Miracle-dz/UniFAR-FTUs huggingface dataset:
Training in Neurology: Diagnostic Accuracy Among Neurology Residents

Objective To describe cases presented by junior neurology residents and to evaluate resident diagnostic patterns to help address individual and systemic educational needs. Methods For 6 academic years, details of all morning report cases assessed and presented by junior neurology residents were logged, including the resident's independent initial diagnostic impression. Cases were later revisited at subsequent morning reports to “close the loop” on a final diagnosis. We conducted retrospective review to quantify case demographics and to determine resident diagnostic accuracy based on prespecified localization pathways. Results Demographic analysis included 1,472 cases; of these, 1,301 qualified for accuracy analysis due to diagnostic uncertainty at time of morning report. Non-neurologic etiologies represented 26.0% of cases. CNS etiologies were the majority (86.0%) of neurologic cases. The most frequent diagnoses were ischemic stroke and seizure. Overall resident diagnostic accuracy was 64.0%. Accuracy was similar between central and peripheral etiologies. Of 1,301 cases, 15.3% were overcalled as neurologic, while neurologic disease was rarely mistaken as non-neurologic (5.1%). Most diagnostic errors (49.1%) occurred when determining whether a case was neurologic. Where in the localization pathway errors occurred varied between etiologies. Conclusion Overall diagnostic accuracy for neurology junior residents in our cohort was similar to prior work conducted in smaller samples. Analysis of errors, particularly at the critical “neurologic or non-neurologic” decision point, warrants further investigation. Close the loop methodology is simple to employ and can guide educational and quality initiatives to improve neurology resident clinical acumen.
Quality improvement at scale: evaluation of the drivers and barriers to adoption and sustainability of an intervention to reduce late referral in chronic kidney disease

This quality improvement project aimed to drive large scale and sustained change to reduce the burden of chronic kidney disease in the UK. The intervention is a software program that extracts relevant biochemical data from laboratory databases which then generate graphs of estimated kidney function (eGFR) over time. Graphs showing progressive kidney disease are sent directly back to general practitioners (GPs) to alert them to rereview patient care and if necessary, refer to renal services. The aim of this evaluation study was to explain the barriers and drivers to implementation and adoption of the eGFR graph intervention. This evaluation study involved 5 of the 20 participating renal units (sites). A developmental evaluation approach was used. Methods included collection of descriptive data about graph reporting; GP surveys (n=68); focus groups (n=4) with practices; face-to-face interviews with secondary care clinicians (n=10). Results showed the mean number of graphs reviewed per week per site was 230, taking 1 hour per week per site. Only 18.2% graphs highlighted a concerning decline in kidney function. Important enablers to sustain the intervention were low cost, easy to understand, a sense of local ownership and perceived impact. Barriers included nephrologists’ perceived increase in new referrals. We concluded that developmental evaluation can explain the barriers/drivers to implementation of a national quality improvement project that involves a variety of different stakeholders. The intervention has the potential to slow down progression of kidney disease due to the eGFR prompts alerting GPs to review the patient record and take action, such as reviewing medications and referring to renal teams if progressive kidney disease had not been identified previously.
Response Surface Methodology for Optimization of Process Parameters and Antioxidant Properties of Mulberry (Morus alba L.) Leaves by Extrusion

Mulberry (Morus alba L.) leaves (MLs), originally used to feed silkworms, have recently been recognized as a food ingredient containing health-beneficial, bioactive compounds. In this study, the extrusion process was applied for the enhancement of the amount of extractable flavonoids from MLs. Extrusion conditions were optimized by water solubility index, total phenolic content, and total flavonoid content (TF) using response surface methodology, and antioxidative stress activities were evaluated in macrophage cells. According to the significance of regression coefficients of TF, the optimal extrusion parameters were set as barrel temperature of 114 °C, moisture feed content of 20%, and screw speed of 232 rpm. Under these conditions, the TF of extruded ML reached to 0.91% and improved by 63% compared with raw ML. Fifteen flavonoids were analyzed using ultra-high-performance liquid chromatograph coupled with photodiode array detection and quadrupole time-of-flight mass spectrometry (UPLC-PDA-QTOF/MS), and the extrusion resulted in increases in quercetin-3-gentiobioside, quercetin-3,7-di-O-glucoside, kaempferol-3,7-di-O-glucoside, rutin, isoquercitrin, and moragrol C. Besides, regarding antioxidative activity, extruded ML water extract inhibited the production of H2O2-induced reactive oxygen species and attenuated nuclear morphology alterations in macrophage cells. The findings of this study should be useful in food processing design to improve the extractable functional compounds in MLs.
A Heuristic Method for Controller Placement and Enhanced Availability between SDN Controllers

