Category: Nevin Manimala

PLoS One. 2024 Nov 18;19(11):e0311058. doi: 10.1371/journal.pone.0311058. eCollection 2024.

ABSTRACT

The mutation-selection mechanism of Darwinian evolution gives rise not only to adaptation to environmental conditions but also to the enhancement of robustness against mutations. When two or more phenotypes have the same fitness value, the robustness distribution for different phenotypes can vary. Thus, we expect that some phenotypes are favored in evolution and that some are hardly selected because of a selection bias for mutational robustness. In this study, we investigated this selection bias for phenotypes in a model of gene regulatory networks (GRNs) using numerical simulations. The model had one input gene accepting a signal from the outside and one output gene producing a target protein, and the fitness was high if the output for the full signal was much higher than that for no signal. The model exhibited three types of responses to changes in the input signal: monostable, toggle switch, and one-way switch. We regarded these three response types as three distinguishable phenotypes. We constructed a randomly generated set of GRNs using the multicanonical Monte Carlo method originally developed in statistical physics and compared it to the outcomes of evolutionary simulations. One-way switches were strongly suppressed during evolution because of their lack of mutational robustness. By examining one-way switch GRNs in detail, we found that mutationally robust GRNs obtained by evolutionary simulations and non-robust GRNs obtained by McMC have different network structures. While robust GRNs have a common core motif, non-robust GRNs lack this motif. The bistability of non-robust GRNs is considered to be realized cooperatively by many genes, and these cooperative genotypes have been suppressed by evolution.

PMID:39556585 | DOI:10.1371/journal.pone.0311058

PLOS Glob Public Health. 2024 Nov 18;4(11):e0003959. doi: 10.1371/journal.pgph.0003959. eCollection 2024.

ABSTRACT

Healthcare workers continue to experience high levels of work-related stress which continue to negatively affect their psychological, physical, and emotional well-being. This is even more prevalent among healthcare workers who work in surgical specialities, with the surgical operation room becoming a known stressor at hospitals. This study aims to assess work-related stress among surgical team members at Ahmadu Bello University Teaching Hospital in Zaria between January 2021-2022. Data analysis involved descriptive and inferential statistical approaches using the Statistical Package for Social Science (SPSS) version 23.0. The study found an overall high prevalence of work-related stress, with 65% of participants reporting moderate levels of stress. The majority of the participants have a mean age of 39.4 ± 7.8 years, most of them being physicians (66.3%), being males (59.9%), and identified with a Hausa ethnic tribe. Notably, the multiple regression analysis found that tribe (p = 0.008), professional cadres (p = 0.001) and age/years of experience (p = 0.0035) emerged as significant predictors of work-related stress. Key determinants of work-related stress among surgical team members include workload, complexity of work, and conflicting cognitive job demands that continue to subject professionals to increasing workloads and constant decision-making about their job. Organizational factors, such as job policy and procedure, communication problems, and the nature of facilities, were identified as the highest contributors to work-related stress in organizational, interpersonal, and physical/environmental dimensions. The findings lead to the conclusion that a considerable proportion of surgical team members experience a relatively high level of work-related stress, primarily attributed to workload and cognitive demands. In light of these results, urgent efforts are recommended to improve the working conditions and environment for surgical team members. Furthermore, the integration of stress management measures into the educational programs for the surgical team is emphasized to effectively address and mitigate the impact of work-related stress.

PMID:39556579 | DOI:10.1371/journal.pgph.0003959

PLoS One. 2024 Nov 18;19(11):e0301111. doi: 10.1371/journal.pone.0301111. eCollection 2024.

ABSTRACT

OBJECTIVE: Peer review frequently follows a process where reviewers first provide initial reviews, authors respond to these reviews, then reviewers update their reviews based on the authors’ response. There is mixed evidence regarding whether this process is useful, including frequent anecdotal complaints that reviewers insufficiently update their scores. In this study, we aim to investigate whether reviewers anchor to their original scores when updating their reviews, which serves as a potential explanation for the lack of updates in reviewer scores.

