Miracle-dz/UniFAR-FTUs huggingface dataset:
Design and Validation of Two Predictive Models for Mortality and Readmission Following Surgery in Patients with Liver Cirrhosis

Monica L. Schmidt: Design and Validation of Two Predictive Models for Mortality and Readmission Following Surgery in Patients with Liver Cirrhosis (Under the direction of Morris Weinberger) Cirrhosis is the 12 th leading cause of death in the United States. By 2020, it is expected to affect more than 1 million Americans. Cirrhosis is a costly, chronic condition requiring frequent hospitalizations and unplanned readmissions. Patients with cirrhosis often require routine surgeries including hernia repair, coronary artery bypass surgery and orthopedic hip or knee replacements. These procedures present a greater risk of morbidity and mortality for cirrhotic patients, including a 8-fold increase in risk of mortality and higher hepatic decompensation after surgery. Predicting post-operative mortality prior to surgery or post-operative readmission would allow patients and clinicians to make informed decisions that optimize survival and reduce readmission costs. Currently, the MELD score is often used, inappropriately, to assess risk of procedures in patients with decompensated cirrhosis. However, no models exist that predict mortality or readmission among patients with cirrhosis. This study aimed to develop and validate two predictive models; one for mortality among all patients with cirrhosis undergoing surgery; the other will predict readmission among cirrhosis patients discharged alive after the index surgery. Each two model was then compared to the MELD score. The NSQIP Mortality Model was significantly better than the MELD score at predicting mortality (p<0.001) and had an area under the receiver operating characteristic (AUROC) curve of 0.84. The readmission model was also significantly better than the MELD score (p<0.001), with an AUROC of 0.75. Both models iv provide the basis for developing two decision tools that can assist clinicians and patients in making informed decisions that optimize survival and reduce unplanned readmissions.
In Our Own Time: Medical Students’ Informal Social Studying and Learning

Abstract Phenomenon: Social studying and learning (SSL) is any independent, elective, self-directed and self-organized approach to learning that involves students working with their peers for the purposes of study, learning, or revision. While in-class collaborative learning has been relatively well-explored, very little is known about how medical students engage in informal SSL or about the impacts it can have. The purpose of this study was to explore medical students’ practices and perceptions regarding SSL, and the ways in which this shaped their overall learning experiences. Approach: A constructivist grounded theory study was conducted at the University of Calgary. Data were collected from 23 semi-structured student interviews, which were audio recorded and transcribed. Data were analyzed using iterative data collection, memo-ing, and focused coding. Findings: Despite SSL being a common part of students’ medical school experience and something that was promoted by academic advisors, how students actually engaged with SSL varied substantially, including who made use of SSL, how they made use of it, the size and focus of SSL groups, how these groups functioned, and what individuals sought to get out of them. Some students found SSL helped them to be more efficient and focused in their studying, while others benefited from comparing their knowledge and skills with those of their peers. Not everyone benefited, as some students found SSL stressful, unproductive, or socially uncomfortable. While student engagement in SSL was an enabler of academic success for some it could also be an indicator of social isolation and low self-esteem for others. Insights: Understanding how SSL can influence student experiences has the potential to inform students how and why they might engage in SSL, and it can help educators better support their students, particularly in those schools that actively encourage SSL.
Ex-vivo lung perfusion versus standard protocol lung transplantation-mid-term survival and meta-analysis.