The Controller Placement Problem is an important and inherent component of SDN network design. Several QoS requirements such as delay and availability impose constraints on the controller placement in the network. The problem of guaranteeing ‘five-nines' availability between the controllers in a SDN network is addressed. We consider the problem of controller placement under delay constraints, while assuming a sub-graph of enhanced availability between the controllers. The sub-graph can be upgraded at a given cost, to achieve the desired availability requirements. To solve this problem, we propose a heuristic method to evaluate several controller node sets and the upgrade cost of the sub-graph for enhanced availability. The heuristic includes solving two optimization sub-problems, which are both NP-hard. The computational results show the trade-off between the number of controllers and upgrade cost and show that slightly increasing the number of controllers can lead to a significant reduction in the upgrade cost.
Decreased connection density and modularity of functional brain networks during n‐back working memory paradigm

Investigating how the brain adapts to increased mental workload through large‐scale functional reorganization appears as an important research question. Functional connectivity (FC) aims at capturing how disparate regions of the brain dynamically interact, while graph theory provides tools for the topological characterization of the reconstructed functional networks. Although numerous studies investigated how FC is altered in response to increased working memory (WM) demand, current results are still contradictory as few studies confirmed the robustness of these findings in a low‐density setting.
Varying degree of physiological integration among host instars and their endoparasitoid affects stress‐induced mortality

In natural populations of insect herbivores, genetic differentiation is likely to occur due to variation in host plant utilization and selection by the local community of organisms with which they interact. In parasitoids, engaging in intimate associations with their host during immature development, local variation may exist in host quality for parasitoid development. We compared the development of a gregarious endoparasitoid, Cotesia glomerata L. (Hymenoptera: Braconidae), collected in The Netherlands, in three strains and three caterpillar instars (L1–L3) of its main host, Pieris brassicae L. (Lepidoptera: Pieridae). Hosts had been collected in The Netherlands and France, and were reared in the laboratory for one generation. We also used an established Dutch laboratory strain that had not been exposed to parasitoids for at least 24 generations. Parasitoid survival to adulthood was inversely correlated with host instar at parasitism. Adult parasitoid body mass was largest when hosts were parasitized as L1 and smallest when hosts were parasitized as L3, whereas egg‐to‐adult development time was quickest on L3 hosts and slowest on L1 hosts. Higher survival and faster development of C. glomerata on French L2 hosts also showed that there is variation in host‐instar‐related suitability. Many L2 and most L3 caterpillars that were parasitized exhibited signs of pathogen infection and perished within a few days of parasitism, whereas this never happened when hosts were parasitized as L1 or in non‐parasitized control caterpillars. Our results reveal that, irrespective of the host strain, L1 hosts are optimally synchronized with C. glomerata development. By contrast, the high precocious mortality of L3 larvae may be due to stress‐induced regulation by the parasitoid in order to ‘force’ its developmental program into synchrony with the developing parasitoid larvae. Our results underscore a potentially important role played by pathogens in mediating herbivore–parasitoid interactions that are host‐instar‐dependent in their expression.
Src family kinases-mediated negative regulation of sperm acrosome reaction in chickens (Gallus gallus domesticus)

