Miracle-dz/UniFAR-FTUs huggingface dataset:
Risk Factors for Intrapartum Cesarean Section Delivery in Low-risk Multiparous Women Following at Least a Prior Vaginal Birth (Robson Classification 3 and 4)

Abstract Objective The aim of the present study was to evaluate the risk factors for cesarean section (C-section) in low-risk multiparous women with a history of vaginal birth. Methods The present retrospective study included low-risk multiparous women with a history of vaginal birth who gave birth at between 37 and 42 gestational weeks. The subjects were divided into 2 groups according to the mode of delivery, as C-section Group and vaginal delivery Group. Risk factors for C-section such as demographic characteristics, ultrasonographic measurements, smoking, weight gain during pregnancy (WGDP), interval time between prior birth, history of macrosomic birth, and cervical dilatation at the admission to the hospital were obtained from the charts of the patients. Obstetric and neonatal outcomes were compared between groups. Results The most common C-section indications were fetal distress and macrosomia (33.9% [n = 77 and 20.7% [n = 47] respectively). A bivariate correlation analysis demonstrated that mothers aged > 30 years old (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.30–3.34; p = 0.002), parity >1 (OR: 1.81; 95%CI: 1.18–2.71; p = 0.006), fetal abdominal circumference (FAC) measurement > 360 mm (OR: 34.20; 95%CI: 8.04—145.56; p < 0.001)) and < 345 mm (OR: 3.06; 95%CI: 1.88–5; p < 0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35–19.21; p = 0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1–2.33; p = 0.041), and cervical dilatation < 5cm at admission (OR: 2.12; 95%CI: 1.34–3.34; p = 0.001) were associated with the group requiring a C-section. Conclusion This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4. Fetal distress and suspected fetal macrosomia constituted most of the C-section indications.
A case report of pyogenic liver abscess caused by hypervirulent Klebsiella pneumoniae diagnosed by metagenomic next-generation sequencing

A 56-year-old woman with a history of diabetes mellitus presented with high fever but no abdominal pain. An abdominal computed tomography scan showed a large liver abscess. Hypervirulent, string test-positive, rmpA/ampA2-, and iutA-positive Klebsiella pneumoniae was rapidly identified from drainage fluid of the liver abscess using metagenomic next-generation sequencing (mNGS). After intravenous antibiotic therapy and drainage of the abscess, the patient’s condition resolved. This case report highlights the value of mNGS in rapidly and accurately identifying a pathogenic microorganism, which helps reduce the incidence of antimicrobial resistance and enables the targeted use of antibiotics.
Drug‐Eluting Endotracheal Tubes for Preventing Bacterial Inflammation in Subglottic Stenosis

Subglottic stenosis (SGS) results from dysregulated extracellular matrix deposition by laryngotracheal fibroblasts causing scar tissue formation following intubation. Recent work has highlighted a relationship between this inflammatory state and imbalances in the upper airway microbiome. Herein, we engineer novel drug‐eluting endotracheal (ET) tubes to deliver a model antimicrobial peptide Lasioglossin‐III (Lasio) for the local modulation of the microbiome during intubation.
The Galleria mellonella-Enteropathogenic Escherichia coli Model System: Characterization of Pathogen Virulence and Insect Immune Responses

Abstract The use of Galleria mellonella (Linnaeus) (Lepidoptera: Pyralidae), an economical insect model, for the study of enteropathogenic Escherichia coli (Migula) (EPEC), a diarrheagenic human pathogen, has been demonstrated previously but remains poorly understood. The present study characterizes the Galleria-EPEC system extensively for future studies using this system. We found that EPEC causes disease in G. mellonella larvae when injected intrahemocoelically but not orally. Disease manifests as increased mortality, decreased survival time, delayed pupation, decreased pupal mass, increased pupal duration, and hemocytopenia. Disease symptoms are dose-dependent and can be used as metrics for measuring EPEC virulence in future studies. The type III secretion system was only partially responsible for EPEC virulence in G. mellonella while the majority of the virulence remains unknown in origin. EPEC elicits insect anti-bacterial immune responses including melanization, hemolymph coagulation, nodulation, and phagocytosis. The immune responses were unable to control EPEC replication in the early stage of infection (≤3 h post-injection). EPEC clearance from the hemocoel does not guarantee insect survival. Overall, this study provided insights into EPEC virulence and pathogenesis in G. mellonella and identified areas of future research using this system.
Medical Students’ Perceptions of Play and Learning: Qualitative Study With Focus Groups and Thematic Analysis

