Category: Nevin Manimala

PLoS One. 2024 Oct 15;19(10):e0311850. doi: 10.1371/journal.pone.0311850. eCollection 2024.

ABSTRACT

In ophthalmology and otolaryngology, data collected from paired body parts are typically reformatted into categorical bilateral data structures for subsequent research. This article applies Donner’s equal correlation coefficient model and obtains nine simultaneous confidence intervals (SCI) of proportion ratios under three asymptotic statistical methods and three ways of multiplicity adjustment. The empirical coverage probability and mean interval width are evaluated through Monte Carlo simulations. A real example is used to demonstrate the proposed methods.

PMID:39405312 | DOI:10.1371/journal.pone.0311850

PLoS One. 2024 Oct 15;19(10):e0309177. doi: 10.1371/journal.pone.0309177. eCollection 2024.

ABSTRACT

BACKGROUND: Women developing preeclampsia (PE) or fetal growth restriction (FGR) during pregnancy are at higher risk for cardiovascular diseases (CVD) later in life. We aimed to analyse cardiovascular health of women 10-20 years after affected pregnancies in comparison to women after uneventful pregnancies. In addition, we assessed a potential long-term effect of the NO-donor pentaerythrityl tetranitrate (PETN).

METHODS: Women 10-20 years after severe PE, including women receiving PETN during pregnancy and matched controls were recruited and assessed for baseline clinical data and cardiovascular function by transthoracic echocardiography, VICORDER and USCOM. SPSS was used for statistical analysis.

RESULTS: 53 participants after PE/FGR (13 with former PETN intake) and 51 controls were recruited for follow-up at an average of 14 years after index pregnancies. Compared to controls, women after PE/FGR had a significantly higher incidence of arterial hypertension (13.7% vs. 41.5%, p<0.001), and were more likely to be hypertensive (41.2% vs. 67.30%, p = 0.008). There were no differences in cardiovascular function observed. Affected women with PETN intake during pregnancy showed lower mean values for right atrial area and ventricle in comparison to controls and also to affected women without former medication.

CONCLUSIONS: In conclusion, our study results confirm that the risk of CVD is increased in women after PE/FGR compared to women after uneventful pregnancies. Contrary to our expectations, no major cardiovascular changes were observed in our cohort 10-20 years post pregnancy. The observed differences found in right heart dimensions were within reference ranges, and should be interpreted with caution.

PMID:39405308 | DOI:10.1371/journal.pone.0309177

PLoS One. 2024 Oct 15;19(10):e0311542. doi: 10.1371/journal.pone.0311542. eCollection 2024.

ABSTRACT

The aim of this research is to investigate the role of servicescape on re-patronage and recommended intention through pleasure feeling and satisfaction in healthcare settings that put substantial contribution in the process of healthcare service delivery. Data were collected through cross-sectional convenience sampling via a self-administered survey questionnaire from 431 clinical outpatients who revisit the same hospital of metropolitan areas of Punjab, Pakistan. Structural Equation Modeling (SEM) was carried out for path analysis through AMOS (24.0 V), while statistical measures were analyzed using SPSS (25.0 V). The present study results revealed that patients’ intention optimistically triggered through partial mediation and affirm the direct and indirect association with servicescape. It also revealed that patient-recommended and re-patronage intentions to visit the clinic were statistically substantial and positively influenced by intervening constructs of pleasure feeling and satisfaction. Additionally, it is found that servicescape and pleasure feeling contributed to 30% change in satisfaction. Moreover, pleasure feeling, and satisfaction contributed to 50% change in re-patronage and 31% change in recommendation intention of the patients. The current study findings contribute significantly to servicescape literature from a theatrical perspective and reevaluate the patterns and operations in healthcare. It also helps managers and administrators of private hospitals to make strategies to increase patient satisfaction.

PMID:39405306 | DOI:10.1371/journal.pone.0311542

J Med Internet Res. 2024 Oct 15;26:e49704. doi: 10.2196/49704.

ABSTRACT

BACKGROUND: Studies have shown that patients have difficulty understanding medical jargon in electronic health record (EHR) notes, particularly patients with low health literacy. In creating the NoteAid dictionary of medical jargon for patients, a panel of medical experts selected terms they perceived as needing definitions for patients.

OBJECTIVE: This study aims to determine whether experts and laypeople agree on what constitutes medical jargon.

