Category: Nevin Manimala

Med Care. 2024 Jun 5. doi: 10.1097/MLR.0000000000002019. Online ahead of print.

ABSTRACT

BACKGROUND: The Elixhauser Comorbidity Index (ECI) is widely used, but its performance in homeless populations has not been evaluated.

OBJECTIVES: Using a national sample of inpatients, this study compared homeless and nonhomeless inpatients on common clinical diagnoses and evaluated ECI performance in predicting mortality among homeless inpatients.

RESEARCH DESIGN: A retrospective study was conducted using 2019 National Inpatient Sample (NIS) data, the largest publicly available all-payer inpatient health care database in the United States.

SUBJECTS: Among 4,347,959 hospitalizations, 78,819 (weighted 1.8%) were identified as homeless.

MEASURES: The ECI consists of 38 medical conditions; homelessness was defined using the International Classification of Diseases Tenth Revision Clinical Modification (ICD-10-CM) diagnostic code, and clinical conditions were based on the Clinical Classifications Software Refined (CCSR) for ICD-10-CM.

RESULTS: Leading clinical diagnoses for homeless inpatients included schizophrenia and other psychotic disorders (13.3%), depressive disorders (9.4%), and alcohol-related disorders (7.2%); leading diagnoses for nonhomeless inpatients were septicemia (10.2%), heart failure (5.2%), and acute myocardial infarction (3.0%). Metastatic cancer and liver disease were the most common ECI diagnoses for both homeless and nonhomeless inpatients. ECI indicators and summary scores were predictive of in-hospital mortality for homeless and nonhomeless inpatients, with all models yielding concordance statistics above 0.80, with better performance found among homeless inpatients.

CONCLUSIONS: These findings underlie the high rates of behavioral health conditions among homeless inpatients and the strong performance of the ECI in predicting in-hospital mortality among homeless inpatients, supporting its continued use as a case-mix control method and predictor of hospital readmissions.

PMID:38838297 | DOI:10.1097/MLR.0000000000002019

Am J Speech Lang Pathol. 2024 Jun 5:1-15. doi: 10.1044/2024_AJSLP-23-00348. Online ahead of print.

ABSTRACT

PURPOSE: This study explored the acceptability and impact of relationship-centered communication partner training (RC-CPT) in couples impacted by aphasia. In particular, couples considered whether discussing their relationship roles and responsibilities was important and relevant to the changes they desire. Preliminary quasi-experimental data regarding perceived communication confidence and the marriage relationship were also obtained.

METHOD: Three couples participated in RC-CPT across two sessions. Surveys were used to measure communication confidence and the marital relationship before and after participation in RC-CPT. The quantitative findings were analyzed using descriptive statistics. Couples also participated in a semistructured interview about the acceptability of RC-CPT during a third session. The interviews were transcribed and analyzed using reflexive codebook analysis.

RESULTS: Quantitative data indicated that participants generally maintained or improved self-rated accessibility, responsiveness, engagement, conflict resolution, and communication within their marriage after participating in RC-CPT. Additionally, individuals with aphasia demonstrated enhanced communication confidence scores. Qualitative analysis revealed three themes: (a) Impact on Communication, (b) Impact on Relationship, and (c) Impact on Psychosocial Well-Being. Feedback from participants regarding future development was also included.

CONCLUSIONS: The convergence of quantitative and qualitative data supports the conclusion that couples experienced positive changes in their communication, relationship, and psychosocial well-being during the intervention, suggesting that RC-CPT has the potential to positively impact both communicative and psychosocial effects of aphasia on couples. Moreover, this study highlights the promise of RC-CPT as a relationship-centered counseling tool, warranting further exploratory and experimental research.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25937383.

PMID:38838246 | DOI:10.1044/2024_AJSLP-23-00348

Am J Speech Lang Pathol. 2024 Jun 5:1-22. doi: 10.1044/2024_AJSLP-23-00321. Online ahead of print.

ABSTRACT

PURPOSE: This study investigated the effects of the SPEAK OUT! & LOUD Crowd therapy program on speaking rate, percent pause time, intelligibility, naturalness, and communicative participation in individuals with Parkinson’s disease (PD).

