Category: Nevin Manimala

Clinics (Sao Paulo). 2024 Dec 2;80:100540. doi: 10.1016/j.clinsp.2024.100540. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Malignant hilar obstruction usually presents in advanced-stage disease with a poor prognosis. Effective biliary drainage is essential for the beginning of palliative chemotherapy. There is a debate on the amount of liver parenchyma that should be drained to achieve clinical success. This study aimed to correlate the volume of liver drained with clinical success rate.

METHODS: The authors conducted a retrospective study including patients with malignant hilar biliary obstruction who underwent retrograde endoscopic cholangiography for biliary drainage from January 2014 to December 2018. The main outcome was a correlation of clinical success rate with hepatic volume drained. Secondary outcomes were correlation of clinical success rate with the quantity of liver sectors drained and unilateral versus bilateral drainage.

RESULTS: 82 patients met inclusion criteria (58.5 % female), with a mean age of 60±13 years. The main cause of hilar obstruction was cholangiocarcinoma (32.9 %) followed by lymph node metastasis (23.2 %). Technical success was achieved in 75 patients (91.5 %), and clinical success in 45 patients (60 %). The authors found a significant correlation between clinical success rate when at least 50 % of viable parenchyma was drained (p = 0.016; OR = 4.15, 95 % CI 1.4-12.5). Considering liver sectors, higher clinical success rates were found when at least 2 sectors were drained (p < 0.001; OR = 8.50, 95 % CI 2.7-26.7). The correlation between unilateral versus bilateral drainage and clinical success was not statistically significant.

CONCLUSION: Drainage of at least 50 % of volume hepatic parenchyma was associated with better outcomes as well as drainage of at least 2 hepatic sectors, regardless of if unilateral or bilateral.

PMID:39626325 | DOI:10.1016/j.clinsp.2024.100540

Nanotechnology. 2024 Dec 3. doi: 10.1088/1361-6528/ad99df. Online ahead of print.

ABSTRACT

The optothermal Raman method is useful in determining the in-plane thermal conductivity of two-dimensional (2D) materials that are either suspended or supported on a substrate. We compare this method with the Stokes/anti-Stokes scattering thermometry method, which can play a role in both calibration of Raman peak positions as well as extraction of the local phonon temperature. This work demonstrates that the Stokes/anti-Stokes intensity ratio plays an important role in determining the in-plane thermal conductivity of 2D tin diselenide (SnSe₂) dry-transferred onto a polished copper (Cu) substrate. The statistically-averaged thermal conductivity of the 108±24 nm-thick SnSe₂yielded 5.4±3.5 Wm^-1K^-1for the optothermal Raman method, and 2.40±0.81 Wm^-1K^-1for the Stokes/anti-Stokes thermometry method, indicating that the Stokes/anti-Stokes thermometry method to calculate the thermal conductivity of a material can simultaneously increase both precision and accuracy. The uncertainty value was also lowered by a factor of 1.9 from the traditional optothermal Raman method to the Stokes/anti-Stokes thermometry method. The low in-plane thermal conductivity of 2D SnSe₂, 1.3-2.9 times lower than bulk, is useful for applications in thermal and electrical energy conversion and thermoelectric devices.

PMID:39626316 | DOI:10.1088/1361-6528/ad99df

J Natl Cancer Inst. 2024 Nov 29:djae310. doi: 10.1093/jnci/djae310. Online ahead of print.

ABSTRACT

BACKGROUND: Oncoplastic breast conserving surgery (OP-BCS) is becoming increasingly popular to avoid mastectomy or optimize cosmetic outcomes of breast conserving surgery (BCS). Few studies have compared clinical outcomes and patient-reported outcomes (PROs) of OP-BCS to conventional BCS (C-BCS). This study aims to compare clinical outcomes and short and long-term PROs after OP-BCS and C-BCS in a large prospective breast cancer cohort.

METHODS: Women in the prospective, multicenter UMBRELLA-breast cancer cohort who underwent OP-BCS or C-BCS were included. Clinical outcomes and PROs (measured by EORTC QLQ-C30/BR23) up to 24 months postoperatively were evaluated. Mixed-model analysis was performed to assess differences in PROs over time between groups.

