Miracle-dz/UniFAR-FTUs huggingface dataset:
Exploring Burnout Among Malaysian Junior Doctors Using the Abbreviated Maslach Burnout Inventory

Objective: The study aimed to explore the prevalence of burnout among the junior doctors and to examine the psychometric properties of abbreviated Maslach Burnout Inventory (aMBI). Methods: A cross-sectional study was conducted using aMBI self-reported questionnaire and Hospital Anxiety Depression Scale which was carried out on a sample of 117 junior doctors working in a teaching hospital in Malaysia. Results: Exploratory factor analysis of aMBI revealed a three-factor structure labelled as emotional exhaustion, depersonalization and personal accomplishment with Crohnbach’s alpha of 0.85, 0.59 and 0.64 respectively. The total variance was 67%. Prevalence of burnout was found at 26.5%. Emotional exhaustion and depersonalization were positively correlated with depression and anxiety. Shorter duration of residence (less than six months) and being posted to Trauma & Emergency unit were associated with higher mean score of burnout. Conclusion: This study provides the knowledge of level of burnout among the junior doctors and the abbreviated Maslach Burnout Inventory has a satisfied psychometirc properties for screening burnout among junior doctors in Malaysia. Please click PDF below to download the full paper.
Maternal and Neonatal Outcomes After Antepartum Treatment of Influenza With Antiviral Medications

OBJECTIVE: To review the maternal and neonatal outcomes after antepartum exposure to M2 ion channel inhibitors or oseltamivir to provide some guidance on the risk, if any, of antiviral medication during pregnancy. METHODS: This was a retrospective cohort study examining maternal and neonatal outcomes after antepartum exposure to antiviral therapy for influenza. We evaluated maternal characteristics, pregnancy outcomes, and fetal outcomes and compared them with our overall obstetric population. RESULTS: Exposure to antiviral therapies (M2 ion channel inhibitors [n=104] compared with oseltamivir [n=135] compared with the control group [n=82,097]) during pregnancy was not associated with increased rates of preterm birth (7% compared with 10% compared with 6%, P=.190), premature rupture of membranes (23% compared with 16% compared with 22%, P=.154), gestational diabetes (4% compared with 8% compared with 6%, P=.388), or preeclampsia (6% compared with 1% compared with 4%, P=.209). Exposure was not associated with increased duration of hospital stay for mother or neonate. There were no differences in the incidence of minor malformations (19% compared with 15% compared with 22%, P=.101). Liveborn singletons without major malformations did not have differences in fetal weight (3,238±586 g compared with 3,281±642 g compared with 3,336±571 g, P=.186), need for intubation (2% compared with 0.8% compared with 1%, P=.552), intensive care nursery admission (3% compared with 3% compared with 2%, P=.418), or hyperbilirubinemia (12% compared with 9% compared with 8%, P=.282). Liveborn singletons had no grade 3 or 4 intraventricular hemorrhages, seizures, or neonatal deaths. Two preterm neonates exposed to different classes of medications had necrotizing enterocolitis (1.0% compared with 0.8% compared with 0.02%, P<.001). CONCLUSION: We found no evidence of an association between antepartum antiviral exposure and adverse outcomes. LEVEL OF EVIDENCE: II
Need for eye care among older adults with diabetes mellitus in fee-for-service and managed Medicare.

OBJECTIVE To compare rates of need for eye care among Medicare beneficiaries with network-model Medicare+Choice (MC) and fee-for-service (FFS) health insurance. METHODS Cross-sectional study of a random sample of MC and FFS community-dwelling Medicare beneficiaries with diabetes who are older than 65 years of age in Los Angeles County. Study ophthalmologists masked to the participants' type of health insurance performed standardized dilated eye examinations and indicated the need for ophthalmic care during the next 6 months. To evaluate the association between type of insurance and need for treatment, we constructed logistic regression models adjusted for participant sociodemographic and clinical characteristics. RESULTS The 311 MC and 107 FFS respondents reported comparable rates of eye care provider visits and preexisting eye diseases. However, on masked clinical examination, MC respondents were more likely to have diabetic retinopathy, visually significant cataract, glaucoma, or suspected glaucoma than FFS participants (68% vs 46%, P<.001). In multivariate analyses, persons enrolled in MC were significantly more likely than FFS participants to require further treatment during the next 6 months (42% vs 24%, P = .01). CONCLUSIONS Data from standardized study ophthalmic examinations suggest high rates of unrecognized and untreated eye diseases among Medicare beneficiaries enrolled in both FFS and MC and significantly higher rates of need for care among MC participants.
Cross-Cultural Patterns in Dynamic Ratings of Positive and Negative Natural Emotional Behaviour

