Miracle-dz/UniFAR-FTUs huggingface dataset:
Are underprivileged and less empowered women deprived of respectful maternity care: Inequities in childbirth experiences in public health facilities in Pakistan

Background Attainment of healthcare in respectful and dignified manner is a fundamental right for every woman regardless of the individual status. However, social exclusion, poor psychosocial support, and demeaning care during childbirth at health facilities are common worldwide, particularly in low- and middle-income countries. We concurrently examined how women with varying socio-demographic characteristics are treated during childbirth, the effect of women’s empowerment on mistreatment, and health services factors that contribute to mistreatment in secondary-level public health facilities in Pakistan. Methods A cross-sectional survey was conducted during August–November 2016 among 783 women who gave birth in six secondary-care public health facilities across four contiguous districts of southern Sindh. Women were recruited in health facilities and later interviewed at home within 42 days of postpartum using a WHO’s framework-guided 43-item structured questionnaire. Means, standard deviation, and average were used to describe characteristics of the participants. Multivariable linear regression was applied using Stata 15.1. Results Women experiencing at least one violation of their right to care by hospital staff during intrapartum care included: ineffective communication (100%); lack of supportive care (99.7%); loss of autonomy (97.5%); failure of meeting professional clinical standards (84.4%); lack of resources (76.3%); verbal abuse (15.2%); physical abuse (14.8%); and discrimination (3.2%). Risk factors of all three dimensions showed significant association with mistreatment: socio-demographic: primigravida and poorer were more mistreated; health services: lesser-education on birth preparedness and postnatal care leads to higher mistreatment; and in terms of women’s empowerment: women who were emotionally and physically abused by family, and those with lack of social support and lesser involvement in joint household decision making with husbands are more likely to be mistreated as compared to their counterparts. The magnitude of relationship between all significant risk factors and mistreatment, in the form of β coefficients, ranged from 0.2 to 5.5 with p-values less than 0.05. Conclusion There are glaring inequalities in terms of the way women are treated during childbirth in public health facilities. Measures of socio-demographic, health services, and women’s empowerment showed a significant independent association with mistreatment during childbirth. At the health system level, there is a need for urgent solutions for more inclusive care to ensure that all women are treated with compassion and dignity, complemented by psychosocial support for those who are emotionally disturbed and lack social support.
Preparing Patients and Clinicians for Open Notes in Mental Health: Qualitative Inquiry of International Experts

Background In a growing number of countries worldwide, clinicians are sharing mental health notes, including psychiatry and psychotherapy notes, with patients. Objective The aim of this study is to solicit the views of experts on provider policies and patient and clinician training or guidance in relation to open notes in mental health care. Methods In August 2020, we conducted a web-based survey of international experts on the practice of sharing mental health notes. Experts were identified as informaticians, clinicians, chief medical information officers, patients, and patient advocates who have extensive research knowledge about or experience of providing access to or having access to mental health notes. This study undertook a qualitative descriptive analysis of experts’ written responses and opinions (comments) to open-ended questions on training clinicians, patient guidance, and suggested policy regulations. Results A total of 70 of 92 (76%) experts from 6 countries responded. We identified four major themes related to opening mental health notes to patients: the need for clarity about provider policies on exemptions, providing patients with basic information about open notes, clinician training in writing mental health notes, and managing patient-clinician disagreement about mental health notes. Conclusions This study provides timely information on policy and training recommendations derived from a wide range of international experts on how to prepare clinicians and patients for open notes in mental health. The results of this study point to the need for further refinement of exemption policies in relation to sharing mental health notes, guidance for patients, and curricular changes for students and clinicians as well as improvements aimed at enhancing patient and clinician-friendly portal design.
Biogenic copper nanoparticles from Avicennia marina leaves: Impact on seed germination, detoxification enzymes, chlorophyll content and uptake by wheat seedlings

