Category: Nevin Manimala

J Forensic Sci. 2022 Feb 6. doi: 10.1111/1556-4029.14991. Online ahead of print.

ABSTRACT

Forensic camera device identification addresses the scenario, where an investigator has two pieces of evidence: a digital image from an unknown camera involved in a crime, such as child pornography, and a person of interest’s (POI’s) camera. The investigator wants to determine whether the image was taken by the POI’s camera. Small manufacturing imperfections in the photodiode cause slight variations among pixels in the camera sensor array. These spatial variations, called photo-response non-uniformity (PRNU), provide an identifying characteristic, or fingerprint, of the camera. Most work in camera device identification leverages the PRNU of the questioned image and the POI’s camera to make a yes-or-no decision. As in other areas of forensics, there is a need to introduce statistical and probabilistic methods that quantify the strength of evidence in favor of the decision. Score-based likelihood ratios (SLRs) have been proposed in the forensics community to do just that. Several types of SLRs have been studied individually for camera device identification. We introduce a framework for calculating and comparing the performance of three types of SLRs – source-anchored, trace-anchored, and general match. We employ PRNU estimates as camera fingerprints and use correlation distance as a similarity score. Three types of SLRs are calculated for 48 camera devices from four image databases: ALASKA; BOSSbase; Dresden; and StegoAppDB. Experiments show that the trace-anchored SLRs perform the best of these three SLR types on the dataset and the general match SLRs perform the worst.

PMID:35128659 | DOI:10.1111/1556-4029.14991

Health Serv Res. 2022 Feb 6. doi: 10.1111/1475-6773.13949. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop and test of a measure of patient-centered care (PCC) culture in hospital-based perinatal care.

DATA SOURCES: US perinatal hospitals; 1 provided survey development data and 14 contributed data for survey testing.

STUDY DESIGN: We used qualitative and quantitative methods to develop the Mother-Infant Centered Care (MICC) culture survey. Qualitative methods included observation, focus group, interviews, and expert consultations to adapt items from other settings and create new items capturing dimensions of PCC articulated by The Commonwealth Fund. We quantitatively assessed survey psychometric properties using reliability (Cronbach’s α and Pearson correlation coefficients) and validity (exploratory and confirmatory factor analysis [CFA]) statistics, and refined the survey. After confirming aggregation suitability (ICCs), we calculated “MICC culture scores” at the individual-, unit-, and hospital-level and assessed associations between scores and survey-collected, staff-reported outcomes to evaluate concurrent validity.

DATA COLLECTION: Survey development included 12 site-visit observations, one semi-structured focus group (five participants), two semi-structured interviews, five cognitive interviews, and three expert consultations. Survey testing used online surveys administered to obstetric and neonatal unit staff (N=316).

PRINCIPAL FINDINGS: Using responses from 10 hospitals with ≥4 responses from both units (n=240), the 20-item MICC culture survey demonstrated reliability (Cronbach’s α=0.95) while capturing all PCC dimensions (subscale Cronbach’s α=0.72-0.87). CFA showed validity through goodness-of-fit (overall chi-square=214 [p-value=0.012], SRMR=0.056, RMSEA=0.041, CFI=0.97, and TLI=0.96). Aggregation statistics (ICCs<0.05) justify unit- and hospital-level aggregation. Demonstrating preliminary validity, individual-, unit-, and hospital-level MICC culture scores were associated with all outcomes (satisfaction with care provided, within-unit team effectiveness, and relational coordination [RC] between units) (p-values<0.05), except for neonatal unit scores and RC (p-value=0.11).

CONCLUSIONS: The MICC culture survey is a psychometrically sound measure of PCC culture for hospital-based perinatal care. Survey scores are associated with staff-reported outcomes. Future studies with patient outcomes will aid identification of improvement opportunities in perinatal care.

PMID:35128641 | DOI:10.1111/1475-6773.13949

J Ayub Med Coll Abbottabad. 2021 Oct-Dec;33(4):659-663.

