Category: Nevin Manimala

PLoS One. 2023 Nov 14;18(11):e0293287. doi: 10.1371/journal.pone.0293287. eCollection 2023.

ABSTRACT

In laparoscopic surgery, one of the main byproducts is the gaseous particles, called surgical smoke, which is found hazardous for both the patient and the operating room staff due to their chemical composition, and this implies a need for its effective elimination. The dynamics of surgical smoke are monitored by the underlying flow inside the abdomen and the hidden Lagrangian Coherent Structures (LCSs) present therein. In this article, for an insufflated abdomen domain, we analyse the velocity field, obtained from a computational fluid dynamics model, first, by calculating the flow rates for the outlets and then by identifying the patterns which are responsible for the transportation, mixing and accumulation of the material particles in the flow. From the finite time Lyapunov exponent (FTLE) field calculated for different cross-sections of the domain, we show that these material curves are dependent on the angle, positions and number of the outlets, and the inlet. The ridges of the backward FTLE field reveal the regions of vortex formation, and the maximum accumulation, details which can inform the effective placement of the instruments for efficient removal of the surgical smoke.

PMID:37963139 | DOI:10.1371/journal.pone.0293287

Am Nat. 2023 Nov;202(5):699-720. doi: 10.1086/726036. Epub 2023 Oct 18.

ABSTRACT

AbstractDifferences among hummingbird species in bill length and shape have rightly been viewed as adaptive in relation to the morphology of the flowers they visit for nectar. In this study we examine functional variation in a behaviorally related but neglected feature: hummingbird feet. We gathered records of hummingbirds clinging by their feet to feed legitimately as pollinators or illegitimately as nectar robbers-“unorthodox” feeding behaviors. We measured key features of bills and feet for 220 species of hummingbirds and compared the 66 known “clinger” species (covering virtually the entire scope of hummingbird body size) with the 144 presumed “non-clinger” species. Once the effects of phylogenetic signal, body size, and elevation above sea level are accounted for statistically, hummingbirds display a surprising but functionally interpretable negative correlation. Clingers with short bills and long hallux (hind-toe) claws have evolved-independently-more than 20 times and in every major clade. Their biomechanically enhanced feet allow them to save energy by clinging to feed legitimately on short-corolla flowers and by stealing nectar from long-corolla flowers. In contrast, long-billed species have shorter hallux claws, as plant species with long-corolla flowers enforce hovering to feed, simply by the way they present their flowers.

PMID:37963119 | DOI:10.1086/726036

Am Nat. 2023 Nov;202(5):616-629. doi: 10.1086/726220. Epub 2023 Oct 19.

ABSTRACT

AbstractMortality is considered one of the main costs of dispersal. A reliable evaluation of mortality, however, is often hindered by a lack of information about the fate of individuals that disappear under unexplained circumstances (i.e., missing individuals). Here, we addressed this uncertainty by applying a Bayesian mortality analysis that inferred the fate of missing individuals according to information from individuals with known fate. Specifically, we tested the hypothesis that mortality during dispersal is higher than mortality among nondispersers using 32 years of mark-resighting data from a free-ranging population of the endangered African wild dog (Lycaon pictus) in northern Botswana. Contrary to expectations, we found that mortality during dispersal was lower than mortality among nondispersers, indicating that higher mortality is not a universal cost of dispersal. Our findings suggest that group living can incur costs for certain age classes, such as limited access to resources as group density increases, that exceed the mortality costs associated with dispersal. By challenging the accepted expectation of higher mortality during dispersal, we urge for further investigations of this key life history trait and propose a robust statistical approach to reduce bias in mortality estimates.

PMID:37963118 | DOI:10.1086/726220

JMIR Form Res. 2023 Nov 14;7:e48637. doi: 10.2196/48637.

ABSTRACT

BACKGROUND: Working pregnant women often need to adjust their physically demanding jobs for a healthy pregnancy. However, uncertainty about the extent of these adjustments can hinder their effectiveness. To address this, we developed the Job Adjustment mobile app, which allows users to input job and health details to generate a variety of personalized action plans. As this is the first version of the app, assessing its feasibility and usability is crucial.

OBJECTIVE: This study aims to verify the feasibility and usability of the Job Adjustment mobile app.

METHODS: A longitudinal observational study was conducted on pregnant Japanese women who were allowed to use the app anytime from 12 to 34 weeks of gestation; they received reminder emails every 2 weeks encouraging app use. A questionnaire was administered before app use and at 20 and 32 weeks of gestation. Feasibility was evaluated across 4 domains: implementation, demand, acceptability, and adverse events. Implementation was evaluated based on 3 parameters: dropout rate, initial reminder email receipt rate, and adherence rate (measured as pregnant women who used the app at intervals of 2.5 weeks or less). Demand was measured by intervals between use and intervals between log-in, and participants answered 15 questions to assess acceptability. Adverse events were assessed by analyzing the degree of anxiety related to work. Demographic data were analyzed to determine any statistically significant differences in intervals between uses. Usability was evaluated using the System Usability Scale.

