Category: Nevin Manimala

Am J Drug Alcohol Abuse. 2024 Jul 23:1-8. doi: 10.1080/00952990.2024.2380463. Online ahead of print.

ABSTRACT

Background: Innovative analytic approaches to drug studies are needed to understand better the co-use of opioids with non-opioids among people using illicit drugs. One approach is the Bayesian kernel machine regression (BKMR), widely applied in environmental epidemiology to study exposure mixtures but has received far less attention in substance use research.Objective: To describe the utility of the BKMR approach to study the effects of drug substance mixtures on health outcomes.Methods: We simulated data for 200 individuals. Using the Vale and Maurelli method, we simulated multivariate non-normal drug exposure data: xylazine (mean = 300 ng/mL, SD = 100 ng/mL), fentanyl (mean = 200 ng/mL, SD = 71 ng/mL), benzodiazepine (mean = 300 ng/mL, SD = 55 ng/mL), and nitazene (mean = 200 ng/mL, SD = 141 ng/mL) concentrations. We performed 10,000 MCMC sampling iterations with three Markov chains. Model diagnostics included trace plots, r-hat values, and effective sample sizes. We also provided visual relationships of the univariate and bivariate exposure-response and the overall mixture effect.Results: Higher levels of fentanyl and nitazene concentrations were associated with higher levels of the simulated health outcome, controlling for age. Trace plots, r-hat values, and effective sample size statistics demonstrated BKMR stability across multiple Markov chains.Conclusions: Our understanding of drug mixtures tends to be limited to studies of single-drug models. BKMR offers an innovative way to discern which substances pose a greater health risk than other substances and can be applied to assess univariate, bivariate, and cumulative drug effects on health outcomes.

PMID:39042906 | DOI:10.1080/00952990.2024.2380463

JMIR Med Educ. 2024 Jul 23;10:e52818. doi: 10.2196/52818.

ABSTRACT

BACKGROUND: The rapid evolution of ChatGPT has generated substantial interest and led to extensive discussions in both public and academic domains, particularly in the context of medical education.

OBJECTIVE: This study aimed to evaluate ChatGPT’s performance in a pulmonology examination through a comparative analysis with that of third-year medical students.

METHODS: In this cross-sectional study, we conducted a comparative analysis with 2 distinct groups. The first group comprised 244 third-year medical students who had previously taken our institution’s 2020 pulmonology examination, which was conducted in French. The second group involved ChatGPT-3.5 in 2 separate sets of conversations: without contextualization (V1) and with contextualization (V2). In both V1 and V2, ChatGPT received the same set of questions administered to the students.

RESULTS: V1 demonstrated exceptional proficiency in radiology, microbiology, and thoracic surgery, surpassing the majority of medical students in these domains. However, it faced challenges in pathology, pharmacology, and clinical pneumology. In contrast, V2 consistently delivered more accurate responses across various question categories, regardless of the specialization. ChatGPT exhibited suboptimal performance in multiple choice questions compared to medical students. V2 excelled in responding to structured open-ended questions. Both ChatGPT conversations, particularly V2, outperformed students in addressing questions of low and intermediate difficulty. Interestingly, students showcased enhanced proficiency when confronted with highly challenging questions. V1 fell short of passing the examination. Conversely, V2 successfully achieved examination success, outperforming 139 (62.1%) medical students.

CONCLUSIONS: While ChatGPT has access to a comprehensive web-based data set, its performance closely mirrors that of an average medical student. Outcomes are influenced by question format, item complexity, and contextual nuances. The model faces challenges in medical contexts requiring information synthesis, advanced analytical aptitude, and clinical judgment, as well as in non-English language assessments and when confronted with data outside mainstream internet sources.

PMID:39042876 | DOI:10.2196/52818

JMIR Res Protoc. 2024 Jul 23;13:e56277. doi: 10.2196/56277.

ABSTRACT

BACKGROUND: Potentially inappropriate medication remains a significant concern in general practices, particularly in the context of overactive bladder (OAB) treatment for individuals aged 65 years and older. This study focuses on the exploration of alternative options for treating OAB and the deprescribing of anticholinergic drugs commonly used in OAB. The research aims to comprehensively evaluate the efficiency of deprescribing through a mixed methods approach, combining quantitative assessment and qualitative exploration of perceptions, experiences, and potential barriers among patients and health care personnel.

