Miracle-dz/UniFAR-FTUs huggingface dataset:
In-Hospital Fall and Fracture Risk With Conditions in the Elixhauser Comorbidity Index: An Analysis of State Inpatient Data

Objective In-hospital falls (IHFs) are a significant burden to the healthcare industry and patients seeking inpatient care. Many falls lead to injuries that could be considered a hospital-acquired condition (HAC). We demonstrated how administrative data can be used to quantify how many IHFs occur and identify what conditions increase the risk for these falls. Methods Iowa State Inpatient Database records from 2008 to 2014 for adults older than 50 years were used to quantify IHFs, falls resulting in an HAC (HAC IHFs), and fractures during in-hospital treatment. The medical conditions used in the Elixhauser Comorbidity Index were evaluated for the risk of the separate fall-related outcomes using Poisson regression. Results There were 1770 records that had an IHF for an IHF rate of 0.26 per 1000 patient days. Psychoses (rate ratio = 1.95, 95% confidence interval = 1.63–2.34) and alcohol abuse (rate ratio = 1.77, 95% confidence interval = 1.40–2.24) showed the greatest increase in IHF risk. These conditions also increased the risk of HAC IHFs and in-hospital fractures. Fluid and electrolyte disorders, deficiency anemias, and chronic pulmonary disease increased the risk for IHFs/HAC IHFs but did not increase the risk of in-hospital fractures. Conclusions Administrative data can be used to track various fall-related outcomes occurring during inpatient treatment. Several conditions of the Elixhauser Comorbidity Index were identified as increasing the risk of fall-related outcomes and should be considered when evaluating a patient’s risk of falling.
Negative viscosity of liquid crystals in the presence of turbulence: Conductivity dependence, phase diagram, and self-oscillation.

Recently, we reported the discovery of enormous negative viscosity of a nematic liquid crystal in the presence of turbulence induced by ac electric fields, which enabled us to observe unique phenomena related to the negative viscosity, such as spontaneous shear flow, hysteresis in flow curves, and self-oscillation [Orihara et al., Phys. Rev. E 99, 012701 (2019)10.1103/PhysRevE.99. 012701]. In the present paper, we report the rheological properties of another nematic liquid crystal, which is a homologue of the previous one. The properties of the present liquid crystal are strongly dependent on electrical conductivity. Three samples with different conductivities were prepared by changing the amount of an ionic dopant. It was found that the lowest-conductivity sample without dopant shows no negative viscosity whereas the other ion-doped samples exhibit negative viscosity with strong dependence on the frequency of the ac electric field, consistent with microscopic observations. Phase diagrams of the negative- and positive-viscosity states in the amplitude and frequency plane are constructed to show the conductivity effect. Furthermore, we propose a model to reproduce another type of self-oscillation found in the present study.
Genetic Pathways in Nonalcoholic Fatty Liver Disease: Insights From Systems Biology

Nonalcoholic fatty liver disease (NAFLD) represents a burgeoning worldwide epidemic whose etiology reflects multiple interactions between environmental and genetic factors. Here, we review the major pathways and dominant genetic modifiers known to be relevant players in human NAFLD and which may determine key components of the heritability of distinctive disease traits including steatosis and fibrosis. In addition, we have employed general assumptions which are based on known genetic factors in NAFLD to build a systems biology prediction model that includes functional enrichment. This prediction model highlights additional complementary pathways that represent plausible intersecting signaling networks that we define here as an NAFLD‐Reactome. We review the evidence connecting variants in each of the major known genetic modifiers (variants in patatin‐like phospholipase domain containing 3, transmembrane 6 superfamily member 2, membrane‐bound O‐acyltransferase domain containing 7, glucokinase regulator, and hydroxysteroid 17‐beta dehydrogenase 13) to NAFLD and expand the associated underlying mechanisms using functional enrichment predictions, based on both preclinical and cell‐based experimental findings. These major candidate gene variants function in distinct pathways, including substrate delivery for de novo lipogenesis; mitochondrial energy use; lipid droplet assembly, lipolytic catabolism, and fatty acid compartmentalization; and very low‐density lipoprotein assembly and secretion. The NAFLD‐Reactome model expands these pathways and allows for hypothesis testing, as well as serving as a discovery platform for druggable targets across multiple pathways that promote NAFLD development and influence several progressive outcomes. In conclusion, we summarize the strengths and weaknesses of studies implicating selected variants in the pathophysiology of NAFLD and highlight opportunities for future clinical research and pharmacologic intervention, as well as the implications for clinical practice.
Patient Safety Education 20 Years After the Institute of Medicine Report: Results From a Cross-sectional National Survey