METHOD: Six adults with PD completed 12 individual SPEAK OUT! sessions across four consecutive weeks followed by group-based LOUD Crowd sessions for five consecutive weeks. Most therapy sessions were conducted via telehealth, with two participants completing the SPEAK OUT! portion in person. Speech samples were recorded at six time points: three baseline time points prior to SPEAK OUT!, two post-SPEAK OUT! time points, and one post-LOUD Crowd time point. Acoustic measures of speaking rate and percent pause time and listener ratings of speech intelligibility and naturalness were obtained for each time point. Participant self-ratings of communicative participation were also collected at pre- and posttreatment time points.

RESULTS: Results showed significant improvement in communicative participation scores at a group level following completion of the SPEAK OUT! & LOUD Crowd treatment program. Two participants showed a significant decrease in speaking rate and increase in percent pause time following treatment. Changes in intelligibility and naturalness were not statistically significant.

CONCLUSIONS: These findings provide preliminary support for the effectiveness of the SPEAK OUT! & LOUD Crowd treatment program in improving communicative participation for people with mild-to-moderate hypokinetic dysarthria secondary to PD. This study is also the first to demonstrate positive effects of this treatment program for people receiving the therapy via telehealth.

PMID:38838243 | DOI:10.1044/2024_AJSLP-23-00321

J Strength Cond Res. 2024 Jun 4. doi: 10.1519/JSC.0000000000004829. Online ahead of print.

ABSTRACT

Kamandulis, S, Dudėnienė, L, Snieckus, A, Kniubaite, A, Mickevicius, M, Lukonaitiene, I, Venckunas, T, Stasiule, L, and Stasiulis, A. Impact of anaerobic exercise integrated into regular training on experienced judo athletes: running vs. repetitive throws. J Strength Cond Res XX(X): 000-000, 2024-Anaerobic training in high-level athletes is of considerable interest to practitioners aiming to optimize performance. This study compared the impact of interval anaerobic training (IAT) sessions consisting of either high-intensity running or throwing that were performed twice a week together with regular judo training on the anaerobic and aerobic performance of experienced judo athletes. Employing a repeated-measures, counterbalancing, research design, 12 national team judo athletes (7 women and 5 men; mean age, 20.4 ± 0.95 years; mean judo training experience, 13.4 ± 1.4 years; competitive level, black belt first and second Dan) performed each IAT modality for 6 weeks, for a full training cycle of 12 weeks. Assessments of their anaerobic fitness (Cunningham and Faulkner Anaerobic Treadmill Test), sport-specific anaerobic fitness (Special Judo Fitness Test [SJFT]), and aerobic capacity (maximal incremental treadmill running test) were performed before, after 6 weeks, and after 12 weeks of training. The uphill running performance improved by 13.1% over the 12-week period (p = 0.047). Simultaneously, there was a 9.0% improvement in the SJFT index and a 6.9% increase in the number of throws (p = 0.011 and p = 0.017, respectively). Although a trend for throwing drills being more effective than interval sprint running was observed, the interaction effect lacked statistical significance (p = 0.074). Moreover, no substantial changes were noted in aerobic endurance markers. In conclusion, this study suggests that incorporating specific and nonspecific high-intensity drills into a routine training regimen may enhance anaerobic capacity among well-trained judo athletes, potentially leading to favorable competitive outcomes.

PMID:38838240 | DOI:10.1519/JSC.0000000000004829

Cell Rep. 2024 Jun 4;43(6):114313. doi: 10.1016/j.celrep.2024.114313. Online ahead of print.

ABSTRACT

Personalized cancer therapeutics bring directed treatment options to patients based on their tumor’s genetic signature. Unfortunately, tumor genomes are remarkably adaptable, and acquired resistance through gene mutation frequently occurs. Identifying mutations that promote resistance within drug-treated patient populations can be cost, resource, and time intensive. Accordingly, base editing, enabled by Cas9-deaminase domain fusions, has emerged as a promising approach for rapid, large-scale gene variant screening in situ. Here, we adapt and optimize a conditional activation-induced cytidine deaminase (AID)-dead Cas9 (dCas9) system, which demonstrates greater heterogeneity of edits with an expanded footprint compared to the most commonly utilized cytosine base editor, BE4. In combination with a custom single guide RNA (sgRNA) library, we identify individual and compound variants in epidermal growth factor receptor (EGFR) and v-raf murine sarcoma viral oncogene homolog B1 (BRAF) that confer resistance to established EGFR inhibitors. This system and analytical pipeline provide a simple, highly scalable platform for cis or trans drug-modifying variant discovery and for uncovering valuable insights into protein structure-function relationships.

