Miracle-dz/UniFAR-FTUs huggingface dataset:
Community risk perception and barriers for the practice of COVID-19 prevention measures in Northwest Ethiopia: A qualitative study

Background According to the World Health Organization, viral diseases continue to emerge and represent a serious issue for public health. The elderly and those with underlying chronic diseases are more likely to become severe cases. Our study sets out to present in-depth exploration and analyses of the community’s risk perception and barriers to the practice of COVID-19 prevention measures in South Gondar Zone, Northwest Ethiopia. Methods A qualitative study was done in three districts of South Gondar Zone. Community key informants and health extension workers were selected purposely for in-depth interviews and focus group discussion. The interviews were conducted by maintaining WHO recommendations for social distancing and use of appropriate personal protective equipment. The sample size for the study depended on the theoretical saturation of the data at the time of data collection. The qualitative data generated from in-depth interviews and focus group discussions was transcribed verbatim and translated into English language and thematically analyzed using open code software version 4.02. Results Three main themes and five categories emerged from the narrations of the participants regarding the perceived barriers for the practice of COVID-19 prevention measures. A total of 9 community key informants (5 women development armies (HDA), 2 health extension workers (HEW), and 2 religious leaders participated in the in-depth interview, while two focus group discussions (7 participants in each round) were conducted among purposely selected community members. The age of the participants ranged from 24 to 70 years with the median age of 48 years. The major identified barriers for practicing COVID-19 prevention measures were the presence of strong cultural and religious practices, perceiving that the disease does not affect the young, misinformation about the disease, and lack of trust in the prevention measures. Conclusions Socio-cultural, religious, and economic related barriers were identified from the participant’s narratives for the practice of COVID-19 prevention measures in south Gondar Zone. Our findings suggest the need to strengthen community awareness and education programs about the prevention measures of COVID-19 and increase diagnostic facilities with strong community-based surveillance to control the transmission of the pandemic.
The Frequency and Associated Factors of Asymmetrical Prominent Veins: A Predictor of Unfavorable Outcomes in Patients with Acute Ischemic Stroke

Objectives The present study is aimed at investigating the frequency and associated factors of asymmetrical prominent veins (APV) in patients with acute ischemic stroke (AIS). Methods Consecutive patients with AIS admitted to the Comprehensive Stroke Center of Shanghai Fourth People's Hospital between January 2013 and December 2017 were enrolled. MRI including diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and susceptibility-weighted imaging (SWI) was performed within 12 hours of symptom onset. The volume of asymmetrical prominent veins (APV) was evaluated using the Signal Processing In nuclear magnetic resonance software (SPIN, Detroit, Michigan, USA). Multivariate analysis was used to assess relationships between APV findings and medical history, clinical variables as well as cardio-metabolic indices. Results Seventy-six patients met the inclusion criteria. The frequency of APV ≥ 10 mL was 46.05% (35/76). Multivariate analyses showed that proximal artery stenosis or occlusion (≥50%) (P < 0.001, adjusted odds ratio (OR) = 660.0, 95%CI = 57.28-7604.88) and history of atrial fibrillation (P < 0.001, adjusted OR = 10.48, 95%CI = 1.78-61.68) were independent factors associated with high APV (≥10 mL). Conclusion Our findings suggest that the frequency of APV ≥ 10 mL is high in patients with AIS within 12 hours of symptom onset. History of atrial fibrillation and severe proximal artery stenosis or occlusion are strong predictors of high APV as calculated by SPIN on the SWI map.
A New Environmental Dependency Syndrome Occurring With Frontotemporal Lobe Degeneration: Hypervisual Illusory Spread Syndrome

A 59-year-old man presented with non-fluent aphasia and behavioral variant frontotemporal lobe degeneration (FTD), volunteered unusual visual symptoms that were best described as illusory visual spread (the image spreading over a larger area). This type of visual hyperfunction, related to the palinopsia syndromes, has not been reported in association with FTD. The syndrome may be best understood in terms of a visual variant of the environmental dependency syndrome, akin to the verbal variant of forced hyperphasia syndrome.
Expression Pattern of Genes in Condyloma Acuminata Treated with Clinacanthus nutans Lindau Cream versus Podophyllin

