Category: Nevin Manimala

J Vis Exp. 2023 Apr 3;(194). doi: 10.3791/6550.

ABSTRACT

An erratum was issued for: Endotracheal Intubation Using a Flexible Intubation Endoscope As a Standardized Model for Safe Airway Management in Swine. The Protocol, Representative Results, and Discussion sections were updated. In the Protocol, step 1.5 was updated from: Disinfect the skin with a disinfectant (alcoholic) before inserting a peripheral vein cannula (22 G) into an ear vein. Spray the area, wipe once, then spray again, and allow the disinfectant to dry. to: Disinfect the skin with a disinfectant (alcoholic) before inserting a peripheral vein cannula (22 G) into an ear vein. Spray the area, wipe once, then spray again, and allow the disinfectant to dry. Secure the ear cannula with a band-aid (See Table of Materials). In the Protocol, step 3.7 was updated from: While maintaining the position of the endoscope, advance the endotracheal tube until it becomes visible in the camera image. NOTE: If the endotracheal tube cannot be advanced through the glottic plane, there is a possibility that it has become caught on the arytenoid cartilage. In this case, the endotracheal tube must be withdrawn 1 cm and rotated by 90° before gently advancing again. If necessary, this maneuver can be repeated. Similar calibers of flexible intubation endoscope and endotracheal tube can minimize the risk of this issue occurring. If the endotracheal tube cannot be advanced despite this maneuver, it is likely that the subglottic narrowness-the narrowest part of the porcine larynx-cannot be passed. In this case, a smaller endotracheal tube size needs to be selected. Regular commercially available endotracheal tubes in sizes 6.5 cm or 7.0 cm ID should be able to pass the glottis as long as no anatomic abnormalities are present. to: While maintaining the position of the endoscope, advance the endotracheal tube until it becomes visible in the camera image. NOTE: If the endotracheal tube cannot be advanced through the glottic plane, there is a possibility that it has become caught on the arytenoid cartilage. In this case, the endotracheal tube must be withdrawn 1 cm and rotated by 90° before gently advancing again. If necessary, this maneuver can be repeated. Similar calibers of flexible intubation endoscope and endotracheal tube can minimize the risk of this issue occurring. If the endotracheal tube cannot be advanced despite this maneuver, it is likely that the subglottic narrowness-the narrowest part of the porcine larynx-cannot be passed. In this case, a smaller endotracheal tube size needs to be selected. Regular commercially available endotracheal tubes in sizes 6.5 cm or 7.0 cm ID should be able to pass the glottis as long as no anatomic abnormalities are present. Endotracheal tube size requirements vary depending on the piglet size and breed. In the Representative Results, the sixth paragraph was updated from: Statistical analyses were performed using commercially available software (see Table of Materials). Normal distribution was examined using the Kolmogorov-Smirnoff test²⁸. If a normal distribution was determined, group differences were analyzed using t-tests of independent samples²⁹ or the Mann-Whitney U test³⁰ for the non-parametric version. Data are presented as mean (± standard deviation). Correlations of ordinal-scale data were examined using Spearman’s correlation coefficient³¹. A significance level of p < 0.05 was assumed. to: Statistical analyses were performed using commercially available software (see Table of Materials). Normal distribution was examined using the Kolmogorov-Smirnoff test²⁸. If a normal distribution was determined, group differences were analyzed using t-tests of independent samples²⁹ or the Mann-Whitney U test³⁰ for the non-parametric version. Data are presented as mean (± standard deviation). Correlations of ordinal-scale data were examined using Spearman’s correlation coefficient³¹. A significance level of p < 0.05 was assumed. All tests were performed with exploratory intention; therefore p-values are descriptive. Nevertheless, p < 0.05 was accepted as indicative of statistical significance. In the Representative Results, the legend for figure 1 was updated from: Figure 1: Number of intubation attempts in group comparison. For the group that was intubated using a flexible intubation endoscope, every intubation attempt was successful; in the group that was conventionally intubated, it took an average of 1.4 attempts before the endotracheal tube could be placed correctly. Error bars show the standard deviation. Please click here to view a larger version of this figure. to: Figure 1: Number of intubation attempts in group comparison. For the group that was intubated using a flexible intubation endoscope, every intubation attempt was successful; in the group that was conventionally intubated, it took an average of 1.4 attempts before the endotracheal tube could be placed correctly. Error bars show the standard deviation. n = 5 (for each group). Please click here to view a larger version of this figure. In the Representative Results, figure 2 was updated from: Figure 2: Time until CO2 detection in group comparison. For the group that was intubated using a flexible intubation endoscope, it took significantly longer until end-tidal CO2 could be detected, depicted as mean and standard deviation. Please click here to view a larger version of this figure. to: Figure 2: Time until CO2 detection in group comparison. For the group that was intubated using a flexible intubation endoscope, it took significantly longer until end-tidal CO2 could be detected, depicted as mean and standard deviation. n = 5 (for each group). Please click here to view a larger version of this figure. In the Discussion, the fifth paragraph was updated from: The increased duration had no clinical significance in this cohort. At no time was the termination criterion-a saturation of less than 93%-reached. This is shown in the results because a procedure change was unnecessary at any time. Prior adequate mask ventilation is a critical step to allow sufficient time for fiberoptic endotracheal tube placement to avoid rapid desaturation³⁴. These results are consistent with previous studies comparing conventional intubation and endoscopically assisted intubations with inexperienced providers³⁵. to: The increased duration had no clinical significance in this cohort. At no time was the termination criterion-a saturation of less than 93%-reached. This is shown in the results because a procedure change was unnecessary at any time. Prior adequate mask ventilation is a critical step to allow sufficient time for fiberoptic endotracheal tube placement to avoid rapid desaturation³⁴. These results are consistent with previous studies comparing conventional intubation and endoscopically assisted intubations with inexperienced providers³⁵. We attribute the prolonged duration of fiberoptic intubation to the fact that one must first reorient again after insertion, whereas with conventional intubation, one retains a view of the glottis. It is also important to avoid contact with the mucosa with the flexible intubation endoscope during advancement. This requires occasional corrective maneuvers. Last but not least, after successful placement, retraction of the relatively long endoscope is required, which increases the time to CO2 detection slightly.

