Category: Nevin Manimala

Behav Res Ther. 2023 Nov 11;171:104436. doi: 10.1016/j.brat.2023.104436. Online ahead of print.

ABSTRACT

BACKGROUND: Positive valence emotions serve functions that may facilitate response to exposure therapy – they encourage approach behavior, diminish perceived threat reactivity, and enhance assimilation of new information in memory. Few studies have examined whether positive emotions predict exposure therapy success and extant findings are mixed.

METHODS: We conducted a secondary analysis of an exposure therapy trial for social anxiety disorder to test the hypothesis that patients endorsing higher trait positive emotions at baseline would display the greatest treatment response. N = 152 participants enrolled in a randomized controlled trial of d-cycloserine augmentation completed five sessions of group exposure therapy. Pre-treatment positive emotionality was assessed using the NEO Five-Factor Inventory. Social anxiety symptoms were assessed throughout treatment by blinded evaluators using the Liebowitz Social Anxiety Scale.

RESULTS: Accounting for baseline symptom severity, multilevel growth curve models revealed that patients with higher pre-treatment positive emotionality displayed faster social anxiety symptom reductions and lower scores at 3-month follow-up. This predictive effect remained significant after controlling for baseline depression and extraversion (without the positive emotionality facet).

CONCLUSIONS: These findings add to emerging evidence suggesting that explicitly targeting and enhancing positive emotions during exposure to perceived threat may improve treatment outcomes for anxiety and fear-based disorders.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT02066792https://clinicaltrials.gov/ct2/show/NCT02066792.

PMID:37979218 | DOI:10.1016/j.brat.2023.104436

Am J Otolaryngol. 2023 Nov 11;45(1):104098. doi: 10.1016/j.amjoto.2023.104098. Online ahead of print.

ABSTRACT

INTRODUCTION: Iatrogenic injury to the larynx, particularly the vocal cords from prolonged intubation, has been well-studied; however, tracheal injuries are rarely reported. This study investigates the effectiveness of cuffed, high-volume, low-pressure endotracheal tubes in preventing the development of tracheal ulcers in intubated subjects.

METHODS: A retrospective, IRB-approved review was performed on 1355 subjects who underwent percutaneous tracheostomy from 2002 to 2018. The presence and severity of tracheal ulcers were collected using documentation and photos during percutaneous tracheostomy placement. Primary outcome measures included: the length of time on a ventilator until tracheostomy (LOVT), length of hospitalization (LOH), and mortality in relationship to the severity of the tracheal injury. Data was reported as n (%) and median (IQR). The differences in means between groups were analyzed by ANOVA and Chi-square test with an alpha of 0.05.

RESULTS: 206 subjects met the inclusion criteria; 65 subjects had an absence of tracheal injury, and 141 subjects developed tracheal ulcers. Subjects with tracheal ulcers were grouped by the following severity scale: no ulcer; mild ulcer (minimal mucosal erosion with exudate); moderate ulcer (mucosal erosion); and severe (tracheal ring exposure). There were no statistically significant differences in age (p = 0.99), gender (p = 0.83), BMI (p = 0.44), LOH (p = 0.88), LOVT (p = 0.93), and mortality (p = 0.306) between subjects with differing severity of ulcers. The average annual incidence of clinically significant ulcers (moderate and severe) was 2.2 %.

CONCLUSIONS: The lack of statistical correlation between the duration of intubation and tracheal ulcer severity, along with a low annual incidence of tracheal ulcers, supports the improved safety of high-volume, low-pressure cylindrical, cuffed endotracheal tubes. This study is among the first to specifically focus on injuries at the level of the cuff and tip of endotracheal tubes with implications in preventive measures and potential product design changes.

PMID:37979216 | DOI:10.1016/j.amjoto.2023.104098

Horm Behav. 2023 Nov 16;157:105445. doi: 10.1016/j.yhbeh.2023.105445. Online ahead of print.

ABSTRACT

Sex is ubiquitous and variable throughout the animal kingdom. Historically, scientists have used reductionist methodologies that rely on a priori sex categorizations, in which two discrete sexes are inextricably linked with gamete type. However, this binarized operationalization does not adequately reflect the diversity of sex observed in nature. This is due, in part, to the fact that sex exists across many levels of biological analysis, including genetic, molecular, cellular, morphological, behavioral, and population levels. Furthermore, the biological mechanisms governing sex are embedded in complex networks that dynamically interact with other systems. To produce the most accurate and scientifically rigorous work examining sex in neuroendocrinology and to capture the full range of sex variability and diversity present in animal systems, we must critically assess the frameworks, experimental designs, and analytical methods used in our research. In this perspective piece, we first propose a new conceptual framework to guide the integrative study of sex. Then, we provide practical guidance on research approaches for studying sex-associated variables, including factors to consider in study design, selection of model organisms, experimental methodologies, and statistical analyses. We invite fellow scientists to conscientiously apply these modernized approaches to advance our biological understanding of sex and to encourage academically and socially responsible outcomes of our work. By expanding our conceptual frameworks and methodological approaches to the study of sex, we will gain insight into the unique ways that sex exists across levels of biological organization to produce the vast array of variability and diversity observed in nature.