Objectives Educating healthcare professionals in patient safety is essential to achieving sustainable improvements in care. This study aimed to identify the key constituents of patient safety education alongside its facilitators and barriers from a frontline perspective. Methods An electronic survey was sent to 592 healthcare professionals and educators in patient safety education in the United Kingdom. Two independent reviewers conducted a thematic analysis of the free-text data. Themes focused on effective content, learning practices and facilitators and barriers to patient safety education. Results Of 592 individuals completing the survey, 545 (92%) submitted analyzable responses. Interrater reliability of coding was high with Cohen k value of 0.86. Participants endorsed experiential and interactive learning as ideal modalities for delivery and expressed a need for content to be based on real clinical cases and tailored to the needs of the learners. The most commonly mentioned facilitators were standardization of methods and assessment (49%), dedicated funding (21%), and culture of openness (20%). Staffing problems and high workload (41%) and lack of accessibility of training (23%) were identified as primary barriers of efficacy and uptake. Conclusions This study identified key factors to the success of patient safety education in terms of content and delivery alongside facilitators and barriers. Future curricula developers and interventions should improve standardization, funding, culture, and access so as to optimize education programs to enhance patient safety.
Comparison of the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with NICE guideline CG149 in infants ≥34 weeks’ gestation who developed early-onset sepsis

Objective To compare the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with National Institute for Health and Care Excellence (NICE) guideline CG149 in infants ≥34 weeks’ gestation who developed early-onset sepsis (EOS). Design Retrospective multicentre study. Setting Five maternity services in South West of England and Wales. Patients 70 infants with EOS (<72 hours) confirmed on blood or cerebrospinal fluid culture. Methods Retrospective virtual application of NICE and SRC through review of maternal and neonatal notes. Main outcome measure The number of infants recommended antibiotics by 4 hours of birth. Results The incidence of EOS ≥34 weeks was 0.5/1000 live births. Within 4 hours of birth, antibiotics were recommended for 39 infants (55.7%) with NICE, compared with 27 (38.6%) with SRC. The 12 infants advised early treatment by NICE but not SRC remained well, only one showing transient mild symptoms after 4 hours. Another four babies received antibiotics by 4 hours outside NICE and SRC guidance. The remaining 27 infants (38.6%) received antibiotics when symptomatic after 4 hours. Only one infant who was unwell from birth, died. Eighty-one per cent of all EOS infants were treated for clinical reasons rather than for risk factors alone. Conclusion While both tools were poor in identifying EOS within 4 hours, NICE was superior to SRC in identifying asymptomatic cases. Currently, four out of five EOS have symptoms at first identification, the majority of whom present within 24 hours of birth. Antibiotic stewardship programmes using SRC should include enhanced observation for infants currently treated within NICE guidance.
Cultural aspects of mental health and mental health service delivery with a focus on Nigeria within a global community

ABSTRACT With an endless range of subgroups and individual variations, culture bears upon what all people bring to the clinical setting. Culture could account for health-seeking behaviour, type of services and support system and variations in how people communicate their health concerns. Culture may underlie presentation of sets of symptoms that are peculiar to certain societies – culture-bound syndromes. Culture also influences the meanings that people impart to their illness and also stigma associated with such illnesses. Culture must be viewed from the patients, clinicians and health system dimensions. Changes in mental health service delivery in last few decades have yielded culturally competent mental health services. The aim of this paper was to discuss culture and mental health with a focus on Nigeria and from a global perspective.
Classification of Keratoconus Based on Anterior Corneal High-order Aberrations: A Cross-validation Study

