Miracle-dz/UniFAR-FTUs huggingface dataset:
Using electronic health record audit logs to study clinical activity: a systematic review of aims, measures, and methods

OBJECTIVE To systematically review published literature and identify consistency and variation in the aims, measures, and methods of studies using electronic health record (EHR) audit logs to observe clinical activities. MATERIALS AND METHODS In July 2019, we searched PubMed for articles using EHR audit logs to study clinical activities. We coded and clustered the aims, measures, and methods of each article into recurring categories. We likewise extracted and summarized the methods used to validate measures derived from audit logs and limitations discussed of using audit logs for research. RESULTS Eighty-five articles met inclusion criteria. Study aims included examining EHR use, care team dynamics, and clinical workflows. Studies employed 6 key audit log measures: counts of actions captured by audit logs (eg, problem list viewed), counts of higher-level activities imputed by researchers (eg, chart review), activity durations, activity sequences, activity clusters, and EHR user networks. Methods used to preprocess audit logs varied, including how authors filtered extraneous actions, mapped actions to higher-level activities, and interpreted repeated actions or gaps in activity. Nineteen studies validated results (22%), but only 9 (11%) through direct observation, demonstrating varying levels of measure accuracy. DISCUSSION While originally designed to aid access control, EHR audit logs have been used to observe diverse clinical activities. However, most studies lack sufficient discussion of measure definition, calculation, and validation to support replication, comparison, and cross-study synthesis. CONCLUSION EHR audit logs have potential to scale observational research but the complexity of audit log measures necessitates greater methodological transparency and validated standards.
Community Pharmacist's Perception Towards Their Role In Pakistan's Healthcare System: A Qualitative Study

Summary During the past few years the pharmacy profession has expanded significantly in terms of professional services delivery and now has been recognized as an important profession in the multidisciplinary provision of healthcare. As compared to developed countries, pharmacists role in developing countries are still underutilized and their role as health professionals are not considered to be important by both the community and other healthcare providers. The main objective of this study is to explore the perception of Pakistani community pharmacists regarding their role in Pakistan’s healthcare system. A qualitative approach was used. A total of 10 community pharmacists were interviewed using a semi- structure interview guide. All the interviews were transcribed verbatim and thematically analyzed for its content. Thematic content analysis yield 5 major themes: 1) Provision of pharmacy services to consumers 2) Counseling at pharmacy, 3) Application of good pharmacy practice (GPP), 4) Pakistan Pharmacy Association (PPA) contribution towards pharmacy profession, 5) Strategies to improve community pharmacies. As far as the role of community pharmacists is concerned, some community pharmacists interviewed highlighted the importance of having a good practice standard set by the stake holders in order to improve their current practice and professional image. Respondents also mentioned that it is important for pharmacists to engage more broadly in medical counseling services as currently not many pharmacists are doing it as part of their core duties. Almost all pharmacists interviewed agreed that they have a very big role to play in public health especially on rational medicine use process. Community pharmacists in Pakistan do have concern about their present professional role in the health care system and suggestions have been made to improve their present image in the society.
Maximum Power Point Tracking of Photovoltaic System Based on Reinforcement Learning

Maximum power point tracking technique is often used in photovoltaic (PV) system to extract the maximum power at any environment condition. In this paper, a reinforcement learning based variable step size maximum power point tracking (RL MPPT) method is proposed. Q-learning is used as the algorithm of the proposed methods and is implemented by constructing the Q-table (RL-QT MPPT). A Q-network approach (RL-QN MPPT) is also proposed as a more general representation of the RL MPPT method. Implementing of the algorithm doesn't require the information of the actual PV module in advance, and the proposed system is able to track the MPP offline. With smaller ripples and faster tracking speed, the experiment results of the RL-QT MPPT method and the RL-QN MPPT method are presented.
Hospitalization and emergency department utilization in patients with advanced melanoma receiving pembrolizumab versus ipilimumab plus nivolumab in US academic centers

