Miracle-dz/UniFAR-FTUs huggingface dataset:
Clinical and Genetic Risk Factors of Recurrent Nonalcoholic Fatty Liver Disease After Liver Transplantation

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) has been increasingly reported among recipients of liver transplantation (LT). We aimed to identify clinical and genetic risk factors responsible for the development of early recurrent NAFLD in nonalcoholic steatohepatitis transplant recipients. METHODS: Forty-six total single nucleotide polymorphisms with known association with NAFLD were tested among both recipient and donor liver samples in 66 LT recipients with nonalcoholic steatohepatitis to characterize influences on NAFLD recurrence at ∼1 year post-LT (median interval from LT to biopsy: 377 days). RESULTS: Recurrent NAFLD was identified in 43 (65.2%) patients, 20 (30.3%) with mild recurrence, and 23 (34.8%) with moderate to severe NAFLD. On adjusted analysis, change in the body mass index (BMI) (ΔBMI) was significantly associated with NAFLD recurrence, whereas post-LT diabetes mellitus was associated with increased severity of NAFLD recurrence. ADIPOR1 rs10920533 in the recipient was associated with increased risk of moderate to severe NAFLD recurrence, whereas the minor allele of SOD2 rs4880 in the recipient was associated with reduced risk. Similar reduced risk was noted in the presence of donor SOD2 rs4880 and HSD17B13 rs6834314 polymorphism. DISCUSSION: Increased BMI post-LT is strongly associated with NAFLD recurrence, whereas post-LT diabetes mellitus was associated with increased severity of NAFLD recurrence. Both donor and recipient SOD2 rs4880 and donor HSD17B13 rs6834314 single nucleotide polymorphisms may be associated with reduced risk of early NAFLD recurrence, whereas presence of the minor allele form of ADIPOR1 rs10920533 in the recipient is associated with increased severity NAFLD recurrence.
Sleep quality assessment in intensive care: actigraphy vs. Richards-Campbell sleep questionnaire

Introduction It has been repeatedly shown that sleep of intensive care unit (ICU) patients is fragmented and its architecture is impaired. As sleep disorders have numerous negative effects on the organism, there have been efforts to implement sleep-promoting strategies into practice. When comparing the effectiveness of such measures, sleep quality assessment itself is a considerable problem. Objective The study aimed to assess the quality and quantity of night sleep in ICU patients simultaneously with actigraphy (ACT) and the Richards-Campbell Sleep Questionnaire (RCSQ). The secondary goals were to test the performance and effectiveness of the above methods and to verify correlations between selected RCSQ items and actigraph parameters. Methods A single-center prospective observational study (20 patients staying in a Interdisciplinary Intensive Care Unit). The quality of sleep was assessed using a Czech version of the RCSQ and ACT. The obtained data were analyzed and their dependence or correlations were verified by selected statistical tests. Results The mean RCSQ score was 47.6 (SD 24.4). The worst results were found for sleep latency (44.4; SD 31.2); the best results were for sleep quality (50.2; SD 29.4). The mean sleep effciency measured with ACT reached 86.6% (SD 9.2); the mean number of awakenings per night was 17.1 (SD 8.5). The RCSQ total parameter with a cutoff of 50 (RCSQ total = 50 good sleep / RCSQ total < 50 poor sleep) was shown to be suitable for discrimination of subjectively perceived sleep quality in ICU patients. However, the study failed to show statistically significant relations between subjectively perceived sleep quality (RCSQ) and ACT measurements. Conclusion The RCSQ appears to be a suitable instrument for assessing night sleep quality in ICU patients. On the other hand, the study showed a very low level of agreement between subjective sleep quality assessment and objective ACT measurements. The main drawback of ACT is low reliability of obtained data. Further research is needed to determine its role in sleep quality assessment in the ICU setting.
Predictors of Adult Patient Satisfaction with Inpatient Nursing Care in Public Hospitals of Eastern Amhara Region, Northeastern Ethiopia, 2020

