Miracle-dz/UniFAR-FTUs huggingface dataset:
A Lack of Continuity in Education, Training, and Practice Violates the "Do No Harm" Principle.

The paradigm shift to competency-based medical education (CBME) is under way, but incomplete implementation is blunting the potential impact on learning and patient outcomes. The fundamental principles of CBME call for standardizing outcomes addressing population health needs, then allowing time-variable progression to achieving them. Operationalizing CBME principles requires continuity within and across phases of the education, training, and practice continuum. However, the piecemeal origin of the phases of the "continuum" has resulted in a sequence of undergraduate to graduate medical education to practice that may be continuous temporally but bears none of the integration of a true continuum.With these timed interruptions during phase transitions, learning is not reinforced because of a failure to integrate experiences. Brief block rotations for learners and ever-shorter supervisory assignments for faculty preclude the development of relationships. Without these relationships, feedback falls on deaf ears. Block rotations also disrupt learners' relationships with patients. The harms resulting from such a system include decreases in patient satisfaction with their care and learner satisfaction with their work. Learners in this block system also demonstrate an erosion of empathy compared with those in innovative longitudinal training models. In addition, higher patient mortality during intern transitions has been demonstrated.The current medical education system is violating the first principle of medicine: "Do no harm. " Full implementation of competency-based, time-variable education and training, with fixed outcomes aligned with population health needs, continuity in learning and relationships, and support from a developmental program of assessment, holds great potential to stop this harm.
Prevalence of Metabolic Syndrome in an Employed Population as Determined by Analysis of Three Data Sources

Objective: The aim of this study was to compare estimates of the prevalence and incidence of metabolic syndrome (MetS) using various data sources. Methods: We integrated health risk assessment (HRA), claims, and biometric screening data from Lockheed Martin Corporation. We measured the extent to which MetS risk factors measured using HRA and medical claims correlated with biometric screening data. Results: Using biometric data, 24.9% of employees were identified as having MetS. Prevalence estimates were much lower using HRA data (6.8%) and claims (3.7%). Between 2012 and 2014, 10.4% of the sample newly acquired MetS. The number of MetS risk factors per employee was predictive of diabetes, heart disease, health care costs, and utilization. Conclusion: MetS is prevalent and associated with progression to disease. It is more easily tracked with biometric screening data than with HRA or claims data. Employers should consider efforts to manage and prevent this condition in their workforce.
A Novel Pediatric Residency Coaching Program: Outcomes After One Year.

PROBLEM The ACGME requires all residency programs to assess residents on specialty-specific milestones. Optimal assessment of competence is through direct observation of performance in clinical settings, which is challenging to implement. APPROACH The authors developed the Stanford Pediatric Residency Coaching Program to improve residents' clinical skill development, reflective practice, feedback, and goal setting, and to improve learner assessment. All residents are assigned a dedicated faculty coach who coaches them throughout their training in various settings in an iterative process. Each coaching session consists of four parts: (1) direct observation, (2) facilitated reflection, (3) feedback from the coach, and (4) goal setting. Coaches document each session and participate in the Clinical Competency Committee. Initial program evaluation (2013 -2014) focused on the program's effect on feedback, reflection, and goal setting. Pre- and postintervention surveys of residents and faculty assessed the quantity and quality of feedback provided to residents and faculty members' confidence in giving feedback. OUTCOMES Review of documented coaching sessions showed that all 82 residents had 3 or more direct observations (range: 3-12). Residents and faculty assessed coaches as providing higher-quality feedback and incorporating more reflection and goal setting than noncoaches. Coaches, compared with noncoaches, demonstrated increased confidence in giving feedback on clinical reasoning, communication skills, and goal setting. Noncoach faculty reported giving equal or more feedback after the coaching program than before. NEXT STEPS Further evaluation is under way to explore how coaching residents can affect patient-level outcomes, and to better understand the benefits and challenges of coaching residents.
Evaluation of the fetal QT interval using non-invasive fetal ECG technology

