Miracle-dz/UniFAR-FTUs huggingface dataset:
Students’ and tutors’ experiences of remote ‘student–patient’ consultations

Abstract Background Remote consulting has become part of the medical student clinical experience in primary care, but little research exists regarding the impact on learning. Aim To describe the experiences of General Practitioner (GP) educators and medical students in using student-led remote consultations as an educational tool. Method A qualitative, explorative study conducted at four UK medical schools. GP educators and medical students were purposively sampled and interviewed. Results Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferentiated patients, clinical reasoning, patient inclusion in student education, student–patient interaction, and student–doctor interaction. Discussion Remote consulting has become part of the clinical placement experience. This has been found to expose students to a wider variety of clinical presentations. Verbal communication, history-taking, triage, and clinical reasoning skills were practised through remote consulting, but examination skills development was lacking. Students found building rapport more challenging, although this was mitigated by having more time with patients. Greater clinical risk was perceived in remote consulting, which had potential to negatively impact students’ psychological safety. Frequent debriefs could ameliorate this risk and positively impact student–doctor relationships. Student autonomy and independence increased due to greater participation and responsibility. Pre-selection of patients could be helpful but had potential to expose students to lower complexity patients. Practice points Remote consulting confers unique educational benefits. Remote consulting can help develop history-taking and communication skills, as well as clinical reasoning skills. The psychological safety of the student and the supervisory risk of the tutor can be impacted by remote consulting, but frequent debriefs between the student and tutor can help mitigate this risk. Learning how to conduct remote, and face-to-face consultations is important in medical education.
Lack of Statin Therapy and Outcomes After Ischemic Stroke: A Population-Based Study

Background: Statin treatment is effective at preventing adverse vascular events after ischemic stroke (IS). However, many patients fail to use statins after IS. We studied the impact of not using statins after IS on adverse outcomes. Methods: IS patients (n=59 588) admitted to 20 Finnish hospitals were retrospectively studied. Study data were combined from national registries on hospital admissions, mortality, cancer diagnoses, prescription medication purchases, and permissions for special reimbursements for medications. Usage of prescription medication was defined as drug purchase within 90 days after hospital discharge. Ongoing statin use during follow-up was analyzed in 90-day intervals. Differences in baseline features, comorbidities, other medications, and recanalization therapies were balanced with inverse probability of treatment weighting. Median follow-up was 5.7 years. Results: Statin therapy was not used by 27.1% of patients within 90 days after IS discharge, with women and older patients using statins less frequently. The average proportion of patients without ongoing statin during the 12-year follow-up was 36.0%. Patients without early statins had higher all-cause mortality at 1 year (7.5% versus 4.4% in patients who did use statins; hazard ratio [HR], 1.74 [CI, 1.61–1.87]) and 12 years (56.8% versus 48.6%; HR, 1.37 [CI, 1.33–1.41]). Cumulative incidence of major adverse cerebrovascular or cardiovascular event was higher at 1 year (subdistribution HR, 1.36 [CI, 1.29–1.43]) and 12 years (subdistribution HR, 1.21 [CI, 1.18–1.25]) without early statin use. Cardiovascular death, recurrent IS, and myocardial infarction were more frequent without early statin use. Early statin use was not associated with hemorrhagic stroke during follow-up. Lack of ongoing statin during follow-up was associated with risk of death in time-dependent analysis (adjusted HR, 3.03 [CI, 2.96–3.23]). Conclusions: Lack of statin treatment after IS is associated with adverse long-term outcomes. Measures to further improve timely statin use after IS are needed.
Release of extracellular superoxide dismutase into alveolar fluid protects against acute lung injury and inflammation in Staphylococcus aureus pneumonia.

Acute respiratory distress syndrome (ARDS) remains a significant cause of morbidity and mortality in critically ill patients. Oxidative stress and inflammation play crucial role in pathogenesis of ARDS. Extracellular superoxide dismutase (EC-SOD) is abundant in the lung and is important enzymatic defense against superoxide. Human single nucleotide polymorphism in matrix binding region of EC-SOD leads to substitution of arginine to glycine at position 213 (R213G) and results in release of EC-SOD into alveolar fluid, without affecting enzyme activity. We hypothesized that R213G EC-SOD variant protects against lung injury and inflammation via blockade of neutrophil-recruitment in infectious model of methicillin-resistant S. aureus (MRSA) pneumonia. After inoculation with MRSA, WT mice had impaired integrity of alveolar-capillary barrier and increased levels of IL-1β, IL-6, and TNF-α in the broncho-alveolar lavage fluid (BALF), while infected mice expressing R213G EC-SOD variant maintained the integrity of alveolar-capillary interface and had attenuated levels of proinflammatory cytokines. MRSA-infected mice expressing R213G EC-SOD variant also had attenuated neutrophil numbers in BALF and decreased expression of neutrophil chemoattractant CXCL1 by the alveolar epithelial ATII cells, compared to the infected WT group. The decreased neutrophil numbers in R213G mice were not due to increased rate of apoptosis. Mice expressing R213G variant had differential effect on neutrophil functionality, - the generation of neutrophil extracellular traps (NETs) but not myeloperoxidase (MPO) levels were attenuated in comparison to WT controls. Despite having the same bacterial load in the lung as WT controls, mice expressing R213G EC-SOD variant were protected from extrapulmonary dissemination of bacteria.
Unequal Error Protection Codes for Image Transmission over Noisy Channels and AWGN Channels

