Miracle-dz/UniFAR-FTUs huggingface dataset:
Predictors of disease severity in children presenting from the community with febrile illnesses: a systematic review of prognostic studies

Introduction Early identification of children at risk of severe febrile illness can optimise referral, admission and treatment decisions, particularly in resource-limited settings. We aimed to identify prognostic clinical and laboratory factors that predict progression to severe disease in febrile children presenting from the community. Methods We systematically reviewed publications retrieved from MEDLINE, Web of Science and Embase between 31 May 1999 and 30 April 2020, supplemented by hand search of reference lists and consultation with an expert Technical Advisory Panel. Studies evaluating prognostic factors or clinical prediction models in children presenting from the community with febrile illnesses were eligible. The primary outcome was any objective measure of disease severity ascertained within 30 days of enrolment. We calculated unadjusted likelihood ratios (LRs) for comparison of prognostic factors, and compared clinical prediction models using the area under the receiver operating characteristic curves (AUROCs). Risk of bias and applicability of studies were assessed using the Prediction Model Risk of Bias Assessment Tool and the Quality In Prognosis Studies tool. Results Of 5949 articles identified, 18 studies evaluating 200 prognostic factors and 25 clinical prediction models in 24 530 children were included. Heterogeneity between studies precluded formal meta-analysis. Malnutrition (positive LR range 1.56–11.13), hypoxia (2.10–8.11), altered consciousness (1.24–14.02), and markers of acidosis (1.36–7.71) and poor peripheral perfusion (1.78–17.38) were the most common predictors of severe disease. Clinical prediction model performance varied widely (AUROC range 0.49–0.97). Concerns regarding applicability were identified and most studies were at high risk of bias. Conclusions Few studies address this important public health question. We identified prognostic factors from a wide range of geographic contexts that can help clinicians assess febrile children at risk of progressing to severe disease. Multicentre studies that include outpatients are required to explore generalisability and develop data-driven tools to support patient prioritisation and triage at the community level. PROSPERO registration number CRD42019140542.
Parallel guidewire technique in acute ischemic stroke secondary to carotid artery dissection.

BACKGROUND The aim of the study was to evaluate the influence of endovascular therapy (EVT) on the acute ischemic stroke (AIS) secondary to carotid artery dissection (CAD). METHODS This single-center retrospective study enrolled 17 patients admitted with AIS secondary to CAD from January 2018 to November 2019 in the Department of Neurology, Shenzhen Hospital of Southern Medical University where patients received EVT with guidewire or parallel guidewire. Outcomes including postoperative complications were recorded, the prognostic factors of patients were explored, and the effectiveness of single guidewire versus parallel guidewire on EVT was compared. RESULTS Before treatment, the mean National Institute of Health stroke scale (NIHSS) was 14.4 in 10 cases (58.8%) of CAD complicated with intracranial artery embolism. All patients underwent EVT, and the success rate of operation was 100%. After all interventions, modified thrombolysis in cerebral ischemia (mTICI) 3 reperfusion was achieved in 14 patients (82.4%), and mTICI 2b reperfusion was achieved in 3 (17.6%). One patient had cerebral infarction and edema complicated with cerebral hernia, one patient had cerebral hemorrhage, one patient had complicated subarachnoid hemorrhage, and five cases had asymptomatic cerebral hemorrhage. Three months after treatment, 14 cases (82.3%) achieved a good clinical outcome (modified Rankin scale, mRS: 0-2). Puncture-to-reperfusion time in the parallel guidewire group was significantly shorter than that of the single guidewire group. However, the differences in NIHSS score, postoperative mTICI, and mRS score between both groups did not reach significance. CONCLUSIONS CAD Patients receiving EVT have a good prognosis, and application of a parallel guidewire can reduce operation time.
Barriers to care: The influence of gang violence on heterosexual men’s initiation and adherence within the HIV/TB care cascade

