Miracle-dz/UniFAR-FTUs huggingface dataset:
A Mathematical Model of the Rat Kidney. II. Antidiuresis

Water conservation by the kidney requires a hypertonic medullary interstitium, NaCl in outer medulla (OM) and both NaCl and urea in inner medulla (IM), along with a vascular configuration that protects against washout. A multi‐solute mathematical model of the rat kidney, which includes the important acid‐base species, was developed and used first to examine K+‐induced natriuresis (Am. J. Physiol. 312:F925, 2017). In the present work, model computation has been streamlined by parallelizing the calculation of the model Jacobian, and this has allowed finer medullary spatial resolution, along with more extensive examination of model parameters. Tubule compliance is now represented along the whole nephron, and this attenuates pressure swings due to variations in urine flow. OM NaCl is modestly increased when transporter density in ascending Henle limbs (AHL) from juxtamedullary nephrons (JM), is scaled to match the greater JM nephron solute flow. However, higher NaCl transport produces greater CO2 generation, and by virtue of countercurrent vascular flows, establishment of high medullary pCO2. This CO2 gradient can be mitigated, by assuming that a fraction of medullary AHL and collecting duct transport is powered anaerobically. Reduction of vascular flows or increasing vessel permeabilities does little to further increase OM solute gradients. In contrast to the medullary models of others, vessels in this model all have solute reflection coefficients close to zero; increasing these coefficients provides no substantive enhancement of solute profiles, but does generate high interstitial hydrostatic pressures, which distort tubule architecture. As others have noted, increasing medullary urea delivery via entering vasa recta, enhances IM urea, although not nearly to levels found in rats. In sum, (1) the magnitudes of medullary gradients of Na+, urea, and ammonia are still not captured by the model; and (2) the countercurrent architecture that provides antidiuresis also produces exaggerated pCO2 profiles and appears to be an unappreciated constraint on models of medullary function.
An integrated program of computer-presented and physical cognitive training exercises for children with attention-deficit/hyperactivity disorder

Abstract Background This study integrated an experimental medicine approach and a randomized cross-over clinical trial design following CONSORT recommendations to evaluate a cognitive training (CT) intervention for attention deficit hyperactivity disorder (ADHD). The experimental medicine approach was adopted because of documented pathophysiological heterogeneity within the diagnosis of ADHD. The cross-over design was adopted to provide the intervention for all participants and make maximum use of data. Methods Children (n = 93, mean age 7.3 +/− 1.1 years) with or sub-threshold for ADHD were randomly assigned to CT exercises over 15 weeks, before or after 15 weeks of treatment-as-usual (TAU). Fifteen dropped out of the CT/TAU group and 12 out of the TAU/CT group, leaving 66 for cross-over analysis. Seven in the CT/TAU group completed CT before dropping out making 73 available for experimental medicine analyses. Attention, response inhibition, and working memory were assessed before and after CT and TAU. Results Children were more likely to improve with CT than TAU (27/66 v. 13/66, McNemar p = 0.02). Consistent with the experimental medicine hypotheses, responders improved on all tests of executive function (p = 0.009–0.01) while non-responders improved on none (p = 0.27–0.81). The degree of clinical improvement was predicted by baseline and change scores in focused attention and working memory (p = 0.008). The response rate was higher in inattentive and combined subtypes than hyperactive-impulsive subtype (p = 0.003). Conclusions Targeting cognitive dysfunction decreases clinical symptoms in proportion to improvement in cognition. Inattentive and combined subtypes were more likely to respond, consistent with targeted pathology and clinically relevant heterogeneity within ADHD.
Which measure of socioeconomic status best predicts bilingual lexical abilities and how? A focus on four-year-olds exposed to two majority languages