PMID:38838224 | DOI:10.1016/j.celrep.2024.114313

S Afr J Surg. 2024 May;62(2):69.

ABSTRACT

BACKGROUND: Laparoscopic cholecystectomy (LC) is the standard of care for symptomatic gallstone disease. The procedure has a steep learning curve and may result in significant postoperative morbidity and mortality. LC carries a morbidity of 1.6-5.3%, a mortality of 0.05-0.14% and readmission rates of 3.3% (0-11.7%). We aimed to evaluate the 30-day outcomes of LC across four metropole hospitals in the Western Cape (WC) including mortality, length of stay, readmissions and complications according to the Clavien-Dindo classification system.

METHODS: A retrospective review of a prospective database was performed. Data were collected between September 2019 and July 2022. Relative clinical, operative findings and postoperative outcomes were analysed.

RESULTS: There were 1 000 consecutive LCs included in this study. The mean postoperative length of stay was 1.92 days. Forty surgical complications were noted of which the most common were a bile leak (n = 14) and intra-abdominal collections (n = 11). Seven patients with bile leaks required reintervention. Four (0.4%) bile duct injuries (BDI) were reported in our series. Twenty-five percent of postoperative complications were graded as Clavien-Dindo IIIa and 28% were graded as Clavien-Dindo IIIb. The 30-day readmission rate was 3.8% (n = 38). Thirty-five patients were readmitted with surgical complications. There were three reported deaths (0.3%).

CONCLUSION: Laparoscopic cholecystectomy is considered the standard of treatment for gallstone disease but a small percentage may have serious complications. The outcomes reported in this series are similar to that of other reported studies.

PMID:38838125

S Afr J Surg. 2024 May;62(2):28-32.

ABSTRACT

BACKGROUND: Pancreaticoduodenectomy is a complex intra-abdominal operation used for the treatment of benign and malignant disease of the pancreatic head or periampullary region. Despite developments in surgical techniques, pancreaticoduodenectomy is still associated with high rate of postoperative complications. We performed this systematic review and meta-analysis to compare the surgical outcomes of isolated Roux-en-Y pancreaticojejunostomy (IRYPJ), and conventional pancreaticojejunostomy(CPJ).

METHODS: We performed a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. We searched the following electronic databases – PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Clinical-Trials.gov. Published trials comparing the efficacy and safety of IRYPJ and CPJ after pancreaticoduodenectomy were evaluated. The search terms were “pancreaticoduodenectomy,” “Whipple,” “pylorus-preserving pancreaticoduodenectomy,” “pancreaticojejunostomy,” “Roux-en-Y,” and “isolated Roux loop pancreaticojejunostomy.” Only randomised controlled trials comparing outcome of IRYPJ and CPJ after pancreaticoduodenectomy were included. The analysed outcome measures were postoperative pancreatic fistula (POPF), clinically relevant POPF (CR-POPF), bile leak and delayed gastric emptying (DGE).

RESULTS: The initial search yielded 342 results but only four randomised control trials fulfilled the inclusion criteria and were included for data synthesis and meta-analysis. Meta-analysis of POPF revealed that IRYPJ is associated with less POPF compared to CPJ but the difference was not statistically significant (risk ratio = 0.58, p = 0.56). A similar finding was also observed with CR-POPF (risk ratio = 0.17, p = 0.87) and DGE (risk ratio = 0.74, p = 0.46).

CONCLUSION: Isolated Roux-en-Y pancreaticojejunostomy is not associated with a superior outcome when compared to CPJ.

PMID:38838116

Chaos. 2024 Jun 1;34(6):063114. doi: 10.1063/5.0206232.

