of YWL, making these materials more suitable as feeds for animals, including ruminants.
Convergence of the ADAM algorithm from a Dynamical System Viewpoint

Adam is a popular variant of the stochastic gradient descent for finding a local minimizer of a function. The objective function is unknown but a random estimate of the current gradient vector is observed at each round of the algorithm. This paper investigates the dynamical behavior of Adam when the objective function is non-convex and differentiable. We introduce a continuous-time version of Adam, under the form of a non-autonomous ordinary differential equation (ODE). The existence and the uniqueness of the solution are established, as well as the convergence of the solution towards the stationary points of the objective function. It is also proved that the continuous-time system is a relevant approximation of the Adam iterates, in the sense that the interpolated Adam process converges weakly to the solution to the ODE.
Phenotypic and genotypic drug sensitivity of Mycobacterium tuberculosis complex isolated from South Omo Zone, Southern Ethiopia

Background Knowledge of drug-sensitivity patterns of Mycobacterium tuberculosis complex (MTBC) strains isolated from patients is an important aspect of TB control strategy. This study was conducted to evaluate the drug sensitivity of MTBC isolates in South Omo, southern Ethiopia. Materials and methods A total of 161 MTBC isolates (153 from new cases and eight re-treatment TB cases) were isolated using Lowenstein Jensen medium of which 126 isolates were able to be tested for drug sensitivity by BACTEC™MGIT™ 960 system, while all the 161 isolates were tested by GenoType® MTBDRplus VER 2.0. Descriptive statistics and logistic regression were used to express and present results. Results On the basis of MGIT 960 system, the prevalence of mono-resistance was 9.2% (11/119) in the new cases, although neither poly-resistance nor multidrug resistance (MDR) was recorded in these cases. On the basis of GenoType MTBDRplus assay, two of the 153 isolates (1.3%) of the new cases were mono-resistant for rifampicin (RIF) and one of these isolates had known rpoB gene mutation (H526D). One of the eight (12.5%) isolates obtained from the re-treatment cases was MDR with rpoB gene mutation (D516V) and katG gene mutation (S315T2). Taking MGIT 960 system as a gold standard, the sensitivities of the MTBDRplus assay were 33.3%, 100% and 100% for detection of resistance to isoniazid, RIF and MDR, respectively. On the other hand, its specificities were 99.2%, 100% and 100% for detection of resistance to RIF, isoniazid and MDR, respectively. Conclusion The magnitude of drug resistance was relatively low in the new TB cases of South Omo as compared to the reports from the other regions of the country. This is encouraging and hence the TB Control Program in the Zone should strengthen its program so that the emergence of drug resistance is inhibited.
Individual differences in learning and biogenic amine levels influence the behavioural division between foraging honeybee scouts and recruits

Animals must effectively balance the time they spend exploring the environment for new resources and exploiting them. One way that social animals accomplish this balance is by allocating these two tasks to different individuals. In honeybees, foraging is divided between scouts, which tend to explore the landscape for novel resources, and recruits, which tend to exploit these resources. Exploring the variation in cognitive and physiological mechanisms of foraging behaviour will provide a deeper understanding of how the division of labour is regulated in social insect societies. Here, we uncover how honeybee foraging behaviour may be shaped by predispositions in performance of latent inhibition (LI), which is a form of non-associative learning by which individuals learn to ignore familiar information. We compared LI between scouts and recruits, hypothesizing that differences in learning would correlate with differences in foraging behaviour. Scouts seek out and encounter many new odours while locating novel resources, while recruits continuously forage from the same resource, even as its quality degrades. We found that scouts show stronger LI than recruits, possibly reflecting their need to discriminate forage quality. We also found that scouts have significantly elevated tyramine compared to recruits. Furthermore, after associative odour training, recruits have significantly diminished octopamine in their brains compared to scouts. These results suggest that individual variation in learning behaviour shapes the phenotypic behavioural differences between different types of honeybee foragers. These differences in turn have important consequences for how honeybee colonies interact with their environment. Uncovering the proximate mechanisms that influence individual variation in foraging behaviour is crucial for understanding the ecological context in which societies evolve.
Phylogeny and acoustic signal evolution of a pure tone song katydid Pseudophyllus titan (Orthoptera: Tettigoniidae) based on the complete mitogenome

