Miracle-dz/UniFAR-FTUs huggingface dataset:
The dimensional structure of first episode psychosis: an exploratory factor analysis

Background. Recent research has focused upon the subdiagnostic level in an effort to derive more valid domains of psychotic disorder. This has led to the influential positive–negative dichotomy in schizophrenia being superseded by a three-syndrome model. The strategy of looking for syndromes within poorly validated diagnostic categories, such as schizophrenia, has limitations, particularly since it originated in, and has been largely restricted to, the more chronic subsamples. Method. A representative sample of first episode psychosis (N=509), which includes the full spectrum of functional psychosis, was utilized to re-examine the dimensional structure of functional psychosis from first principles. Patients were assessed with the Royal Park Multidiagnostic Instrument for Psychosis (MIP), a comprehensive procedure that documents the psychopathology of the first episode in a clinically valid manner. Results. Principal axis factor analysis was carried out on the tetrachoric correlation matrix of 92 core psychopathological items. A robust and clinically valid four-factor solution was obtained, comprising depression, mania and only two other factors. The first was a Bleulerian blend of negative symptoms, catatonic/motor symptoms and disorganization. The second was a combination of Schneiderian first rank symptoms, and other hallucinations and delusions. The data thus failed to support the three-syndrome model for non-affective symptoms in this population. A six-factor solution, although partially consistent with other studies, represented a more complex and confusing elaboration of the more clinically valid four-factor solution. Conclusions. The findings have implications for the conceptualization of early psychosis, which need to be explored further in validation studies.
A web-based tool to predict acute kidney injury in patients with ST-elevation myocardial infarction: Development, internal validation and comparison

Background In ST-elevation myocardial infarction (STEMI), acute kidney injury (AKI) may increase subsequent morbidity and mortality. Still, it remains difficult to predict AKI risk in these patients. We sought to 1) determine the frequency and clinical outcomes of AKI and, 2) develop, validate and compare a web-based tool for predicting AKI. Methods & findings In a racially diverse series of 1144 consecutive STEMI patients, Stage 1 or greater AKI occurred in 12.9% and was severe (Stage 2–3) in 2.9%. AKI was associated with increased mortality (5.7-fold, unadjusted) and hospital stay (2.5-fold). AKI was associated with systolic dysfunction, increased left ventricular end-diastolic pressures, hypotension and intra-aortic balloon counterpulsation. A computational algorithm (UT-AKI) was derived and internally validated. It showed higher sensitivity and improved overall prediction for AKI (area under the curve 0.76) vs. other published indices. Higher UT-AKI scores were associated with more severe AKI, longer hospital stay and greater hospital mortality. Conclusions In a large, racially diverse cohort of STEMI patients, Stage 1 or greater AKI was relatively common and was associated with significant morbidity and mortality. A web-accessible, internally validated tool was developed with improved overall value for predicting AKI. By identifying patients at increased risk, this tool may help physicians tailor post-procedural diagnostic and therapeutic strategies after STEMI to reduce AKI and its associated morbidity and mortality.
Balancing Clinical Experience in Outpatient Residency Training

Background. To receive adequate training experience, resident panels in teaching clinics must have a sufficiently diverse patient case-mix. However, case-mix can differ from one resident panel to another, resulting in inconsistent training. Method. Encounter data from primary care residency clinics at Massachusetts General Hospital from July 2008 to May 2010 (64 residents and ~3800 patients) were used to characterize patients by gender, age, major disease category (both acute and chronic, e.g., Cardio Acute, Cardio Chronic, etc., for a total of 44 disease categories), and number of disease categories. Imbalance across resident panels was characterized by the standard deviation for disease category, patient panel size, and annual visit frequency. To balance case-mix in resident panels, patient reassignment algorithms were proposed. First, patients were sorted by complexity; then patients were allocated sequentially to the panel with the least overall complexity. Patient reassignment across resident panels was considered under 3 scenarios: 1) within preceptor, 2) within a group of preceptors, and 3) across the entire practice annually. Results were compared with case-mix (pre-July 2012) and post-July 2012. Results. All 3 reassignment algorithms produced significant reductions in standard deviation of either number of disease categories or diagnoses across residents when compared with baseline (pre-July 2012) and actual July 2012 reassignment. Reassignment across the clinic and group provided the best and second best scenarios, respectively, although both came at the cost of initially reduced patient-preceptor continuity. Conclusion. Systematically reallocating patient panels in teaching clinics potentially can improve the consistency and breadth of the educational experience. The method in principle can be extended to any target of health care system reform where there is patient or clinician turnover.
Insulin resistance: an early metabolic defect of Turner's syndrome.