RESULTS: The analysis included 66 pregnant women, and 61% (n=40) of them were multipara. The dropout rate, adherence rate, and initial reminder email receipt rate were 18% (13/71), 44% (29/66), and 79% (52/66) respectively. The median intervals between use and intervals between log-in were 2.94 (IQR 2.00-5.13) weeks and 2.28 (IQR 1.81-4.00) weeks, respectively. Overall, 60% (35/58) to 90% (52/58) of the participants responded positively to all 15 questions assessing acceptability, and no anxiety regarding work was recorded. The mean System Usability Scale score was 66.1 points. Multipara women had significantly longer intervals between app use compared to primipara women (P=.01).

CONCLUSIONS: The results demonstrated acceptable levels of feasibility and usability of the app. However, the low adherence rates, especially among multipara women, suggest the need for modifications to reduce the time burden of the app. Further research should explore more effective and acceptable intervals between use and timing, involving a larger sample and accounting for diverse characteristics of pregnant women.

TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000042943; https://tinyurl.com/ydrchfas.

PMID:37962945 | DOI:10.2196/48637

JMIR Res Protoc. 2023 Nov 14;12:e52565. doi: 10.2196/52565.

ABSTRACT

BACKGROUND: Mycoplasma genitalium is an emerging sexually transmitted pathogen associated with increasing antibiotic resistance. The current treatment guidelines recommend moxifloxacin-sequential therapy for macrolide-resistant Mgenitalium or strains with unknown resistance profiles. However, it is unclear whether sitafloxacin, a 4th-generation fluoroquinolone antibiotic, is effective against resistant strains.

OBJECTIVE: This study aims to assess and compare the efficacy and safety of sitafloxacin- and moxifloxacin-based treatment regimens for managing Mgenitalium infections.

METHODS: We will conduct this randomized controlled trial at multiple centers in Japan. Eligible participants include adults aged 18 years or older with a confirmed Mgenitalium infection, as determined through the nucleic acid amplification test. Patients will be randomly assigned using a stratified approach based on the treatment facility and infection site. The interventions comprise oral sitafloxacin (200 mg) daily for 7 days (with optional pretreatment of oral doxycycline, 200 mg, daily for up to 7 days), with a control group receiving oral doxycycline (200 mg) daily for 7 days followed by moxifloxacin (400 mg) daily for another 7 days. The primary outcome is the treatment success rate with a superiority margin of 10%, as confirmed through the nucleic acid amplification test. Secondary outcomes encompass changes in the bacterial load at the urogenital or rectal sites and the emergence of posttreatment-resistant mutant strains.

RESULTS: Enrollment commenced in June 2023 and will conclude in December 2024, with findings anticipated by 2025. The expected success rates fall within the range of 80% for sitafloxacin and 42% for moxifloxacin against Mgenitalium carrying the G248T (S83I) mutation, based on previous studies. Accordingly, with a 5% significance level (2-sided) and 80% statistical power, we aim to recruit 50 participants per group, factoring in a 10% expected dropout rate.

CONCLUSIONS: This study will provide valuable insights into the efficacy and safety of sitafloxacin- versus moxifloxacin-based sequential therapy in treating Mgenitalium infections. These findings have the potential to influence clinical guidelines, favoring more effective therapeutic choices. The multicenter approach enhances the robustness of this study. However, a limitation is the potential insufficiency of statistical power to detect posttreatment-resistant mutant strains in each group, rendering posttreatment-resistance mutations a notable concern. In the future, we may need to increase the sample size to enhance power.

TRIAL REGISTRATION: Japan Registry of Clinical Trials (jRCTs031230111); https://jrct.niph.go.jp/en-latest-detail/jRCTs031230111.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52565.

PMID:37962941 | DOI:10.2196/52565

JMIR Res Protoc. 2023 Nov 14;12:e48925. doi: 10.2196/48925.

ABSTRACT

BACKGROUND: Only 5% of the molecules tested in oncology phase 1 trials reach the market after an average of 7.5 years of waiting and at a cost of tens of millions of dollars. To reduce the cost and shorten the time of discovery of new treatments, “drug repurposing” (research with molecules already approved for another indication) and the use of secondary data (not collected for the purpose of research) have been proposed. Due to advances in informatics in clinical care, secondary data can, in some cases, be of equal quality to primary data generated through prospective studies.

