Miracle-dz/UniFAR-FTUs huggingface dataset:
Antipsychotic polypharmacy in adult patients diagnosed with schizophrenia: A retrospective study

Antipsychotic polypharmacy (APP) is a common practice in the treatment of schizophrenia. In this study, we aimed to identify the prevalence of APP in our department, as well as the trends associated with co-prescribing antipsychotics. We collected data from the medical records of all 193 inpatients diagnosed with schizophrenia who were admitted to Prof. Dr. Alexandru Obregia Clinical Psychiatry Hospital (Bucharest, Romania), Department 9, during January 2019-December 2019. Demographic characteristics of the patients, clinical diagnosis, psychiatric admission type and duration of hospitalization were examined. Data regarding the antipsychotic regimen at discharge and other psychotropic drugs used were collected. A total of 69 (35.75%) patients received more than 2 antipsychotics upon discharge. Patients treated with APP did not differ in regards to sex, age, education level, employment status, marital status, living situation, type of admission from those receiving antipsychotic monotherapy (APM). Prolonged hospitalization was found to be an independent predictor of APP (P=0.014). Most of the combinations used in our unit included clozapine (47.8%), and the most frequently used treatment in the APP group was the combination of paliperidone and clozapine (14.5%). In the APP group, 30 (43.5%) patients included in their regimen was a long-acting intramuscular antipsychotic. There was no significant difference in terms of the use of mood stabilizers, antiparkinsonian drugs or anxiolytics between the APP and the APM group; yet, a higher prevalence of antidepressant use, although not statistically significant (P=0.067), in the APP group compared to the APM group, was observed. The use of APP as a long-term regimen is a common practice in our department, as it is worldwide. There is a great need for randomized-control trials and evidence-based studies in order to define the safest and most effective combinations of antipsychotics and also the characteristics of patients that may benefit from these combinations.
Title : Sensitivity of discrete symmetry metrics : implications for metric choice 1 Running title : Sensitivity of discrete symmetry metrics 2 3

15 Gait asymmetry is present in several pathological populations, including those with 16 Parkinson’s disease, Huntington’s disease, and stroke survivors. Previous studies suggest that 17 commonly used discrete symmetry metrics, which compare single bilateral variables, may not 18 be equally sensitive to underlying effects of asymmetry, and the use of a metric with low 19 sensitivity could result in unnecessarily low statistical power. The purpose of this study was to 20 provide a comprehensive assessment of the sensitivity of commonly used discrete symmetry 21 metrics to better inform design of future studies. Monte Carlo simulations were used to estimate 22 the statistical power of each symmetry metric at a range of asymmetry magnitudes, 23 group/condition variabilities, and sample sizes. Power was estimated by repeated comparison of 24 simulated symmetric and asymmetric data with a paired t-test, where the proportion of 25 significant results is equivalent to the power. Simulation results confirmed that not all common 26 discrete symmetry metrics are equally sensitive to reference effects of asymmetry. Multiple 27 symmetry metrics exhibit equivalent sensitivities, but the most sensitive discrete symmetry 28 metric in all cases is a bilateral difference (e.g. left right). A ratio (e.g. left/right) has poor 29 sensitivity when group/condition variability is not small, but a log-transformation produces 30 increased sensitivity. Additionally, two metrics which included an absolute value in their 31 definitions showed increased sensitivity when the absolute value was removed. Future studies 32 should consider metric sensitivity when designing analyses to reduce the possibility of 33 underpowered research. 34
Cancer care disruption and reorganisation during the COVID-19 pandemic in Australia: A patient, carer and healthcare worker perspective

