Category: Nevin Manimala

Phys Rev Lett. 2023 Jan 27;130(4):043802. doi: 10.1103/PhysRevLett.130.043802.

ABSTRACT

Confining photons in cavities enhances the interaction between light and matter. In cavity optomechanics, this enables a wealth of phenomena ranging from optomechanically induced transparency to macroscopic objects cooled to their motional ground state. Previous work in cavity optomechanics employed devices where ubiquitous structural disorder played no role beyond perturbing resonance frequencies and quality factors. More generally, the interplay between disorder, which must be described by statistical physics, and optomechanical effects has thus far been unexplored. Here, we demonstrate how sidewall roughness in air-slot photonic-crystal waveguides can induce sufficiently strong backscattering of slot-guided light to create Anderson-localized modes with quality factors as high as half a million and mode volumes estimated to be below the diffraction limit. We observe how the interaction between these disorder-induced optical modes and in-plane mechanical modes of the slotted membrane is governed by a distribution of coupling rates, which can exceed g_{o}/2π∼200 kHz, leading to mechanical amplification up to self sustained oscillations via optomechanical backaction. Our Letter constitutes the first steps towards understanding optomechanics in the multiple-scattering regime and opens new perspectives for exploring complex systems with a multitude of mutually coupled degrees of freedom.

PMID:36763436 | DOI:10.1103/PhysRevLett.130.043802

Phys Rev Lett. 2023 Jan 27;130(4):048202. doi: 10.1103/PhysRevLett.130.048202.

ABSTRACT

Disordered and amorphous materials often retain memories of perturbations they have experienced since preparation. Studying such memories is a gateway to understanding this challenging class of systems. However, it often requires the ability to measure local structural changes in response to external drives. Here, we show that dissipation is a generic macroscopic indicator of the memory of the largest perturbation. Through experiments in crumpled sheets under cyclic drive, we show that dissipation transiently increases when first surpassing the largest perturbation due to irreversible structural changes with unique statistics. This finding is used to devise novel memory readout protocols based on global observables only. The general applicability of this approach is demonstrated by revealing a similar memory effect in a three-dimensional amorphous solid.

PMID:36763418 | DOI:10.1103/PhysRevLett.130.048202

J Am Assoc Nurse Pract. 2023 Feb 10. doi: 10.1097/JXX.0000000000000834. Online ahead of print.

ABSTRACT

BACKGROUND: Inappropriate antibiotic use contributes to the development of antibiotic resistance. Sinusitis is the fifth most common diagnosis responsible for antibiotic use. Appropriate antibiotic prescribing for acute sinusitis treatment is crucial to mitigate antibiotic resistance threats.

PURPOSE: The purpose of this study was to identify patient and provider characteristics associated with antibiotic prescription and to assess provider adherence to antibiotic prescribing guidelines for acute sinusitis treatment.

METHODOLOGY: Retrospective chart review including acute sinusitis cases diagnosed over 12 months, at two express care clinics in the Southwestern United States. Data extraction identified 371 cases meeting inclusion criteria (age >18 years). Descriptive statistical data analyses included Chi square test.

RESULTS: A majority of cases received antibiotic prescriptions (90.8%, n = 337). Sociodemographic characteristics significantly associated with antibiotic prescription (p < .05) included race, ethnicity, insurance type, and smoking status. Patient-reported nature of symptoms, sinus tenderness, and erythema/edema nasal turbinates were also significantly associated with antibiotic prescription (p < .05). Antibiotic prescription and watchful waiting for acute sinusitis treatment were significantly associated with provider types (p < .05).

CONCLUSIONS: A gap exists between current guidelines and clinical practice for acute sinusitis treatment in outpatient settings. Antibiotic prescription occurred, although not indicated, along with incorrect antibiotic choice, dose, and duration of therapy.

IMPLICATIONS: Outpatient antimicrobial stewardship programs for acute sinusitis treatment with a focus on educational interventions for providers may reduce antibiotic overprescribing for acute sinusitis.

PMID:36763411 | DOI:10.1097/JXX.0000000000000834

Phys Rev Lett. 2023 Jan 20;130(3):031901. doi: 10.1103/PhysRevLett.130.031901.

