Miracle-dz/UniFAR-FTUs huggingface dataset:
Determination of disease severity in COVID-19 patients using deep learning in chest X-ray images.

PURPOSE Chest X-ray plays a key role in diagnosis and management of COVID-19 patients and imaging features associated with clinical elements may assist with the development or validation of automated image analysis tools. We aimed to identify associations between clinical and radiographic features as well as to assess the feasibility of deep learning applied to chest X-rays in the setting of an acute COVID-19 outbreak. METHODS A retrospective study of X-rays, clinical, and laboratory data was performed from 48 SARS-CoV-2 RT-PCR positive patients (age 60±17 years, 15 women) between February 22 and March 6, 2020 from a tertiary care hospital in Milan, Italy. Sixty-five chest X-rays were reviewed by two radiologists for alveolar and interstitial opacities and classified by severity on a scale from 0 to 3. Clinical factors (age, symptoms, comorbidities) were investigated for association with opacity severity and also with placement of central line or endotracheal tube. Deep learning models were then trained for two tasks: lung segmentation and opacity detection. Imaging characteristics were compared to clinical datapoints using the unpaired student's t-test or Mann-Whitney U test. Cohen's kappa analysis was used to evaluate the concordance of deep learning to conventional radiologist interpretation. RESULTS Fifty-six percent of patients presented with alveolar opacities, 73% had interstitial opacities, and 23% had normal X-rays. The presence of alveolar or interstitial opacities was statistically correlated with age (P = 0.008) and comorbidities (P = 0.005). The extent of alveolar or interstitial opacities on baseline X-ray was significantly associated with the presence of endotracheal tube (P = 0.0008 and P = 0.049) or central line (P = 0.003 and P = 0.007). In comparison to human interpretation, the deep learning model achieved a kappa concordance of 0.51 for alveolar opacities and 0.71 for interstitial opacities. CONCLUSION Chest X-ray analysis in an acute COVID-19 outbreak showed that the severity of opacities was associated with advanced age, comorbidities, as well as acuity of care. Artificial intelligence tools based upon deep learning of COVID-19 chest X-rays are feasible in the acute outbreak setting.
Artists on the edge of the world: An integrated approach to the study of Magdalenian engraved stone plaquettes from Jersey (Channel Islands)

The Upper Palaeolithic is characterised by the appearance of iconographic expressions most often depicting animals, including anthropomorphic forms, and geometric signs. The Late Upper Palaeolithic Magdalenian saw a flourishing of such depictions, encompassing cave art, engraving of stone, bone and antler blanks and decoration of tools and weapons. Though Magdalenian settlement exists as far northwest as Britain, there is a limited range of art known from this region, possibly associated with only fleeting occupation of Britain during this period. Stone plaquettes, flat fragments of stone engraved on at least one surface, have been found in large quantities at numerous sites spanning the temporal and geographical spread of the Magdalenian, but they have been absent so far from the archaeological record of the British Isles. Between 2015 and 2018, ten fragments of stone plaquettes extensively engraved with abstract designs were uncovered at the Magdalenian site of Les Varines, Jersey, Channel Islands. In this paper, we report detailed analyses of these finds, which provide new evidence for technologies of abstract mark-making, and their significance within the lives of people on the edge of the Magdalenian world. These engraved stone fragments represent important, rare evidence of artistic expression in what is the far northern and western range of the Magdalenian and add new insight to the wider significance of dynamic practices of artistic expression during the Upper Palaeolithic.
The impact of respiratory colonisation on the development of ventilator‐associated pneumonia in critically ill children

Healthcare-associated infections are a serious problem worldwide, as they increase morbidity, mortality and lengthen hospital stays. About 10-20% of patients on mechanical ventilation risk developing ventilator-associated pneumonia (VAP), which varies by geographical region but still is the second most common nosocomial infection in the paediatric intensive care unit (PICU). VAP mortality is up to 20% in paediatrics.
Identification of novel therapeutic targets for blocking acantholysis in pemphigus

Pemphigus is caused by autoantibodies against desmoglein (Dsg) 1, Dsg3, and/or non‐Dsg antigens. Pemphigus vulgaris (PV) is the most common manifestation of pemphigus, with painful erosions on mucous membranes. In most cases, blistering also occurs on the skin, leading to areas of extensive denudation. Despite improvements in pemphigus treatment, time to achieve remission is long, severe adverse events are frequent and 20% of patients do not respond adequately. Current clinical developments focus exclusively on modulating B cell function or autoantibody half‐life. However, topical modulation of PV autoantibody‐induced blistering is an attractive target because it could promptly relieve symptoms.
Clinical differences of hand and rotary instrumentations during biomechanical preparation in primary teeth - A systematic review and Meta-analysis.