ABSTRACT South Africa is burdened by twin epidemics of HIV and tuberculosis (TB) in which men are less likely than their female counterparts to engage with prevention, treatment and care. In some Cape Flats communities in Cape Town, South Africa, the challenge to men is compounded by high levels of gang violence. This study investigates the role of gang violence as a barrier to men’s entry and retention in the HIV/TB care cascade. Data for this study drew from six weeks of participant observation and eleven in-depth interviews in Hanover Park, a largely Coloured township of Cape Town. Key findings concerned men’s restricted mobility due to gang violence as a result of conflict over gang territory. Men both inside and outside gangs are affected by this violence, with men in gangs, in most cases, being totally cut off from healthcare services. Men in gangs are a key risk population group for both HIV and TB programming. Community-based interventions that address the effects of violence on health services should be designed for the communities on the Cape Flats. Findings could potentially be extrapolated to other settings affected by gang violence, both within South Africa and abroad.
Assessment of the Patient Protection and Affordable Care Act’s Increase in Fees for Primary Care and Access to Care for Dual-Eligible Beneficiaries

Key Points Question Was the Affordable Care Act’s increase in Medicaid fees to Medicare levels for primary care practitioners (fee bump) associated with increases in visits for dual-eligible Medicare and Medicaid beneficiaries? Findings In this cohort study of 3 052 044 Medicare beneficiaries, primary care visit rates for dual-eligible Medicare and Medicaid beneficiaries did not increase during years of the fee bump compared with Medicare beneficiaries with low income whose fees did not change. Decreases in relative visit rates with primary care physicians were partially offset by increases in visits with nurse practitioners and physician assistants. Meaning In this study, the policy eliminated payment differentials for dual-eligible vs non–dual-eligible Medicare beneficiaries, but it was not associated with gains in primary care use for dual-eligible beneficiaries.
Silencing long non-coding RNA HNF1A-AS1 inhibits growth and resistance to TAM of breast cancer cells via the microRNA-363/SERTAD3 axis

Abstract Long non-coding RNAs (lncRNAs) can exert effects on drug resistance of cancer cells. This study investigated the role of lncRNA HNF1A-antisense 1 (HNF1A-AS1) in growth and Tamoxifen (TAM) sensitivity of breast cancer (BC) cells. HNF1A-AS1 expression was promoted in BC cells and tissues. BC cells with HNF1A-AS1 silencing were constructed to detect cell proliferation. TAM resistant cell line with HNF1A-AS1 silencing and parent cell line with overexpressed HNF1A-AS1 were constructed to measure drug resistance. Silencing HNF1A-AS1 reduced proliferation and TAM resistance of BC cells. The downstream microRNAs (miRs) of HNF1A-AS1 and its targets were figured out and their functions in TAM resistance of BC cells were identified. HNF1A-AS1 sponged miR-363 to promote SERTAD3 expression. Downregulation of miR-363 or upregulation of SERTAD3 stimulated TAM resistance of BC cells. The findings in vitro were reproduced in in vivo experiments. It could be concluded that silencing HNF1A-AS1 inhibited growth and drug resistance to TAM of BC cells through the miR-363/SERTAD3 axis and the inactivation of the TGF-β/Smad pathway.
Comparison of ultrasound-guided costoclavicular and supraclavicular brachial plexus block for upper extremity surgery: a propensity score matched retrospective cohort study.