OBJECTIVE: This study aims to evaluate the efficiency and safety of the intervention in which health care staff in primary care encourage patients to participate in deprescribing their drugs for OAB. In addition, we aim to identify factors contributing to or obstructing the deprescribing process that will drive more informed decisions in the field of deprescribing and support effective and safe treatment of patients.

METHODS: The drugs for overactive bladder in primary care (DROP) study uses a rigorous research design, using a randomized controlled trial (RCT) with an embedded sequential explanatory mixed methods approach. All general practices within the North Denmark Region will be paired based on the number of general practitioners (GPs) and urban or rural locations. The matched pairs will be randomized into intervention and control groups. The intervention group will receive an algorithm designed to guide the deprescribing of drugs for OAB, promoting appropriate medication use. Quantitative data will be collected from the RCT including data from Danish registries for prescription analysis. Qualitative data will be obtained through interviews and focus groups with GPs, staff members, and patients. Finally, the quantitative and qualitative findings are merged to understand deprescribing for OAB comprehensively. This integrated approach enhances insights and supports future intervention improvement.

RESULTS: The DROP study is currently in progress, with randomization of general practices underway. While they have not been invited to participate yet, they will be. The inclusion of GP practices is scheduled from December 2023 to April 2024. The follow-up period for each patient is 6 months. Results will be analyzed through an intention-to-treat analysis for the RCT and a thematic analysis for the qualitative component. Quantitative outcomes will focus on changes in prescriptions and symptoms, while the qualitative analysis will explore experiences and perceptions.

CONCLUSIONS: The DROP study aims to provide an evidence-based intervention in primary care that ensures the deprescription of drugs for OAB when there is an unfavorable risk-benefit profile. The DROP study’s contribution lies in generating evidence for deprescribing practices and influencing best practices in health care.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06110975; https://clinicaltrials.gov/study/NCT06110975.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56277.

PMID:39042875 | DOI:10.2196/56277

J Occup Environ Hyg. 2024 Jul 23:1-6. doi: 10.1080/15459624.2024.2371904. Online ahead of print.

ABSTRACT

Occupational noise exposure continues to be a prevalent hazard in many industries. While the proliferation of noise dosimeters and wearable devices has made it easier to assess a worker’s exposure to noise, many employees exposed to hazardous (i.e., >85 dBA) levels of noise may go their entire career without ever having their personal noise levels measured. In contrast to other occupational exposures, noise is easily perceived by the individual exposed, allowing them to develop subjective judgments regarding its characteristics. To determine whether such self-reported exposures to occupational noise are associated with hearing loss, this analysis used audiometric data and self-reported occupational exposure to loud noise from the National Health and Nutrition Examination Survey (NHANES), which has collected such data from 1999 to May 2020. Linear and logistic regressions models found a statistically significant association between self-reported noise exposure and worsened hearing at the 3, 4, 6, and 8 kHz hearing frequency as well as an elevated odds ratio for the development of hearing loss greater than 25 dB at the 2, 3, and 4 kHz audiometric frequencies. The results of this analysis suggest that in the absence of exposure measurements, workers are likely able to detect exposure to hazardous levels of noise. In these instances, additional measurements should be collected to determine if the workers should be enrolled in a hearing conservation program.

PMID:39042873 | DOI:10.1080/15459624.2024.2371904

J Vet Dent. 2024 Jul 23:8987564241264036. doi: 10.1177/08987564241264036. Online ahead of print.