Non-invasive fetal electrocardiography (NI-FECG) is a promising alternative continuous fetal monitoring method that has the potential to allow morphological analysis of the FECG. However, there are a number of challenges associated with the evaluation of morphological parameters from the NI-FECG, including low signal to noise ratio of the NI-FECG and methodological challenges for getting reference annotations and evaluating the accuracy of segmentation algorithms. This work aims to validate the measurement of the fetal QT interval in term laboring women using a NI-FECG electrocardiogram monitor. Fetal electrocardiogram data were recorded from 22 laboring women at term using the NI-FECG and an invasive fetal scalp electrode simultaneously. A total of 105 one-minute epochs were selected for analysis. Three pediatric electrophysiologists independently annotated individual waveforms and averaged waveforms from each epoch. The intervals measured on the averaged cycles taken from the NI-FECG and the fetal scalp electrode showed a close agreement; the root mean square error between all corresponding averaged NI-FECG and fetal scalp electrode beats was 13.6 ms, which is lower than the lowest adult root mean square error of 16.1 ms observed in related adult QT studies. These results provide evidence that NI-FECG technology enables accurate extraction of the fetal QT interval.
Subsequent publication of abstracts presented at the International Association of Paediatric Dentistry meetings.

BACKGROUND Presentation of scientific information at international meetings is important for the dissemination of new scientific research. It is often assumed that the information contained in an abstract will subsequently be published in a scientific journal in full-length form. OBJECTIVE The aim of this investigation was to study the publication rate of abstracts presented to the International Association of Paediatric Dentistry (IAPD) congresses in London 1999 and Paris 2001, and factors that predict subsequent publication were also investigated. MATERIALS AND METHODS Abstracts presented at the IAPD congresses were reviewed. A Medline/PubMed search, encompassing 1999-2006, was performed. RESULTS At the two IAPD congresses, a total of 771 abstracts were presented, 231 (30%) as oral presentations, 327 (42%) as poster discussion presentations, and 212 (28%) as poster presentations. During the period studied, 204 (27%) of the 771 abstracts were expanded into articles published in Medline/PubMed indexed journals. The publication ratio for orally presented abstracts was 40%, poster discussion presentation 21%, and for poster presentations 19% (P < 0.0001). The mean time from the congress to publication was 20 months. CONCLUSION The results of this study show that 40% of orally presented abstracts at IAPD congresses were followed by a subsequent scientific publication in a peer-reviewed journal.
Lymph node‐induced immune tolerance in chronic lymphocytic leukaemia: a role for caveolin‐1

Emerging evidence indicates that the tumour microenvironment (TME) regulates the behaviour of chronic lymphocytic leukaemia (CLL). However, the precise mechanism and molecules involved in this process remain unknown. Gene expression profiles of CLL cells from lymph node (LN), bone marrow (BM) and peripheral blood (PB) indicate overexpression of a tolerogenic signature in CLL cells in lymph nodes (LN‐CLL). Based on their role in B cell biology, the progression of CLL, or immune regulation, a few genes of this 83‐gene signature were selected for further analyses. We observed a significant correlation between the clinical outcomes and the expression of CAV1 (P = 0·041), FGFR1 isoform 8 (P = 0·032), PTPN6 (P = 0·031) and ZWINT (P < 0·001). CAV1, a molecule involved in the regulation of tumour progression in other cancers, was seven‐fold higher in LN‐CLL cells compared to BM‐ and PB‐CLL cells. Knockdown of CAV1 expression in CLL cells resulted in significantly decreased migration (P = 0·016) and proliferation (P = 0·04). When CAV1 was knocked down in B and T cell lines, we observed an inability to form immune synapses. Furthermore, CAV1 knockdown in CLL cells impaired their ability to form immune synapses with autologous T lymphocytes and allogeneic, healthy T cells. Subsequent analyses of microarray data showed differential expression of cytoskeletal genes, specifically those involved in actin polymerization. Therefore, we report a novel role for CAV1 in tumour‐induced immunosuppression during the progression of CLL.
ChREBP promotes the differentiation of leukemia-initiating cells to inhibit leukemogenesis through the TXNIP/RUNX1 pathways

