Miracle-dz/UniFAR-FTUs huggingface dataset:
Opportunities and challenges for a standardized curriculum in a student-run clinic network

Abstract Purpose Student-run clinics (SRCs) are prevalent in medical schools. Although these are popular among students and provide ample learning opportunities, these opportunities are not well-characterized. SRCs are poised to support medical schools’ ability to meet accreditation standards and student growth and learning, particularly in areas missing from traditional curricula, such as social determinants of health, interprofessional education and inequities. Materials and methods At the Crimson Care Collaborative (CCC), a network of 7 Harvard Medical School affiliated student-faculty practices in the greater Boston area, we sought to understand what learning opportunities and challenges exist and if a standardized curriculum could improve learning and result in less duplication of teaching efforts. We conducted semi-structured individual interviews of student and faculty leaders and conducted a thematic analysis of the data. Results Four key themes emerged: (1) Standardization provides opportunities and challenges, (2) Embrace the unique learning opportunities of each clinic, (3) Educational coaches enhance learning opportunities and increase efficiency, (4) Reflection is a useful tool for improvement & learning. Discussion Our results demonstrate a benefit to both a standardized curriculum for all SRC sites focused on broad clinical, skill-based training and site-specific teaching focusing on the unique clinical needs of each student-run clinic.
Digital radiography reject analysis: A comparison between two radiology departments in New Zealand

Image reject analysis (RA) in direct digital radiography (DDR) is an important quality indicator tool. Analysis of rejected images is a component of quality assurance (QA) programmes, with the overall aim of reducing patient radiation dose. This study aimed to compare differences in image rejection rates (RR) and the reasons for rejection between two radiology departments.
Determinants and predictors of mental health during and after COVID-19 lockdown among university students in Malaysia

Background Young adults, particularly university students might be at greater risk of developing psychological distress, and exhibiting symptoms of anxiety and depression during the COVID-19 pandemic. The primary objective of this study was to explore and compare the determinants and predictors of mental health (anxiety and depression) during and after the COVID-19 lockdown among university students. Methods This was an observational, cross-sectional study with a sample size of 417 students. An online survey utilizing International Physical Activity Questionnaire–Short Form (IPAQ-SF), General Anxiety Disorder–7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) was distributed to Universiti Tunku Abdul Rahman students via Google forms. Results During lockdown, family income [χ2 (1, n = 124) = 5.155, p = 0.023], and physical activity (PA) [χ2 (1, n = 134) = 6.366, p = 0.012] were associated with anxiety, while depression was associated with gender [χ2 (1, n = 75) = 4.655, p = 0.031]. After lockdown, family income was associated with both anxiety [χ2 (1, n = 111) = 8.089, p = 0.004], and depression [χ2 (1, n = 115) = 9.305, p = 0.002]. During lockdown, family income (OR = 1.60, p = 0.018), and PA (OR = 0.59, p = 0.011) were predictors for anxiety, while gender (OR = 0.65, p = 0.046) was a predictor for depression. After lockdown, family income was a predictor for both anxiety (OR = 1.67, p = 0.011), and depression (OR = 1.70, p = 0.009). Conclusion Significant negative effects attributed to the COVID-19 lockdown, and certain factors predisposed to the worsening of mental health status in university students. Low family income, PA, and female gender were the major determinants and predictors linked to anxiety and depression.
Efficacy and Safety of Renal Function on Edoxaban Versus Warfarin for Atrial Fibrillation: A Systematic Review and Meta-Analysis