Clinacanthus nutans Lindua (C. nutans), a strong antiviral traditional medicine, can be used to treat condyloma acuminata (CA) caused by the human papillomavirus (HPV). However, its molecular mechanism for CA elimination is unknown. Herein, we conducted a randomized clinical trial to evaluate the effectiveness of C. nutans and its molecular mechanism compared with podophyllin, the gold standard treatment. Using a randomized block design, six patients were treated with C. nutans and podophyllin for four weeks. Efficacy of drugs was assessed by size reduction of the warts and HPV viral load quantification using droplet digital PCR. The gene expression profiling of CA was analyzed using NanoString Technology. After the podophyllin and C. nutans treatments, CA lesion sizes were reduced to 97.0% and 84.4% clearance, and the HPV viral loads were reduced by 74.0% and 46.6%, respectively. The gene expression pattern of immune profiling showed that 23 genes (i.e., HLA-DPB, CCL3, CXCL2, CXCR2, and OSM) were significantly differentially expressed by podophyllin, whereas 2 genes (IFNL1 and IRF2) were remarkably expressed by C. nutans. In inflammatory profiling, 108 genes (i.e., CXCL2, IL8, and STAT3) were highly expressed by podophyllin, but none of genes were observed to change expression by C. nutans. These results suggested that podophyllin may reduce the HPV infection through a mechanism related to proinflammatory response. In addition, C. nutans was found to suppress the HPV infection through mechanism related to the activation of immune response. This study shows novel therapeutic mechanisms of podophyllin and C. nutans. It is suggested that C. nutans might be used as an alternative treatment for CA treatment.
HB-HTA as an implementation problem in Polish health policy

Hospital Based Health Technology Assessment (HB-HTA) is a new policy implemented in Poland to allow for a more practical and contextualized assessment related to the use of specific medical procedures, devices, or equipment. It requires changes in governance relating to the healthcare sector. One of the forms of governance improvement is to involve society in the process of creating public services. This can be implemented, e.g., by applying the pragmatic model of public responsiveness. The aim of this research was to identify and analyze forces which will shape a dynamic process in determining the implementation of HB-HTA. The results obtained in the Gioia analysis led to the identification of the main forces driving and restraining the implementation of HB-HTA. The grouping and interpretation allowed for the twelve most important dimensions to be distinguished, which were recognized as conceptual categories necessary to build theories that describe the studied phenomenon. This study contributes to the development of the idea of responsiveness in public management theory and in health care services, and ultimately helps to better enable the adjustment of health services to the dynamically changing needs of Polish society.
What contributes to good outcomes? The perspective of young people on short-term psychoanalytic psychotherapy for depressed adolescents

Depression is the fourth leading cause of adolescent illness and disability worldwide. A growing evidence base demonstrates that Short Term Psychoanalytic Psychotherapy [STPP] is an efficacious treatment for moderate to severe adolescent depression. However, with research in its infancy, key factors contributing to efficacy are unknown. Service users’ lived experiences provide valuable insight in this area. This study aimed to elucidate what adolescents value in treatment by inductively exploring lived experiences of STPP. Five adolescents with the largest reduction in depressive symptoms scores between baseline and end of treatment, who had taken part in a large-scale randomized controlled trial, were sampled. In-depth interviews carried out soon after the end of therapy were analysed using Interpretative Phenomenological Analysis. Three superordinate themes were identified: “Therapy as a Transformational Process”, “Explorative and Exposing: The Therapeutic Space” and “Being Heard and Working Together: The Therapeutic Relationship”. Adolescents valued a process of collaborative exploration with the therapist which when it was achieved was felt to facilitate a deep-rooted transformation in self-perception. Additionally, they described how an adjustment was needed to the particular frame of a psychoanalytic therapy. However, not all participants with a good treatment outcome experienced therapy in this way, suggesting a potential gap between the quantitative assessment of outcomes, and the way young people experience and understand the change process. Clinical implications and directions for research are discussed.
Use of Automated Irrigating Drainage System in Six Patients With Chronic Subdural Hematoma: A Single-Center Experience

