Miracle-dz/UniFAR-FTUs huggingface dataset:
Synthesizing electronic health records using improved generative adversarial networks

Objective The aim of this study was to generate synthetic electronic health records (EHRs). The generated EHR data will be more realistic than those generated using the existing medical Generative Adversarial Network (medGAN) method. Materials and Methods We modified medGAN to obtain two synthetic data generation models-designated as medical Wasserstein GAN with gradient penalty (medWGAN) and medical boundary-seeking GAN (medBGAN)-and compared the results obtained using the three models. We used 2 databases: MIMIC-III and National Health Insurance Research Database (NHIRD), Taiwan. First, we trained the models and generated synthetic EHRs by using these three 3 models. We then analyzed and compared the models' performance by using a few statistical methods (Kolmogorov-Smirnov test, dimension-wise probability for binary data, and dimension-wise average count for count data) and 2 machine learning tasks (association rule mining and prediction). Results We conducted a comprehensive analysis and found our models were adequately efficient for generating synthetic EHR data. The proposed models outperformed medGAN in all cases, and among the 3 models, boundary-seeking GAN (medBGAN) performed the best. Discussion To generate realistic synthetic EHR data, the proposed models will be effective in the medical industry and related research from the viewpoint of providing better services. Moreover, they will eliminate barriers including limited access to EHR data and thus accelerate research on medical informatics. Conclusion The proposed models can adequately learn the data distribution of real EHRs and efficiently generate realistic synthetic EHRs. The results show the superiority of our models over the existing model.
Evaluating Barriers and Opportunities in Delivering High-Quality Oncology Care in a Resource-Limited Setting Using a Comprehensive Needs Assessment Tool

Purpose Despite recognition of both the growing cancer burden in low- and middle-income countries and the disproportionately high mortality rates in these settings, delivery of high-quality cancer care remains a challenge. The disparities in cancer care outcomes for many geographic regions result from barriers that are likely complex and understudied. This study describes the development and use of a streamlined needs assessment questionnaire (NAQ) to understand the barriers to providing quality cancer care, identifies areas for improvement, and formulates recommendations for implementation. Methods Using a comprehensive NAQ, in-depth interviews were conducted with 17 hospital staff involved in cancer care at two teaching hospitals in Nigeria. Data were analyzed using content analysis and organized into a framework with preset codes and emergent codes, where applicable. Results Data from the interviews were organized into six broad themes: staff, stuff, system, space, lack of palliative care, and provider bias, with key barriers within themes including: financial, infrastructural, lack of awareness, limited human capacity resources, lack of palliative care, and provider perspective on patient-related barriers to cancer care. Specific solutions based on ability to reasonably implement were subcategorized into short-, medium-, and long-term goals. Conclusion This study provides a framework for a streamlined initial needs assessment and a unique discussion on the barriers to high-quality oncology care that are prevalent in resource-constrained settings. We report the feasibility of collecting and organizing data using a streamlined NAQ and provide a thorough and in-depth understanding of the challenges in this setting. Knowledge gained from the assessments will inform steps to improve oncology cancer in these settings.
Living Donor Liver Transplantation for Acute‐on‐Chronic Liver Failure

