Category: Nevin Manimala

J Dev Behav Pediatr. 2024 Nov 26. doi: 10.1097/DBP.0000000000001329. Online ahead of print.

ABSTRACT

OBJECTIVE: Despite automatic eligibility, many children with medical conditions associated with increased risk of disability do not receive Early Intervention (EI) services. State EI programs have compiled lists of established conditions to facilitate automatic enrollment; yet little is known about professionals’ knowledge and utilization of these lists. This study examined the knowledge of these established conditions lists and associated policies and procedures among pediatricians and EI personnel. State initiatives and approaches undertaken to improve familiarity and utilization of the list, along with recommendations for its improvement were examined.

METHOD: In this mixed-methods study, self-rated survey data were collected from 193 EI personnel responsible for intake and eligibility evaluations, and 69 pediatricians providing primary care. Follow-up interviews were then conducted with 45 EI personnel and 22 pediatricians. Quantitative data were analyzed using descriptive statistics, and qualitative data underwent thematic analysis.

RESULTS: Pediatricians rated their knowledge of their state’s established conditions list and related policies and procedures lower than EI personnel. Both groups emphasized the significance of the list in referral and eligibility determination but highlighted its underutilization and lack of professional development activities. Consequently, recommendations were made to improve state established conditions lists and their utilization in ensuring direct EI enrollment for eligible children.

CONCLUSION: The lack of shared knowledge and utilization of established conditions lists and associated policies and procedures among pediatricians and EI personnel may result in referral failure for eligible children. Addressing this challenge requires improvement in the content and statewide distribution to improve accessibility and usability.

PMID:39625642 | DOI:10.1097/DBP.0000000000001329

Sleep Breath. 2024 Dec 3;29(1):40. doi: 10.1007/s11325-024-03219-6.

ABSTRACT

PURPOSE: Muscle relaxation in the neck during sleep is crucial for achieving quality sleep, and varying pillow heights can significantly influence the myoelectric activity of the neck muscles. This study aims to investigate the effects of different pillow heights on neck muscle activity, with the goal of providing evidence-based recommendations for pillow selection.

METHODS: A total of 15 asymptomatic participants in this study, aged 18 to 30, were assigned to three groups based on pillow height: height 1 (0.5*Shoulder width), height 2 (1.0*Shoulder width), and height 3 (1.5*Shoulder width). Electromyography (EMG) was employed to measure muscle activity in the sternocleidomastoid and trapezius muscles during lateral sleeping positions. Sleep comfort was evaluated using a 100 mm visual analog scale (VAS). Statistical analysis was conducted using ANOVA to assess the differences in muscle activity and comfort levels across the various pillow heights.

RESULTS: The muscle activation levels revealed that both the sternocleidomastoid and trapezius muscle exhibited the lowest EMG activity in the height 2 (p < 0.001). In contrast, the sternocleidomastoid muscle recorded the highest activation, demonstrating significantly greater average electromyography (AEMG) and integrated electromyography (iEMG) at height 1 (p < 0.001). Meanwhile, the trapezius muscle showed the highest AEMG at height 3 (p < 0.001). Additionally, height 2 was identified as the most comfortable option when compared to height 1 and 3 (p < 0.001).

CONCLUSIONS: This study concludes that varying pillow heights are linked to neck muscle activity and sleep comfort. These findings underscore the importance of an appropriate pillow height to maintain a healthy cervical spine and promote restful sleep.

PMID:39625641 | DOI:10.1007/s11325-024-03219-6

Blood Res. 2024 Dec 3;59(1):40. doi: 10.1007/s44313-024-00047-1.