Background Chronic subdural hematoma (cSDH) is predicted to become the most common intracranial neurosurgical condition by 2030. Recurrence is estimated between 5-15%, and the use of a surgical drain is associated with lower recurrence rates. The authors present their experience with six patients undergoing cSDH evacuation with an irrigating drainage system, comprising the largest single-institution group in the United States (US). Methods IRB-approved, retrospective chart review was performed for six patients who underwent irrigating surgical drain placement during cSDH evacuation. Outcome measures included device settings and duration of the irrigating drain, postoperative length of stay, neurological status at follow-up, and hematoma recurrence. Results There were no recurrences noted within this group at last follow-up, with an average follow-up length over three months. The average postoperative length of stay was 2.67 ± 0.51 days. Patients were drained on average for 1.41 ± 0.49 days at 0cm water, irrigating at 55.25 ± 46.44cc/hr. On postoperative day one, average hematoma size and midline shift (MLS) reduction were respectively 13.43 ± 3.31mm and 5.71 ± 1.33mm. No device-related complications were noted. Conclusion The authors' early experience with this irrigating drainage device demonstrates that it is safe and effective for this population. Although this is a preliminary study on a small sample size, the excellent results warrant further investigation and establishment of a standard protocol to compare against current treatment regimens.
Forecasting care seekers satisfaction with telemedicine using machine learning and structural equation modeling

Many individuals visit rural telemedicine centres to obtain safe and effective health remedies for their physical and emotional illnesses. This study investigates the antecedents of patients’ satisfaction relating to telemedicine adoption in rural public hospitals settings in Bangladesh through the adaptation of Expectation Disconfirmation Theory extended by Social Cognitive Theory. This research advances a theoretically sustained prediction model forecasting patients’ satisfaction with telemedicine to enable informed decision making. A research model explores four potential antecedents: expectations, performance, disconfirmation, and enjoyment; that significantly contribute to predicting patients’ satisfaction concerning telemedicine adoption in Bangladesh. This model is validated using two-staged structural equation modeling and artificial neural network approaches. The findings demonstrate the determinants of patients’ satisfaction with telemedicine. The presented model will assist medical practitioners, academics, and information systems practitioners to develop high-quality decisions in the future application of telemedicine. Pertinent implications, limitations and future research directions are endorsed securing long-term telemedicine sustainability.
eARDS: A multi-center validation of an interpretable machine learning algorithm of early onset Acute Respiratory Distress Syndrome (ARDS) among critically ill adults with COVID-19

We present an interpretable machine learning algorithm called ‘eARDS’ for predicting ARDS in an ICU population comprising COVID-19 patients, up to 12-hours before satisfying the Berlin clinical criteria. The analysis was conducted on data collected from the Intensive care units (ICU) at Emory Healthcare, Atlanta, GA and University of Tennessee Health Science Center, Memphis, TN and the Cerner® Health Facts Deidentified Database, a multi-site COVID-19 EMR database. The participants in the analysis consisted of adults over 18 years of age. Clinical data from 35,804 patients who developed ARDS and controls were used to generate predictive models that identify risk for ARDS onset up to 12-hours before satisfying the Berlin criteria. We identified salient features from the electronic medical record that predicted respiratory failure among this population. The machine learning algorithm which provided the best performance exhibited AUROC of 0.89 (95% CI = 0.88–0.90), sensitivity of 0.77 (95% CI = 0.75–0.78), specificity 0.85 (95% CI = 085–0.86). Validation performance across two separate health systems (comprising 899 COVID-19 patients) exhibited AUROC of 0.82 (0.81–0.83) and 0.89 (0.87, 0.90). Important features for prediction of ARDS included minimum oxygen saturation (SpO2), standard deviation of the systolic blood pressure (SBP), O2 flow, and maximum respiratory rate over an observational window of 16-hours. Analyzing the performance of the model across various cohorts indicates that the model performed best among a younger age group (18–40) (AUROC = 0.93 [0.92–0.94]), compared to an older age group (80+) (AUROC = 0.81 [0.81–0.82]). The model performance was comparable on both male and female groups, but performed significantly better on the severe ARDS group compared to the mild and moderate groups. The eARDS system demonstrated robust performance for predicting COVID19 patients who developed ARDS at least 12-hours before the Berlin clinical criteria, across two independent health systems.
Cytomegalovirus Donor Seropositivity Negatively Affects Survival After Heart Transplantation