Biogenic copper nanoparticles (Cu NPs) were synthesized using the aqueous crude extract of mangrove leaves, Avicennia marina (CE). GC-MS metabolite profiling of CE showed that their carbohydrates are mainly composed of D-mannose (29.21%), D-fructose, (18.51%), L-sorbose (12.91%), D-galactose (5.47%) and D-Talose (5.21%). Ultra-fine nanoparticles of 11.60 ±4.65 nm comprising Cu2O and Cu(OH)2 species were obtained with a carbohydrate and phenolic content of 35.6±3.2% and 3.13±0.05 mgGA/g, respectively. The impact of the biogenic Cu NPs on wheat seedling growth was dose-dependent. Upon treatment with 0.06 mg/mL of Cu NPs, the growth was promoted by 172.78 ± 23.11 and 215.94 ± 37.76% for wheat root and shoot, respectively. However, the lowest relative growth % of 81.94 ± 11.70 and 72.46 ± 18.78% were recorded for wheat root and shoot, respectively when applying 0.43 mg/mL of Cu NPs. At this concentration, peroxidase activity (POX) of the germinated wheat seeds also decreased, while ascorbic acid oxidase (AAO) and polyphenol oxidase (PPO) activities increased. Higher uptake of copper was observed in the root relative to the shoot implying the accumulation of the nanoparticles in the former. The uptake was also higher than that of the commercial Cu NPs, which showed an insignificant effect on the seedling growth. By treating the wheat leaves in foliar application with 0.06 mg/mL of Cu NPs, their contents of Chlorophyll a, Chlorophyll b, and total chlorophyll were enhanced after 21 days of application. Meanwhile, the high concentration (0.43 mg/mL) of Cu NPs was the most effective in reducing the leaf content of chlorophyll (a, b, and total) after the same time of application. The findings of this study manifest the potential of utilizing controlled doses of the prepared biogenic Cu NPs for inhibition or stimulation of seedling growth.
The experience of widening participation students in undergraduate medical education in the UK: A qualitative systematic review

Abstract Introduction: Most widening participation (WP) research is focused on medical school recruitment; there is a paucity of research examining whether the experience of medical school itself is an equal experience for both ‘traditional’ and WP students. Methods: This qualitative systematic review used the Joanna Briggs Institute (JBI) meta-aggregative approach to characterise the experience of undergraduate medical education in the UK from the perspective of WP students. Seven databases were searched, 27 studies were critically appraised, and 208 findings were grouped into 12 categories and four synthesised findings. Results: The majority of the research found relates to ethnic minority groups, with reports of other WP groups being less frequent. Whilst WP programmes attempt to alleviate disadvantages prior to entering university, our findings suggest that difficulties follow WP students into medical school. Unfamiliarity with higher education and lack of representation of WP staff in faculty can deter help-seeking behaviour and result in lack of trust. Furthermore, students from different backgrounds can find their identity conflicted upon entering medical school. Despite difficulties in establishing social networks with ‘traditional’ medical student peers, WP students form strong relationships with students from similar backgrounds. Conclusions: Ultimately, these students find that the uniqueness of their experience is a useful tool for communicating with diverse patients which they come across and are able to overcome adversity with the help of a supportive institution.
Hypoglycemic attacks and growth failure are the most common manifestations of citrin deficiency after 1 year of age