DESIGN: We design a novel randomized controlled trial to test if reviewers exhibit anchoring. In the experimental condition, participants initially see a flawed version of a paper that is corrected after they submit their initial review, while in the control condition, participants only see the correct version. We take various measures to ensure that in the absence of anchoring, reviewers in the experimental group should revise their scores to be identically distributed to the scores from the control group. Furthermore, we construct the reviewed paper to maximize the difference between the flawed and corrected versions, and employ deception to hide the true experiment purpose.

RESULTS: Our randomized controlled trial consists of 108 researchers as participants. First, we find that our intervention was successful at creating a difference in perceived paper quality between the flawed and corrected versions: Using a permutation test with the Mann-Whitney U statistic, we find that the experimental group’s initial scores are lower than the control group’s scores in both the Evaluation category (Vargha-Delaney A = 0.64, p = 0.0096) and Overall score (A = 0.59, p = 0.058). Next, we test for anchoring by comparing the experimental group’s revised scores with the control group’s scores. We find no significant evidence of anchoring in either the Overall (A = 0.50, p = 0.61) or Evaluation category (A = 0.49, p = 0.61). The Mann-Whitney U represents the number of individual pairwise comparisons across groups in which the value from the specified group is stochastically greater, while the Vargha-Delaney A is the normalized version in [0, 1].

PMID:39556577 | DOI:10.1371/journal.pone.0301111

JAMA Netw Open. 2024 Nov 4;7(11):e2445309. doi: 10.1001/jamanetworkopen.2024.45309.

ABSTRACT

IMPORTANCE: Cardiovascular-kidney-metabolic (CKM) syndrome-a novel, multistage, multisystem disorder as defined by the American Heart Association-is highly prevalent in the US. However, the prevalence of CKM stages by social determinants of health (SDOH) remains unclear.

OBJECTIVE: To investigate whether the prevalence of CKM stages varies by SDOH in US adults.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the National Health and Nutrition Examination Survey (1999-2018) and included a nationally representative sample of adults aged 30 to 79 years through complex, multistage probability sampling. Data were analyzed from April 1 to June 15, 2024.

EXPOSURES: The exposures included 5 CKM stages (ie, stages 0-4) reflecting progressive pathophysiology, with advanced (stages 3 or 4) and nonadvanced (stages 0, 1, or 2) disease. CKM stages were defined based on risk factors for metabolic syndrome, cardiovascular disease, and chronic kidney disease.

MAIN OUTCOME AND MEASURES: The main outcome was the age-standardized prevalence of CKM stages and advanced CKM stages across SDOH, including education, marital status, family income, food security, health insurance, employment, home ownership, and health care access.

RESULTS: Among 29 722 participants (weighted mean [SE] age, 50.8 [0.1] years; weighted 50.7% male), the age-standardized prevalence of CKM stages 0 to 4 was 13.6% (95% CI, 13.0%-14.3%), 29.9% (95% CI, 29.1%-30.7%), 43.7% (95% CI, 42.9%-44.5%), 4.7% (95% CI, 4.4%-5.0%), and 8.1% (95% CI, 7.6%-8.5%), respectively. Significant differences were observed in the prevalence of CKM stages across all unfavorable SDOH of interest compared with their favorable counterparts, with unemployment (18.8% [95% CI, 17.7%-20.1%] vs 11.4% [95% CI, 11.0%-11.9%]), low family income (16.1% [95% CI, 15.4%-16.8%] vs 10.1% [95% CI, 9.5%-10.7%]), and food insecurity (18.3% [95% CI, 17.1%-19.6%] vs 11.7% [95% CI, 11.2%-12.2%]) associated with an increased likelihood of advanced CKM stages. Participants with 2 or more unfavorable SDOH were more likely to have advanced CKM stages (age-standardized prevalence, 15.8% [95% CI, 15.2%-16.5%] vs 10.5% [95% CI, 9.9%-11.1%] with <2 unfavorable SDOH). Living in a rented home (15.9% [95% CI, 14.7%-17.0%] vs 9.3% [95% CI, 8.7%-9.9%] owning the home) or not living with a partner (13.2% [95% CI, 12.3%-14.3%] vs 9.2% [95% CI, 8.5%-9.8%] living with a partner) increased the likelihood of advanced CKM stages in female but not male participants.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, disparities in the prevalence of CKM stages by SDOH, particularly family income, food security, and employment, with notable sex differences, were observed in US adults. These findings highlight the need to address inequities in CKM syndrome through targeted interventions.