Abstract Background: Both pembrolizumab (PEMBRO) and ipilimumab + nivolumab (IPI + NIVO) are FDA-approved immunotherapy regimens for advanced melanoma (AM). Each regimen has different toxicity profiles potentially impacting healthcare resource utilization (HCRU). This study compared real-world hospitalization and emergency department (ED) utilization within 12 months of therapy initiation of each regimen. Methods: A retrospective cohort study was conducted in AM patients ≥18 years old initiating PEMBRO or IPI + NIVO between January 1, 2016–December 30, 2017. Patients were identified from 12 US-based academic and satellite centers. All-cause hospitalization ED visits were identified. These events were used to calculate rates per 1,000 patient months. Utilization between groups was compared using multivariate logistic regression. Results: In total, 400 patients were included (200 PEMBRO, 200 IPI + NIVO). PEMBRO vs IPI + NIVO patients had poorer Eastern Cooperative Group (ECOG) performance status, 29% 2–4, vs 12% (p < .001); more diabetes, 21% vs 13% (p = .045); were more often PD-L1 expression positive, 77% vs 63% (p = .011); and less likely BRAF mutant, 35% vs 50% (p = .003). The proportion with more than one hospitalization over 12 months was 17% PEMBRO vs 24% IPI + NIVO. Less than 2% had more than one admission and none had more than two. Unadjusted mean (SD) hospitalizations per 1,000 patient-months were 16 (37) and 20 (38), PEMBRO and IPI + NIVO, respectively. Adjusted odds ratio for hospitalization was 0.6 (95% CI = 0.3–0.9; p = .027) for PEMBRO vs IPI + NIVO. ED visits occurred in 18% vs 21%, PEMBRO and IPI + NIVO, respectively, 0.7 (p = .186). Conclusions: PEMBRO patients had a significantly lower probability of hospitalization through 12 months vs IPI + NIVO. The probability of ED visits did not differ.
The Distribution of Advanced Practice Nurses Within the Psychiatric Workforce

OBJECTIVE: To examine the size and distribution of the advanced practice psychiatric nurse workforce relative to the total psychiatry workforce to determine whether nurses are predominantly working in areas with higher or lower levels of behavioral health specialists. METHODS: State-level data for psychiatric nurses were obtained from the American Nurses Credentialing Center, and included mental health psychiatric nurse practitioners, adult psychiatric nurse practitioners, child psychiatric clinical nurse specialists, and adult psychiatric clinical nurse specialists. Supply estimates of the full psychiatry workforce were calculated for comparison purposes. State population estimates were obtained from U.S. Census Bureau data. State workforce estimates were converted to a 1:100,000 provider-to-population ratio to analyze the density of providers across states. RESULTS: In 2018, the psychiatric workforce supply was estimated to be composed of 66,740 providers, including psychiatrists (n = 47,046; 71%), psychiatric nurses (n = 17,534; 26%), physician assistants (n = 1,164; 2%), and psychiatric pharmacists (n = 966; 1%). Overall, psychiatric providers appeared to be most densely concentrated in the northeast region of the United States. A dearth of providers was most pronounced within areas in the 12-state Midwest region, southern states, California, and Nevada. The average concentration of psychiatric workers was 22.61 per 100,000 population. CONCLUSIONS: The findings of this study find inconsistent pattern of how psychiatric nurses are distributed relative to the rest of the workforce, but reinforce the idea that they are essential in addressing care needs in areas with low concentrations of psychiatry specialists—especially if they are authorized to work to the full extent of their training/education.
A Fire Reconnaissance Robot Based on SLAM Position, Thermal Imaging Technologies, and AR Display