Citrin deficiency develops in different symptomatic periods from the neonatal period to adulthood. Some infantile patients are diagnosed by newborn mass screening or symptoms of neonatal intrahepatic cholestasis caused by citrin deficiency, some patients in childhood may develop hepatopathy or dyslipidemia as failure to thrive and dyslipidemia caused by citrin deficiency, and some adults are diagnosed after developing adult‐onset type 2 citrullinemia (CTLN2) with hyperammonemia or encephalopathy. A diagnosis is needed before the development of severe phenotypic CTLN2 but is often difficult to obtain because newborn mass screening cannot detect all patients with citrin deficiency, and undiagnosed patients often appear healthy in childhood. There are only a few reports that have described patients in childhood. To explore the clinical features of undiagnosed patients with citrin deficiency in childhood, we studied 20 patients who were diagnosed after the first year of life. Of these patients, 45% experienced hypoglycemic attacks in childhood. The acetoacetic acid level during hypoglycemic attacks was lower than expected. Growth failure at diagnosis (45%) was also noted. From the patients' history, fat‐ and protein‐rich food preferences (80%), a low birth weight (70%), and prolonged jaundice or infantile hepatopathy (40%) were identified. To diagnose citrin deficiency in childhood, we should ask about food preferences and a history of infantile hepatopathy for all children with severe hypoglycemia or growth failure and consider the genetic test for citrin deficiency if the patient has characteristic food preferences or a history of infantile hepatopathy.
Identification of Novel Cross-Talk between the Neuroendocrine and Autonomic Stress Axes Controlling Blood Pressure

The hypothalamic paraventricular nucleus (PVN) controls neuroendocrine axes and the autonomic nervous system to mount responses that cope with the energetic burdens of psychological or physiological stress. Neurons in the PVN that express the angiotensin Type 1a receptor (PVNAgtr1a) are implicated in neuroendocrine and autonomic stress responses; however, the mechanism by which these neurons coordinate activation of neuroendocrine axes with sympathetic outflow remains unknown. Here, we use a multidisciplinary approach to investigate intra-PVN signaling mechanisms that couple the activity of neurons synthesizing corticotropin-releasing-hormone (CRH) to blood pressure. We used the Cre-Lox system in male mice with in vivo optogenetics and cardiovascular recordings to demonstrate that excitation of PVNAgtr1a promotes elevated blood pressure that is dependent on the sympathetic nervous system. Next, neuroanatomical experiments found that PVNAgtr1a synthesize CRH, and intriguingly, fibers originating from PVNAgtr1a make appositions onto neighboring neurons that send projections to the rostral ventrolateral medulla and express CRH type 1 receptor (CRHR1) mRNA. We then used an ex vivo preparation that combined optogenetics, patch-clamp electrophysiology, and Ca2+ imaging to discover that excitation of PVNAgtr1a drives the local, intra-PVN release of CRH, which activates rostral ventrolateral medulla-projecting neurons via stimulation of CRHR1(s). Finally, we returned to our in vivo preparation and found that CRH receptor antagonism specifically within the PVN lowered blood pressure basally and during optogenetic activation of PVNAgtr1a. Collectively, these results demonstrate that angiotensin II acts on PVNAgtr1a to conjoin hypothalamic-pituitary-adrenal axis activity with sympathetically mediated vasoconstriction in male mice. SIGNIFICANCE STATEMENT The survival of an organism is dependent on meeting the energetic demands imposed by stressors. This critical function is accomplished by the CNS's ability to orchestrate simultaneous activities of neurosecretory and autonomic axes. Here, we unveil a novel signaling mechanism within the paraventricular nucleus of the hypothalamus that links excitation of neurons producing corticotropin-releasing-hormone with excitation of neurons controlling sympathetic nervous system activity and blood pressure. The implication is that chronic stress exposure may promote cardiometabolic disease by dysregulating the interneuronal cross-talk revealed by our experiments.
Insight into resident burnout, mental wellness, and coping mechanisms early in the COVID-19 pandemic

