Miracle-dz/UniFAR-FTUs huggingface dataset:
Demonstrating the protective effect of a 70-year-old occupational exposure limit against pneumoconiosis caused by mica

Workers involved in crushing, milling, screening, and bagging of mica scrap are at increased risk to develop pneumoconiosis, a progressive material overloading of the lung that can lead to fibrosis and, in the later stages, to dyspnea. Pneumoconiosis is only seen after 10–20 years of respiratory mica exposure, and it can have a latency period of up to 40 years—today’s cases date back to exposures during the second half of the 20th century. An occupational lifetime exposure level of 3 mg/m3 respirable mica dust has been considered to present no risk of pneumoconiosis since 1951 when the American Conference of Governmental Industrial Hygienists (ACGIH) established a 20 million particles per cubic foot (mppcf) (3.5 mg/m3 respirable particles) exposure limit. As a result, numbers of unspecified and other pneumoconioses in the United States have steadily declined since the early 1970s. Data from the National Institute for Occupational Safety and Health documents a 91% decrease between 1972 and 2014 (i.e., the peak of documented cases and the latest reported data) for combined cases of aluminosis, berylliosis, stannosis, siderosis, and fibrosis from production and use of bauxite, graphite fibers, wollastonite, cadmium, Portland cement, emery, kaolin, antimony, and mica. Ample evidence indicates that the 70-year-old occupational lifetime exposure level of 3 mg/m3 respirable mica dust is protective of workers’ health.
Potential relationships between COVID-19 and the thyroid gland: an update

In this review, I aim to provide a complete overview of recent advances in knowledge regarding severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2)-induced thyroid dysfunction. I discuss the findings regarding the role of SARS-CoV-2 in the development of thyroid dysfunction, including subacute thyroiditis, Graves’ disease, non-thyroidal illness, thyrotoxicosis and Hashimoto’s thyroiditis during and subsequent to coronavirus disease 2019 (COVID-19). The thyroid gland and the entire hypothalamic–pituitary–thyroid (HPT) axis may represent key targets of SARS-CoV-2. Thyroid dysfunction during and subsequent to COVID-19 has been documented in clinical studies and is usually reversible. Most of the thyroid disorders, including Graves’ disease, euthyroid sick syndrome, Hashimoto’s thyroiditis and subacute thyroiditis, have been documented as sequelae to COVID-19, and the SARS-CoV-2 virus has been implicated in the aetiology of each. COVID-19 has been suggested to trigger the activation of pre-existing thyroid disease or autoimmunity. Furthermore, patients with uncontrolled thyrotoxicosis are at risk of SARS-CoV-2 infection-related consequences. Because of the neutropenia caused by antithyroid medications, which may obscure the signs of COVID-19, this group of patients should receive special attention. It is suggested that thyroid dysfunction during COVID-19 is caused by direct infection of the thyroid or “cytokine storm”-mediated autoimmune effects on the thyroid.
Validation of a developmental screening checklist for Chinese preschoolers in Hong Kong

ABSTRACT There are concerns about the cultural validity of applying developmental screeners developed and normed in Western countries to other sociocultural contexts. Given the scarcity of culturally validated developmental checklists for use among Chinese children, the Hong Kong Society for the Protection of Children (HKSPC) has developed the HKSPC Developmental Checklist (HKSPC-DC) for preschool teachers to identify children at risk of developmental delays through daily observation of children’s functioning at school. This study explored the psychometric properties of the HKSPC-DC among 1183 preschool children aged 2–6 recruited from 14 nursery schools in Hong Kong. The HKSPC-DC showed excellent internal consistency, good interrater and test–retest reliabilities, and acceptable concurrent validity when correlated with the Taipei City Developmental Checklist for Preschoolers (Taipei II), which is the only screening instrument developed in a Chinese society and validated across 4- to 72-month-olds. The HKSPC-DC also showed good discriminatory power in identifying preschoolers potentially at risk of developmental delays. This screening tool may help facilitate early identification of children with developmental vulnerabilities in Chinese preschool populations.
Lao Noma Survivors: A Case Series, 2002–2020