ABSTRACT

Veterinary studies documenting the effect of endodontic treatment on tooth fracture resistance are scarce. The objective of this ex vivo study was to evaluate the effects of mesial access preparation and restoration, as well as pulp chamber access, instrumentation, obturation, and restoration, on the fracture resistance and characteristics of canine teeth in dogs. Sixty-five dog canine teeth were divided into 4 groups: 1. Standard endodontic treatment through a mesial access only; 2. Treatment as per group 1, adding an incisal access, instrumentation and obturation of the pulp chamber, and restoration of the access; 3. Treatment as per group 2, without pulp chamber obturation or restoration of the incisal access; and 4. Untreated teeth. The fracture resistance and characteristics of each group were documented using axial compression testing, angled 45° disto-occlusal to the long axis of the crown. The maximum force prior to fracture in groups 1, 3, and 4 were not statistically different, demonstrating that restored mesial and incisal accesses with pulp chamber instrumentation did not statistically affect fracture resistance. However, obturated and restored group 2 teeth demonstrated decreased fracture resistance compared to all other groups (P < .001). Additionally, 26.7% of group 1 teeth sustained complicated crown fractures, while 100% of group 2 teeth fractured within the obturation or restorative materials, preventing pulp exposure in these cases. Although the cause and clinical importance of decreased tooth fracture resistance following pulp chamber obturation and restoration remains unknown, it may provide protective value for maintaining a coronal seal in the event of tooth fracture.

PMID:39042869 | DOI:10.1177/08987564241264036

Prehosp Emerg Care. 2024 Jul 23:1-9. doi: 10.1080/10903127.2024.2379872. Online ahead of print.

ABSTRACT

Objectives: The American Board of Emergency Medicine (ABEM) Emergency Medical Services Medicine (EMS) was approved by the American Board of Medical Specialties on September 23, 2010. Subspecialty certification in EMS was contingent on two key elements-completing Accreditation Council for Graduate Medical Education (ACGME)-accredited EMS training and passing the subspecialty certification examination developed by ABEM. The first EMS certification examination was offered in October 2013. Meaningful certification requires rigorous assessment. In this instance, the EMS certification examination sought to embrace the tenets of validity, reliability, and fairness. For the purposes of this report, the sources of validity evidence were anchored on the EMS core content, the examination development process, and the association between fellowship training and passing the certification examination.Methods: We chose to use validity evidence that included: 1) content validity (based on the EMS core content); 2) response processes (test items require intended cognitive processes); 3) internal structure supported by the internal relationships among items; 4) relations to other variables, specifically the association between examination performance and ACGME-accredited fellowship training; and 5) the consequences of testing.Results: There is strong content validity evidence for the EMS examination based on the core content and its detailed development process. The core content and supporting job-task analysis was also used to define the examination blueprint. Internal structure support was evidenced by Cronbach’s coefficient alpha, which ranged from 0.82 to 0.92. Physicians who completed ACGME-accredited EMS fellowship training were more likely to pass the EMS certification examination (chi square, p < 0.0001; Cramér’s, V = 0.24). Finally, there were two sources of consequential validity evidence-use of test results to determine certification and use of the resulting certificate.Conclusions: There is substantial and varied validity evidence to support the use of the EMS certifying examination in making summative decisions to award certification in EMS. Of note, there was a statistically significant association between ACGME-accredited fellowship training and passing the examination.

PMID:39042827 | DOI:10.1080/10903127.2024.2379872

J Complement Integr Med. 2024 Jul 23. doi: 10.1515/jcim-2024-0183. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate and compare the antibacterial efficacy of licorice gel and tetracycline gel against Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia.

METHODS: An indigenously prepared 50 μL licorice and tetracycline gel was subjected to antibacterial sensitivity test (thrice) against Aa, Pg, Pi by agar well diffusion method using Brain Heart Infusion media. Colonies of Aa, Pg, Pi was transferred into broth and incubated at 37 °C for 24 h and diameter of inhibition zone was measured.

RESULTS: The drug release profile of licorice gel at six regular intervals was higher when compared to tetracycline. MIC of licorice gel (50 μg/mL) against Aa (14 mg), Pg (7 mg), Pi (7 mg) respectively. The diameter of inhibition zone of licorice gel was significant against Aa when compared to tetracycline gel. However, tetracycline gel exhibited significant diameter of inhibition zone against Pg and Pi when compared to licorice gel. There was a statistical significance difference between licorice and tetracycline gel against Aa (p=0.043*), Pg (p=0.037*), Pi (p=0.046*) while assessing antibacterial sensitivity test.

CONCLUSIONS: Licorice gel has anti-inflammatory and anti-microbial properties which can act against periodontal pathogens and can be considered in treating periodontal disease at low concentrations. Therefore, it can be used as an adjunctive local drug delivery agent to non-surgical periodontal therapy (NSPT) in treating periodontal disease.