Background Acute augmentation of stress and disruption of training, such as during the COVID-19 pandemic, may impact resident wellbeing. Objectives We investigated how residents in various specialties in the United States were impacted by COVID-19 on mental wellbeing and resilience levels, and the methodology for coping with the stress incurred. Methods In April 2020, the authors electronically surveyed 200 residency programs of all specialties nationally. The survey utilized two validated questionnaires to assess wellbeing and resilience, while investigating demographics and coping mechanisms. The authors used student t-test and ANOVA to quantitatively analyze the data. Results The sample consisted of 1115 respondents (with an 18% response rate). Male gender & Age >39 years were associated with more favorable average well-being indices (both p<0.01). Regarding resources, institutional support (IS) appeared favorable for resident well-being (IS 2.74, SD1.96 vs NoIS 3.71, SD2.29, p<0.01) & resilience (IS 3.72, SD0.70 vs NoIS 3.53, SD0.73, p = 0.05). The effects of mindfulness practices (MP) were not statistically significant for improvement of wellness (MP 2.87, SD 1.99 vs No MP 2.76, SD 2.15, p = 0.85) or resilience (MP 3.71, SD 0.70 vs No MP 3.72, SD 0.68, p = 0.87). Conclusions Findings highlight the critical importance of resident mental status in cases of augmented stress situations. Institutional support may contribute to promotion of resident wellbeing.
Multimodal Recruitment to Study Ovulation and Menstruation Health: Internet-Based Survey Pilot Study

Background Multimodal recruitment strategies are a novel way to increase diversity in research populations. However, these methods have not been previously applied to understanding the prevalence of menstrual disorders such as polycystic ovary syndrome. Objective The purpose of this study was to test the feasibility of recruiting a diverse cohort to complete a web-based survey on ovulation and menstruation health. Methods We conducted the Ovulation and Menstruation Health Pilot Study using a REDCap web-based survey platform. We recruited 200 women from a clinical population, a community fair, and the internet. Results We recruited 438 women over 29 weeks between September 2017 and March 2018. After consent and eligibility determination, 345 enrolled, 278 started (clinic: n=43; community fair: n=61; internet: n=174), and 247 completed (clinic: n=28; community fair: n=60; internet: n=159) the survey. Among all participants, the median age was 25.0 (SD 6.0) years, mean BMI was 26.1 kg/m2 (SD 6.6), 79.7% (216/271) had a college degree or higher, and 14.6% (37/254) reported a physician diagnosis of polycystic ovary syndrome. Race and ethnicity distributions were 64.7% (176/272) White, 11.8% (32/272) Black/African American, 7.7% (21/272) Latina/Hispanic, and 5.9% (16/272) Asian individuals; 9.9% (27/272) reported more than one race or ethnicity. The highest enrollment of Black/African American individuals was in clinic (17/42, 40.5%) compared to 1.6% (1/61) in the community fair and 8.3% (14/169) using the internet. Survey completion rates were highest among those who were recruited from the internet (159/174, 91.4%) and community fairs (60/61, 98.4%) compared to those recruited in clinic (28/43, 65.1%). Conclusions Multimodal recruitment achieved target recruitment in a short time period and established a racially diverse cohort to study ovulation and menstruation health. There were greater enrollment and completion rates among those recruited via the internet and community fair.
Breath‐holding and tidal breathing nasal NO to screen children for Primary Ciliary Dyskinesia

Nasal nitric oxide (nNO) measurement is recommended to screen for Primary Ciliary Dyskinesia (PCD) in subjects with suggestive history and symptoms. Clinical use of alternative methods (i.e., breath‐hold [BH], tidal breathing [TB]) in children unable to perform the gold standard slow Exhalation against a Resistance (ER) method has not been sufficiently evaluated. We extracted retrospectively (2013–2019) 454 files (374 subjects) containing nNO results. Median [IQR] age at inclusion was 7.0 [4.7–11.0] years, 105 (28.1%) children were younger than 5 years. ER or BH methods were more frequently mastered by children older than 5 years compared to younger children (69.4% and 52.7% vs. 21% and 5.6%, respectively; p < .0001), the latter succeeding only in TB measurement in 77.4% of cases. In 130 files with both ER and BH measurements (nNO‐ER and nNO‐BH), nNO‐BH was 102 [96.2; 108.3]% that of nNO‐ER. In 175 files including nNO‐ER and nNO‐TB measurements, nNO‐TB was 64.4 [IQR: 53.7; 80.4]% that of nNO‐ER with an excellent correlation between nNO values (r = .94 [95% CI 0.91; 0.95]; p < .0001) and discordance in the interpretation of nNO results in 16 (10.2%) cases. Final PCD diagnosis was similar in patients included before or after 5 years of age (confirmed 16 (15.2%) and 48 (17.8%); excluded 81 (77.1%) and 192 (71.4%), respectively; p = . 32). In conclusion, reliable nNO‐BH and nNO‐ER results are interchangeable. Children tested with ER or with TB method have similar final PCD diagnosis. Alternative methods to measure nNO might be studied further for use in clinical practice.
Evaluating meaningful levels of financial toxicity in gynecologic cancers

