Category: Nevin Manimala

Equine Vet J. 2023 Mar 14. doi: 10.1111/evj.13934. Online ahead of print.

ABSTRACT

BACKGROUND: Equestrian eventing is a dangerous Olympic sport, with 16 rider and 69 horse fatalities at competition in the last 10 years. Despite this, there is limited research that aims to improve safety within the sport.

OBJECTIVES: The purpose of this study was to identify risk factors for horse falls, which are the leading cause of rider fatality within the sport.

STUDY DESIGN: Retrospective cohort study.

METHODS: Competition data between January 2005 and December 2015 were analysed. Descriptive statistics followed by univariable logistic regression to identify risk factors for inclusion in a multivariable logistic regression model were conducted. Models were constructed stepwise using a bi-directional process and assessed using the Akaike Information Criterion. A total of 749 534 cross-country starts were analysed for association with the risk of horse falls.

RESULTS: Sixteen risk factors were identified including: higher event levels, higher dressage penalties and higher number of days since horses’ last start. For example, horse and rider combinations competing at BE100 (OR 1.64, CI 1.37-1.96, p < 0.001), Novice (OR 3.58, CI 3.03-4.24, p < 0.001), Intermediate (OR 8.00, CI 6.54-9.78, p < 0.001), Advanced (OR 12.49, CI 9.42-16.57, p < 0.001) and International (OR 4.63, CI 3.50-6.12, p < 0.001) all had a higher risk of having a horse fall in comparison to combinations competing at BE90 level. Furthermore, for every additional 10 dressage penalties awarded to a horse and rider combination, there was a higher risk of a horse fall (OR 1.20, CI 1.12-1.28, p < 0.001).

MAIN LIMITATIONS: The study is not geographically comprehensive (UK only) and does not include any information on training activity of horses and riders.

CONCLUSIONS: This is the largest-scale study ever conducted on horse falls during eventing competition. Study results can be utilised by sport governing bodies to inform policy which has the potential to reduce the risk of injury and fatality to sport participants. This article is protected by copyright. All rights reserved.

PMID:36917550 | DOI:10.1111/evj.13934

JMIR Res Protoc. 2023 Mar 14;12:e41040. doi: 10.2196/41040.

ABSTRACT

BACKGROUND: Digital transformation is impacting health care delivery. Great market dynamism is bringing opportunities and concerns alike into public discussion. Digital health apps are a vibrant segment where regulation is emerging, with Germany paving the way with its DiGA (Digitale Gesundheitsanwendungen, in German, meaning digital health apps) program. Simultaneously, mental ill-health constitutes a global health concern, and prevalence is expected to worsen due to the COVID-19 pandemic and its containment measures. Portugal and its National Health System may be a useful testbed for digital health interventions.

OBJECTIVE: The paper outlines the protocol for a research project on the attitudes of physicians and potential users toward digital mental health apps to improve access to care, patient outcomes, and reduce the burden of disease of mental ill-health.

METHODS: Web surveys will be conducted to acquire data from the main stakeholders (physicians and the academic community). Data analysis will replicate the statistical analysis performed in the studies from Dahlhausen and Borghouts to derive conclusions regarding the relative acceptance and likelihood of successful implementation of digital mental health apps in Portugal.

RESULTS: The findings of the proposed studies will elicit important information on how physicians and individuals perceive digital mental health app interventions to improve access to care, patient outcomes, and reduce the burden of disease of mental ill-health. Data collection ran between September 26 and November 6, 2022, for the first study and September 20 and October 20, 2022, for the second study. We obtained 160 responses to the first study’s survey and 539 answers to the second study’s survey. Data analysis is concluded, and both studies’ results are expected to be published in 2023.

CONCLUSIONS: The results of the studies projected in this research protocol will have implications for researchers and academia, industry, and policy makers concerning the adoption and implementation of digital health mental apps and associated interventions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41040.

PMID:36917172 | DOI:10.2196/41040

Brief Bioinform. 2023 Mar 14:bbad092. doi: 10.1093/bib/bbad092. Online ahead of print.