BACKGROUND Ultrasound-guided costoclavicular (CC) brachial plexus blocks (BPBs) are a novel approach for nerve block in upper extremity surgery. However, comparisons between CC-BPB and conventional supraclavicular (SC) BPB have not clearly delineated the benefits or costs of either method. METHODS This retrospective cohort study enrolled patients receiving BPB due to upper extremity fracture between June 2019 and May 2020. Data were collected from the medical records of patients, including age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status, side of block, and operative location. Enrolled patients were matched in a 1:2 ratio using propensity score matching models. The primary outcomes in this study were the proportions of complete sensory and motor blocks and the secondary outcomes included other block-related outcomes, pain-related outcomes, and side effects or complications. RESULTS The study enrolled 235 patients with upper extremity fracture and there was a significant difference in the side of block when comparing ultrasound-guided CC-BPB and SC-BPB. After propensity score matching, 62 patients receiving ultrasound-guided CC-BPB and 124 receiving ultrasound-guided SCBPB were enrolled. The proportions of complete sensory and motor block at each interval after injection showed no significant difference when the groups were compared. Although CC-BPB involved a longer procedure time than SC-BPB (6.2±0.7 vs. 5.1±0.5 min, P<0.001), it provided a longer duration of nerve block (duration of sensory block: 468.2±103.5 vs. 396.5±83.4 min, P<0.001; duration of motor block: 554.6±99.5 vs. 469.7±96.0 min, P<0.001). Patients with Horner's syndrome were also more prevalent in the SC-BCB group (n=11) (8.9%) in comparison to one patient (1.6%) in CC-BPB group (P=0.04). CONCLUSIONS CC-BPB is a safe and efficient approach for upper extremity surgery.
Health behaviours and beliefs among Malawian adults taking antihypertensive medication and antiretroviral therapy: A qualitative study

ABSTRACT In order to understand HIV-positive Malawian adults’ experiences with hypertension management, we conducted qualitative interviews with 30 hypertensive adults who were also taking antiretroviral therapy. These interviews regarding hypertension management behaviours and beliefs were audio-recorded, transcribed, translated into English, and coded in Atlas.ti. Despite acknowledging the dangers of hypertension and the benefits of medication, many respondents missed their antihypertensive medication. Primary reasons included feeling healthy, health workers’ advice to stop taking medicine when blood pressure normalised, side effects, and using herbs or non-prescription medicines to manage hypertension. Women highlighted difficulties with dietary modifications, and changes in their social relationships. Both men and women spoke about hypertension-related challenges with employment and household economics. These results suggest numerous challenges among adults managing hypertension and HIV in Malawi, and frequent suboptimal adherence to medication. We identified new key themes – the quality of adherence counselling for antihypertensive medication, the effects of hypertension on financial stability, and the role of social relationships in self-care – and encourage further investigation into these topics in low-income, high-burden countries.
Therapeutic distance in client-therapist narratives: client attachment, therapist attachment, and dyadic effects

Abstract Based on the attachment framework, therapeutic distance conceptualization focuses on closeness–distance dynamics in the therapeutic relationship. We aimed to evaluate the psychometric properties of the Therapeutic-Distance-Scale, Observer-version (TDS-O) and apply a dyadic approach to examine associations between attachment characteristics and therapeutic distance experiences of clients, therapists, and mutual effects. Sixty-six clients and their 29 therapists completed the ECR and relational narratives collected in RAP interviews at early, mid, and late psychodynamic-therapy were rated on TDS-O scales: too close, too distant, autonomy, and engagement. The TDS-O showed good IRR, internal reliability and content validity. Client anxiety was not associated with therapeutic distance but associated with autonomy. Client avoidance associated with clients’ experiencing therapist as too close, and lower engagement only at early therapy, but was not associated with therapists’ experience. Therapist anxiety was not related to closeness–distance at early therapy but related to gaps between client and therapist experiences at mid and late therapy. Therapist avoidance related to clients experiencing therapists as too close and granting less autonomy at early and mid-therapy, and to therapist experience of distance at late therapy. The findings underscore the importance of therapists’ regulating therapeutic distance through attunement to client’s interpersonal needs and therapy phase.
Regional disparity in extinction risk: Comparison of disjunct plant genera between eastern Asia and eastern North America

