Category: Nevin Manimala

J Allied Health. 2023 Summer;52(2):89-96.

ABSTRACT

BACKGROUND: An urgent educational need is to examine the current gaps in cultural competence/humility, diversity, equity, inclusion, and accessibility (DEIA) that may significantly affect the teaching and learning environments among students/faculty. This mixed-methods study examined the current level of cultural competemility and perceptions of diversity, equity, and inclusion (DEI)-related challenges and recommendations among students/faculty of health professions.

METHODS: Students and faculty completed a survey including the Inventory for Assessing the Process of Cultural Competemility Among Healthcare Professionals (IAPCC-HCP©) and open-ended questions on their DEI perceptions and needs. Data were analyzed via descriptive statistics and independent t-tests. Qualitative data were coded using thematic content analysis.

OUTCOMES: A total of 100 participants (64 students, 38 faculty) completed the survey. The majority identified as Caucasian or non-Hispanic White and female, and were satisfied with DEIA-related school-level initiatives and familiar with how to use pronouns to reflect all genders. Compared to students, faculty scored slightly higher, although not significantly, in five of six domains, including Cultural Humility, Cultural Awareness, Culture Skill, Cultural Encounters and Cultural Desire. Participants shared their need to address: 1) DEIA gaps in knowledge and Schools of Health Professions curriculum; 2) involvement of students; 3) racism, biases, and discrimination; and 4) recognition of underrepresented groups. Training needs were in the areas of 1) DEIA assessment and training for students and faculty; 2) DEIA school activities; 3) DEIA-informed policies; and 4) modifications to clinical education.

CONCLUSION: The faculty more than students expressed the need to enhance their DEI and cultural knowledge. Our findings can guide further development of educational activities and school-level DEI initiatives in schools of health professions.

PMID:37269026

Cancer Treat Res Commun. 2023 May 25;36:100724. doi: 10.1016/j.ctarc.2023.100724. Online ahead of print.

ABSTRACT

AIM: This study aimed to investigate whether the site of the tumour within the right colon affects survival in patients who underwent right colectomy for colon cancer.

METHODS: An observational retrospective longitudinal study was performed in patients who underwent right colectomy for non-metastatic, invasive right-sided colon cancer. Patients were categorized into two groups based on tumour location: (i) caecum and ascending colon; (ii) hepatic flexure and proximal transverse colon. Demographic and clinical features were characterized, and a survival analysis was performed.

RESULTS: Of the 198 patients enroled in the study, 134 (67.8%) had caecal or ascending colon cancer and 64 (32.3%) had hepatic flexure or transverse colon cancer. Seventy (35.4%) were female and the mean age at the time of surgery was 71.6 (SD 11.4). The groups were comparable with respect to the number of lymph nodes sampled, the pTNM stage, the histological differentiation grade and the likelihood of patients receiving adjuvant chemotherapy. Recurrence rate was nearly twice as high in the hepatic flexure and proximal transverse colon group (12.5% vs 6.7%), but this difference was not statistically significant (p = 0.174). Kaplan-Meier analysis showed no differences in disease-free (p = 0.255) and overall survival (p = 0.258) between the groups.

CONCLUSION: In our population, specific location of right-sided colon cancers does not appear to have an influence on survival. Further investigation is needed to determine if tumour subsite has an impact on the recurrence rate, and whether it should be considered in defining prognosis and treatment.

PMID:37267659 | DOI:10.1016/j.ctarc.2023.100724

Nutrition. 2023 May 13;112:112078. doi: 10.1016/j.nut.2023.112078. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to identify the prognosis relevant to the Controlling Nutritional Status (CONUT) score in locally advanced rectal cancer patients who were treated with neoadjuvant chemoradiotherapy before radical surgery.

METHODS: From a retrospective database of 568 patients undergoing radical surgery for rectal cancer at two Chinese institutions between 2012 and 2022, data for 300 patients with locally advanced rectal cancer were identified. The optimal cutoff value for the CONUT score in predicting overall survival (OS) was determined using X-tile software. The associations of the CONUT score with the recurrent metastasis and clinicopathologic parameters were analyzed. The CONUT score’s ability to predict OS was also compared with other prognostic markers. Univariate and multivariate Cox regression analysis for OS was performed. Subgroup analysis was conducted to evaluate further the CONUT score’s predicting value.

RESULTS: The optimal CONUT score cutoff value was determined as 5 according to X-tile. Patients were divided into CONUT-high (CONUT score ≥ 5) and CONUT-low (CONUT score < 5) groups. CONUT score is significantly correlated with hemoglobin, globulin, and platelets. Time-dependent receiver operating characteristic of the CONUT score predicting OS outperformed all common prognostic markers. Multivariate Cox regression analysis identified CONUT score as an independent prognostic factor for OS (hazard ratio = 5.701; 95% CI, 2.336-13.914; P < 0.001). In the subgroups of age, sex, carcinoembryonic antigen, ypTNM, and tumor response status, significant statistical differences can be observed between CONUT-high and -low.

