Category: Nevin Manimala

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

JAMA Netw Open. 2024 Oct 1;7(10):e2441874. doi: 10.1001/jamanetworkopen.2024.41874.

ABSTRACT

IMPORTANCE: Mental disorders among the pediatric population are a major area of public health concern. Little is known regarding changes in pediatric hospital resource use related to mental health (MH) long after the onset of the COVID-19 pandemic in March 2020.

OBJECTIVE: To assess rates and trends of hospitalizations and emergency department (ED) visits related to MH and self-harm (SH) among children before and during the 3 years following the pandemic onset.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used national hospital data. The study sample included all MH- and SH-related hospitalizations and ED visits among children aged 6 to 17 years in France between January 1, 2016, to May 31, 2023.

MAIN OUTCOMES AND MEASURES: Interrupted time-series analysis of monthly rates of MH- and SH-related hospitalizations and ED visits per 100 000 children was conducted to assess changes before and every year after the pandemic onset. Rate ratios (RRs) between estimated and expected rates were calculated.

RESULTS: Overall, 583 244 hospitalizations (81.4% for MH and 18.6% for SH) and 432 725 ED visits (79.9% for MH and 20.1% for SH) were analyzed. The mean (SD) age of the children was 13.7 (2.9) and 14.8 (1.7) years for MH-related and SH-related hospitalizations, respectively, and 14.2 (2.6) and 14.6 (2.1) years for MH-related and SH-related ED visits, respectively. For MH-related hospitalizations, 52.6% were female and 47.4% were male; for SH-related hospitalizations, 83.1% were female and 16.9% were male. For MH-related ED visits, 62.8% were female and 37.2% were male; for SH-related ED visits, 77.4% were female and 22.6% were male. Before the pandemic, an increasing trend in all monthly rates, except that of MH-related hospitalizations, was observed. After an immediate decrease in hospitalization and ED visit rates during the initial pandemic period (March 1 to May 31, 2020), trends increased in the first 2 years following the pandemic onset and decreased thereafter. Overall, rates of MH-related hospitalizations and ED visits exceeded expected rates in only the second year after the pandemic onset, with increases of 6.0% (RR, 1.06 [95% CI, 1.05-1.06]) and 5.0% (RR, 1.05 [95% CI, 1.04-1.05]), respectively. However, rates of hospitalizations and ED visits for behavioral syndromes (mainly eating and sleeping disorders) persistently exceeded expected rates, with increases of 29.0% (RR, 1.29 [95% CI, 1.25-1.34]) and 26.0% (RR, 1.26 [95% CI, 1.21-1.31]) in the third year, respectively. Likewise, rates of SH-related hospitalizations and ED visits persistently rose above expected rates, with increases of 29.0% (RR, 1.29 [95% CI, 1.26-1.32]) and 43.0% (RR, 1.43 [95% CI, 1.40-1.47]) in the third year, respectively.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, persistent increases in the use of hospital resources to treat eating and sleeping disorders and intentional SH among pediatric patients were observed long after the onset of the COVID-19 pandemic. These findings warrant future research to identify persistent stress factors in children.

PMID:39470637 | DOI:10.1001/jamanetworkopen.2024.41874

JAMA Netw Open. 2024 Oct 1;7(10):e2442091. doi: 10.1001/jamanetworkopen.2024.42091.

ABSTRACT

IMPORTANCE: Suicide is a leading cause of death among young people. Accurate detection of self-injurious thoughts and behaviors (SITB) underpins equity in youth suicide prevention.

OBJECTIVES: To compare methods of detecting SITB using structured electronic health information and measure algorithmic performance across demographics.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used medical records among youths aged 6 to 17 years with at least 1 mental health-related emergency department (ED) visit in 2017 to 2019 to an academic health system in Southern California serving 787 000 unique individuals each year. Analyses were conducted between January and September 2023.

EXPOSURES: Multiexpert electronic health record review ascertained the presence of SITB using the Columbia Classification Algorithm of Suicide Assessment. Random forest classifiers with nested cross-validation were developed using (1) International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for nonfatal suicide attempt and self-harm and chief concern and (2) all available structured data, including diagnoses, medications, and laboratory tests.

MAIN OUTCOME AND MEASURES: Detection performance was assessed overall and stratified by age group, sex, and race and ethnicity.

RESULTS: The sample comprised 2702 unique youths with an MH-related ED visit (1384 youths who identified as female [51.2%]; 131 Asian [4.8%], 266 Black [9.8%], 719 Hispanic [26.6%], 1319 White [48.8%], and 233 other race [8.6%]; median [IQR] age, 14 [12-16] years), including 898 children and 1804 adolescents. Approximately half of visits were related to SITB (1286 visits [47.6%]). Sensitivity of SITB detection using only codes and chief concern varied by age group and increased until age 15 years (6-9 years: 59.3% [95% CI, 48.5%-69.5%]; 10-12 years: 69.0% [95% CI, 63.8%-73.9%]; 13-15 years: 88.4% [95% CI, 85.1%-91.2%]; 16-17 years: 83.1% [95% CI, 79.1%-86.6%]), while specificity remained constant. The area under the receiver operating characteristic curve (AUROC) was lower among preadolescents (0.841 [95% CI, 0.815-0.867]) and male (0.869 [95% CI, 0.848-0.890]), Black (0.859 [95% CI, 0.813-0.905]), and Hispanic (0.861 [95% CI, 0.831-0.891]) youths compared with adolescents (0.925 [95% CI, 0.912-0.938]), female youths (0.923 [95% CI, 0.909-0.937]), and youths of other races and ethnicities (eg, White: 0.901 [95% CI, 0.884-0.918]). Augmented classification (ie, using all available structured data) outperformed classification with codes and chief concern alone (AUROC, 0.975 [95% CI, 0.968-0.980] vs 0.894 [95% CI, 0.882-0.905]; P < .001).