Targeting leukemia-initiating cells (LICs) is the key to eradicating leukemia and preventing its relapse. Recent studies have indicated that metabolic regulation may play a critical role in the maintenance of stemness in LICs, although the detailed mechanisms are poorly understood. Herein, we provide intriguing evidence showing that a glucose-responsive transcription factor, carbohydrate responsive element binding protein (ChREBP), served as a tumor suppressor rather than an oncogene, as previously described, to inhibit the development of acute myeloid leukemia by promoting the differentiation of LICs. Using an MLL-AF9-induced murine leukemia model, we demonstrated that the deletion of ChREBP resulted in the blockage of the differentiation of LICs and significantly reduced survival in ChREBP-null leukemic mice. However, ChREBP was not required for the normal repopulation abilities of hematopoietic stem cells. ChREBP promoted leukemia cell differentiation through the direct inhibition of RUNX1 or the transactivation of TXNIP to downregulate the RUNX1 level and ROS generation. Moreover, knockdown of ChREBP in human leukemia THP1 cells led to markedly enhanced proliferation and decreased differentiation upon PMA treatment. Collectively, we unraveled an unexpected role of ChREBP in leukemogenesis, which may provide valuable clues for developing novel metabolic strategies for leukemia treatment.
The association between varicocoeles and vascular disease: an analysis of U.S. claims data

S‪tudies have suggested an association between varicocele, hypogonadism, and elevated oxidative stress markers, but no other health risks have been associated with varicoceles. ‬‬‬‬We sought to determine the association between varicocele and incident medical comorbidities. ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Using the Truven Health MarketScan® claims database from 2001 to 2009, we identified 4459 men with varicoceles, and 100,066 controls based on ICD‐9 and CPT codes, with an average follow‐up of 3.1 person years. Men with varicoceles were classified as symptomatic or asymptomatic based on co‐existing diagnoses. Men with medical comorbidities present before or within 1 year of index diagnosis were excluded. Metabolic and cardiovascular outcome variables were identified via ICD‐9 codes. A Cox regression analysis was used to assess incident risk of metabolic and cardiovascular disease amongst the different groups. Men with varicoceles had a higher incidence of heart disease compared to men who underwent infertility testing (HR 1.22, 95% CI: 1.03–1.45), and men who underwent vasectomy (HR 1.32, 95% CI 1.13–1.54). The varicoceles group also had a higher risk of diabetes (HR 1.73, 95% CI: 1.37–2.18) and hyperlipidemia (HR 1.15, 95% CI: 1.03–1.28) compared to the vasectomy group. Furthermore, men with symptomatic varicoceles (n = 3442) had a higher risk of heart disease, diabetes, and hyperlipidemia following diagnosis, while men with asymptomatic varicoceles (n = 1017) did not. Given the prevalence of varicoceles, further research is needed to understand the implications of a varicocele to a man's overall health.
Influence of Polymer Residues on the Double Resonance Process of Bilayer Graphene

PMMA is commonly used for graphene transfer and device processing. However, it leaves a thin layer of polymer residues after standard acetone cleaning and causes electrical and thermal performance degradation of graphene devices. In this paper, we present a research of the impact of polymer residues on surface morphologies and electronic properties of bilayer graphene using Raman spectroscopy in combination with atomic force microscopy (AFM). The electronic structure of bilayer graphene is well captured in its Raman spectrum, of which the 2D band reveals four double resonance Raman scattering processes. The Raman analyses show universal blueshifts of the G band and the four 2D sub-bands P11, P12, P21, P22, as well as reduced intensity ratios of the sub-bands to the G band I(Pij)/I(G) after surface contamination by polymer residues, implying an electronic structure modulation in bilayer graphene. The effects are mainly attributed to p-type doping and extrinsic scattering induced by residual impurities and defects.
Selective deletion of Smad4 in postnatal germ cells does not affect spermatogenesis or fertility in mice