ABSTRACT. Noma is a rapidly progressing infection of the oral cavity, mostly affecting children aged between 2 and 5 years. If untreated, mortality can reach 90% within a few weeks after the onset of symptoms. Most of the published literature on noma are case reports or case series from Africa. Studies including noma survivors in Asia are limited. We present a case series of noma survivors in Laos. A retrospective analysis of data collected to monitor the care provided to Lao noma survivors who presented for treatment from 2002 to 2020 was conducted. The review assessed data including sociodemographic characteristics, diagnosis, mouth opening, self-reported quality of life at admission and after surgery, and the names used for the disease. Of the 50 patients included, 25 (50%) were female. The median age of self-reported onset of acute noma was 4 years (interquartile range [IQR] 2–7 years). The noma survivors came from 14/17 (82%) of Lao provinces. There were 64 surgeries conducted on 45 of these survivors. There was a median of 25 years (IQR 16–33 years) between the time of acute infection and the provision of surgical care. Improvements in nutritional status and quality of life were evident after surgery. Patients referred to the disease as “Pak Phuey,” which means diseased mouth. Noma survivors frequently live for years with disabling sequelae. Surgical rehabilitation improves the quality of life for noma survivors.
Impact of Telestroke Implementation on Emergency Department Transfer Rate

Background and Objectives Telestroke networks are associated with improved outcomes from acute ischemic stroke (AIS) and facilitate greater access to care, particularly in underserved regions. These networks also have the potential to influence patient disposition through avoiding unnecessary interhospital transfers. This study examines the effect of implementation of the VA National Telestroke Program (NTSP) on interhospital transfer among Veterans. Methods We analyzed patients with AIS presenting to the emergency departments of 21 VA hospitals before and after telestroke implementation. Transfer rates were determined through review of administrative data and chart review and patient and facility-level characteristics were collected to identify predictors of transfer. Comparisons were made using t test, Wilcoxon rank sum, and χ2 analysis. Multivariable logistic regression with sensitivity analysis was conducted to assess the influence of telestroke implementation on transfer rates. Results We analyzed 3,488 stroke encounters (1,056 pre-NTSP and 2,432 post-NTSP). Following implementation, we observed an absolute 14.4% decrease in transfers across all levels of stroke center designation. Younger age, higher stroke severity, and shorter duration from symptom onset were associated with transfer. At the facility level, hospitals with lower annual stroke volume were more likely to transfer; 1 hospital saw an increase in transfer rates following implementation. After adjusting for patient and facility characteristics, the implementation of VA NTSP resulted in a nearly 60% reduction in odds of transfer (odds ratio 0.39 [0.19, 0.77]). Discussion In addition to improving treatment in acute stroke, telestroke networks have the potential to positively affect the efficiency of interhospital networks through disposition optimization and the avoidance of unnecessary transfers.
Metabolomic markers of biological fluid in women with reproductive failure: a systematic review of current literatures

Abstract Understanding metabolic changes in reproductive failure, including early miscarriage (EM), recurrent miscarriage (RM), and repeated implantation failure (RIF), may be beneficial to understand the pathophysiology, thus improving pregnancy outcomes. Nine metabolomic profiling studies in women with reproductive failures (4 for EM, 3 for RM, and 2 for RIF) were included for systematic review. In total 78, 75, and 25 significant metabolites were identified and 40, 40, and 34 metabolic pathways were enriched in EM, RM, and RIF, respectively. Among them, 7 and 11 metabolites, and 28 and 28 pathways were shared between EM and RM and between RM and RIF, respectively. Notably, histidine metabolism has the highest impact in EM; phenylalanine, tyrosine, and tryptophan biosynthesis. Ubiquinone and other terpenoid–quinone biosynthesis metabolism have the highest impact factor in RM; alanine, aspartate, and glutamate metabolism have the highest impact factor in RIF. This study not only summarized the common and distinct metabolites and metabolic pathways in different reproductive failures but also summarized limitations of the study designs and methodologies. Hence, further investigations and validations of these metabolites are still urgently needed to understand the underlying metabolic mechanism for the development and treatment of reproductive failures. Summary sentence Nine metabolomic studies related to reproductive failure were included in this review. Though alterations in metabolites were identified, study designs and methodologies remained controversial. Hence, further studies and validation are necessary. Graphical Abstract
Cerebral Microbleeds, Cerebral Amyloid Angiopathy, and Their Relationships to Quantitative Markers of Neurodegeneration