PMID:39042815 | DOI:10.1515/jcim-2024-0183

Phys Rev Lett. 2024 Jul 5;133(1):010201. doi: 10.1103/PhysRevLett.133.010201.

ABSTRACT

It is well known that the set of statistics that can be observed in a Bell-type experiment is limited by quantum theory. Unfortunately, tools are missing to identify the precise boundary of this set. Here, we propose to study the set of quantum statistics from a dual perspective. By considering all Bell expressions saturated by a given realization, we show that the Clauser-Horne-Shimony-Holt expression can be decomposed in terms of extremal Tsirelson inequalities that we identify. This brings novel insight into the geometry of the quantum set in the (2,2,2) scenario. Furthermore, this allows us to identify all the Bell expressions that are able to self-test the Tsirelson realization.

PMID:39042799 | DOI:10.1103/PhysRevLett.133.010201

Transplantation. 2024 Aug 1;108(8):1782-1792. doi: 10.1097/TP.0000000000004985. Epub 2024 Jul 20.

ABSTRACT

BACKGROUND: Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage kidney disease and frequently recurs after kidney transplantation. Recurrent FSGS (rFSGS) is associated with poor allograft and patient outcomes. Bleselumab, a fully human immunoglobulin G4 anti-CD40 antagonistic monoclonal antibody, disrupts CD40-related processes in FSGS, potentially preventing rFSGS.

METHODS: A phase 2a, randomized, multicenter, open-label study of adult recipients (aged ≥18 y) of a living or deceased donor kidney transplant with a history of biopsy-proven primary FSGS. The study assessed the efficacy of bleselumab combined with tacrolimus and corticosteroids as maintenance immunosuppression in the prevention of rFSGS >12 mo posttransplantation, versus standard of care (SOC) comprising tacrolimus, mycophenolate mofetil, and corticosteroids. All patients received basiliximab induction. The primary endpoint was rFSGS, defined as proteinuria (protein-creatinine ratio ≥3.0 g/g) with death, graft loss, or loss to follow-up imputed as rFSGS, through 3 mo posttransplant.

RESULTS: Sixty-three patients were followed for 12 mo posttransplantation. Relative decrease in rFSGS occurrence through 3 mo with bleselumab versus SOC was 40.7% (95% confidence interval, -89.8 to 26.8; P = 0.37; absolute decrease 12.7% [95% confidence interval, -34.5 to 9.0]). Central-blinded biopsy review found relative (absolute) decreases in rFSGS of 10.9% (3.9%), 17.0% (6.2%), and 20.5% (7.5%) at 3, 6, and 12 mo posttransplant, respectively; these differences were not statistically significant. Adverse events were similar for both treatments. No deaths occurred during the study.

CONCLUSIONS: In at-risk kidney transplant recipients, bleselumab numerically reduced proteinuria occurrence versus SOC, but no notable difference in occurrence of biopsy-proven rFSGS was observed.

PMID:39042770 | DOI:10.1097/TP.0000000000004985

Holist Nurs Pract. 2024 Jul 23. doi: 10.1097/HNP.0000000000000667. Online ahead of print.

ABSTRACT

The physical and psychological health management of nurses is very important not only for individual nurses but also for organizations and patients. However, nurses are exposed to high stress, sleep problems, and high presenteeism. Therefore, this study aimed to examine the effects of auricular acupressure (AA) on nurses’ stress, sleep problems, and presenteeism. This randomized controlled trial encompassed 60 nurses divided into an experimental group (n = 30) and a control group (n = 30). Auricular acupressure using AA stickers with small magnets attached was performed in the experimental group, and a placebo AA using simple AA stickers (without the small magnets) was performed in the control group. The treatment lasted 7 weeks. To confirm the results, stress, sleep quality, and presenteeism were measured at pre- and posttest. There was a statistically significant difference in scores for sleep quality (t = -1.98, P = .047), health problems (z = -2.38, P = .017), and work impairment (t = -4.46, P < .001) between the experimental and control groups at posttest. Auricular acupressure increased sleep quality scores and decreased presenteeism. Auricular acupressure using AA stickers with small magnets attached was effective in improving sleep quality and reducing presenteeism in nurses.

PMID:39042725 | DOI:10.1097/HNP.0000000000000667