SMAD4 is the central component of canonical signaling in the transforming growth factor beta (TGFβ) superfamily. Loss of Smad4 in Sertoli cells affects the expansion of the fetal testis cords, whereas selective deletion of Smad4 in Leydig cells alone does not appreciably alter fetal or adult testis development. Loss of Smad4 in Sertoli and Leydig cells, on the other hand, leads to testicular dysgenesis, and tumor formation in mice. Within the murine testes, Smad4 is also expressed in germ cells of the seminiferous tubules. We therefore, crossed Ngn3‐Cre or Stra8‐Cre transgenic mice with Smad4‐flox mice to generate conditional knockout animals in which Smad4 was specifically deleted in postnatal germ cells to further uncover cell type‐specific requirement of Smad4. Unexpectedly, these germ‐cell‐knockout mice were fertile and did not exhibit any detectable abnormalities in spermatogenesis, indicating that Smad4 is not required for the production of sperm; instead, these data indicate a cell type‐specific requirement of Smad4 primarily during testis development. Mol. Reprod. Dev. 83: 615–623, 2016. © 2016 Wiley Periodicals, Inc.
The Role of Rho Kinase Inhibitors in Corneal Endothelial Dysfunction.

BACKGROUND The cornea is transparent tissue that serves as the window of the eye, allowing light to enter from the outer environment. The corneal endothelium maintains corneal transparency; thus, its dysfunction results in corneal haziness and causes severe vision loss. The only available therapeutic choice for treating corneal endothelial dysfunction has been transplantation using donor corneas; consequently, researchers have been pressed to develop new therapeutic options. METHODS The goal of the review is to provide an overview of the research into Rho kinase (ROCK) inhibitors in the field of corneal endothelium therapy and the potential for clinical use of ROCK inhibitors. RESULTS We reported that ROCK inhibitor enhances wound healing in the corneal endothelium. We further proposed the development of ROCK inhibitors as drugs that suppress the incidence of bullous keratopathy following severe corneal endothelial damage, especially that occurring during cataract surgery, one of the leading causes of corneal transplantation. We also proposed the use of ROCK inhibitors as adjunct drugs for cell-based therapeutic treatment of corneal endothelial dysfunction. ROCK inhibitors promote the engraftment of injected cultured corneal endothelial cells to the recipient cornea, thereby enabling the regeneration of corneal endothelium. Of note, we have initiated clinical research into cell injection therapy using a ROCK inhibitor as an adjunct drug. CONCLUSION This review documents the potency of ROCK inhibitors in clinical use, both as eye drops and as adjunct drugs for cell-based therapy for the treatment of corneal endothelial dysfunction.
Antileukemic effects of neurokinin-1 receptor inhibition on hematologic malignant cells: a novel therapeutic potential for aprepitant

Genetic and laboratory studies have remodeled the conventional understanding of cancer pathogenesis by identifying different molecular alterations. Intrigued by the contribution of neurokinin-1 receptor (NK1R) network in cancer pathogenesis, we investigated the antileukemic effects of aprepitant, a nonpeptide antagonist of NK1R, in a panel of hematological cell lines. In this study, we found that aprepitant decreased the survival of all the tested cells; however, as compared with NB4, viability of the other cell lines was inhibited at higher concentrations. By increasing both p21 and p73 along with suppressing c-Myc and hTERT, aprepitant probably disordered cell distribution in the cell cycle, decreased DNA replication rate, and, thereby, impeded the proliferative capability of NB4 cells. Moreover, exposing cells to this agent led to activation of the caspase-3-dependent apoptotic pathway through altering the expression of apoptosis-related genes. Noteworthy, aprepitant also sensitized NB4 cells to the cytotoxic effects of arsenic trioxide and vincristine. Overall, it seems that pharmaceutical targeting of NK1R using aprepitant, either as a single agent or in combination, possesses novel promising potential for leukemia treatment strategies.
Harmonic Mean Iteratively Reweighted Least Squares for low-rank matrix recovery