Background and Objectives Age-related cognitive impairment is driven by the complex interplay of neurovascular and neurodegenerative disease. There is a strong relationship between cerebral microbleeds (CMBs), cerebral amyloid angiopathy (CAA), and the cognitive decline observed in conditions such as Alzheimer disease. However, in the early, preclinical phase of cognitive impairment, the extent to which CMBs and underlying CAA affect volumetric changes in the brain related to neurodegenerative disease remains unclear. Methods We performed cross-sectional analyses from 3 large cohorts: The Northern Manhattan Study (NOMAS), Alzheimer's Disease Neuroimaging Initiative (ADNI), and the Epidemiology of Dementia in Singapore study (EDIS). We conducted a confirmatory analysis of 82 autopsied cases from the Brain Arterial Remodeling Study (BARS). We implemented multivariate regression analyses to study the association between 2 related markers of cerebrovascular disease—MRI-based CMBs and autopsy-based CAA—as independent variables and volumetric markers of neurodegeneration as dependent variables. NOMAS included mostly dementia-free participants age 55 years or older from northern Manhattan. ADNI included participants living in the United States age 55–90 years with a range of cognitive status. EDIS included community-based participants living in Singapore age 60 years and older with a range of cognitive status. BARS included postmortem pathologic samples. Results We included 2,657 participants with available MRI data and 82 autopsy cases from BARS. In a meta-analysis of NOMAS, ADNI, and EDIS, superficial CMBs were associated with larger gray matter (β = 4.49 ± 1.13, p = 0.04) and white matter (β = 4.72 ± 2.1, p = 0.03) volumes. The association between superficial CMBs and larger white matter volume was more evident in participants with 1 CMB (β = 5.17 ± 2.47, p = 0.04) than in those with ≥2 CMBs (β = 1.97 ± 3.41, p = 0.56). In BARS, CAA was associated with increased cortical thickness (β = 6.5 ± 2.3, p = 0.016) but not with increased brain weight (β = 1.54 ± 1.29, p = 0.26). Discussion Superficial CMBs are associated with larger morphometric brain measures, specifically white matter volume. This association is strongest in brains with fewer CMBs, suggesting that the CMB/CAA contribution to neurodegeneration may not relate to tissue loss, at least in early stages of disease.
Aerobic exercise in patients with haemophilia: A systematic review on safety, feasibility and health effects

Haemophilia is a congenital bleeding disorder going along with disease‐specific joint complications and general health implications attributed to the lack of daily movement. Recent guidelines recommend physical activity for people with haemophilia (PwH). Yet, aerobic exercise in PwH is little studied and seldomly prescribed by clinicans.
The SARS‐CoV‐2 pandemic in Germany may represent the sum of a large number of local but independent epidemics each initiated by individuals aged 10–19 years, middle‐aged males, or elderly individuals

Many epidemiological aspects of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemics, particularly those affecting children, are still sparsely elucidated. Data on the first pandemic phase during the year 2020 indicated that children might serve as a virus reservoir. We now analyzed data on more than 530 000 SARS‐CoV‐2 polymerase chain reaction (PCR) and 12 503 anti‐SARS‐CoV‐2 antibody tests performed in the west of Germany until Week 4 of 2021. We show that children of at least 10 years of age may play a prominent role in the pandemic showing highest PCR‐positive rates in the first (Weeks 28–35), second (Weeks 42–48), and third wave (Week 50 of 2020–Week 2 2021) of the second pandemic phase, although the waves were not mainly initiated by children. The waves' kinetics differed even in nearby cities. Low PCR‐positive rates were confined to areas of lower population density. PCR‐positive rates were higher among middle‐aged males compared with women and among very old females compared with males. From Week 25, seroprevalence rates slowly increased to 50%, indicating ongoing virus activity. In conclusion, the SARS‐CoV‐2 pandemics is characterized by many local but interacting epidemics, initiated and driven by different social groups. Children may not be the main initiators of virus spreading but older children may significantly affect the course of the pandemic. High population density is associated with higher SARS‐CoV‐2 incidence.
Efficacy and Safety of Endobronchial Ultrasonography with a Guide-sheath for Acute Pulmonary Lesions in Patients with Haematological Diseases