Abstract Background: Edoxaban is a novel oral anticoagulant which may decrease the risk of stroke and systemic embolism in patients suffering from atrial fibrillation (AF). However, the decreased efficacy of edoxaban versus warfarin for the avoidance of stroke and systemic embolism in AF with creatinine clearance (CrCl) > 95 mL/min has been reported. The purpose of this meta-analysis is to further clarify the safety (major bleeding) and efficacy (stroke or systemic embolism) of edoxaban for AF patients with various CrCl. Methods: A systematic search of studies on edoxaban and warfarin in AF patients related to renal function was conducted in PubMed, Medline, Web of Science databases, EBSCO, Embase, and the Cochrane Central Register of Controlled Trials. In this meta-analysis (protocol number: PROSPERO CRD 42021245512), we included studies that provide specific data on three outcomes: ischemic stroke or systemic embolism (S/SE), bleeding, and all-cause mortality. Results: This meta-analysis enrolled two randomized controlled trials (RCTs) studies and two retrospective studies that enrolled 28,065 patients. According to CrCl, subjects are divided into three groups (CrCl 30–50 mL/min, CrCl 50–95 mL/min, CrCl > 95 mL/min). In AF patients with CrCl 30–50 mL/min, edoxaban 30 mg daily is similar to warfarin in the prevention of ischemic S/SE and all-cause mortality, resulting in lower bleeding rate and better net clinical outcome (ischemic S/SE: hazard ratio (HR), 0.85, 95% confidence interval (CI), 0.19–1.87; all-cause mortality: HR, 0.65, 95% CI, 0.35–1.19; bleeding: HR, 0.75, 95% CI, 0.60–0.93; net clinical outcome: HR, 0.75, 95% CI, 0.63–0.90). In the group of CrCl 50–95 mL/min, the net clinical outcome was more favorable with edoxaban 60 mg daily than warfarin (HR, 0.81, 95% CI: 0.68–0.96), and there was no significant difference between edoxaban 60 mg daily and warfarin in terms of prevention of bleeding, ischemic S/SE, and all-cause mortality. For AF patients with CrCl > 95 mL/min, there was a statistically significant difference in lower bleeding rate between edoxaban 60 mg daily and warfarin (bleeding: HR: 0.70, 95% CI: 0.58–0.84). There was no differential safety in ischemic S/SE, all-cause mortality, and net clinical outcome. Conclusion: Overall, edoxaban was superior to warfarin in terms of net clinical outcome in various groups of CrCl with AF patients. Although there was no significant difference in net clinical outcome between edoxaban and warfarin for AF patients with CrCl > 95 mL/min, edoxaban is not inferior to warfarin in safety and effectiveness in the various levels of CrCl. Edoxaban may be a more effective and safe treatment than warfarin for patients with chronic kidney disease (CKD) who require anticoagulation. More high-quality and long-term clinical research are needed to further estimate the effects of edoxaban.
Toward Single-Time-Point Image-Based Dosimetry of 177Lu-PSMA-617 Therapy

Visual Abstract Radiopharmaceutical therapies (RPTs) with 177Lu-prostate-specific membrane antigen (PSMA) ligands have demonstrated promising results for the treatment of metastatic castration-resistant prostate cancer. The lack of absorbed-dose–effect relationships currently prevents patient-specific activity personalization. To ease the implementation of dosimetry in the routine clinical workflow for RPT, simplified methods such as single-time-point (STP) instead of multiple-time-point (MTP) imaging protocols are required. This work aimed at assessing differences in the time-integrated activity (TIA) of STP versus MTP image-based dosimetry for 177Lu-PSMA-617 therapy. Methods: Twenty metastatic castration-resistant prostate cancer patients with MTP quantitative 177Lu-SPECT imaging data (∼24, 48, and 72 h post injection (p.i.)) available on first and second 177Lu-PSMA-617 therapy cycles were included in this study. Time–activity curves were fitted for kidneys and lesions to derive effective half-lives and yield a reference TIA. STP approaches involved the formula by Hänscheid (STPH) and a prior-information method (STPprior) that uses the effective half-lives from the first therapy cycle. All time points were considered for the STP approaches. Percentage differences (PDs) in TIA between STP and MTP were compared for the second therapy cycle. Results: Using STPH at 48 h p.i. for kidneys showed a −1.3% ± 5.6% PD from MTP, whereas STPprior showed a PD of 4.6% ± 6.2%. The smallest average PDs for the 56 investigated individual lesions were found using STPprior at 48 h p.i. , at only 0.4% ± 14.9%, whereas STPH at 72 h p.i. had a smallest PD of −1.9% ± 14.8%. Conclusion: STP dosimetry for 177Lu-PSMA-617 therapy using a single SPECT/CT scan at 48 or 72 h p.i. is feasible, with a PD of less than ±20% compared with MTP. The validity of both STPH and STPprior has been demonstrated. We believe this finding can increase the adoption of dosimetry and facilitate implementation in routine clinical RPT workflows. Doing so will ultimately enable the finding of dose–effect relationships based on fixed therapy activities that may, in future, allow for absorbed-dose–based RPT activity personalization.
Nonparametric Person-Fit Analysis of Polytomous Item Scores