ABSTRACT

The diagnosis of acute ischemic stroke (AIS) can be challenging when neuroimaging findings are normal or equivocal. Neutrophil extracellular traps (NETs), particularly histone H3.1, have potential as biomarkers for AIS. This study evaluated NETs, specifically histone H3.1, as diagnostic biomarkers for AIS. This prospective study included 89 patients with AIS and 20 healthy controls. Plasma histone H3.1 levels were measured using the Nu.Q® H3.1 enzyme-linked immunosorbent assay (ELISA). Seven cytokines were analyzed using a bead-based immunoassay. Statistical analyses were used to compare histone H3.1 levels between groups and evaluate correlations with clinical parameters and cytokines. Histone H3.1 levels were significantly higher in patients with AIS (271.05 ± 33.40 ng/mL) versus controls (95.33 ± 12.86 ng/mL, p < 0.001). Multivariable logistic regression identified H3.1 as an independent risk factor for AIS (p = 0.006), with an area under the curve of 0.907. Significant correlations were found between H3.1, interleukin-6 (0.290, p = 0.013) and vascular cell adhesion molecule 1 (0.297, p = 0.011). In conclusion, the NETs H3.1 ELISA test is a reliable new diagnostic option that supports the diagnosis of AIS.

PMID:39625632 | DOI:10.1007/s44313-024-00047-1

Qual Life Res. 2024 Dec 3. doi: 10.1007/s11136-024-03850-6. Online ahead of print.

ABSTRACT

PURPOSE: Patient-reported outcome measures (PROMs) are being used more frequently in total knee arthroplasty (TKA). By utilizing high-quality scales, surgeons can achieve a more comprehensive and accurate evaluation of the effectiveness of TKA surgery. Currently, there is no widely accepted conceptual model for TKA PROMs. The objective of this study is to fill this gap by developing a conceptual model and preliminary content for a PROM that is specifically designed for TKA patients in mainland China.

METHODS: The study design consisted of three stages: (1) a targeted literature review followed by the formation of a conceptual model pool; (2) qualitative data collection involving experts and patients, leading to the development of the preliminary Chinese TKA PROM (CTP); and (3) review of the CTP by experts using the Delphi method, along with cognitive debriefing interviews with patients.

RESULTS: 64 patients and 28 experts took part in this study. The conceptual model focused on six key concepts: pain, symptom, function, quality of life, expectation, and satisfaction. To match the model, the authors developed a total of 35 items.

CONCLUSION: A conceptual model and preliminary content for CTP was developed with substantial participation from patients and a multidisciplinary group of experts. The integration of patient and clinical perspectives ensured a comprehensive representation of all relevant disease experiences and the focus of clinical practice. With further refinement through psychometric testing, the CTP is positioned to provide a standardized, comprehensive measure for research specific to Chinese TKA patients.

PMID:39625626 | DOI:10.1007/s11136-024-03850-6

Environ Sci Pollut Res Int. 2024 Dec 3. doi: 10.1007/s11356-024-35410-3. Online ahead of print.

ABSTRACT

The properties of soil matrix have an impact on the fluorescence intensity of polycyclic aromatic hydrocarbons (PAHs), which restricts the application of fluorescence spectral technology in detecting PAHs in soil. The present study explored the mechanism of the influence of soil matrix properties on the fluorescence intensity of PAHs from the perspective of specific surface area (SSA). A three-factor three-level experimental design was adopted for investigating the relationship between soil matrix properties, PAH fluorescence intensity, and soil SSA. The typical benzo[ghi]perylene pollutant in soil as the research object, 27 soil samples with different sand content, moisture content, humic acid content, and given benzo[ghi]perylene concentration (2 mg/g) were prepared. On the basis of obtaining the fluorescence spectra and SSA data of soil samples, statistical analyses of fluorescence intensity and SSA were investigated in relation to the soil matrix properties. The statistical results showed that the soil matrix properties had a significant influence (P < 0.05) on the fluorescence intensity and SSA. Furthermore, combined with the technology of fluorescence microscopy imaging, the influence mechanism of soil matrix properties on fluorescence intensity was revealed. The soil matrix properties affected the soil SSA, resulting in a change of benzo[ghi]perylene concentration in the soil surface at the probe window, thereby affecting the fluorescence intensity.

PMID:39625621 | DOI:10.1007/s11356-024-35410-3

Ann Med. 2024 Dec;56(1):2427909. doi: 10.1080/07853890.2024.2427909. Epub 2024 Dec 3.