RESULTS: 1628 (84.9%) patients received C-BCS and 290 (15.1%) OP-BCS. After C-BCS and OP-BCS, free resection margins were obtained in 84.2% (n = 1370) and 86.2% (n = 250), respectively, reoperation for re-exision of margins <3 months occurred in 5.3% (n = 86) and 4.8% (n = 14), median time interval from surgery until adjuvant systemic therapy was 66 and 63 days, and 36 and 41 days until radiotherapy. Shortly postoperative, OP-BCS was associated with statistically significant lower mean scores for physical functioning (83.6 vs 87.2) and body image (82.8 vs 89.4) and more pain (19.8 vs 26.5) and breast symptoms (22.7 vs 30.3) than C-BCS. Body image scores remained significantly less favorable after OP-BSC than C-BCS up to 24 months postoperatively (87.8 vs 92.2).

CONCLUSIONS: Oncoplastic surgery safely enables BCS, but may lead to less favorable long-term body image compared to C-BCS. These findings are important for patient education and shared decision-making.

PMID:39626303 | DOI:10.1093/jnci/djae310

Am J Trop Med Hyg. 2024 Dec 3:tpmd240221. doi: 10.4269/ajtmh.24-0221. Online ahead of print.

ABSTRACT

In refugee and internally displaced person settlements, hygienic water handling and free residual chlorine (FRC) are crucial for protecting water against recontamination after distribution up to the household point-of-consumption. We conducted a secondary analysis of water quality and water handling data collected in refugee camps in South Sudan, Jordan, and Rwanda using statistical and process-based modeling to explore how water handling practices affect FRC decay and household FRC outcomes. The two practices that consistently produced a significant effect on FRC decay and household FRC were storing water in direct sunlight and transferring water between containers during household storage. Samples stored in direct sunlight had 0.22-0.31 mg/L lower household FRC and had FRC decay rates between 2 and 3.7 times higher than samples stored in the shade, and samples that were transferred between containers had 0.031-0.51 mg/L lower household FRC and decay rates 1.65-3 times higher than non-transferred samples in sites in which the effect was significant, suggesting that humanitarian responders should aim to provide additional water storage containers to prevent water transferring in households and encourage water-users not to store water in direct sunlight. By contrast, the effect of the three recommended hygienic water handling behaviors (clean, covered containers and drawing by tap or pouring) was mixed or inconclusive. These inconclusive results were likely due to imbalanced or unreliable approaches to gathering the data, and we recommend that hygienic water handling practices that mechanistically provide a physical barrier against recontamination should always be promoted in humanitarian settings.

PMID:39626299 | DOI:10.4269/ajtmh.24-0221

J Anim Sci. 2024 Nov 29:skae363. doi: 10.1093/jas/skae363. Online ahead of print.

ABSTRACT

Genetic selection for traits that have direct impact on profitability, such as productive longevity (PL), which blends cow longevity with regular reproductive performance, is fundamental for the economic success of beef cow-calf operations. The purpose of this study was to develop data screening strategy and a statistical model to predict genetic merit for PL in a multibreed beef cattle population. Pedigree (n = 1,352,765) and phenotype (n = 978,382) information were provided by Leachman Cattle of Colorado and genotypes (n = 26,342) were provided by the Zoetis commercial genotyping laboratory. A repeatability model (REP) including the systematic effects of age at first calving, year-season of progeny birth, pedigree-based retained heterosis, and parity number, as well as the random effects of additive genetic, permanent environment, contemporary group, and residual were fitted to adjust PL. In addition, a random regression model (RRM) was fitted to investigate PL considering the same effects, with the difference that random effects were regressed on parity. Estimated breeding value (EBV) were obtained by single-step GBLUP (ssGBLUP) and transformed to predict differences in number of calves through linear regression. Predictive performance was assessed in a group of 7,268 cows born in 2010. Heritability estimates for PL were relatively low, with values of 0.109 for REP and a decreasing trend for RRM with values ranging from 0.16 to 0.04. Repeatability for PL was of moderate magnitude, with values of 0.415 for REP and from 0.29 to 0.57 for RRM. Heritability estimates suggest that most of phenotypic variation was accounted for by environmental factors, but long-term genetic selection could still be effective. REP was more efficient than RRM, showing lower number of iterations and time to reach convergence with comparable solutions to RRM. Validation results showed that correlations between EBV and phenotypes (observed/pre-corrected) increased over the years ranging from 0.04 to 0.92. Repeatability values and the validation approach suggested that using a cow’s first record (second parity success or failure) is a reasonably good indicator of posterior performance for PL. Therefore, the inclusion of PL in a multibreed genetic evaluation program, incorporation into selection indexes with existing economic traits, can enable more profitable selection and breeding decisions in beef cattle herds.