METHODS: Using an observational study design, we compared the ability of medical experts and laypeople to identify medical jargon in EHR notes. The laypeople were recruited from Amazon Mechanical Turk. Participants were shown 20 sentences from EHR notes, which contained 325 potential jargon terms as identified by the medical experts. We collected demographic information about the laypeople’s age, sex, race or ethnicity, education, native language, and health literacy. Health literacy was measured with the Single Item Literacy Screener. Our evaluation metrics were the proportion of terms rated as jargon, sensitivity, specificity, Fleiss κ for agreement among medical experts and among laypeople, and the Kendall rank correlation statistic between the medical experts and laypeople. We performed subgroup analyses by layperson characteristics. We fit a beta regression model with a logit link to examine the association between layperson characteristics and whether a term was classified as jargon.

RESULTS: The average proportion of terms identified as jargon by the medical experts was 59% (1150/1950, 95% CI 56.1%-61.8%), and the average proportion of terms identified as jargon by the laypeople overall was 25.6% (22,480/87,750, 95% CI 25%-26.2%). There was good agreement among medical experts (Fleiss κ=0.781, 95% CI 0.753-0.809) and fair agreement among laypeople (Fleiss κ=0.590, 95% CI 0.589-0.591). The beta regression model had a pseudo-R² of 0.071, indicating that demographic characteristics explained very little of the variability in the proportion of terms identified as jargon by laypeople. Using laypeople’s identification of jargon as the gold standard, the medical experts had high sensitivity (91.7%, 95% CI 90.1%-93.3%) and specificity (88.2%, 95% CI 86%-90.5%) in identifying jargon terms.

CONCLUSIONS: To ensure coverage of possible jargon terms, the medical experts were loose in selecting terms for inclusion. Fair agreement among laypersons shows that this is needed, as there is a variety of opinions among laypersons about what is considered jargon. We showed that medical experts could accurately identify jargon terms for annotation that would be useful for laypeople.

PMID:39405109 | DOI:10.2196/49704

ACS Appl Mater Interfaces. 2024 Oct 15. doi: 10.1021/acsami.4c15275. Online ahead of print.

ABSTRACT

We applied Bayesian optimization (BO), a machine learning (ML) technique, to optimize the growth conditions of monolayer WS₂ using photoluminescence (PL) intensity as the objective function. Through iterative experiments guided by BO, an improvement of 86.6% in PL intensity is achieved within 13 optimization rounds. Statistical analysis revealed the relationships between growth conditions and PL intensity, highlighting the importance of critical conditions, including the tungsten source concentration and Ar flow rate. Furthermore, the effectiveness of BO is demonstrated by comparison with random search, showing its ability to converge to optimal conditions with fewer iterations. This research highlights the potential of ML-driven approaches in accelerating material synthesis and optimization processes, paving the way for advances in two-dimensional (2D) material-based technologies.

PMID:39405090 | DOI:10.1021/acsami.4c15275

Ear Nose Throat J. 2024 Oct 15:1455613241290498. doi: 10.1177/01455613241290498. Online ahead of print.

ABSTRACT

Background: Nasal bone fractures are pretty common. The most common causes include interpersonal violence, traffic accidents, sports injuries, and falls. This study aimed to assess patients presenting with nasal bone fractures not only for nasal trauma but also for personality disorders, impulsivity, and attention-deficit/hyperactivity disorder (ADHD) using psychiatric questionnaires. Methods: The study included 41 patients, and the control group consisted of 43 volunteers without nasal bone fracture; neither the patients nor the volunteers had previously been diagnosed with or treated for psychiatric disorders. The psychiatric questionnaires administered were the Eysenck Personality Questionnaire Revised-Short Form (EPQR-S), the Barratt Impulsivity Scale-Short Form (BIS-11-SF), and Turgay’s Adult ADD/ADHD DSM-IV-based Scale. Results: The most common cause of nasal bone fractures in our study was violence (41.5%), followed by traffic accidents (29.3%), falls (17%), and sports injuries (12.2%). In the EPQR-S assessment, the nasal bone fracture (NBF) group had significantly-higher total scores than the control group (CG) (P < .001). In the subscales of the questionnaire, extroversion, psychoticism, and lie subscale scores were higher in the NBF group than in the CG. In the BIS-11-SF assessment, the NBF group had higher total scores than the CG (P < .001). Assessment using Turgay’s adult ADD/ADHD DSM IV-based diagnostic screening and rating scale revealed no statistically-significant difference between the NBF group and the CG in terms of attention deficit and hyperactivity. Conclusion: We found that psychoticism patterns and impulsivity were more prevalent in the patient group, whereas ADD/ADHD was not. The results of our study suggest that performing a psychiatric assessment may be the right decision in patients presenting with NBFs caused by violence, whether they are the aggressor or the victim.