In this paper Unequal error protection codes for image transmission over noisy channels and Additive White Gaussian Noise (AWGN) channels are evaluated. The ability of computation of the bit sensitivity of the compressed image data allows one to achieve a highly effective unequal error protection for image transmission over noisy channels and AWGN channels. A channel code is proposed to protect progressively compressed and packetized image data that is transmitted across noisy channels and AWGN channels. A group of unequal error protection codes using Trellis Coded Modulation (TCM) for the JPEG compressed images is investigated. Simulation results of two levels of Unequal Error Protection Codes (UEP) with TCM and four levels of UEP with TCM are evaluated.
Feature selection in wind speed forecasting systems based on meta-heuristic optimization

Technology for anticipating wind speed can improve the safety and stability of power networks with heavy wind penetration. Due to the unpredictability and instability of the wind, it is challenging to accurately forecast wind power and speed. Several approaches have been developed to improve this accuracy based on processing time series data. This work proposes a method for predicting wind speed with high accuracy based on a novel weighted ensemble model. The weight values in the proposed model are optimized using an adaptive dynamic grey wolf-dipper throated optimization (ADGWDTO) algorithm. The original GWO algorithm is redesigned to emulate the dynamic group-based cooperative to address the difficulty of establishing the balance between exploration and exploitation. Quick bowing movements and a white breast, which distinguish the dipper throated birds hunting method, are employed to improve the proposed algorithm exploration capability. The proposed ADGWDTO algorithm optimizes the hyperparameters of the multi-layer perceptron (MLP), K-nearest regressor (KNR), and Long Short-Term Memory (LSTM) regression models. A dataset from Kaggle entitled Global Energy Forecasting Competition 2012 is employed to assess the proposed algorithm. The findings confirm that the proposed ADGWDTO algorithm outperforms the literature’s state-of-the-art wind speed forecasting algorithms. The proposed binary ADGWDTO algorithm achieved average fitness of 0.9209 with a standard deviation fitness of 0.7432 for feature selection, and the proposed weighted optimized ensemble model (Ensemble using ADGWDTO) achieved a root mean square error of 0.0035 compared to state-of-the-art algorithms. The proposed algorithm’s stability and robustness are confirmed by statistical analysis of several tests, such as one-way analysis of variance (ANOVA) and Wilcoxon’s rank-sum.
Quasi–incompressible Cahn–Hilliard fluids and topological transitions

One of the fundamental problems in simulating the motion of sharp interfaces between immiscible fluids is a description of the transition that occurs when the interfaces merge and reconnect. It is well known that classical methods involving sharp interfaces fail to describe this type of phenomena. Following some previous work in this area, we suggest a physically motivated regularization of the Euler equations which allows topological transitions to occur smoothly. In this model, the sharp interface is replaced by a narrow transition layer across which the fluids may mix. The model describes a flow of a binary mixture, and the internal structure of the interface is determined by both diffusion and motion. An advantage of our regularization is that it automatically yields a continuous description of surface tension, which can play an important role in topological transitions. An additional scalar field is introduced to describe the concentration of one of the fluid components and the resulting system of equations couples the Euler (or Navier–Stokes) and the Cahn–Hilliard equations. The model takes into account weak non–locality (dispersion) associated with an internal length scale and localized dissipation due to mixing. The non–locality introduces a dimensional surface energy; dissipation is added to handle the loss of regularity of solutions to the sharp interface equations and to provide a mechanism for topological changes. In particular, we study a non–trivial limit when both components are incompressible, the pressure is kinematic but the velocity field is non–solenoidal (quasi–incompressibility). To demonstrate the effects of quasi–incompressibility, we analyse the linear stage of spinodal decomposition in one dimension. We show that when the densities of the fluids are not perfectly matched, the evolution of the concentration field causes fluid motion even if the fluids are inviscid. In the limit of infinitely thin and well–separated interfacial layers, an appropriately scaled quasi–incompressible Euler–Cahn–Hilliard system converges to the classical sharp interface model. In order to investigate the behaviour of the model outside the range of parameters where the sharp interface approximation is sufficient, we consider a simple example of a change of topology and show that the model permits the transition to occur without an associated singularity.
Reasoning with Knights and Knaves: Towards an understanding of reasoning about truth and falsity

