Category: Nevin Manimala

JMIR Hum Factors. 2023 Mar 8;10:e42145. doi: 10.2196/42145.

ABSTRACT

BACKGROUND: The older population needs solutions for independent living and reducing the burden on caregivers while maintaining the quality and dignity of life.

OBJECTIVE: The aim of this study was to design, develop, and evaluate an older adult health care app that supports trained caregivers (ie, formal caregivers) and relatives (ie, informal caregivers). We aimed to identify the factors that affect user acceptance of interfaces depending on the user’s role.

METHODS: We designed and developed an app with 3 user interfaces that enable remote sensing of an older adult’s daily activities and behaviors. We conducted user evaluations (N=25) with older adults and their formal and informal caregivers to obtain an overall impression of the health care monitoring app in terms of user experience and usability. In our design study, the participants had firsthand experience with our app, followed by a questionnaire and individual interview to express their opinions on the app. Through the interview, we also identified their views on each user interface and interaction modality to identify the relationship between the user’s role and their acceptance of a particular interface. The questionnaire answers were statistically analyzed, and we coded the interview answers based on keywords related to a participant’s experience, for example, ease of use and usefulness.

RESULTS: We obtained overall positive results in the user evaluation of our app regarding key aspects such as efficiency, perspicuity, dependability, stimulation, and novelty, with an average between 1.74 (SD 1.02) and 2.18 (SD 0.93) on a scale of -3.0 to 3.0. The overall impression of our app was favorable, and we identified that “simple” and “intuitive” were the main factors affecting older adults’ and caregivers’ preference for the user interface and interaction modality. We also identified a positive user acceptance of the use of augmented reality by 91% (10/11) of the older adults to share information with their formal and informal caregivers.

CONCLUSIONS: To address the need for a study to evaluate the user experience and user acceptance by older adults as well as both formal and informal caregivers regarding the user interfaces with multimodal interaction in the context of health monitoring, we designed, developed, and conducted user evaluations with the target user groups. Our results through this design study show important implications for designing future health monitoring apps with multiple interaction modalities and intuitive user interfaces in the older adult health care domain.

PMID:36884275 | DOI:10.2196/42145

J Med Internet Res. 2023 Mar 8;25:e42822. doi: 10.2196/42822.

ABSTRACT

BACKGROUND: Sharing health data is challenging because of several technical, ethical, and regulatory issues. The Findable, Accessible, Interoperable, and Reusable (FAIR) guiding principles have been conceptualized to enable data interoperability. Many studies provide implementation guidelines, assessment metrics, and software to achieve FAIR-compliant data, especially for health data sets. Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) is a health data content modeling and exchange standard.

OBJECTIVE: Our goal was to devise a new methodology to extract, transform, and load existing health data sets into HL7 FHIR repositories in line with FAIR principles, develop a Data Curation Tool to implement the methodology, and evaluate it on health data sets from 2 different but complementary institutions. We aimed to increase the level of compliance with FAIR principles of existing health data sets through standardization and facilitate health data sharing by eliminating the associated technical barriers.

METHODS: Our approach automatically processes the capabilities of a given FHIR end point and directs the user while configuring mappings according to the rules enforced by FHIR profile definitions. Code system mappings can be configured for terminology translations through automatic use of FHIR resources. The validity of the created FHIR resources can be automatically checked, and the software does not allow invalid resources to be persisted. At each stage of our data transformation methodology, we used particular FHIR-based techniques so that the resulting data set could be evaluated as FAIR. We performed a data-centric evaluation of our methodology on health data sets from 2 different institutions.

RESULTS: Through an intuitive graphical user interface, users are prompted to configure the mappings into FHIR resource types with respect to the restrictions of selected profiles. Once the mappings are developed, our approach can syntactically and semantically transform existing health data sets into HL7 FHIR without loss of data utility according to our privacy-concerned criteria. In addition to the mapped resource types, behind the scenes, we create additional FHIR resources to satisfy several FAIR criteria. According to the data maturity indicators and evaluation methods of the FAIR Data Maturity Model, we achieved the maximum level (level 5) for being Findable, Accessible, and Interoperable and level 3 for being Reusable.