To evaluate whether insulin resistance contributes to the increased risk of diabetes in patients with Turner's syndrome, we measured insulin sensitivity (using the euglycemic insulin clamp technique, 40 mU/m2.min) and whole body glucose and lipid oxidation (assessed by indirect calorimetry) in two groups of nondiabetic patients with Turner's syndrome and age-matched normal controls. Group 1 consisted of eight young patients (mean age, 10 +/- 0.8 yr) who had never received hormone therapy, and group 2 consisted of five patients (mean age, 17.6 +/- 1.4 yr) who had been or were on estrogen therapy. In group 2, [3-3H]glucose was also infused during the euglycemic clamp to assess hepatic sensitivity to insulin. During the euglycemic clamp, insulin-stimulated glucose metabolism was decreased in both groups of patients [group 1, 8.4 +/- 1.0 vs. 14.7 +/- 2 mM/m2.min in controls (P less than 0.05); group 2, 9 +/- 0.7 vs. 11.7 +/- 0.9 mM/m2.min in controls (P less than 0.05)]. The impairment of insulin-stimulated glucose metabolism in patients with Turner's syndrome was accounted for by reduced nonoxidative glucose disposal; glucose oxidation rose to a similar extent in Turner patients and normal controls. Insulin-induced suppression of hepatic glucose production (group 2) and plasma FFA and branched chain amino acid levels in Turner patients was also indistinguishable from that in normal controls. Our data suggest that in patients with Turner's syndrome, insulin resistance is a very early metabolic defect that may be restricted to nonoxidative pathways of intracellular glucose metabolism.
To Feed or Not to Feed? Case Presentation and Best Practice Guidance for Human Milk Feeding and Group B Streptococcus in Developed Countries

Group B Streptococcus (GBS) is the most frequent cause of neonatal invasive disease. Two forms of GBS are recognized: early-onset and late-onset disease. The average incidence of late-onset disease is 0.24 per 1000, a figure that has remained substantially unchanged over time. Exposure to breast milk represents a potential source of infection, especially in late-onset and/or recurrent GBS disease. As a result, both breastfeeding and the use of breast milk have been questioned. We report for the first time the case of both simultaneous and recurrent infection in newborn preterm twins, born 3 weeks apart, resulting from ingestion of GBS positive breast milk. A genetically identical strain was found in both breast milk and her newborn infants. Transmission of GBS through breast milk should be considered in late-onset GBS sepsis. An eradicating antibiotic treatment of GBS positive mothers with ampicillin plus rifampin and temporary discontinuation of breastfeeding and/or the use of heat processed breast milk may represent preventive measures, although outcomes are inconsistent, for recurrent GBS disease. Guidelines on breastfeeding and prevention of recurrent neonatal GBS disease are needed. It is unfortunate that existing scientific literature is scarce and there is no general consensus. As a consequence, we propose a best practice approach on the topic.
The human SH‐SY5Y neuroblastoma cell‐line expresses a functional P2X7 purinoceptor that modulates voltage‐dependent Ca2+ channel function