At the end of the eighties a type of logical puzzle called knight and knave prob2 lems(Smullyan, 1987) enters the scene of psychology of reasoning(Rips, 1989). 3 They are staged on an imaginary island where only two kinds of people live: 4 knights, who always tell the truth, and knaves, who always lie. It is furthermore 5 assumed that they have complete and correct knowledge of each other’s being 6 knight or knave. A puzzle then consists of a number of utterances from a few of 7 these inhabitants. The task for the reader is to decide of each character whether 8 he or she is a knight or a knave. 9 To illustrate, consider the example in table 1. 10 As with all puzzles, there are multiple ways to arrive at the solution. One 11
Preferences of general practitioners for delivering adult vaccination: A discrete choice experiment

ABSTRACT Preventive health workers rather than general practitioners (GPs) are the principal providers of vaccines in China, which may be a determinant of the unmet demand for vaccination, especially for adults, in recent years. GPs’ preferences had a significant influence on alternative approaches to adult vaccination delivery. To better understand GP’s preferences for adult vaccination services, we employed a discrete choice experiment with seven attributes: income, setting, information system, workshop, workload, performance measurement, and managerial support. Mixed logit models and latent class models were used for statistical analyses. In general, support from primary healthcare managers was the strongest driver of choice, followed by a 10% increase in workload, separate adult vaccination clinic, 5% increase in workload, and independent information system. Monthly income was significantly associated with provision of adult vaccination services. Based on the influence of latent factors, GPs fell into three classes that were correlated with GPs’ years of practice, workload, income satisfaction, and knowledge-attitude-practicescore. Classes 1 and 2 valued the service setting and performance measurement differently, while Class 3 valued the service setting only (preferred separate adult vaccination clinics to provide service). This study generated actionable information to guide innovation in the adult vaccination delivery system in China.
Integral and Differential Cross Sections for Electron Impact Ionization

Calculated Coulomb-Born exchange cross sections for hydrogenic ions from 1s through 6h exist in the literature. An analytic fit formula to these cross sections has been derived by fitting simultaneously to n, l, and u where n is the principal quantum number, l is the orbital angular momentum, and u is the impact electron energy in threshold units. The resulting fit, which is easily integrated over a Maxwellian velocity distribution, reproduces the calculated cross section to better than 10%. A prescription is given for applying the cross sections to nonhydrogenic ions. In addition, the cross sections differential with respect to the energy of the scattered electron have been fitted
Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis

Abstract Aims Coronary heart disease is the most common reason for referral to exercise-based cardiac rehabilitation (CR) globally. However, the generalizability of previous meta-analyses of randomized controlled trials (RCTs) is questioned. Therefore, a contemporary updated meta-analysis was undertaken. Methods and results Database and trial registry searches were conducted to September 2020, seeking RCTs of exercise-based interventions with ≥6-month follow-up, compared with no-exercise control for adults with myocardial infarction, angina pectoris, or following coronary artery bypass graft, or percutaneous coronary intervention. The outcomes of mortality, recurrent clinical events, and health-related quality of life (HRQoL) were pooled using random-effects meta-analysis, and cost-effectiveness data were narratively synthesized. Meta-regression was used to examine effect modification. Study quality was assessed using the Cochrane risk of bias tool. A total of 85 RCTs involving 23 430 participants with a median 12-month follow-up were included. Overall, exercise-based CR was associated with significant risk reductions in cardiovascular mortality [risk ratio (RR): 0.74, 95% confidence interval (CI): 0.64–0.86, number needed to treat (NNT): 37], hospitalizations (RR: 0.77, 95% CI: 0.67–0.89, NNT: 37), and myocardial infarction (RR: 0.82, 95% CI: 0.70–0.96, NNT: 100). There was some evidence of significantly improved HRQoL with CR participation, and CR is cost-effective. There was no significant impact on overall mortality (RR: 0.96, 95% CI: 0.89–1.04), coronary artery bypass graft (RR: 0.96, 95% CI: 0.80–1.15), or percutaneous coronary intervention (RR: 0.84, 95% CI: 0.69–1.02). No significant difference in effects was found across different patient groups, CR delivery models, doses, follow-up, or risk of bias. Conclusion This review confirms that participation in exercise-based CR by patients with coronary heart disease receiving contemporary medical management reduces cardiovascular mortality, recurrent cardiac events, and hospitalizations and provides additional evidence supporting the improvement in HRQoL and the cost-effectiveness of CR.
Update on the genetics of paragangliomas