We propose a new Iteratively Reweighted Least Squares (IRLS) algorithm for the problem of recovering a matrix X ∈ ℝd1 × d2 of rank r ≪ min(d1, d2) from incomplete linear observations, solving a sequence of quadratic problems. The easily implementable algorithm, which we call Harmonic Mean Iteratively Reweighted Least Squares (HM-IRLS), is superior compared to state-of-the-art algorithms for the low-rank recovery problem in several performance aspects. More specifically, the strategy HM-IRLS uses to optimize a non-convex Schatten-p penalization to promote low-rankness carries three major strengths, in particular for the matrix completion setting.
Inhibition of miR‐200b/miR‐429 contributes to neuropathic pain development through targeting zinc finger E box binding protein‐1

Many studies have reported that microRNAs participate in neuropathic pain development. Previously, miR‐200b and miR‐429 are reported to be involved in various diseases. In our current study, we focused on their roles in neuropathic pain and we found that miR‐200b and miR‐429 were significantly decreased in chronic constriction injury (CCI) rat spinal cords and isolated microglials. miR‐200b and miR‐429 overexpression were able to relieve neuropathic pain through modulating PWT and PWL in CCI rats. Meanwhile, we observed that both miR‐200b and miR‐429 upregulation could repress neuroinflammation via inhibiting inflammatory cytokines such as IL‐6, IL‐1β, and TNF‐α in CCI rats. By carry out bioinformatics technology, Zinc finger E box binding protein‐1 (ZEB1) was predicted as target of miR‐200b, and miR‐429 and dual‐luciferase reporter assays confirmed the correlation between them. ZEB1 has been reported to regulate a lot of diseases. Here, we found that ZEB1 was greatly increased in CCI rats and miR‐200b and miR‐429 overexpression markedly suppressed ZEB1 mRNA expression in rat microglial cells. In addition, knockdown of ZEB1 can reduce neuropathic pain development and co‐transfection of LV‐anti‐miR‐200b/miR‐429 reversed this phenomenon in vivo. Taken these together, our results suggested that miR‐200b/miR‐429 can serve as an important regulator of neuropathic pain development by targeting ZEB1.
Race and Trust in the Health Care System

Objective. A legacy of racial discrimination in medical research and the health care system has been linked to a low level of trust in medical research and medical care among African Americans. While racial differences in trust in physicians have been demonstrated, little is known about racial variation in trust of health insurance plans and hospitals. For the present study, the authors analyzed responses to a cross-sectional telephone survey to assess the independent relationship of self-reported race (non-Hispanic black or non-Hispanic white) with trust in physicians, hospitals, and health insurance plans. Methods. Respondents ages 18–75 years were asked to rate their level of trust in physicians, health insurance plans, and hospitals. Items from the Medical Mistrust Index were used to assess fear and suspicion of hospitals. Results. Responses were analyzed for 49 (42%) non-Hispanic black and 69 (58%) non-Hispanic white respondents (N=118; 94% of total survey population). A majority of respondents trusted physicians (71%) and hospitals (70%), but fewer trusted their health insurance plans (28%). After adjustment for potential confounders, non-Hispanic black respondents were less likely to trust their physicians than non-Hispanic white respondents (adjusted absolute difference 37%; p=0.01) and more likely to trust their health insurance plans (adjusted absolute difference 28%; p=0.04). The difference in trust of hospitals (adjusted absolute difference 13%) was not statistically significant. Non-Hispanic black respondents were more likely than non-Hispanic white respondents to be concerned about personal privacy and the potential for harmful experimentation in hospitals. Conclusions. Patterns of trust in components of our health care system differ by race. Differences in trust may reflect divergent cultural experiences of blacks and whites as well as differences in expectations for care. Improved understanding of these factors is needed if efforts to enhance patient access to and satisfaction with care are to be effective.
Near-Linear Time Local Polynomial Nonparametric Estimation

Local polynomial regression (Fan & Gijbels, 1996) is an important class of methods for nonparametric density estimation and regression problems. However, straightforward implementation of local polynomial regression has quadratic time complexity which hinders its applicability in large-scale data analysis. In this paper, we significantly accelerate the computation of local polynomial estimates by novel applications of multi-dimensional binary indexed trees (Fenwick, 1994). Both time and space complexities of our proposed algorithm are nearly linear in the number of inputs. Simulation results confirm the efficiency and effectiveness of our approach.