Due to hot toxic smoke and unknown risks under fire conditions, detection and relevant reconnaissance are significant in avoiding casualties. A fire reconnaissance robot was therefore developed to assist in the problem by offering important fire information to fire fighters. The robot consists of three main systems, a display operating system, video surveillance, and mapping and positioning navigation. Augmented reality (AR) goggle technology with a display operating system was also developed to free fire fighters’ hands, which enables them to focus on rescuing processes and not system operation. Considering smoke disturbance, a thermal imaging video surveillance system was included to extract information from the complicated fire conditions. Meanwhile, a simultaneous localization and mapping (SLAM) technology was adopted to build the map, together with the help of a mapping and positioning navigation system. This can provide a real-time map under the rapidly changing fire conditions to guide the fire fighters to the fire sources or the trapped occupants. Based on our experiments, it was found that all the tested system components work quite well under the fire conditions, while the video surveillance system produces clear images under dense smoke and a high-temperature environment; SLAM shows a high accuracy with an average error of less than 3.43%; the positioning accuracy error is 0.31 m; and the maximum error for the navigation system is 3.48%. The developed fire reconnaissance robot can provide a practically important platform to improve fire rescue efficiency to reduce the fire casualties of fire fighters.
Facial perception, self-esteem and psychosocial well-being in patients after nasal surgery due to trauma, cancer and aesthetic needs (cluster analysis of multiple interrelations)

Abstract Background: Facial anthropometric measurements in relation to self-esteem and self-perception have become a very popular topic, not only in anthropological and psychological research, but also in plastic reconstructive surgery. Aim: To compare the interrelations between facial perception, self-esteem and psychosocial well-being in patients after nasal surgery due to trauma, cancer and aesthetic needs. Subjects and methods: In total, ninety patients after nasal surgery (due to trauma, cancer and aesthetic reasons), and thirty control persons underwent facial anthropometry and answered questions related to facial perception (FP), self-esteem (SE) and psychosocial well-being (PW). Cluster analysis was performed. Results: Facial measurements were not related to the perception of the whole face in all investigated persons. The whole face and nasal perception were interrelated in the majority of male groups and in the control female group. SE in females from the control and cancer groups was not related to real facial parameters or FP, however, in females after aesthetic surgery it was related to nasal tip protrusion. SE in females after nasal surgery due to trauma was strongly related to FP. SE in almost all groups of males was related to real facial parameters, and in males after aesthetic surgery it was related to FP. PW was mostly linked to SE in males and females after aesthetic surgery, in other groups it was related to FP. Conclusions: FP was most frequently not related to real facial measurements; however, it was related to PW. Patients after aesthetic nasal surgery had specific relations between FP, SE and PW.
Piperine Is a Mechanism-Based Inactivator of CYP3A

Piperine (PPR) is the representative alkaloid component of the piper species (family: Piperaceae). Our rapid screening study found PPR caused time-dependent inhibition of cytochrome P450s (CYP) 3A and 2D6, and CYP3A was inactivated the most. Further study demonstrated that PPR is a time-, concentration-, and NADPH-dependent inhibitor of CYP3A, and significant loss (49.5% ± 3.9%) of CYP3A activity was observed after 20minute incubations with 80 μM PPR at 37°C. The values of KI and kinact were 30.7 μM and 0.041 minutes−1, respectively. CYP3A competitive inhibitor ketoconazole showed protective effect against the enzyme inactivation. Superoxide dismutase/catalase and GSH displayed minor protection against the PPR-caused enzyme inactivation. Ferricyanide partially reduced the enzyme inhibition by PPR. Additionally, NADPH-dependent formation of reactive metabolites from PPR were found in human liver microsomal incubation mixtures. An ortho-quinone intermediate was trapped by NAC in microsomal incubations with PPR. DM-PPR, demethylene metabolite of PPR, showed weak enzyme inactivation relative to that caused by PPR. It appears that both carbene and ortho-quinone intermediates were involved in the inactivation of CYP3A caused by PPR. SIGNIFICANCE STATEMENT CYP3A subfamily members (mainly CYP3A4 and CYP3A5) play a critical role in drug metabolism. Piperine (PPR), a methylenedioxyphenyl derivative combined with an unsaturated ketone, is the major active ingredient of pepper. PPR revealed time-, concentration-, and NADPH-dependent inhibitory effect on CYP3A. Carbene and quinone metabolites were both involved in the observed CYP3A inactivation by PPR. Apparently, the unsaturated ketone moiety did not participate in the enzyme inactivation. The present study sounds an alert of potential risk for food-drug interactions.
Epilithic microalgal species discriminate low and high levels of dissolved phosphate in rivers of Northern Mindanao, Southern Philippines