Background Studies of cross-cultural variations in the perception of emotion have typically compared rates of recognition of static posed stimulus photographs. That research has provided evidence for universality in the recognition of a range of emotions but also for some systematic cross-cultural variation in the interpretation of emotional expression. However, questions remain about how widely such findings can be generalised to real life emotional situations. The present study provides the first evidence that the previously reported interplay between universal and cultural influences extends to ratings of natural, dynamic emotional stimuli. Methodology/Principal Findings Participants from Northern Ireland, Serbia, Guatemala and Peru used a computer based tool to continuously rate the strength of positive and negative emotion being displayed in twelve short video sequences by people from the United Kingdom engaged in emotional conversations. Generalized additive mixed models were developed to assess the differences in perception of emotion between countries and sexes. Our results indicate that the temporal pattern of ratings is similar across cultures for a range of emotions and social contexts. However, there are systematic differences in intensity ratings between the countries, with participants from Northern Ireland making the most extreme ratings in the majority of the clips. Conclusions/Significance The results indicate that there is strong agreement across cultures in the valence and patterns of ratings of natural emotional situations but that participants from different cultures show systematic variation in the intensity with which they rate emotion. Results are discussed in terms of both ‘in-group advantage’ and ‘display rules’ approaches. This study indicates that examples of natural spontaneous emotional behaviour can be used to study cross-cultural variations in the perception of emotion.
Activation of AMPK reduces the co-transporter activity of NKCC1

Abstract The co-transporter activity of Na+-K+-2Cl− 1 (NKCC1) is dependent on phosphorylation. In this study we show the energy-sensing kinase AMPK inhibits NKCC1 activity. Three separate AMPK activators (AICAR, Phenformin and A-769662) inhibited NKCC1 flux in a variety of nucleated cells. Treatment with A-769662 resulted in a reduction of NKCC1T212/T217 phosphorylation, and this was reversed by treatment with the non-selective AMPK inhibitor Compound C. AMPK dependence was confirmed by treatment of AMPK null mouse embryonic fibroblasts, where A-769662 had no effect on NKCC1 mediated transport. AMPK was found to directly phosphorylate a recombinant human-NKCC1 N-terminal fragment (1–293) with the phosphorylated site identified as S77. Mutation of Serine 77 to Alanine partially prevented the inhibitory effect of A-769662 on NKCC1 activity. In conclusion, AMPK can act to reduce NKCC1-mediated transport. While the exact mechanism is still unclear there is evidence for both a direct effect on phosphorylation of S77 and reduced phosphorylation of T212/217.
The Ethics of End-of-Life Care for Prison Inmates

Terminally ill elderly and long-term disabled persons under our system of health care are eligible for Medicare and may qualify for the hospice care benefit. Despite such provisions, research shows that individuals still frequently do not receive the health care they need. But, as inadequate as end-of-life care can be for the general population, these inadequacies are exacerbated for individuals incarcerated in U.S. prisons and jails. Although inmates are guaranteed a basic level of health care under the Eighth Amendment and Due Process Clause, they lack the mobility or freedom to choose their health care coverage, and they are dependent on an institutional system for such care. Inside prison, security and access issues affect the care inmates receive. Further, the availability of adequate clinical resources, especially for high-cost procedures, may be problematic in some jurisdictions. In addition to the practical, institutional, and legal barriers to providing and improving general end-of-life care, efforts to improve end-of-life care for prisoners may also encounter a lack of public sympathy.
Student Buy-In Toward Formative Assessments: The Influence of Student Factors and Importance for Course Success †