SIGNIFICANCE Placido disc–based videokeratography is one of the most extensively used methods for corneal topographic assessments in keratoconus. Anterior corneal wavefront analysis has been demonstrated to be an effective tool to manage keratoconus eyes. However, currently, there is no clinically adequate classification system for keratoconus. PURPOSE The aim of this study was to analyze the usefulness of anterior corneal high-order aberrations in keratoconus classification provided by Placido disc–based videokeratography conducting a cross-validation analysis. METHODS Corneal topography of 70 normal and 77 keratoconic eyes (divided according to the Amsler-Krumeich classification [n = 21, stage 1; n = 30, stage 2; and n = 26, stage 3]) was assessed using Placido disc–based videokeratography (Oculus Keratograph [Oculus Optikgeräte GmbH, Wetzlar, Germany]). Receiver operating characteristic curve analysis was used to compare the mean values of coma, trefoil, tetrafoil, secondary astigmatism, spherical aberration, and coma-like, third-, and fourth-order root mean square (RMS) to calculate cutoff values, sensitivity, and specificity to discriminate between normal and stage 1 keratoconus eyes and between each keratoconus stage after cross-validation analysis. RESULTS All wavefront aberrations were significantly different between the normal and keratoconus groups (P ≤ .01). The coma and third-order RMS values (cutoff values, 0.367 and 0.359 μm, respectively) provide better sensitivity (99 and 100%, respectively) and specificity (100%) to discriminate keratoconus (stage 1) from healthy eyes compared with trefoil, tetrafoil, secondary astigmatism, spherical aberration, and coma-like and fourth-order RMS values (sensitivity >84% and specificity >57%). The coma and third-order RMS values showed the highest specificity (100%) and great sensitivity (90 and 87%, respectively) to differentiate between stages 1 and 2 and good sensitivity (97 and 100%) and specificity (81 and 88%) to differentiate between stages 2 and 3. CONCLUSIONS Anterior corneal high-order aberrations, specifically coma and third-order RMS, could be useful in keratoconus diagnosis and topographical classification. These new cutoff values could improve different stages of keratoconus eyes discrimination.
Case-Fatality Risk Estimates for COVID-19 Calculated by Using a Lag Time for Fatality

We estimated the case-fatality risk for coronavirus disease cases in China (3.5%); China, excluding Hubei Province (0.8%); 82 countries, territories, and areas (4.2%); and on a cruise ship (0.6%). Lower estimates might be closest to the true value, but a broad range of 0.25%–3.0% probably should be considered.
Endoscopic and Histological Assessment, Correlation, and Relapse in Clinically Quiescent Ulcerative Colitis (MARQUEE).

OBJECTIVE It is difficult to predict relapse in quiescent ulcerative colitis (UC), but newer endoscopic and histological indices could improve this. This study aimed to determine in UC patients in clinical remission (1) the prevalence of active endoscopic and histological disease; (2) the correlation between endoscopic and histological scores; and (3) the predictive power of these scores for clinical relapse. DESIGN This multicenter prospective cohort study conducted by the Crohn's and Colitis Foundation Clinical Research Alliance included 100 adults with UC in clinical remission undergoing surveillance colonoscopy for dysplasia. Endoscopic activity was assessed using the Mayo endoscopic score (MES), ulcerative colitis endoscopic index of severity (UCEIS), and ulcerative colitis colonoscopic index of severity (UCCIS). Histology was assessed with the Riley index subcomponents, total Riley score, and basal plasmacytosis. RESULTS Only 5% of patients had an MES of 0, whereas 38% had a score of 2 to 3; using the UCEIS, the majority of patients had at least mild activity, and 15% had more severe activity. Many patients also had evidence of histological disease activity. The correlations among endoscopic indices, histological subcomponents, and total score were low; the highest correlations occurred with the subcomponent architectural irregularity (ρ = 0.43-0.44), total Riley score (ρ = 0.35-0.37), and basal plasmacytosis (ρ = 0.35-0.36). Nineteen patients relapsed clinically over 1 year, with the subcomponent architectural irregularity being the most predictive factor (P = 0.0076). CONCLUSIONS This multicenter prospective study found a high prevalence of both endoscopic and histological disease activity in clinically quiescent UC. The correlations between endoscopy and histology were low, and the power to predict clinical relapse was moderate.
Anti‐BP180 autoantibody levels at diagnosis correlate with 1‐year mortality rates in patients with bullous pemphigoid