CONCLUSIONS: We developed and extensively evaluated our data transformation approach to unlock the value of existing health data residing in disparate data silos to make them available for sharing according to the FAIR principles. We showed that our method can successfully transform existing health data sets into HL7 FHIR without loss of data utility, and the result is FAIR in terms of the FAIR Data Maturity Model. We support institutional migration to HL7 FHIR, which not only leads to FAIR data sharing but also eases the integration with different research networks.

PMID:36884270 | DOI:10.2196/42822

JAMA Netw Open. 2023 Mar 1;6(3):e231993. doi: 10.1001/jamanetworkopen.2023.1993.

ABSTRACT

IMPORTANCE: Headache is the most common symptom after pediatric concussion.

OBJECTIVES: To examine whether posttraumatic headache phenotype is associated with symptom burden and quality of life 3 months after concussion.

DESIGN, SETTING, AND PARTICIPANTS: This was a secondary analysis of the Advancing Concussion Assessment in Pediatrics (A-CAP) prospective cohort study, conducted September 2016 to July 2019 at 5 Pediatric Emergency Research Canada (PERC) network emergency departments. Children aged 8.0-16.99 years presenting with acute (<48 hours) concussion or orthopedic injury (OI) were included. Data were analyzed from April to December 2022.

EXPOSURE: Posttraumatic headache was classified as migraine or nonmigraine headache, or no headache, using modified International Classification of Headache Disorders, 3rd edition, diagnostic criteria based on self-reported symptoms collected within 10 days of injury.

MAIN OUTCOMES AND MEASURES: Self-reported postconcussion symptoms and quality-of-life were measured at 3 months after concussion using the validated Health and Behavior Inventory (HBI) and Pediatric Quality of Life Inventory-Version 4.0 (PedsQL-4.0). An initial multiple imputation approach was used to minimize potential biases due to missing data. Multivariable linear regression evaluated the association between headache phenotype and outcomes compared with the Predicting and Preventing Postconcussive Problems in Pediatrics (5P) clinical risk score and other covariates and confounders. Reliable change analyses examined clinical significance of findings.

RESULTS: Of 967 enrolled children, 928 (median [IQR] age, 12.2 [10.5 to 14.3] years; 383 [41.3%] female) were included in analyses. HBI total score (adjusted) was significantly higher for children with migraine than children without headache (estimated mean difference [EMD], 3.36; 95% CI, 1.13 to 5.60) and children with OI (EMD, 3.10; 95% CI, 0.75 to 6.62), but not children with nonmigraine headache (EMD, 1.93; 95% CI, -0.33 to 4.19). Children with migraine were more likely to report reliable increases in total symptoms (odds ratio [OR], 2.13; 95% CI, 1.02 to 4.45) and somatic symptoms (OR, 2.70; 95% CI, 1.29 to 5.68) than those without headache. PedsQL-4.0 subscale scores were significantly lower for children with migraine than those without headache only for physical functioning (EMD, -4.67; 95% CI, -7.86 to -1.48).

CONCLUSIONS AND RELEVANCE: In this cohort study of children with concussion or OI, those with posttraumatic migraine symptoms after concussion had higher symptom burden and lower quality of life 3 months after injury than those with nonmigraine headache. Children without posttraumatic headache reported the lowest symptom burden and highest quality of life, comparable with children with OI. Further research is warranted to determine effective treatment strategies that consider headache phenotype.

PMID:36884251 | DOI:10.1001/jamanetworkopen.2023.1993

Ophthalmic Surg Lasers Imaging Retina. 2023 Mar 1:1-8. doi: 10.3928/23258160-20230223-01. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: This study explores the connection between macular atrophy (MA) status at baseline and best visual acuity (BVA) after 5 to 7 years of anti-vascular endothelial growth factor (anti-VEGF) injections on eyes with neovascular age-related macular degeneration (nAMD).