Background. Prior studies have shown that cytomegalovirus (CMV) infection is a risk factor for the development of cardiac allograft vasculopathy (CAV) and is associated with reduced long-term survival after heart transplantation (HTx). The aim of this International Society for Heart and Lung Transplantation Transplant Registry study was to compare posttransplant survival in different CMV donor:recipient serologic combinations. Methods. We performed a retrospective cohort study, using the International Society for Heart and Lung Transplantation Thoracic Transplant Registry, on 15 885 adult primary heart transplant recipients with known CMV serologic status between July 2004 and June 2014. Posttransplant survival and risk of developing CAV were compared across 4 groups: CMV-seronegative recipients (R–) receiving CMV-positive grafts (D+), intermediate-risk patients (D+R+ and D–R+), and low-risk patients (D–R–). Results. Baseline characteristics (donor/recipient age, body mass index, recipient serum creatinine, blood group, donor cause of death, recipient diagnosis, and ischemic time) were mostly balanced between the groups. Kaplan-Meier survival analyses over a follow-up of 10 y revealed significantly worse survival for both D+ groups as compared to the CMV low-risk group (D+R+: 56.61% [95% confidence interval, 53.94-59.41] versus D–R–: 63.09% [59.74-66.64] P < 0.01 and D+R–: 57.69% [56.03-59.39] versus D–R–; P < 0.001), whereas recipient seropositivity alone was not associated with reduced survival (D–R+ versus D–R– P = 0.178). The risk of developing CAV after HTx was not significantly increased in D+ as compared to D– groups. Conclusions. In a large contemporary cohort, CMV status at the time of HTx was not associated with CAV development. However, there was a significant association between donor CMV seropositivity and reduced short- and long-term survival after HTx. Approaches to mitigate the impact of CMV on posttransplant survival are needed.
Impact of the COVID‐19 pandemic on the psychological health of individuals with mental health conditions: A mixed methods study

Abstract Objectives This study explored how the coronavirus disease 2019 (COVID‐19) pandemic has affected individuals with mental health conditions. Methods Participants were 477 adults (82% female) who reported a past‐year mental health condition. They completed an online survey that included an open‐ended question. Mixed methods analysis was conducted. Results While all mental health conditions were moderately impacted by the COVID‐19 pandemic, self‐reported impact on anxiety disorder and obsessive‐compulsive disorder symptoms was greater than for all other mental health symptoms. Thematic analysis revealed five themes: (1) the contribution of the pandemic to worsening mental health; (2) life interruptions due to the pandemic; (3) increased loneliness/isolation; (4) upsides of the pandemic; and (5) normalization of the anxieties previously experienced by those with mental health conditions. Conclusion Individuals with pre‐existing mental health conditions reported a worsening of symptoms during the COVID‐19 pandemic. Governments and organizations must focus on supporting and increasing access to treatment for this population.
Genomic analysis of Burkholderia cenocepacia isolated from a liver abscess in a patient with cystic fibrosis

Burkholderia cenocepacia complex is associated with high transmissibility, virulence, and poor prognosis in cystic fibrosis (CF) patients. However, extrapulmonary infections are rare. We investigated the genome of a B. cenocepacia IIIA isolated from a liver abscess in a Brazilian CF patient and compared it to strain J2315. The whole genome was sequenced, and contigs were annotated by Rapid Annotation using Subsystem Technology. The Pathosystems Resource Integration Center was used to map antimicrobial and virulence genes. The genomic island (GIs) analysis was performed using two prediction methods, and the presence of putative plasmids and insertion sequences (ISs) was investigated. The isolate was confirmed as B. cenocepacia IIIA to ST‐28 (ET12 lineage). A total of 64 genes for antimicrobial resistance and 47 genes related to virulence were identified. Among the virulence factors, there was a predominance of factors related to the invasion mechanism, to the flagellar biosynthesis protein, and to the RNA polymerase sigma factor for flagellar operon (cdpA). Two IS families (IS3 and IS5) and only one plasmid were found. On average 56 GIs were predicted by at least one of the methods applied. Comparative analysis showed resistance mechanisms and virulence factors revealing invasive determinants used by B. cenocepacia IIIA (ET12) in the process of disease spread to other infection sites (extrapulmonary) of highly virulent strains in CF patients.
Biomechanical Evaluation of Semi-rigid Junctional Fixation Using a Novel Cable Anchor System to Prevent Proximal Junctional Failure in Adult Spinal Deformity Surgery