Abstract Ensifera is an extremely diverse group in the order Orthoptera, and it has been the subject of considerable research, especially in terms of phylogeny and bioacoustics. Katydids are known for using high-frequency broadband signals whereas most cricket songs are pure tones with a frequency range of 2–8 kHz. Pseudophyllus titan is a special katydid emits low-frequency pure tone songs similar to that of crickets. Acoustic communication of Ensifera were widely studied, but song evolution could deserve new examination taking into account the newly available phylogenies. To examine the song evolution of P. titan in the Ensifera, the mitogenomes of P. titan and three other ensiferan species (Sphagniana ussuriana, Oecanthus sinensis, Truljalia hibinonis) were obtained by high-throughput sequencing. In addition, the phylogeny of Ensifera was reconstructed including 63 in-group taxa, and the divergence time was further estimated for major ensiferan lineages. Lastly, the evolutions of song frequency were evaluated based on an ancestral character state reconstruction (ACSR). Moreover, we have studied the calling songs of 78 katydids and performed ACSR based on five genes. All phylogeny analyses confirmed that the superfamily Schizodactyloidea was placed basally to the non-grylloid clade. P. titan was in the Pseudophyllinae clade, and this clade had a distant relationship form other lineages in Phaneropteridae. The ACSR showed that P. titan evolved low-frequency pure tone songs independently after ancestors of katydids evolved high-frequency broadband noise. Referring to the geologic time scale, we suggest that the song frequency evolution in the Ensifera to some extent caused by adaptations to the changing habitat under conditions of climate change and plant evolution.
Phase 2a Safety, Pharmacokinetics, and Acceptability of Dapivirine Vaginal Rings in US Postmenopausal Women

BACKGROUND Postmenopausal women have unique sociobiological human immunodeficiency virus (HIV) risks. We evaluated the safety, pharmacokinetics, and acceptability of a microbicide dapivirine (DPV) vaginal ring (VR) versus placebo in postmenopausal women. METHODS We enrolled 96 HIV-negative postmenopausal US women in a phase 2a double-blind, randomized (3:1) trial of monthly VRs containing 25 mg DPV or placebo used continuously for 12 weeks. We assessed safety by adverse events (AEs). DPV concentrations were quantified in plasma and vaginal fluid. Steady-state concentrations were analyzed at 4, 8, and 12 weeks using repeated measures ANOVA. We assessed acceptability by self-report. RESULTS We found no differences in the proportion of women with related grade 2 or higher reproductive system AEs (DPV: 6/72 (8%), placebo: 3/24 (13%), P = . 68) or grade 3 or higher AEs (DPV: 4/72 (6%), placebo: 0/24 (0%), P = . 57). In the DPV arm, 2/72 (3%) declined to resume product use due to AEs. Median DPV concentrations in plasma (262.0 pg/mL at week 12) and vaginal fluid (40.6 ng/mg at week 12) were constant over 12 weeks and exceeded the in vitro 50% effective concentration by 5000-fold in vaginal fluid by week 4. VR acceptability was high; 84/93 (90%) "very much liked or liked" the VR. CONCLUSIONS DPV VRs were safe, well tolerated, and acceptable in postmenopausal women. Plasma concentrations were comparable to published data on DPV use in reproductive-age women (median plasma concentration: 264 pg/mL). Given the reassuring safety and pharmacokinetic data, the DPV VR is promising for preexposure prophylaxis in postmenopausal women. CLINICAL TRIALS REGISTRATION NCT02010593.
Childhood Brain Development, the Educational Achievement Gap, and Cognitive Enhancement