Person-fit methods are used to uncover atypical test performance as reflected in the pattern of scores on individual items in a test. Unlike parametric person-fit statistics, nonparametric person-fit statistics do not require fitting a parametric test theory model. This study investigates the effectiveness of generalizations of nonparametric person-fit statistics to polytomous item response data. A simulation study using varying test and item characteristics shows that a simple count of the Guttman errors is effective in detecting serious person misfit. The simulation study further shows that in most conditions a simple nonparametric person-fit statistic is as effective as a commonly used parametric person-fit statistic in detecting deviant item score vectors. An empirical example illustrates the use of the nonparametric person-fit statistics in real data.
Empirically Based Gamma-Distributed Random Wall Pressure Field in Silo

Measurements show that silo wall pressures exhibit large fluctuations in time and space during discharge of the silo. This observation is important for the design of the silo wall because spatial pressure variations may impose substantial bending moments in the silo wall that otherwise may be small or vanishing due to the carrying ability of the membrane forces in the silo wall. Information about the stochastic properties of this pressure variation cannot be obtained from any existing continuum model for the silo medium flowing within the confinement of the silo. Therefore the modeling must presently be tied to statistical analyses of the empirical evidence combined with simple mechanical principles. This paper analyzes the same data set as that analyzed by Munch-Andersen et al., but on the basis of a completely different and physically less disputable stochastic pressure field model than the one considered by them. It is shown that an explicitly constructed gamma distribution type of field in equilibrium.
Reaching Populations at Risk for HIV Through Targeted Facebook Advertisements: Cost-Consequence Analysis

Background An undiagnosed HIV infection remains a public health challenge. In the digital era, social media and digital health communication have been widely used to accelerate research, improve consumer health, and facilitate public health interventions including HIV prevention. Objective We aimed to evaluate and compare the projected cost and efficacy of different simulated Facebook (FB) advertisement (ad) approaches targeting at-risk populations for HIV based on new HIV diagnosis rates by age group and geographic region in the United States. Methods We used the FB ad platform to simulate (without actually launching) an automatically placed video ad for a 10-day duration targeting at-risk populations for HIV. We compared the estimated total ad audience, daily reach, daily clicks, and cost. We tested ads for the age group of 13 to 24 years (in which undiagnosed HIV is most prevalent), other age groups, US geographic regions and states, and different campaign budgets. We then estimated the ad cost per new HIV diagnosis based on HIV positivity rates and the average health care industry conversion rate. Results On April 20, 2021, the potential reach of targeted ads to at-risk populations for HIV in the United States was approximately 16 million for all age groups and 3.3 million for age group 13 to 24 years, with the highest potential reach in California, Texas, Florida, and New York. When using different FB ad budgets, the daily reach and daily clicks per US dollar followed a cumulative distribution curve of an exponential function. Using multiple US $10 ten-day ads, the cost per every new HIV diagnosis ranged from US $13.09 to US $37.82, with an average cost of US $19.45. In contrast, a 1-time national ad had a cost of US $72.76 to US $452.25 per new HIV diagnosis (mean US $166.79). The estimated cost per new HIV diagnosis ranged from US $13.96 to US $55.10 for all age groups (highest potential reach and lowest cost in the age groups 20-29 and 30-39 years) and from US $12.55 to US $24.67 for all US regions (with the highest potential reach of 6.2 million and the lowest cost per new HIV diagnosis at US $12.55 in the US South). Conclusions Targeted personalized FB ads are a potential means to encourage at-risk populations for HIV to be tested, especially those aged 20 to 39 years in the US South, where the disease burden and potential reach on FB are high and the ad cost per new HIV diagnosis is low. Considering the cost efficiency of ads, the combined cost of multiple low-cost ads may be more economical than a single high-cost ad, suggesting that local FB ads could be more cost-effective than a single large-budget national FB ad.
Real-life comparison of efficacy and safety profiles of two prolonged-release tacrolimus formulations in de novo kidney transplant recipients: 24 months of follow-up

