Miracle-dz/UniFAR-FTUs huggingface dataset:
X + Y = Time for QI: Meaningful Engagement of Residents in Quality Improvement During the Ambulatory Block.

Background Meaningful resident engagement in quality improvement (QI) remains challenging. Barriers include a lack of time and of faculty with QI expertise. We leveraged our internal medicine (IM) residency program's adoption of an "X" (inpatient rotations) plus "Y" (ambulatory block) schedule to implement a QI curriculum for all residents during their ambulatory block. Objective We sought to engage residents in interprofessional QI, improve residents' QI confidence and knowledge and application to practice, and create opportunities for QI scholarship. Methods In July 2015, the program provided dedicated time for QI in the ambulatory block. All categorical IM residents and 11 voluntary faculty mentors were divided into 10 teams based on clinic site and "Y" block schedule. Teams participated in resident-led, interprofessional ambulatory QI projects. Resident QI knowledge and confidence were assessed before the curriculum and 11 months after using the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) and surveys. QI project implementation and scholarship were tracked. Results All categorical residents (N = 81) participated. Residents reported increased confidence in all QI skills, and they demonstrated increased knowledge, with mean QIKAT-R paired scores improving from 15.8 ± 4.6 to 19.1 ± 5.9 (n = 45 pairs, P < .001). A total of 9 of 10 teams implemented process changes, and 6 team project improvements have been sustained. Conclusions This ongoing curriculum engaged IM and IM-psychiatry residents in QI during their ambulatory block using volunteer clinic faculty mentors. Residents demonstrated improved QI confidence and knowledge. The majority of resident projects were sustained and generated scholarship.
Manifold Structured Prediction

Structured prediction provides a general framework to deal with supervised problems where the outputs have semantically rich structure. While classical approaches consider finite, albeit potentially huge, output spaces, in this paper we discuss how structured prediction can be extended to a continuous scenario. Specifically, we study a structured prediction approach to manifold-valued regression. We characterize a class of problems for which the considered approach is statistically consistent and study how geometric optimization can be used to compute the corresponding estimator. Promising experimental results on both simulated and real data complete our study.
Coenzyme Q10 or Creatine Counteract Pravastatin-Induced Liver Redox Changes in Hypercholesterolemic Mice

Statins are the preferred therapy to treat hypercholesterolemia. Their main action consists of inhibiting the cholesterol biosynthesis pathway. Previous studies report mitochondrial oxidative stress and membrane permeability transition (MPT) of several experimental models submitted to diverse statins treatments. The aim of the present study was to investigate whether chronic treatment with the hydrophilic pravastatin induces hepatotoxicity in LDL receptor knockout mice (LDLr-/-), a model for human familial hypercholesterolemia. We evaluated respiration and reactive oxygen production rates, cyclosporine-A sensitive mitochondrial calcium release, antioxidant enzyme activities in liver mitochondria or homogenates obtained from LDLr-/- mice treated with pravastatin for 3 months. We observed that pravastatin induced higher H2O2 production rate (40%), decreased activity of aconitase (28%), a superoxide-sensitive Krebs cycle enzyme, and increased susceptibility to Ca2+-induced MPT (32%) in liver mitochondria. Among several antioxidant enzymes, only glucose-6-phosphate dehydrogenase (G6PD) activity was increased (44%) in the liver of treated mice. Reduced glutathione content and reduced to oxidized glutathione ratio were increased in livers of pravastatin treated mice (1.5- and 2-fold, respectively). The presence of oxidized lipid species were detected in pravastatin group but protein oxidation markers (carbonyl and SH- groups) were not altered. Diet supplementation with the antioxidants CoQ10 or creatine fully reversed all pravastatin effects (reduced H2O2 generation, susceptibility to MPT and normalized aconitase and G6PD activity). Taken together, these results suggest that 1- pravastatin induces liver mitochondrial redox imbalance that may explain the hepatic side effects reported in a small number of patients, and 2- the co-treatment with safe antioxidants neutralize these side effects.
Cell-nonautonomous local and systemic responses to cell arrest enable long-bone catch-up growth in developing mice