Abstract This study evaluates the ability of different measures of socioeconomic status (SES) to predict lexical outcomes for preschoolers raised in a context of nationwide bilingualism. The participants were 58 children aged 3;11–4;3 from Maltese-dominant homes who attended state preschools. Receptive picture name judgement and picture naming, in Maltese and English, were employed to measure receptive and expressive lexical abilities, respectively. Lexical outcomes for four individual SES variables and a single composite SES measure were similar but not directly interchangeable. The composite SES variable emerged as most strongly predictive of children's lexical performance. Receptive judgement of phonological accuracy improved similarly in both languages with higher composite SES. Naming skills increased significantly in English but not in Maltese, suggesting differences in English input related to parental SES. A focus on SES in relation to lexical skills in two majority languages is novel and adds to current understanding of normative bilingual acquisition.
Magnetic Resonance Imaging Findings Differentiating Cutaneous Basal Cell Carcinoma from Squamous Cell Carcinoma in the Head and Neck Region

Objective This study aimed to evaluate the efficacy of magnetic resonance (MR) imaging in differentiating between cutaneous basal cell carcinoma (cBCC) and cutaneous squamous cell carcinoma (cSCC) in the head and neck region. Materials and Methods Among patients with cutaneous head and neck cancers, 14 with primary cBCCs and 15 with primary cSCCs with a histologic tumor height of ≥ 4 mm underwent MR examinations; the findings were then examined for correlations. Results cBCCs (71%) occurred more frequently on the nose than cSCCs (13%) (p < 0.01). The maximum diameter (23.5 ± 7.2 mm vs. 12.7 ± 4.5 mm; p < 0.01) and diameter-to-height ratio (2.8 ± 0.9 vs. 1.7 ± 0.4; p < 0.01) were significantly greater in cSCCs than in cBCCs. Superficial ulcer formation (67% vs. 21%; p < 0.05), protrusion into the subcutaneous tissue (60% vs. 21%; p < 0.05), ill-demarcated deep tumor margins (60% vs. 7%; p < 0.01), and peritumoral fat stranding (93% vs. 7%; p < 0.01) were more frequently observed in cSCCs than in cBCCs. Intratumoral T2-hyperintense foci (57% vs. 13%; p < 0.05) were more frequently observed in cBCCs than in cSCCs. Conclusion cBCCs predominantly occurred on the nose with intratumoral T2-hyperintense foci, whereas cSCCs predominantly exhibited a flattened configuration, superficial ulcer formation, protrusion into the subcutaneous tissue, ill-demarcated deep tumor margin, and peritumoral fat stranding.
Potential Presymptomatic Transmission of SARS-CoV-2, Zhejiang Province, China, 2020

We report a 2-family cluster of persons infected with severe acute respiratory syndrome coronavirus 2 in the city of Zhoushan, Zhejiang Province, China, during January 2020. The infections resulted from contact with an infected but potentially presymptomatic traveler from the city of Wuhan in Hubei Province.
Metagenomics of Imported Multidrug-Resistant Mycobacterium leprae, Saudi Arabia, 2017

Using shotgun metagenomics, we identified an imported case of multidrug-resistant Mycobacterium leprae in a Filipino resident of Saudi Arabia in 2017. We determined the phylogenomic lineage (3K1) and identified mutations in rpoB and rrs corresponding to the multidrug-resistance phenotype clinically observed. Metagenomics sequencing can be used to identify multidrug-resistant M. leprae.
Adult outcomes of childhood bronchiectasis

ABSTRACT Recent literature has highlighted the importance of transition from paediatric to adult care for children with chronic conditions. Non-cystic fibrosis bronchiectasis is an important cause of respiratory morbidity in low-income countries and in indigenous children from affluent countries; however, there is little information about adult outcomes of childhood bronchiectasis. We reviewed the clinical course of 31 Alaska Native adults 20–40 years of age from Alaska’s Yukon Kuskokwim Delta with childhood bronchiectasis. In patients with chronic suppurative lung disease, a diagnosis of bronchiectasis was made at a median age of 4.5 years by computerised tomography (68%), bronchogram (26%), and radiographs (6%). The patients had a median of 75 lifetime respiratory ambulatory visits and 4.5 hospitalisations. As children, 6 (19%) experienced developmental delay; as adults 9 (29%) experienced mental illness or handicap. Four (13%) patients were deceased, four (13%) had severe pulmonary impairment in adulthood, 17 (54%) had persistent or intermittent respiratory symptoms, and seven (23%) were asymptomatic. In adulthood, only five were seen by adult pulmonologists and most had no documentation of a bronchiectasis diagnosis. Lack of provider continuity, remote location and co-morbidities can contribute to increased adult morbidity. Improving the transition to adult care starting in adolescence and educating adult providers may improve care of adults with childhood bronchiectasis.
Who Should Pay for Interdependent Risk? Policy Implications for Security Interdependence Among Airports