PMID:39626265 | DOI:10.1093/jas/skae363

J Med Internet Res. 2024 Dec 3;26:e57708. doi: 10.2196/57708.

ABSTRACT

BACKGROUND: Asynchronous digital health (eg, web-based portal, text, and email communication) can overcome practical barriers associated with in-person and remote synchronous (real-time) consultations. However, little is known about the effectiveness and acceptability of asynchronous digital health to support care for individuals with asthma (eg, asthma reviews).

OBJECTIVE: We aimed to systematically review the qualitative and quantitative evidence on the role of asynchronous digital health for asthma care.

METHODS: Following Cochrane methodology, we searched 6 databases (January 2001-July 2022; search update: September 2023) for quantitative, qualitative, or mixed methods studies supporting asthma care using asynchronous digital health. Screening and data extraction were duplicated. We assessed the risk of bias in the clinical outcomes of randomized controlled trials included in the meta-analysis using the revised Cochrane risk of bias tool. For the remaining studies, we evaluated the methodological quality using the Downs and Black checklist, critical appraisal skills program, and mixed methods appraisal tool for quantitative, qualitative, and mixed methods studies, respectively. We determined the confidence in the evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) criteria. We conducted a meta-analysis of trial data and a thematic analysis of qualitative data.

RESULTS: We included 30 studies (20 quantitative, 6 qualitative, and 4 mixed methods) conducted in 9 countries involving individuals with asthma, their caregivers, and health care professionals. Asynchronous digital consultations linked with other functionalities, compared to usual care, improved asthma control (standardized mean difference 0.32, 95% CI 0.02-0.63; P=.04) and reduced hospitalizations (risk ratio 0.36; 95% CI 0.14-0.94; P=.04). However, there were no significant differences in quality of life (standardized mean difference 0.16; 95% CI -0.12 to 0.43; P=.26) or emergency department visits (risk ratio 0.83; 95% CI 0.33-2.09; P=.69). Patients appreciated the convenience of asynchronous digital health, though health care professionals expressed concerns. Successful implementation necessitated an organizational approach. Integrative synthesis underscored the ease of asking questions, monitoring logs, and medication reminders as key digital functionalities.

CONCLUSIONS: Despite low confidence in evidence, asynchronous consultation supported by digital functionalities is an effective and convenient option for nonemergency asthma care. This type of consultation, well accepted by individuals with asthma and their caregivers, offers opportunities for those facing challenges with traditional synchronous consultations due to lifestyle or geographic constraints. However, efficient organizational strategies are needed to manage the associated workload.

TRIAL REGISTRATION: PROSPERO CRD42022344224; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=344224.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1371/journal.pone.0281538.

PMID:39626243 | DOI:10.2196/57708

J Med Internet Res. 2024 Dec 3;26:e56874. doi: 10.2196/56874.

ABSTRACT

BACKGROUND: Clinical diagnostic assessments and the outcome monitoring of patients with depression rely predominantly on interviews by professionals and the use of self-report questionnaires. The ubiquity of smartphones and other personal consumer devices has prompted research into the potential of data collected via these devices to serve as digital behavioral markers for indicating the presence and monitoring of the outcome of depression.

OBJECTIVE: This paper explores the potential of using behavioral data collected with smartphones to detect and monitor depression symptoms in patients diagnosed with depression. Specifically, it investigates whether this data can accurately classify the presence of depression, as well as monitor the changes in depressive states over time.

METHODS: In a prospective cohort study, we collected smartphone behavioral data for up to 1 year. The study consists of observations from 164 participants, including healthy controls (n=31) and patients diagnosed with various depressive disorders: major depressive disorder (MDD; n=85), MDD with comorbid borderline personality disorder (n=27), and major depressive episodes with bipolar disorder (n=21). Data were labeled based on depression severity using 9-item Patient Health Questionnaire (PHQ-9) scores. We performed statistical analysis and used supervised machine learning on the data to classify the severity of depression and observe changes in the depression state over time.