Environmental conditions influence communities of riverine epilithic microalgae. In order to test the hypothesis that certain species can discriminate high and low dissolved phosphate concentrations, epilithic microalgae were collected and dissolved orthophosphate concentration concurrently determined at 63 rivers of Northern Mindanao. Microalgae were identified to the lowest taxon, and density of each species was estimated following standard methods for epilithic microalgae. Dissolved phosphate varied significantly between rivers with 27% of the sites registering high levels which were primarily attributed to anthropogenic input. Constrained multivariate linear Redundancy Analysis (RDA) showed that phosphate significantly explained the variability of abundance for Gomphonema sp.1, Melosira varians, Navicula concentrica, Navicula sp.8, Navicula sp.9, Navicula sp.12, Navicula sp.15, and Oscillatoria sp.1. Discriminant analysis showed that Gomphonema sp.1 and Navicula sp.12, and Oscillatoria sp.1 can discriminate high and low phosphate concentrations, respectively. Hence, these species may be regarded as practical environmental indicators of levels of dissolved phosphate in tropical river systems. This electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.
Bridging regenerative medicine based therapies into the 21st Century: solo or symphony?

Clinical translation in the field of regenerative medicine means manufacturing a safe, reproducible and effective clinical product for the benefit of patients. This represents the ultimate goal of applied research, but beyond researchers and clinicians, multiple intermediate players are involved, including other researchers, reviewers, funding agencies, scientific societies, guideline authors, and policy regulators. Consequently, bridging translational research and regenerative medicine therapies into the 21 st Century requires a resolute effort. We envisage that strategic and synergistic efforts in seven key areas will facilitate the mainstream adoption and implementation of regenerative medicine based therapies.
The automaticity of semantic processing revisited: Auditory distraction by a categorical deviation.

Automatic information processing has been and still is a debated topic. Traditionally, automatic processes are deemed to take place autonomously and independently of top-down cognitive control. For decades, the literature on reading has brought to the fore empirical phenomena such as Stroop and semantic priming effects that provide support for the assumption that semantic information can be accessed automatically. More recently, there has been growing evidence that semantic processing is in fact susceptible to higher-level cognitive influences, suggesting that this form of processing is instead conditionally automatic. The purpose of the present study was to revisit this debate using a novel approach: The automatic access to the meaning of irrelevant auditory stimuli was tested through the assessment of their distractive power. More specifically, we aimed to examine whether a categorical change in the content of to-be-ignored auditory sequences composed of speech items that are personally nonsignificant to participants (e.g., a digit among letters) can disrupt an unrelated visual focal task. In seven experiments, we assessed this categorical deviation effect and its functional properties. We established that distraction by categorical deviation is noncontingent on the activated task set and appears resistant to top-down control manipulations. By suggesting not only that the semantic content of the irrelevant sound can be extracted preattentively, but also that such semantic activation is ineluctable during auditory distraction, these findings shed new light on the automatic nature of semantic processing. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Influence of Spectroscopic Techniques on the Estimation of the Degree of Conversion of Bulk-fill Composites.