Background In times where distance learning is becoming the norm, game-based learning (GBL) is increasingly applied to health profession education. Yet, decisions for if, when, how, and for whom GBL should be designed cannot be made on a solid empirical basis. Though the act of play seems to be intertwined with GBL, it is generally ignored in the current scientific literature. Objective The objective of our study was to explore students’ perceptions of play in leisure time and of GBL as part of a mechanistic, bottom-up approach towards evidence-informed design and implementation of GBL in health profession education. Methods We conducted 6 focus group discussions with medical and dentistry students, which were analyzed using thematic analysis. Results A total of 58 students participated. We identified 4 major themes based on the students’ perception of play in leisure time and on the combination of play and learning. Our results indicate that, while play preferences were highly various in our health profession student cohort, pleasure was the common ground reported for playing. Crucially, play and the serious act of learning seemed paradoxical, indicating that the value and meaning of play are strongly context-dependent for students. Conclusions Four key points can be constructed from our study. First, students play for pleasure. Perceptions of pleasure vary considerably among students. Second, students consider play as inefficient. Inefficiency will only be justified when it increases learning. Third, play should be balanced with the serious and only be used for difficult or tedious courses. Fourth, GBL activities should not be made compulsory for students. We provide practical implications and directions for future research.
Extrapolating Long-term Event-Free and Overall Survival With Dapagliflozin in Patients With Heart Failure and Reduced Ejection Fraction: An Exploratory Analysis of a Phase 3 Randomized Clinical Trial.

Importance Sodium glucose cotransporter 2 inhibitors reduce morbidity and mortality in patients with heart failure and reduced ejection fraction (HFrEF). Clinicians may find estimates of the projected long-term benefits of sodium glucose cotransporter 2 inhibitors a helpful addition to clinical trial results when communicating the benefits of this class of drug to patients. Objective To estimate the projected long-term treatment effects of dapagliflozin in patients with HFrEF over the duration of a patient's lifetime. Design, Setting, and Participants Exploratory analysis was performed of Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF), a phase 3 randomized, placebo-controlled clinical trial conducted at 410 sites in 20 countries. Patients with an ejection fraction less than or equal to 40% in New York Heart Association functional classification II to IV and elevated plasma levels of N-terminal pro B-type natriuretic peptide were enrolled between February 15, 2017, and August 17, 2018, with final follow-up on June 6, 2019. Mean (SD) duration of follow-up was 17.6 (5.2) months. Interventions Dapagliflozin, 10 mg, once daily vs placebo in addition to standard therapy. Main Outcomes and Measures The primary composite outcome was time to first hospitalization for heart failure, urgent heart failure visit requiring intravenous therapy, or cardiovascular death. The trial results were extrapolated to estimate the projected long-term treatment effects of dapagliflozin over the duration of a patient's lifetime for the primary outcome and the secondary outcome of death from any cause. Results A total of 4744 patients (1109 women [23.4%]; 3635 men [76.6%]) were randomized in DAPA-HF, with a mean (SD) age of 66.3 (10.9) years. The extrapolated mean event-free survival for an individual aged 65 years from a primary composite end point event was 6.2 years for placebo and 8.3 years for dapagliflozin, representing an event-free survival time gain of 2.1 years (95% CI, 0.8-3.3 years; P = .002). When considering death from any cause, mean extrapolated life expectancy for an individual aged 65 years was 9.1 years for placebo and 10.8 years for dapagliflozin, with a gain in survival of 1.7 years (95% CI, 0.1-3.3; P = .03) with dapagliflozin. Similar results were seen when extrapolated across the age range studied. In analyses of subgroups of patients in DAPA-HF, consistent benefits were seen with dapagliflozin on both event-free and overall survival. Conclusions and Relevance These findings indicate that dapagliflozin provides clinically meaningful gains in extrapolated event-free and overall survival. These findings may be helpful in communicating the benefits of this treatment to patients with HFrEF. Trial Registration ClinicalTrials.gov Identifier: NCT03036124.
RNA editing enzyme adenosine deaminases acting on RNA 1 deficiency increases the sensitivity of non‐small cell lung cancer cells to anlotinib by regulating CX3CR1‐fractalkine expression