PMID:37979209 | DOI:10.1016/j.yhbeh.2023.105445

J Aging Soc Policy. 2023 Nov 18:1-24. doi: 10.1080/08959420.2023.2284570. Online ahead of print.

ABSTRACT

Policies aimed at increasing employment among older people often focus on the statutory retirement age. Taking into account the characteristics of workers and work-related factors, we examine the impact of reaching the statutory retirement age on continuing employment. In addition to the use of survival trees, we propose a novel method to predict the probability of staying in employment based on an ensemble of survival trees. We focus on Poland as an example of a European country with a particularly low share of older workers in the labor force. Moreover, reform was carried out in Poland in 2017, lowering the previously raised pension eligibility age. Like other EU countries, pension eligibility in Poland starts after reaching the statutory retirement age. Our results suggest that the timing of retirement is determined by the statutory retirement age to a limited extent compared to other factors. In the case of women, a match of education and occupation, the employment sector, and holding a managerial position had a greater impact on continuing employment than reaching retirement age. In the case of men, the type of job contract had the greatest impact on continuing employment. Our findings indicate that the policies and initiatives aimed at extending working life should pay more attention to work-related factors and gender differences in employment.

PMID:37979192 | DOI:10.1080/08959420.2023.2284570

Bull Hosp Jt Dis (2013). 2023 Dec;81(4):279-284.

ABSTRACT

PURPOSE: The purpose of this study was to systematically review the evidence in the literature in order to evaluate the outcomes following medial patellofemoral ligament (MPFL) reconstruction with allograft compared to autograft reconstruction.

METHODS: A systematic literature search was performed based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Inclusion criteria for the study was clinical studies reporting on MPFL reconstruction with allograft. Recurrence rate, complications, rate of return-to-play, and functional outcomes including the Kujala, Tegner, and visual analog scale (VAS) scores were evaluated. Statistical analysis was performed using GraphPad Prism 8.3.

RESULTS: Our review identified 12 studies with a total of 336 patient knees meeting the inclusion criteria. The majority of patients were female (61.6%), with a mean age of 22.3 years and a mean follow-up of 43.4 months. The overall rate of recurrence of lateral patellar instability was 2.7% in the allograft cohort as compared to 7.8% in the autograft cohort (p = 0.01). The mean Kujala score was 91.8%, and the mean VAS score was 1.3 at final follow-up. Additionally, 81.5% of patients were able to return to play in the studies reporting this outcome measure. The overall complication rate was 1.4%.

CONCLUSION: The overall rate of recurrence was lower following MPFL reconstruction with allograft as compared to autograft in the treatment of lateral patellar instability. Additionally, there were excellent patient reported outcomes and a low complication rate following the use of allograft for MPFL reconstructionPurpose: The purpose of this study was to systematically review the evidence in the literature in order to evaluate the outcomes following medial patellofemoral ligament (MPFL) reconstruction with allograft compared to autograft reconstruction.

METHODS: A systematic literature search was performed based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Inclusion criteria for the study was clinical studies reporting on MPFL reconstruction with allograft. Recurrence rate, complications, rate of return-to-play, and functional outcomes including the Kujala, Tegner, and visual analog scale (VAS) scores were evaluated. Statistical analysis was performed using GraphPad Prism 8.3.

RESULTS: Our review identified 12 studies with a total of 336 patient knees meeting the inclusion criteria. The majority of patients were female (61.6%), with a mean age of 22.3 years and a mean follow-up of 43.4 months. The overall rate of recurrence of lateral patellar instability was 2.7% in the allograft cohort as compared to 7.8% in the autograft cohort (p = 0.01). The mean Kujala score was 91.8%, and the mean VAS score was 1.3 at final follow-up. Additionally, 81.5% of patients were able to return to play in the studies reporting this outcome measure. The overall complication rate was 1.4%.