BACKGROUND The hand and rotary instruments are used for cleaning and shaping of root canals during biomechanical preparation in primary teeth. AIM To determine clinical differences of hand versus rotary root canal instrumentation in primary teeth. DESIGN Comprehensive searches were made in four electronic databases [MEDLINE (via PubMed), EMBASE, Google Scholar, and The Cochrane Central Register of Controlled Trials] till March 2020, and prospective studies that met the inclusion criteria were included. The primary outcome was instrumentation time while secondary outcomes were quality of obturation, obturation time, and clinical and radiographic success. From 604 screened studies, eleven studies qualified for meta-analysis. The Random effect model and Generic Inverse Variance approach were used for meta-analysis. RESULTS There was significant decrease in instrumentation time [MD-5.00 minutes(95% CI:3.05-6.94),p<0.00001, moderate evidence quality] and obturation time [MD-0.43 minutes(95% CI:0.15-0.71),p=0.003, low evidence quality] with rotary instrumentation. Optimal quality of obturation was achieved in significantly more number of teeth [Risk ratio (RR)=0.71(95% CI:0.53-0.95),p=0.02, moderate to high evidence quality] with rotary instrumentation. Similar clinical and radiographic success was observed in hand and rotary instrumentation techniques. CONCLUSION Significant reduction in instrumentation time of five minutes was observed using rotary instrumentation with moderate quality evidence.
New Directions in Pulmonary Gene Therapy.

The lung has long been a target for gene therapy, yet efficient delivery and phenotypic disease correction has remained challenging. While there have been significant advancements in gene therapies of other organs, including the development of several ex vivo therapies, in vivo therapeutics of the lung have been slower to transition to the clinic. Within the past few years, the field has witnessed an explosion in the development of new gene addition and gene editing strategies for the treatment monogenic disorders. In this review, we will summarize current developments in gene therapy for cystic fibrosis, alpha-1 antitrypsin deficiency, and surfactant protein deficiencies. We will explore the different gene addition and gene editing strategies under investigation and review the challenges of delivery to the lung.
Physical activity is associated with lower arterial stiffness in normal‐weight postmenopausal women

The impact of physical exercise, as preventative measure, to control the progression of cardiovascular disease in midlife remains under investigation. We aimed to investigate the effect of different levels of intensity of physical activity on metabolic and vascular profile in healthy postmenopausal women. A total of 625 healthy postmenopausal women (mean age 57.7 ± 7.6 years) were evaluated using the short IPAQ questionnaire for quantification of physical activity. The energy expenditure was estimated in metabolic equivalent of energy (MET) hours per week. Pulse wave velocity (PWV) was measured as an index of arterial stiffness. Intima‐media thickness of both right and left common carotid artery, carotid bulb and internal carotid artery, and combined carotid IMT were also assessed by non‐invasive and well‐validated methods. Mean values of PWV decreased linearly with increasing intensity of physical activity (classes of physical activity: sedentary vs walking vs moderate vs vigorous activity: 9.07 ± 1.22 m/s vs 9.12 ± 1.72 m/s vs 8.47 ± 1.31m/s vs 7.94 ± 0.40 m/s, ANOVA P for linear trend .003). In non‐obese postmenopausal women, PWV values associated with: (a) the total number of METs (b‐coefficient = −0.261, P = .002) as well as with SBP; (b) or with the number of moderate METs (b‐coefficient = −0.192, P = .025) as well as with age and SBP. No significant associations were observed between the intensity of physical exercise and arterial stiffness in the overweight‐obese group. Physical activity is negatively associated with arterial stiffness in postmenopausal women with normal weight. This association was not observed in overweight or obese women.
Dietary Vitamin D Supplementation Is Ineffective in Preventing Murine Cow’s Milk Allergy, Irrespective of the Presence of Nondigestible Oligosaccharides