Formative assessment (FA) techniques, such as pre-class assignments, in-class activities, and post-class homework, have been shown to improve student learning. While many students find these techniques beneficial, some students may not understand how they support learning or may resist their implementation. Improving our understanding of FA buy-in has important implications, since buy-in can potentially affect whether students fully engage with and learn from FAs. We investigated FAs in 12 undergraduate biology courses to understand which student characteristics influenced buy-in toward FAs and whether FA buy-in predicted course success. We administered a mid-semester survey that probed student perceptions toward several different FA types, including activities occurring before, during, and after class. The survey included closed-ended questions aligned with a theoretical framework outlining key FA objectives. We used factor analysis to calculate an overall buy-in score for each student and general linear models to determine whether certain characteristics were associated with buy-in and whether buy-in predicted exam scores and course grades. We found that unfixed student qualities, such as perceptions, behaviors, and beliefs, consistently predicted FA buy-in, while fixed characteristics, including demographics, previous experiences, and incoming performance metrics, had more limited effects. Importantly, we found that higher buy-in toward most FA types predicted higher exam scores and course grades, even when controlling for demographic characteristics and previous academic performance. We further discuss steps that instructors can take to maximize student buy-in toward FAs.
Evaluation of ovarian reserve in Hashimoto's thyroiditis

Abstract Human ovary is commonly the target of an autoimmune attack in cases of organ- or non-organ-specific autoimmune disorders. Hashimoto’s thyroiditis (HT) is likely to be associated with ovarian dysfunction and diminished ovarian reserve. In this study, we aimed to evaluate the possible negative association between this significantly prevalent autoimmune disease and the ovarian reserve. Thirty-two premenopausal women with primary hypothyroidism, who under replacement therapy with thyroxine were recruited. Forty-nine healthy female subjects who had normal anti-thyroid antibody levels and were comparable with the HT group in terms of age and BMI values, comprised the control group. There was no statistically significant difference between the study and the control patients in terms of antral follicle count. Serum anti-Müllerian hormone (AMH) levels were significantly higher in woman with HT compared to the control group. The results of this study found no impairment in ovarian reserve parameters of patients with HT. Interestingly, the results revealed a significant increase in serum AMH levels of the patients with HT compared to controls. Hashimoto's thyroiditis may share a common etiologic linkage with polycystic ovary syndrome; therefore, leading to elevated serum AMH levels, which we are currently unable to define elaborately. Chinese abstract 人类卵巢经常成为器官特异性或非器官特异性自身免疫性疾病的靶器官。 桥本甲状腺炎(HT)或与卵巢功能不全和卵巢储备功能降低有关。 本研究的目标为评估这种常见的自身免疫性疾病与卵巢储备可能存在的负相关性。 32名原发性甲状腺功能低下并使用甲状腺素进行替代治疗的绝经前妇女被纳入了此项研究。 对照组包括49名抗甲状腺抗体正常的，与HT组年龄和BMI值相仿的受试者。 在窦卵泡数方面，实验组和对照组并无明显的统计学差异。 与对照组相比，HT组血清抗苗勒氏管激素水平显著升高。 研究结果未发现HT患者的卵巢储备相关参数受到损伤。 有趣的是，研究结果显示出HT患者相比较对照组AMH的显著升高。 桥本甲状腺炎与多囊卵巢综合征或具有相同的病原学联系。 因此，导致了血清AMH的升高，这是我们目前无法精确判定的。
Determining the contribution of volcanic ash and boundary layer aerosol in backscatter lidar returns: A three‐component atmosphere approach

[1] A solution of the lidar equation is discussed, that permits combining backscatter and depolarization measurements to quantitatively distinguish two different aerosol types with different depolarization properties. The method has been successfully applied to simultaneous observations of volcanic ash and boundary layer aerosol obtained in Exeter, United Kingdom, on 16 and 18 April 2010, permitting the contribution of the two aerosols to be quantified separately. First a subset of the atmospheric profiles is used where the two aerosol types belong to clearly distinguished layers, for the purpose of characterizing the ash in terms of lidar ratio and depolarization. These quantities are then used in a three-component atmosphere solution scheme of the lidar equation applied to the full data set, in order to compute the optical properties of both aerosol types separately. On 16 April a thin ash layer, 100–400 m deep, is observed (average and maximum estimated ash optical depth: 0.11 and 0.2); it descends from ∼2800 to ∼1400 m altitude over a 6-hour period. On 18 April a double ash layer, ∼400 m deep, is observed just above the morning boundary layer (average and maximum estimated ash optical depth: 0.19 and 0.27). In the afternoon the ash is entrained into the boundary layer, and the latter reaches a depth of ∼1800 m (average and maximum estimated ash optical depth: 0.1 and 0.15). An additional ash layer, with a very small optical depth, was observed on 18 April at an altitude of 3500–4000 m. By converting the lidar optical measurements using estimates of volcanic ash specific extinction, derived from other works, the observations seem to suggest approximate peak ash concentrations of ∼1500 and ∼1000 μg/m3, respectively, on the two observations dates.
Cathepsin D, but not cathepsin B, releases T cell stimulatory fragments from lysozyme that are functional in the context of multiple murine class II MHC molecules

