Category: Nevin Manimala

Infect Chemother. 2024 Jul 4. doi: 10.3947/ic.2024.0026. Online ahead of print.

ABSTRACT

BACKGROUND: Antibiotic Stewardship Programs (ASP) have improved empirical and directed antibiotic treatment in Gram-negative bloodstream infections. A decrease in mortality, readmission, and length of hospitalization has been reported.

MATERIALS AND METHODS: A pre-post-quasi-experimental study was conducted between November and April 2015-2016 (pre-intervention period), 2016-2017, 2017-2018, and 2018-2019 (post-intervention periods), to analyse the impact of ASP on empirical, directed, and entire treatment optimization, as well as mortality, readmission, and length of hospitalization, in hospitalized patients with Gram-negative bacilli (GNB) bloodstream infections.

RESULTS: One hundred seventy-four patients were included (41 in the pre-intervention group, 38 in the first-year post-intervention group, 50 in the second-year post-intervention group, and 45 in the third-year post-intervention group). There was a significant improvement in directed treatment optimization (43.9% in the pre-intervention group, 68.4% in the first-year post-intervention group, 74% in the second-year post-intervention group, and 88.9% in the third-year post-intervention group, P <0.001), as well as in entire treatment optimization (19.5%, 34.2%, 40.0%, and 46.7%, respectively, P=0.013), with increased optimal directed (adjusted odds ratio [aOR], 3.71; 95% confidence interval [CI], 1.60-8.58) and entire treatment (aOR, 3.31; 95% CI, 1.27-8.58). Although a tendency toward improvement was observed in empirical treatment after ASP implementation, it did not reach statistical significance (41.5% vs. 57.9%, P=0.065). No changes in mortality, readmission, or length of hospitalization were detected.

CONCLUSION: ASP implementation improved both directed and entire treatment optimization in patients with GNB bloodstream infections over time. Nevertheless, no improvement was found in clinical outcomes such as mortality, readmission, or length of hospitalization.

PMID:39098002 | DOI:10.3947/ic.2024.0026

Phys Act Nutr. 2024 Jun;28(2):1-6. doi: 10.20463/pan.2024.0009. Epub 2024 Jun 30.

ABSTRACT

PURPOSE: Obesity is characterized by a progressive increase in body fat accompanied by insulin resistance (IR) and elevated blood pressure (BP), and presents significant health risks, particularly in aged individuals. This study aimed to evaluate the effects of physical activity (PA) on free fatty acid (FFA) levels, IR, and BP in obese older women.

METHODS: Twenty-three participants were randomly assigned to either the control group (CON, n = 11) or the physical activity group (PA, n = 12). The PA group was provided with a target of achieving &gt;7,000 steps/day for 5 days each week. Body composition, FFA levels, IR, and BP were measured at pre- and post- of the 12-week intervention.

RESULTS: The analysis revealed a statistically significant interaction between FFA (p &lt; 0.01), IR (p &lt; 0.01), and SBP (p &lt; 0.001). FFA (p &lt; 0.5), IR (p &lt; 0.5), and systolic blood pressure (SBP) (p &lt; 0.01) were significantly decreased in the PA group compared to those in the CON group, which showed no significant changes in FFA, IR, and SBP.

CONCLUSION: PA significantly decreased FFA, IR, and SBP in older women with obesity. Therefore, PA is an effective intervention for the prevention and management of obesity and cardiovascular diseases in obese older women.

PMID:39097991 | DOI:10.20463/pan.2024.0009

Bone Joint Res. 2024 Aug 5;13(8):392-400. doi: 10.1302/2046-3758.138.BJR-2023-0412.R1.

ABSTRACT

AIMS: The Oxford Shoulder Score (OSS) is a 12-item measure commonly used for the assessment of shoulder surgeries. This study explores whether computerized adaptive testing (CAT) provides a shortened, individually tailored questionnaire while maintaining test accuracy.

METHODS: A total of 16,238 preoperative OSS were available in the National Joint Registry (NJR) for England, Wales, Northern Ireland, the Isle of Man, and the States of Guernsey dataset (April 2012 to April 2022). Prior to CAT, the foundational item response theory (IRT) assumptions of unidimensionality, monotonicity, and local independence were established. CAT compared sequential item selection with stopping criteria set at standard error (SE) < 0.32 and SE < 0.45 (equivalent to reliability coefficients of 0.90 and 0.80) to full-length patient-reported outcome measure (PROM) precision.