Introduction: Cow’s milk allergy (CMA) is one of the most common food allergies especially early in life. A mixture of nondigestible short-chain galacto-oligosaccharides, long-chain fructo-oligosaccharides, and pectin-derived acidic-oligosaccharides (GFA) may reduce allergy development and allergic symptoms in murine CMA. Recently, vitamin D (VitD) has been suggested to have beneficial effects in reducing allergy as well. Objective: In this study, the immune modulatory effect on allergy prevention using the combination of GFA and VitD was investigated. Methods: Female C3H/HeOuJ mice were fed a control or GFA-containing diet with depleted, standard (1,000 IU/kg), or supplemented (5,000 IU/kg) VitD content for 2 weeks before and during whey sensitization (n = 10–15). Mice were sensitized 5 times intragastrically with PBS as a control, whey as cow’s milk allergen, and/or cholera toxin as adjuvant on a weekly interval. One week after the last sensitization, mice were intradermally challenged in both ear pinnae and orally with whey, subsequently the acute allergic skin response and shock symptoms were measured. After 18 h, terminal blood samples, mesenteric lymph nodes, and spleens were collected. Whey-specific immunoglobulin (Ig) E and IgG1 levels were measured by means of ELISA. T cell subsets and dendritic cells (DCs) were studied using flow cytometry. Results: Additional VitD supplementation did not lower the allergic symptoms compared to the standard VitD diet. CMA mice fed the GFA diet supplemented with VitD (GFA VitD+) significantly decreased the acute allergic skin response of whey sensitized mice when compared to the CMA mice fed VitD (VitD+) group (p < 0.05). The effect of GFA was not improved by extra VitD supplementation even though the CMA mice fed the GFA VitD+ diet had a significantly increased percentage of CD103+ DCs compared to the VitD+ group (p < 0.05). The VitD-deprived mice showed a high percentage of severe shock and many reached the humane endpoint; therefore, these groups were not further analyzed. Conclusions: High-dose VitD supplementation in mice does not protect against CMA development in the presence or absence of GFA.
Short-term variability in subjective memory decline: the influence of age and neuroticism

ABSTRACT This study was designed to investigate whether differences in age and neuroticism would predict short-term change in subjective memory decline. The sample consisted of 52 younger adult (M age = 21.19, sd = 3.22) and 59 older adult volunteers (M age = 77.52, sd = 8.07). Participants were administered self-report measures and a battery of cognitive tests. A subjective memory decline measure was administered at three time points (baseline, posttest, 2-week follow-up). At T2, the significant predictors of posttest subjective memory decline were age, perceived performance, and neuroticism with a significant age by neuroticism interaction. Older adults who were higher in neuroticism had higher posttest subjective memory decline than other participants. At T3, the only significant predictor of subjective memory decline was age with older adults reporting more perceived decline. This study showed that perceived memory decline, which is often thought to be fairly stable, was reactive to cognitive testing, particularly for older adults who were high in neuroticism.
Real-world Comorbidity Burden, Health Care Utilization, and Costs of Nonalcoholic Steatohepatitis Patients With Advanced Liver Diseases