A novel Cable Anchor was compared with other promising techniques in a biomechanical experiment to assess the potential as semi-rigid junctional fixation technique for adult spinal deformity surgery. The achievement of a gradual range of motion transition zone suggests the Cable Anchor may reduce the incidence of proximal junctional failure. Study Design. A porcine cadaveric biomechanical study. Objective. To biomechanically evaluate a novel Cable Anchor System as semi-rigid junctional fixation technique for the prevention of proximal junctional failure after adult spinal deformity surgery and to make a comparison to alternative promising prophylactic techniques. Summary of Background Data. The abrupt change of stiffness at the proximal end of a pedicle screw construct is a major risk factor for the development of proximal junctional failure after adult spinal deformity surgery. A number of techniques that aim to provide a gradual transition zone in range of motion (ROM) at the proximal junction have previously been studied. In this study, the design of a novel Cable Anchor System, which comprises a polyethylene cable for rod fixation, is assessed. Methods. Ten T6–T13 porcine spine segments were subjected to cyclic 4 Nm pure-moment loading. The following conditions were tested: uninstrumented, 3 level pedicle screw fixation (PSF), and PSF with supplementary Cable Anchors applied proximally at 1-level (Anchor1) or 2-levels (Anchor2), transverse process hooks (TPH), and 2-level sublaminar tapes (Tape2). The normalized segmental range of motion in the junctional zone was compared using one-way analysis of variance and linear regression. Results. Statistical comparison at the level proximal to PSF showed significantly lower ROMs for all techniques compared to PSF fixation alone in all movement directions. Linear regression demonstrated a higher linearity for Anchor1 (0.820) and Anchor2 (0.923) in the junctional zone in comparison to PSF (1-level: 0.529 and 2-level: 0.421). This linearity was similar to the compared techniques (TPH and Tape2). Conclusion. The Cable Anchor System presented in this study demonstrated a gradual ROM transition zone at the proximal end of a rigid pedicle screw construct similar to TPH and 2-level sublaminar tape semi-rigid junctional fixation constructs, while providing the benefit of preserving the posterior ligament complex. Level of Evidence: 5
Acute Physical and Mental Activity Influence on Concussion Recovery

ABSTRACT Introduction Physical activity (PA) and mental activity (MA) postconcussion has received renewed attention to improve concussion management; however, most protocols start after several days and do not assess the acute window. Therefore, the purpose of this study was to assess PA and MA in the first 48 h postconcussion on the time to symptom-free status and return to play. Methods We recruited 78 NCAA Division I athletes (male, 51.3%; age, 19.6 ± 1.4 yr; height, 173.7 ± 11.5 cm; weight, 80.1 ± 23.2 kg) who were diagnosed with a sports-related concussion. Participants completed a 0–5 PA and MA scale daily until fully cleared for return to participation (mean, 15.1 ± 6.9 d). A quadratic model regression assessed PA and MA over the first 2 d (acute) postconcussion on to time to symptom-free status and return to play. Results The overall model was significant for both time to symptom free (r2 = 0.27, P = 0.004) and return to play (r2 = 0.23, P = 0.019). Reported PA was the only significant predictor for time to symptom-free (P = 0.002) and return-to-participation (P = 0.006) day. Reported MA was not associated either outcome. Conclusions The primary finding of this study was that mild to moderate PA acutely postconcussion was associated with reduced time to symptom free and return to participation as opposed to either lower or higher levels of PA. Conversely, acute MA was not associated with recovery outcomes. These results further elucidate the role of postconcussion PA.