Acute‐on‐chronic liver failure (ACLF) is a syndrome characterized by acute decompensation of previously diagnosed or undiagnosed liver disease with organ failure(s) with high short‐term mortality. This study was conducted to report the outcomes of living donor liver transplantation (LDLT) in ACLF and assess the survival benefit of liver transplantation (LT) in these patients. It was a retrospective study of 218 ACLF patients on the basis of European Association for the Study of the Liver (EASL)–chronic liver failure criteria from January 2014 through November 2017. Patients were considered for LDLT if there was no improvement on standard medical therapy for 5‐10 days. Prior to LDLT, active sepsis was excluded/treated, and renal, circulatory, and respiratory failures were improved to the greatest extent possible. The mean age was 42.9 years, and 181 patients were male. Sepsis was the most common acute precipitating event followed by alcohol. Of the patients, 35 (16.1%), 66 (30.3%), and 117 (53.7%) were classified into ACLF grades 1, 2, and 3, respectively. Although 80% of the ACLF 1 group and 72.7% of the ACLF 2 group underwent LDLT, only 35% of the ACLF 3 group could undergo LDLT. The circulatory and respiratory failures at admission were significantly higher in the nontransplant group with poor subsequent response to standard medical therapy, exclusion from LDLT, and poor outcomes. None of the patients on high support for circulatory and respiratory failure underwent LDLT. Posttransplant survival at 1 year was comparable among different grades of ACLF (92.9%, 85.4%, and 75.6%; P = 0.15). Among patients in the ACLF 3 group, survival at 90 days was extremely poor in those who could not undergo LDLT (5.9% versus 78%; P < 0.001). In conclusion, LDLT results in good survival with acceptable post‐LT morbidity in patients with ACLF.
Reference Intervals of Thyroid Hormones and Correlation of BMI with Thyroid Function in Healthy Zhuang Ethnic Pregnant Women

Ethnic differences in the level of thyroid hormones exist among individuals. The American Thyroid Association (ATA) recommends that an institution or region should establish a specific thyroid hormone reference value for each stage of pregnancy. To date, a limited number of studies have reported the level of thyroid hormones in Chinese minorities, and the exact relationship between BMI and thyroid function in pregnant women is ill. This study was performed to establish trimester-specific reference ranges of thyroid hormones in Zhuang ethnic pregnant women and explore the role of body mass index (BMI) on thyroid function. A total of 3324 Zhuang ethnic health pregnant women were recruited in this Zhuang population-based retrospective cross-sectional study. The values of thyroid stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) were determined by automatic chemiluminescence immunoassay analyzer. Multivariate linear regression and binary logistic regression were constructed to evaluate the influence of BMI on the thyroid function. The established reference intervals for the serum thyroid hormones in three trimesters were as follows: TSH, 0.02–3.28, 0.03–3.22, and 0.08-3.71 mIU/L; FT4, 10.57–19.76, 10.05–19.23, and 8.96–17.75 pmol/L; FT3, 3.51–5.64, 3.42–5.42, and 2.93–5.03 pmol/L. These values were markedly lower than those provided by the manufacturers for nonpregnant adults which can potentially result in 6.10% to 19.73% misclassification in Zhuang pregnant women. Moreover, BMI was positively correlated with isolated hypothyroxinemia (OR=1.081, 95% CI=1.007–1.161), while the correlation between the BMI and subclinical hypothyroidism was not statistically significant (OR=0.991, 95% CI=0.917–1.072). This is the first study focusing on the reference ranges of thyroid hormones in Guangxi Zhuang ethnic pregnant women, which will improve the care of them in the diagnosis and treatment. We also found that high BMI was positively associated with the risk of isolated hypothyroxinemia.
Nurses' organizational communication satisfaction, emotional labor, and prosocial service behavior: A cross-sectional study.

In this study, we investigated nurses' organizational communication satisfaction and emotional labor in an attempt to identify the factors that influence nurses' prosocial service behavior in Korea. A cross-sectional study was conducted on 145 nurses at two Korean tertiary hospitals in 2017. Most participants (89%) were female, and the mean age was 28.45 ± 5.50 years; data analysis was mainly based on a multiple regression. It was consequently found that nurses' organizational communication satisfaction and emotional labor positively affected their prosocial service behavior. The potential benefits of emotional labor were also explored, and these variables were determined to explain 41.1% of the variance in prosocial service behavior. These findings provide evidence that organizational communication satisfaction and emotional labor in nurses can have significant effects on their prosocial service behavior.
Yeast Models of Phosphomannomutase 2 Deficiency, a Congenital Disorder of Glycosylation