The acrosome reaction (AR) is a strictly-regulated, synchronous exocytosis that is required for sperm to penetrate ova. This all-or-nothing process occurs only once in the sperm lifecycle through a sequence of signaling pathways. Spontaneous, premature AR therefore compromises fertilization potential. Although protein kinase A (PKA) pathways play a central role in AR across species, the signaling network used for AR induction is poorly understood in birds. Mechanistic studies of mammalian sperm AR demonstrate that PKA activity is downstreamly regulated by Src family kinases (SFKs). Using SFK inhibitors, our study shows that in chicken sperm, SFKs play a role in the regulation of PKA activity and spontaneous AR without affecting motility. Furthermore, we examined the nature of SFK phosphorylation using PKA and protein tyrosine phosphatase inhibitors, which demonstrated that unlike in mammals, SFK phosphorylation in birds does not occur downstream of PKA and is primarily regulated by calcium-dependent tyrosine phosphatase activity. Functional characterization of SFKs in chicken sperm showed that SFK activation modulates the membrane potential and plays a role in inhibiting spontaneous AR. Employing biochemical isolation, we also found that membrane rafts are involved in the regulation of SFK phosphorylation. This study demonstrates a unique mechanism for regulating AR induction inherent to avian sperm that ensure fertilization potential despite prolonged storage.
Communal Living: Glycan Utilization by the Human Gut Microbiota.

Our lower gastrointestinal tract plays host to a vast consortium of microbes, known as the Human Gut Microbiota (HGM). The HGM thrives on a complex and diverse range of glycan structures from both dietary and host sources, the breakdown of which requires the concerted action of cohorts of Carbohydrate-Active Enzymes (CAZymes), carbohydrate-binding proteins, and transporters. The glycan utilization profile of individual taxa, whether "specialist" or "generalist", is dictated by the number and functional diversity of these glycan utilization systems. Furthermore, taxa in the HGM may either compete or cooperate in glycan deconstruction, thereby creating a complex ecological web spanning diverse nutrient niches. As a result, our diet plays a central role in shaping the composition of the HGM. This review presents an overview of our current understanding of glycan utilization by the HGM on three levels: 1) molecular mechanisms of individual glycan deconstruction and uptake by key bacteria, 2) glycan-mediated microbial interactions, and 3) community-scale effects of dietary changes. Despite significant recent advancements, there remains much to be discovered regarding complex glycan metabolism in the HGM and its potential to effect positive health outcomes. This article is protected by copyright. All rights reserved.
Oxidation of Protein Kinase A Regulatory Subunit PKARIα Protects Against Myocardial Ischemia-Reperfusion Injury by Inhibiting Lysosomal-Triggered Calcium Release

Supplemental Digital Content is available in the text. Background: Kinase oxidation is a critical signaling mechanism through which changes in the intracellular redox state alter cardiac function. In the myocardium, PKARIα (type-1 protein kinase A) can be reversibly oxidized, forming interprotein disulfide bonds in the holoenzyme complex. However, the effect of PKARIα disulfide formation on downstream signaling in the heart, particularly under states of oxidative stress such as ischemia and reperfusion (I/R), remains unexplored. Methods: Atrial tissue obtained from patients before and after cardiopulmonary bypass and reperfusion and left ventricular (LV) tissue from mice subjected to I/R or sham surgery were used to assess PKARIα disulfide formation by immunoblot. To determine the effect of disulfide formation on PKARIα catalytic activity and subcellular localization, live-cell fluorescence imaging and stimulated emission depletion super-resolution microscopy were performed in prkar1 knock-out mouse embryonic fibroblasts, neonatal myocytes, or adult LV myocytes isolated from “redox dead” (Cys17Ser) PKARIα knock-in mice and their wild-type littermates. Comparison of intracellular calcium dynamics between genotypes was assessed in fura2-loaded LV myocytes, whereas I/R-injury was assessed ex vivo. Results: In both humans and mice, myocardial PKARIα disulfide formation was found to be significantly increased (2-fold in humans, P=0.023; 2.4-fold in mice, P<0.001) in response to I/R in vivo. In mouse LV cardiomyocytes, disulfide-containing PKARIα was not found to impact catalytic activity, but instead led to enhanced AKAP (A-kinase anchoring protein) binding with preferential localization of the holoenzyme to the lysosome. Redox-dependent regulation of lysosomal two-pore channels by PKARIα was sufficient to prevent global calcium release from the sarcoplasmic reticulum in LV myocytes, without affecting intrinsic ryanodine receptor leak or phosphorylation. Absence of I/R-induced PKARIα disulfide formation in “redox dead” knock-in mouse hearts resulted in larger infarcts (2-fold, P<0.001) and a concomitant reduction in LV contractile recovery (1.6-fold, P<0.001), which was prevented by administering the lysosomal two-pore channel inhibitor Ned-19 at the time of reperfusion. Conclusions: Disulfide modification targets PKARIα to the lysosome, where it acts as a gatekeeper for two-pore channel–mediated triggering of global calcium release. In the postischemic heart, this regulatory mechanism is critical for protection from extensive injury and offers a novel target for the design of cardioprotective therapeutics.
Vehicle-to-Infrastructure Visible Light Communications: Channel Modelling and Capacity Calculations