ABSTRACT

We present the study of B[over ¯]^{0}→Σ_{c}(2455)^{0,++}π^{±}p[over ¯] decays based on 772×10^{6} BB[over ¯] events collected with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider. The Σ_{c}(2455)^{0,++} candidates are reconstructed via their decay to Λ_{c}^{+}π^{∓} and Λ_{c}^{+} decays to pK^{-}π^{+}, pK_{S}^{0}, and Λπ^{+} final states. The corresponding branching fractions are measured to be B(B[over ¯]^{0}→Σ_{c}(2455)^{0}π^{+}p[over ¯])=(1.09±0.06±0.07)×10^{-4} and B(B[over ¯]^{0}→Σ_{c}(2455)^{++}π^{-}p[over ¯])=(1.84±0.11±0.12)×10^{-4}, which are consistent with the world average values with improved precision. A new structure is found in the M_{Σ_{c}(2455)^{0,++}π^{±}} spectrum with a significance of 4.2σ including systematic uncertainty. The structure is possibly an excited Λ_{c}^{+} and is tentatively named Λ_{c}(2910)^{+}. Its mass and width are measured to be (2913.8±5.6±3.8) MeV/c^{2} and (51.8±20.0±18.8) MeV, respectively. The products of branching fractions for the Λ_{c}(2910)^{+} are measured to be B(B[over ¯]^{0}→Λ_{c}(2910)^{+}p[over ¯])×B(Λ_{c}(2910)^{+}→Σ_{c}(2455)^{0}π^{+})=(9.5±3.6±1.6)×10^{-6} and B(B[over ¯]^{0}→Λ_{c}(2910)^{+}p[over ¯])×B(Λ_{c}(2910)^{+}→Σ_{c}(2455)^{++}π^{-})=(1.24±0.35±0.10)×10^{-5}. Here, the first and second uncertainties are statistical and systematic, respectively.

PMID:36763394 | DOI:10.1103/PhysRevLett.130.031901

Oncologist. 2023 Feb 10:oyac251. doi: 10.1093/oncolo/oyac251. Online ahead of print.

ABSTRACT

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are the leading causes of hepatocellular carcinoma (HCC) worldwide. Limited data exist on surgical outcomes for NAFLD/NASH-related HCC compared with other HCC etiologies. We evaluated differences in clinicopathological characteristics and outcomes of patients undergoing surgical resection for NAFLD/NASH-associated HCC compared with other HCC etiologies.

METHODS: Demographic, clinicopathological features, and survival outcomes of patients with surgically resected HCC were collected. NAFLD activity score (NAS) and fibrosis score were assessed by focused pathologic review in a subset of patients.

RESULTS: Among 492 patients screened, 260 met eligibility (NAFLD/NASH [n = 110], and other etiologies [n = 150]). Median age at diagnosis was higher in the NAFLD/NASH HCC cohort compared with the other etiologies cohort (66.7 vs. 63.4 years, respectively, P = .005), with an increased percentage of female patients (36% vs. 18%, P = .001). NAFLD/NASH-related tumors were more commonly >5 cm (66.0% vs. 45%, P = .001). There were no significant differences in rates of lymphovascular or perineural invasion, histologic grade, or serum AFP levels. The NAFLD/NASH cohort had lower rates of background liver fibrosis, lower AST and ALT levels, and higher platelet counts (P < .01 for all). Median overall survival (OS) was numerically shorter in NAFLD/NASH vs other etiology groups, however, not statistically significant.

CONCLUSIONS: Patients with NAFLD/NASH-related HCC more commonly lacked liver fibrosis and presented with larger HCCs compared with patients with HCC from other etiologies. No differences were seen in rates of other high-risk features or survival. With the caveat of sample size and retrospective analysis, this supports a similar decision-making approach regarding surgical resection for NAFLD/NASH and other etiology-related HCCs.

PMID:36763374 | DOI:10.1093/oncolo/oyac251

JAMA Netw Open. 2023 Feb 1;6(2):e2255626. doi: 10.1001/jamanetworkopen.2022.55626.

