Nevin Manimala

Nucleic Acids Res. 2024 Oct 29:gkae962. doi: 10.1093/nar/gkae962. Online ahead of print.

ABSTRACT

The emergence of spatial transcriptomic technologies has opened new avenues for investigating gene activities while preserving the spatial context of tissues. Utilizing data generated by such technologies, the identification of spatially variable (SV) genes is an essential step in exploring tissue landscapes and biological processes. Particularly in typical experimental designs, such as case-control or longitudinal studies, identifying SV genes between groups is crucial for discovering significant biomarkers or developing targeted therapies for diseases. However, current methods available for analyzing spatial transcriptomic data are still in their infancy, and none of the existing methods are capable of identifying SV genes between groups. To overcome this challenge, we developed SPADE for spatial pattern and differential expression analysis to identify SV genes in spatial transcriptomic data. SPADE is based on a machine learning model of Gaussian process regression with a gene-specific Gaussian kernel, enabling the detection of SV genes both within and between groups. Through benchmarking against existing methods in extensive simulations and real data analyses, we demonstrated the preferred performance of SPADE in detecting SV genes within and between groups. The SPADE source code and documentation are publicly available at https://github.com/thecailab/SPADE.

PMID:39470725 | DOI:10.1093/nar/gkae962

J Med Internet Res. 2024 Oct 29;26:e51655. doi: 10.2196/51655.

ABSTRACT

BACKGROUND: Short videos have demonstrated huge potential in disseminating health information in recent years. However, to our knowledge, no study has examined information about colorectal polyps on short-video sharing platforms.

OBJECTIVE: This study aimed to analyze the content and quality of colorectal polyps-related videos on short-video sharing platforms.

METHODS: The terms “” (intestinal polyps) or “” (colonic polyps) or “” (rectal polyps) or “” (colorectal polyps) or “” (polyps of large intestine) were used to search in TikTok (ByteDance), WeChat (Tencent Holdings Limited), and Xiaohongshu (Xingyin Information Technology Limited) between May 26 and June 8, 2024, and then the top 100 videos for each search term on different platforms were included and recorded. The Journal of American Medical Association (JAMA) score, the Global Quality Scale (GQS), the modified DISCERN, and the Patient Education Materials Assessment Tool (PEMAT) were used to evaluate the content and quality of selected videos by 2 independent researchers. SPSS (version 22.0; IBM Corp) and GraphPad Prism (version 9.0; Dotmatics) were used for analyzing the data. Descriptive statistics were generated, and the differences between groups were compared. Spearman correlation analysis was used to evaluate the relationship between quantitative variables.

RESULTS: A total of 816 eligible videos were included for further analysis, which mainly conveyed disease-related knowledge (n=635, 77.8%). Most videos were uploaded by physicians (n=709, 86.9%). These videos had an average JAMA score of 2.0 (SD 0.6), GQS score of 2.5 (SD 0.8), modified DISCERN score of 2.5 (SD 0.8), understandability of 80.4% (SD 15.6%), and actionability of 42.2% (SD 36.1%). Videos uploaded by news agencies were of higher quality and received more likes and comments (all P<.05). The number of collections and shares of videos about posttreatment caveats were more than those for other content (P=.03 and P=.006). There was a positive correlation between the number of likes, comments, collections, and shares (all P<.001). The duration and the number of fans were positively correlated with the quality of videos (all P<.05).

CONCLUSIONS: There are numerous videos about colorectal polyps on short-video sharing platforms, but the reliability and quality of these videos are not good enough and need to be improved.

PMID:39470708 | DOI:10.2196/51655

Health Care Women Int. 2024 Oct 29:1-16. doi: 10.1080/07399332.2024.2405569. Online ahead of print.

ABSTRACT

Little is known regarding the protective factors against suicide and violence against women in Muslim majority countries. The authors of this study aim to address this gap. Women with lived experience of suicide and violence (N = 51), and mental health providers in Azerbaijan participated in either in-depth qualitative interviews or focus groups. We used a mixed-methods design in this study. Descriptive statistics and bivariate analyses were conducted. Conventional content analysis was used for qualitative data. Psychological support, psychoeducation, providing women with financial opportunities and changing cultural values regarding gender norms were identified as the strongest protective factors against suicide and violence against women. Our findings point to culturally relevant protective factors that can inform prevention and intervention efforts to mitigate risk of suicide and violence against women in Azerbaijan and Muslim majority countries with shared values and cultural norms.

PMID:39470703 | DOI:10.1080/07399332.2024.2405569

JMIR Form Res. 2024 Oct 29;8:e56898. doi: 10.2196/56898.