The COVID-19 pandemic has dramatically impacted cancer care worldwide. Disruptions have been seen across all facets of care. While the long-term impact of COVID-19 remains unclear, the immediate impacts on patients, their carers and the healthcare workforce are increasingly evident. This study describes disruptions and reorganisation of cancer services in Australia since the onset of COVID-19, from the perspectives of people affected by cancer and healthcare workers. Two separate online cross-sectional surveys were completed by: a) cancer patients, survivors, carers, family members or friends (n = 852) and b) healthcare workers (n = 150). Descriptive analyses of quantitative survey data were conducted, followed by inductive thematic content analyses of qualitative survey responses relating to cancer care disruption and perceptions of telehealth. Overall, 42% of cancer patients and survivors reported experiencing some level of care disruption. A further 43% of healthcare workers reported atypical delays in delivering cancer care, and 50% agreed that patient access to research and clinical trials had been reduced. Almost three quarters (73%) of patients and carers reported using telehealth following the onset of COVID-19, with high overall satisfaction. However, gaps were identified in provision of psychological support and 20% of participants reported that they were unlikely to use telehealth again. The reorganisation of cancer care increased the psychological and practical burden on carers, with hospital visitation restrictions and appointment changes reducing their ability to provide essential support. COVID-19 has exacerbated a stressful and uncertain time for people affected by cancer and healthcare workers. Service reconfiguration and the adoption of telehealth have been essential adaptations for the pandemic response, offering long-term value. However, our findings highlight the need to better integrate psychosocial support and the important role of carers into evolving pandemic response measures. Learnings from this study could inform service improvements that would benefit patients and carers longer-term.
International trade and Covid‐19: City‐level evidence from China's lockdown policy

Abstract This paper examines the impact of Covid‐19 lockdowns on exports by Chinese cities. We use city‐level export data at a monthly frequency from January 2018 through April 2020. Differences‐in‐differences estimates suggest cities in lockdown experienced a ceteris paribus 34 percentage points reduction in the year‐on‐year growth rate of exports. The lockdown impacted the intensive and extensive margin, with higher exit and lower new entry into foreign markets. The drop in exports was smaller in (i) coastal cities; (ii) cities with better‐developed ICT infrastructure; and (iii) cities with a larger share of potential teleworkers. Time‐sensitive and differentiated goods experienced a more pronounced decline in export growth. Global supply chain characteristics matter, with more upstream products and industries that had accumulated larger inventories experiencing a smaller decline in export growth. Also, products that relied more on imported (domestic) intermediates experienced a sharper (flatter) slowdown in export growth. The rapid recovery in cities' exports after lockdowns were lifted suggests the policy was cost‐effective in terms of its effects on trade.
Dispositional and online-specific Fear of Missing Out are associated with the development of IUD symptoms in different internet applications

Abstract Background and aims An increasing number of people experience negative consequences from the excessive use of different Internet applications or sites (e.g., Instagram, League of Legends, YouTube). These consequences have been referred to as specific Internet Use Disorders (IUDs). The present study aims to examine the Fear of Missing Out (FoMO) on rewarding experiences with respect to specific Internet activities. FoMO has been found to mediate the link between psychopathology and symptoms of Internet Communication Disorder (ICD). However, the role of FoMO in other IUDs is controversial. Methods The current study (N = 7,990) consecutively screened in vocational schools) analyzed the associations between online-specific state-FoMO, general trait-FoMO, mental health, and IUD symptoms in a structural equation model. After testing the model for the entire sample of Internet users, it was analyzed separately for the two main user groups: Social Networking Site (SNS) users and gamers. Results The proposed model explained 42.0% of the variance in IUD symptoms in the total sample, 46.8% for SNS users, and 32.8% for gamers. Results suggest that impaired mental health and high trait-FoMO predict IUD symptoms. For both SNS users and gamers, trait-FoMO mediated the link between low mental health and IUD, whereas state-FoMO mediated the link between trait-FoMO and IUD in both user groups. Discussion Our results partly support the theoretical model of specific IUDs, highlighting trait-FoMO as a predisposing fear of disconnection related to general mental health. Online-specific FoMO appears to contribute to problematic Internet use mainly because of its link to the general fear of disconnection. Moreover, the described mechanism seems to be comparable for both females and males. Conclusions FoMO is a multidimensional construct underlying IUD symptoms related to the use of socially gratifying, but distinct Internet applications. FoMO and psychopathology should be targeted together in prevention and treatment plans of IUDs.
Suicide Screening in a Large Pediatric Emergency Department

