Category: Nevin Manimala

Pediatr Emerg Care. 2023 May 18. doi: 10.1097/PEC.0000000000002964. Online ahead of print.

ABSTRACT

OBJECTIVE: We sought to describe how the Emergency Department Work Index (EDWIN) saturation tool (1) correlates with PED overcrowding during a capacity management activation policy, known internally as Purple Alert and (2) compare overall hospital-wide capacity metrics on days in which the alert was instituted versus days it was not.

METHODS: This study was conducted between January 1, 2017 and December 31, 2019 in a 30-bed academic quaternary care, urban PED within a university hospital. The EDWIN tool was implemented in January 2019 and objectively measured the busyness of the PED. To determine correlation with overcrowding, EDWIN scores were calculated at alert initiation. Mean alert hours per month were plotted on a control chart before and after EDWIN implementation. We also compared daily numbers of PED visits, inpatient admissions, and patients left without being seen (LWBS) for days with and without alert initiation to assess whether or not Purple Alert correlated with high PED usage.

RESULTS: During the study period, the alert was activated a total of 146 times; 43 times after EDWIN implementation. Mean EDWIN score was 2.5 (SD 0.5, min 1.5, max 3.8) at alert initiation. There were no alert occurrences for EDWIN scores less than 1.5 (not overcrowded). There was no statistically significant difference for mean alert hours per month before and after EDWIN was instituted (21.4 vs 20.2, P = 0.08). Mean numbers of PED visits, inpatient admissions, and patients left without being seen were higher on days with alert activation (P < 0.001 for all).

CONCLUSIONS: The EDWIN score correlated with PED busyness and overcrowding during alert activation and correlated with high PED usage. Future studies could include implementing a real-time Web-based EDWIN score as a prediction tool to prevent overcrowding and verifying EDWIN generalizability at other PED sites.

PMID:37195644 | DOI:10.1097/PEC.0000000000002964

Soft Matter. 2023 May 17. doi: 10.1039/d3sm00034f. Online ahead of print.

ABSTRACT

We use numerical simulations to study the dynamics of dense assemblies of self-propelled particles in the limit of extremely large, but finite, persistence times. In this limit, the system evolves intermittently between mechanical equilibria where active forces balance interparticle interactions. We develop an efficient numerical strategy allowing us to resolve the statistical properties of elastic and plastic relaxation events caused by activity-driven fluctuations. The system relaxes via a succession of scale-free elastic events and broadly distributed plastic events that both depend on the system size. Correlations between plastic events lead to emergent dynamic facilitation and heterogeneous relaxation dynamics. Our results show that dynamical behaviour in extremely persistent active systems is qualitatively similar to that of sheared amorphous solids, yet with some important differences.

PMID:37195636 | DOI:10.1039/d3sm00034f

J Clin Monit Comput. 2023 May 17. doi: 10.1007/s10877-023-01030-4. Online ahead of print.

ABSTRACT

Monitoring of high-risk patients in hospital wards is crucial in identifying and preventing clinical deterioration. Sympathetic nervous system activity measured continuously and non-invasively by Electrodermal activity (EDA) may relate to complications, but the clinical use remains untested. The aim of this study was to explore associations between deviations of EDA and subsequent serious adverse events (SAE). Patients admitted to general wards after major abdominal cancer surgery or with acute exacerbation of chronic obstructive pulmonary disease were continuously EDA-monitored for up to 5 days. We used time-perspectives consisting of 1, 3, 6, and 12 h of data prior to first SAE or from start of monitoring. We constructed 648 different EDA-derived features to assess EDA. The primary outcome was any SAE and secondary outcomes were respiratory, infectious, and cardiovascular SAEs. Associations were evaluated using logistic regressions with adjustment for relevant confounders. We included 714 patients and found a total of 192 statistically significant associations between EDA-derived features and clinical outcomes. 79% of these associations were EDA-derived features of absolute and relative increases in EDA and 14% were EDA-derived features with normalized EDA above a threshold. The highest F1-scores for primary outcome with the four time-perspectives were 20.7-32.8%, with precision ranging 34.9-38.6%, recall 14.7-29.4%, and specificity 83.1-91.4%. We identified statistically significant associations between specific deviations of EDA and subsequent SAE, and patterns of EDA may be developed to be considered indicators of upcoming clinical deterioration in high-risk patients.

PMID:37195623 | DOI:10.1007/s10877-023-01030-4

J Clin Monit Comput. 2023 May 17. doi: 10.1007/s10877-023-01023-3. Online ahead of print.