ABSTRACT

OBJECTIVE: This study aims to assess the robustness of cardiovascular disease randomized controlled trials (RCTs) with primary continuous outcomes from a clinical perspective, utilizing the concepts of continuous fragility index (CFI), reverse continuous fragility index (RCFI) and their corresponding quotients (CFQ, RCFQ).

METHODS: A cross-sectional study was conducted, searching PubMed for cardiovascular RCTs published between January 1, 2018, to December 31, 2022, in eight high-impact journals. Inclusion criteria were phase III or IV trials with 1:1 randomization, reporting at least one primary continuous outcome. Data analysis involved altering each outcome until achieving the reversal of significance (ɑ = 0.05) to determine the CFI or RCFI. The fragility quotients were then calculated by dividing the CFI or RCFI by the sample size, and Spearman’s correlation assessed correlation analyses.

RESULTS: Of 3983 records were screened, and 64 RCTs (76 outcomes) were included. The fragility index was analysed with 72 outcomes. The overall median CFI was 7, with an associated median CFQ of 0.032. Nonsignificant P values exhibited greater statistical instability (median RCFI = 5, RCFQ = 0.023) than significant P values (median CFI = 14, CFQ = 0.062). Interestingly, “fragile” values were found in 36% (9/25) of CFI or 46.7% (7/15) of RCFI. Additionally, fragility index showed a significant association with several variables.

CONCLUSIONS: The findings suggest that changing only a small number of interventions (median of 7) could alter outcome significance. Reporting the fragility index alongside P values is recommended to provide a clearer understanding of statistical findings’ robustness.HighlightsThe continuous fragility index (CFI) represents the minimum patient count needed to modify significance by altering their intervention.Among 72 primary continuous outcomes in 64 cardiovascular RCTs, the overall median CFI was 7, with a corresponding CFQ of 0.032.CFI demonstrated moderate to strong correlations with sample size, total dropouts, and patient numbers analyzed.

PMID:39624960 | DOI:10.1080/07853890.2024.2427909

Cancer Med. 2024 Dec;13(23):e70436. doi: 10.1002/cam4.70436.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Prior work has demonstrated racial disparities in surgical outcomes for solid organ cancers. We sought to assess the relationship between hospital quality and racial disparities in achievement of textbook outcomes among patients undergoing surgery for prostate, kidney, and bladder cancer.

METHODS: We used 100% national Medicare Provider Analysis and Review files from 2017 to 2020 to assess textbook outcomes in Patients undergoing bladder (i.e., radical cystectomy), kidney (i.e., radical or partial nephrectomy), and prostate (i.e., radical prostatectomy) surgery for genitourinary malignancies. Our exposure was hospital-level quality, assessed by the predicted to expected ratio of achievement of textbook outcomes, agnostic to social and economic determinants of health. Our main outcome was achievement of textbook outcomes in White and Black patients. We defined the textbook outcome as the absence of in-hospital mortality, mortality within 30 days of surgery, readmission within 30 days of discharge, a postoperative complication, and prolonged length of stay. The secondary outcome was percentage of Black and White patients treated at the highest quality hospitals.

RESULTS: As hospital quality increased, disparities in the receipt of textbook outcome for White and Black patients narrowed. For every 0.1 increment increase in the predicted to expected ratio of hospital quality, Black-White disparities in the odds of achieving textbook outcomes decreased by 5.7% (interaction OR: 1.06; 95% CI 1.01-1.11 p = 0.026). Black patients were less likely to be treated at the highest quality hospitals compared to White patients (45.2% vs. 49.5% p = < 0.001%).

CONCLUSIONS: Compared to White patients, Black patients had lower odds of textbook outcomes after surgery for prostate, kidney, and bladder cancer. The racial differences in achieving textbook outcomes were narrowed as hospital quality increased. Black patients were less likely than White patients to be treated at the highest-quality hospitals. Our findings underscore the importance of improved access to high quality care among Black patients.

PMID:39624952 | DOI:10.1002/cam4.70436

Pulmonology. 2025 Dec 31;31(1):2429911. doi: 10.1080/25310429.2024.2429911. Epub 2024 Dec 3.