Adenosine deaminases acting on RNA 1 (ADAR1) has been identified to play key roles in non‐small cell lung cancer (NSCLC) progression, and can modulate the sensitivity of cancer cells to anticancer drugs. The current study aimed to investigate the effect of ADAR1 on the sensitivity of NSCLC cells to anlotinib. We established anlotinib‐resistant NSCLC (NSCLC/AR) cells, including NCI‐H1975/AR and A549/AR cells. Results showed that ADAR1 was significantly upregulated in NSCLC/AR cells. Genetic‐knockdown of ADAR1 increased the sensitivity of NSCLC/AR cells to anlotinib by inducing cell proliferation suppression, cell cycle arrest, and apoptosis. Furthermore, knockdown of ADAR1 decreased the level of C‐X3‐C motif chemokine ligand 1 (CX3CL1) in NCI‐H1975/AR and A549/AR cells after anlotinib treatment. Introduction of exogenous CX3CL1 significantly reversed the positive effect of ADAR1 deficiency on NSCLC/AR cell sensitivity, exhibited by the increase of cell viability and decrease of apoptosis. Further in‐vivo study demonstrated that knockdown of ADAR1 inhibited NCI‐H1975/AR cell tumorigenesis by reducing CX3CL1 expression. Collectively, ADAR1 deficiency increased the sensitivity of NSCLC/AR cells to anlotinib by downregulating CX3CL1, which might provide a potential strategy for NSCLC/AR therapy.
Large‐scale reanalysis of refrigerated antemortem blood samples for ethanol content at random intervals

Ethanol stability in antemortem blood stored under various conditions has been widely studied. Most such studies have somewhat limited sample size (<50) and limited variation in the length of time between the blood draw and the first analysis and between the first analysis and the reanalysis. In the work presented here, the antemortem blood drawn for forensic purposes and stored refrigerated (~4°C) in 371 cases was analyzed for ethanol concentration using headspace gas chromatography at various times after the blood draw based on routine case flow and then also analyzed at various times within approximately 1 year after the first analysis. This methodology is intended to provide insight into the range of differences expected when cases are analyzed in the normal flow of casework and then reanalyzed at random times afterwards as occurs when reanalysis is performed by the defense or by the laboratory if the original analyst is unavailable to testify. In 22 cases, the same blood tube from the case was reanalyzed. The previously unopened blood tube from the case was analyzed in 349 cases. The 25 cases in which the blood was ethanol‐negative based on the first analysis remained ethanol‐negative when reanalyzed. The average difference in ethanol concentration between tests for the ethanol‐positive cases was −0.004 g/dL. This decrease was statistically significant at the 0.05 level of significance. The range of differences was −0.0197 to 0.0103 g/dL. The difference measured in 85% of the ethanol‐positive cases was in in the range of −0.008 to −0.001 g/dL.
Factors associated with difficulty in adapting and intent to leave among new graduate nurses in South Korea