PMID:39556396 | DOI:10.1001/jamanetworkopen.2024.45309

JAMA Netw Open. 2024 Nov 4;7(11):e2445525. doi: 10.1001/jamanetworkopen.2024.45525.

ABSTRACT

IMPORTANCE: The burden of liver cancer varies worldwide. An upward trend in both hepatocellular carcinoma (HCC) incidence and mortality in the past 2 decades has been observed.

OBJECTIVE: To assess observed HCC-related age-standardized mortality rates (ASMRs) in the US for 2006 to 2022 and provide ASMR projections through 2040.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the National Vital Statistics System, which is accessible through the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research website. Data on deaths attributed to HCC (from January 1, 2006, to December 31, 2022) were obtained for adults 25 years or older and were stratified by liver disease etiology, age, sex, and race and ethnicity. Etiologies included alcohol-associated liver disease (ALD), hepatitis B virus (HBV), hepatitis C virus (HCV), and metabolic dysfunction-associated steatotic liver disease (MASLD).

MAIN OUTCOMES AND MEASURES: The main outcomes were (1) observed ASMRs of HCC per 100 000 persons using Joinpoint regression (National Cancer Institute) to assess trends during 2006 to 2022 and (2) ASMRs projected for 2023 to 2040 using Prophet and AutoARIMA modeling.

RESULTS: This study included 188 280 HCC-related deaths from 2006 to 2022. Most deaths occurred among males (77.4%). The annual percentage change was 4.1% (95% CI, 2.2% to 7.7%) for 2006 to 2009 and decreased to 1.8% (95% CI, 0.7% to 2.0%) for 2009 to 2022, with an overall observed ASMR of 5.03 per 100 000 persons in 2022 and a projected ASMR of 6.39 per 100 000 persons by 2040, with consistent trends for both sexes. By etiology, ASMRs decreased for HCV- and HBV-related mortality but increased for ALD- and MASLD-related mortality. In 2022, MASLD surpassed HBV as the third-leading cause of HCC-related death and was projected to overtake HCV in 2032 as the second-leading cause; ALD was projected to be the leading cause of HCC-related death in 2026. In 2022, the ASMR was higher among individuals aged 65 years or older compared with those aged 25 to 64 years (18.37 vs 1.79 per 100 000 persons). The American Indian or Alaska Native population had the largest increase in projected ASMR by 2040 (14.71 per 100 000 persons) compared with the Asian population (3.03 per 100 000 persons).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, ASMRs for ALD- and MASLD-related HCC death increased rapidly from 2006 to 2022; ALD-related HCC was projected to be the leading cause by 2026, with MASLD as the second-leading cause by 2032. These findings may serve as a reference for public health decision-making and timely identification of groups at high risk of HCC death.

PMID:39556395 | DOI:10.1001/jamanetworkopen.2024.45525

JAMA Netw Open. 2024 Nov 4;7(11):e2445536. doi: 10.1001/jamanetworkopen.2024.45536.

ABSTRACT

IMPORTANCE: Federally qualified health centers (FQHCs) have increasingly participated in the Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs), one of the most widespread value-based programs. Although FQHCs may strengthen ACOs’ ability to provide affordable care to diverse Medicare beneficiaries, evidence on ACOs’ performance by FQHC participation is limited.

OBJECTIVES: To compare beneficiary characteristics, utilization, expenditure, and quality between ACOs with and without FQHC participation and assess changes in ACO performance after including first FQHCs.

DESIGN, SETTING, AND PARTICIPANTS: Using MSSP public use files, this cross-sectional study compared performance of ACOs that always had FQHC participation with ACOs that never had FQHC participation from January 1, 2016, to December 31, 2022, supplemented with staggered difference-in-differences analyses of ACOs’ first-time inclusion of FQHCs on performance measures. Data analysis was performed from December 1, 2023, to February 29, 2024.

EXPOSURE: Participation of FQHCs in the MSSP.

MAIN OUTCOMES AND MEASURES: Measures of ACO-assigned beneficiaries, utilization, expenditure, and quality per ACO-year.