Research on the effects of adversity on the brain of children initially encountered strong skepticism mainly due to the fear of stigmatization and the potential pathologizing of poverty as a disease. Despite initial resistance, an increasing body of work demonstrates a correlation between low socioeconomic status and brain development. This article will focus specifically on the impact of poverty (material, economic, and social) on childhood brain development and educational achievement. Some suggest that the use of cognitive enhancers in healthy students is perfectly acceptable and should be promoted to counterbalance the failure of traditional means to improve educational achievements. In this article, I critically assess the claim that a broad use of cognitive enhancers should be promoted and offer an alternative approach. The first section evaluates the neuroscientific facts and evidence of the impact of poverty on brain development and outlines some of the criticisms raised against the “neuroscience of poverty. ” The second section focuses on the proposal made by Ray (2016) that promotes the use of cognitive enhancers as a means to address poor educational attainment. I criticize the basis of her argument and propose a different approach I call the clinical ideal. Subsequently, I provide some ethical pointers to allow an ethical and prudent use of cognitive enhancers in the educational setting. The main point of the article is not to reject prima facie the use of cognitive enhancers in socially disadvantaged students but rather provide a more nuanced approach.
A Span Selection Model for Semantic Role Labeling

We present a simple and accurate span-based model for semantic role labeling (SRL). Our model directly takes into account all possible argument spans and scores them for each label. At decoding time, we greedily select higher scoring labeled spans. One advantage of our model is to allow us to design and use span-level features, that are difficult to use in token-based BIO tagging approaches. Experimental results demonstrate that our ensemble model achieves the state-of-the-art results, 87.4 F1 and 87.0 F1 on the CoNLL-2005 and 2012 datasets, respectively.
Military Deployments and Suicide: A Critical Examination

Deployment to a combat zone is a fundamental mission for most military forces, but prior research suggests that there is a complex and nuanced association between deployment and related risk factors for suicide. Deployment and combat experiences vary greatly among military personnel and can affect a variety of protective and risk factors for suicide. This article offers a critical examination of the association among modern U.S. military deployments, suicide attempts, and death while considering the context of a prominent theory of suicide. Although previous work has demonstrated that deployment is not associated with suicide overall in this population, there is growing evidence that risk may be elevated shortly after deployment, and for some subgroups. Specific aspects of combat exposure, including the experience of killing or witnessing death in combat, may be important contributing factors. An analysis of the literature illustrates that deployment-related risk factors for suicide are complex. The limitations of the literature are discussed, and future directions are suggested.
Extended Sinus Tarsi Approach for Treatment of Displaced Intraarticular Calcaneal Fractures Compared to Extended Lateral Approach

Background: We compared the radiographic results and clinical outcomes of patients operated on via the extended sinus tarsi approach (ESTA) and the extended lateral approach (ELA) for treatment of displaced intraarticular calcaneal fractures. Methods: We retrospectively studied the utility of the ELA (46 patients, 52 feet) and the ESTA (56 patients, 64 feet) in patients operated on between January 2009 and March 2015. We evaluated pre- and postoperative x-rays and computed tomography (CT) data. Pain, patient-reported functional outcomes, satisfaction, and postoperative complications were investigated at the 3-year follow-up. Results: Neither the postoperative nor 3-year follow-up Böhler angles, nor the calcaneal width, differed significantly between the 2 groups (both P > .05). However, the maximum step-off of the posterior facet on the 3-month CT follow-up of the ESTA group was significantly less than that of the ELA group (P < .05). We found no significant between-group differences in terms of postoperative translation (P = .232) or angulation (P = .132) of the sustentacular fragment on the 3-month CT follow-up. At the 3-year follow-up, we found no significant between-group difference in the mean visual analog scale pain score at rest (P = .641) or during weightbearing (P = .525). We found no significant between-group difference in the Foot Function Index (FFI) (P = .712) or self-reported satisfaction (P = .823). The ELA group experienced significantly more wound complications (P = .041) and nonunions (P = .041) than the ESTA group. Four instances of superficial peroneal nerve injury were reported in the ESTA group (P = .127). Conclusion: Compared with the ELA, the ESTA afforded comparable, favorable radiological results and clinical outcomes, associated with fewer wound complications and nonunions. We suggest that the ESTA is an effective operative option when treating displaced, intraarticular calcaneal fractures. Level of Evidence: Level III, comparative study.
Factors Associated With Successful Setup of a Self-Fitting Hearing Aid and the Need for Personalized Support.