Suicide is a leading cause of death among children and adolescents, and research has shown a significant increase in the rates of emergency department (ED) visits because of suicide ideation and attempts for children younger than 18 years. Objective This study examined the feasibility of screening all patients entering the ED using the Columbia–Suicide Severity Rating Scale as well as examining the rates of suicide ideation and attempts endorsed by adolescents who present at the ED. Methods This study used a sample of 12,113 patients between the ages of 11 and 19 years. Results Results revealed that 13.5% of the participants endorsed passive suicide ideation in the month leading up to their ED visit and 11.3% of the participants reported active ideation in the prior month. Results also revealed that patients whose chief complaints were coded as psychiatric or medical trauma were more likely to endorse either active or passive suicidal ideation than other presenting problems. Patients with a psychiatric or medical trauma chief complaint were also more likely to report lifetime suicidal behavior and suicidal behavior 3 months before the ED visit. Conclusions In addition to findings, implications, feasibility, and lessons learned are discussed for other institutions or departments considering implementation of a widespread screening. Highlights: • Suicide screenings were implemented in a large pediatric emergency department. • One in 5 endorsed suicidal ideation or behavior regardless of presenting problem. • Feasibility and lessons learned are discussed for others hoping to implement a widespread screening.
Long-Term Outcome of Children with Short Bowel Syndrome Treated with a Modification of the STEP Technique Avoiding Mesenteric Defect

Abstract Background The Serial Transverse Enteroplasty Procedure (STEP) Registry has reported a 47% success to achieve enteral autonomy in pediatric short bowel syndrome (SBS). We have performed the STEP with a technical modification (MSTEP) consisting in stapler application without mesenteric defects that can also be applied to the duodenum. Our experience with this technique is described. Materials and Methods In this study, 16 children with SBS underwent MSTEP (2005–2019). Indications were nutritional autonomy achievement (n = 11, with duodenal lengthening in 5/11) and bacterial overgrowth treatment (n = 5). Results With a median follow-up of 5.8 years (0.7–13.7 years), 5 of 11 (45%) patients achieved enteral autonomy, 4 of them with duodenal lengthening. Four of four who preserved > 50% colon, while only one of seven with < 50% of colon achieved enteral autonomy (p < 0.05). After redo procedures, three of four attained enteral autonomy. Thus, 8 of 11 (73%) progressed to enteral autonomy, including all with duodenal lengthening. One child, already parenteral nutrition free, died due to central line sepsis. All the patients from the bacterial translocation group improved their metabolic/nutritional status, but one required subsequent enterectomy of the lengthened intestine due to multiple ulcers in the staple lines. Conclusion The effectiveness of MSTEP to achieve enteral autonomy seems similar to the classical STEP. It can be applied to the duodenum. The retained colon length may influence the post-STEP enteral autonomy achievement.
Application of artificial intelligence to the electrocardiogram

Abstract Artificial intelligence (AI) has given the electrocardiogram (ECG) and clinicians reading them super-human diagnostic abilities. Trained without hard-coded rules by finding often subclinical patterns in huge datasets, AI transforms the ECG, a ubiquitous, non-invasive cardiac test that is integrated into practice workflows, into a screening tool and predictor of cardiac and non-cardiac diseases, often in asymptomatic individuals. This review describes the mathematical background behind supervised AI algorithms, and discusses selected AI ECG cardiac screening algorithms including those for the detection of left ventricular dysfunction, episodic atrial fibrillation from a tracing recorded during normal sinus rhythm, and other structural and valvular diseases. The ability to learn from big data sets, without the need to understand the biological mechanism, has created opportunities for detecting non-cardiac diseases as COVID-19 and introduced challenges with regards to data privacy. Like all medical tests, the AI ECG must be carefully vetted and validated in real-world clinical environments. Finally, with mobile form factors that allow acquisition of medical-grade ECGs from smartphones and wearables, the use of AI may enable massive scalability to democratize healthcare.
Non-suicidal self-injury and suicidal behavior during the COVID-19 pandemic in Brazil