PATIENTS AND METHODS: This retrospective study included patients with neovascular age-related macular degeneration receiving anti-VEGF injections at least twice-yearly for 5+ years at Cole Eye Institute. Analyses of variance and linear regressions explored the connection between MA status, baseline MA intensity, and 5-year BVA change.

RESULTS: Of 223 included patients, 5-year BVA change was not statistically significant between MA status groups or from baseline. The population’s average 7-year BVA change was -6.3 Early Treatment Diabetic Retinopathy Study letters. Type and frequency of anti-VEGF injections were comparable between MA status groups (P > .05).

CONCLUSION: Regardless of MA status, 5- and 7-year BVA change lacked clinical relevance. If receiving regular treatment for 5+ years, patients with baseline MA achieve comparable visual outcomes to those without MA, with similar treatment and visit burdens. [Ophthalmic Surg Lasers Imaging Retina 2023;54(X):X-X.].

PMID:36884230 | DOI:10.3928/23258160-20230223-01

JAMA Dermatol. 2023 Mar 8. doi: 10.1001/jamadermatol.2022.6624. Online ahead of print.

ABSTRACT

IMPORTANCE: Prior studies have demonstrated an association between cutaneous chronic graft-vs-host disease (cGVHD) and mortality. Assessment of the prognostic value of different measures of disease severity would assist in risk stratification.

OBJECTIVE: To compare the prognostic value of body surface area (BSA) and National Institutes of Health (NIH) Skin Score on survival outcomes stratified by erythema and sclerosis subtypes of cGVHD.

DESIGN, SETTING, AND PARTICIPANTS: Multicenter prospective cohort study from the Chronic Graft-vs-Host Disease Consortium including 9 medical centers in the US, enrolled from 2007 through 2012 and followed until 2018. Participants were adults and children with a diagnosis of cGVHD requiring systemic immunosuppression and with skin involvement during the study period, who had longitudinal follow-up. Data analysis was performed from April 2019 to April 2022.

EXPOSURES: Patients underwent continuous BSA estimation and categorical NIH Skin Score grading of cutaneous cGVHD at enrollment and every 3 to 6 months thereafter.

MAIN OUTCOMES AND MEASURES: Nonrelapse mortality (NRM) and overall survival (OS), compared between BSA and NIH Skin Score longitudinal prognostic models, adjusted for age, race, conditioning intensity, patient sex, and donor sex.

RESULTS: Of 469 patients with cGVHD, 267 (57%) (105 female [39%]; mean [SD] age, 51 [12] years) had cutaneous cGVHD at enrollment, and 89 (19%) developed skin involvement subsequently. Erythema-type disease had earlier onset and was more responsive to treatment compared with sclerosis-type disease. Most cases (77 of 112 [69%]) of sclerotic disease occurred without prior erythema. Erythema-type cGVHD at first follow-up visit was associated with NRM (hazard ratio, 1.33 per 10% BSA increase; 95% CI, 1.19-1.48; P < .001) and OS (hazard ratio, 1.28 per 10% BSA increase; 95% CI, 1.14-1.44; P < .001), while sclerosis-type cGVHD had no significant association with mortality. The model with erythema BSA collected at baseline and first follow-up visits retained 75% of the total prognostic information (from all covariates including BSA and NIH Skin Score) for NRM and 73% for OS, with no statistical difference between prognostic models (likelihood ratio test χ2, 5.9; P = .05). Conversely, NIH Skin Score collected at the same intervals lost significant prognostic information (likelihood ratio test χ2, 14.7; P < .001). The model incorporating NIH Skin Score instead of erythema BSA accounted for only 38% of the total information for NRM and 58% for OS.