ABSTRACT

IMPORTANCE: Hypertension self-management is recommended for optimal blood pressure (BP) control, but self-identified residential contextual factors that hinder hypertension self-care are understudied.

OBJECTIVE: To quantify perceived neighborhood health and hypertension self-care and assess interactions with the area deprivation index (ADI) and healthy food availability at home.

DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study was conducted in Baltimore, Maryland, including primary care adults enrolled in the Achieving Blood Pressure Control Together trial between September 1, 2013, and June 30, 2014. Participants were Black and had at least 2 BP readings greater than or equal to 140/90 mm Hg in the 6 months before enrollment. Analyses were conducted from August 5, 2021, to January 28, 2022.

EXPOSURES: Participants’ perceived neighborhood health, defined as the mean standardized score across 4 subdomains of aesthetic quality, walkability, safety, and violence, with a higher score signifying better neighborhood health.

MAIN OUTCOMES AND MEASURES: Hypertension self-care behavior and self-efficacy. Multivariable generalized linear models were fit regressing each outcome on perceived neighborhood health (higher scores on each domain signify better perceived neighborhood health), adjusted for confounders, and interaction terms between neighborhood health and potential modifiers (ADI [higher percentiles correspond to more deprivation] and healthy food availability [higher scores indicate greater availability]) of the primary association were included.

RESULTS: Among 159 participants (median [IQR] age, 57 [49-64] years; mean [SD] age, 57 (11) years; 117 women [74%]), median (IQR) hypertension self-care behavior was 50 (45-56) and self-efficacy was 64 (57-72). Better perceived neighborhood health was associated with greater hypertension self-care behavior (β, 2.48; 95% CI, 0.63-4.33) and self-efficacy (β, 4.42; 95% CI, 2.25-6.59); these associations persisted for all neighborhood health subdomains except aesthetic quality. There were no statistically significant interactions between perceived neighborhood health or its subdomains with ADI on self-care behavior (P = .74 for interaction) or self-efficacy (P = .85 for interaction). However, better perceived neighborhood aesthetic quality had associations with greater self-care behavior specifically at higher healthy food availability at home scores: β at -1 SD, -0.29; 95% CI, -2.89 to 2.30 vs β at 1 SD, 2.97; 95% CI, 0.46-5.47; P = .09 for interaction). Likewise, associations of perceived worse neighborhood violence with lower self-care behavior were attenuated at higher healthy food availability at home scores (β for -1 SD, 3.69; 95% CI, 1.31-6.08 vs β for 1 SD, 0.01; 95% CI, -2.53 to 2.54; P = .04 for interaction).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, better perceived neighborhood health was associated with greater hypertension self-care among Black individuals with hypertension, particularly among those with greater in-home food availability. Thus, optimizing hypertension self-management may require multifaceted interventions targeting both the patients’ perceived contextual neighborhood barriers to self-care and availability of healthy food resources in the home.

PMID:36763360 | DOI:10.1001/jamanetworkopen.2022.55626

JAMA Netw Open. 2023 Feb 1;6(2):e2255697. doi: 10.1001/jamanetworkopen.2022.55697.

ABSTRACT

IMPORTANCE: Survivors of breast cancer present more severe symptoms of genitourinary syndrome of menopause (GSM) than patients without history of breast cancer. Recently, new treatments, such as vaginal laser therapy, have appeared, but evidence of their efficacy remains scarce.

OBJECTIVE: To assess the safety and efficacy of carbon dioxide (CO2) vs sham vaginal laser therapy after 6 months of follow-up in survivors of breast cancer with GSM receiving aromatase inhibitors.

DESIGN, SETTING, AND PARTICIPANTS: This prospective double-blind sham-controlled randomized clinical trial with two parallel study groups was performed during October 2020 to March 2022 in a tertiary referral hospital. Survivors of breast cancer using aromatase inhibitors were assessed for eligibility, and eligible patients were randomized into the 2 treatment groups. Follow-up was conducted at 6 months. Data were analyzed in July 2022.

INTERVENTIONS: All patients from both groups were instructed to use the first-line treatment (FLT) based on nonhormonal moisturizers and vaginal vibrator stimulation. Patients for each group were allocated to 5 monthly sessions of fractional CO2 laser therapy (CLT) or sham laser therapy (SLT).