We study interdependent risks in security, and shed light on the economic and policy implications of increasing security interdependence in presence of reactive attackers. We investigate the impact of potential public policy arrangements on the security of a group of interdependent organizations, namely, airports. Focusing on security expenditures and costs to society, as assessed by a social planner, to individual airports and to attackers, we first develop a game‐theoretic framework, and derive explicit Nash equilibrium and socially optimal solutions in the airports network. We then conduct numerical experiments mirroring real‐world cyber scenarios, to assess how a change in interdependence impact the airports' security expenditures, the overall expected costs to society, and the fairness of security financing. Our study provides insights on the economic and policy implications for the United States, Europe, and Asia.
Managing loneliness: a qualitative study of older people’s views

Abstract Engaging with older people who self-identify as lonely may help professionals in mental health and other services understand how they deal with loneliness. The evidence-base for effective interventions to address loneliness is inconclusive. This study aimed to explore how community-dwelling lonely older people in England manage their experiences of loneliness. Twenty eight community-dwelling older people identifying as lonely, based on responses to two loneliness measures (self-report and a standardised instrument), participated in in-depth interviews between 2013 and 2014. Fifteen lived alone. Thematic analysis of transcribed interviews was conducted by a multidisciplinary team including older people. Participants drew on a range of strategies to ameliorate their distress which had been developed over their lives and shaped according to individual coping styles and contexts. Strategies included physical engagement with the world beyond their home, using technologies, planning, and engagement with purpose in an ‘outside world’, and acceptance, endurance, revealing and hiding, positive attitude and motivation, and distraction within an ‘inside world’. Strategies of interests and hobbies, comparative thinking, religion and spirituality and use of alcohol straddled both the inside and outside worlds. Participants conveyed a personal responsibility for managing feelings of loneliness rather than relying on others. This study includes the experiences of those living with loneliness whilst also living with other people. When developing policy and practice responses to loneliness it is important to listen attentively to the views of those who may not be engaging with services designed for ‘the lonely’ and to consider their own strategies for managing it.
Prevalence of Hemoglobinopathies (β-Thalassemia and Sickle Cell Trait) in the Adult Population of Al Majma’ah, Saudi Arabia

Abstract Despite the high prevalence of hemoglobinopathies in Saudi Arabia, the prevalence data in some regions are lacking. Updating the epidemiological survey of hemoglobinopathies at regular intervals is necessary to develop effective prevention and control strategies. Therefore, the primary aim of this study was to determine the prevalence of selected hemoglobinopathies in Saudi adults attending premarital screening at the King Khaled General Hospital (KKGH), Al Majma’ah, Saudi Arabia. The current retrospective study was approved by the Central Institutional Review Board (IRB) of the Ministry of Health (with central IRB log #2019-0039E) and was carried out at the above hospital. The data of the premarital couples, who attended the premarital screening center at KKGH from 1 October 2016 to 30 September 2019, was included in this study. A cation exchange high performance liquid chromatography (HPLC) system was used for screening of the selected hemoglobinopathies. In total, 3755 cases including 1953 (52.01%) males and 1802 (47.99%) females, were screened for hemoglobinopathies. Abnormal hemoglobin (Hb) fractions were observed in 38 (1.01%) cases. The prevalence of β-thalassemia (β-thal) trait was 0.69% (26/3755) and that of sickle cell trait 0.32% (12/3755). Our results showed that the prevalence of β-thal trait is higher than that of sickle cell trait in the adult population of Al Majma’ah. Further comprehensive programs should be carried out to determine the prevalence of hemoglobinopathies in various provinces and cities of Saudi Arabia and other countries. This will help to maintain the updated records of the disease incidence for improving the control measures.
Examining income dynamics and externalizing and internalizing trajectories through a developmental psychopathology lens: A nationally representative study