PMID:37011175 | DOI:10.3791/6550

Psychol Trauma. 2023 Apr 3. doi: 10.1037/tra0001467. Online ahead of print.

ABSTRACT

OBJECTIVE: Although there is a growing body of literature that discusses the etiology and impact of racial trauma, there are few evidence-based treatment modalities to support BIPOC individuals who have experienced race trauma. Furthermore, current clinicians are ill-equipped to navigate racial trauma symptoms in the therapy due to a dearth in training opportunities during their educational and professional careers. The current study addresses the dearth in racial trauma therapy training opportunities for clinicians through the implementation and evaluation of a training protocol based on the KNIFFLEY Racial Trauma Therapy Model (KRTTM) with community-based clinicians.

METHOD: Fifty-four clinicians who participated in the KRTTM training protocol completed a 7-item efficacy scale as well as a 17-item training satisfaction survey before and at the end of the training.

RESULTS: Results of the paired-samples t-test revealed a statistically significant change in perceived efficacy among clinicians who completed the KRTTM training. Specifically, survey scores among clinicians averaged approximately 22 (i.e., M = 22.2, SD = 4.9) at pretest and 30 (i.e., M = 29.8, SD = 3.7) at posttest, indicating a statistically significant increase in perceived efficacy, t(53), -9.9, p = .000. Further, results of the paired-samples t-test split by race indicated differences in pretest efficacy scores between White (M = 21.7, SD = 4.5) and BIPOC (M = 23.6, SD = 5.9) clinicians in this study.

CONCLUSIONS: Overall, the results from the current study highlight that there is a need for more training on evidenced-based treatment models, to include the KRTTM intervention, to build clinicians’ capacity to provide support to BIPOC individuals who have experienced racial trauma during their lifetimes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37011154 | DOI:10.1037/tra0001467

Psychol Trauma. 2023 Apr 3. doi: 10.1037/tra0001465. Online ahead of print.

ABSTRACT

OBJECTIVE: City Birth Trauma Scale (City BiTS) is an instrument designed to evaluate and diagnose postpartum posttraumatic stress disorder (PTSD) according to the 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). No validated Swedish instrument exists to measure postpartum PTSD according to DSM-5. Therefore, the primary aim of this study was to assess the psychometric properties of the Swedish version of the City BiTS (City BiTS-Swe) and to examine the latent factor structure of postpartum PTSD. The secondary aim was to report the Swedish prevalence of PTSD following childbirth.