CONCLUSION: The overall rate of recurrence was lower following MPFL reconstruction with allograft as compared to autograft in the treatment of lateral patellar instability. Additionally, there were excellent patient reported outcomes and a low complication rate following the use of allograft for MPFL reconstruction.

PMID:37979146

Bull Hosp Jt Dis (2013). 2023 Dec;81(4):273-278.

ABSTRACT

PURPOSE: The use of intraoperative technology is increasing among orthopedic surgeons in the United States. However, there is continued debate as to whether intraoperative technologies provide clinical benefits in patients undergoing total knee arthroplasty (TKA). This study sought to determine whether the use of a novel intraoperative navigation technology produces equivalent or superior short-term outcomes compared to conventional technique.

METHODS: Fifty-nine consecutive patients underwent primary TKA with a novel imageless intraoperative navigational technology between October 2019 and January 2020 at a single, urban, orthopedic specialty hospital. A 1:1 cohort propensity matching was performed with patients with similar demographics who underwent primary TKA without the use of technology. Demographics, clinical data, as well as preoperative and 3-month Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR) scores were collected. Demographic differences, clinical data, and mean KOOS, JR scores were assessed using chi-squared analysis for categorical variables and independent sample t-test for continuous variables.

RESULTS: Upon 1:1 cohort matching, patients in both the navigational cohorts and non-navigational cohorts were statistically similar demographically. Length of stay (2.11 vs. 1.71 days; p = 0.108), surgical time (108.89 vs. 101.19 minutes, p = 0.066), discharge disposition (p = 0.675), 90- day readmissions (4 vs. 4, p = 0.999), and 90-day reoperations (2 vs. 2, p = 0.999) did not statistically differ between the two matched cohorts. Additionally, KOOS, JR scores evaluated between the two cohorts preoperatively (46.06 vs. 45.17, p = 0.836) and at 3-month follow-up (57.63 vs. 55.06, p = 0.580) were similar.

CONCLUSION: This study demonstrates that the use of this novel intraoperative navigational technology yields similar short-term TKA results when compared to conventionally performed TKA. Further studies are required to validate new technologies and determine their effect on long-term clinical and patient-reported outcomes.

PMID:37979145

Bull Hosp Jt Dis (2013). 2023 Dec;81(4):259-264.

ABSTRACT

BACKGROUND: Deep surgical site infections (dSSI) following total knee arthroplasty (TKA) are associated with morbidity and poor outcomes. Although numerous patient and non-patient factors have been correlated with dSSI development, the temporal and seasonal variability of dSSI is unclear. The purpose of this study was to investigate the monthly and seasonal variability of dSSI rates following TKA.

METHODS: The dSSI database at a single large, urban, academic medical center was reviewed for TKAs performed between January 2009 and August 2018. The monthly and seasonal variability of dSSI was evaluated using a Poisson regression. Additionally, the change in dSSI rate was calculated over the entire study period.

RESULTS: We reviewed 15,230 consecutive TKAs. The average dSSI rate following TKA was 1.11% (SD: 0.91). The rate of dSSI decreased over the study period (r = 0.94, 95% CI: 0.85-1.05) but did not reach statistical significance. With summer as the reference season, there were no significant differences in the dSSI rate in fall, winter, or spring. With July as the reference season, there were no differences in the dSSI rate in any other months of the year.

CONCLUSION: Although non-significant, this analysis found a decreasing rate of dSSI after TKA over a nearly 10-year period. Interestingly, there was no difference in the dSSI rate following TKA in July as compared to other months or in summer as compared to other seasons. This conflicts with previous reports that have found an increased incidence of dSSI and other complications in July when the graduate medical education calendar begins.

PMID:37979143

Infection. 2023 Nov 18. doi: 10.1007/s15010-023-02126-4. Online ahead of print.

ABSTRACT

PURPOSE: Cladophialophora bantiana is a wonted melanized fungus causing brain abscess. In past many cases were reported from Asia, particularly from India. Of late, there is a rise in cases in places besides Asia and hence a review of the cases is warranted.

METHODS: We present a case of fatal cerebral phaeohyphomycosis caused by C. bantiana and conduct a systematic review of culture confirmed brain abscess due to C. bantiana reported between 2015 and 2022.