CONCLUSIONS AND RELEVANCE: In this prospective cohort study, erythema-type cutaneous cGVHD was associated with increased risk of mortality. Erythema BSA collected at baseline and follow-up predicted survival more accurately than the NIH Skin Score in patients requiring immunosuppression. Accurate assessment of erythema BSA may assist in identifying patients with cutaneous cGVHD at high risk for mortality.

PMID:36884224 | DOI:10.1001/jamadermatol.2022.6624

Ann Am Thorac Soc. 2023 Mar 8. doi: 10.1513/AnnalsATS.202209-829OC. Online ahead of print.

ABSTRACT

RATIONALE: Studies estimating rate of lung function decline in cystic fibrosis (CF) have been inconsistent regarding methods used. How the methodology used impacts validity of the results and comparability between studies is unknown.

OBJECTIVES: The Cystic Fibrosis Foundation established a workgroup whose tasks were to examine the impact of differing approaches to estimating rate of decline in lung function and to provide analysis guidelines.

METHODS: We utilized a natural history cohort of 35,252 individuals with CF aged > 6 years of the Cystic Fibrosis Foundation Patient Registry (CFFPR), 2003-2016. Modeling strategies using linear and nonlinear forms of marginal and mixed-effects models, which have previously quantified rate of forced expiratory volume in 1 second (FEV1) decline (% predicted/year), were evaluated under clinically relevant scenarios of available lung function data. Scenarios varied by sample size (overall CFFPR, medium-sized cohort of 3,000 subjects, and small-sized cohort of 150), data collection/reporting frequency (encounter, quarterly, and annual), inclusion of FEV1 during pulmonary exacerbation, and follow-up length (<2 years, 2-5 years, entire duration).

RESULTS: Rate-of-FEV1-decline estimates (% predicted/year) differed between linear marginal and mixed-effects models; overall cohort estimates (95% confidence interval) were 1.26 (1.24-1.29) and 1.40 (1.38-1.42), respectively. Marginal models consistently estimated less rapid lung function decline than mixed-effects models across scenarios except for short-term follow-up (both were ~1.4). Rate-of-decline estimates from nonlinear models diverged by age 30. Among mixed-effects models, nonlinear and stochastic terms fit best except for short-term follow-up (< 2 years). Overall CFFPR analysis from a joint longitudinal-survival model implied that an increase in rate of decline of 1% predicted/year in FEV1 associated with a 1.52-fold (52%) increase in the hazard of death/lung transplantation, but results exhibited immortal cohort bias.

CONCLUSIONS: Differences were as high as 0.5% predicted/year between rate-of-decline estimates, but we found estimates were robust to lung function data availability scenarios except short-term follow-up and older age ranges. Inconsistencies among previous study results may be attributable to inherent differences in study design, inclusion criteria, or covariate adjustment. Results-based decision points reported herein will support researchers in selecting a strategy to model lung function decline most reflective of nuanced, study-specific goals.

PMID:36884219 | DOI:10.1513/AnnalsATS.202209-829OC

J Robot Surg. 2023 Mar 8. doi: 10.1007/s11701-023-01551-9. Online ahead of print.

ABSTRACT

The present study aimed to compare the efficacy and safety between robot-assisted nephroureterectomy (RANU) and open nephroureterectomy (ONU) for the treatment of upper tract urothelial carcinoma (UTUC). We systematically searched four electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) to locate pertinent studies published in English up to January 2023. The primary outcomes evaluated included perioperative results, complications, and oncologic outcomes. Statistical analyses and calculations were performed using Review Manager 5.4. The study was registered with PROSPERO (ID: CRD42022383035). In total, eight comparative trials, including 37,984 patients were enrolled. Compared to ONU, RANU was associated with a significantly shorter length of stay (weighted mean difference [WMD] – 1.63 days, 95% confidence interval [CI] – 2.90, – 0.35; p = 0.01), less blood loss (WMD – 107.04 mL, 95% CI – 204.97, – 9.11; p = 0.03), less major complication(OR 0.78, 95% CI 0.70, 0.88; p < 0.0001), and lower positive surgical margin (PSM) (OR 0.33, 95% CI 0.12, 0.92; p = 0.03). However, no statistically significant differences were observed between the two groups in operative time, transfusion rates, rate of lymph node dissection, lymph node yield, overall complications, overall survival, cancer-specific survival, recurrence-free survival, and progression-free survival. RANU has superior advantages compared to ONU in terms of length of hospital stay, blood loss, postoperative complications, and PSM, while providing comparable oncologic outcomes in patients with UTUC.