Catch-up growth after insults to growing organs is paramount to achieving robust body proportions. In fly larvae, local injury is followed by local and systemic compensatory mechanisms that allow damaged tissues to regain proportions with other tissues. In vertebrates, local catch-up growth has been described after transient reduction of bone growth, but the underlying cellular responses are controversial. We developed an approach to study catch-up growth in foetal mice by inducing mosaic expression of the cell cycle suppressor p21 in the cartilage cells (chondrocytes) that drive long bone elongation. By specifically targeting the left hindlimb, the right limb served as an internal control. Strikingly, left-right limb symmetry was not altered, revealing deployment of compensatory mechanisms. Above a certain threshold of insult, an orchestrated response was triggered involving local enhancement of bone growth and systemic growth reduction that ensured body proportions were maintained. The local response entailed hyper-proliferation of spared left-limb chondrocytes that was associated with reduced chondrocyte density. The systemic effect involved impaired placental IGF signalling and function, revealing bone-placenta communication. Thus, vertebrates, much like invertebrates, can mount coordinated local and systemic responses to developmental insults to ensure normal body proportions are maintained.
The frequency of bacterial contamination and diversity of drug resistance patterns in devices and staff of endoscopy and colonoscopy units

Background: This study aimed at analyzing microbial contamination in medical equipment, environment, and staff of a gastroenterology unit. Methods: Samples of gastrointestinal imaging devices, the environment, and staff were collected using standard swab-rinse technique and biochemical or molecular characteristics of the isolates, their susceptibility to antibiotics, and similarity of the resistance patterns were investigated. Results: Out of 107 samples, bacterial contamination was detected in the hands of staff (54.1%), imaging devices (56.7%), and in the environment (54.5%). While Pseudomonas spp. were detected only in the imaging devices (13.5%), Bacillus spp. (32.4% and 31.5%), Enterococcus spp. (14.3% and 5.9%), Clostridium difficile (10.8% and 10.5%), and Staphylococcus epidermidis (5.4% and 15.9%) were orderly the most common isolates from samples of the imaging devices and the environment. Nearly, 40% of P. aeruginosa strains were resistant to cefepime, while resistance to cephalosporins and β-lactamase inhibitor was detected in 33% and 75% of S. aureus strains, respectively. Homology of resistance patterns was detected between the imaging devices and hands of the staff. Conclusion: Our results proposed biofilm and spore forming bacteria as main contaminants of imaging devices in this hospital. Homology of the resistance patterns proposed involvement of staff in contamination of the equipment.
Peace with Hunger: Colombia’s Checkered Experience with Post-Conflict Sustainable Community Development in Emerald-Mining Regions

The interactions between conflict and local development has puzzled scholars and practitioners alike. This article explores why the advent of peace in Colombia’s emerald-mining regions for the past few years, as well as a broader national peace process, has not delivered the expected development dividends among mining communities. We contrast differences in stakeholders’ perceptions between levels of governance (local, regional and national). Based on the research, we conclude that while stakeholder collaboration is successful at the regional and national levels of governance, it fails at the local level. While peace has allowed an increase in mainstream business investment in mining, this has concentrated production in a few hands leading to a deterioration in many aspects of community livelihoods and wealth distribution. There has been a shift in the concentration of wealth and production from traditional elites to large companies. Communities noted a loss of collective assets and lack of community and institutional capacity to overcome pressing issues in a post-conflict market economy that favors those who control capital and technology. Based on an evaluation of community perceptions through a focus group methodology, this study recommends ways to prepare and better coordinate stakeholders to engage with complex relationships, and protect community assets in a collaborative governance scenario. This research suggests that political reconciliation processes amid complex resource geographies require greater devolution and community engagement on post-conflict economic development during the peace process itself.
Modulating Neural Circuits with Transcranial Magnetic Stimulation: Implications for Addiction Treatment Development