RESULTS: Of the 39 cases found, majority (68%) were immunocompromised. The various clinical presentations were headache (53%), hemiparesis (34%), visual disturbance (25%), altered sensorium (18%), aphasia/dysarthria (12%) and seizures (9%). Isolated lesion was observed in 18 (60%) patients. In the sequence of occurrence, the lesions were in frontal (30%), temporal (27%) and parietal (20%) region. There were five cases with coinfections such as concurrent detection of Nocardia pneumonia in two cases, toxoplasma DNA in brain abscess, coexisting pulmonary Cryptococcus neoformans infection and coexisting Candida in a case of brain abscess in one case each. Surgical intervention was performed in 84% cases. Antifungal therapy included voriconazole (80%), liposomal amphotericin B (76%), 5-fluorocytosine (30%), posaconazole (10%), and amphotericin B deoxycholate (6%). The overall mortality was 50% with lower mortality (42%) in regions outside Asia compared to Asia (63.6%) though not statistically significant.

CONCLUSIONS: C. bantiana brain abscess is an emerging infection worldwide. Next generation sequencing is an upcoming promising diagnostic test. Early complete excision of the lesion with effective antifungals may improve the outcome.

PMID:37979132 | DOI:10.1007/s15010-023-02126-4

Environ Sci Pollut Res Int. 2023 Nov 18. doi: 10.1007/s11356-023-30907-9. Online ahead of print.

ABSTRACT

This study delves into the intricate relationship between financial inclusion (FIC) and economic development (ED) within the context of QUAD nations, including the USA, Australia, India, and Japan. Using panel data spanning from 2000 to 2021, the research investigates this relationship by employing various statistical techniques. Initially, the Jarque-Bera (JB) normality test highlights the non-normal distribution of the data. Furthermore, the findings reveal varying slopes and cross-sectional interdependence among the variables, while the panel unit root test confirms their non-stationarity. Consequently, the adoption of the method of moment quantile regression is deemed appropriate for the analysis. The study’s results uncover a negative association between FIC and total natural resource rent (TNRR), while renewable-energy usage (REU), ED, and foreign direct investment (FDI) exhibit a positive relationship with FIC. Notably, the impact of TNRR on FIC diminishes at higher quantiles, indicating a diminishing effect. Similarly, the influence of REU and ED on FIC also decreases at higher quantiles, suggesting a reduced contribution as other sectors gain prominence. Conversely, FDI positively affects FIC, with a more pronounced impact observed at higher quantiles. Policy recommendations for QUAD nations include enhancing FIC initiatives, promoting REU, fostering balanced ED, attracting FDI, and encouraging collaborative efforts among the nations. Furthermore, it is imperative for developing nations to implement widespread financial literacy programs specifically targeting vulnerable and marginalized populations, equipping individuals with essential knowledge to make informed financial decisions and gain access to formal financial services.

PMID:37979108 | DOI:10.1007/s11356-023-30907-9

Arch Orthop Trauma Surg. 2023 Nov 18. doi: 10.1007/s00402-023-05090-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Total knee arthroplasty (TKA) can be performed with either conventional off-the-shelf (OTS) or customized individually-made (CIM) implants. The evidence for CIM implants is limited and variable, and the aim of this review was to compare clinical and radiological outcomes between CIM and OTS implants.

METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Studies reporting on clinical, radiological, or alignment outcomes for CIM and OTS implants were selected. The studies were appraised using the Methodical index for non-randomized studies tool.

RESULTS: Twenty-three studies fulfilled the inclusion criteria. The studies comprised 2856 CIM and 1877 OTS TKAs. Revision rate was higher with CIM (5.9%) compared to OTS (3.7%) implants [OR 1.23(95% CI 0.69-2.18)]. Manipulation under anesthesia (MUA) was higher in CIM (2.2%) compared to OTS (1.1%) group [OR 2.95(95% CI 0.95-9.13)] and complications rate was higher in CIM (5%) vs. OTS (4.5%) [OR 1.45(95% CI 0.53-3.96)] but neither reached statistical significance. Length of stay was significantly shorter in CIM group 2.9 days vs. 3.5 days [MD – 0.51(95% CI – 0.82 to – 0.20)]. Knee Society Score showed no difference between CIM and OTS groups for Knee 90.5 vs. 90.6 [MD – 0.27(95% CI – 4.27 to 3.73)] and Function 86.1 vs. 83.1 [MD 1.51(95% CI – 3.69 to 6.70)].

CONCLUSION: CIM implants in TKA have theoretical benefits over OTS prostheses. However, in this present review, CIM implants were associated with higher revisions, MUA, and overall complication rates. There was no difference in outcome score and CIM implants did not improve overall target alignment; however, more CIM TKAs were found to be in the HKA target zone compared to OTS TKAs. The findings of this review do not support the general utilization of CIM over OTS implants in TKA.

PMID:37979098 | DOI:10.1007/s00402-023-05090-8