RESULTS: Among 752 ACOs in the descriptive analysis, 140 ACOs always had at least 1 FQHC participant, whereas 612 ACOs never had FQHC participants. Compared with ACOs that never had FQHC participation, those that always had FQHC participation provided care to more socioeconomically disadvantaged beneficiaries (mean [SD] with dual eligibility, 2035.8 [2110.6] vs 1040.9 [1084.2] person-years; with disability, 3341.1 [3474.9] vs 1705.1 [1664.9] person-years; in racial and ethnic minoritized groups, 3690.6 [4118.4] vs 2515.1 [2762.9] person-years), with fewer primary care visits (mean [SD], 9956.6 [1926.3] vs 10 858.8 [2383.4] per 1000 person-years), more emergency department visits (mean [SD], 771.6 [190.9] vs 657.2 [160.0] per 1000 person-years), and lower levels of several quality measures. In the difference-in-differences analysis, 43 ACOs included FQHCs for the first time. Including first FQHCs was associated with increases of 872.9 dual-eligible (95% CI, 345.9-1399.8), 1137.6 disability (95% CI, 390.1-1885.1), and 1350.8 racial and ethnic minority (95% CI, 447.4-2254.1) person-years, with increases in rates of influenza immunization (5.9 percentage points [pp]; 95% CI, 1.4-10.4 pp), tobacco screening and cessation intervention (11.8 pp; 95% CI, 3.7-20.0 pp), and depression screening and follow-up (8.9 pp; 95% CI, 0.5-17.4 pp). No associations were observed between FQHC inclusion and utilization or expenditure.

CONCLUSIONS AND RELEVANCE: In this repeated cross-sectional study, MSSP ACOs with FQHC participation served more socioeconomically disadvantaged Medicare beneficiaries than those without FQHC participation. The inclusion of first FQHCs was associated with increased rates of several preventive services without increasing costs. Participation of safety net practices appeared to improve access to ACOs among beneficiaries from underserved communities.

PMID:39556394 | DOI:10.1001/jamanetworkopen.2024.45536

JAMA Netw Open. 2024 Nov 4;7(11):e2445543. doi: 10.1001/jamanetworkopen.2024.45543.

ABSTRACT

IMPORTANCE: Little is known about the epidemiology of out-of-hospital cardiac arrest (OHCA) in patients with asystole in countries where prehospital resuscitation is not withheld or terminated.

OBJECTIVE: To investigate the secular trends in the patient outcomes and advanced life support (ALS) procedures and evaluate the association of ALS procedures with favorable outcomes among patients with OHCA and asystole.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data from a nationwide prospective OHCA registry in Japan. OHCA occurred from June 1, 2014, to December 31, 2020. Adults with an initial rhythm of asystole and OHCA were included in the analysis, which was conducted between July 29, 2022, and August 24, 2024.

EXPOSURES: Year of OHCA and prehospital ALS procedures (advanced airway management [AAM] and intravenous epinephrine administration).

MAIN OUTCOMES AND MEASURES: Trends in prehospital and in-hospital ALS procedures and patient outcomes were described using the Jonckheere-Terpstra trend test for continuous variables and the Cochran-Armitage trend test for categorical variables. The primary outcome was a favorable neurological outcome at 30 days. The secondary outcomes included a favorable neurological outcome at 90 days and survival at 30 and 90 days. Associations between prehospital procedures and outcomes were analyzed using time-dependent propensity score and risk-set matching.

RESULTS: Of 60 349 patients with OHCA, 35 843 (59.4%) presented with asystole (median age, 77 [IQR, 64-85] years; 20 573 [57.4%] men). Among these, 33 674 patients (93.9%) underwent ALS procedures, with 67 (0.2%) achieving a favorable neurological outcome at 30 days. No significant trends in the outcomes were noted, except for a decline in return of spontaneous circulation (424 of 1848 [22.9%] to 1178 of 5892 [20.0%]; P = .003). Neither AAM (odds ratio [OR], 1.27 [95% CI, 0.76-2.12]; P = .36) nor intravenous epinephrine administration (OR, 0.53 [95% CI, 0.24-1.13]; P = .10) was associated with a favorable neurological outcome at 30 days, although both were associated with survival at 30 days (ORs, 1.45 [95% CI, 1.21-1.74] and 1.81 [95% CI, 1.44-2.27], respectively; P < .001 for both).