Fura‐2 imaging of purinergic stimulation of non‐differentiated neuronal human SH‐SY5Y cells resulted in a rapid elevation in intracellular Ca2+ ([Ca2+]i) that was dependent on extracellular Ca2+. The rank order of agonists (200 µm) was as follows: 2′,3′‐O‐(4‐benzoyl‐benzoyl)‐ATP (BzATP) > ATP4– > ATP; whereas 2‐(methylthio)‐ATP, ADP, UTP and α,β‐methylene‐ATP and β,γ‐methylene‐ATP were ineffective. The response to BzATP was inhibited by pyridoxal‐phosphate‐6‐azophenyl‐2′,4′‐disulfonic‐acid (PPADS, 1 µm), 1‐(N,O‐bis[5‐isoquinolinesulfonyl]‐N‐methyl‐l‐tyrosyl)‐4‐phenylpiperazine (KN‐62, 100 nm) and 8‐(3‐benzamido‐4–4‐methylbenzamido)‐naphthalene‐1,3,5‐trisulfonic‐acid (suramin, 200 µm). The presence of a P2X7 receptor was confirmed by western blot studies using anti‐P2X7. EC50 for BzATP was 212 ± 6 µm. BzATP > 30 µm induced an initial, transient increase in [Ca2+]i before a plateau level was reached. BzATP < 30 µm only produced a monophasic increase to the plateau level. The transient phase was reduced by the introduction of nimodipine (3 µm) and to a smaller degree by ω‐conotoxin GVIA (1 µm) despite an almost equal presence of L and N‐type Ca2+‐channels. In whole‐cell voltage‐clamp studies at − 90 mV, BzATP (300 µm) produced a fast activating inward current with a similar pharmacology as observed with Fura‐2 imaging. Current clamp studies showed a dose‐dependent depolarization to BzATP and ATP4–. BzATP also triggered transmitter release. Thus, the human neuronal SH‐SY5Y cell line expresses a functional P2X7 receptor coupled to activation of Ca2+‐channels.
Metabolic imaging in obesity: underlying mechanisms and consequences in the whole body

Obesity is a phenotype resulting from a series of causative factors with a variable risk of complications. Etiologic diversity requires personalized prevention and treatment. Imaging procedures offer the potential to investigate the interplay between organs and pathways underlying energy intake and consumption in an integrated manner, and may open the perspective to classify and treat obesity according to causative mechanisms. This review illustrates the contribution provided by imaging studies to the understanding of human obesity, starting with the regulation of food intake and intestinal metabolism, followed by the role of adipose tissue in storing, releasing, and utilizing substrates, including the interconversion of white and brown fat, and concluding with the examination of imaging risk indicators related to complications, including type 2 diabetes, liver pathologies, cardiac and kidney diseases, and sleep disorders. The imaging modalities include (1) positron emission tomography to quantify organ‐specific perfusion and substrate metabolism; (2) computed tomography to assess tissue density as an indicator of fat content and browning/ whitening; (3) ultrasounds to examine liver steatosis, stiffness, and inflammation; and (4) magnetic resonance techniques to assess blood oxygenation levels in the brain, liver stiffness, and metabolite contents (triglycerides, fatty acids, glucose, phosphocreatine, ATP, and acetylcarnitine) in a variety of organs.
Determinants of health-related quality of life in adults living with HIV in Vietnam

Abstract Health-related quality of life (HRQL) is a good indicator to monitor and evaluate healthcare services for adults with HIV/AIDS. This study described HRQL of adults with HIV and its determinants, and compared it with HRQL for the general population. A cross-sectional study with a national multistage sampling of households with and without HIV-positive people was conducted in 2008. Six provinces were purposively selected to represent areas of the country and progressions of HIV epidemics. Households were sampled with probability-proportional-to-size, following the selection of rural and urban districts. A total of 820 HIV-positive and HIV-negative adults (mean age: 32.5; 38.7% female) were interviewed. Among 400 HIV-positive people, 52.3% had a history of injecting drugs, and 56.3% were at AIDS stage and receiving antiretroviral treatment (ART). HRQL was measured using the EuroQOL five-dimension questionnaire (EQ-5D). Multiple regression models were purposefully constructed to examine the determinants of HRQL. The EQ-5D index and visual analog scale (VAS) score in less advanced HIV people (0.90, 69.3) and AIDS patients (0.88, 65.2) were significantly lower than those of the general population (0.96, 81.6) (p<0.001). The frequency of reported problems across EQ-5D dimensions in the HIV population (2.4–30.9%) was significantly higher than in the general population (0.7–12.1%). Compared to ART patients, those at earlier HIV stages reported having problems at similar proportions across four HRQL dimensions, except pain/discomfort, where ART patients had a significantly higher proportion. Injecting drug users taking ART perceived lower HRQL score than non-injecting drug users. Multiple regression determined that joblessness (p<0.01) and inaccessibility to health services (p<0.05) were associated with lower HRQL. In addition, involvements in self-help groups significantly improved HRQL among HIV-positive participants (p<0.05). The findings highlight the need to improve the health service referral system and enhance psychological and social supports for patients in early stages of HIV infection in Vietnam.
[miR-610 suppresses lung cancer cell proliferation and invasion by targeting GJA3].