OBJECTIVE: The objective of this study is to identify drugs currently marketed for other indications that may have an effect on the prognosis of patients with cancer.

METHODS: We plan to monitor a cohort of patients with high-lethality cancers treated in the public health system of Catalonia between 2006 and 2012, retrospectively, for survival for 5 years after diagnosis or until death. A control cohort, comprising people without cancer, will also be retrospectively monitored for 5 years. The following study variables will be extracted from different population databases: type of cancer (patients with cancer cohort), date and cause of death, pharmacological treatment, sex, age, and place of residence. During the first stage of statistical analysis of the patients with cancer cohort, the drugs consumed by the long-term survivors (alive at 5 years) will be compared with those consumed by nonsurvivors. In the second stage, the survival associated with the consumption of each relevant drug will be analyzed. For the analyses, groups will be matched for potentially confounding variables, and multivariate analyses will be performed to adjust for residual confounding variables if necessary. The control cohort will be used to verify whether the associations found are exclusive to patients with cancer or whether they also occur in patients without cancer.

RESULTS: We anticipate discovering multiple significant associations between commonly used drugs and the survival outcomes of patients with cancer. We expect to publish the initial results in the first half of 2024.

CONCLUSIONS: This retrospective study may identify several commonly used drugs as candidates for repurposing in the treatment of various cancers. All analyses are considered exploratory; therefore, the results will have to be confirmed in subsequent clinical trials. However, the results of this study may accelerate drug discovery in oncology.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48925.

PMID:37962929 | DOI:10.2196/48925

JMIR Form Res. 2023 Nov 14;7:e51752. doi: 10.2196/51752.

ABSTRACT

BACKGROUND: There has been a growth surge in the use of social media among individuals today. The widespread adoption of these platforms, coupled with their engaging features, presents a unique opportunity for the dissemination of health advocacy information. Social media is known as a powerful tool used to share health policy and advocacy efforts and disseminate health information to digital community members and networks. Yet, there is still a gap in the full exploitation of this powerful instrument, among health care professionals, for health advocacy campaigns.

OBJECTIVE: This paper aims to describe the process of mobilizing social media platforms such as Twitter (rebranded to X Corp in 2023) for health advocacy of the digital community. Additionally, it aims to share the lessons and insights gained during this digital health advocacy engagement process.

METHODS: We performed a comprehensive review of Twitter analytical data to examine the impact of our social media posts. We then consolidated these analytic reports with our meeting logs to describe our systematic, iterative, and collaborative design process to implement social media efforts and generate key lessons learned.

RESULTS: Our review of monthly Twitter analytical reports and regular team meeting logs revealed several themes for successful and less successful practices in relation to our social media-based health advocacy efforts. The successful practices noted by the team included using personable, picture-based tweets; using a series of posts on a particular topic rather than an isolated post; leveraging team members’ and partners’ collaborations in shared posts; incorporating hashtags in tweets; using a balanced mix of texts and graphics in posts; using inclusive (nondestigmatizing) languages in tweeted posts; and use of polls to share tweets. Among the many lessons learned, we also experienced limitations including a lack of comprehensive statistics on Twitter usage for health care-related purposes such as health advocacy and limits in collating the estimates of the actual impact made on the intended digital community members by our posts.

CONCLUSIONS: Twitter has been successfully used in promoting health advocacy content, and the social media team aims to explore other social media platforms that have a wider reach than Twitter. We will continue making necessary adjustments in strategies, techniques, and styles to engage the audience as we expand onto new platforms like Instagram and TikTok for health advocacy promotions.

PMID:37962914 | DOI:10.2196/51752

Kidney360. 2023 Nov 14. doi: 10.34067/KID.0000000000000301. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic resulted in an unprecedented shift in the delivery of outpatient medical care, including the rapid transition of services from in-person to telehealth. We adapted an evidence-based personalized health planning group visit care model traditionally offered in-person to telehealth to support the care of patients with type 2 diabetes mellitus (T2D) and chronic kidney disease (CKD). Despite the need to leverage telehealth technologies to better support self-management for patients with CKD, scant evidence exists on how to do so.

METHODS: We conducted prospective adaptations of in-person evidence-based group visit model for telehealth delivery for patients with CKD and T2D. Intervention adaptations are reported using the Framework for Reporting Adaptations and Modifications (FRAME) taxonomy. The adapted virtual group visit care model was pilot tested among adults with T2D and stage 3b or 4 CKD. Feasibility outcomes included recruitment, attendance, satisfaction, and self-reported goal progress. Clinical outcomes were evaluated using Wilcoxon signed rank tests and included hemoglobin A1C (HbA1c), diastolic and systolic blood pressure, body mass index, and estimated glomerular filtration rate.