ABSTRACT

Reservoir computers (RCs) are powerful machine learning architectures for time series prediction. Recently, next generation reservoir computers (NGRCs) have been introduced, offering distinct advantages over RCs, such as reduced computational expense and lower training data requirements. However, NGRCs have their own practical difficulties, including sensitivity to sampling time and type of nonlinearities in the data. Here, we introduce a hybrid RC-NGRC approach for time series forecasting of dynamical systems. We show that our hybrid approach can produce accurate short-term predictions and capture the long-term statistics of chaotic dynamical systems in situations where the RC and NGRC components alone are insufficient, e.g., due to constraints from limited computational resources, sub-optimal hyperparameters, sparsely sampled training data, etc. Under these conditions, we show for multiple model chaotic systems that the hybrid RC-NGRC method with a small reservoir can achieve prediction performance approaching that of a traditional RC with a much larger reservoir, illustrating that the hybrid approach can offer significant gains in computational efficiency over traditional RCs while simultaneously addressing some of the limitations of NGRCs. Our results suggest that the hybrid RC-NGRC approach may be particularly beneficial in cases when computational efficiency is a high priority and an NGRC alone is not adequate.

PMID:38838103 | DOI:10.1063/5.0206232

Influenza Other Respir Viruses. 2024 Jun;18(6):e13238. doi: 10.1111/irv.13238.

ABSTRACT

BACKGROUND: COVID-19 may become a seasonal disease. SARS-CoV-2 active circulation coupled with vaccination efforts has undoubtedly modified the virus dynamic. It is therefore important investigate SARS-CoV-2 dynamic in different groups of population following the course of spatiotemporal variance and immunization.

METHODS: To investigate SARS-CoV-2 clearance in different ethnic groups and the impact of immunization, we recruited 777 SARS-CoV-2-positive patients (570 Africans, 156 Caucasians, and 51 Asians). Participants were followed and regularly tested for 2 months until they had two negative tests.

RESULTS: The vaccination rate was 64.6%. African individuals were less symptomatic (2%), Caucasians (41%) and Asians (36.6%). On average, viral clearance occurred after 10.5 days. Viral load at diagnosis was inversely correlated with viral clearance (p < 0.0001). The time of SARS-CoV-2 clearance was higher in Africans and Caucasians than in Asians (Dunn’s test p < 0.0001 and p < 0.05, respectively). On average, viral clearance occurred within 9.5 days during the second semester (higher rate of vaccination and SARS-CoV-2 exposition), whereas it took 13.6 days during the first semester (lower rate of vaccination and SARS-CoV-2 exposition) (Mann-Whitney t-test p < 0.0001).

CONCLUSION: In conclusion, ethnicity and spatiotemporal changes including SARS-CoV-2 exposition and immunization affect SARS-CoV-2 clearance.

PMID:38838076 | DOI:10.1111/irv.13238

Int Wound J. 2024 Feb;21(2):e14710. doi: 10.1111/iwj.14710.

ABSTRACT

To explore the knowledge, attitudes and practice (KAP) status of preventing pressure injury among clinical nurses working in paediatric ICU, and to examine factors affecting nurses’ KAP. A questionnaire survey was conducted among 1906 paediatric ICU nurses in 18 children’s hospitals by convenience sampling method. The survey tools were self-designed general data questionnaire, KAP questionnaire for the prevention of pressure injury and the influencing factors were analysed. A total of 1906 valid questionnaires were collected. The scores of overall KPA, knowledge, attitudes, and practice were 101.24 ± 17.22, 20.62 ± 9.63, 54.93 ± 5.81and 25.67 ± 6.76, respectively. The results of multiple linear regression analysis showed that education background, professional title, age and specialist nurse were the main influencing factor of nurses’ knowledge of preventing PI; education background and specialist nurse were the main influencing factors of nurses’ attitudes of preventing PI; knowledge, attitudes and education background were the main influencing factors of nurses’ practice of preventing PI. Paediatric ICU nurses have a positive attitude towards the prevention of PI, but their knowledge and practice need to be improved. According to different characteristics of nurses, nursing managers should carry out training on the knowledge of prevention of PI to establish a positive attitude, so as to drive the change of nursing practice and improve the nursing practice level of ICU nurses to prevent of PI.

PMID:38838072 | DOI:10.1111/iwj.14710