Supplemental Digital Content is available in the text. Goals: This study evaluates the real-world comorbidity burden, health care resource utilization (HRU), and costs among nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) patients with advanced liver diseases [compensated cirrhosis (CC), decompensated cirrhosis (DCC), liver transplantation (LT), hepatocellular carcinoma (HCC)]. Background: NAFLD/NASH is a leading cause of liver diseases. Materials and Methods: Adult NAFLD/NASH patients were identified retrospectively from MarketScan Commercial claims (2006-2016). Following initial NAFLD/NASH diagnosis, advanced liver diseases were identified using the first diagnosis as their index date. Mean annual all-cause HRU and costs (2016 USD) were reported. Adjusted costs were estimated through generalized linear models. Cumulative costs were illustrated for patient subsets with variable follow-up for each stage. Results: Within the database, 485,774 NAFLD/NASH patients met eligibility criteria. Of these, 93.4% (453,564) were NAFLD/NASH patients without advanced liver diseases, 1.6% (7665) with CC, 3.3% (15,833) with DCC, 0.1% (696) with LT, and 0.1% (428) with HCC. Comorbidity burden was high and increased as patients progressed through liver disease severity stages. Compared with NAFLD/NASH without advanced liver diseases (adjusted costs: $23,860), the annual cost of CC, DCC, LT, and HCC were 1.22, 5.64, 8.27, and 4.09 times higher [adjusted costs: $29,078, $134,448, $197,392, and $97,563 (P<0.0001)]. Inpatient admissions significantly drove increasing HRU. Conclusion: Study findings suggest the need for early identification and effective management of NAFLD/NASH patients to minimize comorbidity burden, HRU, and costs in the privately insured US population.
Test–Retest Reliability of Handgrip Strength in Patients with Chronic Obstructive Pulmonary Disease

Abstract The purpose of this study was to investigate the intra-rater reliability and agreement of handgrip strength (HGS) measurement using a hydraulic hand dynamometer in patients with chronic obstructive pulmonary disease (COPD). A sample of 19 COPD patients (18 males and 1 female; mean ± SD age, 66.9 ± 6.3 years) was evaluated using a hand dynamometer by the same rater in two different testing sessions with a 7-d interval. During each session, patients were asked to exert three maximal isometric contractions on the dominant hand and the mean value of the 3 efforts (measured in kilogram-force [Kgf]) was used for data analysis. The intraclass correlation coefficient (ICC2,1), the standard error of measurement (SEM), the minimal detectable change (MDC), and Bland–Altman methods were used to estimate the degree of test–retest reliability and the measurement error, respectively. HGS in COPD patients revealed an ICC2,1 score of 0.99, suggesting excellent test–retest reliability. The calculated SEM was relatively small (0.59 Kgf), and the MDC presented a clinically acceptable value of 1.64 Kgf. These findings, in conjunction with the narrow width of the 95% limits of agreements (95% limits of agreement, −2.5–2.1 Kgf) in the Bland–Altman plot, reflected the measurement precision and the narrow variation of the differences during the 2 testing sessions. The results of this study demonstrated an excellent test–retest reliability of HGS measurement, indicating that this method is reliable for repeated monitoring of peripheral muscle strength in patients with COPD.
Psychological responses and lifestyle changes among pregnant women with respect to the early stages of COVID-19 pandemic

Objectives: The COVID-19 pandemic has caused a profound impact on health and well-being of populations. However, there are limited studies that have investigated the psychological aspects of vulnerable groups including pregnant women amid the COVID-19 pandemic. Therefore, we aimed to assess the psychological impact of the COVID-19 pandemic among Chinese pregnant women from February 2020 until March 2020. Methods: Our study was conducted using a modified validated online questionnaire comprising of sociodemographic, the Impact of Event Scale (IES), attitude and mental health-related questions towards COVID-19. Results: A total of 560 women were included. The overall mean age and IES of women was 25.8 ± 2.7 years and 31.4 ± 13.7. Moreover, 67.1% of them had IES ⩾26. Psychological impact seemed to be more severe in women in second trimester of pregnancy (the highest IES) (p = .016). There was a significant association between trimesters of pregnancy and some indicators of negative health impacts (including increased stress from work, increased stress from home, feeling apprehensive and helpless during the early stages of the COVID-19 pandemic) (all p < .05). Conclusions: Our results reported moderate-to-severe stressful impact among Chinese pregnant women. We recommend that appropriate measures should be taken to address the maternal mental health issues.
Characterization of patients with advanced chronic pancreatitis using natural language processing of radiology reports