Background New graduate nurses experience difficulty in adapting to a new environment, which affects intent to leave. However, data on the factors contributing to difficulty in adapting and intent to leave among new graduate nurses are insufficient. Purpose The aim of the study was to explore and compare factors associated with difficulty in adapting and the intent to leave among new graduate nurses in South Korea. Methodology This cross-sectional study used secondary data analysis. Primary data were obtained from the 2015–2016 Korean National Graduates Occupational Mobility Survey. Descriptive statistics, independent t tests, and chi-square statistics with weighted samples besides multivariate logistic regression analyses were conducted (N = 467). Results Roughly 46% of nurses reported difficulty adapting, and 16% expressed their intent to leave. The factors linked to difficulty in adapting were working at large hospitals with rotating shifts, low person–job fit, and low satisfaction with personal competency; intent to leave was associated with high monthly salary and low satisfaction with the workplace (all ps < .05). Difficulty in adapting did not equate to their intent to leave. Conclusions There were high rates of difficulty in adapting and intent to leave among new graduate nurses. Although different factors were associated with difficulty adapting and intent to leave, workplace condition is a common factor. Practice Implications Different strategies are needed to improve adaptation and intention of leaving among new graduate nurses. For better adaptation, developing training programs enhancing professional competency with a sufficient training period is required. In addition, providing staff and resources to reduce the intent to leave is crucial.
Pervasive Positive Selection on Virus Receptors Driven by Host-Virus Conflicts in Mammals

Viral receptors are cellular proteins hijacked by viruses to help their infections. A complete picture on the evolution of viral receptors in mammals is still lacking. ABSTRACT Viruses hijack cellular proteins, known as viral receptors, to initiate their infections. Viral receptors are subject to two conflicting directional forces, namely, negative selection to maintain their cellular function and positive selection resulted from the ever-changing host-virus arms race. Much remains unclear about how viral receptors evolved in mammals and whether viral receptors from different mammal groups experienced different strengths of natural selection. Here, we perform evolutionary analyses of 92 viral receptors in five major orders of mammals, including Carnivora, Cetartiodactyla, Chiroptera, Primates, and Rodentia. In all five mammal orders, signals of positive selection are detected for a high proportion of viral receptors (from 41% in Carnivora to 65% in Rodentia). Many positively selected residues overlap the host-virus interaction interface. Compared with control genes, we find viral receptors underwent elevated rates of adaptive evolution in all five mammal orders, suggesting that host-virus conflicts are the main driver of the adaptive evolution of viral receptors in mammals. Interestingly, the overall strength of natural selection acting on viral receptors driven by the host-virus arms race is largely homogenous and correlated among different mammal orders, with bats and rodents, zoonosis reservoirs of importance, being unexceptional. Taken together, our findings indicate host-virus conflicts have driven the elevated rate of adaptive evolution in viral receptors across mammals and might have important implications in zoonosis surveillance and prediction. IMPORTANCE Viral receptors are cellular proteins hijacked by viruses to help their infections. A complete picture on the evolution of viral receptors in mammals is still lacking. Here, we perform a comprehensive evolutionary analysis of the evolution of 92 viral receptors in five mammal orders, including Carnivora, Cetartiodactyla, Chiroptera, Primates, and Rodentia. We find that positive selection pervasively occurred during the evolution of viral receptors, and viral receptors exhibit an elevated rate of adaptive evolution compared to that of control genes in all five mammal orders, suggesting host-virus conflicts are a major driver of the adaptive evolution of viral receptors. Interestingly, the strength of positive selection acting on viral receptors is similar among the five mammal orders. Our study might have important implications in understanding the evolution of host-virus interaction.
Convolutional Neural Network With Sparse Strategies to Classify Dynamic Functional Connectivity