In this paper, we investigate the performance of a visible light communication (VLC) system for vehicle-to-infrastructure (V2I) connectivity. Two headlamps of the vehicle serve as wireless transmitters while photodetectors located within the traffic light pole act as wireless receivers. We use non-sequential ray-tracing approach to obtain optical channel impulse responses (CIRs) for the V2I scenario under consideration assuming different positions of the vehicle within the road. Based on the CIRs to model propagation environment as well as the effects of LED non-linear characteristics, we calculate the achievable signal-to-noise ratio and achievable data rates for VLC-based V2I systems.
Classification of Learning Styles in Multimedia Learning Using Eye-Tracking and Machine Learning

The existence of a multimedia learning system still presents the same material for every student. Educational theory suggests that learning content ideally should be adaptive by considering each student’s learning style. To make learning more optimal, it is necessary to detect learning styles. Several learning detection approaches have been implemented. Conventional methods such as student assessment tests and interviews tend to be more subjective. An objective method of eye-tracking has been researched but limited as a validation tool for differentiating learning styles. To overcome the above mentioned problems, this study proposes a new approach using machine learning and eye-tracking techniques. The experiment and analysis involved 68 students. There were 23 male participants and 45 female participants. In the experiment, participants were assigned to interact with learning content and their eye movements were recorded using an eye-tracker sensor. From the experimental results using three classification algorithms — SVM, Naïve Bayes, and Logistic Regression — and using SVM-RFE as a feature selection method, the best model was achieved by Naïve Bayes algorithm through three features selected from SVM-RFE method. The model yielded 71% of accuracy, 60% of sensitivity, and 75% of specificity. This empirical study provides an opportunity for machine learning and eye-tracking approaches to automatically classify learning styles. These results can be used as guidelines for developing an adaptive multimedia learning system by considering students’ learning styles.
Demulsification of Oil-Water Emulsions by Microwave Irradiation

The studies of oil recovery, size of dispersed droplets and temperature profile during microwave demulsification were carried out. Microwave demulsification has no secondary pollution problems, because no chemical additives are required. Also, because microwave selectively heats emulsion, faster separation rate and less energy consumption than conventional heating are possible. As the 20, 30, and 50%(v/v)O/W emulsions were continuously irradiated by microwave for 120 seconds, percentages of oil recovery after 1hr settlement were 75, 84, and 95% respectively. Also, the rates of temperature rise were 0.478, 0.505, and 0.602(/s) respectively. Likewise, because the viscosity of emulsion was decreased with temperature rise, the diameter of dispersed oil droplet was increased and the coalescence of it was accelerated. Therefore, demulsification was quickly accomplished.
Impact of lockdown for COVID-19 pandemic in Indian children and youth with type 1 diabetes from different socio-economic classes