ABSTRACT

Metagenomic sequencing (mNGS) is a powerful diagnostic tool to detect causative pathogens in clinical microbiological testing owing to its unbiasedness and substantially reduced costs. Rapid and accurate classification of metagenomic sequences is a critical procedure for pathogen identification in dry-lab step of mNGS test. However, clinical practices of the testing technology are hampered by the challenge of classifying sequences within a clinically relevant timeframe. Here, we present GPMeta, a novel GPU-accelerated approach to ultrarapid pathogen identification from complex mNGS data, allowing users to bypass this limitation. Using mock microbial community datasets and public real metagenomic sequencing datasets from clinical samples, we show that GPMeta has not only higher accuracy but also significantly higher speed than existing state-of-the-art tools such as Bowtie2, Bwa, Kraken2 and Centrifuge. Furthermore, GPMeta offers GPMetaC clustering algorithm, a statistical model for clustering and rescoring ambiguous alignments to improve the discrimination of highly homologous sequences from microbial genomes with average nucleotide identity >95%. GPMetaC exhibits higher precision and recall rate than others. GPMeta underlines its key role in the development of the mNGS test in infectious diseases that require rapid turnaround times. Further study will discern how to best and easily integrate GPMeta into routine clinical practices. GPMeta is freely accessible to non-commercial users at https://github.com/Bgi-LUSH/GPMeta.

PMID:36917170 | DOI:10.1093/bib/bbad092

JMIR Public Health Surveill. 2023 Mar 14;9:e44274. doi: 10.2196/44274.

ABSTRACT

BACKGROUND: Cognitive and gait speed decline are common conditions in older adults and are often associated with future adverse consequences. Although an association between cognitive function and gait speed has been demonstrated, its temporal sequence remains unclear, especially in older Chinese adults. Clarifying this could help identify interventions to improve public health in older adults.

OBJECTIVE: This study aims to examine the longitudinal reciprocal association between gait speed and cognitive function and the possible temporal sequence of changes in both factors in a national longitudinal cohort.

METHODS: Data were derived from 2 waves (2011 baseline and 2015 follow-up) of the China Health and Retirement Longitudinal Study (CHARLS). Participants 60 years or older, without dementia or Parkinson disease at baseline, and with completed data on gait speed and cognition at both baseline and follow-up were included. Usual gait speed was measured over two 2.5-m walks. Mental intactness and episodic memory were used to assess global cognitive function. Cross-lagged panel models and linear mixed-effects models were used to examine the association between cognition and gait speed over time. Standardized coefficients were reported.

RESULTS: A total of 3009 participants (mean age 66.4 years, SD 5.4 years; 1422/3009, 47.26%, female participants) were eligible for inclusion in our analyses. Cross-lagged panel analyses revealed that after accounting for baseline gait speed, cognition, and potential confounders, baseline global cognition (β=.117, 95% CI 0.082-0.152; P<.001), mental intactness (β=.082, 95% CI 0.047-0.118; P<.001), and episodic memory (β=.102, 95% CI 0.067-0.137; P<.001) were associated with subsequent gait speed. Simultaneously, baseline gait speed was also associated with subsequent global cognition (β=.056, 95% CI 0.024-0.087; P=.001), mental intactness (β=.039, 95% CI 0.008-0.069; P=.01), and episodic memory (β=.057, 95% CI 0.023-0.092; P=.001). The comparison of standardized cross-lagged coefficients suggested that the effect size of baseline global cognition on subsequent gait speed was significantly larger than the reverse effect (χ₁²=6.50, P for difference=.01). However, the effects of both mental intactness and episodic memory on subsequent gait speed were not significantly stronger than those of the reverse pathway (χ₁²=3.33, P for difference=.07 and χ₁²=3.21, P for difference=.07). Linear mixed-effects analyses further supported these bidirectional relationships, revealing that lower baseline cognitive scores predicted steeper declines in gait speed trajectory, and slower baseline gait speed predicted more declines in cognitive trajectory over time.