Background Providing a holistic nursing care approach and meeting patients’ satisfaction has become a major health service performance indicator globally. Despite a number of efforts to improve patient satisfaction with nursing care, the practice is still insufficient to meet the required standard in the developing world including Ethiopia. Accordingly, this study was initiated to identify the gaps in adult patient satisfaction with inpatient nursing care practice in Eastern Amhara region, Ethiopia. Objective To assess the determinants of patient satisfaction with inpatient nursing care among public hospitals in Eastern Amhara region, northeastern Ethiopia. Methods A facility-based cross-sectional study was conducted between June 5, 2020 and July 4, 2020 in three public hospitals in the eastern region of Amhara. Systematic random sampling technique was used to recruit 244 participants from the sampled study. Newcastle Satisfaction with the Nursing Scale was used for data collection. Multivariate logistic regression analysis was used to determine the association and a P<0.05 was deemed to be significant. Results The overall proportion of admitted patient satisfaction with nursing care was 118 (48.4%). Besides, the capability of nurses at their job was the highest nursing care satisfaction parameter, 133 (54.5%), while nurse’s awareness of patients’ needs was the lowest parameter, 43 (17.6%), according to this study. Having primary education (AOR=8.575; 95% CI: 1.770, 14.532), being a farmer by occupation (AOR=3.702; 95% CI=1.047–13.087), and having a health insurance scheme (AOR=5.621; 95% CI=1.489–11.213) were the important predictors for patient satisfaction with inpatient nursing care. Conclusion The overall patient satisfaction with nursing care in this study was found to be sub-standard and needs a great deal of effort. It is recommended that employees shall be included in the health insurance package.
Convergent Validity of Three Pressure Injury Risk Assessment Scales: Comparing the PPRA-Home (Pressure Injury Primary Risk Assessment Scale for Home Care) to Two Traditional Scales

Purpose The Pressure Injury Primary Risk Assessment Scale for Home Care (PPRA-Home) was developed to predict pressure injury risk in geriatric individuals requiring long-term care in home settings. This study aimed to compare the convergent validity of the PPRA-Home to that of the two other standardized pressure injury prevention scales: the Braden and Ohura-Hotta (OH) scales. Methods A multicenter, cross-sectional study was conducted with 34 home-based geriatric support service providers located in five Japanese districts. The study included 69 participants (30 had a pressure injury and 39 did not) who were at classified at care levels of 1 through 5 under Japan’s long-term care insurance system. Care managers served as assessors for the PPRA-Home, while physicians or certified expert nurses served as assessors for the Braden and OH scales. Convergent validity was investigated by examining correlation coefficients between total scores on the PPRA-Home and the other two scales. Receiver operating curve analysis was used to quantify each scale’s accuracy for the two groups: those with and without a pressure injury. Results The PPRA-Home was found to be negatively correlated with the Braden scale (r=−0.79, p<0.05), and positively correlated with the OH scale (r=0.58, p<0.05). The area under the curve (AUC) for the PPRA-Home, Braden scale, and OH scale were 0.737, 0.814, and 0.794, respectively. A PPRA-Home cutoff score of 4 had a sensitivity of 63.3% and specificity of 81.6%. Conclusion The AUC for the PPRA-Home as scored by care managers was similar to those of the Braden and OH scales as scored by physicians or expert nurses. More research on the PPRA-Home’s content and predictive validity is required.
Sleep quality of student athletes and non-athletes - the role of chronotype, stress and life satisfaction

Objective There are many internal and external factors that can affect sleep deterioration. The adopted model of the relationship between chronotype, stress, life satisfaction and sleep quality was verified in the study. Material and Methods In total, 335 healthy university students were surveyed using the Morningness-Eveningness Questionnaire, Perceived Stress Scale, Satisfaction with Life Scale and Pittsburgh Sleep Quality Index. The study included two groups: individuals involved in sport activities (student athletes, n=207) and those who declared (in the short form of the International Physical Activity Questionnaire) low physical activity level (non-athlete students, n=128). Results Student athletes were less stressed (p<0.001) and declared higher life satisfaction (p<0.001) and sleep quality (p<0.001) compared to non-athletes. Non-athletes tended to identify the evening hours as their best time for functioning (p<0.001), but the mean results of both groups oscillated around the so-called intermediate type. Despite the differences in mean values, the model invariance for both groups was confirmed, which means that the proposed theoretical model applies equally to student athletes and non-athletes. The path analysis results indicate that chronotype has a direct negative influence on sleep quality (preferring morning hours results in higher sleep quality). However, perceived stress partially mediates this relationship (p<0.001). Discussion Sleep quality should not be considered without taking into account circadian preferences. Effective coping with stress may also be a buffer in reducing sleep problems.
Slo-Mo anti-neutrophil cytoplasmic antibody-associated renal vasculitis