RESULTS: Confirmatory factor analysis (CFA) for unidimensionality exhibited satisfactory fit with root mean square standardized residual (RSMSR) of 0.06 (cut-off ≤ 0.08) but not with comparative fit index (CFI) of 0.85 or Tucker-Lewis index (TLI) of 0.82 (cut-off > 0.90). Monotonicity, measured by H value, yielded 0.482, signifying good monotonic trends. Local independence was generally met, with Yen’s Q3 statistic > 0.2 for most items. The median item count for completing the CAT simulation with a SE of 0.32 was 3 (IQR 3 to 12), while for a SE of 0.45 it was 2 (IQR 2 to 6). This constituted only 25% and 16%, respectively, when compared to the 12-item full-length questionnaire.

CONCLUSION: Calibrating IRT for the OSS has resulted in the development of an efficient and shortened CAT while maintaining accuracy and reliability. Through the reduction of redundant items and implementation of a standardized measurement scale, our study highlights a promising approach to alleviate time burden and potentially enhance compliance with these widely used outcome measures.

PMID:39097982 | DOI:10.1302/2046-3758.138.BJR-2023-0412.R1

NMR Biomed. 2024 Aug 4:e5230. doi: 10.1002/nbm.5230. Online ahead of print.

ABSTRACT

Native T1 mapping is a non-invasive technique used for early detection of diffused myocardial abnormalities, and it provides baseline tissue characterization. Post-contrast T1 mapping enhances tissue differentiation, enables extracellular volume (ECV) calculation, and improves myocardial viability assessment. Accurate and precise segmenting of the left ventricular (LV) myocardium on T1 maps is crucial for assessing myocardial tissue characteristics and diagnosing cardiovascular diseases (CVD). This study presents a deep learning (DL)-based pipeline for automatically segmenting LV myocardium on T1 maps and automatic computation of radial T1 and ECV values. The study employs a multicentric dataset consisting of retrospective multiparametric MRI data of 332 subjects to develop and assess the performance of the proposed method. The study compared DL architectures U-Net and Deep Res U-Net for LV myocardium segmentation, which achieved a dice similarity coefficient of 0.84 ± 0.43 and 0.85 ± 0.03, respectively. The dice similarity coefficients computed for radial sub-segmentation of the LV myocardium on basal, mid-cavity, and apical slices were 0.77 ± 0.21, 0.81 ± 0.17, and 0.61 ± 0.14, respectively. The t-test performed between ground truth vs. predicted values of native T1, post-contrast T1, and ECV showed no statistically significant difference (p > 0.05) for any of the radial sub-segments. The proposed DL method leverages the use of quantitative T1 maps for automatic LV myocardium segmentation and accurately computing radial T1 and ECV values, highlighting its potential for assisting radiologists in objective cardiac assessment and, hence, in CVD diagnostics.

PMID:39097976 | DOI:10.1002/nbm.5230

Afr J Reprod Health. 2024 Jul 31;28(7):47-53. doi: 10.29063/ajrh2024/v28i7.5.

ABSTRACT

This study aimed to analyze factors associated with obstetric fistula care-seeking behavior in Guinea, based on data from the 2018 Demographic and Health Survey. Women aged 15-49 years who reported having obstetric fistula constituted the study population, statistical analysis was using Stata 16.0 software. Multivariate logistic regression was used to identify the factors associated with fistula care-seeking behavior. Among women with obstetric fistula, 78.9% sought care; 21.1% of those who sought care underwent repair. Factors associated with care-seeking behavior were being divorced (AOR =8.08; 95% CI:1.56-41.84), having a job (AOR =3.23; 95% CI: 1.11-9.44), being a member of a poor household (AOR =6.49; 95% CI:1.21-34.82) and whose fistula had appeared 6 days or more after the occurrence of the causal circumstance (AOR =3.63 95% CI: 1.28-10.28). This study suggests that the foundations on which fistula prevention and treatment programs are built should be reviewed, taking into account the factors highlighted by this study.