ABSTRACT

BACKGROUND: The health care landscape is evolving rapidly due to rising costs, an aging population, and the increasing prevalence of diseases. To address these challenges, the Ministry of Health of Malaysia implemented transformation strategies such as the Casemix system and hospital information system to enhance health care quality, resource allocation, and cost-effectiveness. However, successful implementation relies not just on the technology itself but on the acceptance and engagement of the users involved.

OBJECTIVE: This study aims to develop and refine items of a quantitative instrument measuring the critical success factors influencing acceptance of Casemix system implementation within the Ministry of Health’s Total Hospital Information System (THIS).

METHODS: A cross-sectional pilot study collected data from medical doctors at a hospital equipped with the THIS in the federal territory of Putrajaya, Malaysia. This pilot study’s minimum sample size was 125, achieved through proportionate stratified random sampling. Data were collected using a web-based questionnaire adapted from the human, organization, and technology-fit evaluation framework and the technology acceptance model. The pilot data were analyzed using exploratory factor analysis (EFA), and the Cronbach α assessed internal reliability. Both analyses were conducted in SPSS (version 25.0; IBM Corp).

RESULTS: This study obtained 106 valid responses, equivalent to an 84.8% (106/125) response rate. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.859, and the Bartlett test of sphericity yielded statistically significant results (P<.001). Principal component analysis identified 9 components explaining 84.07% of the total variance, surpassing the minimum requirement of 60%. In total, 9 unique slopes indicated the identification of 9 components through EFA. While no new components emerged from the other 7 constructs, only the organizational factors construct was divided into 2 components, later named organizational structure and organizational environment. In total, 98% (41/42) of the items had factor loadings of >0.6, leading to the removal of 1 item for the final instrument for the field study. EFA ultimately identified 8 main constructs influencing Casemix implementation within the THIS: system quality, information quality, service quality, organizational characteristics, perceived ease of use, perceived usefulness, intention to use, and acceptance. Internal reliability measured using the Cronbach α ranged from 0.914 to 0.969, demonstrating high reliability.

CONCLUSIONS: This study provides insights into the complexities of EFA and the distinct dimensions underlying the constructs that influence Casemix system acceptance in the THIS. While the findings align with extensive technology acceptance literature, the results accentuate the necessity for further research to develop a consensus regarding the most critical factors for successful Casemix adoption. The developed instrument is a substantial step toward better understanding the multidimensional challenges of health care system transformations in Malaysia, postulating an underpinning for future fieldwork and broader application across other hospitals.

PMID:39470697 | DOI:10.2196/56898

Ther Adv Cardiovasc Dis. 2024 Jan-Dec;18:17539447241290438. doi: 10.1177/17539447241290438.

ABSTRACT

BACKGROUND: The no-reflow (NRF) phenomenon is the “Achilles heel” of interventionists after performing percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). No definitive treatment has been proposed for NRF, and preventive strategies are central to improving care for patients who develop NRF.

OBJECTIVES: In this study, we aim to investigate the clinical prediction models developed to predict NRF in STEMI patients undergoing primary PCI.

DESIGN: Systematic review.

DATA SOURCES AND METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were observed. Studies that developed clinical prediction modeling for NRF after primary PCI in STEMI patients were included. Data extraction was performed using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS) checklist. The Prediction Model Risk of Bias Assessment Tool (PROBAST) tool was used for critical appraisal of the included studies.

RESULTS: The three most common predictors were age, total ischemic time, and preoperative thrombolysis in myocardial infarction flow grade. Most of the included studies internally validated their developed model via various methods: random split, bootstrapping, and cross-validation. Only three studies (18%) externally validated their model. Six studies (37%) reported a calibration plot with or without the Hosmer-Lemeshow test. The reported area under the curve ranged from 0.648 to 0.925. The most common biases were in the statistical domain.

CONCLUSION: Clinical prediction models aid in individualizing care for STEMI patients with NRF after primary PCI. Of the 16 included studies, we report four to have a low risk of bias and low concern with regard to our research question, which should undergo external validation with or without updating in future studies.

PMID:39470690 | DOI:10.1177/17539447241290438

Clin Exp Dent Res. 2024 Dec;10(6):e70015. doi: 10.1002/cre2.70015.

ABSTRACT

OBJECTIVES: Many international dental organizations have been advocating for sustainable practices in dentistry, whereby significant reductions in environmental impacts are needed. The aim of this study was to analyze dental clinical waste in a university clinic setting to explore opportunities for sustainable practices.