Phosphomannomutase 2 Deficiency (PMM2-CDG) is the most common monogenic congenital disorder of glycosylation (CDG) affecting at least 800 patients globally. PMM2 orthologs are present in model organisms, including the budding yeast Saccharomyces cerevisiae gene SEC53. Here we describe conserved genotype-phenotype relationships across yeast and human patients between five PMM2 loss-of-function missense mutations and their orthologous SEC53 mutations. These alleles range in severity from folding defective (hypomorph) to dimerization defective (severe hypomorph) to catalytic dead (null). We included the first and second most common missense mutations – R141H, F119L respectively– and the most common compound heterozygote genotype – PMM2R141H/F119L – observed in PMM2-CDG patients. Each mutation described is expressed in haploid as well as homozygous and heterozygous diploid yeast cells at varying protein expression levels as either SEC53 protein variants or PMM2 protein variants. We developed a 384-well-plate, growth-based assay for use in a screen of the 2,560-compound Microsource Spectrum library of approved drugs, experimental drugs, tool compounds and natural products. We identified three compounds that suppress growth defects of SEC53 variants, F126L and V238M, based on the biochemical defect of the allele, protein abundance or ploidy. The rare PMM2 E139K protein variant is fully functional in yeast cells, suggesting that its pathogenicity in humans is due to the underlying DNA mutation that results in skipping of exon 5 and a nonfunctional truncated protein. Together, these results demonstrate that yeast models can be used to characterize known and novel PMM2 patient alleles in quantitative growth and enzymatic activity assays, and used as patient avatars for PMM2-CDG drug screens yielding compounds that could be rapidly cross-validated in zebrafish, rodent and human organoid models.
Examining the association between diabetes, depressive symptoms, and suicidal ideation among Aboriginal Canadian peoples living off-reserve: a cross-sectional, population-based study

Background Diabetes is a prevalent chronic condition that has been linked to depression and suicidal behavior. The Aboriginal peoples of Canada are known to suffer from significant health disparities and higher burden of physical and mental illnesses. The purpose of this study was to assess whether diabetes is associated with higher depressive symptoms and lifetime suicidal ideation among Aboriginal Canadian peoples living off-reserve. Methods Data were obtained from the Aboriginal Peoples Survey, 2012. Depressive symptoms were evaluated by a modified version of the previously validated K-10 scale, while diabetes and suicidal ideation were self-reported. A secondary analysis was conducted on a weighted sample of 689,860 participants for depressive symptoms (9.25% diabetics) and 694,960 for suicidal ideation (9.39% diabetics). Descriptive statistics and multiple logistic regression analysis were conducted. Results Our study found that the prevalence of depressive symptoms was higher among diabetics (17.53%) compared with nondiabetics (11.12%; OR =1.70, 95% CI: 1.22–1.61). After adjusting for sociodemographic variables, smoking/alcohol use/drug use, anxiety disorders, and other chronic illnesses, diabetes was still significantly associated with depressive symptoms (aOR =1.46, 95% CI: 1.03–2.07). Additionally, diabetics (23.86%) were more likely to report suicidal ideation compared with nondiabetics (18.71%; OR =1.36, 95% CI: 1.05–1.77). Controlling for the effect of sociodemographics and health-related behaviors, diabetes was still associated with higher risk of reporting suicidal ideation (aOR =1.40, 95% CI: 1.05–1.88). Conclusion Our results suggest that the Aboriginal Canadian diabetic patients living off-reserve are at higher risk of depressive symptoms and suicidal ideation. Culturally appropriate co-screening strategies need to be implemented in primary health care settings to provide the supports necessary for this vulnerable population. Further research is needed to fully elucidate the nature of these associations in order to develop effective intervention and treatment approaches.
Validity of Privacy-Protecting Analytical Methods That Use Only Aggregate-Level Information to Conduct Multivariable-Adjusted Analysis in Distributed Data Networks