RESULTS: Our correlation analysis revealed 32 behavioral markers associated with the changes in depressive state. Our analysis classified patients who are depressed with an accuracy of 82% (95% CI 80%-84%) and change in the presence of depression with an accuracy of 75% (95% CI 72%-76%). Notably, the most important smartphone features for classifying depression states were screen-off events, battery charge levels, communication patterns, app usage, and location data. Similarly, for predicting changes in depression state, the most important features were related to location, battery level, screen, and accelerometer data patterns.

CONCLUSIONS: The use of smartphone digital behavioral markers to supplement clinical evaluations may aid in detecting the presence and changes in severity of symptoms of depression, particularly if combined with intermittent use of self-report of symptoms.

PMID:39626241 | DOI:10.2196/56874

Online J Public Health Inform. 2024 Dec 3;16:e57718. doi: 10.2196/57718.

ABSTRACT

BACKGROUND: Smoking is a modifiable risk factor for SARS-CoV-2 infection. Evidence of smoking behavior during the pandemic is ambiguous. Most investigations report an increase in smoking. In this context, Google Trends data monitor real-time public information-seeking behavior and are therefore useful to characterize smoking-related interest over the trajectory of the pandemic.

OBJECTIVE: This study aimed to use Google Trends data to evaluate the effect of the pandemic on public interest in smoking-related topics with a focus on lockdowns, vaccination campaigns, and incidence.

METHODS: The weekly relative search volume was retrieved from Google Trends for England, Germany, Italy, and Spain from December 31, 2017, to April 18, 2021. Data were collected for keywords concerning consumption, cessation, and treatment. The relative search volume before and during the pandemic was compared, and general trends were evaluated using the Wilcoxon rank-sum test. Short-term changes and hereby temporal clusters linked to lockdowns or vaccination campaigns were addressed by the flexible spatial scan statistics proposed by Takahashi and colleagues. Subsequently, the numbers of clusters after the onset of the pandemic were compared by chi-square test.

RESULTS: Country-wise minor differences were observed while 3 overarching trends prevailed. First, regarding cessation, the statistical comparison revealed a significant decline in interest for 58% (7/12) of related keywords, and fewer clusters were present during the pandemic. Second, concerning consumption, significantly reduced relative search volume was observed for 58% (7/12) of keywords, while treatment-related keywords exhibited heterogeneous trends. Third, substantial clusters of increased interest were sparsely linked to lockdowns, vaccination campaigns, or incidence.

CONCLUSIONS: This study reports a substantial decline in overall relative search volume and clusters for cessation interest. These results underline the importance of intensifying cessation aid during times of crisis. Lockdowns, vaccination, and incidence had less impact on information-seeking behavior. Other public measures that positively affect smoking behavior remain to be determined.

PMID:39626237 | DOI:10.2196/57718

J Med Internet Res. 2024 Dec 3;26:e60892. doi: 10.2196/60892.

ABSTRACT

BACKGROUND: Portable spirometers are increasingly used to measure lung function at home, but doubts about the accuracy of these devices persist. These doubts stand in the way of the digital transition of chronic respiratory disease care, hence there is a need to address the accuracy of home spirometry in routine care across multiple settings and ages.

OBJECTIVE: This study aimed to assess the accuracy, reproducibility, and responsiveness to the treatment of home spirometry in long-term pediatric and adult cystic fibrosis care.

METHODS: This retrospective observational study was carried out in 5 Dutch cystic fibrosis centers. Home spirometry outcomes (forced expiratory volume in one second [FEV₁], and forced vital capacity [FVC]) for 601 anonymized users were collected during 3 years. For 81 users, data on clinic spirometry and elexacaftor/tezacaftor/ivacaftor (ETI) use were available. Accuracy was assessed using Bland-Altman plots for paired clinic-home measurements on the same day and within 7 days of each other (nearest neighbor). Intratest reproducibility was assessed using the American Thoracic Society/European Respiratory Society repeatability criteria, the coefficient of variation, and spirometry quality grades. Responsiveness was measured by the percentage change in home spirometry outcomes after the start of ETI.