MAIN OUTCOMES AND MEASURES: The primary outcome was sexual function, evaluated through Female Sexual Function Index (FSFI) score. Other subjective measures of efficacy included a visual analog scale of dyspareunia, vaginal pH, a Vaginal Health Index, quality of life (assessed via Short-Form 12), and body image (assessed with the Spanish Body Image Scale). Objective measures of efficacy included vaginal maturation index, vaginal epithelial elasticity (measured in Pascals) and vaginal epithelial thickness (measured in millimeters). Measures were assessed before and after the intervention. Tolerance (measured on a Likert scale), adverse effects, and estradiol levels were recorded.

RESULTS: Among 211 survivors of breast cancer assessed, 84 women were deemed eligible and 72 women (mean [SD] age, 52.6 [8.3] years) were randomized to CLT (35 participants) or SLT (37 participants) and analyzed. There were no statistically significant differences between groups at baseline. At 6 months, both groups showed improvement in FSFI (mean [SD] score at baseline vs 6 months: CLT, 14.8 [8.8] points vs 20.0 [9.5] points; SLT, 15.6 [7.0] points vs 23.5 [6.5] points), but there was no significant difference between CLT and SLT groups in the improvement of sexual function evaluated through the FSFI test overall (mean [SD] difference, 5.2 [1.5] points vs 7.9 [1.2] points; P = .15) or after excluding women who were not sexually active (mean [SD] difference, 2.9 [1.4] points vs 5.5 [1.1] points; P = .15). There were also no differences between improvement of the 2 groups at 6 months of follow-up in the other assessed subjective outcomes, including dyspareunia (mean [SD] difference, -4.3 [3.4] vs -4.5 [2.3]; P = .73), Vaginal Health Index (mean [SD] difference, 3.3 [4.1] vs 5.0 [4.5]; P = .17), body image (mean [SD] difference, -3.7 [4.5] vs -2.7 [4.8]; P = .35), and quality of life (mean [SD] difference, -0.3 [3.6] vs -0.7 [3.2]; P = .39). Similarly, there were no differences in improvements in objective outcomes, including vaginal pH (mean [SD] difference, -0.6 [0.9] vs -0.8 [1.2]; P = .29), vaginal maturation index (mean [SD] difference, 10.2 [17.4] vs 14.4 [17.1]; P = .15), vaginal epithelial thickness (mean [SD] difference, 0.021 [0.014] mm vs 0.013 [0.012] mm; P = .30), vaginal epithelial elasticity (mean [SD] difference, -1373 [3197] Pascals vs -2103 [3771] Pascals; P = .64). There were significant improvements in the overall analysis regardless of group in many outcomes. The 2 interventions were well tolerated, but tolerance was significantly lower in the CLT group than the SLT group (mean [SD] Likert scale score, 3.3 [1.3] vs 4.1 [1.0]; P = .007). No differences were observed in complications or serum estradiol levels.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, vaginal laser treatment was found to be safe after 6 months of follow-up, but no statistically significant differences in efficacy were observed between CLT and SLT.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04619485.

PMID:36763359 | DOI:10.1001/jamanetworkopen.2022.55697

Diabetes Technol Ther. 2023 Feb 10. doi: 10.1089/dia.2022.0491. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this multicenter observational real-world study was to investigate glycemic outcomes in children and adolescents with type 1 diabetes over the first six-month use of MiniMed™ 780G. Secondary objective was to evaluate demographic and clinical factors that may be significantly associated with the achievement of therapeutic goals.

METHODS: Demographic, anamnestic, and clinical data of study participants were collected at time of enrolment. Data on ambulatory glucose profile were acquired at 3 and 6 months after activating Auto Mode. Aggregated glucose metrics and device settings of the entire study period were analyzed to identify predictors of optimal glycemic control, assessed by the concomitant achievement of time in range (TIR) > 70%, coefficient of variation (CV) < 36%, glucose management index (GMI) < 7%, and time below range (TBR) < 4%.