Abstract This study sought to determine the explanatory variables behind suicidal behavior and non-suicidal self-injury during the early months of the COVID-19 pandemic in Brazil. The sample comprised 4797 adults, who filled out a series of standardized instruments and additional questions on COVID-19 exposure (self and others), self-injury, and suicidal behavior. One in 10 participants reported self-injury, and three in 10 had considered or attempted suicide. The factors associated with self-injury and suicidal behavior were lower educational level, younger age, chronic diseases, and anxiety. The factors associated with suicidal behavior were regular employment, living alone, and Black ethnicity.
Shared medical appointments for weight loss: a systematic review.

PURPOSE Shared medical appointments (SMAs) may help mitigate some of the barriers for managing obesity in primary care. The primary aim of this systematic review was to measure the effect of weight loss SMAs. METHODS Systematic searches using keywords and Medical Subject Headings for overweight, obesity, and SMAs were conducted in the CENTRAL, Medline Complete, PsycINFO, Scopus, CINAHL, EMBASE, and Web of Science databases with no date limits. Risk of bias was assessed using the Effective Health Practice Project Quality Assessment Tool for Quantitative Studies. RESULTS Fifteen studies involving weight loss SMAs in adults and children were identified. Six studies had controls. Inconsistency in reporting weight loss or weight change in controlled studies meant that data could not be pooled for meta-analysis. Results from individual studies indicated that SMAs can support adult patients to achieve significant weight loss. Women and older adults were more likely to take up SMA invitations. Results from the 5 studies involving children were less conclusive. Studies involving participants of a higher socioeconomic status tended to report lower attrition than studies involving participants who experienced disadvantage. These findings should be interpreted with caution as all but 1 included study was assessed as being weak in quality. CONCLUSIONS Overall, SMAs may be of benefit to address obesity in primary care, particularly for women and older adults. Appropriately designed prospective and controlled studies are required to engage their target audience and to assess whether SMAs are superior to other weight loss options in primary care.
Effect of initial laser beam diameter on breakdown and ignition properties of n-decane/N2/O2 mixtures

ABSTRACT Traditional spark plug igniters are widely used in engine applications. This technology is better known among others, and some limitations appear in its control in terms of space and location of the deposited energy. An alternative laser igniter device to overcome this problem is more and more studied. The principle of this technology is to focalize a Gaussian laser beam in the center of a combustion chamber. However, optics used to focalize the laser beam are a crucial point to achieve ignition. The presented experimental work highlights the role of the beam diameter for the same laser source in the ignition process of a reactive mixture. In this paper, five beam diameters have been investigated for five equivalent ratios of n-decane/N2/O2 mixture at 1 bar and 347 K with the Langlie method. Results yield that ignition needs less and less energy sent from the laser source when the beam diameter is more and more expanded.
Impact of the coronavirus pandemic on mental health and health care in adults with neurofibromatosis: Patient perspectives from an online survey

The coronavirus pandemic increased anxiety and stress and prevented access to health care worldwide; it is unclear how COVID‐19 affected adults with a multisystem genetic disorder such as neurofibromatosis (NF). An anonymous online survey was distributed through an international registry and foundations to adults with NF (June–August 2020) to assess the impact of the pandemic on mental health and NF health care. Six hundred and thirteen adults (18–81 years; M = 45.7) with NF1 (77.8%), NF2 (14.2%), and schwannomatosis (7.8%) provided complete responses. Respondents rated moderate‐to‐high amounts of worry about the impact of COVID‐19 on their emotional (46.3%) and physical health (46.7%), and 54.8% endorsed moderate‐to‐high pandemic‐related stress. Adults with diagnosed/suspected mental health disorders or moderate‐to‐severe NF symptom impact as well as females endorsed higher COVID‐19 stress (ps < 0.01). Less than half who missed a doctor's appointment for their NF care (43.4%) used telehealth. Of these, 33.3% and 46.2% reported that telehealth met their needs to a moderate or high degree, respectively. Results indicated that subgroups of adults with NF experience higher COVID‐19‐related worries and stress and may need additional support. Furthermore, telehealth is under‐utilized and could help NF providers connect with patients, although improved delivery and patient training may facilitate expanded use of these services.
Serum beta‐secretase 1 (BACE1) activity increases in patients with mild cognitive impairment