Background While extended criteria lung donation has helped expand the lung donor pool, utilization of lungs from donors of at least one other solid organ is still limited to around 15-30%. Ex-vivo lung perfusion (EVLP) offers the ability to expand the number of useable lung grafts through assessment and reconditioning of explanted lungs, particularly those not initially meeting criteria for transplantation. This meta-analysis aimed to examine the mid- to long-term survival and other short-term outcomes of patients transplanted with EVLP-treated lungs versus standard/cold-storage protocol lungs. Methods Literature search of ten medical databases was conducted for original studies involving "ex-vivo lung perfusion" and "EVLP". Included articles were assessed by two independent researchers, survival data from Kaplan-Meier curves digitized, and individual patient data imputed to conduct aggregated survival analysis. Meta-analyses of suitably reported outcomes were conducted using a random-effects model. Results Thirteen studies met inclusion criteria, with a total of 407 EVLP lung transplants and 1,765 as per standard/cold storage protocol. One study was a randomized controlled trial while the remainder were single-institution cohort series of varying design. The majority of donor lungs were from brain death donors, with EVLP lungs having significantly worse PaO2/FiO2 ratio and significantly greater rate of abnormal chest X-ray. Aggregated survival analysis of all included studies revealed no significant survival difference for EVLP or standard protocol lungs (hazard ratio 1.00; 95% confidence interval: 0.79-1.27, P=0.981). Survival at 12, 24, and 36 months for the EVLP cohort was 84%, 79%, and 74%, respectively. Survival at 12, 24, and 36 months for the standard protocol cohort was 85%, 79%, and 73%, respectively. Meta-analysis did not find a significant difference in risk of 30-day mortality or primary graft dysfunction grade 3 at 72 hours between cohorts. Conclusions There was no significant difference in mid- to long-term survival of EVLP lung transplant patients when compared to standard protocol donor lungs. The incidence of 30-day mortality and primary graft dysfunction grade 3 at 72 hours did not differ significantly between groups. EVLP offers the potential to increase lung donor utilization while providing similar short-term outcomes and mid- to long-term survival.
How do pigs deal with dietary phosphorus deficiency?

Abstract Feeding strategies for growing monogastric livestock (particularly pigs) must focus on maximising animal performance, while attempting to reduce environmental P load. Achieving these goals requires a comprehensive understanding of how different P feeding strategies affect animal responses and an ability to predict P retention. Although along with Ca, P is the most researched macromineral in pig nutrition, knowledge gaps still exist in relation to: (1) the effects of P feed content on feed intake (FI); (2) the impact of P intake on body composition; (3) the distribution of absorbed P to pools within the body. Here, we address these knowledge gaps by gathering empirical evidence on the effects of P-deficient feeds and by developing a predictive, mechanistic model of P utilisation and retention incorporating this evidence. Based on our statistical analyses of published literature data, we found: (1) no change in FI response in pigs given lower P feed contents; (2) the body ash–protein relationship to be dependent upon feed composition, with the isometric relationship only holding for pigs given balanced feeds and (3) the priority to be given towards P retention in soft tissue over P retention in bones. Subsequent results of the mechanistic model of P retention indicated that a potential reduction in P feeding recommendations could be possible without compromising average daily gain; however, such a reduction would impact P deposition in bones. Our study enhances our current knowledge of P utilisation and by extension excretion and could contribute towards developing more accurate P feeding guidelines.
A new anthropometric index to predict percent body fat in young adults

Abstract Objective: To propose a new anthropometric index that can be employed to better predict percent body fat (PBF) among young adults and to compare with current anthropometric indices. Design: Cross-sectional. Setting: All measurements were taken in a controlled laboratory setting in Seoul (South Korea), between 1 December 2015 and 30 June 2016. Participants: Eighty-seven young adults (18–35 years) who underwent dual-energy x-ray absorptiometry (DXA) were used for analysis. Multiple regression analyses were conducted to develop a body fat index (BFI) using simple demographic and anthropometric information. Correlations of DXA measured PBF (DXA_PBF) with previously developed anthropometric indices and the BFI were analysed. Receiver operating characteristic curve analyses were conducted to compare the ability of anthropometric indices to identify obese individuals. Results: BFI showed a strong correlation with DXA_PBF (r = 0·84), which was higher than the correlations of DXA_PBF with the traditional (waist circumference, r = 0·49; waist to height ratio, r = 0·68; BMI, r = 0·36) and alternate anthropometric indices (a body shape index, r = 0·47; body roundness index, r = 0·68; body adiposity index, r = 0·70). Moreover, the BFI showed higher accuracy at identifying obese individuals (area under the curve (AUC) = 0·91), compared with the other anthropometric indices (AUC = 0·71–0·86). Conclusions: The BFI can accurately predict DXA_PBF in young adults, using simple demographic and anthropometric information that are commonly available in research and clinical settings. However, larger representative studies are required to build on our findings.
Correlation between biofilm formation and antibiotic resistance in Pseudomonas aeruginosa: a meta-analysis.