CONCLUSIONS: There is a longitudinal bidirectional association between usual gait speed and both global cognitive function and specific domains of mental intactness and episodic memory among Chinese older adults. Baseline global cognition is likely to have a stronger association with subsequent gait speed than the reverse pathway. This interlinkage is noteworthy and may have implications for public health. Maintaining normal cognitive function may be an important interventional strategy for mitigating age-related gait speed reduction.

PMID:36917163 | DOI:10.2196/44274

Int J Surg. 2023 Mar 15. doi: 10.1097/JS9.0000000000000321. Online ahead of print.

ABSTRACT

OBJECTIVE: comparison of the perioperative outcomes of laparoscopic retroperitoneal lymph node dissection (L-RPLND) and open retroperitoneal lymph node dissection (O-RPLND) for low-stage (stage I/II) testicular germ cell tumors.

METHODS: We performed a systematic review and cumulative meta-analysis of the primary outcomes of interest according to PRISMA criteria, and the quality assessment of the included studies followed the AMSTAR guidelines. Four databases were searched, including Embase, PubMed, Cochrane Library, and Web of Science. The search period was from the creation of each database to October 2022. The statistical analysis software uses Stata17.

RESULTS: There were nine studies involving 579 patients. Compared with O-RPLND, L-RPLND was associated with shorter length of stay (WMD=-3.99, 95% CI [-4.80, -3.19], P<0.05), less estimated blood loss (WMD=-0.95, 95% CI [-1.35, -0.54], P<0.05), shorter time to oral intake after surgery (WMD=-0.77, 95% CI [-1.50, -0.03], P<0.05), and lower overall complications (OR=0.58, 95% CI [0.38, 0.87], P<0.05). Subgroup analysis found that the complication rate of Clavien-Dindo grade II was lower in L-RPLND (OR=0.24, 95% CI [0.11, 0.55], P<0.05). Interestingly, there was no statistically significant difference between the two groups in terms of operation time, lymph node yields, and recurrence rate during follow-up.

CONCLUSION: Laparoscopic retroperitoneal lymph node dissection is superior to open retroperitoneal lymph node dissection and is worthy of clinical promotion.

PMID:36917132 | DOI:10.1097/JS9.0000000000000321

Int J Surg. 2023 Mar 15. doi: 10.1097/JS9.0000000000000202. Online ahead of print.

ABSTRACT

BACKGROUND: The SARS-CoV-2 pandemic is estimated to have claimed more than 6 million lives globally since it started in 2019. Germany was exposed to two waves of COVID-19 during 2020, one starting in April and the other in October. To ensure sufficient capacity for COVID-19 patients in intensive care units, elective medical procedures were postponed. The fraction of major abdominal cancer resections affected by these measures remains unknown, and the most affected patient cohort has yet to be identified.

METHODS: This is a register-based, retrospective, nationwide cohort-study of anonymized “diagnosis related groups” (DRG) billing data provided by the Federal Statistical Office in Germany. Cases were identified using diagnostic and procedural codes for major cancer resections. Population-adjusted cancer resection rates as primary endpoint were compared at baseline (2012-2019) to those in 2020.

RESULTS: A change in resection rates for all analyzed entities (esophageal, gastric, liver, pancreatic, colon, rectum, and lung cancer) was observed from baseline to 2020. Total monthly oncological resections dropped by 7.4% (8.7% normalized to the annual German population, P=0.011). Changes ranged from +3.7% for pancreatic resections (P=0.277) to -19.4% for rectal resections (P<0.001). Reductions were higher during lockdown periods. During the first lockdown period (April thru June), the overall drop was 14.3% (8.58 per 100,000 vs 7.35 per 100,000, P<0.001). There was no catch-up effect during summer months except for pancreatic cancer resections. In the second lockdown period, there was an overall drop of 17.3%. In subgroup analyses, the elderly were most affected by the reduction in resection rates. There was a significant negative correlation between regional SARS-CoV-2-incidences and resections rates. This correlation was strongest for rectal cancer resections (spearman r: -0.425, P<0.001).