Introduction Calcineurin inhibitors constitute a cornerstone of immunosuppressive therapy in kidney transplant recipients. There are two main formulations of tacrolimus (Tac) which exhibit a prolonged-release mode of action: Advagraf® (MR-4) and Envarsus® (LCPT). However, they are not bioequivalent. Data comparing both once-daily prolonged-release formulations of Tac are insufficient. Objective The aim of the study was to compare safety and efficacy profiles of once-daily LCPT and MR-4 formulations of tacrolimus in adult kidney transplant recipients. Patients and methods An observational, cohort single-center study was performed. One hundred fifteen kidney transplant recipients transplanted between 2016 and 2019 were enrolled to the study (59 vs 56, Envarsus® vs Advagraf®, respectively). Safety and efficacy profiles were assessed. Results Patient and graft survival at 12 and 24 months did not differ between the groups. There were no significant differences in serum creatinine at any timepoint. C/D ratio in the LCPT group was significantly higher at 12 and 24 months. Sepsis occurrence was more frequent in MR-4 group at 12 months. Conclusion Both prolonged-release formulations of tacrolimus are safe and effective in immunosuppressive therapy in kidney transplant recipients.
Fuzzy understanding of neighborhoods with nearest unlike neighbor sets

A new fuzzy learning and classification scheme based on developing a fuzzy understanding of neighborhoods with nearest unlike neighbor sets (NUNS) is reported in this study. NUNS, by definition, the set of samples identified as the nearest from the other class(es) for each given sample, represent in essence the boundaries between pattern classes known in the problem environment. Accordingly, samples close to the NUNS are likely to have more ambiguity or uncertainty in their labels than those farther away from these NUNS. This information about the uncertainty or imprecision in the labels of the given training set can be extracted and represented in terms of fuzzy memberships. These fuzzy membership values, which may be determined in the learning phase using appropriate fuzzy membership models, can then be utilized in the classification phase to derive the identity of an unknown sample. This classification can be accomplished using any one of the established fuzzy classification techniques.
Small area estimation of mean price of habitation transaction using time-series and cross-sectional area-level models

In this paper, a new small domain estimator for area-level data is proposed. The proposed estimator is driven by a real problem of estimating the mean price of habitation transaction at a regional level in a European country, using data collected from a longitudinal survey conducted by a national statistical office. At the desired level of inference, it is not possible to provide accurate direct estimates because the sample sizes in these domains are very small. An area-level model with a heterogeneous covariance structure of random effects assists the proposed combined estimator. This model is an extension of a model due to Fay and Herriot [5], but it integrates information across domains and over several periods of time. In addition, a modified method of estimation of variance components for time-series and cross-sectional area-level models is proposed by including the design weights. A Monte Carlo simulation, based on real data, is conducted to investigate the performance of the proposed estimators in comparison with other estimators frequently used in small area estimation problems. In particular, we compare the performance of these estimators with the estimator based on the Rao–Yu model [23]. The simulation study also accesses the performance of the modified variance component estimators in comparison with the traditional ANOVA method. Simulation results show that the estimators proposed perform better than the other estimators in terms of both precision and bias.
A memetic algorithm for finding multiple subgraphs that optimally cover an input network