RESULTS: Bland-Altman analysis was performed for 86 same-day clinic-home spirometry pairs and for 263 nearest neighbor clinic-home spirometry pairs (n=81). For both sets and for both FEV₁ and FVC, no heteroscedasticity was present and hence the mean bias was expressed as an absolute value. Overall, home spirometry was significantly lower than clinic spirometry (mean ΔFEV_1clinic-home 0.13 L, 95% CI 0.10 to 0.19; mean ΔFVC_clinic-home 0.20 L, 95% CI 0.14 to 0.25) and remained lower than clinic spirometry independent of age and experience. One-way ANOVA with post hoc comparisons showed significantly lower differences in clinic-home spirometry in adults than in children (Δmean 0.11, 95% CI -0.20 to -0.01) and teenagers (Δmean 0.14, 95% CI -0.25 to -0.02). For reproducibility analyses, 2669 unique measurement days of 311 individuals were included. Overall, 87.3% (2331/2669) of FEV₁ measurements and 74.3% (1985/2669) of FVC measurements met reproducibility criteria. Kruskal-Wallis with pairwise comparison demonstrated that for both FVC and FEV₁, coefficient of variation was significantly lower in adults than in children and teenagers. A total of 5104 unique home measurements were graded. Grade E was given to 2435 tests as only one home measurement was performed. Of the remaining 2669 tests, 43.8% (1168/2669) and 43.6% (1163/2669) received grade A and B, respectively. The median percentage change in FEV₁ from baseline after initiation of ETI was 19.2% after 7-14 days and remained stable thereafter (n=33).

CONCLUSIONS: Home spirometry is feasible but not equal to clinic spirometry. Home spirometry can confirm whether lung functions remain stable, but the context of measurement and personal trends are more relevant than absolute outcomes.

PMID:39626236 | DOI:10.2196/60892

J Med Internet Res. 2024 Dec 3;26:e53685. doi: 10.2196/53685.

ABSTRACT

BACKGROUND: In the United States, racial and ethnic disparities in substance use treatment outcomes are persistent, especially among underrepresented minority (URM) populations. Technology-based interventions (TBIs) for substance use treatment show promise in reducing barriers to evidence-based treatment, yet no studies have described how TBIs may impact racial or ethnic health equity.

OBJECTIVE: This study explored whether TBIs in substance use treatment research promote health equity among people who identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native through their inclusion in research. We explored whether research that includes the aforementioned groups consciously considers race and/or ethnicity beyond including these populations as participants.

METHODS: We conducted a scoping review of 5 electronic databases to identify TBIs in substance use treatment studies published in English between January 2000 and March 2021. Studies were included if ≥50% of participants identified as African American or Black, Hispanic or Latino, or American Indian or Alaska Native when combined. Included studies were evaluated for conscious consideration of race and ethnicity in at least one manuscript section. Finally, we conducted a critical appraisal of each study’s potential to facilitate insights into the impact of a TBI for members of specific URM groups.

RESULTS: Of 6897 titles and abstracts screened and 1158 full-text articles assessed for eligibility, nearly half (532/1158, 45.9%) of the full-text articles were excluded due to the absence of data on race, ethnicity, or not meeting the aforementioned demographic eligibility criteria. Overall, 110 studies met the inclusion criteria. Study designs included 39.1% (43/110) randomized trials, and 35.5% (39/110) feasibility studies. In total, 47.3% (52/110) of studies used computer-based interventions, including electronic screening, brief interventions, and referrals to treatment, whereas 33.6% (37/110) used interactive voice response, ecological momentary assessment or interventions, or SMS text messaging via mobile phones. Studies focused on the following substances: alcohol or drugs (45/110, 40.9%), alcohol alone (26/110, 23.6%), opioids (8/110, 7.3%), cannabis (6/110, 5.5%), cocaine (4/110, 3.6%), and methamphetamines (3/110, 2.7%). Of the studies that consciously considered race or ethnicity (29/110, 26.4%), 6.4% (7/110) explicitly considered race or ethnicity in all manuscript sections. Overall, 28.2% (31/110) of the studies were critically appraised as having a high confidence in the interpretability of the findings for specific URM groups.

CONCLUSIONS: While the prevalence of TBIs in substance use treatment has increased recently, studies that include and consciously consider URM groups are rare, especially for American Indian or Alaska Native and Hispanic or Latino groups. This review highlights the limited research on TBIs in substance use treatment that promotes racial and ethnic health equity and provides context, insights, and direction for researchers working to develop and evaluate digital technology substance use interventions while promoting health equity.

PMID:39626234 | DOI:10.2196/53685