Study aim To develop and apply a natural language processing algorithm for characterization of patients diagnosed with chronic pancreatitis in a diverse integrated U.S. healthcare system. Methods Retrospective cohort study including patients initially diagnosed with chronic pancreatitis (CP) within a regional integrated healthcare system between January 1, 2006 and December 31, 2015. Imaging reports from these patients were extracted from the electronic medical record system and split into training, validation and implementation datasets. A natural language processing (NLP) algorithm was first developed through the training dataset to identify specific features (atrophy, calcification, pseudocyst, cyst and main duct dilatation) from free-text radiology reports. The validation dataset was applied to validate the performance by comparing against the manual chart review. The developed algorithm was then applied to the implementation dataset. We classified patients with calcification(s) or ≥2 radiographic features as advanced CP. We compared etiology, comorbid conditions, treatment parameters as well as survival between advanced CP and others diagnosed during the study period. Results 6,346 patients were diagnosed with CP during the study period with 58,085 radiology studies performed. For individual features, NLP yielded sensitivity from 88.7% to 95.3%, specificity from 98.2% to 100.0%. A total of 3,672 patients met cohort inclusion criteria: 1,330 (36.2%) had evidence of advanced CP. Patients with advanced CP had increased frequency of smoking (57.8% vs. 43.0%), diabetes (47.6% vs. 35.9%) and underweight body mass index (6.6% vs. 3.6%), all p<0.001. Mortality from pancreatic cancer was higher in advanced CP (15.3/1,000 person-year vs. 2.8/1,000, p<0.001). Underweight BMI (HR 1.6, 95% CL 1.2, 2.1), smoking (HR 1.4, 95% CL 1.1, 1.7) and diabetes (HR 1.4, 95% CL 1.2, 1.6) were independent risk factors for mortality. Conclusion Patients with advanced CP experienced increased disease-related complications and pancreatic cancer-related mortality. Excess all-cause mortality was driven primarily by potentially modifiable risk factors including malnutrition, smoking and diabetes.
Absenteeism and the Technical Safety Index of a tertiary hospital nursing team.

OBJECTIVE To identify the nursing team absenteeism rate, calculate the Technical Safety Index and compare them to the percentage established by the Federal Nursing Council. METHOD A descriptive, analytical, and retrospective study which included nursing professionals working in a public and tertiary hospital. The Human Resources Department database of the Institution was used for data collection. Absenteeism was considered as any unplanned absence. RESULTS Ninety-nine (99) professionals participated, of which 21 were nurses and 78 were nursing technicians. Weekly days off prevailed among the expected absences, with 17% for both categories. Maternity leave prevailed among nurses and medical leave among nursing technicians regarding absenteeism, with averages of 12% and 9%, respectively. The Technical Safety Index was 42% for nurses and 38% for nursing technicians. CONCLUSION The nursing teams absenteeism rate was 21.5%, while the Technical Safety Index was 40%, thus constituting higher values than those established by the Federal Nursing Council.
The role of connectivity in the interplay between climate change and the spread of alien fish in a large Mediterranean river

Understanding how global change and connectivity will jointly modify the distribution of riverine species is crucial for conservation biology and environmental management. However, little is known about the interaction between climate change and fragmentation and how movement barriers might impede native species from adjusting their distributions versus limit the further spread of alien species. In this study, we modelled the current and future distributions of 11 native and five alien fishes in the large and heavily fragmented Ebro River, located within the Mediterranean region, which has many freshwater endemics severely threatened by global change. We considered 10 climate change models and five modelling algorithms and assessed the effects of connectivity on the accessibility of future suitable habitats. Thereby, we identify most conflict‐prone river reaches, that is, where barriers pose a particular trade‐off between isolating and negatively impacting native species versus potentially reducing the risk of alien species spread. Our results projected upstream habitat shifts for the vast majority of the species. Climate change affected species differently, with alien species generally showing larger habitat gains compared to natives. Most pronounced distributional changes (i.e. losses of native species and gains of alien species) and compositional turnover might be expected in the lower and mid reaches of large tributaries of the Ebro River. The role of anthropogenic barriers in this context is often ambiguous but rather unfavourable, as they not only restrict native fishes but also alter stream habitats and flow conditions. However, with our spatial modelling framework, we could identify specific river reaches where the connectivity trade‐off in the context of climate change is particularly relevant. Overall, our findings emphasize the importance of the complex effects that climate change, riverine connectivity and alien species are expected to impose on river communities and the urgent need to adapt management strategies accordingly.