Distributed data networks enable large-scale epidemiologic studies, but protecting privacy while adequately adjusting for a large number of covariates continues to pose methodological challenges. Using 2 empirical examples within a 3-site distributed data network, we tested combinations of 3 aggregate-level data-sharing approaches (risk-set, summary-table, and effect-estimate), 4 confounding adjustment methods (matching, stratification, inverse probability weighting, and matching weighting), and 2 summary scores (propensity score and disease risk score) for binary and time-to-event outcomes. We assessed the performance of combinations of these data-sharing and adjustment methods by comparing their results with results from the corresponding pooled individual-level data analysis (reference analysis). For both types of outcomes, the method combinations examined yielded results identical or comparable to the reference results in most scenarios. Within each data-sharing approach, comparability between aggregate- and individual-level data analysis depended on adjustment method; for example, risk-set data-sharing with matched or stratified analysis of summary scores produced identical results, while weighted analysis showed some discrepancies. Across the adjustment methods examined, risk-set data-sharing generally performed better, while summary-table and effect-estimate data-sharing more often produced discrepancies in settings with rare outcomes and small sample sizes. Valid multivariable-adjusted analysis can be performed in distributed data networks without sharing of individual-level data.
Parental Corporal Punishment and Child Temperament: Independent and Interactive Predictors of Child Emotion Regulation in China

The goal of this study was to simultaneously examine the independent and interactive effects of paternal and maternal corporal punishment, and child temperament on child emotion regulation over time in China. These links were assessed on a longitudinal study of 619 father–mother dyads and their children in primary schools (data collected in 2011 and 2014). Results showed an additive model where both parental corporal punishment and child temperament independently predicted child emotion regulation 3 years later. In addition, the effects of parental corporal punishment exhibited gender differences, with paternal corporal punishment predicting girls’ emotion regulation and both paternal and maternal corporal punishment predicting boys’ emotion regulation 3 years later. Moreover, the interactive effects of paternal and maternal corporal punishment and temperament on child emotion regulation were not found in the present study. These findings point to the importance of examining multiple factors within the family system to further understand the developmental process of child emotion regulation, particularly within the Chinese cultural context.
Towards an integrated understanding of neural networks

Neural networks underpin both biological intelligence and modern Al systems, yet there is relatively little theory for how the observed behavior of these networks arises. Even the connectivity of neurons within the brain remains largely unknown, and popular deep learning algorithms lack theoretical justification or reliability guarantees. This thesis aims towards a more rigorous understanding of neural networks. We characterize and, where possible, prove essential properties of neural algorithms: expressivity, learning, and robustness. We show how observed emergent behavior can arise from network dynamics, and we develop algorithms for learning more about the network structure of the brain. Thesis Supervisor: Title: Professor Thesis Supervisor: Title: Professor Thesis Supervisor: Title: Professor Nir Shavit
Tuberculosis elimination in Oman: winning the war on the disease

In 2014, the World Health Assembly adopted the new End TB Strategy that targets ending tuberculosis (TB) by 2035. This article describes the progress made to eliminate TB in Oman. Data from officials and other sources provided the information to assess the situation in Oman. In the period 1981–1992, TB notifications decreased by 11% per year. Between 1992 and 2016, the rates declined more slowly at 4.6% per year, i.e. from 16 to 7.8 per 100 000. During 2010–2016, 2352 TB cases (80% males and 60% Omani nationals) were reported. Bacteriologically confirmed TB cases decreased from 47 to 38 per million population, with a cumulative decline of 19%. The success rate of TB treatment was >87%. Among the new cases, 1.2% were multidrug-resistant TB cases. TB mortality rate dropped by 39% between 1990 and 2016. TB control efforts in Oman have produced remarkable effects. However, the pre-elimination threshold set at <10 notified TB cases per million population per year is not yet in reach. There is a need for an urgent national response and careful consideration of new available interventions. The national TB control programme of Oman has enforced concrete steps to implement key TB elimination measures. The overall TB notification rate for all new TB cases declined significantly from 91 to 7.8 per 100 000 population during 1981–2016 (p<0.001). http://ow.ly/sZyJ30mrueV
How many copies of GSTM1 and GSTT1 are associated with head and neck cancer risk?