Abstract Prior research has documented elevations in levels of internalizing and externalizing behaviors among children in lower income families in comparison to more advantaged peers. However, most studies focus on behavior problems at a single point in time or within a short developmental period. Associations between income dynamics and developmental trajectories of behavior problems over time are less understood. To address this, the current study uses data from the National Longitudinal Study of Youth (N = 7,476; 50.8% male) to examine how income dynamics (annual income and income volatility) across three distinct developmental periods from early childhood to early adolescence relate to trajectories of externalizing and internalizing problems. Group-based mixture modeling revealed a five-group trajectory model for externalizing behavior and a four-group trajectory model for internalizing behavior. Higher cumulative annual income predicted greater likelihood of belonging to the low-stable group compared to the other, more problematic groups for both externalizing and internalizing trajectories. In addition, income losses predicted higher risk of membership in any group other than the low-stable group for internalizing and externalizing behavior. Developmental period-specific income dynamics, though not as consistent as cumulative dynamics, also predicted trajectory group membership.
Cultural and Environmental Enablers and Barriers to Participation and Retention in Clinical Trials for Cancer Research.

Background West Virginia (WV) residents have often rejected participation in community-based cancer research studies. Nationally, 49% of eligible patients participate in clinical trials but less than 10% of patients in WV participate. Objective To understand issues related to recruitment and retention of patients for cancer research in Appalachian WV. Methods Data were obtained from 3 focus groups including: (1) 9 patients who participated in clinical cancer trials, (2) 8 cancer research nurse coordinators, and (3) 10 physicians involved in cancer research. Groups were audio-taped and transcriptions were analyzed using MAXQDA and results were verified by two co-investigators. Results Most enablers and barriers identified were cultural as indicated by 72% of patients; 68% nurse coordinators; and 55% physicians. Patients identified personal emotional strength as an enabler, and negative health behaviors and fears as barriers. Enablers that nurses identified were positive patient characteristics and barriers included fear of trials, randomization, and death. Physicians identified enablers as a patient's understanding of the clinical trial and motivation to help others and the inverse of these two enablers as barriers. Conclusion A foundation for improving recruitment and retention of participants in cancer research in Appalachia was identified. The next step will involve cancer community organizations and patients in developing a plan to enhance enablers and overcome barriers to patient recruitment in cancer studies. Implications for Practice Cultural influences must be considered when recruiting for clinical trials. Community organizations educating the public about cancer research may be the key to enhancing patient enrollment.
Sex Differences in Circulating Soluble Urokinase‐Type Plasminogen Activator Receptor (suPAR) Levels and Adverse Outcomes in Coronary Artery Disease