OBJECTIVE To investigate the function and mechanism of miR-610 in lung cancer cell proliferation and invasion. METHODS The expression of miR-610 was detected by real-time PCR in lung cancer cell lines 95D and 95C with different metastatic ability. miR-610 mimics and inhibitor were transfected into 95D and 95C cells, respectively, and CCK-8 kit and BrdU incorporation assay were used to detect the effect of miR-610 on lung cancer cell proliferation. Cell scratch test and Transwell test were used to detect the effect of miR-610 on lung cancer cell invasion. Bioinformatics software was used to predict the potential target genes of miR-610. Dual-luciferase reporter gene system and Western blot were applied to test whether miR-610 regulates GJA3 expression directly. RESULTS The expression of miR-610 in the weakly metastatic lung cancer 95C cells was (8.75 ± 0.21) times higher than that in the highly metastatic lung cancer 95D cells (P < 0.01). BrdU incorporation assay showed that the number of proliferating 95C cells was (37.41 ± 2.39)% in the control group and (59.63 ± 4.57)% in the miR-610 mimics transfection group (P < 0.01). The number of proliferating 95D cells was (68.75 ± 4.28)% in the control group and (46.13 ± 3.27)% in the miR-610 mimics transfection group (P < 0.01). Cell scratch test showed that at 24 and 48 hours after scratching, the scratch width of 95C cells in the miR-610 inhibitor group was reduced to (58.74 ± 4.62)% and (34.63 ± 2.73)%, respectively, of the initial scratch width, both were significantly lower than that of blank control group and miR-610 inhibitor control group (P < 0.01 for both). The scratch width of 95D cells in the miR-610 inhibitor group was (88.59 ± 6.92)% and (72.24 ± 5.46)%, respectively, of the initial scratch width, and both were significantly higher than that of the blank control group and miR-610 inhibitor control group (P < 0.01 for both). Transwell assay showed that the numbers of invading 95C cells after transfection with miR-610 inhibitor was (112.4 ± 10.6) cells/square in the miR-610 inhibitor control group and (161.8 ± 12.5) cells/square in the miR-610 inhibitor group, indicating a significantly increased invasion ability of 95C cells in the miR-610 inhibitor transfection group (P < 0.01). The numbers of invading 95D cells after transfection with miR-610 mimics was (178.4 ± 12.3) cells/square in the miR-610 mimics control group and (76.7 ± 5.8) cells/square in the miR-610 mimics group, indicating a significantly decreased invasion ability of 95D cells in the miR-610 mimics transfection group (P < 0.01). These data indicated that miR-610 can suppress the invasion of lung cancer cells. CONCLUSION miR-610 suppresses lung cancer cell proliferation and invasion by targeting GJA3 expression.
Signs of post-traumatic stress disorder in caregivers following an expected death: A qualitative study

Background: Complications of grief are an important area of investigation with potential to improve the well-being of palliative care caregivers. There has been little study of the prevalence or significance of post-traumatic stress disorder for those bereaved after an expected death. Aim: To identify evidence suggestive of post-traumatic stress disorder symptoms in a population of bereaved caregivers of patients who have died of ovarian cancer. Design: Caregivers’ recollections of their end-of-life experiences were coded and analysed, using qualitative data obtained from interviews 6 months after the patient’s death. Setting/participants: Australian Ovarian Cancer Study–Quality of Life Study is a population-based epidemiological study using mixed methods to explore caregivers’ experiences following the expected death of a woman with ovarian cancer. Thirty-two caregivers from the Australian Ovarian Cancer Study–Quality of Life Study participated in semi-structured telephone interviews 6 months post-bereavement. Results: When describing the patient’s death at their 6-month interview, all interviewees used language consistent with some degree of shock and traumatisation. For the majority, there was also evidence suggesting resilience and resolution. However, a number of interviewees describe intrusive memories associated with physical sights and sounds that they witnessed at the deathbed. Conclusions: This exploratory study demonstrates the phenomenon of the ‘shocked caregiver’. If trauma symptoms are present in bereaved carers in palliative care, it has implications for palliative care provision. Given that trauma symptoms may be distinct from prolonged grief disorder, this may also have implications for provision of bereavement counselling. Further research into this phenomenon is required.
Client and therapist reasons for termination: a conceptualization and preliminary validation.