METHOD: A total of 619 women, who had given birth at five clinics in the past 6-16 weeks, completed an online version of City BiTS-Swe and the Edinburgh Postnatal Depression Scale (EPDS). Additionally, sociodemographic and medical data were collected. A second questionnaire was answered by 110 women to examine reliability over time.

RESULTS: The confirmatory factor analysis using the two-factor model gave best fit to the data. We found a high internal consistency (α = .89-.87) and good test-retest reliability (ICC = 0.53-0.90). Divergent reliability with EPDS showed significant correlations with satisfying results for the subscale birth-related symptoms (r = .41). We also found discriminant validity concerning mode of birth, parity, gestational age, mental illness, history of traumatic childbirth, and history of traumatic event as expected. The prevalence of PTSD was 3.8%.

CONCLUSIONS: The City BiTS-Swe is a valid and reliable instrument to assess and diagnose PTSD following childbirth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37011151 | DOI:10.1037/tra0001465

Psychol Rev. 2023 Apr 3. doi: 10.1037/rev0000426. Online ahead of print.

ABSTRACT

Ensemble representations have been considered as one of the strategies that the visual system adopts to cope with its limited capacity. Thus, they include various statistical summaries such as mean, variance, and distributional properties and are formed over many stages of visual processing. The present study proposes a population-coding model of ensemble perception to provide a theoretical and computational framework for these various facets of ensemble perception. The proposed model consists of a simple feature layer and a pooling layer. We assumed ensemble representations as population responses in the pooling layer and decoded various statistical properties from population responses. Our model successfully predicted averaging performance in orientation, size, color, and motion direction across different tasks. Furthermore, it predicted variance discrimination performance and the priming effects of feature distributions. Finally, it explained the well-known variance and set-size effects and has a potential for explaining the adaptation and clustering effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37011150 | DOI:10.1037/rev0000426

Medwave. 2023 Apr 3;23(3):e2667. doi: 10.5867/medwave.2023.03.2667.

ABSTRACT

OBJECTIVE: The efficient use of wards intended for elective surgeries is essential to resolve cases on the surgical waiting list. This study aims to estimate the efficiency of ward use in the Chilean public health system between 2018 and 2021.

METHODS: The design was an ecological study. Section A.21 of the database constructed by the monthly statistical summaries that each public health network facility reported to the Ministry of Health between 2018 and 2021 was analyzed. Data from subsections A, E and F were extracted: ward staffing, total elective surgeries by specialty, number and causes of suspension of elective surgeries. Then, the surgical performance during working hours and the percentage of hourly occupancy for a working day was estimated. Additionally, an analysis was made by region with data from 2021.

RESULTS: The percentage of elective wards in use ranged from 81.1% to 94.1%, while those enabled for those staffing ranged from 70.5% to 90.4% during 2018 and 2021. The total number of surgeries was highest in 2019 (n = 416 339), but for 2018, 2020, and 2021 it ranged from 259 000 to 297 000. Suspensions varied between 10.8% (2019) and 6.9% (2021), with the leading cause being patient-related. When analyzing the number of cases canceled monthly by facility, we saw that the leading cause was trade union-related. The maximum throughput of a ward intended for elective surgery was reached in 2019 and was 2.5 surgeries; in 2018, 2020 and 2021, the throughput borders on two surgeries per ward enabled for elective surgery. The percentage of ward time occupied during working hours by contract day varies between 80.7% (2018) and 56.8% (2020).

CONCLUSIONS: All the parameters found and estimated in this study show that there is an inefficient utilization of operating rooms in Chilean public healthcare facilities.

PMID:37011148 | DOI:10.5867/medwave.2023.03.2667

Am J Gastroenterol. 2023 Mar 31. doi: 10.14309/ajg.0000000000002275. Online ahead of print.

ABSTRACT

BACKGROUND: This study is to evaluate safety and pharmacokinetics (PK) of larsucosterol (DUR-928 or 25HC3S) in subjects with alcohol-associated hepatitis (AH), a devastating acute illness without FDA-approved therapies.

METHOD: This Phase 2a, multicenter, open-label, dose escalation study evaluated safety, PK, and efficacy signals of larsucosterol in 19 clinically diagnosed AH subjects. Based on MELD (Model for End-stage Liver Disease) score, 7 subjects were considered to have moderate AH and 12 to have severe AH. All subjects received 1 or 2 intravenous (IV) infusions (72 hours apart) of larsucosterol at a dose of 30, 90, or 150mg, and were followed for 28 days. Efficacy signals from a subgroup of severe AH subjects were compared with two matched arms of severe AH subjects treated with standard of care (SOC), including corticosteroids (CS), from a contemporaneous study.