ABSTRACT

BACKGROUND: In January, 2020 COVID-19 infection was declared a public health emergency characterized as pandemic by the World Health Organization (WHO). In March 2020, special guidelines were issued to address mental and psychological aspects of the disease survivors and community at large. This study was conducted with the aim to evaluate the psychological impact of COVID-19 on mothers in the postpartum period.

METHODS: It was cross-sectional study of six months duration on COVID-19 positive deliveries and Covid negative mothers. A total of 84 women (42 Covid Positive and 42 Covid negative) were included through non-probability quota with consecutive sampling technique. Mothers with pre-existing mental health issues, those who had been on medication for any psychological issues or those who suffered from obstetrical and neonatal complications or required transfer to High Dependency Unit (HDU) were excluded from the study. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen the women for postpartum depression. Independent sample t test was used for continuous variables and Fisher exact test was used for qualitative variables.

RESULTS: Mean EPDS score was 9.48±6.33 in COVID-19 positive group. The sub-scale analysis showed mean scores 1.6±1.76 and 4.86±2.94 for Anhedonia and Anxiety with statistically significant difference.

CONCLUSIONS: Women experiencing COVID-19 infection during pregnancy were found to have greater anxiety and nervousness in post-natal period compared to their COVID-19 negative counterparts.

PMID:35124926

J Ayub Med Coll Abbottabad. 2021 Oct-Dec;33(4):664-667.

ABSTRACT

BACKGROUND: The present era has been commanded by ample studies correlating breathing modes & risk of occurrence of malocclusion. The early intervention of altered breathing patterns can head off the long-lasting effects of already established malocclusion. The main intention of this project was to establish the possible correlation between mouth-breathing & malocclusions.

METHODS: Sixty-two (62) patients undergoing orthodontic treatment were evaluated via data form (including history & clinical evaluation). SPSS software version 25.0 was used for data analysis. Patient’s age, gender, type of Angle’s malocclusion & breathing pattern was taken in account while analysing data. Descriptive statistics & Chi- Square test was applied on the data. It was anticipated that mouth breathing is associated with malocclusion. p-value of less than 0.05 was considered to be statistically significant.

RESULTS: A total of 29 males & 33 females participated in the study. The mean age was 13 years (range 6-20 years). A significant correlation was found between mouth-breathing, tongue thrust (p=0.03) & bleeding gums (p=0.006). Other parameters had no significant correlation with mouth-breathing.

CONCLUSIONS: The current study revealed that mouth breathing has significant association with opened mouth at rest & gingival abnormalities (bleeding/ swollen gums) implying that timely diagnosis of such abnormal breathing pattern can hinder with development of altered occlusion & dentofacial conformation.

PMID:35124927

J Ayub Med Coll Abbottabad. 2021 Oct-Dec;33(4):598-601.

ABSTRACT

BACKGROUND: The study was to look for effectiveness of vitamin D-3 in cutaneous warts in comparison with cryotherapy at dermatology department of Pak Emirates Military Hospital Rawalpindi. It was a randomized control trial conducted at the Department of dermatology Pak Emirates Military Hospital Rawalpindi. Ten months, June 2019 to May 2020.

METHODS: A total of 50 patients of cutaneous warts diagnosed by consultant dermatologist were included in the study. Patients were randomized into groups by lottery method. Group A received the Intralesional vitamin D 3 while Group B received cryotherapy. Comparison was made in both the groups regarding the response as complete or partial or no resolution of the wart.

RESULTS: Out of 50 patients with cutaneous warts on any location of the body, 23 (46%) received intralesional vitamin D3 while 27 (54%) received cryotherapy as allocated treatment. Twenty-four (48%) patients were female while 26 (52%) were male. Planter warts 41 (82%) were the commonest type according to the site of warts followed by palmar 6 (12%). Application of chi-square test revealed that Vitamin D3 was statistically significantly related to complete resolution of warts as compared to cryotherapy (p-value<0.05).