Abstract Nephrologists are familiar with severe cases of anti-neutrophil cytoplasmic antibodies-associated vasculitis (AAV) presenting as rapidly progressive glomerulonephritis. However, less is known about AAV with slowly progressive renal involvement. While its existence is acknowledged in textbooks, much remains unknown regarding its relative frequency versus more aggressive cases as well as about the optimal therapeutic approach and response to therapy. Moreover, this uncommon presentation may be underdiagnosed, given the scarce familiarity of physicians. In this issue of Clinical Kidney Journal, Trivioli et al. report the largest series to date and first systematic assessment of patients with AAV and slowly progressive renal involvement, defined as a reduction in estimated glomerular filtration rate (eGFR) of 25–50% in the 6 months prior to diagnosis after excluding secondary causes. Key findings are that slowly progressive AAV may be less common than previously thought, although it still represents the second most common presentation of renal AAV, it usually has a microscopic polyangiitis, anti-myeloperoxidase, mainly renal phenotype in elderly individuals, diagnosis may be late (over one-third of patients had end-stage kidney disease at diagnosis), clearly identifying an unmet need for physician awareness about this presentation, but those not needing renal replacement therapy at diagnosis still responded to immunosuppression.
A Sustainable Approach to Prepectoral Breast Reconstruction Using Meshed Acellular Dermal Matrix

Background: Prepectoral implant-based breast reconstruction provides an alternative to submuscular reconstruction, but the increased acellular dermal matrix (ADM) required has the potential to lead to increased costs and decreased supply of this limited-resource material. We present a method for prepectoral reconstruction utilizing skin-graft meshing techniques to increase the surface area of usable ADM. Methods: Forty-four patients underwent this technique from February 2019 to February 2020. Patient characteristics, operative details, and outcomes, including complications and patient satisfaction utilizing the BREAST-Q, were analyzed. Cost analysis relative to projected cost of nonmeshed techniques was performed. Results: There were 20 unilateral and 24 bilateral procedures, for a total of 68 breast reconstructions. Mean age was 45.9 years (32–71). Mean implant volume was 485 cm3 (265–800), and one sheet of ADM was used for each breast with an average surface area of 161 cm2. Median follow-up was 350 days (212–576). Minor complications included an infection treated with oral antibiotics. Major complications included one axillary hematoma and one delayed implant loss. One patient underwent revision for asymmetry. Mean BREAST-Q score was 47.4/60. Cost ranged from $4113 to 5025 per breast, compared with the projected $9125–18250 per breast for other techniques in the literature. Conclusions: In contrast to previously described uses of ADM in prepectoral reconstruction, meshing maximizes resource utilization by expanding the coverage of a single sheet. Early findings demonstrate minimal complications and high patient satisfaction, suggesting the approach has potential to provide the benefits of prepectoral reconstruction while responsibly preserving product availability and tempering healthcare costs.
The Association Between Area Deprivation Index and Patient-Reported Outcomes in Patients with Advanced Cancer

Background: This analysis describes associations between area deprivation and patient-reported outcomes among patients with advanced cancer. Methods: This is a cross-sectional analysis of baseline data from a multisite primary palliative care intervention trial. Participants were adult patients with advanced cancer. Patient-level area deprivation scores were calculated using the Area Deprivation Index (ADI). Quality of life and symptom burden were measured. Uni- and multivariate regressions estimated associations between area deprivation and outcomes of interest. Results: Among 672 patients, ∼0.5 (54%) were women and most (94%) were Caucasian. Mean age was 69.3±10.2 years. Lung (36%), breast (13%), and colon (10%) were the most common malignancies. Mean ADI was 64.0, scale of 1 (low)–100 (high). In unadjusted univariate analysis, Functional Assessment of Cancer Therapy—Palliative (p=0.002), Edmonton Symptom Assessment Scale (p=0.025) and the Hospital Anxiety and Depression Scale anxiety (p=0.003) and depression (p=0.029) scores were significantly associated with residence in more deprived areas (p=0.003). In multivariate analysis, controlling for patient-level factors, living in more deprived areas was associated with more anxiety (p=0.019). Conclusion: Higher ADI was associated with higher levels of anxiety among patients with advanced cancer. Geographic information could assist clinicians with providing geographically influenced social support strategies.
Neopterin: A Promising Candidate Biomarker for Severe COVID-19