Bullous pemphigoid (BP) is the most frequent autoimmune blistering disease mainly affecting elderly patients. Among several published risk factors, a recent post hoc analysis linked anti‐BP180 autoantibodies (AABs) to fatal outcomes in BP. To date, this finding has not been confirmed independently.
High Real-World Medication Adherence and Durable Clinical Benefit in Medicare Patients Treated with 5 Alpha-Reductase Inhibitors for Benign Prostatic Hyperplasia.

PURPOSE Although clinical trials demonstrate 5 alpha-reductase inhibitors (5ARIs) are efficacious treatments for benign prostatic hyperplasia (BPH), 5ARIs have low reported medication adherence outside of clinical trials. We evaluate real-world drug adherence and clinical outcomes in Medicare patients with lower urinary tract symptoms from BPH managed with 5ARI therapy. METHODS Using healthcare and pharmacy claims from Partners Healthcare Medicare Accountable Care Organization enrollees (January 2009 - July 2018), we identify men initiating a 5ARI for BPH with more than one medication dispensation. Adherence was calculated as ≥80% proportion of days covered. A Cox proportional hazards model was used to evaluate the primary outcome of treatment failure, defined as any BPH-related surgery. RESULTS Among 3,107 men initiating 5ARI therapy for BPH and filling at least two prescriptions, 74.9% had high medication adherence over the first year. Patients with low adherence had 29% higher hazards of undergoing surgical intervention (95% confidence interval [CI]: 1.02-1.59, p = 0.036) after adjusting for age, BPH severity, the presence of hematuria, bladder stones, and type of 5ARIs. The presence of bladder stones (hazard ratio [HR] = 1.70, 95% CI: 1.02-2.86, p = 0.04) and finasteride vs. dutasteride use (HR = 1.41, 95% CI: 1.01-1.98, p = 0.05) were also risk factors for surgical intervention. CONCLUSION Among Medicare patients, 5ARI treatment adherence was high and associated with lower hazards of surgical intervention. 5ARI therapy may be more feasible for older men with BPH than previously reported and demonstrates modest clinical benefit.
Case series: Adolescent victims of the vaping public health crisis with pulmonary complications

Alongside the epidemic use of electronic cigarettes (e‐cigarettes) across the country, evidence of multiple pulmonary complications has emerged, with the most immediately life‐threatening being the new clinical condition of e‐cigarette/vaping‐associated lung injury (EVALI), with investigation actively underway to further define this entity and determine the cause or causes. We present a series of cases of respiratory illnesses associated with e‐cigarette use, many of which meet criteria for suspected or confirmed EVALI, managed at a pediatric tertiary care center, demonstrating notable variation in presenting symptoms and severity. Most cases improved with supportive respiratory care and the administration of corticosteroids and antibiotics, although generally no infection was found. The cases also tend to show improvement with discontinuation of the use of e‐cigarettes. We discuss challenges in determining the contribution of e‐cigarettes to the case pathology and review possible diagnostic and treatment options. In patients suffering from e‐cigarette‐related respiratory illness including EVALI, the primary treatment goal should be the cessation of e‐cigarette use and avoidance of other possible pulmonary toxins, including conventional cigarettes. Prevention of e‐cigarette use is critical in the youth population, as these patients are typically nicotine naïve and do not engage in smoking conventional cigarettes before initiation of vaping.
Incident HIV among pregnant and breastfeeding women in sub-Saharan Africa: a systematic review and meta-analysis.