Biofilm formation is one of the important resistance mechanisms in Pseudomonas aeruginosa. This study aimed to consider the correlation between biofilm formation and antibiotic resistance in Pseudomonas aeruginosa through a systematic review and meta-analysis. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) strategies. Scientific databases were searched by MeSH terms and keywords such as "Pseudomonas aeruginosa", "biofilm formation", "antibiotic resistance", "prevalence" AND "Iran", to obtain articles published from 1st January 2016 to 30th November 2019. Studies recording biofilm formation and antibiotic resistance in P. aeruginosa recovered from clinical samples of Iranian patients were included. Data analysis was performed using CMA software. The combined biofilm formation rate was reported as 87.6 % (95% CI: 80-92.5). The heterogeneity index among the selected articles was Q2=96.5, I2=85.5, and t=0.26 (p=0.16). The pooled occurrences of strong, moderate and weak biofilms were 47.7% (95% CI: 28.7-67.3), 30.2% (95% CI: 19.4-43.8), and 27.4% (95% CI: 8.8-59.8), respectively. The pooled prevalence of MDR P. aeruginosa strains was as follows: 62.5% (95% CI: 40-77.2). The highest combined rates of antibiotic resistance were against ceftriaxone and tobramycin with the rates of 79.2. 9% (95% CI: 54.2-96.2) and 64.4% (95% CI: 36.3-92), respectively. Also, the lowermost antibiotic resistance rates were against colistin and polymyxin B, with the prevalence of 2.1% (95% CI: 0.2-18.1), and 3% (95% CI: 0.5-17.3), respectively. More than half of the studies included in the present review showed a significant correlation between biofilm formation and antibiotic resistance pattern.
Laser‐Induced Graphene for Electrothermally Controlled, Mechanically Guided, 3D Assembly and Human–Soft Actuators Interaction

Mechanically guided, 3D assembly has attracted broad interests, owing to its compatibility with planar fabrication techniques and applicability to a diversity of geometries and length scales. Its further development requires the capability of on‐demand reversible shape reconfigurations, desirable for many emerging applications (e.g., responsive metamaterials, soft robotics). Here, the design, fabrication, and modeling of soft electrothermal actuators based on laser‐induced graphene (LIG) are reported and their applications in mechanically guided 3D assembly and human–soft actuators interaction are explored. Over 20 complex 3D architectures are fabricated, including reconfigurable structures that can reshape among three distinct geometries. Also, the structures capable of maintaining 3D shapes at room temperature without the need for any actuation are realized by fabricating LIG actuators at an elevated temperature. Finite element analysis can quantitatively capture key aspects that govern electrothermally controlled shape transformations, thereby providing a reliable tool for rapid design optimization. Furthermore, their applications are explored in human–soft actuators interaction, including elastic metamaterials with human gesture‐controlled bandgap behaviors and soft robotic fingers which can measure electrocardiogram from humans in an on‐demand fashion. Other demonstrations include artificial muscles, which can lift masses that are about 110 times of their weights and biomimetic frog tongues which can prey insects.
Improving Student Capabilities through Research-Based Learning Innovation on E-Learning System

A current higher education curriculum has shifted from a training and professional development model to a capability development model, from work-oriented to a life orientation, from a teaching paradigm to a learning paradigm. The logical consequence of this shift requires innovation not only in the form of instruments and digitization of learning but also in learning innovation in the learning process and student learning experiences. This study aims to design learning innovations using research-based learning models that are integrated through e-learning to improve student capabilities. This study used research and development method with a 4-D model. This study found that there was an increase in the quality of learning in social studies learning courses and an increase in student capabilities through a research-based learning approach implemented through the e-learning system.
Efficacy and safety of tranexamic acid for reducing blood loss in elderly patients with intertrochanteric fracture treated with intramedullary fixation surgery: A meta-analysis of randomized controlled trials.