Paragangliomas (PGL) of the adrenal (also known as pheochromocytomas) or extra-adrenal neural crest-derived cells are highly heritable tumors, usually driven by single pathogenic variants that occur mutually exclusively in genes involved in multiple cellular processes, including the response to hypoxia, MAPK/ERK signaling, and WNT signaling. The discovery of driver mutations has led to active clinical surveillance with outcome implications in familial PGL. The spectrum of mutations continues to grow and reveal unique mechanisms of tumorigenesis that inform tumor biology and provide the rationale for targeted therapy. Here we review recent progress in the genetics and molecular pathogenesis of PGLs and discuss new prospects for advancing research with new disease models and ongoing clinical trials presented at the recent International Symposium of Pheochromocytomas and Paragangliomas (ISP2022) held in October 2022 in Prague.
Simultaneous determination of time delays and stacking weights in seismic array beamforming

An algorithm for the estimation of time delays and weights in an arbitrary-single or three-component seismic array is developed by the use of a linearized waveform inversion technique. This algorithm differs from conventional crosscorrelation methods in its ability to simultaneously obtain time delays and weights by minimizing residuals of all possible waveform fittings, and by its robustness in the presence of high random noise levels and local geological scattering. There are N stations in an array, and for each station, a beam is formed by a weighted linear combination of the remaining (N - 1) seismic traces. The time delays and weights are model parameters to be found by minimizing the sum of N objective functions. Two optimization algorithms for solving the least-squares problem, singular-value decomposition and conjugate gradient, are compared, and the conjugate gradient method is found to be satisfactory and faster for large arrays. The algorithm was tested using synthetic array data with high noise, real data from shots in a borehole to a linear array on land, and Ms 6.7 earthquake data recorded with a broadband three-component array. The success with synthetic and real data shows the algorithm to be useful for seismic data stacking, residual static corrections, and phase picking when the data quality is poor.
Study of oscillatory and chaotic behavior in non-symmetric Hopfield networks

Hopfield networks have been applied and their stable behavior studied. Nevertheless, neural networks as non-linear systems may exhibit very rich behaviors which can eventually be exploited to extend the range of their applications. In this paper we show different behaviors that are found when the condition of symmetry in the weight matrix is broken in discrete and continuous Hopfield networks, in both cases being discrete-time synchronous. Specifically, an outer product asymmetry (OPA) is defined which lends itself to experimentally find expressions for bounds of structural stability. It is found, for all the cases examined, that these formulas lead to rational numbers and depend only on the size of the network and the number of stored patterns. Also, another type of asymmetry, which we refer to as competitive asymmetry, is applied. This type of asymmetry produces quasi-periodic and chaotic behaviors. Lyapunov exponents and the fractal dimension of the attractors, which characterize these behaviors, are calculated by means of several computational methods.
A protocol for a systematic review of behaviour change techniques used in the context of stillbirth prevention

Background: Stillbirth is a devastating pregnancy outcome that affects approximately 3.5 per 1000 births in high-income countries. Previous research has highlighted the importance of focusing prevention efforts on targeting risk factors and vulnerable groups. A wide range of risk factors has been associated with stillbirth before, including maternal behaviours such as back sleep position, smoking, alcohol intake, illicit drug use, and inadequate attendance at antenatal care. Given the modifiable nature of these risk factors, there has been an increase in the design of behaviour change interventions targeting such behaviours to reduce the risk of stillbirth. Objectives: The aim of this study is to identify all behavioural interventions with a behavioural component designed and trialled for the prevention of stillbirth in high-income countries, and to identify the behaviour change techniques (BCTs) used in such interventions using the Behaviour Change Techniques Taxonomy V1 (BCTTv1). Inclusion criteria: Interventions will be included in this review if they (1) have the objective of reducing stillbirth rates with a focus on behavioural risk factors; (2) are implemented in high-income countries; (3) target pregnant women or women of childbearing age; and (4) are published in research articles. Methods: A systematic search of the literature will be conducted. The results of the search will be screened against our inclusion criteria by two authors. The following data items will be extracted from the selected papers: general information, study characteristics, participant and intervention/approach details. The Cochrane Effective Practice and Organization of Care (EPOC) risk of bias criteria will be used to assess the methodological quality of included studies. Intervention content will be coded for BCTs as present (+) or absent (-) by two authors using the BCTTv1, discrepancies will be discussed with a third author. A narrative synthesis approach will be used to present the results of this systematic review.