Climate and land cover changes are increasing threats to biodiversity globally. However, potentially varying biotic sensitivity is a major source of uncertainty for translating environmental changes to extinction risks. To reduce this uncertainty, we assessed how extinction risks will be affected by future human‐driven environmental changes, focusing on 554 species from 52 disjunct plant genera between eastern Asia (EAS) and eastern North America (ENA) to control for differences in environmental sensitivity at the genus level. Species distribution models were used to estimate and compare the vulnerability of species in disjunct genera between the two regions under two climate and land cover change scenarios (RCP2.6 and RCP8.5) in the 2070s, allowing to assess the effects of differences in climate and land cover pressures. Compared with ENA, stronger pressures from climate and land cover changes along with smaller range sizes in EAS translate into a larger number and proportion of species in disjunct genera becoming threatened by the 2070s. These regional differences are more pronounced under a best‐case climate scenario (RCP2.6), illustrating that strong climate change (RCP8.5) may override any regional buffer capacities. The main variables determining extinction risks differed between the two continental regions, with annual temperature range and cropland expansion being important in EAS, and annual precipitation being important in ENA. These results suggest that disparities in regional exposure to anthropogenic environmental changes may cause congeneric species with relatively similar sensitivity to have different future risks of extinction. Moreover, the findings highlight the context‐specific nature of anthropogenic effects on biodiversity and the importance of making region‐specific policies for conservation and restoration in response to the intensifying global changes.
Effects of dose titration on adherence and treatment duration of pregabalin among patients with neuropathic pain: A MarketScan database study

Objective To examine pregabalin dose titration and its impact on treatment adherence and duration in patients with neuropathic pain (NeP). Methods MarketScan database (2009–2014) was used to extract a cohort of incident adult pregabalin users with NeP who had at least 12 months of follow-up data. Any dose augmentation within 45 days following the first pregabalin claim was defined as dose titration. Adherence (measured by medication possession ratio/MPR) and persistence (measured as the duration of continuous treatment) were compared between the cohorts with and without dose titration. Logistic regressions and Cox proportional hazards models were used to identify the factors associated with adherence (MPR ≥ 0.8) and predictors of time to discontinuation. Results Among the 5,186 patients in the analysis, only 18% of patients had dose titration. Patients who had dose titration were approximately 2.6 times as likely to be adherent (MPR ≥ 0.8) (odds ratio = 2.59, P < 0.001) than those who did not have dose titration. Kaplan-Meier analysis shows that the time to discontinuation or switch was significantly longer among patients who had dose titration (4.99 vs. 4.04 months, P = 0.009). Conclusions Dose titration was associated with improved treatment adherence and persistence among NeP patients receiving pregabalin. The findings will provide valuable evidence to increase physician awareness of dose recommendations in the prescribing information and to educate patients on the importance of titration and adherence.
Surprising simplicity in the modeling of dynamic granular intrusion

Unexpected simplifications arise in high-speed granular intrusion modeling. Granular intrusions, such as dynamic impact or wheel locomotion, are complex multiphase phenomena where the grains exhibit solid-like and fluid-like characteristics together with an ejected gas-like phase. Despite decades of modeling efforts, a unified description of the physics in such intrusions is as yet unknown. Here, we show that a continuum model based on the simple notions of frictional flow and tension-free separation describes complex granular intrusions near free surfaces. This model captures dynamics in a variety of experiments including wheel locomotion, plate intrusions, and running legged robots. The model reveals that one static and two dynamic effects primarily give rise to intrusion forces in such scenarios. We merge these effects into a further reduced-order technique (dynamic resistive force theory) for rapid modeling of granular locomotion of arbitrarily shaped intruders. The continuum-motivated strategy we propose for identifying physical mechanisms and corresponding reduced-order relations has potential use for a variety of other materials.
Phase separation behavior of cyanate ester resin/polysulfone blends

The composition of the blends and the curing temperature affect the morphology of the blends and the phase separation mechanism. The phase separation mechanism depends on the viscosity of medium at the initial stage of phase separation determined by the amount of thermoplastics and the curing temperature, and is closely related with the final morphology. When the homogeneous bisphenol A dicyanate (BADCy)/polysulfone (PSF) blends with low content of PSF (less than 10 wt %) were cured isothermally, the blends were phase separated by nucleation and growth (NG) mechanism to form the PSF particle structure. On the other hand, with more than 20 wt % of PSF content, the BADCy/PSF blends were phase separated by spinodal decomposition (SD) to form the BADCy particle structure. With about 15 wt % of PSF content, the blends were phase separated by SD and then NG to form a combined structure having both the PSF particle structure and the BADCy particle structure. © 1999 John Wiley & Sons, Inc. J Appl Polym Sci 74: 33–45, 1999
Tunable One-Pot Syntheses of Hexagonal-, Cubic-, and Lamellar-Mesostructured Vanadium−Phosphorus Oxides