MATERIAL AND METHODS: Fifty dental units (chairs) that are routinely used in delivery of dental treatment and involved supervising clinicians, dental students, and patients were randomly selected, and the clinical waste generated was collected, segregated, and weighed. Statistical analysis was performed to analyze differences in waste production based on treatment performed.

RESULTS: The mean waste production generated by each chair was 81.4 g of aprons, 56.2 g of gloves, 17.2 g of masks, 24.0 g of sterile wrappings, 48.8 g of other plastics, 100.8 g of cellulose-based items, and 25.8 g of miscellaneous items. Higher waste was generated from the chairs performing endodontic procedures when compared with examinations. A potential annual greenhouse gas saving of approximately 10 kg CO₂e per year (when one patient is treated daily) can be achieved if sterile wrapping plastics were to be recycled.

CONCLUSIONS: Simple yet achievable opportunities for efficient clinical waste management at university clinics exist, which in turn will increase environmental sustainability in the post-COVID-19 era. Increased awareness and incentives for sustainable measures could potentially enhance the possibility of wider adoption of ecofriendly approaches.

PMID:39470688 | DOI:10.1002/cre2.70015

Can Urol Assoc J. 2024 Aug 30. doi: 10.5489/cuaj.8775. Online ahead of print.

ABSTRACT

INTRODUCTION: We aimed to assess the relationship between the distance traveled to receive treatment for urolithiasis and early outcomes.

METHODS: This is a population-based study of patients who received interventions for urolithiasis in Ontario between 2003 and 2019 using administrative data. Patients were stratified into three groups according to the distance travelled. Descriptive statistics and the Chi-squared test were used to examine differences between these groups based on the urolithiasis treatment of choice. The primary outcomes were reoperation rates and readmission rates. To identify the factors associated with the co-primary outcomes, both univariate and multivariable logistic regression models were employed.

RESULTS: A total of 127 195 patients were included in the final analysis, with the majority of patients (n=100 124, 78.7%) having their stone procedure within 30 km from their residence, whereas 9586 patients (7.5%) travelled a distance greater than 90 km. Most of those that travelled >90 km were for extracorporeal shock wave lithotripsy (ESWL) (59%). Type of procedure and region of residence were the only variables that appeared to have a clinically relevant association with greater distance travelled. Unadjusted analysis suggested longer distance travelled was associated with a decrease in the need for a repeat procedure; however, this was likely confounded by an association between distance traveled and procedure type. In adjusted analysis, early post-procedure health resource use did not appear to be dramatically increased with greater distance from care. Indeed, readmission rates at 30 days were marginally lower among those who travelled 30-60 km vs. <30 km (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.80-0.92, and had no detectable difference at >90 km vs. <30 km (OR 0.97, 95% CI 0.88, 1.08). These observations of fewer or no difference in readmissions and emergency visits for those that travelled the greatest distances generally held true in the subgroup analysis for each surgical procedure.

CONCLUSIONS: This population-based study found no clinically remarkable associations between the distance travelled for urolithiasis treatment and early outcomes. In fact, some marginal decreases in resource use were observed with greater travel distance perhaps reflecting some effect of travel to higher volume referral centers or enhanced processes for those that needed to travel farther for care. This information could be important for clinicians to help appropriate counselling and health systems planning.

PMID:39470664 | DOI:10.5489/cuaj.8775

Can Urol Assoc J. 2024 Aug 30. doi: 10.5489/cuaj.8872. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study is to evaluate YouTube content about metoidioplasty on completeness of perioperative information, actionability, understandability, degree of misinformation, quality, and presence of commercial bias.

METHODS: A YouTube search for “Metoidioplasty” was conducted and the first 100 video results were watched by five independent reviewers. Videos in English <30 minutes in length were included and videos primarily showing surgical footage were excluded. Videos were evaluated between January 2022 and June 2022. Each video was evaluated for presenter demographics, channel/video statistics, and whether it covered topics including anatomy, treatment options, outcomes, procedure risks, and misinformation, and whether it had a clickbait title. Calculated scores for validated DISCERN and Patient Education Materials Assessment Tool (PEMAT) metrics were the primary outcome variables used to quantify quality, actionability, and understandability. For PEMAT, a cutoff of 75% was used to differentiate between “poor” versus “good/sufficient.” Multivariate and univariate logistic regressions were performed to assess correlations among primary outcome variables and other variables.

RESULTS: Of the 79 videos analyzed, 24% (n=19) were of high quality; 99% (n=78) had poor understandability and 100% (n=79%) had poor actionability. Patients/consumers were the most common publisher type (n=71, 90%).