CONCLUSION: Cutaneous warts were most commonly seen on the feet of the affected patients. They had a good response to both of the therapies but intralesional vitamin D3 emerged as more effective option of the two in terms of management of these cutaneous warts.

PMID:35124915

J Ayub Med Coll Abbottabad. 2021 Oct-Dec;33(4):607-611.

ABSTRACT

BACKGROUND: Tamoxifen is a selective oestrogen receptor modulator; in the breast, it decreases the growth and proliferation of breast epithelial cells. We assessed the weight change after Tamoxifen use in breast cancer patients.

METHODS: This was a single-centred, prospective, observational cohort study. All patients diagnosed with breast cancer with ER and/or PR positivity were enrolled in the study. Out of these, 90 patients who have been prescribed Tamoxifen treatment either in adjuvant or palliative setting gave their consent to participate. Demographic data, treatment plan, menstrual status, weight, BMI, serum fasting lipid profile, change in diet, and change in physical activity were recorded at the time of diagnosis and then quarterly until 1 year of treatment.

RESULTS: A mean age of 42.12±8.5 years was reported, and the mean weight was 62.22±10.6 kg. The majority of the patients, i.e., 68 (75.55%) had advanced tumour stages (III and IV). The study reported that the mean weight of the patients changed significantly at different time intervals during the treatment course (p<0.0005). Moreover, there was an upward trend in weight from the time of starting Tamoxifen to 3-months (62.22±1.51 kg vs 62.88±1.45 kg, respectively). There was a statistically significant increase in weight at 6-month, 9-month, and 12-month of Tamoxifen treatment (63.72±1.46 kg, 64.35±1.42 kg, 65.12±1.44 kg, respectively). Also, most of the patients gained weight as time passed by.

CONCLUSIONS: This study indicated that Tamoxifen has a significant correlation with the increase in weight in hormone receptor-positive breast cancer patients in our population.

PMID:35124917

Liver Transpl. 2022 Feb 6. doi: 10.1002/lt.26425. Online ahead of print.

ABSTRACT

Cardiovascular disease (CVD) is an important cause of mortality among liver transplantation (LT) recipients, however, the data on CVD risk stratification following LT is limited. Thus, the primary aim of the current study was to evaluate the association between decline in renal function early after LT and atherosclerotic events.

METHOD: This retrospective study included all patients receiving LT between 2007 and 2019. Early renal function was quantified as estimated glomerular filtration rate (GFR) 6 months after LT. The primary endpoint for the study was a composite atherosclerotic cardiovascular event of 3-point major adverse cardiovascular events (MACE), which includes non-fatal myocardial infarction (MI), non-fatal stroke, or death from CVD.

RESULTS: A total of 553 LT recipients met entry criteria. After a median follow up of 74 months (IQR 46, 111), 94 (17%) LT recipients died and CVD associated death occurred in 20 patients. MACE-3 occurred in 66 (12%) with non-fatal myocardial infarction being the most common event (n=30). A strong inverse relationship between early GFR and MACE-3 was noted in unadjusted analysis with HR 0.96 (95% CI 0.95, 0.98, p=0.0001) and remained significant even after accounting for age, gender, coronary artery disease, diabetes, hypertension, calcineurin inhibitor use, and Framingham Risk Score (FRS) (HR 0.96, 95% CI 0.95, 0.97, p=0.0001 per unit increase in GFR). Furthermore, an independent interaction between GFR, FRS and likelihood of developing a MACE-3 was noted.

CONCLUSION: Glomerular filtration rate 6 months following LT is a strong predictor of developing atherosclerotic events. This relationship is independent of traditional CVD risk-stratification model (FRS), thus, has the potential to be incorporated into CVD risk assessment after LT but requires further validation.

PMID:35124881 | DOI:10.1002/lt.26425

Stat Med. 2022 Feb 6. doi: 10.1002/sim.9323. Online ahead of print.