ABSTRACT

Preserving haemodynamics is expected to positively affect tissue oxygen saturation. We hypothesized that maintaining mean arterial blood pressure (MAP) (using phenylephrine (PE) or dobutamine (Dobu)) would equally affect regional cerebral and paravertebral tissue saturation (rS_cO₂ and rS_pvO₂, respectively). Thirty-four patients were randomly assigned to receive either PE or Dobu, in order to keep MAP within 20% of the preoperative value. Their effect on haemodynamics, rS_cO₂ and rS_pvO₂ at thoracic level T₃-T₄, T₉-T₁₀ and lumbar level L₁-L₂ was calculated at different doses. Drug-induced haemodynamic effects differed between groups (∆MAP: -2%±21 and – 19%±17, ∆CI: -14.6%±14.6 and 24.1%±49.9, ∆HR: -21%±21 and 0%±16 for PE and Dobu, respectively). Both groups exhibited a significant decrease in rS_cO₂, with a more pronounced decline in the PE group (-14.1%±16.1) compared to the Dobu group (-5.9%±10.6). There were no significant changes at the paravertebral level in either group, but a slight but statistically significant difference was detected between the two groups at T₃-T₄ and L₁-L₂. Current guidelines advocate maintaining adequate systemic blood pressures to prevent spinal cord ischaemia in specific procedures. However, it is still unknown which circulatory supportive drug is more beneficial for maintaining spinal cord perfusion. Our data indicates that, when used for maintenance of blood pressure within a 20% range of preoperative values, neither phenylephrine nor dobutamine affect paravertebral tissue saturation.

PMID:37195621 | DOI:10.1007/s10877-023-01023-3

Environ Sci Pollut Res Int. 2023 May 17. doi: 10.1007/s11356-023-27395-2. Online ahead of print.

ABSTRACT

Mangrove ecosystems provide numerous benefits, including carbon storage, coastal protection and food for marine organisms. However, mapping and monitoring of mangrove status in some regions, such as the Red Sea area, has been hindered by a lack of data, accurate and precise maps and technical expertise. In this study, an advanced machine learning algorithm was proposed to produce an accurate and precise high-resolution land use map that includes mangroves in the Al Wajh Bank habitat in northeastern Saudi Arabia. To achieve this, high-resolution multispectral images were generated using an image fusion technique, and machine learning algorithms were applied, including artificial neural networks, random forests and support vector machine algorithms. The performance of the models was evaluated using various matrices, and changes in mangrove distribution and connectivity were assessed using the landscape fragmentation model and Getis-Ord statistics. The research gap that this study aims to address is the lack of accurate and precise mapping and assessment of mangrove status in the Red Sea area, particularly in data-scarce regions. Our study produced high-resolution mobile laser scanning (MLS) imagery of 15-m length for 2014 and 2022, and trained 5, 6 and 9 models for artificial neural networks, support vector machines and random forests (RF) to predict land use and land cover maps using 15-m and 30-m resolution MLS images. The best models were identified using error matrices, and it was found that RF outperformed other models. According to the 15-m resolution map of 2022 and the best models of RF, the mangrove cover in the Al Wajh Bank is 27.6 km², which increased to 34.99 km² in the case of the 30-m resolution image of 2022, and was 11.94 km² in 2014, indicating a doubling of the mangrove area. Landscape structure analysis revealed an increase in small core and hotspot areas, which were converted into medium core and very large hotspot areas in 2014. New mangrove areas were identified in the form of patches, edges, potholes and coldspots. The connectivity model showed an increase in connectivity over time, promoting biodiversity. Our study contributes to the promotion of the protection, conservation and planting of mangroves in the Red Sea area.

PMID:37195618 | DOI:10.1007/s11356-023-27395-2

Int Urol Nephrol. 2023 May 17. doi: 10.1007/s11255-023-03599-w. Online ahead of print.

ABSTRACT

BACKGROUND: Sacubitril/valsartan, a new pharmacological class of angiotensin receptor neprilysin inhibitor, is beneficial to heart failure through blocking the degradation of natriuretic peptides and inhibiting renin-angiotensin-aldosterone system (RAAS) activation which also relate to the pathophysiologic mechanisms of chronic kidney disease (CKD). However, its effects on CKD remain unclear. To assess the efficacy and safety of sacubitril/valsartan for patients with CKD, we performed this meta-analysis.

METHODS: The Embase, PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) that compared sacubitril/valsartan with ACEI/ARBs in patients with CKD whose estimated glomerular filtration rate (eGFR) was below 60 mL/min/1.73 m². We adopted the Cochrane Collaboration tool for assessing the risk of bias. The effect size was estimated using the odds ratio (OR) with 95% confidence interval (CI).