CONCLUSIONS: This study demonstrates metoidioplasty content available on YouTube is not comprehensive and is of poor quality, and poor actionability and understandability, demonstrating a clear need for more relevant, accessible, comprehensible, and accurate content.

PMID:39470663 | DOI:10.5489/cuaj.8872

Can Urol Assoc J. 2024 Aug 30. doi: 10.5489/cuaj.8870. Online ahead of print.

ABSTRACT

INTRODUCTION: We sought to assess the performance of the proudP AI algorithm, integrated into a mobile application, in estimating uroflow curves and parameters using recorded urination sounds.

METHODS: A direct comparison was made between the peak flow rate (Qmax), voided volume, and uroflow curves predicted by the proudP algorithm and those obtained through established validation methods. A hardware uroflow simulator replicated uroflow profiles by precisely controlling water flow rates and extracting corresponding sound data. Ten uroflow profiles, representing typical patterns observed in male subjects, were selected. Simulation experiments with proudP were conducted using a standard toilet setup. The uroflow simulator was calibrated to reproduce uroflow profiles, and validation was performed against a Flowmaster uroflowmetry device. Statistical analysis included descriptive summaries, Bland-Altman analysis, and Concordance Correlation Coefficient (CCC) analysis.

RESULTS: The proudP accurately captured various uroflow patterns generated by the simulator, with low standard deviations in Qmax predictions and biases near zero. The SDs of voided volume were slightly larger, primarily due to uroflow patterns with extended voiding times. The study validated the accuracy of proudP against in-office uroflowmetry, demonstrating robustness across different smartphone models.

CONCLUSIONS: proudP proved to be as accurate as in-office uroflowmetry in estimating uroflow rate across various patterns. Its convenience in home monitoring offers patients a means to observe their urination patterns accurately, while enabling healthcare professionals to gain detailed insights remotely. proudP emerges as an essential solution for clinical practice and urological research.

PMID:39470660 | DOI:10.5489/cuaj.8870

JAMA Netw Open. 2024 Oct 1;7(10):e2440983. doi: 10.1001/jamanetworkopen.2024.40983.

ABSTRACT

IMPORTANCE: Reducing low-value care has the potential to improve patient experiences and outcomes and decrease the unnecessary use of health care resources. Research suggests that low-value practices (ie, the potential for harm exceeds the potential for benefit) in adult trauma care are frequent and subject to interhospital variation; evidence on low-value practices in pediatric trauma care is lacking.

OBJECTIVE: To estimate the incidence of low-value practices in pediatric trauma care and evaluate interhospital practice variation.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective multicenter cohort study in a Canadian provincial trauma system was conducted. Children younger than 16 years admitted to any of the 59 provincial trauma centers from April 1, 2016, to March 31, 2022, were included.

MAIN OUTCOMES AND MEASURES: Low-value practices were identified from systematic reviews of clinical practice guidelines on pediatric trauma. The frequencies of low-value practices were evaluated by estimating incidence proportions and cases per 1000 admissions (low if ≤10% and ≤10 cases, moderate if >10% or >10 cases, and high if >10% and >10 cases) were identified. Interhospital variation with intraclass correlation coefficients (ICCs) were assessed (low if <5%, moderate if 5%-20%, and high if >20%).

RESULTS: A total of 10 711 children were included (mean [SD] age, 7.4 [4.9] years; 6645 [62%] boys). Nineteen low-value practices on imaging, fluid resuscitation, hospital/intensive care unit admission, specialist consultation, deep vein thrombosis prophylaxis, and surgical management of solid organ injuries were identified. Of these, 14 (74%) could be evaluated using trauma registry data. Five practices had moderate to high frequencies and interhospital variation: head computed tomography in low-risk children (7.1%; 33 per 1000 admissions; ICC, 8.6%), pretransfer computed tomography in children with a clear indication for transfer (67.6%; 4 per 1000 admissions; ICC, 5.7%), neurosurgical consultation in children without clinically important intracranial lesions (11.6%; 13 per 1000 admissions; ICC, 15.8%), hospital admission in isolated mild traumatic brain injury (38.8%; 98 per 1000 admissions; ICC, 12.4%), and hospital admission in isolated minor blunt abdominal trauma (10%; 5 per 1000 admissions; ICC, 31%).

CONCLUSIONS AND RELEVANCE: In this cohort study, low-value practices appeared to be frequent and subject to interhospital variation. These practices may represent priority targets for deimplementation interventions, particularly as they can be measured using routinely collected data.

PMID:39470640 | DOI:10.1001/jamanetworkopen.2024.40983