Category: Nevin Manimala

JAMA Netw Open. 2023 Jan 3;6(1):e2250126. doi: 10.1001/jamanetworkopen.2022.50126.

ABSTRACT

IMPORTANCE: Factors associated with the risk of dementia remain to be fully understood. Systemic infections are hypothesized to be such factors and may be targets for prevention and screening.

OBJECTIVE: To investigate the association between hospitalization with infection and incident dementia.

DESIGN, SETTING, AND PARTICIPANTS: Data from the community-based Atherosclerosis Risk in Communities (ARIC) study, a prospective cohort study, were used. Enrollment occurred at 4 research centers in the US, initiated in 1987 to 1989. The present study includes data up to 2019, for 32 years of follow-up. Data analysis was performed from April 2021 to June 2022.

EXPOSURES: Hospitalizations with infections were identified via medical record review for selected International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes, from baseline until administrative censoring or dementia diagnosis. Participants were considered unexposed until first hospitalization with infection and exposed thereafter. Selected infection subtypes were also considered.

MAIN OUTCOMES AND MEASURES: Incident dementia and time-to-event data were identified through surveillance of ICD-9 and ICD-10 hospitalization and death certificate codes, in-person assessments, and telephone interviews. A sensitivity analysis was conducted excluding cases occurring within 3 years or beyond 20 years from exposure. Data were collected before study hypothesis formulation.

RESULTS: Of the 15 792 ARIC study participants, an analytical cohort of 15 688 participants who were dementia free at baseline and of Black or White race were selected (8658 female [55.2%]; 4210 Black [26.8%]; mean [SD] baseline age, 54.7 [5.8] years). Hospitalization with infection occurred among 5999 participants (38.2%). Dementia was ascertained in 2975 participants (19.0%), at a median (IQR) of 25.1 (22.2-29.1) years after baseline. Dementia rates were 23.6 events per 1000 person-years (95% CI, 22.3-25.0 events per 1000 person-years) among the exposed and 5.7 events per 1000 person-years (95% CI, 5.4-6.0 events per 1000 person-years) among the unexposed. Patients hospitalized with infection were 2.02 (95% CI, 1.88-2.18; P < .001) and 1.70 (95% CI, 1.55-1.86; P < .001) times more likely to experience incident dementia according to unadjusted and fully adjusted Cox proportional hazards models compared with individuals who were unexposed. When excluding individuals who developed dementia less than 3 years or more than 20 years from baseline or the infection event, the adjusted hazard ratio was 5.77 (95% CI, 4.92-6.76; P < .001). Rates of dementia were significantly higher among those hospitalized with respiratory, urinary tract, skin, blood and circulatory system, or hospital acquired infections. Multiplicative and additive interactions were observed by age and APOE-ε genotype.

CONCLUSIONS AND RELEVANCE: Higher rates of dementia were observed among participants who experienced hospitalization with infection. These findings support the hypothesis that infections are factors associated with higher risk of dementias.

PMID:36622673 | DOI:10.1001/jamanetworkopen.2022.50126

Eur Geriatr Med. 2023 Jan 9. doi: 10.1007/s41999-022-00733-2. Online ahead of print.

ABSTRACT

METHODS: This is a longitudinal observational study with a convenience subsample from the international Back Complaints in the Elders (BACE)-Brazil. Frailty was assessed by researchers at baseline, 6 and 12 months according to the Frailty Phenotype. Pain was assessed using a Numerical Pain Scale (NPS). Disability was assessed using the Roland Morris Disability Questionnaire.

RESULTS: A total of 155 older women (70.4 ± 5.4 years) participated. Follow-up for 6 and 12 months in this study was associated with a change of older women to worse frailty levels (OR = 2.83, 95% CI 1.98-4.67; p < 0.01). A significant association was observed between greater pain intensity and the transition of the older women through the frailty levels (β = – 0.73; p < 0.01) when inserting the pain variable at baseline of the statistical model. Older women who reported greater pain intensity worsened their frailty level. The same happened when the disability variable was inserted in the model (β = – 0.74; p < 0.01). The criteria proposed by Fried et al. were able to identify frailty throughout the follow-up and no prevalence of any item.