Background Women have higher circulating levels of soluble urokinase‐type plasminogen activator receptor (suPAR), and elevated suPAR is associated with cardiovascular risk. The independent association of sex with suPAR and the impact of sex on its association with cardiovascular risk are unknown. Methods and Results Plasma suPAR was measured using ELISA in 2 cohorts of 666 asymptomatic individuals (49 years, 65% women) and 4184 patients with coronary artery disease (63 years, 37% women). Independent association of sex with suPAR was studied using linear regression models adjusted for demographics, risk factors, and visceral adiposity in asymptomatic participants. Impact of sex on association of suPAR with all‐cause mortality was studied in patients with coronary artery disease using multivariable‐adjusted Cox models. Sex‐specific suPAR cutoffs for predicting all‐cause mortality were calculated. Asymptomatic women had 10% higher suPAR compared with men after adjusting for confounders, and visceral adiposity partly accounted for this association. Over a median follow‐up of 5.2 years, 795 deaths were recorded in patients with coronary artery disease. Log2‐transformed suPAR was independently associated with mortality (hazard ratio per 1‐SD 1.72, 95% CI 1.60–1.85) and an interaction with sex was noted (P=0.005). Association of suPAR with mortality was slightly weaker in women (hazard ratio 1.61, 95% CI 1.41–1.83) compared with men (hazard ratio 1.83, 95% CI 1.67–2.00). However, using sex‐specific suPAR cut‐offs (4392 pg/mL for women and 3187 pg/mL for men), a similar mortality incidence was observed for both sexes (38.5% and 35.5%, respectively, P=0.3). Conclusions Women have 10% higher plasma suPAR levels compared with men. Elevated sex‐specific plasma suPAR levels are equally predictive of risk of adverse events in both sexes.
How does small group continuing medical education (CME) impact on practice for rural GPs and their patients, a mixed-methods study

ABSTRACT Studies which report outcomes of continuing medical education (CME) interventions for rural general practitioners (GPs) are limited. This mixed methods study recruited GPs from four CME small group learning (SGL) tutor groups based in different rural locations in the Republic of Ireland. A two-hour teaching module on deprescribing in older patients was devised and implemented. Assessment of educational outcomes was via questionnaires, prescribing audits and qualitative focus groups. All GPs (n = 43) in these CME-SGL groups agreed to participate, 27 of whom (63%) self-identified as being in rural practice. Rural GPs were more likely to be male (56%), in practice for longer (19 years), and attending CME for longer (13 years). The questionnaires indicated learning outcomes were achieved knowledge increased immediately after the education, and was maintained 6 months later. Twenty-four GPs completed audits involving 191 patients. Of these, 152 (79.6%) were de-prescribed medication. In the qualitative focus groups, GPs reported sharing experiences with their peers during CME-SGL helped them to improve patient care and ensured that clinical practice is more consistent across the group. For rural GPs, CME-SGL involving discussion of cases and the practical implementation of guidelines, associated with audit, can lead to changes in patient care.
Cognitive Deficit and White Matter Changes in Persons with Celiac Disease: a Population-Based Study.

BACKGROUND & AIMS There is debate over the presence and prevalence of brain injury in patients with celiac disease. To validate previous reports, we investigated the prevalence of neuropsychological dysfunction in persons with celiac disease included in the National UK Biobank, which contains experimental medical data from 500,000 adults in the United Kingdom. METHODS Biobank participants with celiac disease (n=104; mean age, 63; 65% female) were matched with healthy individuals (controls, n=198; mean age, 63 y; 67% female) for age, sex, level of education, body mass index, and diagnosis of hypertension. All subjects were otherwise healthy. We compared scores from 5 cognitive tests, and multiple-choice responses to 6 questions about mental health, between groups using t test and χ2 analyses. Groupwise analyses of magnetic resonance imaging brain data included a study of diffusion tensor imaging metrics (mean diffusivity, fractional anisotropy, radial diffusivity, axial diffusivity), voxel-based morphometry, and Mann-Whitney U comparisons of Fazekas grades. RESULTS Compared with controls, participants with celiac disease had significant deficits in reaction time (P=.004) and significantly higher proportions had indications of anxiety (P=.025), depression (P=.015), thoughts of self-harm (P=.025) and health-related unhappiness (P=.010). Tract-based spatial statistics analysis revealed significantly increased axial diffusivity in widespread locations, demonstrating white matter changes in brains of participants with celiac disease. Voxel-based morphometry and Fazekas grade analyses did not differ significantly between groups. CONCLUSIONS In an analysis of data from the UK Biobank, we found participants with celiac disease to have cognitive deficit, indications of worsened mental health, and white matter changes, based on analyses of brain images. These findings support the concept that celiac disease is associated with neurological and psychological features.