Although the last 50 years of clinical and preclinical research have demonstrated that addiction is a brain disease, we still have no neural circuit–based treatments for substance dependence or cue reactivity at large. Now, for the first time, it appears that a noninvasive brain stimulation technique known as transcranial magnetic stimulation (TMS), which is Food and Drug Administration approved to treat depression, may be the first tool available to fill this critical void in addiction treatment development. The goals of this review are to 1) introduce TMS as a tool to induce causal change in behavior, cortical excitability, and frontal–striatal activity; 2) describe repetitive TMS (rTMS) as an interventional tool; 3) provide an overview of the studies that have evaluated rTMS as a therapeutic tool for alcohol and drug use disorders; and 4) outline a conceptual framework for target selection when designing future rTMS clinical trials in substance use disorders. The manuscript concludes with some suggestions for methodological innovation, specifically with regard to combining rTMS with pharmacotherapy as well as cognitive behavioral training paradigms. We have attempted to create a comprehensive manuscript that provides the reader with a basic set of knowledge and an introduction to the primary experimental questions that will likely drive the field of TMS treatment development forward for the next several years.
“I don't want to take any risks even if it's gonna mean this service‐user is gonna be happier”: A thematic analysis of community support staff perspectives on delivering Transforming Care

BACKGROUND Transforming Care is making mixed progress in supporting people with intellectual and developmental disabilities, and complex needs, move to more appropriate specialist accommodations closer to home. Community support staff often spend greatest amounts of time with service-users, yet are some of the least heard voices about why placements succeed and fail to varying extents. METHOD Managers and support staff (n = 13), working in ostensibly "specialist" community placements, were interviewed about perceived barriers and facilitators to implementing Transforming Care. Transcripts were subjected to thematic analysis. RESULTS Participants identified difficulties balancing people's rights, safety and quality of life needs, and felt the system's expectations of them are hard to deliver within the resources, legislation, values and support models provided them. Multidisciplinary expertise was highly valued for both emotional and practical support, but was least valued when perceived as overly blaming or inspectorial. Specialist health input was seen to withdraw prematurely for this particular client group. CONCLUSION Recommendations are provided for how staff perspectives should inform Transforming Care in interests of service-users.
Toll-Like Receptor 4 (TLR4) Stimulates Synovial Injury of Temporomandibular Joint in Rats Through the Activation of p38 Mitogen-Activated Protein Kinase (MAPK) Signaling Pathway

Background Synovitis is an important disease that cause intractable pain in temporomandibular joint (TMJ), and the inflammation process played a crucial role in the initiation and development of temporomandibular joint disorder. A series of investigations suggested that the increasing expression of interleukin-(IL) 1β secreted by synovial lining cells plays an important role in synovial inflammation and cartilage destruction in TMJ. In this present study, we investigated the signaling pathways which regulate the expression of IL-1β. Material/Methods The occlusal interference animal model was created to induce synovial injury. Forty-eight rats were divided into 4 groups: 1) control group, 2) occlusal interference group, 3) TAK-242 (a specific inhibitor targeting the Toll-like receptor (TLR)-4) group, and 4) SB203580 (a specific inhibitor targeting the p38) group. The inflammation changes were observed, and the expression of p38 and IL-1β in the synovial membranes were assayed. Results The results showed that downstream p38 MAPK (mitogen-activated protein kinase) signaling was triggered following the activation of TLR4. Moreover, the injection of SB203580 could inhibit the inflammatory reactions and the increased expression of IL-1β at both mRNA and protein levels. Conclusions The results prompted us that TLR4 may stimulates synovial inflammatory reactions and increased expression of IL-1β in rats through the activation of p38 MAPK signaling pathway, p38 was an important mediator in the mechanisms of the initiation and development of synovial injury by regulating the expression of IL-1β in synovial membranes.
Fully Dynamic Maximal Independent Set with Sublinear in n Update Time