CONCLUSIONS: In older women, relevant factors such as pain and disability are closely linked to the frailty phenomenon. Thus, the frailty syndrome must be assessed, monitored and treated in relation to the individualities of older adults, as those with back pain and greater disabilities are more susceptible to frailty.

PMID:36622621 | DOI:10.1007/s41999-022-00733-2

Environ Sci Pollut Res Int. 2023 Jan 9. doi: 10.1007/s11356-022-25080-4. Online ahead of print.

ABSTRACT

As an efficient, economical, and clean energy, natural gas plays an important role in the development of the new energy revolution. Accurate prediction of natural gas consumption and production can adjust energy deployment in advance, which can ensure the stable operation of natural gas. Considering the complex and non-linear characteristics of natural gas production and consumption data, this paper develops a new hybrid forecasting model (WPD-VMD-LSTM) based on the fuzzy entropy, variational mode decomposition (VMD), wavelet packet decomposition (WPD), and Long Short-Term Memory (LSTM). In this model, WPD and VMD undertake the tasks of primary and secondary decompositions, respectively; fuzzy entropy is used for the preprocessing process before the re-decomposition; and LSTM is used to predict the decomposed time series. In particular, the different criteria set by fuzzy entropy lead to the establishment of two prediction models. Then, two models are used to study monthly natural gas consumption and production in the USA. The results demonstrate that the proposed model performs significantly better than other comparable models and the target model has some practical value. Meanwhile, models may cope with different types of energy data, and models can accurately predict energy transformations with strong applicability, which can be applied to future energy forecasting in various fields. Finally, the constructed models are used to forecast the NGC and NGP in the USA in the next 3 years and make reasonable policy recommendations based on the forecast results.

PMID:36622613 | DOI:10.1007/s11356-022-25080-4

Environ Sci Pollut Res Int. 2023 Jan 9. doi: 10.1007/s11356-022-24739-2. Online ahead of print.

ABSTRACT

Over the years, public infrastructure projects have generated substantial attention as they take the initiative to enrich sustainable community development. This paper looks to identify if the delays in public projects significantly impact the sustainable community development. A questionnaire survey approach is used to collect data. This study employed the partial least square structural equation modeling to examine the hypothesized model. Data obtained from 325 project experts in the Pakistani construction industry provided empirical support for the study. The outcome of the statistical analysis showed that project delay significantly influences sustainable community development. Based on the findings, this study suggests valuable insights to project management planners and executors to improve strategic planning for project executions through proper sustainability approaches.

PMID:36622583 | DOI:10.1007/s11356-022-24739-2

Behav Genet. 2023 Jan 9. doi: 10.1007/s10519-022-10131-w. Online ahead of print.

ABSTRACT

Most human traits are influenced by the interplay between genetic and environmental factors. Many statistical methods have been proposed to screen for gene-environment interaction (GxE) in the post genome-wide association study era. However, most of the existing methods assume a linear interaction between genetic and environmental factors toward phenotypic variations, which diminishes statistical power in the case of nonlinear GxE. In this paper, we present a flexible statistical procedure to detect GxE regardless of whether the underlying relationship is linear or not. By modeling the joint genetic and GxE effects as a varying-coefficient function of the environmental factor, the proposed model is able to capture dynamic trajectories of GxE. We employ a likelihood ratio test with a fast Monte Carlo algorithm for hypothesis testing. Simulations were conducted to evaluate validity and power of the proposed model in various settings. Real data analysis was performed to illustrate its power, in particular, in the case of nonlinear GxE.

PMID:36622576 | DOI:10.1007/s10519-022-10131-w

J Racial Ethn Health Disparities. 2023 Jan 9. doi: 10.1007/s40615-022-01504-2. Online ahead of print.

ABSTRACT

BACKGROUND: Restraints are often utilized in the emergency department (ED) to prevent patients from injuring themselves or others while managing their agitation in order to deliver appropriate medical care. Chemical and physical restraints are ordered at the discretion of the medical provider and typically employed after reasonable verbal de-escalation has been attempted. While health inequities and racial bias in medicine and healthcare have been well-established, information on the differences in the selection and use of restraints by race and ethnicity are scarce.