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with OHCA presenting with asystole, the proportion with a favorable neurological outcome at 30 days was substantially low, and no prehospital ALS procedure was associated with a favorable neurological outcome. These findings suggest that discussions regarding implementation of a termination of resuscitation rule for such patients are warranted.

PMID:39556393 | DOI:10.1001/jamanetworkopen.2024.45543

Neuropsychology. 2024 Nov 18. doi: 10.1037/neu0000983. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate associations of executive function (EF) performance in adolescence with dimensional symptoms of inattention and hyperactivity-impulsivity assessed by multiple informants as well as ADHD (attention-deficit/hyperactivity disorder) symptoms based on the Diagnostic and Statistical Manual of Mental Disorders criteria, and whether familial factors and co-occurring symptoms of depressive disorder and conduct disorder explain these associations in a population-based sample.

METHOD: In 14-year-old twins from the population-based FinnTwin12 study (N = 638-1,227), we assessed EF with commonly used neuropsychological tests. Diagnostic and Statistical Manual of Mental Disorders symptoms of ADHD and psychiatric disorders were assessed with a semistructured interview, and dimensional symptoms of inattention and hyperactivity-impulsivity with behavioral ratings made by the twins, their co-twins, and teachers at age 14, and by parents and teachers at age 12, the latter being different from those at age 14.

RESULTS: Teacher-rated inattention had the strongest association with poorer EF performance across two measurement points with different teachers; these associations were not affected by adding symptoms of depressive disorder and conduct disorder as covariates. Within-pair analyses suggested that the associations of inattention and hyperactivity-impulsivity with EF were partly explained by familial factors.

CONCLUSION: Even at a subclinical level in a sample of adolescents representing general population, ADHD symptoms are associated with EF performance. Teachers’ evaluations appear especially valuable when assessing adolescents’ ADHD symptoms. Our findings support the notion of dimensional ADHD symptoms in the population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:39556384 | DOI:10.1037/neu0000983

Cancer Control. 2024 Jan-Dec;31:10732748241302427. doi: 10.1177/10732748241302427.

ABSTRACT

Effective cancer screening is essential for early detection and improved survival outcomes. Cancer is a leading cause of death for Hispanics/Latinx, who represent the largest minority group in the U.S. Despite lower tobacco use, lung cancer is the leading cause of cancer death in Hispanic/Latinx men and the second leading cause in women. Late-stage diagnoses, due to limited screening opportunities, contribute to poor survival rates. Cancer survivors, especially those previously diagnosed with head and neck cancer, face a significantly increased risk of developing lung cancer. Approximately one-fourth of head and neck cancer survivors die from a second malignancy, with lung cancer accounting for over half of these cases. These individuals are nearly three times more likely to develop lung cancer compared to the general population of smokers. In this manuscript, we detail the importance of implementing lung cancer screening in these high-risk populations.

PMID:39556362 | DOI:10.1177/10732748241302427

Personal Disord. 2024 Nov 18. doi: 10.1037/per0000707. Online ahead of print.

ABSTRACT

Disinhibition is a personality trait with broad health implications and has been included in several prominent models of maladaptive personality traits and psychopathology, such as the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Alternative Model of Personality Disorders and the Hierarchical Taxonomy of Psychopathology. Cross-sectional global self-report and clinical interview research suggests that disinhibition is tightly linked with interpersonal problems, particularly antagonistic problems. However, very little work has examined how individual differences in disinhibition manifest in interpersonal functioning in social situations in daily life. We examined how trait disinhibition and its lower level facets (e.g., irresponsibility, impulsivity, distractibility) relate to ecological momentary assessments of interpersonal interactions in daily life across three samples (total person N = 1,068, total observation N = 38,212). Results showed a consistent and positive association between trait disinhibition and negative affect in daily life (both in general and specifically during social interactions), above and beyond the effect of trait antagonism. We also found a negative association between trait disinhibition and warmth during social interactions, though this effect was fully accounted for by trait antagonism. We did not find consistent associations between trait disinhibition and positive affect or dominance in daily life. These findings have implications for the manifestation of disinhibition in daily life and the relation between externalizing and internalizing psychopathology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:39556354 | DOI:10.1037/per0000707