In this study, the major endosomal/lysosomal proteases cathepsin D and cathepsin B were tested on their ability to release T cell stimulatory peptides from hen egg white lysozyme (HEL) in vitro. Whereas neither enzyme could cleave unreduced HEL under mild conditions, reduced HEL was readily cleaved by cathepsin D but not by cathepsin B. Instead, cathepsin B was found to be very active in the trimming of HEL peptides after their release by cathepsin D.
CD30+ lymphoproliferative disorders: histopathology, differential diagnosis, new variants, and simulators

Summary: CD30+ lymphoproliferative disorders of the skin (CD30+ LPD) represent a well‐defined spectrum of primary cutaneous T‐cell lymphomas which have been recognized as distinct entities in recent lymphoma classifications. Lymphomatoid papulosis and anaplastic large‐cell lymphoma share the expression of CD30 antigen as a common phenotypic hallmark but differ in regard to their clinical and histologic features as well as their biologic behavior. This article summarizes the histologic features of CD30+ LPD and presents recently identified new clinicopathologic variants of CD30+ LPD. There is an increasing number of reactive inflammatory disorders and neoplastic diseases which are composed of or contain a significant number of CD30+ cells and mimic LyP or anaplastic large cell lymphoma clinically or histologically. Differential diagnostic considerations focus on other lymphoproliferative processes with CD30+ tumor cells as well as non‐lymphoid neoplasms and inflammatory simulators. The term CD30+ pseudolymphoma is proposed to designate inflammatory processes with CD30+ T cells. The final diagnosis of CD30+ LPD is based on a synthesis of clinical, histologic, phenotypic, and molecular genetic findings.
Four-dimensional flow magnetic resonance imaging-based characterization of aortic morphometry and haemodynamics: impact of age, aortic diameter, and valve morphology.

AIMS Four-dimensional (4D) flow magnetic resonance imaging (MRI) was employed for the simultaneous assessment of morphometry and flow parameters along the thoracic aorta to investigate associations between flow, age, aorta diameter, and aortic valve morphology. METHODS AND RESULTS One hundred and sixty-five subjects, 65 controls, 50 patients with bicuspid aortic valve (BAV), and 50 patients with a dilated aorta, and a tricuspid aortic valve (TAV) underwent 4D flow MRI. Following 3D segmentation of the aorta, a vessel centreline was calculated and used to extract aorta diameter, peak systolic velocity, and normalized systolic flow displacement. Validation of 4D flow MRI-based morphometric measurements compared with manual diameter measurements from standard contrast-enhanced MR angiography in 20 controls showed good agreement (mean difference = 0.4 mm, limits of agreement = ±1.31 mm) except at the sinus of valsalva. BAV showed significant differences in average peak velocity (PV; P < 0.016) compared with TAV and controls between the left ventricle outflow tract to sino-tubular junction (BAV: 1.3 ± 0.3 m/s; TAV: 1.2 ± 0.2 m/s; controls: 1.0 ± 0.1 m/s) and the ascending aorta for average normalized flow displacement (BAV: 0.11 ± 0.02; TAV: 0.09 ± 0.02; controls: 0.06 ± 0.01, P < 0.016) despite similar average aortic dimensions for BAV (37 ± 1 mm) and TAV (39 ± 1 mm). Multivariate linear regression showed a significant correlation of maximal aortic diameter to age, PV, and normalized flow displacement (R(2) = 0.413, P < 0.001). CONCLUSION A single acquisition of 4D flow MRI characterized local morphological and haemodynamic differences between groups along the aorta. BAV showed altered haemodynamics when compared with TAV in spite of having similar aorta dimensions. Maximal aorta diameter was associated with age, PV, and normalized flow displacement.
Both TRIF- and MyD88-Dependent Signaling Contribute to Host Defense against Pulmonary Klebsiella Infection1