Abstract Objectives In March 2020, lockdown was imposed in India to combat spread of Coronavirus, which was extended till 31st May. Implementation of lockdown and limited outdoor activities resulted in changes in routines of children with diabetes. The aim of this study was to assess the impact of lockdown on glycemic control, weight and body mass index (BMI) patterns of children with type 1 diabetes (T1DM) from different socio-economic (SE) classes. Methods This observational study included 77 children and youth (5–20 years) with T1DM having disease duration of ≥6 months. Demographic data and investigations were recorded at two time points (post lockdown when the children came for follow up, pre lockdown data from medical records). Results Glycemic control improved (pre lockdown HbA1C 79.4±19.2 vs. post lockdown Hba1C 74.5±16.9 mmol/mol, p<0.05) and there was weight gain post lockdown (pre lockdown weight z-score −0.4±0.8 vs. post lockdown weight z-score −0.2±0.8, p<0.05) without any significant change in BMI and insulin requirements. Improved glycemic was seen in the lower SE group control post lockdown (p<0.05), whereas in higher SE group, it remained unchanged. Children whose parents were at home during lockdown showed an improved glycemic control (p<0.05) as compared to children whose parents continued to work during lockdown (p>0.01) Conclusions During coronavirus lockdown, glycemic control was adequately maintained in children with T1DM, highlighting importance of stronger family support system leading to more steady daily routine.
A retrospective cohort study reporting rituximab treatment for 33 patients with immunobullous disease.

BACKGROUND Autoimmune bullous disorders, encompassing pemphigus and pemphigoid diseases, are associated with significant morbidity and mortality. This is in part due to high cumulative doses of corticosteroids in combination with immunosuppressant agents used in traditional treatment regimes. Rituximab is an antiCD20 monoclonal antibody which can induce complete remission, but it is currently unlicensed in the UK and approved only after other treatments have failed. METHODS We report a retrospective cohort study of 33 patients with pemphigus and pemphigoid diseases treated with rituximab from a single tertiary centre from 2013-2019. RESULTS 'Complete remission off therapy' was achieved by 27.3% (n=9), a further 27.3% (n=9) had complete remission on minimal therapy. Twenty-one percent (n=7) had 'partial remission on minimal therapy'; 9.1% (n=3) patients were in the 'consolidation phase' and 12.1% (n=4) had a 'relapse/flare'. A steady reduction in prednisolone doses was observed post Rituximab infusion. Pre- Rituximab the median dose of prednisolone was 20mg (range 10-35, IQR 25), 15mg (range 9.5-22.5, IQR 13) at 1 month, 9mg (range 5-10, IQR 5) at 6 months, 4mg (range 0-5mg, IQR 5) at 12 months and 0 (0-4.35, IQR 4.25) at 18 months. Twelve percent (n=4) of patients had documented infusion reaction symptoms. Twelve percent (n=4) had later infective complications. CONCLUSION This real clinic data adds to the evidence that Rituximab is a safe and effective treatment for both pemphigus and pemphigoid autoimmune blistering conditions. Significantly, we were able to demonstrate a substantial reduction in corticosteroid dosage in our cohort of patients following rituximab treatment.
Formation of Particle Flows from a Beam Plasma Generated by a Forevacuum Plasma Electron Source

Beam-plasma technologies are currently successfully used for surface treatment of various materials, coating deposition, plasma-stimulated synthesis and decomposition of inorganic and organic compounds. The most interesting for application is a highly nonequilibrium beam plasma, because it has high chemical activity and ease of control of its parameters due to the variation of the parameters of the electron beam used for its generation. The current stage in the development of beam-plasma technologies has allowed the creation of plasma generators for various applications - from microelectronics to medicine. In this work, a beam plasma generator is described that operates at pressures of 10–50 Pa and allows the generation of a plasma with the concentration of $2\cdot 10^{16}\ \mathrm{cm}^{-3}$ and the temperature of 5 eV. The main feature of the generator is the use of a forevacuum plasma electron source for gas ionization and beam plasma generation. The effect of ion treatment from such a plasma on the optical and surface properties of polypropylene is determined. It is shown that after processing, the absorption in the ultraviolet region increases, and the hydrophilicity of the material also increases.