Objective Acute pulmonary lesions (APLs), defined as an acute infiltrate or nodular lung field, are a major complication in patients with haematological diseases. Recently, endobronchial ultrasonography with a guide-sheath (EBUS-GS) was established as a useful technique for diagnosing pulmonary lesions. This study aimed to evaluate the efficacy and safety of EBUS-GS for managing APLs in patients with haematological diseases. Methods Our single-centre, retrospective, observational, single-arm, descriptive study enrolled 22 consecutive adult (>20-year-old) patients with haematological diseases and concomitant APL who underwent EBUS-GS between January 2011 and June 2016 at Kameda Medical Center, Chiba, Japan. The primary endpoint was the contribution of EBUS-GS to clinical decision-making. Secondary endpoints were an adequate tissue collection rate, diagnostic yield, complication rate, and 30-day mortality. Results The median patient age was 70 years old, and 63.6% were men. Acute myeloid leukaemia was the most frequent underlying disease, accounting for 54.5% of patients. The contribution of EBUS-GS to clinical decision-making was recognised in 11 (50.0%) patients. Adequate tissue collection was achieved in 21 (95.5%) patients. The aetiology of the APL was identified in 9 (40.9%) patients. No complications, including severe haemorrhaging and pneumothorax, were observed in any patients, and the 30-day mortality rate was 0%. Conclusion EBUS-GS may be a suitable diagnostic option for APL in patients with haematological diseases. Further larger-scale and randomised controlled trials are needed to confirm our results.
Racial and Socioeconomic Disparities in Necrotizing Soft-Tissue Infection

Abstract Background: Necrotizing soft-tissue infection (NSTI) is a medical emergency. We investigated the impact of racial, socioeconomic disparities, and comorbidities on mortality, complications, length of stay, and charges in patients with NSTI. Methods: Data were acquired from the National Inpatient Sample from Q4 2015 to 2017. ICD-10, Clinical Modification codes were utilized to identify relevant cases. Logistic regression was used to assess socioeconomic, racial, and health risk factors for adverse outcomes in NSTI patients. Results: Of 16,071,053 cases identified during the study period, 15,078 (0.094%) NSTI cases were recognized. Black patients had increased odds of amputation (OR 1.40 95% CI 1.24–1.58, p < 0.001), prolonged hospital stay (OR 1.40 95% CI 1.24–1.58, p < 0.001), excessive charges (OR 1.22 95% CI 1.03–1.43, p = 0.019), and adverse discharge disposition (OR 1.32 95% CI 1.19–1.46, p < 0.001) compared to white patients. Hispanic patients had increased odds of mortality (OR 1.30 95% CI 1.05–1.60, p = 0.014) and amputation (OR 1.21 95% CI 1.04–1.42, p = 0.016) compared to white patients. Medicare patients had increased odds of mortality (OR 1.35 95% CI 1.09–1.67, p = 0.006), Medicaid patients had increased odd of amputation (OR 1.33 95% CI 1.17–1.51, p < 0.001) and prolonged LOS (OR 1.33 95% CI 1.17–1.51, p < 0.001). Patients in the lower income quartiles had decreased odds of amputation compared to the highest income quartile, including the 26th to 50th income quartile (OR 0.84 95% CI 0.73–0.98, p = 0.022) and 51st to 75th income quartile (OR 0.84 95% CI 0.73–0.98, p = 0.022). Conclusions: Racial and socioeconomic disparities exist for patients being treated for NSTIs.
Reading vertically and horizontally mirrored text: An eye movement investigation