METHODS: This retrospective cohort study utilized national data from HCA Healthcare ED and inpatient database with patient visits from 2016 to 2019 to evaluate the relationships between race and ethnicity and the utilization of restraints in the ED. Associations are reported using linear and logistic regression analyses.

RESULTS: The study population included 12,229 unique ED admissions for patients 16 and older with diagnoses of aggression or agitation who had either chemical or physical restraints used. There was no statistically significant difference when comparing Black or other race to White patients and the type of restraint used. Hispanic patients received 0.206 fewer doses of chemical restraints compared to White patients (p = 0.008, 95% C.I. [-0.359, -0.053]) and were slightly less likely to receive physical restraints compared with White patients (p = 0.044, 95% C.I. [0.467, 0.989]), but there was no difference between use of physical restraint and Black or other patients compared to White patients.

CONCLUSIONS: In this national sample of agitated and/or aggressive ED patients who were restrained, Hispanic patients were slightly less likely to receive physical restraints and received fewer doses of chemical restraints than White patients. There were no differences between Black or other patients compared to White patients in restraint type, number of doses of chemical restraint or time to application of either restraint type. This suggests that physicians apply the use of chemical restraints to agitated and aggressive ED patients based on factors that are not associated with race and ethnicity.

PMID:36622570 | DOI:10.1007/s40615-022-01504-2

Behav Res Methods. 2023 Jan 9. doi: 10.3758/s13428-022-02013-0. Online ahead of print.

ABSTRACT

Trend is one of the data aspects that is an object of assessment in the context of single-case experimental designs. This assessment can be performed both visually and quantitatively. Given that trend, just like other relevant data features such as level, immediacy, or overlap does not have a single operative definition, a comparison among the existing alternatives is necessary. Previous studies have included illustrations of differences between trend-line fitting techniques using real data. In the current study, I carry out a simulation to study the degree to which different trend-line fitting techniques lead to different degrees of bias, mean square error, and statistical power for a variety of quantifications that entail trend lines. The simulation involves generating both continuous and count data, for several phase lengths, degrees of autocorrelation, and effect sizes (change in level and change in slope). The results suggest that, in general, ordinary least squares estimation performs well in terms of relative bias and mean square error. Especially, a quantification of slope change is associated with better statistical results than quantifying an average difference between conditions on the basis of a projected baseline trend. In contrast, the performance of the split-middle (bisplit) technique is less than optimal.

PMID:36622560 | DOI:10.3758/s13428-022-02013-0

Ann Surg Oncol. 2023 Jan 9. doi: 10.1245/s10434-022-12863-9. Online ahead of print.

ABSTRACT

BACKGROUND: SWOG 0809 is the only prospective study of adjuvant chemotherapy followed by chemoradiation focusing on margin status in patients with extrahepatic cholangiocarcinoma (EHCC) and gallbladder cancer (GBCA); however, the effects of adjuvant therapy by nodal status have never been reported in this population.

METHODS: Patients with resected EHCC and GBCA, stage pT2-4, node-positive (N+) or margin-positive (R1) who completed four cycles of chemotherapy followed by radiotherapy were included. Cox regression was used to compare overall survival (OS), disease-free survival (DFS), local recurrence, and distant metastasis by nodal status. DFS rates were compared with historical data via a one-sample t-test.

RESULTS: Sixty-nine patients [EHCC, n = 46 (66%); GBCA, n = 23 (33%)] were evaluated, with a median age of 61.7 years and an R0 rate of 66.7% and R1 rate of 33.3%. EHCC versus GBCA was more likely to be N+ (73.9% vs. 47.8%, p = 0.03). Nodal status did not significantly impact OS (hazard ratio [HR] 1.98, 95% confidence interval [CI] 0.86-4.54, p = 0.11) or DFS (HR 1.63, 95% CI 0.77-3.44, p = 0.20). Two-year OS was 70.6% for node-negative (N0) disease and 60.9% for N+ disease, while 2-year DFS was 62.5% for N0 tumors and 49.8% for N+ tumors. N+ versus N0 tumors showed higher rates of distant failure (42.2% vs. 25.0%, p = 0.04). The 2-year DFS rate in N+ tumors was significantly higher than in historical controls (49.8% vs. 29.7%, p = 0.004).