Abstract Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has rapidly spread across the world since its first emergence in China in late 2019. It is a major public health concern with no effective treatct 3ments. The immunopathology of SARS-CoV-2 is associated with an excessive inflammatory response. Macrophage activation syndrome (MAS) is also associated with the severity of the disease in SARS-CoV-2-infected patients. Neopterin is a macrophage activation marker produced by monocytes and macrophages upon activation by interferon-gamma (IFN-γ). Neopterin is a well-established marker in a variety of diseases, and recent evidence indicates that it could be helpful in early prediction of the severity of COVID-19 disease and serve as a prognostic marker. Here, we outline the role of macrophage activation syndrome in the pathogenesis of SARS-CoV-2 and suggest that neopterin could be used as a biomarker for progression of COVID-19.
Inequality and Inequity in Outpatient Care Utilization in Ethiopia: A Decomposition Analysis of Ethiopian National Health Accounts

Background Inequity in healthcare use is avoidable inequality, and it exists when there are differences in the use of healthcare after standardization of different needs among the population. In Ethiopia, wide variation and lower achievement exists in outpatient visit per person per year against the target to reach by 2020. Therefore, this study is aimed at measuring inequalities and inequities in outpatient care utilization in Ethiopia. Methods The study utilized data from 2015/16 Ethiopian National Health Account survey. The analysis included a weighted sample of 42,460 individuals. Concentration curve and indices were used to measure inequality in outpatient care utilization. Deviations in the degree to which outpatient care was distributed according to need were measured by the horizontal inequity index. All statistical analyses were done using STATA version 14. In all analyses statistical significance was declared at a p-value < 0.05 and a 95% confidence interval. Results The outpatient care utilizations were found to be concentrated among the rich. The actual (C = 0.0335, 95% CI: 0.0298, 0.0431) and need predicted (C = 0.0157, 95% CI: 0.0117, 0.0413) utilizations were concentrated among the rich. The distributions of outpatient care in Ethiopians were pro-rich (rich-favoring). The decomposition analysis revealed that need factors were the main positive contributors to the inequality (23.6%) and non-need factors were among the negative contributors to the inequality (−48.4%). Conclusion This study evidenced the presence of rich-favoring inequality and inequity in outpatient care utilization in Ethiopia. Therefore, there is a need to consider implementation strategies that focus on fairness in healthcare utilization.
The Association Between Age at Initiation of Alcohol Consumption and Type 2 Diabetes Mellitus: A Cohort Study of 0.5 Million Persons in China

Abstract It is well known that alcohol consumption is associated with type 2 diabetes mellitus. However, the association of age at initiation of alcohol consumption and duration of alcohol drinking with type 2 diabetes mellitus among Chinese adults is not fully understood. This study was based on data from the China Kadoorie Biobank, which included 512,712 participants aged 30–79 years who were living in China in 2004–2008. A Cox proportional hazards model was used to estimate the association of AAI and drinking duration with type 2 diabetes. After adjustment for potential covariates, ages at alcohol initiation (AAIs) of 18.1–29.0 years, 29.1–39.0 years, and >39.0 years were associated with 22% (95% confidence interval (CI): 14, 30), 25% (95% CI: 17, 33), and 32% (95% CI: 24, 39) lower hazards of type 2 diabetes compared with abstaining, respectively. Drinking durations of <10.1 years, 10.1–20.0 years, and 20.1–30.0 years were associated with a lower risk of type 2 diabetes, compared with abstaining. Among current (weekly) drinkers, AAI <18.1 years and drinking duration >30.0 years were associated with 18% (95% CI: 4, 33) and 20% (95% CI: 3, 40) higher hazards of type 2 diabetes, compared with AAI 18.1–29.0 years and drinking duration <10.1 years, respectively. In conclusion, late AAI and a short drinking duration were associated with a lower risk of type 2 diabetes in this large prospective cohort study of Chinese adults, but early AAI and long drinking duration were not.
The Effectiveness of the Joint Commission International Accreditation in Improving Quality at King Fahd University Hospital, Saudi Arabia: A Mixed Methods Approach