While the comparison of client and therapist reasons for termination might shed light on their respective views of outcome and process, only one published study has examined directly the reasons given by therapist-client pairs. One barrier to such research is the absence of a systematic conceptualization of reasons for termination that incorporates both therapist and client perspectives. This article describes a comprehensive conceptualization, drawn from the existing literature, and applies a coding system based on that conceptualization to naturalistic clinical data from 123 therapist-client pairs in a psychology training clinic. Coders were able to categorize reliably open-ended client data into reasons for termination. For therapist and client data, the relationships between coding categories and participants' outcome ratings, generally were consistent with expectations, providing limited validation. Some support was found for concordance between therapist and client reasons, especially for those related to therapist or client departures, which were prominent in this setting. As expected, however, therapists were more likely than clients to endorse success as a reason for termination. Negative client feelings about therapy, including dissatisfaction, were reported infrequently as reasons for termination, and with little agreement between clients and therapists, but this may be due to methodological limitations.
Object Recognition Using Deep Convolutional Features Transformed by a Recursive Network Structure

Deep neural networks (DNNs) trained on large data sets have been shown to be able to capture high-quality features describing image data. Numerous studies have proposed various ways to transfer DNN structures trained on large data sets to perform classification tasks represented by relatively small data sets. Due to the limitations of these proposals, it is not well known how to effectively adapt the pre-trained model into the new task. Typically, the transfer process uses a combination of fine-tuning and training of adaptation layers; however, both tasks are susceptible to problems with data shortage and high computational complexity. This paper proposes an improvement to the well-known AlexNet feature extraction technique. The proposed approach applies a recursive neural network structure on features extracted by a deep convolutional neural network pre-trained on a large data set. Object recognition experiments conducted on the Washington RGBD image data set have shown that the proposed method has the advantages of structural simplicity combined with the ability to provide higher recognition accuracy at a low computational cost compared with other relevant methods. The new approach requires no training at the feature extraction phase, and can be performed very efficiently as the output features are compact and highly discriminative, and can be used with a simple classifier in object recognition settings.
Toxicity, efficacy, plasma drug concentrations and protease mutations in patients with advanced HIV infection treated with ritonavir plus saquinavir

Objective:To assess the safety, efficacy and plasma drug levels of the combination of ritonavir plus saquinavir for the treatment of advanced HIV infection. Design:Multicentre pilot study. Patients:Eighteen protease inhibitor-naive patients, with intolerance or contraindication to reverse transcriptase inhibitors, a median CD4 cell count of 12 × 106/l (range, 1–50 × 106/l), and a median HIV viraemia of 5.25 log10copies/ml (range, 4.00–6.13 log10 copies/ml). Methods:Patients received 600 mg twice daily of both ritonavir and saquinavir. Viraemia was measured at baseline and at weeks 5, 9 and 13. Response was defined as a drop of viraemia of more than 1 log10 at week 5. Plasma drug levels were determined after at least 3 weeks of combined treatment: samples were collected before and 1, 2, and 4 h after the morning ingestion of both drugs. The protease gene was sequenced at baseline and under treatment. Results:Among the 16 patients evaluable at week 5, 11 were responders, and among these patients, six remained responders at week 13 (two with undetectable viraemia). Study discontinuations were due to side-effects (n = 4), patient choice (n = 3), protocol violation (n = 1) and death (n = 1). Responders had higher drug levels than non-responders (P < 0.01 for saquinavir, P = 0.04 for ritonavir). In two non-responders, development of multiple new mutations at positions 10, 20, 48, 82, 84 and 90 was observed after 5–13 weeks. Conclusion:The response to ritonavir plus saquinavir in advanced HIV infection is unpredictable. A minority of patients respond with disappearance of HIV viraemia. In other patients, rapid cumulative emergence of protease mutations conferring resistance to treatment cannot always be prevented by good compliance and relatively high plasma drug levels.