ABSTRACT

Alpha-1 Antitrypsin Deficiency (AATD) is a co-dominant condition associated with an increased risk of lung and liver disease. Since it is commonly thought that 95% of severe cases of AATD have PI*ZZ genotype, most studies about AATD have been focused on the Z variant. Nevertheless, over 500 single nucleotide variations in the SERPINA1 gene have been identified. We investigated the clinical presentation of subjects with severe AAT deficiency due to rare genotypes of the SERPINA1 gene. We enrolled patients from the Italian Registry for AATD (RIDA1) with the following inclusion criteria: diagnosis of severe AATD; age >18 years; full clinical data available at diagnosis; three years of follow-up respiratory function data. A total of 281 patients were enrolled from the RIDA1 Registry and subdivided into 3 cohorts: PI*ZZ genotype (n = 160), PI*SZ genotype (n = 54), and rare genotypes PI*R (n = 67). We did not observe any statistical differences among the cohorts regarding sex, smoking habits, occupational exposure and age at diagnosis. Patients with severe AATD due to rare genotypes have clinical characteristics and respiratory profiles similar to PI*ZZ subjects, and differed from the PI*SZ patient group. Early and accurate diagnosis of PI*R subjects is therefore important for their appropriate clinical management.

PMID:39624947 | DOI:10.1080/25310429.2024.2429911

Int J Med Robot. 2024 Dec;20(6):e70016. doi: 10.1002/rcs.70016.

ABSTRACT

BACKGROUND: Most patients present at high risk of perioperative pressure injury. Patients may experience severe agony from pressure injuries, which can also result in potentially fatal infections and increase hospital stays and medical expenses. This is a critical issue that requires immediate attention and resolution.

METHODS: From December 2019 to August 2023, 335 patients receiving Da vinci surgery in a grade A tertiary hospital were chosen to serve as the participants, and univariate analysis and patients undergoing Da vinci surgery had their risk factors for pressure injuries screened using logistic regression analysis, and in patients having Da vinci surgery, a pressure injury risk prediction model was developed.

RESULTS: Among 335 patients, 195 patients acquired pressure injuries, and the results of logistic regression analysis showed that age, length of surgery, BMI, and nasogastric tube (NGT) were independent risk factors for pressure injuries (p < 0.05).

CONCLUSIONS: With great risk prediction ability, the risk prediction model for pressure injuries in patients undergoing Da vinci surgery established in this study can be used as an effective assessment tool.

PMID:39624938 | DOI:10.1002/rcs.70016

Clin Transplant. 2024 Dec;38(12):e70047. doi: 10.1111/ctr.70047.

ABSTRACT

INTRODUCTION: Half of all female kidney transplant (KT) recipients are reproductive-aged, though data on reproductive practices and counseling are limited.

METHODS: This cross-sectional survey evaluated patient experiences, practices, and preferences surrounding contraception and pregnancy in female KT patients (listed or post-transplant) ages 14-45 years.

RESULTS: A total of 152/682 eligible participants (22%; 50 pre- and 102 post-KT) completed the survey with 26% unaware at the time of KT that future pregnancy was possible. The majority (72%) of sexually active patients used contraception during the first year post-KT, though 24% exclusively used high failure-rate methods. Less than half (48%) felt their pre-KT reproductive counseling was adequate to guide decision-making, although 63% reported satisfaction with post-KT counseling. Discussions with transplant providers were the single most favored counseling modality at 74%. Misconceptions of intrauterine device safety and efficacy were identified.

CONCLUSION: Reproductive counseling commonly occurred, although information was inadequate for guiding pregnancy and contraceptive decisions in most pre-KT patients. Misconceptions about pregnancy potential and contraceptive efficacy and safety were common, as well as patient reliance on high-failure contraceptive methods. Improving patient knowledge and access to contraception and pregnancy planning is essential for honoring patients’ reproductive wishes while lowering obstetric, graft, and perinatal risks in post-KT pregnancies.

PMID:39624937 | DOI:10.1111/ctr.70047