CONCLUSIONS: The pandemic lockdowns had a major impact on oncological surgical caseload in Germany in 2020. The elderly were most affected by the reduction. There was a clear correlation between SARS-CoV-2-incidences regionally and the reduction of surgical resection rates. In future pandemic circumstances, oncological surgery has to be prioritized with an extra focus on the most vulnerable patients.

PMID:36917131 | DOI:10.1097/JS9.0000000000000202

J Craniofac Surg. 2023 Mar 13. doi: 10.1097/SCS.0000000000009229. Online ahead of print.

ABSTRACT

BACKGROUND: Chin augmentation (CA) is important treatment modality for microgenia. The use of implantable alloplastic biomaterials in CA grows in popularity, and there is no verifiable documentation of patients’ satisfaction about CA with Medpor (CAWM) exists in the literature, this study examined effectiveness of CAWM by analyzing patient satisfaction.

METHODS: Patients had undergone CAWM were followed up postoperatively. Occurrence of complications was collected, patients’ satisfactions with chin shape and surgical decision were analyzed using FACE-Q scales, the reliability of operation was studied through analyzing the statistics, and the influences of sex and follow-up time on satisfaction were compared.

RESULTS: One hundred ten patients who had undergone CAWM received FACE-Q scales and 64 valid questionnaires were collected. 61 (95.3%) showed high satisfaction with chin shape after CAWM (Cronbach α coefficients were all above 0.8), the median values of satisfaction of chin shape and decision making were 85 (67, 100) and 100 (75,100), respectively. The median chin satisfactions of females and males were 87 (67, 100), 79 (61,100). The median chin satisfactions of patients had surgery before 2 years ago and within 2 years were 81 (67, 100), 87 (64,100), respectively. During the follow-up, among 110, 1 (0.91%) developed graft-related infection and 1 (0.91%) developed an allergic reaction, 1 (0.91%) underwent prosthesis removal because dissatisfaction with chin shape.

CONCLUSIONS: Chin augmentation with prothesis is a safe and efficacious way to improve microgenia. Medpor is the desired implant material with less infection, displacement and bone absorption, which is worthy of promotion and further study in CA surgery.

PMID:36917098 | DOI:10.1097/SCS.0000000000009229

Anal Chem. 2023 Mar 14. doi: 10.1021/acs.analchem.2c04362. Online ahead of print.

ABSTRACT

Compound identification by database searching that matches experimental with library mass spectra is commonly used in mass spectrometric (MS) data analysis. Vendor software often outputs scores that represent the quality of each spectral match for the identified compounds. However, software-generated identification results can differ drastically depending on the initial search parameters. Machine learning is applied here to provide a statistical evaluation of software-generated compound identification results from experimental tandem MS data. This task was accomplished using the logistic regression algorithm to assign an identification probability value to each identified compound. Logistic regression is usually used for classification, but here it is used to generate identification probabilities without setting a threshold for classification. Liquid chromatography coupled with quadrupole-time-of-flight tandem MS was used to analyze the organic monomers leached from resin-based dental composites in a simulated oral environment. The collected tandem MS data were processed with vendor software, followed by statistical evaluation of these results using logistic regression. The assigned identification probability to each compound provides more confidence in identification beyond solely by database matching. A total of 21 distinct monomers were identified among all samples, including five intact monomers and chemical degradation products of bisphenol A glycidyl methacrylate (BisGMA), oligomers of bisphenol-A ethoxylate methacrylate (BisEMA), triethylene glycol dimethacrylate (TEGDMA), and urethane dimethacrylate (UDMA). The logistic regression model can be used to evaluate any database-matched liquid chromatography-tandem MS result by training a new model using analytical standards of compounds present in a chosen database and then generating identification probabilities for candidates from unknown data using the new model.

PMID:36917068 | DOI:10.1021/acs.analchem.2c04362

JAMA. 2023 Mar 14;329(10):819-826. doi: 10.1001/jama.2023.0878.

ABSTRACT

IMPORTANCE: Gender-affirming surgery is often beneficial for gender-diverse or -dysphoric patients. Access to gender-affirming surgery is often limited through restrictive legislation and insurance policies.