CONCLUSIONS: Adjuvant therapy is associated with favorable outcome independent of nodal status and may impact local control in N+ patients. These data could serve as a benchmark for future adjuvant trials, including molecular-targeted agents.

PMID:36622529 | DOI:10.1245/s10434-022-12863-9

J Orthop Traumatol. 2023 Jan 9;24(1):2. doi: 10.1186/s10195-022-00681-4.

ABSTRACT

BACKGROUND: Patient-reported outcome measures (PROMs) were developed to examine patients’ perceptions of functional health. Most studies compare the responsiveness of each type of questionnaire. However, reports of patient preferences among PROMs commonly used with patients with hand/wrist injuries or disorders are limited. This study aimed to compare patient preferences, factors associated with those preferences and responsiveness among the Disability of the Arm, Shoulder, and Hand (DASH), Michigan Hand Outcomes Questionnaire (MHQ), Patient-Rated Wrist/Hand Evaluation (PRWHE) and EQ-5D in patients with hand/wrist injuries or disorders.

MATERIAL AND METHODS: This retrospective cohort study collected data on 183 patients with hand/wrist injuries or diseases who had visited a hand/wrist outpatient clinic or were hospitalized for surgery between 2017 and 2020. Patients had to be at least 18 years old and able to complete the four questionnaires included in the study. The four PROMs (DASH, MHQ, PRWHE and EQ-5D) were administered to the patients prior to treatment. After completing the questionnaires, patients were asked to answer two open-ended questions regarding their preferences. Multinomial logistic regression was used to identify factors related to patient preferences. Results are presented as the relative risk ratio (RRR). The standardized response mean (SRM) was used to evaluate questionnaire responsiveness.

RESULTS: Of the 183 patients, most preferred the PRWHE questionnaire (n = 74, 41%), with the main reasons cited being “specific to injuries/diseases and reflects hand/wrist function (n = 23, 31%)” and “easy to complete (n = 22, 30%).” Sex was found to be associated with patient preference after adjusting for demographic data and reasons for choosing a PROM as confounders (RRR = 0.46, P value = 0.049). The PRWHE had the highest SRM, followed by DASH (0.92 and 0.88, respectively).

CONCLUSIONS: The PRWHE is the most preferred by patients and is the most responsive questionnaire. It is recommended for use in clinical practice in situations where a clinician would like to use only one PROM for evaluating patients with various types of hand/wrist problems.

LEVEL OF EVIDENCE: Prognostic III.

PMID:36622514 | DOI:10.1186/s10195-022-00681-4

Cell Tissue Bank. 2023 Jan 9. doi: 10.1007/s10561-022-10066-w. Online ahead of print.

ABSTRACT

Skeletal problems are an increasing issue due to the increase in the global aging population. Different statistics reports show that today, the global population is aging that results in skeletal problems, increased health system costs, and even higher mortality associated with skeletal problems. Common treatments such as surgery and bone grafts are not always effective and in some cases, they can even cause secondary problems such as infections or improper repair. Cell therapy is a method that can be utilized along with common treatments independently. Mesenchymal stem cells (MSCs) are a very important and efficient source in terms of different diseases, especially bone problems. These cells are present in different tissues such as bone marrow, adipose tissue, umbilical cord, placenta, dental pulp, peripheral blood, amniotic fluid and others. Among the types of MSCs, bone marrow mesenchymal stem cells (BMMSCs) are the most widely used source of these cells, which have appeared to be very effective and promising in terms of skeletal diseases, especially compared to the other sources of MSCs. This study focuses on the specific potential and content of BMMSCs from which the specific capacity of these cells originates, and compares their osteogenic potential with other types of MSCs, and also the future directions in the application of BMMSCs as a source for cell therapy.

PMID:36622494 | DOI:10.1007/s10561-022-10066-w