OBJECTIVES Self-fitting hearing aids have the potential to increase the accessibility of hearing health care. The aims of this study were to (1) identify factors that are associated with the ability to successfully set up a pair of commercially available self-fitting hearing aids; 2) identify factors that are associated with the need for knowledgeable, personalized support in performing the self-fitting procedure; and (3) evaluate performance of the individual steps in the self-fitting procedure. DESIGN Sixty adults with hearing loss between the ages of 51 and 85 took part in the study. Half of the participants were current users of bilateral hearing aids; the other half had no previous hearing aid experience. At the first appointment, participants underwent assessments of health locus of control, hearing aid self-efficacy, cognitive status, problem-solving skills, demographic characteristics, and hearing thresholds. At the second appointment, participants followed a set of computer-based instructions accompanied by video clips to self-fit the hearing aids. The self-fitting procedure required participants to customize the physical fit of the hearing aids, insert the hearing aids into the ear, perform self-directed in situ audiometry, and adjust the resultant settings according to their preference. Participants had access to support with the self-fitting procedure from a trained clinical assistant (CA) at all times. RESULTS Forty-one (68%) of the participants achieved a successful self-fitting. Participants who self-fit successfully were significantly more likely than those who were unsuccessful to have had previous experience with hearing aids and to own a mobile device (when controlling for four potential covariates). Of the 41 successful self-fitters, 15 (37%) performed the procedure independently and 26 (63%) sought support from the CA. The successful self-fitters who sought CA support were more likely than those who self-fit independently to have a health locus of control that is externally oriented toward powerful others. Success rates on the individual steps in the self-fitting procedure were relatively high. No one step was more problematic than any other, nor was there a systematic tendency for particular participants to make more errors than others. Steps that required use of the hearing aids in conjunction with the self-fitting app on the participant's mobile device had the highest rates of support use. CONCLUSIONS The findings of this study suggest that nonaudiologic factors should be considered when selecting suitable candidates for the self-fitting hearing aids evaluated in this study. Although computer-based instructions and video clips were shown to improve self-fitting skill acquisition relative to past studies in which printed instruction booklets were used, the majority of people are still likely to require access to support from trained personnel while carrying out the self-fitting procedure, especially when this requires the use of an app.
Exploring the neurocognitive correlates of challenging behaviours in young people with autism spectrum disorder

Many young people with autism spectrum disorder display ‘challenging behaviours’, characterised by externalising behaviour and self-injurious behaviours. These behaviours can have a negative impact on a young person’s well-being, family environment and educational achievement. However, the development of effective interventions requires greater knowledge of autism spectrum disorder–specific models of challenging behaviours. Autism spectrum disorder populations are found to demonstrate impairments in different cognitive domains, namely social domains, such as theory of mind and emotion recognition, but also non-social domains such as executive functioning and sensory or perceptual processing. Parent-rated self-injurious behaviour and externalising behaviours, and neurocognitive performance were assessed in a population-derived sample of 100 adolescents with autism spectrum disorder. Structural equation modelling was used to estimate associations between cognitive domains (theory of mind, emotion recognition, executive functioning and perceptual processing) and self-injurious behaviour and externalising behaviours. Poorer theory of mind was associated with increased self-injurious behaviour, whereas poorer perceptual processing was associated with increased externalising behaviours. These associations remained when controlling for language ability. This is the first analysis to examine how a wide range of neurocognitive domains relate to challenging behaviours and suggests specific domains that may be important targets in the development of interventions in adolescents with autism spectrum disorder.