OBJECTIVE The aim of this study was to evaluate the efficacy and safety of tranexamic acid (TXA) in elderly patients with intertrochanteric fracture undergoing intramedullary fixation surgery. METHODS We searched MEDLINE, the Cochrane Library and EMBASE for published randomized clinical trials relevant to use of TXA in elderly patients with intertrochanteric fracture treated with intramedullary fixation surgery. Meta-analysis was performed according to the guidelines of the Cochrane Reviewer's Hand book. RESULTS Five trials assessing 540 patients were included for meta-analysis. The pooled results showed that the mean total blood loss in TXA group was significant lower than that in the control group (mean difference - 172.83, 95% CI -241.43 to -104.23; p<0.00001, fixed-effect model). The intra- and postoperative transfusion rate for the TXA group was 34.4% (91/264) and for the control group was 49.27% (136/276), and the relative risk was 0.71 (95% CI 0.52 to 0.97; p<0.03, random-effect model) with substantial heterogeneity (I2=63%, p=0.03). The overall incidence of thrombotic events was 6.43% (17/264) in the intravenous TXA group, 7.63% (21/275) in the control group, with no significant difference (relative risk 0.84, 95% CI 0.46 to 1.54; p=0.57, fixed-effect model). CONCLUSION The present evidence shows that TXA can significantly reduce total and hidden blood loss, transfusion rate, and do not increase the risk of thrombotic events in elderly patients with intertrochanteric fracture undergoing intramedullary fixation surgery. However, the impact of TXA on thrombotic events needs to be researched in more high-quality, large-sample randomized clinical trials. LEVEL OF EVIDENCE Level I Therapeutic Study.
Logistic regression analyses of factors affecting fertility of intrauterine adhesions patients.

Background Intrauterine adhesion (IUA) prevalence is difficult to measure, but appears to have increased over the last few decades. The reproductive outcomes following hysteroscopic adhesiolysis (HA) for moderate-severe IUAs were unsatisfactory, and few studies have analyzed the clinical characteristics pre-, intra- and post-HA to determine the main risk factors for infertility in patients with IUAs. Methods This retrospective observational study included 406 patients, desiring fertility, who had undergone HA between January 1st, 2016 to May 31st, 2017, and had moderate-to-severe IUA [5-12 on the American Fertility Society (AFS) classification scale]. Logistic regression was performed to analyze the data of the clinical characteristics associated with IUA. Results A total of 406 IUA patients were initially collected. Twenty-six [26] were lost during follow-up or excluded by other criteria; 380 were included in the study with a follow-up period ranging from 2 to 3 years. There were 215 patients (56.6%) that became pregnant, of whom 18 spontaneously miscarried, 5 birthed prematurely (31-36 gestational weeks), 182 delivered at term, and 10 were pregnant at the end of the study. A bivariate and binary logistic regression analysis showed that an age of >30 years, cohesive IUA, lack of increased menstrual volume, and more than 2 times undergoing HA procedure were the risk factors for infertility in IUA patients (P<0.05). Conclusions Age, severity of IUA, increased menstrual volume, and HA procedures were the dominant factors affecting reproductive outcomes and may be regarded as potential predictors for evaluating IUA prognosis.
Physical activity, sedentary time and sleep and associations with mood states, shift work disorder and absenteeism among nurses: an analysis of the cross-sectional Champlain Nurses’ Study