RESULTS: Six trials with a total of 6217 patients with CKD were included. In terms of cardiovascular events, sacubitril/valsartan attenuated the risk of cardiovascular death or heart failure hospitalization (OR: 0.68, 95% CI 0.61-0.76, P < 0.00001, I² = 43%). With respect to renal function, sacubitril/valsartan prevented the incidence of serum creatinine (Scr) elevation among patients with CKD (OR: 0.79, 95% CI 0.67-0.95, P = 0.01, I² = 0%). Subgroup analysis about eGFR demonstrated that with long follow-up, sacubitril/valsartan significantly decreased the number of patients with more than 50% reduction in eGFR compared with ACEI/ARBs (OR: 0.52, 95% CI 0.32-0.84, P = 0.008, I² = 9%). In patients with CKD, the incidence of end-stage renal disease (ESRD) was reduced with sacubitril/valsartan treatment, despite no statistically significant difference between the two groups (OR: 0.59, 95% CI 0.29-1.20, P = 0.14, I² = 0%). As for the safety, we found that sacubitril/valsartan was associated with the occurrence of hypotension (OR: 1.71, 95% CI 1.15-2.56, P = 0.008, I² = 51%). However, there was no trend towards increasing the risk of hyperkalemia in patients who received sacubitril/valsartan (OR: 1.09, 95% CI 0.75-1.60, P = 0.64, I² = 64%).

CONCLUSION: This meta-analysis indicated that sacubitril/valsartan improved renal function and conferred effective cardiovascular benefits in patients with CKD, without serious safety issues being observed. Thus, sacubitril/valsartan may be a promising option for patients with CKD. Certainly, further large-scale randomized controlled trials are needed to confirm these conclusions.

SYSTEMATIC REVIEW REGISTRATION: [ https://inplasy.com/inplasy-2022-4-0045/ ], identifier [INPLASY202240045].

PMID:37195574 | DOI:10.1007/s11255-023-03599-w

Int Ophthalmol. 2023 May 17. doi: 10.1007/s10792-023-02715-0. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the efficacy of Repeated CXL (Re-CXL) and determine probable risk factors that lead to Re-CXL in patients with progressive keratoconus.

METHOD: In this retrospective study, the medical records of patients who had been re-operated in our center between 2014 to 2020 due to progressive keratoconus were evaluated; seven eyes of seven patients had undergone Re-CXL procedure. Pre- and post-treatment variables were recorded and analyzed using IBM SPSS Statistics software.

RESULTS: The mean interval between the 1st and 2nd CXL was 49.71 months (range 12-72 months). Out of 7 patients for whom Re-CXL was considered necessary, eye rubbing was detected in 6 patients. Six patients were very young with a mean age of 13 years at primary CXL and 16.83 years at Re-CXL. Visual acuity and astigmatism did not change significantly after the Re-CXL procedure (p-values = 0.18, 0.91, respectively). When measurements of these indices prior to Re-CXL and post Re-CXL were compared, K1 (p-value = 0.01), K2 (p-value = 0.01), Kmean (p-value = 0.01), and Kmax (p-value = 0.008) changed significantly. As to pachymetry (p-value = 0.46), it did not change significantly. Kmax value regressed in all eyes after Re-CXL.

CONCLUSION: Re-CXL procedure was effective in halting the progression of disease. As to the risk factors, eye rubbed-related mechanism like eye rubbing and VKC, lower age, and pre-operative Kmax value > 58 D are the risk factors of Re-CXL procedure.

PMID:37195564 | DOI:10.1007/s10792-023-02715-0

Rev Esp Salud Publica. 2023 May 17;97:e202305038.

ABSTRACT

OBJECTIVE: Field hospitals, also known as alternative care sites, have been an important healthcare reinforcement during the SARS-CoV-2 pandemic worldwide. In the Valencian Community, three of these hospitals were opened, one for each province. Our study aimed to make a comprehensive analysis of this resource in Castellon.

METHODS: A retrospective observational study was carried out with an analytical and statistical component of 3 aspects: infrastructure, satisfaction and clinical data from COVID-positive hospitalized patients. The sources of information were primary, institutional for the infrastructure and personal for the satisfaction surveys and clinical data.