ABSTRACT

Sequential, multiple assignment, randomized trials (SMARTs) compare sequences of treatment decision rules called dynamic treatment regimes (DTRs). In particular, the Adaptive Treatment for Alcohol and Cocaine Dependence (ENGAGE) SMART aimed to determine the best DTRs for patients with a substance use disorder. While many authors have focused on a single pairwise comparison, addressing the main goal involves comparisons of >2 DTRs. For complex comparisons, there is a paucity of methods for binary outcomes. We fill this gap by extending the multiple comparisons with the best (MCB) methodology to the Bayesian binary outcome setting. The set of best is constructed based on simultaneous credible intervals. A substantial challenge for power analysis is the correlation between outcome estimators for distinct DTRs embedded in SMARTs due to overlapping subjects. We address this using Robins’ G-computation formula to take a weighted average of parameter draws obtained via simulation from the parameter posteriors. We use non-informative priors and work with the exact distribution of parameters avoiding unnecessary normality assumptions and specification of the correlation matrix of DTR outcome summary statistics. We conduct simulation studies for both the construction of a set of optimal DTRs using the Bayesian MCB procedure and the sample size calculation for two common SMART designs. We illustrate our method on the ENGAGE SMART. The R package SMARTbayesR for power calculations is freely available on the Comprehensive R Archive Network (CRAN) repository. An RShiny app is available at https://wilart.shinyapps.io/shinysmartbayesr/.

PMID:35124836 | DOI:10.1002/sim.9323

Stat Med. 2022 Feb 6. doi: 10.1002/sim.9343. Online ahead of print.

ABSTRACT

Censoring often occurs in data collection. This article, considers nonparametric regression when the covariate is censored under general settings. In contrast to censoring in the response variable in survival analysis, regression with censored covariates is more challenging but less studied in the literature, especially for dependent censoring. We propose to estimate the regression function using conditional hazard rates. The asymptotic normality of our proposed estimator is established. Both theoretical results and simulation studies demonstrate that the proposed method is more efficient than the estimation based on complete observations and other methods, especially when the censoring rate is high. We illustrate the usefulness of the proposed method using a data set from the Framingham heart study and a data set from a randomized placebo-controlled clinical trial of the drug D-penicillamine.

PMID:35124839 | DOI:10.1002/sim.9343

Hepatology. 2022 Feb 6. doi: 10.1002/hep.32395. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: The Veterans Health Administration (VHA) provides care for more than 80,000 Veterans with cirrhosis. This longitudinal, multi-method evaluation of a novel cirrhosis care quality improvement program aimed to 1) identify implementation strategies associated with evidence-based, guideline-concordant cirrhosis care over time, and 2) use qualitative interviews to operationalize strategies for a manualized intervention.

APPROACH & RESULTS: VHA providers were surveyed annually about the use of 73 implementation strategies to improve cirrhosis care in fiscal years 2018 (FY18) and 2019 (FY19). Implementation strategies linked to guideline-concordant cirrhosis care were identified using bivariate statistics and comparative configurational methods. Semi-structured interviews were conducted with 12 facilities in the highest quartile of cirrhosis care to specify the successful implementation strategies and their mechanisms of change. A total of 106 VHA facilities (82%) responded at least once over the 2-year period (FY18: n=63, FY19: n=100). Facilities reported using a median of 12 (IQR 20) implementation strategies in FY18 and 10 (IQR 19) in FY19. Of 73 strategies, 35 (48%) were positively correlated with provision of evidence-based cirrhosis care. Configurational analysis identified multiple strategy pathways directly linked to more guideline-concordant cirrhosis care. Across both methods, a subset of eight strategies was determined to be core to cirrhosis care improvement and specified using qualitative interviews.

CONCLUSIONS: In a national cirrhosis care improvement initiative, a multi-method approach identified a core subset of successful implementation strategy combinations. This process of empirically identifying and specifying implementation strategies may be applicable to other implementation challenges in hepatology.

PMID:35124820 | DOI:10.1002/hep.32395