PMID:39097972 | DOI:10.29063/ajrh2024/v28i7.5

Clin Exp Optom. 2024 Aug 4:1-12. doi: 10.1080/08164622.2024.2380080. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Constant technological improvements require practitioners to be open to adopting technologies such as telehealth for enhanced patient care. Understanding the barriers and facilitators of telehealth adoption will guide stakeholders in making decisions for safe and effective implementation of telehealth.

BACKGROUND: Effective use of telehealth improves patient outcomes. It is unclear if optometry students feel supported in using and/or are accepting of telehealth. This study evaluated telehealth acceptance of optometry students, its association with their technology self-efficacy, and whether telehealth training alters this relationship.

METHODS: Final-year optometry students at the University of Melbourne were invited to participate in a telehealth course. A 22-item online survey adapted from the Technology Proficiency Self-Assessment for twenty-first Century Learning was used to evaluate technology self-efficacy pre- and post-learning. Telehealth acceptance was evaluated using a 34-item survey according to the Unified Theory of Acceptance and Use of Technology-2. A 5-point Likert scale was used for each item, yielding two total scores. Respondent demographics, frequency of usage and number of devices were recorded. Descriptive statistics, ANOVA and Pearson correlation were used to analyse demographic variables and relationship between technology self-efficacy and telehealth acceptance.

RESULTS: 58 (68%) and 49 (58%) students participated in the pre- and post-learning surveys. Majority were 20-29-year-old females. Students used between two and four devices for online activities, with 62% being online at least hourly. Technology self-efficacy scores (average ± SD) pre- and post-learning were 83.8% ± 8.2 and 87.8% ± 7.1. Telehealth acceptance scores pre- and post-learning were 66.1% ± 9.6 and 73.98% ± 9.9. There was no association with gender, number of devices and frequency of online use for all scores. Correlation between technology self-efficacy and telehealth acceptance was insignificant pre-learning (p = 0.3) but was significant post-learning (p = 0.04).

CONCLUSION: Optometry students demonstrated high technology self-efficacy compared to telehealth acceptance. Telehealth training resulted in marked improvement in telehealth acceptance.

PMID:39097971 | DOI:10.1080/08164622.2024.2380080

Ann Biomed Eng. 2024 Aug 4. doi: 10.1007/s10439-024-03595-w. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to explore how cyclic loading influences creep response in the lumbar spine under combined flexion-compression loading.

METHODS: Ten porcine functional spinal units (FSUs) were mechanically tested in cyclic or static combined flexion-compression loading. Creep response between loading regimes was compared using strain-time histories and linear regression. High-resolution computed tomography (µCT) visualized damage to FSUs. Statistical methods, ANCOVA and ANOVA, assessed differences in behavior between loading regimes.

RESULTS: Cyclic and static loading regimes exhibited distinct creep response patterns and biphasic response. ANCOVA and ANOVA analyses revealed significant differences in slopes of creep behavior in both linear phases. Cyclic tests consistently showed endplate fractures in µCT imaging.

CONCLUSION: The study reveals statistically significant differences in creep response between cyclic and static loading regimes in porcine lumbar spinal units under combined flexion-compression loading. The observed biphasic behavior suggests distinct phases of tissue response, indicating potential shifts in load transfer mechanisms. Endplate fractures in cyclic tests suggest increased injury risk compared to static loading. These findings underscore the importance of considering loading conditions in computational models and designing preventive measures for occupations involving repetitive spinal loading.

PMID:39098978 | DOI:10.1007/s10439-024-03595-w

Eur J Appl Physiol. 2024 Aug 5. doi: 10.1007/s00421-024-05554-8. Online ahead of print.

ABSTRACT

When measuring maximum strength, a high accuracy and precision is required to monitor the training adaptations. Based on available reliability parameters, the literature suggests the replacement of the one repetition maximum (1RM) by isometric testing to save testing time. However, from a statistical point of view, correlation coefficients do not provide the required information when aiming to replace one test by another. Therefore, the literature suggests the inclusion of the mean absolute error (MAE), the mean absolute percentage error (MAPE) for agreement analysis. Consequently, to check the replaceability of 1RM testing methods, the current study examined the agreement of isometric and dynamic testing methods in the squat and the isometric mid-thigh pull. While in accordance with the literature, correlations were classified high r = 0.638-0.828 and ICC = 0.630-0.828, the agreement analysis provided MAEs of 175.75-444.17 N and MAPEs of 16.16-57.71% indicating an intolerable high measurement error between isometric and dynamic testing conditions in the squat and isometric mid-thigh pull. In contrast to previous studies, using MAE, MAPE supplemented by CCC and BA analysis highlights the poor agreement between the included strength tests. The recommendation to replace 1RM testing with isometric testing routines in the squat does not provide suitable concordance and is not recommended.