OBJECTIVES To compare the degree of conversion (DC) of different flowable and sculptable bulk-fill composites (BFC), at 0- and 4-mm depths from the surface, by Fourier transform infrared (FTIR), attenuated total reflection FTIR (ATR-FTIR), and FT-Raman spectroscopic techniques. METHODS AND MATERIALS Six BFC were investigated, including three sculptable composites (Admira Fusion [Voco], Aura Bulk Fill [SDI], and X-tra Fill [Voco]) and three flowable composites (Venus Bulk Fill [Heraeus], Filtek [3M], and X-tra Base [Voco]). Three molds of each composite were light cured as specified by the manufacturer. For each mold, slices corresponding to 0-mm (surface) and 4-mm depth were analyzed by spectroscopic techniques: ATR-FTIR, FTIR, and FT-Raman. The spectra of uncured composite material were used as an analytical control for background subtraction of the treated composite. The area and amplitude of the reference peaks (1607 and 1637 cm-1) were obtained to calculate the DC percentage at 0- and 4-mm depth. A Kruskal-Wallis nonparametric test was used for materials, and paired comparisons were made using Mann-Whitney nonparametric test. Wilcoxon's rank test was used for comparison between spectroscopic methods and between 0- and 4-mm depth in each composite. Significance was accepted at p<0.05. RESULTS FTIR showed significantly lower DC values, both in areas and amplitudes of the peaks, when compared with the results reported by different BFC. Differences between the surface and 4-mm depth were detected more precisely by FT-Raman. ATR-FTIR obtained DC values significantly higher than those obtained by FTIR. CONCLUSIONS The vibrational spectroscopy method significantly influenced DC measurements of the flowable and sculptable BFC explored.
Early economic evaluation of MRI-guided laser interstitial thermal therapy (MRgLITT) and epilepsy surgery for mesial temporal lobe epilepsy

Background MRI-guided laser interstitial thermal therapy (MRgLITT) is a new minimally invasive treatment for temporal lobe epilepsy (TLE), with limited effectiveness data. It is unknown if the cost savings associated with shorter hospitalization could offset the high equipment cost of MRgLITT. We examined the cost-utility of MRgLITT versus surgery for TLE from healthcare payer perspective, and the value of additional research to inform policy decision on MRgLITT. Methods We developed a microsimulation model to evaluate quality adjusted life years (QALYs), costs, and incremental cost-effectiveness ratio (ICER) of MRgLITT versus surgery in TLE, assuming life-time horizon and 1.5% discount rate. Model inputs were derived from the literature. We conducted threshold and sensitivity analyses to examine parameter uncertainties, and expected value of partial perfect information analyses to evaluate the expected monetary benefit of eliminating uncertainty on probabilities associated with MRgLITT. Results MRgLITT yielded 0.08 more QALYs and cost $7,821 higher than surgery, with ICER of $94,350/QALY. Influential parameters that could change model outcomes include probabilities of becoming seizure-free from disabling seizures state and returning to disabling seizures from seizure-free state 5 years after surgery and MRgLITT, cost of MRgLITT disposable equipment, and utilities of disabling seizures and seizure-free states of surgery and MRgLITT. The cost-effectiveness acceptability curve showed surgery was preferred in more than 50% of iterations. The expected monetary benefit of eliminating uncertainty for probabilities associated with MRgLITT was higher than for utilities associated with MRgLITT. Conclusions MRgLITT resulted in more QALYs gained and higher costs compared to surgery in the base-case. The model was sensitive to variations in the cost of MRgLITT disposable equipment. There is value in conducting more research to reduce uncertainty on the probabilities and utilities of MRgLITT, but priority should be given to research focusing on improving the precision of estimates on effectiveness of MRgLITT.
Direct oral anticoagulants uptake and an oral anticoagulation paradox.

Oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation is underutilised. One of the impediments to warfarin therapy is the frequent monitoring required, usually at a specialised warfarin clinic. The advent of direct oral anticoagulants (DOACs) facilitates OAC therapy without an onerous monitoring regimen. This benefit may result in the more significant adoption of DOACs in areas without a warfarin clinic. This study analysed national administrative data for reimbursed pharmacy claims to assess OAC prescribing from 2010 to 2017 and compared the use of DOAC in areas with warfarin clinics compared to those without. Over the study period, the number of patients on OAC increased by 84%, due to a rapid increase in DOAC prescribing. The findings demonstrate that DOACs have resulted in an increase in the overall uptake of OAC therapy in Ireland. However, the increased utilization was not evidently related to populations underserved by warfarin clinics.