Beta‐secretase 1 (BACE1) is considered as the key enzyme in amyloid‐β formation. Previous works suggest that high BACE1 activity may be present in brain, cerebrospinal fluid and serum of patients with late‐onset Alzheimer's disease (LOAD) as well as mild cognitive impairment (MCI). Therefore, we evaluated whether serum BACE1 activity increases in MCI patients and is associated with the progression from MCI to dementia. BACE1 activity was measured in the serum of 259 MCI patients (162 amnestic—aMCI, 97 non‐amnestic—naMCI) and 204 healthy Controls. After a median follow‐up of 32 months (range: 10–153), 116 MCI progressed to dementia (87 aMCI and 29 naMCI). Serum BACE1 activity was higher in MCI compared with Controls (p < 0.001), and in aMCI with brain atrophy compared with naMCI without brain atrophy (p = 0.04). No difference in BACE1 activity emerged between converter and non‐converter MCI, and this was true for both aMCI and naMCI. However, among aMCI with better cognitive performance (n. 163, MMSE score ≥24/30) those converting to dementia had higher BACE1 activity compared to stable ones (p = 0.05). This was not associated with an increased risk to develop dementia (hazard ratio: 1.65; 95% confidence interval: 0.67–4.01). In conclusion, serum BACE1 activity significantly increased in MCI patients (both amnestic and non‐amnestic) compared with Controls. Moreover, higher serum BACE1 activity was observed only among aMCI with a better cognitive performance who progressed to dementia, suggesting that a dysregulation of this enzyme might be an early event primarily associated with neurodegeneration.
Anatomical Variations in the Origin of the Lumbar Artery: A Cadaveric Study Augmented by CT Findings

ABSTRACT Background: Anatomical variations of lumbar arteries predispose them to iatrogenic injury during endovascular intervention or surgery. Due to limited morphological data on lumbar arteries in our setting, we aimed to determine their variant anatomy among Kenyans. Methods: We performed the study on 90 cadaveric specimens and 120 computed tomography (CT) scans. Cadavers were dissected to expose the aorta and the lumbar arteries emerging from them. The number, origins, location relative to the vertebral bodies, and relations to aortic bifurcation were determined in cadavers and CT scans. Data were analyzed using SPSS (version 21.0). Results: On average, 3 (3/90 [3.3%]), 4 (63/90 [70%]) or 5 (24/90 [26.7%]) pairs of lumbar arteries were observed among the cadaveric specimens, whereas 4 (100/120 [83.3%]) or 5 (20/120 [16.7%]) pairs were observed in CTs. Differences in the number of pairs observed in the cadaveric versus CT study were not statistically significant (P = .542). There were no sex differences in the number of lumbar artery pairs observed in CT scans (P = .178). The first 3 lumbar artery pairs had a single-origin, whereas the fourth lumbar artery had a common-stem origin. The first, second, and third lumbar arteries mostly originated at the upper third of their respective vertebral bodies. The fourth lumbar artery predominantly originated at the lower third. Conclusion: Our study's findings show unique variation in the lumbar arteries' relation to the vertebral bodies and the distances between artery pairs. Level of Evidence: IV (cross-sectional study). Clinical Relevance: Variations in the anatomy of the lumbar arteries should be taken into consideration, especially in surgical or interventional procedures to avoid inadvertent injury of the vessels.