Classification of dynamic functional connectivity (DFC) is becoming a promising approach for diagnosing various neurodegenerative diseases. However, the existing methods generally face the problem of overfitting. To solve it, this paper proposes a convolutional neural network with three sparse strategies named SCNN to classify DFC. Firstly, an element-wise filter is designed to impose sparse constraints on the DFC matrix by replacing the redundant elements with zeroes, where the DFC matrix is specially constructed to quantify the spatial and temporal variation of DFC. Secondly, a 1×1 convolutional filter is adopted to reduce the dimensionality of the sparse DFC matrix, and remove meaningless features resulted from zero elements in the subsequent convolution process. Finally, an extra sparse optimization classifier is employed to optimize the parameters of the above two filters, which can effectively improve the ability of SCNN to extract discriminative features. Experimental results on multiple resting-state fMRI datasets demonstrate that the proposed model provides a better classification performance of DFC compared with several state-of-the-art methods, and can identify the abnormal brain functional connectivity.
Robust joint modelling of longitudinal and survival data: Incorporating a time‐varying degrees‐of‐freedom parameter

Monitoring of individual biomarkers has the potential of explaining the hazard of survival outcomes. In practice, these measurements are intermittently observed and are known to be subject to substantial measurement error. Joint modelling of longitudinal and survival data enables us to associate intermittently measured error‐prone biomarkers with risks of survival outcomes and thus plays an important role in the analysis of medical data. Most of the joint models available in the literature have been built on the Gaussian assumption. This makes them sensitive to outliers. In this work, we study a range of robust models to address this issue. Of particular interest is the common occurrence in medical data that outliers can occur with different frequencies over time, for example, in the period when patients adjust to treatment changes. Motivated by the analysis of data gathered from patients with primary biliary cirrhosis, a new model with a time‐varying robustness is introduced. Through both the motivating example and a simulation study, this research not only stresses the need to account for longitudinal outliers in the analysis of medical data and in joint modelling research but also highlights the bias and inefficiency from not properly estimating the degrees‐of‐freedom parameter. This work presents a number of methods in addition to the time‐varying robustness, and each method can be fitted using the R package robjm.
Financial Preparedness for Emergencies: Age Patterns and Multilevel Vulnerabilities

Guided mainly by the social vulnerability perspective and life course perspective, this study examined age patterns of financial preparedness for emergencies and how they were contextualized by vulnerabilities at the individual and community levels. We matched data from the Federal Emergency Management Agency 2018 National Household Survey and 15 indicators of the Social Vulnerability Index at the county level. Two-level logistic regressions were conducted with the working sample, which included 4,623 respondents from 958 counties. The results showed that adults aged 18 to 44 were more likely than those aged 65 to 74 to set aside money for emergencies among Hispanics, those with minor children in the household, and in communities with higher levels of poverty, higher percentages of minorities, and higher percentages of no vehicles, but less likely to do so among the White and those with insurance. The findings were discussed within a multilevel layered vulnerability framework.
Antibacterial and Osteoinductive Implant Surface Using Layer-by-Layer Assembly

Osseointegration of dental, craniofacial, and orthopedic implants is critical for their long-term success. Multifunctional surface treatment of implants was found to significantly improve cell adhesion and induce osteogenic differentiation of dental-derived stem cells in vitro. Moreover, local and sustained release of antibiotics via nanolayers from the surface of implants can present unparalleled therapeutic benefits in implant dentistry. Here, we present a layer-by-layer surface treatment of titanium implants capable of incorporating BMP-2–mimicking short peptides and gentamicin to improve their osseointegration and antibacterial features. Additionally, instead of conventional surface treatments, we employed polydopamine coating before layer-by-layer assembly to initiate the formation of the nanolayers on rough titanium surfaces. Cytocompatibility analysis demonstrated that modifying the titanium implant surface with layer-by-layer assembly did not have adverse effects on cellular viability. The implemented nanoscale coating provided sustained release of osteoinductive peptides with an antibacterial drug. The surface-functionalized implants showed successful osteogenic differentiation of periodontal ligament stem cells and antimicrobial activity in vitro and increased osseointegration in a rodent animal model 4 wk postsurgery as compared with untreated implants. Altogether, our in vitro and in vivo studies suggest that this approach can be extended to other dental and orthopedic implants since this surface functionalization showed improved osseointegration and an enhanced success rate.