The first fully dynamic algorithm for maintaining a maximal independent set (MIS) with update time that is sublinear in the number of edges was presented recently by the authors of this paper [Assadi et al., STOC'18]. The algorithm is deterministic and its update time is O(m3/4), where m is the (dynamically changing) number of edges. Subsequently, Gupta and Khan and independently Du and Zhang [arXiv, April 2018] presented deterministic algorithms for dynamic MIS with update times of O(m2/3) and [MATH HERE], respectively. Du and Zhang also gave a randomized algorithm with update time [MATH HERE]. Moreover, they provided some partial (conditional) hardness results hinting that the update time of m1/2−e, and in particular n1−e for n-vertex dense graphs, is a natural barrier for this problem for any constant e > 0, for deterministic and randomized algorithms that satisfy a certain natural property.In this paper, we break this natural barrier and present the first fully dynamic (randomized) algorithm for maintaining an MIS with update time that is always sublinear in the number of vertices, namely, an [MATH HERE] expected amortized update. We also show that a simpler variant of our algorithm can already achieve an O(m1/3) expected amortized update time, which results in an improved performance over our [MATH HERE] update time algorithm for sufficiently sparse graphs, and breaks the m1/2 barrier of Du and Zhang for all values of m.
A Multi-View Ensemble Classification Model for Clinically Actionable Genetic Mutations

This paper presents details of our winning solutions to the task IV of NIPS 2017 Competition Track entitled Classifying Clinically Actionable Genetic Mutations. The machine learning task aims to classify genetic mutations based on text evidence from clinical literature with promising performance. We develop a novel multi-view machine learning framework with ensemble classification models to solve the problem. During the Challenge, feature combinations derived from three views including document view, entity text view, and entity name view, which complements each other, are comprehensively explored. As the final solution, we submitted an ensemble of nine basic gradient boosting models which shows the best performance in the evaluation. The approach scores 0.5506 and 0.6694 in terms of logarithmic loss on a fixed split in stage-1 testing phase and 5-fold cross validation respectively, which also makes us ranked as a top-1 team out of more than 1,300 solutions in NIPS 2017 Competition Track IV.
The Electrophysiological Features in X-Linked Charcot-Marie-Tooth Disease With Transient Central Nervous System Deficits

Background: Electrophysiological examination plays an important role in the diagnosis of X-linked Charcot-Marie-Tooth disease (CMTX1) with transient central nervous system deficits. However, the electrophysiological features are seldom reported. Methods: We reviewed and analyzed published reports to determine the electrophysiological features of CMTX1 patients with transient central nervous system deficits. Results: A total of 21 CMTX1 patients with transient central nervous system deficits were found in 17 published case reports/series. The age of onset ranged from 0.5 to 18 years (mean 12.02 ± 0.78 years). All patients were male. Recurrent episodes of central nervous system deficits were reported in all 21 cases and resolved in periods ranging from several minutes to 3 days. All 20 patients who had MRIs at presentation had bilaterally symmetrical abnormal T2/Diffusion signals in the white matter without enhancement of gadolinium. All subsequent MRIs showed improvement or were within normal limits. The median motor nerve conduction velocity (MNCV), motor latencies, and compound muscle action potential (CMAP) amplitude were the most commonly measurable electrophysiological parameters (85.7%). All cases that had MNCV at presentation had slower and significantly decreased MNCV compared with the normal value (34.1 ± 1.10 m/s vs. 46.8±2.05 m/s, P < 0.0001; 95% CI, −17.4 to −7.92). The average variations of MNCV in median nerve, ulnar nerve, peroneal nerve, and tibial nerve were 22.0 ± 5.96%, 27.6 ± 11.9%, 25.9 ± 4.36%, and 27.3 ± 4.30%, respectively. All cases with measured sensory nerve conduction velocity (SNCV) at presentation had slower and significantly decreased SNCV compared with the normal value (35.3 ± 1.33 m/s vs. 47.7 ± 2.40 m/s, P < 0.001; 95% CI −18.2 to −6.46). The average variations of SNCV in median nerve, ulnar nerve, and sural nerve were 19.9 ± 8.24%, 25.2 ± 7.75%, and 23.2 ± 3.95%, respectively. Conclusion: This case series serves as a reminder that electrophysiological examination should be included in the diagnosis of recurrent and episodic neurological deficit with white matter lesions. Median MNCV is a sensitive and valuable parameter to support the diagnosis of CMTX1 with transient central nervous system deficits.
Isolation and identification of specific bacteriophage against enteropathogenic Escherichia coli (EPEC) and in vitro and in vivo characterization of bacteriophage.