Abstract Purpose: GSTM1 and GSTT1 present a polymorphism that can drive complete gene deletions. The current methodology can powerfully determine GSTM1 and GSTT1 copy number variations (CNVs), which may clarify the real contribution of each gene copies to the cellular detoxification process and tumour risk. However, only analysing the presence/absence of these genes yielded controversial results for several disorders, including cancer. Because head and neck cancer (HNC) is becoming a serious global health problem, this study determined the CNVs of GSTM1 and GSTT1 in an HNC case-control population and investigated the possible association between gene copy numbers and tumour risk. Methods: CNV was evaluated by (Ct) 2−ΔΔCt qPCR methodology in 619 HNC patients and 448 patients with no tumour diagnosis. Results: The genes copy number range was 0–3. The CNV of GSTM1 and GSTT1 frequencies were similar between the cases and control. Thus, none copy of GSTM1 and GSTT1 were associated with HNC risk. Notwithstanding, one copy of both genes had higher frequencies among individuals who carried GSTM1 and GSTT1. Conclusions: One copy number of GSTM1 and GSTT1 presented a higher frequency among carrier genes, but the CNV of GSTM1 and GSTT1 was not associated with HNC risk.
Glaucoma Workup in Congenital Zika Syndrome

Purpose: The main aim of this study was to perform a glaucoma workup in infants with congenital Zika syndrome (CZS). Patient and Methods: This cross-sectional study included 188 eyes of 107 children (1.1±0.3 y; range, 0.3 to 1.8 y) with CZS. The confirmation of the syndrome was possible in 77 of 107 (72.0%) of the enrolled infants based on positive immunoglobulin M antibody capture enzyme-linked immunosorbent assay for Zika virus in the cerebrospinal fluid. All infants underwent a complete ophthalmic examination and bilateral fundus imaging was captured using a wide-angle digital fundus camera (RetCam). Results: Five eyes (2.6%) presented 2 criteria for glaucoma diagnosis: 1 eye (0.5%) presented increased intraocular pressure and increased vertical cup-to-disc ratio (CDR); 3 eyes (1.6%) presented increased horizontal corneal diameter and increased vertical, and 1 eye (0.5%) presented myopia related to increased axial length and increased vertical CDR. When excluding the CDR criterion, there was no case of glaucoma in this sample. A significant correlation was observed between high vertical CDR and small cephalic perimeter at birth (P=0.002) and the presence of clinical macular lesions (P=0.031). Conclusion and Relevance: Although childhood glaucoma was not detected in this sample, increased vertical CDR is present in children with CZS, associated with microcephaly and clinical macular lesions at birth. This finding may lead to a misdiagnosis of glaucoma.
Experimental Determination of Optimal Conditions for Reactive Coupling of Biodiesel Production With in situ Glycerol Carbonate Formation in a Triglyceride Transesterification Process

This study investigated a reactive coupling to determine the optimal conditions for transesterification of rapeseed oil (RSO) to fatty acid methyl ester (FAME) and glycerol carbonate (GLC) in a one-step process, and at operating conditions which are compatible with current biodiesel industry. The reactive coupling process was studied by transesterification of RSO with various molar ratios of both methanol and dimethyl carbonate (DMC), using triazabicyclodecene (TBD) guanidine catalyst and reaction temperatures of 50–80°C. The optimal reaction conditions obtained, using a Design of Experiments approach, were a 2:1 methanol-to-RSO molar ratio and 3:1 DMC-to-RSO molar ratio at 60°C. The FAME and GLC conversions at the optimal conditions were 98.0 ± 1.5 and 90.1 ± 2.2%, respectively, after 1 h reaction time using the TBD guanidine catalyst. Increase in the DMC-to-RSO molar ratio from 3:1 to 6:1 slightly improved the GLC conversion to 94.1 ± 2.8% after 2 h, but this did not enhance the FAME conversion. Methanol substantially improved both FAME and GLC conversions at 1:1–2:1 methanol-to-RSO molar ratios and enhanced the GLC separation from the reaction mixture. It was observed that higher methanol molar ratios (>3:1) enhanced only FAME yields and resulted in lower GLC conversions due to reaction equilibrium limitations. At a 6:1 methanol-to-RSO molar ratio, 98.4% FAME and 73.3% GLC yields were obtained at 3:1 DMC-to-RSO molar ratio and 60°C. This study demonstrates that formation of low value crude glycerol can be reduced by over 90% compared to conventional biodiesel production, with significant conversion to GLC, a far more valuable product.