PMID:36884204 | DOI:10.1007/s11701-023-01551-9

Environ Sci Pollut Res Int. 2023 Mar 8. doi: 10.1007/s11356-023-26221-z. Online ahead of print.

ABSTRACT

Environmental degradation has attained much attention from researchers and policymakers at national and global levels. The ever-increasing energy use in production methods is considered one of the fundamental reasons for environmental degradation. The concept of environmental efficiency in the wake of sustainable growth evolved in the last three decades. The present study has been designed to estimate environmental efficiency using the Malmquist-Luenberger productivity index (MLI) using annual data from 43 Asian countries from 1990 to 2019. The MLI is an established econometric approach to estimate cases where input variables are used to get output variables in desirable and undesirable forms. Labor, capital, and energy consumption are input variables, while carbon dioxide (CO₂) emissions (undesirable variable) and gross domestic product (undesirable variable) are taken as output variables. The results suggested that, on average, environmental efficiency has decreased by 0.3% over the period in selected Asian countries. Cambodia, Turkey, and Nepal have the highest total factor productivity (TFP) output growth rate on average among 43 Asian countries. These countries are excellent examples of sustainable development that balances environmental protection and efficiency. On the other hand, Kuwait, Mongolia, and Yemen showed the least TFP growth. The study also employed unconditional and convergence tests where the countries’ conditional convergence is based on foreign direct investment, population density, inflation, industrialization, and globalization. Some policy implications for Asian countries are also discussed at the end of the study.

PMID:36884174 | DOI:10.1007/s11356-023-26221-z

Environ Sci Pollut Res Int. 2023 Mar 8. doi: 10.1007/s11356-023-26156-5. Online ahead of print.

ABSTRACT

Electrolytic manganese residue (EMR) is a solid waste produced in the process of electrolytic manganese metal (EMM) production. In recent years, the accumulation of EMR has caused increasingly serious environmental problems. To better understand the state of EMR recycling in recent years, this paper used a comprehensive literature database to conduct a statistical analysis of EMR-related publications from 2010 to 2022 from two perspectives: harmless green treatment and resource utilization. The results showed that the research on the comprehensive utilization of EMR mainly focused on the fields of chemical hazard-free treatment and manufacturing building materials. The related studies of EMR in the fields of biological harmlessness, applied electric field harmlessness, manganese series materials, adsorbents, geopolymers, glass-ceramics, catalysts, and agriculture were also reported. Finally, we put forward some suggestions to solve the EMR problem, hoping that this work could provide a reference for the clean disposal and efficient utilization of EMR.

PMID:36884169 | DOI:10.1007/s11356-023-26156-5

J Gambl Stud. 2023 Mar 8. doi: 10.1007/s10899-023-10195-1. Online ahead of print.

ABSTRACT

Gambling disorder is a common and problematic behavioral disorder associated with depression, substance abuse, domestic violence, bankruptcy, and high suicide rates. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), pathological gambling was renamed “gambling disorder” and moved to the Substance-Related and Addiction Disorders chapter to acknowledge that research suggests that pathological gambling and alcohol and drug addiction are related. Therefore, this paper provides a systematic review of risk factors for gambling disorder. Systematic searches of EBSCO, PubMed, and Web of Science identified 33 records that met study inclusion criteria. A revised study acknowledges as risk factors for developing/maintaining a gambling disorder being a single young male, or married for less than 5 years, living alone, having a poor education, and struggling financially.

PMID:36884150 | DOI:10.1007/s10899-023-10195-1