RESULTS: Adaptation areas included outreach, visit format, educational materials design and access, staffing, and patient engagement strategies. 39% (43) of patients (110) contacted verbalized interest, and 58% (25) of those participated. 72% completed >6 group sessions. 68% of patients reported completing one or more health goals, with nutrition and physical activity being the most common. We observed a statistically significant improvement in HbA1c (p = 0.0176) six months post-program participation.

CONCLUSIONS: Adapting evidence-based interventions for telehealth delivery is challenging due to the risk of altering an intervention’s core components responsible for observed benefits. We adapted an in-person group visit model for the care of T2D and CKD for telehealth delivery. The telehealth approach was feasible and preliminary data suggested it improved relevant health and patient-recorded outcomes up to six months post-program completion. The approaches used here may be applicable to the adaptation of other clinical programs for telehealth delivery.

PMID:37962910 | DOI:10.34067/KID.0000000000000301

ACS Appl Mater Interfaces. 2023 Nov 14. doi: 10.1021/acsami.3c13956. Online ahead of print.

ABSTRACT

Memristive devices, known for their nonvolatile resistive switching, are promising components for next-generation neuromorphic computing systems, which mimic the brain’s neural architecture. Specifically, these devices are well-suited for functioning as artificial synapses due to their analogue tunability and low energy consumption. However, the improvement of their performance and reliability remains a pressing challenge. In this study, we report the development and comprehensive characterization of memristive devices based on a parylene-MoO_x (PPX-Mo) nanocomposite layer, which exhibit improved characteristics over their parylene-based counterparts: lower switching voltage and energy, smaller dispersion, and better resistive plasticity. A robust statistical analysis identified the optimal synthesis parameters for these devices, providing valuable insights for future device optimization. The most probable resistive switching mechanism of the devices is proposed. By successfully integrating these memristors into a neuromorphic computing model and showcasing their scalability in crossbar geometry, we demonstrate their potential as functional artificial synapses. The results obtained from this study can be useful for the development of hardware-brain-inspired computational systems.

PMID:37962902 | DOI:10.1021/acsami.3c13956

JMIR Mhealth Uhealth. 2023 Nov 3;11:e44703. doi: 10.2196/44703.

ABSTRACT

BACKGROUND: Hearing disability in preschool children can delay or impact oral communication and social skills. Provision of hearing screening tests by standard audiometry in low- to middle-income countries is problematic due to a lack of pediatric audiologists, standard hearing equipment, and standard soundproof rooms. Therefore, an innovative hearing screening tool that is easily accessible and inexpensive such as a mobile app should be considered. Headphones have been a crucial part of hearing screenings. Audiometric headphones, which serve as the reference standard, have been used in most studies. However, since audiometric headphones are not accessible in rural areas, we hypothesized that generic headphones can also be used in hearing screenings.

OBJECTIVE: This study aimed to determine the sensitivity, specificity, κ coefficiency, and time consumption of the PASS-Pro (Preschool Audiometry Screening System-Pro) app when using TDH39 headphones, Beyerdynamic DT 770 PRO headphones, and generic earmuff headphones compared to standard conditioned play audiometry.

METHODS: We recruited preschool children aged 4 to 5 years to participate in this study. The children received 3 PASS-Pro screening tests using different types of headphones in a quiet room and 1 standard conditioned play audiometry in a soundproof room. All tests were administered in random order. The agreement coefficient, sensitivity, specificity, and mean test duration were determined.

RESULTS: A total of 44 children participated in this study. For mild hearing loss screening, the κ coefficients between standard conditioned play audiometry and the PASS-Pro app using TDH39 headphones, Beyerdynamic DT 770 PRO headphones, and generic earmuff headphones were 0.195, 0.290, and 0.261 (P=.02, P=.002, and P=.004), respectively. The sensitivity for all headphones was 50% and the specificity was more than 88%. For moderate hearing loss screening, the κ coefficients were 0.206, 0.272, and 0.235 (all Ps=.001), respectively. The sensitivity for all headphones was 100% and the specificity was more than 92%. There were no statistical differences in sensitivity and specificity between the reference headphone (TDH39), Beyerdynamic DT 770 PRO headphone, and generic earmuff headphones (all Ps >.05). The PASS-Pro app used significantly less time to carry out hearing tests than conditioned play audiometry (P<.001).

CONCLUSIONS: The PASS-Pro app, used with generic headphones, is effective for conducting hearing screening tests in preschool children with high sensitivity and specificity.

PMID:37962900 | DOI:10.2196/44703