CONCLUSIONS: The present study finds that the preoperative CONUT score may be a useful prognostic indicator in clinical scenarios.

PMID:37267656 | DOI:10.1016/j.nut.2023.112078

ACS Chem Neurosci. 2023 Jun 2. doi: 10.1021/acschemneuro.3c00001. Online ahead of print.

ABSTRACT

The emergence of new tools to image neurotransmitters, neuromodulators, and neuropeptides has transformed our understanding of the role of neurochemistry in brain development and cognition, yet analysis of this new dimension of neurobiological information remains challenging. Here, we image dopamine modulation in striatal brain tissue slices with near-infrared catecholamine nanosensors (nIRCat) and implement machine learning to determine which features of dopamine modulation are unique to changes in stimulation strength, and to different neuroanatomical regions. We trained a support vector machine and a random forest classifier to decide whether the recordings were made from the dorsolateral striatum (DLS) versus the dorsomedial striatum (DMS) and find that machine learning is able to accurately distinguish dopamine release that occurs in DLS from that occurring in DMS in a manner unachievable with canonical statistical analysis. Furthermore, our analysis determines that dopamine modulatory signals including the number of unique dopamine release sites and peak dopamine released per stimulation event are most predictive of neuroanatomy. This is in light of integrated neuromodulator amount being the conventional metric used to monitor neuromodulation in animal studies. Lastly, our study finds that machine learning discrimination of different stimulation strengths or neuroanatomical regions is only possible in adult animals, suggesting a high degree of variability in dopamine modulatory kinetics during animal development. Our study highlights that machine learning could become a broadly utilized tool to differentiate between neuroanatomical regions or between neurotypical and disease states, with features not detectable by conventional statistical analysis.

PMID:37267623 | DOI:10.1021/acschemneuro.3c00001

Int Braz J Urol. 2023 Jul-Aug;49(4):479-489. doi: 10.1590/S1677-5538.IBJU.2023.0123.

ABSTRACT

PURPOSE: To evaluate the potential oncologic benefit of a visibly complete transurethral resection of a bladder tumor (TURBT) prior to neoadjuvant chemotherapy (NAC) and radical cystectomy (RC).

MATERIALS AND METHODS: We identified patients who received NAC and RC between 2011-2021. Records were reviewed to assess TURBT completeness. The primary outcome was pathologic downstaging (<ypT2N0), with complete pathologic response (ypT0N0) and survival as secondary endpoints. Logistic regression and Cox proportional hazards models were utilized.

RESULTS: We identified 153 patients, including 116 (76%) with a complete TURBT. Sixty-four (42%) achieved <ypT2N0 and 43 (28%) achieved ypT0N0. When comparing those with and without a complete TURBT, there was no significant difference in the proportion with <ypT2N0 (43% vs 38%, P=0.57) or ypT0N0 (28% vs 27%, P=0.87). After median follow-up of 3.6 years (IQR 1.5-5.1), 86 patients died, 37 died from bladder cancer, and 61 had recurrence. We did not observe a statistically significant association of complete TURBT with cancer-specific or recurrence-free survival (p≥0.20), although the hazard of death from any cause was significantly higher among those with incomplete TURBT even after adjusting for ECOG and pathologic T stage, HR 1.77 (95% CI 1.04-3.00, P=.034).

CONCLUSIONS: A visibly complete TURBT was not associated with pathologic downstaging, cancer-specific or recurrence-free survival following NAC and RC. These data do not support the need for repeat TURBT to achieve a visibly complete resection if NAC and RC are planned.

PMID:37267613 | DOI:10.1590/S1677-5538.IBJU.2023.0123

Int Braz J Urol. 2023 Jul-Aug;49(4):469-478. doi: 10.1590/S1677-5538.IBJU.2023.0031.

ABSTRACT

PURPOSE: To compare the effects of different combinations of radical nephroureterectomy (RNU) and bladder cuff excision (BCE) surgical procedures on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC).

MATERIALS AND METHODS: This retrospective observational study included 452 patients who underwent RNU with BCE for UTUC between January 2010 and December 2020. The patients were classified into three groups based on different combinations of RNU and BCE surgical procedures: open RNU with open BCE (group 1, n=104), minimally invasive (MIS) RNU with open BCE (group 2, n=196), and MIS RNU with intracorporeal BCE (group 3, n=152). Data on demographics, body mass index, history, preoperative renal function, perioperative status, tumor characteristics, histopathology, and recurrence conditions were collected. Multivariate Cox regression analyses were performed to determine the impact of the surgical procedures on IVR. P-values < 0.05 were considered statistically significant.