RESULTS: A set of 6×3 metres polyvalent tents was chosen, which joined formed a single-floor area of about 3.500 m². Although hospital opened for approximately a year and a half with multiple uses, most in relation to the COVID pandemic (vaccination center, emergency room observation, hospital assistance, warehouse…), reception of positive patients for the virus began during the third wave of the pandemic, remaining active for eleven days. A total of thirty-one patients with a mean age of 56 years were admitted. 41.9% did not have any comorbidity and 54.8% needed treatment with oxygen therapy. Furthermore, the length of stay was three days, finding a significant relationship between this one, the oxygen flow required during admission and the age. Satisfaction was measured by a survey of seventeen questions where an average satisfaction of 8.33/10.

CONCLUSIONS: This is one of the few studies in the literature in which a field hospital is analyzed from such different points of view. After this analysis, it is concluded that it is an extraordinary and temporary resource whose use is useful without reflecting an increase of morbidity/mortality among our patients and with a very favorable subjective assessment.

PMID:37194648

J Magn Reson Imaging. 2023 May 17. doi: 10.1002/jmri.28773. Online ahead of print.

ABSTRACT

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) stromal disposition is thought to influence chemotherapy efficacy and increase tissue stiffness, which could be quantified noninvasively via MR elastography (MRE). Current methods cause position-based errors in pancreas location over time, hampering accuracy. It would be beneficial to have a single breath-hold acquisition.

PURPOSE: To develop and test a single breath-hold three-dimensional MRE technique utilizing prospective undersampling and a compressed sensing reconstruction (CS-MRE).

STUDY TYPE: Prospective.

POPULATION: A total of 30 healthy volunteers (HV) (31 ± 9 years; 33% male) and five patients with PDAC (69 ± 5 years; 80% male).

FIELD STRENGTH/SEQUENCE: 3-T, GRE Ristretto MRE.

ASSESSMENT: First, optimization of multi breath-hold MRE was done in 10 HV using four combinations of vibration frequency, number of measured wave-phase offsets, and TE and looking at MRE quality measures in the pancreas head. Second, viscoelastic parameters delineated in the pancreas head or tumor of CS-MRE were compared against (I) 2D and (II) 3D four breath-hold acquisitions in HV (N = 20) and PDAC patients. Intrasession repeatability was assessed for CS-MRE in a subgroup of healthy volunteers (N = 15).

STATISTICAL TESTS: Tests include repeated measures analysis of variance (ANOVA), Bland-Altman analysis, and coefficients of variation (CoVs). A P-value <.05 was considered statistically significant.

RESULTS: Optimization of the four breath-hold acquisitions resulted in 40 Hz vibration frequency, five wave-phases, and echo time (TE) = 6.9 msec as the preferred method (4BH-MRE). CS-MRE quantitative results did not differ from 4BH-MRE. Shear wave speed (SWS) and phase angle differed significantly between HV and PDAC patients using 4BH-MRE or CS-MRE. The limits of agreement for SWS were [-0.09, 0.10] m/second and the within-subject CoV was 4.8% for CS-MRE.

DATA CONCLUSION: CS-MRE might allow a single breath-hold MRE acquisition with comparable SWS and phase angle as 4BH-MRE, and it may still enable to differentiate between HV and PDAC.

LEVEL OF EVIDENCE: 2 Technical Efficacy Stage: 2.

PMID:37194646 | DOI:10.1002/jmri.28773

Crisis. 2023 May 17. doi: 10.1027/0227-5910/a000908. Online ahead of print.

ABSTRACT

Abstract Background: Socioeconomic factors such as financial stress and unemployment are known predictors of suicide. However, no large-scale meta-analyses exist. Aims: Determine the suicide risk following unemployment or financial stress. Method: Literature searched through July 31, 2021. Robust meta-analysis and metaregression of the risk of suicide following financial stress (23 studies) or unemployment (43 studies), from 20 nations. Subgroup meta-analyses by sex, age, year, country, and methodology. Results: The suicide risk following financial stress or unemployment was not significantly elevated among those with diagnosed mental illness. In the general population, we found significantly elevated suicide risks for financial stress (RR: 1.742; 95% CI: 1.339, -2.266) and unemployment (RR: 1.874; CI: 1.501, -2.341). However, neither was significant among studies controlling for physical/mental health (perhaps partially due to lower statistical power). We observed no significant differences by sex, age, or by GDP. We observed a higher suicide risk following unemployment in more recent years. Limitations: Publication bias was evident. We could not examine some individual-level characteristics, most notably the severity/duration of unemployment/financial stress. Heterogeneity was high for some meta-analyses. Studies from non-OECD countries are under-represented. Conclusion: After accounting for physical/mental health, financial stress and unemployment weakly associated with suicide, and the associations may be nonsignificant.

PMID:37194640 | DOI:10.1027/0227-5910/a000908