RESULTS: All 19 larsucosterol-treated subjects survived the 28-day study. Fourteen (74%) of all subjects including 8 (67%) of the severe AH subjects were discharged ≤72 hours after receiving a single infusion. There were no drug-related serious adverse events (SAEs) nor early terminations due to the treatment. PK profiles were not affected by disease severity. Biochemical parameters improved in most subjects. Serum bilirubin levels declined notably from baseline to Day7 and Day28, and MELD scores were reduced at Day28. The efficacy signals compared favorably with two matched groups treated with SOC. Lille scores at Day7 were <0.45 in 16 of the 18 (89%) subjects with Day7 samples. Lille scores from 8 severe AH subjects who received 30 or 90mg larsucosterol (doses used in Phase 2b trial) were statistically significantly lower (p<0.01) than those severe AH subjects treated with SOC from the contemporaneous study.

CONCLUSION: Larsucosterol was well tolerated at all 3 doses in AH subjects without safety concerns. Data from this pilot study showed promising efficacy signals in AH subjects. Larsucosterol is being evaluated in a Phase 2b multicenter, randomized, double-blinded, placebo-controlled (AHFIRM) trial.

PMID:37011138 | DOI:10.14309/ajg.0000000000002275

PLoS Comput Biol. 2023 Apr 3;19(4):e1010983. doi: 10.1371/journal.pcbi.1010983. Online ahead of print.

ABSTRACT

Despite the considerable progress of in vivo neural recording techniques, inferring the biophysical mechanisms underlying large scale coordination of brain activity from neural data remains challenging. One obstacle is the difficulty to link high dimensional functional connectivity measures to mechanistic models of network activity. We address this issue by investigating spike-field coupling (SFC) measurements, which quantify the synchronization between, on the one hand, the action potentials produced by neurons, and on the other hand mesoscopic “field” signals, reflecting subthreshold activities at possibly multiple recording sites. As the number of recording sites gets large, the amount of pairwise SFC measurements becomes overwhelmingly challenging to interpret. We develop Generalized Phase Locking Analysis (GPLA) as an interpretable dimensionality reduction of this multivariate SFC. GPLA describes the dominant coupling between field activity and neural ensembles across space and frequencies. We show that GPLA features are biophysically interpretable when used in conjunction with appropriate network models, such that we can identify the influence of underlying circuit properties on these features. We demonstrate the statistical benefits and interpretability of this approach in various computational models and Utah array recordings. The results suggest that GPLA, used jointly with biophysical modeling, can help uncover the contribution of recurrent microcircuits to the spatio-temporal dynamics observed in multi-channel experimental recordings.

PMID:37011110 | DOI:10.1371/journal.pcbi.1010983

PLoS Negl Trop Dis. 2023 Apr 3;17(4):e0011244. doi: 10.1371/journal.pntd.0011244. Online ahead of print.

ABSTRACT

In Cambodia, goat production and meat consumption are customary among Muslim communities. Recently, goat meat has gained popularity among Cambodians. Goat farmers use a traditional management system, including grazing, requiring minimal labour. The close proximity between humans and animals could increase the risk of zoonotic disease transmission. A serological survey was undertaken to estimate the prevalence of some priority zoonoses and high-impact animal diseases in the Cambodian goat population. A total of 540 samples were collected from goats in six provinces and analysed with commercially available enzyme-linked immunosorbent assays for Brucella species, Q fever (Coxiella burnetii), Foot and Mouth Disease virus non-structural protein (FMDV NSP) and Peste des Petits Ruminants virus (PPRV). True seroprevalences with a 95% Confidence Interval (CI), taking into account imperfect tests, risk factors and odds ratios (ORs), were calculated to better understand the disease distribution and epidemiology. Independent variables used in statistical modellings included sex, body condition score, age, vaccination history, province and commune, while dependent variables were ELISA test results. The overall true prevalence of antibodies to Brucella spp., C. burnetii, FMDV and PPRV, were 0.1% (95% CI 0.0, 1.0), 7.2% (95% CI 5.3, 9.7), 57.7% (95% CI 53.1, 62.3) and 0.0% (95% CI 0.0, 0.0), respectively. There was no identified risk factor for brucellosis and PPR. The two risk factors for C. burnetii seropositivity were sex (p-value = 0.0005) and commune (p-value <0.0001). However, only the OR of C. burnetii seropositive female goat was significant at 9.7 (95% CI 2.7, 35.5) times higher than male. The risk factors of FMD NSP seropositivity were age (p-value = 0.001) and commune (p-value <0.0001). Only the age ‘more than two-year-old’ group with a significant OR of 6.2 (95% CI 2.1, 18.4) using the ‘up to one-year-old’ group as the reference. In summary, Brucella spp. seroprevalence was low, while no evidence of PPRV antibodies was detected in the goat populations. C. burnetii seroprevalence in female goats was significantly higher than for males, and there were significant differences in C. burnetii seroprevalence between communes. The overall FMDV NSP seroprevalence was high, especially in older animals. Vaccination should be advocated to protect animals from FMDV and improve productivity. As the impacts of these zoonoses on human and animal health were still unknown, further investigation of these zoonotic diseases’ epidemiology is recommended.