RESULTS: After a median follow-up of 29.5 months, the IVR rate was 29.6% and the IVR-free survival rate was the lowest in group 2 (group 1 vs. group 2 vs. group 3: 69.0% vs. 55.1% vs. 67.5%; log-rank P=0.048). The overall survival rate was comparable among the three groups. Multivariate analysis revealed that group 2 had a significantly higher risk of IVR than group 1 (hazard ratio=1.949, 95% confidence interval=1.082-3.511, P=0.026), while groups 1 and 3 had similar risks.

CONCLUSIONS: For patients with UTUC, MIS RNU with open BCE is associated with a higher risk of IVR than open RNU with open BCE and MIS RNU with intracorporeal BCE.

PMID:37267612 | DOI:10.1590/S1677-5538.IBJU.2023.0031

Chronic Obstr Pulm Dis. 2023 Jun 2. doi: 10.15326/jcopdf.2022.0382. Online ahead of print.

ABSTRACT

INTRODUCTION: Chronic obstructive disease (COPD) risk factors, smoking and chronic infection (Cytomegalovirus (CMV)) may mold NK cell populations. What is not known is the magnitude of effect of CMV seropositivity imparts on populations in smokers with and at-risk for COPD. We investigate the independent influence of CMV seropositivity on NK cell populations and differential effects when stratifying by COPD and degree of smoking history.

METHODS: Descriptive statistics determine relationship between cytotoxic NK cell populations and demographic and clinical variables. Multivariable linear regression and predictive modeling was performed to determine associations between positive CMV serology and proportions of CD57+ and NKG2C+ NK cells. We dichotomized our analysis by those with a heavy smoking history, COPD, and describing the effect size of CMV seropositivity on NK cell populations.

RESULTS: When controlled for age, race, sex, pack-years smoked, body-mass index, and lung function, CMV+ serostatus was independently associated with a higher proportion of CD57+, NKG2C+, and NKG2C+CD57+ NK cells. CMV+ serostatus was the sole predictor of larger NKG2C+ and CD57+NKG2C+ populations. Associations are more pronounced in those with COPD and heavy smokers.

CONCLUSIONS: Among Veterans who are current and former smokers, CMV+ serostatus was independently associated with larger CD57+ and NKG2C+ populations, with a larger effect in heavy smokers and those with COPD, and was the sole predictor for increased expression of NKG2C+ and CD57+NKG2C+ populations. These findings may be broadened to include the assessment of longitudinal NK cell population change, accrued inflammatory potential, and further identification of pro-inflammatory NK cell population clusters.

PMID:37267601 | DOI:10.15326/jcopdf.2022.0382

J Clin Oncol. 2023 Jun 2:JCO2300845. doi: 10.1200/JCO.23.00845. Online ahead of print.

NO ABSTRACT

PMID:37267581 | DOI:10.1200/JCO.23.00845

Phys Rev Lett. 2023 May 19;130(20):200402. doi: 10.1103/PhysRevLett.130.200402.

ABSTRACT

We introduce a wide class of quantum maps that arise in collisional reservoirs and are able to thermalize a system if they operate in conjunction with an additional dephasing mechanism. These maps describe the effect of collisions and induce transitions between populations that obey detailed balance, but also create coherences that prevent the system from thermalizing. We combine these maps with a unitary evolution acting during random Poissonian times between collisions and causing dephasing. We find that, at a low collision rate, the nontrivial combination of these two effects causes thermalization in the system. This scenario is suitable for modeling collisional reservoirs at equilibrium. We justify this claim by identifying the conditions for such maps to arise within a scattering theory approach and provide a thorough characterization of the resulting thermalization process.

PMID:37267544 | DOI:10.1103/PhysRevLett.130.200402

Phys Rev Lett. 2023 May 19;130(20):207101. doi: 10.1103/PhysRevLett.130.207101.

ABSTRACT

We study a one-dimensional gas of N Brownian particles that diffuse independently, but are simultaneously reset to the origin at a constant rate r. The system approaches a nonequilibrium stationary state with long-range interactions induced by the simultaneous resetting. Despite the presence of strong correlations, we show that several observables can be computed exactly, which include the global average density, the distribution of the position of the kth rightmost particle, and the spacing distribution between two successive particles. Our analytical results are confirmed by numerical simulations. We also discuss a possible experimental realization of this resetting gas using optical traps.

PMID:37267543 | DOI:10.1103/PhysRevLett.130.207101