PMID:39098977 | DOI:10.1007/s00421-024-05554-8

Environ Sci Pollut Res Int. 2024 Aug 5. doi: 10.1007/s11356-024-34549-3. Online ahead of print.

ABSTRACT

BACKGROUND: Various factors have been found responsible for the increment in ecological footprint resulting difficulties in maintaining environmental sustainability. This has been noticed through a modeling perspective. Identifying the factors affecting Ecological Footprint helps policymakers to formulate policies regarding sustainability. However, studies conducted based upon systematic reviews on Ecological Footprint through modeling are still limited.

OBJECTIVE: This study intends to identify influential factors associated with ecological footprint through a systematic review.

METHODS: ProQuest, Science Direct, Scopus, and Web of Science databases were used to search literature systematically. Particular keywords and Boolean operators were applied to dig out relevant studies for the review. Peer-reviewed research articles published in the English language till September 13, 2023, were incorporated for the analysis. Following the guidelines of Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA), 1011 articles were identified from four different databases and only 37 research papers were eligible for this study. These articles were assessed and relevant information was extracted and then amalgamated into the systematic review.

RESULTS: Gross domestic product, urbanization, energy consumption, renewable energy, non-renewable energy, natural resources, bio-capacity, human capital, foreign direct investment, trade openness, and financial development were observed as key factors of the ecological footprint.

CONCLUSION: Factors known to influence ecological footprint need to be addressed properly for environmental sustainability including widespread use of renewable energy.

PMID:39098973 | DOI:10.1007/s11356-024-34549-3

Clin Oral Investig. 2024 Aug 5;28(8):465. doi: 10.1007/s00784-024-05854-5.

ABSTRACT

OBJECTIVE: To evaluate the effect of four different photoactivation protocols (according to “photoactivated faces” – mesial/distal, cervical/incisal or center – and “photoactivation time” – 6-3 s) of a high-power photo activator (Valo Cordless^®-Ultradent) on the shear bond strength (SBS) between metal brackets and dental enamel and on the degree of conversion (DC) of an orthodontic resin.

MATERIALS AND METHODS: 40 bovine incisor crowns were randomly assigned to 4 groups (n = 10). The brackets were bonded with Transbond XT^® resin using 4 protocols according to the “photoactivation protocol” factor (which was subdivided into photoactivated faces and photoactivation time): V3C = 3 s + center; V6C = 6 s + center; V3M3D = 3 s on mesial + 3 s on distal; V3C3I = 3 s on cervical + 3 s on incisal. All the samples were stored for 4 months (water,37ºC) and then subjected to a SBS test (100KgF,1 mm/min). 40 resin discs were made to evaluate the monomer degree of conversion. Data from the SBS and DC were assessed by One-way ANOVA and Tukey’s test (5%). Bond failures were analyzed according to the Adhesive Remnant Index (ARI) and evaluated by the Kruskal-Wallis test (5%).

RESULTS: There was a statistically significant difference (p = 0.008) in the One-way ANOVA result for SBS values between all groups, but the protocols showed statistically similar results (p ≥ 0.05-Tukey’s tests) concerning the photoactivated faces (V6C, V3M3D and V3C3I) and photoactivation time (V3C and V6C) factors individually. There was no statistically significant difference (p ≥ 0.05) in the One-way ANOVA result for DC values.

CONCLUSION: The SBS and DC values will vary depending on the protocol applied.

CLINICAL RELEVANCE: It is possible to maintain the bracket fixation quality with the use of a high-power LED photo activator associated with a shorter photoactivation time. However, it is assumed that not all types of protocols that might be applied will provide quality bonding, such as V3C, V3M3D and V3C3I, which may – depending on the SBS and DC values – affect the final treatment time, due to brackets debonding, or increase of possibility of damage to dental enamel during bracket removal. Clinical studies are suggested to confirm the hypotheses of this research.

PMID:39098966 | DOI:10.1007/s00784-024-05854-5