Introduction Saudi Arabia has one of the highest numbers of health organizations accredited by the Joint Commission International. This study aimed to measure this process’s effectiveness in improving quality at King Fahd Hospital of the University in Khobar, Saudi Arabia. Additionally, the study investigated health providers’ perceptions of this process. Materials and Methods This research utilized a convergent parallel mixed method. For the quantitative analysis, an interrupted time series was conducted to assess the changes in a total of 12 quality outcomes pre- and post-accreditation. Thematic analysis was utilized to collect and analyze qualitative data from hospital employees and health providers. Results The quantitative results indicated that pursuing accreditation positively impacted nine out of 12 outcomes. The improved outcomes included: the average length of stay, the percentage of hand hygiene compliance, the rate of nosocomial infections, the percentage of radiology reporting outliers, the rate of pressure ulcers, the percentage of the correct identification of patients, the percentage of critical lab reporting, and the bed occupancy rate. The outcomes that did not improve were the rate of patients leaving the ER without being seen, the percentage of OR cancelations, and the rate of patient falls. The qualitative analysis suggested that the accreditation process was perceived positively by participants. Nevertheless, participants also highlighted some of the drawbacks of this process, including: the potential bias in observation-based key performance indicators, the focus on improving process without enhancing the hospital structure, and the increased workload. Conclusion International accreditation had a positive impact on quality and was received positively by providers. However, several issues need to be addressed by hospital administrators in future accreditation cycles. According to participants, the most notable issue during the first two accreditation cycles was the increased workload and paperwork, which can potentially distract from patient care.
Provable Model-based Nonlinear Bandit and Reinforcement Learning: Shelve Optimism, Embrace Virtual Curvature

This paper studies model-based bandit and reinforcement learning (RL) with nonlinear function approximations. We propose to study convergence to approximate local maxima because we show that global convergence is statistically intractable even for one-layer neural net bandit with a deterministic reward. For both nonlinear bandit and RL, the paper presents a model-based algorithm, Virtual Ascent with Online Model Learner (ViOlin), which provably converges to a local maximum with sample complexity that only depends on the sequential Rademacher complexity of the model class. Our results imply novel global or local regret bounds on several concrete settings such as linear bandit with finite or sparse model class, and two-layer neural net bandit. A key algorithmic insight is that optimism may lead to over-exploration even for two-layer neural net model class. On the other hand, for convergence to local maxima, it suffices to maximize the virtual return if the model can also reasonably predict the size of the gradient and Hessian of the real return.
Ensemble perspective for understanding temporal credit assignment

Recurrent neural networks are widely used for modeling spatiotemporal sequences in both nature language processing and neural population dynamics. However, understanding the temporal credit assignment is hard. Here, we propose that each individual connection in the recurrent computation is modeled by a spike and slab distribution, rather than a precise weight value. We then derive the mean-field algorithm to train the network at the ensemble level. The method is then applied to classify handwritten digits when pixels are read in sequence, and to the multisensory integration task that is a fundamental cognitive function of animals. Our model reveals important connections that determine the overall performance of the network. The model also shows how spatiotemporal information is processed through the hyperparameters of the distribution, and moreover reveals distinct types of emergent neural selectivity. To provide a mechanistic analysis of the ensemble learning, we first derive an analytic solution of the learning at the infinitely large network limit. We then carry out a low-dimensional projection of both neural and synaptic dynamics, analyze symmetry breaking in the parameter space, and finally demonstrate the role of stochastic plasticity in the recurrent computation. Therefore, our study sheds light on mechanisms of how weight uncertainty impacts the temporal credit assignment in recurrent neural networks from the ensemble perspective.