Klebsiella pneumoniae causes extensive lung damage. TLR signaling involves adaptors TRIF and MyD88. However, the relative contribution of TRIF and MyD88 signaling in host defense against pulmonary K. pneumoniae infection has not been elucidated. Therefore, we investigated the role of TRIF and MyD88 in K. pneumoniae pneumonia. TRIF−/− mice infected with K. pneumoniae showed impaired survival and reduced bacterial clearance, neutrophil influx, histopathologic evidence of inflammation, and TNF-α, IL-6, KC, MIP-2, but not LIX, expression in the lungs. In addition, K. pneumoniae-induced late NF-κB activation and phosphorylation of MAPKs was attenuated in the lungs of TRIF−/− mice. However, MyD88−/− mice infected with K. pneumoniae showed a much more remarkable phenotype, including impaired survival and reduced bacterial clearance, histopathology, and TNF-α, IL-6, KC, MIP-2, and LIX expression with almost no neutrophil influx in the lungs. In MyD88−/− mice, K. pneumoniae-induced early NF-κB and MAPK activation in the lungs was also reduced. Furthermore, the role of MyD88 is dominant over TRIF because TRIF/MyD88 double knockout mice displayed a more pronounced phenotype than TRIF−/− mice. Moreover, human alveolar macrophages pretreated with MyD88 blocking peptide showed attenuated TNF-α, IL-6, and IL-8 expression. Also, C57BL/6 mice pretreated with MyD88 blocking peptide exhibited attenuation in K. pneumoniae-induced neutrophil influx and enhanced bacterial burden in the lungs and dissemination. Overall, this investigation provides new insights into the TRIF and MyD88 signaling triggered by pulmonary K. pneumoniae infection in the lungs and demonstrate the therapeutic potential of MyD88 in reducing excessive neutrophil influx in human disease during Gram-negative bacterial pneumonia.
Modeling the second-level digital divide: A five-country study of social differences in Internet use

Based on representative surveys on Internet use, this article advances comparative research on the second-level digital divide by modeling Internet usage disparities for five countries with narrowing access gaps. Four core Internet usage types are constructed and predicted by sociodemographic variables in a structural model. Overall, the findings confirm the recently identified shift in the digital divide from access to usage in five further countries. Results show that sociodemographics alone account for up to half of the variance in usage in these high-penetration countries, with age being the strongest predictor. Measurement invariance tests indicate that a direct comparison is only valid between three of the five countries explored. Methodologically, this points to the indispensability of such tests for unbiased comparative research.
Evaluation of DELTA PREP

Background. Intimate partner violence (IPV) has been recognized as a public health problem since the late 20th century. To spur IPV prevention efforts nationwide, the DELTA PREP Project selected 19 state domestic violence coalitions to build organizational prevention capacity and catalyze IPV primary prevention strategies within their states. Objective. DELTA PREP’s summative evaluation addressed four major questions: (1) Did coalitions improve their prevention capacity during the project period? (2) Did coalitions serve as catalysts for prevention activities within their states during the project period? (3) Was initial prevention capacity associated with the number of prevention activity types initiated by coalitions by the end of the project? (4) Did coalitions sustain their prevention activities 6 months after the end of the project period? Results. DELTA PREP achieved its capacity-building goal, with all 19 participant coalitions integrating prevention within their organizations and serving as catalysts for prevention activities in their states. At 6 months follow up, coalitions had sustained almost all prevention activities they initiated during the project. Baseline prevention capacity (Beginner vs. Intermediate) was not associated with the number of prevention activity types coalitions implemented by the end of the project. Conclusion. Service and treatment organizations are increasingly asked to integrate a full spectrum of prevention strategies. Selecting organizations that have high levels of general capacity and readiness for an innovation like integrating a public health approach to IPV prevention will likely increase success in building an innovation-specific capacity, and in turn implementing an innovation.