PMID:39405071 | DOI:10.1177/01455613241290498

JAMA Netw Open. 2024 Oct 1;7(10):e2438526. doi: 10.1001/jamanetworkopen.2024.38526.

NO ABSTRACT

PMID:39405066 | DOI:10.1001/jamanetworkopen.2024.38526

JAMA Netw Open. 2024 Oct 1;7(10):e2438541. doi: 10.1001/jamanetworkopen.2024.38541.

ABSTRACT

IMPORTANCE: Despite being recommended by clinical guidelines, substantial concerns remain regarding the use of high-sensitivity cardiac troponin assays and whether it is associated with increased resource use, myocardial infarction (MI) or myocardial injury diagnoses, and procedural rates.

OBJECTIVE: To characterize the association of reporting high-sensitivity cardiac troponin T (hs-cTnT) to the lowest limit of quantification vs conventional troponin reporting with clinical outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a historically controlled baseline and follow-up design to compare clinical outcomes after changing hs-cTnT reporting to the lowest limit of quantification. All patients aged 18 years or older presenting to any public emergency department (ED) in the state of South Australia between February 1, 2020, and February 28, 2021, who had an hs-cTnT test in the 6 months before and after the change in troponin reporting practice were included. Outcomes were assessed after adjusting for patient characteristics using inverse probability treatment weighting. The data analysis was performed between May 1, 2022, and July 27, 2023.

EXPOSURE: hs-cTcnT reporting.

MAIN OUTCOMES AND MEASURES: The main outcomes were frequency of diagnosed MI, coronary angiography, percutaneous coronary intervention, and coronary artery bypass graft (CABG); hospital length of stay; and ED discharge rate as measured using time-to-event Cox regression models. The secondary outcome was the composite 12-month event rate of all-cause mortality, MI, and myocardial injury.

RESULTS: A total of 40 921 patients were included, of whom 20 206 were included in the unmasked hs-cTnT reporting group (median [IQR] age, 62.0 [46.0-77.0]; 10 120 females [50.1%]) and 20 715 were included in the conventional troponin reporting group (median [IQR] age, 63.0 [47.0-77.0] years; 10 752 males [51.9%]). Unmasked hs-cTnT reporting was associated with higher ED discharge rates (45.2% vs 39.0%; P < .001) and a shorter median hospital length of stay (7.68 [IQR, 4.32-46.80] hours vs 7.92 [IQR, 4.56-49.92] hours; P < .001). There was no difference in diagnosis of MI, coronary angiography, percutaneous coronary intervention, or coronary artery bypass graft. The composite of all-cause mortality, MI, and myocardial injury at 12 months was similar (adjusted hazard ratio, 0.95; 95% CI, 0.90-1.01; P = .09).

CONCLUSIONS AND RELEVANCE: This cohort study found that unrestricted reporting of hs-cTnT results to the lowest limit of quantification was not associated with an increase in the diagnosis of MI, invasive coronary procedures, or harm at 12 months but may be associated with improved hospital resource use.

PMID:39405063 | DOI:10.1001/jamanetworkopen.2024.38541

JAMA Netw Open. 2024 Oct 1;7(10):e2438563. doi: 10.1001/jamanetworkopen.2024.38563.

ABSTRACT

IMPORTANCE: Marginalized populations have been disproportionately affected by the COVID-19 pandemic. Critically ill patients belonging to racial and ethnic minority populations treated in hospitals operating under crisis or near-crisis conditions may have experienced worse outcomes than White individuals.

OBJECTIVE: To examine whether hospital strain was associated with worse outcomes for older patients hospitalized with sepsis and whether these increases in poor outcomes were greater for members of racial and ethnic minority groups compared with White individuals.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, multivariable regression analysis was conducted to assess differential changes in all-cause 30-day mortality and major morbidity among older racial and ethnic minoritized individuals hospitalized with sepsis compared with White individuals and changes in hospital strain using Medicare claims data. Data were obtained on patients hospitalized between January 1, 2016, and December 31, 2021, and analyzed between December 16, 2023, and July 11, 2024.

EXPOSURE: Time-varying weekly hospital percentage of inpatients with COVID-19.