OBJECTIVE: To investigate the association between California’s 2013 implementation of the Insurance Gender Nondiscrimination Act, which prohibits insurers and health plans from limiting benefits based on a patient’s sex, gender, gender identity, or gender expression, and utilization of gender-affirming surgery among California residents.

DESIGN, SETTING, AND PARTICIPANTS: Population epidemiology study of transgender and gender-diverse patients undergoing gender-affirming surgery (facial, chest, and genital surgery) between 2005 and 2019. Utilization of gender-affirming surgery in California before and after implementation of the Insurance Gender Nondiscrimination Act in July 2013 was compared with utilization in Washington and Arizona, control states chosen because of geographic similarity and because they expanded Medicaid on the same date as California-January 1, 2014. The date of last follow-up was December 31, 2019.

EXPOSURES: California’s Insurance Gender Nondiscrimination Act, implemented on July 9, 2013.

MAIN OUTCOMES AND MEASURES: Receipt of gender-affirming surgery, defined as undergoing at least 1 facial, chest, or genital procedure.

RESULTS: A total of 25 252 patients (California: n = 17 934 [71%]; control: n = 7328 [29%]) had a diagnosis of gender dysphoria. Median ages were 34.0 years in California (with or without gender-affirming surgery), 39 years (IQR, 28-49 years) among those undergoing gender-affirming surgery in control states, and 36 years (IQR, 22-56 years) among those not undergoing gender-affirming surgery in control states. Patients underwent at least 1 gender-affirming surgery within the study period in 2918 (11.6%) admissions-2715 (15.1%) in California vs 203 (2.8%) in control states. There was a statistically significant increase in gender-affirming surgery in the third quarter of July 2013 in California vs control states, coinciding with the timing of the Insurance Gender Nondiscrimination Act (P < .001). Implementation of the policy was associated with an absolute 12.1% (95% CI, 10.3%-13.9%; P < .001) increase in the probability of undergoing gender-affirming surgery in California vs control states observed in the subset of insured patients (13.4% [95% CI, 11.5%-15.4%]; P < .001) but not self-pay patients (-22.6% [95% CI, -32.8% to -12.5%]; P < .001).

CONCLUSIONS AND RELEVANCE: Implementation in California of its Insurance Gender Nondiscrimination Act was associated with a significant increase in utilization of gender-affirming surgery in California compared with the control states Washington and Arizona. These data might inform state legislative efforts to craft policies preventing discrimination in health coverage for state residents, including transgender and gender-diverse patients.

PMID:36917051 | DOI:10.1001/jama.2023.0878

Am J Phys Med Rehabil. 2023 Mar 14. doi: 10.1097/PHM.0000000000002239. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this umbrella review with meta-meta-analysis was to assess the effectiveness of orthopedic manual therapy in isolation on pain sensitization in patients with chronic musculoskeletal pain.

DESIGN: A systematic search was performed in different databases including systematic reviews with or without meta-analysis. The outcome measures included were pressure pain threshold, temporal summation, and conditioned pain modulation. We statistically synthesized the results of the different reviews through a random-effect meta-analysis of all standardized mean differences and the corresponding 95% confidence interval reported by each study.

RESULTS: For mechanical hyperalgesia, the meta-meta-analysis of three meta-analysis revealed a statistically significant small-moderate effect of orthopedic manual therapy, with no evidence of heterogeneity and moderate quality evidence. In terms of temporal summation, one meta-analysis revealed a statistically significant small effect of orthopedic manual therapy intervention, with moderate heterogeneity and low quality of evidence. Finally, one review without meta-analysis found that orthopedic manual therapy improved endogenous analgesia with low quality evidence.

CONCLUSION: Orthopedic manual therapy in isolation improved mechanical hyperalgesia with moderate quality evidence, as well as temporal summation and conditioned pain modulation with low quality evidence. However, its effects are limited only to immediate and short-term.

PMID:36917046 | DOI:10.1097/PHM.0000000000002239