In recent years, the increasing resistance of enteropathogenic Escherichia coli (EPEC) to commonly used antibiotics has made it difficult to choose the best treatment option. Bacteriophage therapy could be a potent alternative to antibiotic therapy for antibiotic-resistant bacteria. The aim of the present study was to isolate and identify a specific bacteriophage against EPEC and characterize bacteriophage in vitro and in vivo. The specific bacteriophage was isolated, and the effect of phage therapy on 48 mice (Balb/c) was investigated. Animals were divided into six groups, including A: PBS (negative control); B: bacteria (positive control); C: bacteria + ciprofloxacin (after 24 h); D: bacteria + bacteriophage (after 24 h); E: bacteria + ciprofloxacin + bacteriophage (after 24 h) and F: bacteriophage + bacteria (after 24 h). Specific bacteriophage against EPEC was isolated from hospital sewage. The bacteriophage had an icosahedral head (120 nm) and a tail (138 nm). The single dose of the bacteriophage (2 × 109 pfu ml-1) was able to control the infection. Unfortunately, because of the misuse of antibiotics by EPEC infected patients, the antibiotic resistant bacteria will become prevalent in the future and the treatment of EPEC infection is going to become more difficult than ever.
3 Selecting a Random Feature Stein Discrepancy

Computable Stein discrepancies have been deployed for a variety of applications, ranging from sampler selection in posterior inference to approximate Bayesian inference to goodness-of-fit testing. Existing convergence-determining Stein discrepancies admit strong theoretical guarantees but suffer from a computational cost that grows quadratically in the sample size. While linear-time Stein discrepancies have been proposed for goodness-of-fit testing, they exhibit avoidable degradations in testing power—even when power is explicitly optimized. To address these shortcomings, we introduce feature Stein discrepancies (ΦSDs), a new family of quality measures that can be cheaply approximated using importance sampling. We show how to construct ΦSDs that provably determine the convergence of a sample to its target and develop high-accuracy approximations—random ΦSDs (RΦSDs)—which are computable in near-linear time. In our experiments with sampler selection for approximate posterior inference and goodness-of-fit testing, RΦSDs perform as well or better than quadratic-time KSDs while being orders of magnitude faster to compute.
Point of Care 2.0: Gerinnungsdiagnostik mit ROTEM® sigma und TEG® 6s

Zusammenfassung TEG® 6s und ROTEM® sigma sind die neueste Generation von 2 häufig perioperativ eingesetzten Point-of-Care-Methoden zur Gerinnungsdiagnostik. Sie basieren auf Systemen zur automatischen Probenvorbereitung und -analyse mit Einweg-Testkassetten – personal- und zeitintensives Pipettieren entfällt größtenteils. Dieser Beitrag beschreibt die Testprinzipien und diskutiert Vor- und Nachteile bei der Integration der Methoden in den klinischen Alltag.
Experiences of Inpatient Bone Marrow Transplantation Nurses and Providers Using Electronic Symptom Reporting.

PURPOSE To investigate the use of electronic patient-reported outcomes (PROs) to assess symptoms and how they can provide opportunities to clinicians to address symptoms in a timely manner to improve clinical care. As part of a larger study to evaluate whether providing standardized symptom reports to the medical team would decrease the time to treatment of reported symptoms in hematopoietic stem-cell transplant recipients, we assessed nurses' and providers' perceptions of electronic symptom reporting. METHODS Semistructured interviews of RNs, MDs, NPs and PAs were conducted at an academic cancer center in the southeastern United States. Nurses' and providers' perceptions of electronic symptom reporting were explored. Interviews were audio-recorded, transcribed, and coded by two investigators to identify major themes. RESULTS Fourteen RNs and seven providers (MDs, PAs, and NPs) participated in the interviews. Three main themes emerged from the interviews: electronic symptom reporting may improve assessment and care, integrating symptom reporting into nurse workflow presents difficulties, and there are barriers for completion of surveys. CONCLUSION The majority of nurses and providers believed that the inclusion of electronic symptom reporting in bone marrow transplantation inpatient units has the potential to improve care but that barriers to implementation remain.