Background Research has suggested ideal combinations of sleep, physical activity (PA) and sedentary time (ST) (i.e., optimal sleep/high PA/low ST) are associated with better overall health. Previous research has shown nurses spend more than half their day sedentary, do not generally meet PA guidelines and have difficulty obtaining adequate sleep. There has been no known work to examine how combinations of sleep, PA and ST relate to the work performance and mental health of nurses. Our objective was to assess the associations of sleep, PA and ST with absenteeism, mood states and shift work disorder (SWD) in a sample of Canadian nurses. Methods A total of 342 nurses from the Champlain Nurses’ Study (mean age ± SD = 43 ± 12 years, 94% women) wore an ActiGraph GT3X accelerometer for ≥ 4 days for ≥ 10 h/day to derive time spent in moderate-to-vigorous intensity physical activity (MVPA) and ST and reported sleep time for ≥ 4 days using daily activity logs. Behavioural patterns were categorized into four groups for comparison based on opposing combinations of sleep, MVPA and ST (e.g., optimal sleep/high MVPA/low ST vs. non-optimal sleep/low MVPA/high ST). Self-reported absenteeism, mood states and SWD as measured by the Profile of Mood States (POMS) and Shift Work Disorder Screening questionnaires, respectively, were compared across combinations of high versus low MVPA and ST, and optimal vs. non-optimal sleep. Results Nurses spent an average of 444 ± 11 min/day sedentary, 14 ± 15 min/day in bouts ≥ 10 minutes of MVPA (23% met PA guidelines) and reported an average of 8 h and 39 min ± 1 h 6 min of sleep/24-h. Significant associations between behaviour groups and the POMS score and its vigor subscale, as well as SWD were observed, however, none were observed for absenteeism. The healthiest behaviour group had a significantly lower mood disturbance compared to 2/3 unhealthy behaviours and greater vigor compared to 2/3 and 3/3 unhealthy behaviours. SWD trended toward being higher amongst the group with 2/3 unhealthy behaviours. Meeting PA guidelines was associated with significantly lower total mood disturbance versus not meeting guidelines (median [IQR] = 0.4 [4.5] vs. 1.3 [4.4], Z = − 2.294, df = 1, p = 0.022), as well as lower anger, higher vigor and lower fatigue. Low ST was associated with lower POMS total mood disturbance scores versus higher ST (0.6 [4.4] vs. 1.4 [4.3], Z = 2.028, df = 1, p = 0.043), as well as higher vigor and lower fatigue. Conclusions In this sample of hospital nurses, the combined effects of sleep, PA and ST are associated with total mood disturbance and SWD. Achieving the recommended levels in all three behaviours may be beneficial in decreasing total mood disturbance and minimizing the effects of SWD. Future work is needed to address the low PA and high ST levels of nurses and to better understand how these behaviours can be improved to optimize the mental health of the health workforce.
Prevalence of Psychiatric Disorders in Iran: A Systematic Review and Meta-analysis

The prevalence of mental disorders in Iran is rising for many reasons including the population growth and its problems, the collapse of the family foundation, the economic problems, etc. Epidemiological studies of psychiatric disorders play an important role in determining the general mental health of the population and policy-making and future planning of service delivery. To identify the relevant studies, two authors independently searched different scholarly databases including Embase, PubMed/MEDLINE, ISI/Web of Science (WOS), Scopus, Psych INFO, and Iranian databases such as MagIran, SID, IranPsych, and Irandoc from 1st January 2007 up to 1st July 2018. The gray literature (through Google Scholar) was also mined. Studies written in English or in the Persian language were searched. After searching the databases and removing duplicates cases, a total of 10 studies were selected and included in the study, which reported a total of 14 prevalence rates. There were a total of 72,262 participants, of whom 32,925 were male and 39,337 were female. The prevalence of psychiatric disorders in studies which used screening tool was 31.03% (95% confidence interval: 25.99–36.07). The prevalence was 25.42% in studies which used clinical interviews (95% CI: 15.96–34.88). There is an undeniable fact that the prevalence of mental disorders in Iran has been increasing, and this could be a warning to policy-makers and health system managers. Hence, it is necessary to pay attention to this issue to maintain social capital, vitality, and efficiency of individuals and society as a whole.