MAIN OUTCOMES AND MEASURES: Composite of all-cause 30-day mortality and major morbidity.

RESULTS: Among the 5 899 869 hospitalizations for sepsis (51.5% women; mean [SD] age, 78.2 [8.8] years), there were 177 864 (3.0%) Asian, 664 648 (11.3%) Black, 522 964 (8.9%) Hispanic, and 4 534 393 (76.9%) White individuals. During weeks when the hospital COVID-19 burden was greater than 40%, the risk of death or major morbidity increased nearly 2-fold (adjusted odds ratio [AOR], 1.90; 95% CI, 1.80-2.00; P < .001) for White individuals compared with before the pandemic. Asian, Black, and Hispanic individuals experienced 44% (AOR, 1.44; 95% CI, 1.28-1.61; P < .001), 21% (AOR, 1.21; 95% CI, 1.11-1.33; P < .001), and 45% (AOR, 1.45; 95% CI, 1.32-1.59; P < .001) higher risk of death or morbidity, respectively, compared with White individuals when the hospital weekly COVID-19 burden was greater than 40%.

CONCLUSION AND RELEVANCE: In this cross-sectional study, older adults hospitalized with sepsis were more likely to die or experience major morbidity as the hospital COVID-19 burden increased. These increases in adverse outcomes were greater in magnitude among members of minority populations than for White individuals.

PMID:39405062 | DOI:10.1001/jamanetworkopen.2024.38563

JAMA Netw Open. 2024 Oct 1;7(10):e2439509. doi: 10.1001/jamanetworkopen.2024.39509.

ABSTRACT

IMPORTANCE: There is growing interest in developing coordinated regional systems for nontraumatic surgical emergencies; however, our understanding of existing emergency general surgery (EGS) care communities is limited.

OBJECTIVE: To apply network analysis methods to delineate EGS care regions and compare the performance of this method with the Dartmouth Health Referral Regions (HRRs).

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted using the 2019 California and New York state emergency department and inpatient databases. Eligible participants included all adult patients with a nonelective admission for common EGS conditions. Interhospital transfers (IHTs) were identified by transfer indicators or temporally adjacent hospitalizations at 2 different facilities. Data analysis was conducted from January to May 2024.

EXPOSURE: Admission for primary EGS diagnosis.

MAIN OUTCOMES AND MEASURES: Regional EGS networks (RENs) were delineated by modularity optimization (MO), a community detection method, and compared with the plurality-based Dartmouth HRRs. Geographic boundaries were compared through visualization of patient flows and associated health care regions. Spatial accuracy of the 2 methods was compared using 6 common network analysis measures: localization index (LI), market share index (MSI), net patient flow, connectivity, compactness, and modularity.

RESULTS: A total of 1 244 868 participants (median [IQR] age, 55 [37-70 years]; 776 725 male [62.40%]) were admitted with a primary EGS diagnosis. In New York, there were 405 493 EGS encounters with 3212 IHTs (0.79%), and 9 RENs were detected using MO compared with 10 Dartmouth HRRs. In California, there were 839 375 encounters with 10 037 IHTs (1.20%), and 14 RENs were detected compared with 24 HRRs. The greatest discrepancy between REN and HRR boundaries was in rural regions where one REN often encompassed multiple HRRs. The MO method was significantly better than HRRs in identifying care networks that accurately captured patients living within the geographic region as indicated by the LI and MSI for New York (mean [SD] LI, 0.86 [1.00] for REN vs 0.74 [1.00] for HRR; mean [SD] MSI, 0.16 [0.13] for REN vs 0.32 [0.21] for HRR) and California (mean [SD] LI, 0.83 [1.00] for REN vs 0.74 [1.00] for HRR; mean [SD] MSI, 0.19 [0.14] for REN vs 0.39 [0.43] for HRR). Nearly 27% of New York hospitals (37 of 139 hospitals [26.62%]) and 15% of California hospitals (48 of 336 hospitals [14.29%]) were reclassified into a different community with the MO method.

CONCLUSIONS AND RELEVANCE: Development of optimal health delivery systems for EGS patients will require knowledge of care patterns specific to this population. The findings of this cross-sectional study suggest that network science methods, such as MO, offer opportunities to identify empirical EGS care regions that outperform HRRs and can be applied in the development of coordinated regional systems of care.

PMID:39405059 | DOI:10.1001/jamanetworkopen.2024.39509