OBJECTIVES A previous meta-analysis reported high HIV incidence among pregnant and breastfeeding women in sub-Saharan Africa (SSA), but limited evidence of elevated risk of HIV acquisition during pregnancy or breastfeeding when compared to non-pregnant periods. The rapidly evolving HIV prevention and treatment landscape since publication of this review may have important implications for maternal HIV incidence. DESIGN Systematic review and meta-analysis. METHODS We searched four databases and abstracts from relevant conferences through December 1, 2018, for literature on maternal HIV incidence in SSA. We used random-effects meta-analysis to summarize incidence rates and ratios, and to estimate 95% prediction intervals (PI). We evaluated potential sources of heterogeneity with random-effects meta-regression. RESULTS Thirty-seven publications contributed 100,758 person-years (PY) of follow-up. The estimated average HIV incidence rate among pregnant and breastfeeding women was 3.6 per 100PY (95%PI: 1.2, 11.1), while the estimated average associations between pregnancy and risk of HIV acquisition, and breastfeeding and risk of HIV acquisition, were close to the null. Wide 95% PIs around summary estimates, however, highlighted the variability of HIV incidence across populations of pregnant and breastfeeding women in SSA. Average HIV incidence was associated with age, partner HIV status, and calendar time. Average incidence was highest among studies conducted pre-2010 (4.1/100PY, 95%PI: 1.1, 12.2) and lowest among studies conducted post-2014 (2.1/100PY, 95%PI: 0.7, 6.5). CONCLUSIONS Substantial HIV incidence among pregnant and breastfeeding women in SSA, even in the current era of combination HIV prevention and treatment, underscores the need for prevention tailored to high-risk pregnant and breastfeeding women.
Implementation of a Mobile Platform Based on Fiber Bragg Grating Sensors for Automotive Traffic Monitoring

Instrumentation techniques, implementation and installation methods are major concerns in today’s distributed and quasi-distributed monitoring applications using fiber optic sensors. Although many successful traffic monitoring experiments have been reported using Fiber Bragg Gratings (FBGs), there has been no standardized solution proposed so far to have FBG seamlessly implemented in roads. In this work, we investigate a mobile platform including FBG sensors that can be positioned on roads for the purpose of vehicle speed measurements. The experimental results prove the efficiency of the proposed platform, providing a perspective toward weigh-in-motion systems.
Molecular Insight into the Therapeutic Promise of Flavonoids against Alzheimer’s Disease

Alzheimer’s disease (AD) is one of the utmost chronic neurodegenerative disorders, which is characterized from a neuropathological point of view by the aggregates of amyloid beta (Aβ) peptides that are deposited as senile plaques and tau proteins which form neurofibrillary tangles (NFTs). Even though advancement has been observed in order to understand AD pathogenesis, currently available therapeutic methods can only deliver modest symptomatic relief. Interestingly, naturally occurring dietary flavonoids have gained substantial attention due to their antioxidative, anti-inflammatory, and anti-amyloidogenic properties as alternative candidates for AD therapy. Experimental proof provides support to the idea that some flavonoids might protect AD by interfering with the production and aggregation of Aβ peptides and/or decreasing the aggregation of tau. Flavonoids have the ability to promote clearance of Aβ peptides and inhibit tau phosphorylation by the mTOR/autophagy signaling pathway. Moreover, due to their cholinesterase inhibitory potential, flavonoids can represent promising symptomatic anti-Alzheimer agents. Several processes have been suggested for the aptitude of flavonoids to slow down the advancement or to avert the onset of Alzheimer’s pathogenesis. To enhance cognitive performance and to prevent the onset and progress of AD, the interaction of flavonoids with various signaling pathways is proposed to exert their therapeutic potential. Therefore, this review elaborates on the probable therapeutic approaches of flavonoids aimed at averting or slowing the progression of the AD pathogenesis.