PMID:37011099 | DOI:10.1371/journal.pntd.0011244

Int J Gynaecol Obstet. 2023 Apr 3. doi: 10.1002/ijgo.14763. Online ahead of print.

ABSTRACT

BACKGROUND: Trichomonas vaginalis infection is the most prevalent non-viral sexually transmitted infection (STI) in women and has been suggested as a risk factor for developing cervical cancer.

OBJECTIVE: We aimed to investigate the associations between T. vaginalis infection and cervical carcinogenesis.

SEARCH STRATEGY: A comprehensive systematic search was conducted in five databases on 21 October 2021.

SELECTION CRITERIA: Studies assessing the relationship between T. vaginalis infection, HPV co-infections, cervical dysplasia, and cervical cancer were found eligible.

DATA COLLECTION AND ANALYSIS: Summary estimates for pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated with a random-effects model. Statistical heterogeneity was measured with I² and Cochran’s Q tests.

MAIN RESULTS: The 29 articles included 473 740 women, of whom 8518 were T. vaginalis-positive. Our results showed that T. vaginalis-infected women had 1.79 times higher odds of being diagnosed with HPV co-infection (95% CI 1.27-2.53; I² 95%). We also found that T. vaginalis infection was associated with high-grade squamous intraepithelial lesion diagnosis (OR 2.34, 95% CI 1.10-4.95; I² 75%) and cervical cancer (OR 5.23, 95% CI 3.03-9.04; I² 3%).

CONCLUSIONS: Our results showed an association between T. vaginalis and cervical carcinogenesis in sexually active women.

PMID:37010897 | DOI:10.1002/ijgo.14763

Neuro Oncol. 2023 Apr 3:noad066. doi: 10.1093/neuonc/noad066. Online ahead of print.

ABSTRACT

BACKGROUND: Prospective data on maintenance therapy with bevacizumab for persons with NF2-related schwannomatosis (NF2-SWN) is lacking. In this prospective multicenter phase 2 study, we evaluated the efficacy, safety, and tolerability of bevacizumab for maintenance therapy in children and adults with NF2-SWN and hearing loss due to vestibular schwannomas (VS).

METHODS: Following induction therapy, participants received bevacizumab 5 mg/kg every 3 weeks for 18 months. Participants were monitored for changes in hearing, tumor size, and quality of life (QOL), and for adverse events. Hearing loss was defined as a statistically significant decline in word recognition score (WRS) or pure tone average compared to study baseline; tumor growth was defined as >20% increase in volume compared to baseline.

RESULTS: Twenty participants with NF2-SWN (median age 23.5 years; range, 12.5-62.5 years) with hearing loss in the target ear (median WRS 70%, range 2-94%) received maintenance bevacizumab. Freedom from hearing loss in the target ear was 95% after 48 weeks, 89% after 72 weeks, and 70% after 98 weeks. Freedom from tumor growth in the target VS was 94% after 48 weeks, 89% after 72 weeks, and 89% after 98 weeks. NF2-related QOL remained stable for 98 weeks whereas tinnitus-related distress decreased. Maintenance bevacizumab was well tolerated, with three participants (15%) discontinuing treatment due to adverse events.

CONCLUSIONS: Maintenance bevacizumab (5 mg/kg every 3 weeks) is associated with high rates of hearing and tumor stability during 18 months of follow-up. No new unexpected adverse events related to bevacizumab were identified in this population.

PMID:37010875 | DOI:10.1093/neuonc/noad066