Objective The Comprehensive Score for Financial Toxicity (COST) is a validated instrument measuring the economic burden experienced by patients with cancer. We evaluated the frequency of financial toxicity at different COST levels and stratified risk factors and associations with cost-coping strategies by financial toxicity severity. Methods We analyzed previously collected survey data of gynecologic oncology patients from two tertiary care institutions. Both surveys included the COST tool and questions assessing economic and behavioral cost-coping strategies. We adapted a proposed grading scale to define three groups: no/mild, moderate, and severe financial toxicity and used χ2, Fisher’s exact test, and Wilcoxon rank sum test to compare groups. We used Poisson regression to calculate crude and adjusted risk ratios for cost-coping strategies, comparing patients with moderate or severe to no/mild financial toxicity. Results Among 308 patients, 14.9% had severe, 32.1% had moderate, and 52.9% had no/mild financial toxicity. Younger age, non-white race, lower education, unemployment, lower income, use of systemic therapy, and shorter time since diagnosis were associated with worse financial toxicity (all p<0.05). Respondents with moderate or severe financial toxicity were significantly more likely to use economic cost-coping strategies such as changing spending habits (adjusted risk ratio (aRR) 2.7, 95% CI 1.8 to 4.0 moderate; aRR 3.6, 95% CI 2.4 to 5.4 severe) and borrowing money (aRR 5.5, 95% CI 1.8 to 16.5 moderate; aRR 12.7, 95% CI 4.3 to 37.1 severe). Those with severe financial toxicity also had a significantly higher risk of behavioral cost-coping through medication non-compliance (aRR 4.6, 95% CI 1.2 to 18.1). Conclusions Among a geographically diverse cohort of gynecologic oncology patients, nearly half reported financial toxicity (COST <26), which was associated with economic cost-coping strategies. In those 14.9% of patients reporting severe financial toxicity (COST <14) there was also an increased risk of medication non-compliance, which may lead to worse health outcomes in this group.
Musical improvisation enhances interpersonal coordination in subsequent conversation: Motor and speech evidence

This study explored the effects of musical improvisation between dyads of same-sex strangers on subsequent behavioural alignment. Participants–all non-musicians–conversed before and after either improvising music together (Musical Improvisation—MI—group) or doing a motoric non-rhythmic cooperative task (building a tower together using wooden blocks; the Hands-Busy—HB—group). Conversations were free, but initially guided by an adaptation of the Fast Friends Questionnaire for inducing talk among students who are strangers and meeting for the first time. Throughout, participants’ motion was recorded with an optical motion-capture system (Mocap) and analysed in terms of speed cross-correlations. Their conversations were also recorded on separate channels using headset microphones and were analysed in terms of the periodicity displayed by rhythmic peaks in the turn transitions across question and answer pairs (Q+A pairs). Compared with their first conversations, the MI group in the second conversations showed: (a) a very rapid, partially simultaneous anatomical coordination between 0 and 0.4 s; (b) delayed mirror motoric coordination between 0.8 and 1.5 s; and (c) a higher proportion of Periodic Q+A pairs. In contrast, the HB group’s motoric coordination changed slightly in timing but not in degree of coordination between the first and second conversations, and there was no significant change in the proportion of periodic Q+A pairs they produced. These results show a convergent effect of prior musical interaction on joint body movement and use of shared periodicity across speech turn-transitions in conversations, suggesting that interaction in music and speech may be mediated by common processes.