Hexagonal-, cubic-, and lamellar-mesostructured vanadium−phosphorus oxides were hydrothermally synthesized by using V metal as a reducing agent and a V source. The respective phases were tunably synthesized in the ranges of pH 2.63−2.95, 3.00−3.36, and 3.45−4.45. It is suggested that the formation of these mesostructured materials depends on the solution species of vanadium and phosphorus. The unit cell constants of hexagonal, cubic, and lamellar phases were determined to be a = 5.05 nm, a = 8.54 nm, and c = 3.22 nm, respectively. IR spectroscopy, XRD, and elemental analyses show that hexagonal- and cubic-mesostructured materials possess an amorphous wall of vanadium−phosphorus oxides and their P/V ratios were 0.99 and 0.76, respectively. On the other hand, the lamellar mesostructured material possessed more crystalline layers of vanadium−phosphorus oxide with a P/V ratio of 0.50. The cetyltrimethylammonium templates could be exchanged with K+ or Cs+.
Genomic data show little geographical structure across the naturally fragmented range of the purple-gaped honeyeater

Abstract. Using single nucleotide polymorphisms and mitochondrial DNA sequences we find some evidence of genetic structure within a widespread and naturally fragmented species, the purple-gaped honeyeater (Lichenostomus cratitius), of southern Australian mallee shrublands. The very earliest stages of differentiation either side of the Nullarbor Barrier may already have been arrested by gene flow, some of which may have been anthropogenically induced.
Scalable Belief Updating for Urban Air Quality Modeling and Prediction

Air pollution is one of the major concerns in global urbanization. Data science can help to understand the dynamics of air pollution and build reliable statistical models to forecast air pollution levels. To achieve these goals, one needs to learn the statistical models which can capture the dynamics from the historical data and predict air pollution in the future. Furthermore, the large size and heterogeneity of today’s big urban data pose significant challenges on the scalability and flexibility of the statistical models. In this work, we present a scalable belief updating framework that is able to produce reliable predictions, using over millions of historical hourly air pollutant and meteorology records. We also present a non-parametric approach to learn the statistical model which reveals interesting periodical dynamics and correlations of the dataset. Based on the scalable belief update framework and the non-parametric model learning approach, we propose an iterative update algorithm to accelerate Gaussian process, which is notorious for its prohibitive computation with large input data. Finally, we demonstrate how to integrate information from heterogeneous data by regarding the beliefs produced by other models as the informative prior. Numerical examples and experimental results are presented to validate the proposed method.
Hydrodynamic-driven morphogenesis of karst draperies: spatio-temporal analysis of the two-dimensional impulse response

Abstract We study the role of hydrodynamic instabilities in the morphogenesis of some typical karst draperies structures encountered in limestone caves. The problem is tackled using the long wave approximation for the fluid film that flows under an inclined substrate, in the presence of substrate variations that grow according to a deposition law. We numerically study the linear and nonlinear evolution of a localized initial perturbation both in the fluid film and on the substrate, i.e. the Green function. A novel approach for the spatio-temporal analysis of two-dimensional signals resulting from linear simulations is introduced, based on the concepts of the Riesz transform and the monogenic signal, the multidimensional complex continuation of a real signal. This method allows for a deeper understanding of the pattern formation. The linear evolution of an initial localized perturbation in the presence of deposition is studied. The deposition linearly selects substrate structures aligned along the streamwise direction, as the spatio-temporal response is advected away. Furthermore, the growth of the initial defect produces a quasi-steady region also characterized by streamwise structures both on the substrate and the fluid film, which is in good agreement with the Green function for a steady defect on the substrate, in the absence of deposition.