Finding dense subgraphs is a central problem in graph mining, with a variety of real-world application domains including biological analysis, financial market evaluation, and sociological surveys. While a series of studies have been devoted to finding subgraphs with maximum density, the problem of finding multiple subgraphs that best cover an input network has not been systematically explored. The present study discusses a variant of the densest subgraph problem and presents a mathematical model for optimizing the total coverage of an input network by extracting multiple subgraphs. A memetic algorithm that maximizes coverage is proposed and shown to be both effective and efficient. The method is applied to real-world networks. The empirical meaning of the optimal sampling method is discussed.
The Quality of Literature Search Reporting in Systematic Reviews Published in the Urological Literature (1998-2021)

Purpose: We evaluate to what extent systematic reviews published in the urological literature follow best practices for the reporting of searches. Materials and Methods: Systematic reviews addressing questions of therapy/prevention were sought out in 5 major urological journals from January 1998 to December 2021. Two members performed study selection and data abstraction independently and in duplicate. The methodological and reporting quality of these systematic reviews was assessed using operationalized criteria based on the PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-analyses–literature search extension) and PRISMA 2020 checklists. Proportions of systematic reviews that satisfied each criterion were compared based on period (1998-2012, 2013-2016, and 2017-2021) and journal of publication. Results: The search identified 483 systematic reviews that met inclusion criteria. Most systematic reviews searched 2 or more electronic databases (88.6%); few searched abstract proceedings (26.7%), clinical trial registries (15.1%), or dedicated databases of the “gray literature” (6.2%). Approximately 1 in 3 systematic reviews (32.3%) were explicit in not restricting searches by language. A few criteria demonstrated improved reporting over time including use of clinical trial registries (6.8% vs 14.4% vs 23.3%; P = .001), searches unrestricted by language (37.3% vs 49.3% vs 55.1%; P = .006), and flow diagram reporting (34.8% vs 82.9% vs 93.2%; P = .001) but not the search of abstract proceedings (28.6% vs 24.0% vs 27.3%; P = .647). Reporting characteristics across journals were similar. Conclusions: Systematic reviews published in the urological literature have considerable shortcomings regarding the reporting of their underlying search strategies. Efforts must be taken to improve search strategies in the form of better training in systematic review methods as well as the more stringent enforcement of reporting guidelines.
Hankel norm approximation of linear systems with time-varying delay: continuous and discrete cases

This paper investigates the problem of Hankel norm model reduction for linear systems with time-varying delay in the state. For a given stable system, our attention is focused on the construction of reduced-order model, which guarantees the corresponding error system to be asymptotically stable and has a specified Hankel norm error performance. Two different approaches are proposed to solve this problem. One casts the model reduction into a convex optimization problem by using a linearization procedure, and the other is based on the cone complementarity linearization idea, which casts the model reduction into a sequential minimization problem subject to linear matrix inequality constraints. Both continuous and discrete time cases are considered. A numerical example is provided to show the effectiveness of the proposed theory.
Circulating Fatty Acid-binding Protein 4 Response to Acute Aerobic Exercise in Healthy Men

Abstract This study aimed to investigate the association between changes in FABP4 concentration and hormone and metabolite levels during and after acute low- and moderate-intensity aerobic exercise in healthy men. Eleven healthy men (24.4±1.4 years) were administered three trials in random order: 1) low-intensity aerobic exercise trial (LE trial; acute exercise at 40% peak oxygen uptake [Vo 2 peak]+bed rest), 2) moderate-intensity aerobic exercise trial (ME trial: acute exercise at 60%Vo 2 peak+bed rest), and 3) bed rest (Con trial). Expired gas and venous blood samples were collected at baseline, and immediately, 30 and 60 min after exercise, and substrate oxidation and hormone, metabolite, and FABP4 concentrations were measured. FABP4 concentration did not increase during aerobic exercise in LE and ME trials (p>0.05). However, FABP4 concentration significantly increased after the acute aerobic exercise in both the LE and ME trials (p≤0.003). Increased FABP4 concentration after acute exercise was not correlated with adrenaline, noradrenaline, other hormone, and metabolite concentration changes. These findings suggest that FABP4 concentration increases after acute aerobic exercise independently of exercise intensity. Furthermore, increased FABP4 concentration after acute aerobic exercise may not be involved in the magnitude of adrenaline, noradrenaline, and lipolytic response.