RESULTS: Our study cohort consisted of 111 children and adolescents (54.1% female) aged 7-18 years. All the most relevant clinical targets were achieved according to recommendations from the International Consensus both at 3 and 6 months. When considering aggregated data, primary goals in terms of TIR, CV, GMI, and TBR were achieved respectively by 72.1%, 74.8%, 68.5%, and 74.8% of participants. Additionally, 44 individuals (39.6%) concomitantly addressed all the above clinical targets. Regression analysis revealed that older age, briefer duration of disease, and shorter active insulin time were significant predictors of optimal glucose control. Comparing two groups of individuals stratified according to the HbA1c mean value in the year preceding MiniMed™ 780G use, achieving glycemic targets was observed in the subgroup with lower HbA1c.

CONCLUSIONS: Our study highlights the effectiveness and safety of MiniMed™ 780G in the pediatric population. More extensive and personalized training on advanced hybrid closed loop use should be considered for younger people and those with long disease duration.

PMID:36763343 | DOI:10.1089/dia.2022.0491

Transl Stroke Res. 2023 Feb 10. doi: 10.1007/s12975-023-01134-8. Online ahead of print.

ABSTRACT

Most ischemic stroke (IS) patients go untreated due to limited treatment windows, restrictive eligibility criteria, and poor availability of current clinical therapies. Neuroprotective treatments targeting protracted neurodegeneration are needed yet keep failing in clinical trials. Over half of IS patients are female, and the scarcity of neuroprotective studies using female animals hinders translational success. This pilot review and meta-analysis assessed the relationship between the risk of bias and efficacy of studies testing post-ischemic neuroprotective therapies using female rodent models of IS. We carried out a systematic search of the PubMed database for studies published between 1999 and May 2022, used the CAMARADES checklist to evaluate study quality, and extracted data pertaining to lesion volume and behavioral assessment. We found that 34 studies met our inclusion criteria, with pooled effect sizes depicting a significant treatment effect. However, researchers used mostly healthy young females, administered therapies within short time windows, ignored hormonal influences, and did not assess long-term outcomes. Interestingly, studies failing to report factors impacting internal validity, such as blinding and random allocation, had inflated effect sizes or did not reach statistical significance. There was also a relationship between low study quality and larger effect sizes for functional outcome, stressing the need to follow the existing translational design, reporting, and data analysis guidelines. In this review, we cover previous recommendations and offer our own in hopes that rigorous and meticulous research using female animal models of IS will increase our chances of successful bench-to-bedside translation.

PMID:36763321 | DOI:10.1007/s12975-023-01134-8

Pharmacoecon Open. 2023 Feb 10. doi: 10.1007/s41669-023-00393-3. Online ahead of print.

ABSTRACT

BACKGROUND: Innovative medicines are provided with dedicated funds and immediate market access in Italy. Innovativeness evaluation considers unmet need, added therapeutic value, and quality of the evidence.

OBJECTIVE: We aimed to evaluate the internal consistency and drivers of the innovativeness appraisal process.

METHODS: Appraisal reports on innovativeness refer to 1997-2021. We used both a descriptive approach and probabilistic multivariate analysis, using logistic regression models to compute odds ratios and 95% confidence intervals. The dependent variable is innovativeness status (innovative vs. non-innovative; full innovativeness vs. conditional innovativeness). Explanatory variables, besides the three above-mentioned domains, are the year of evaluation, drug type, target disease and population, and the number and type of available studies.

RESULTS: Among the 141 medicines scrutinized, 31.9%, 29.8%, and 38.3% were evaluated as fully innovative, conditionally innovative, and non-innovative, respectively. Added therapeutic value and the quality of the evidence were associated with the odds of receiving innovative status, and full compared with conditional innovativeness; unmet need was not a predictive variable. Other factors played a minor role: medicines for both solid tumours and rare diseases are more likely to be judged innovative; conditional innovativeness is more probable for medicines for rare diseases.

CONCLUSIONS: Innovativeness status is driven by the added therapeutic value and quality of evidence. The appraisal process is internally consistent and predictable. This provides industry with a clear indication of what is needed to ensure that access to their medicines is prioritized.

PMID:36763319 | DOI:10.1007/s41669-023-00393-3