This study examined the cognitive processes involved in reading vertically and horizontally mirrored text. We tracked participants’ eye movements while they were reading the Potsdam Sentence Corpus which consists of 144 sentences with target words that are manipulated for length and frequency. Sentences were presented in three different conditions: In the normal condition, text was presented with upright letters, in the vertical condition, each letter was flipped around its vertical (left-right) axis while in the horizontal condition, letters were flipped around their horizontal (up-down) axis. Results show that reading was slowed down in both mirror conditions and that horizontal mirroring was particularly disruptive. In both conditions, we found larger effects of word length than in the normal condition indicating that participants read the sentences more serially and effortfully. Similarly, frequency effects were larger in both mirror conditions in later reading measures (gaze duration, go-past time, and total reading time) and particularly pronounced in the horizontal condition. This indicates that reading mirrored script involves a late checking mechanism that is particularly important for reading a horizontally mirrored script. Together, our findings demonstrate that mirroring affects both early visual identification and later linguistic processes.
Risk Factors and Pivotal Periods: Marital Status over 28 Years for Parents of Individuals with Autism

Longitudinal, prospective analyses of marital status in parents of individuals with autism are needed. We describe the timing of divorce, and the factors that contribute to divorce in a longitudinal sample of families of individuals with autism. Participants included parents of 219 children, initially referred for autism and other developmental delays, followed to age 30 years. Approximately 36% of individuals with autism in our sample experienced a parental divorce by age 30. Higher rates of divorce were associated with maternal education, race and age at child's birth, as well as autism symptom severity and diagnosis. Divorces were most common in early years (under age 5) and also in the teenage years and beyond (over age 15). After age 15, higher risk was associated with higher cognitive ability and daily living skills, and being a multiplex family. Results suggest that divorce risk in families of children with autism remains high through childhood into early adulthood. Understanding factors related to changes in marital status may help us better support families across time.
Environmental determinants predicting population vulnerability to high yellow fever incidence

Yellow fever (YF) is an endemic mosquito-borne disease in Brazil, though many locations have not observed cases in recent decades. Some locations with low disease burden may resemble locations with higher disease burden through environmental and ecohydrological characteristics, which are known to impact YF burden, motivating increased or continued prevention measures such as vaccination, mosquito control or surveillance. This study aimed to use environmental characteristics to estimate vulnerability to observing high YF burden among all Brazilian municipalities. Vulnerability was defined in three categories based on yearly incidence between 2000 and 2017: minimal, low and high vulnerability. A cumulative logit model was fit to these categories using environmental and ecohydrological predictors, selecting those that provided the most accurate model fit. Per cent of days with precipitation, mean temperature, biome, population density, elevation, vegetation and nearby disease occurrence were included in best-fitting models. Model results were applied to estimate vulnerability nationwide. Municipalities with highest probability of observing high vulnerability was found in the North and Central-West (2000–2016) as well as the Southeast (2017) regions. Results of this study serve to identify specific locations to prioritize new or ongoing surveillance and prevention of YF based on underlying ecohydrological conditions.
Inequality of the Safety Net: The Rural-Urban Continuum, County-Level Poverty, and Nonprofit Human Services Expenditures

Using IRS-990 data from the National Center for Charitable Statistics, this study assesses differences in county expenditures on nonprofit human services, by level of county rurality, in American counties. It also examines the relationship between nonprofit human services expenditures and county-level poverty rates. The findings suggest that rural counties have a negative association with nonprofit human services expenditures as compared with urban counties after controlling for relevant covariates. There is intrarural heterogeneity: The most rural counties have the lowest rates of nonprofit human services expenditures and a negative association with nonprofit human services expenditures that persists after controlling for all covariates, whereas the most populous rural counties have relatively higher rates of expenditures. A negative association between county-level poverty and nonprofit human services expenditures is explained by the combination of county-level rurality and regional effects, underscoring the importance of policy attention to the underprovision of human services in rural counties.