CONCLUSIONS AND RELEVANCE: In this study, diagnostic codes and chief concern underestimated SITB prevalence, particularly among minoritized youths. These results suggest that priority on algorithmic fairness in suicide prevention strategies must extend to accurate detection of youths with suicide-related emergencies.

PMID:39470636 | DOI:10.1001/jamanetworkopen.2024.42091

JAMA Netw Open. 2024 Oct 1;7(10):e2442204. doi: 10.1001/jamanetworkopen.2024.42204.

ABSTRACT

IMPORTANCE: Having diverse participants in clinical trials ensures new drug products work well across different demographic groups, making health care safer and more effective for everyone. Information on the extent of Native Hawaiian and Pacific Islander participation in clinical trials is limited.

OBJECTIVE: To examine representation of Native Hawaiian and Pacific Islanders in clinical trials leading to the first US Food and Drug Administration (FDA) approvals for the 10 drug products with the top worldwide sales forecasts in 2024.

DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional secondary analysis of existing data from clinical trials that took place from 2006 to 2021 in the US. All clinical trials that were included in the FDA first approval application for the 10 drug products were evaluated in this study. Data were analyzed from February to August 2024.

EXPOSURE: Participation in a clinical drug trial.

MAIN OUTCOMES AND MEASURES: Comparison of the proportion of Native Hawaiian and Pacific Islander participation in clinical trials for the 10 drug products with top sales forecasts in 2024 to the Native Hawaiian and Pacific Islander population proportion.

RESULTS: In this cross-sectional study of 139 062 individuals, Native Hawaiian and Pacific Islander participation in clinical trials for the 10 drug products with top sales forecasts was either unknown or low. For 6 of the 10 drug products (60%), the number of Native Hawaiian and Pacific Islander participants was not documented. All trials that reported Native Hawaiian and Pacific Islander participation had fewer Native Hawaiian and Pacific Islander participants than would be expected based on their US population proportion, with 2 of the differences being statistically significant. Of the trials that disaggregated Native Hawaiian and Pacific Islander participants from other racial groups, the number of Native Hawaiian and Pacific Islander participants was 8 for risankizumab-rzaa (0.38% of participants vs 0.49% of the population; percentage point difference, -0.11%; 95% CI, -0.37% to -0.15%), 7 for bictegravir/emtricitabine/tenofovir alafenamide (0.38% of participants vs 0.49% of the population; percentage point difference, -0.10%; 95% CI, -0.39% to 0.18%), 27 for 4vHPV/9vHPV (0.15% of participants vs 0.46% of the population; percentage point difference, -0.31%; 95% CI, -0.37% to -0.26%), and 90 for BNT162B2 COVID-19 vaccine (0.20% of participants vs 0.52% of the population; percentage point difference, -0.32; 95% CI, -0.36% to -0.27%).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, limited documentation and participation of Native Hawaiian and Pacific Islander individuals in clinical trials for drug products with top sales forecasts was found. This is especially concerning because Native Hawaiian and Pacific Islander individuals have a higher risk than other racial groups for type 2 diabetes, cancer, and several other conditions the products examined in this study treat. Given the importance of enrolling Native Hawaiian and Pacific Islander participants in clinical trials, sites should be established in key geographic regions, such as Hawai’i, and postmarket studies should be conducted within Native Hawaiian and Pacific Islander populations.

PMID:39470635 | DOI:10.1001/jamanetworkopen.2024.42204

Chaos. 2024 Oct 1;34(10):103124. doi: 10.1063/5.0219848.

ABSTRACT

Resonance and synchronized rhythm are significant phenomena observed in dynamical systems in nature, particularly in biological contexts. These phenomena can either enhance or disrupt system functioning. Numerous examples illustrate the necessity for organs within the human body to maintain their rhythmic patterns for proper operation. For instance, in the brain, synchronized or desynchronized electrical activities can contribute to neurodegenerative conditions like Huntington’s disease. In this paper, we utilize the well-established Hodgkin-Huxley (HH) model, which describes the propagation of action potentials in neurons through conductance-based mechanisms. Employing a “data-driven” approach alongside the outputs of the HH model, we introduce an innovative technique termed “dynamic entrainment.” This technique leverages deep learning methodologies to dynamically sustain the system within its entrainment regime. Our findings show that the results of the dynamic entrainment technique match with the outputs of the mechanistic (HH) model.

PMID:39470595 | DOI:10.1063/5.0219848

Chaos. 2024 Oct 1;34(10):103148. doi: 10.1063/5.0219799.

ABSTRACT

Recently, we developed a theory of a geometrically growing system. Here, we show that the theory can explain some phenomena of power-law distribution, including classical demographic and economic and novel instances of the COVID-19 pandemic, without introduction of delicate economic or pandemic propagation models but only on a statistical way. A convexity in the low-size part of the distribution diagram is one peculiarity of the theory, which is absent in the power-law distribution. We found that the distribution of the geometrically growing system in the diagram could have a trend to flatten in the evolution of the system so that the relative ratio between the biggest and smallest sizes within the system increases. The system can act as a reverse machine to convert the diffusion in parametric space to a concentration in size.

PMID:39470594 | DOI:10.1063/5.0219799