Category: Nevin Manimala

J Aerosol Med Pulm Drug Deliv. 2021 Oct 12. doi: 10.1089/jamp.2021.0010. Online ahead of print.

ABSTRACT

Background: Drug inhalation is common mode of treatment for chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the efficiency of aerosol devices in a simulated COPD adult lung model using five commercially available hand-held mesh nebulizers. Materials and Methods: Five nebulizers (PARI VELOX^®, Omron NE-U22, Aeroneb^® Go, APEX PY001, and Pocket Air^®) were tested with a unit dose of 5.0 mg/2.5 mL salbutamol. An in vitro lung model (compliance: 0.06 L/cm H₂O, resistance: 20 cm H₂O/L/sec) was constructed to simulate parameters (tidal volume of 500 mL, respiratory rate of 15 breaths/min, inspiratory time of 1 second) of an adult patient with COPD. A bacterial filter was attached at the bronchi level for drug collection, referring as inhaled mass. After nebulization, the inhaled mass (%), dose remaining on each component (%), particle size characteristics, and nebulizer performances were analyzed. Particle size characteristics were analyzed using an 8-stage Anderson Cascade Impactor. The salbutamol particles deposited were eluted and analyzed using a spectrophotometer at 276 nm. The inhaled mass (%), dose remaining on each component (%), particle size distribution, and nebulizer performance were statistically analyzed using analysis of variance (ANOVA) with Sheffee post hoc tests. Results: Pocket Air and APEX PY001 showed the greatest inhaled mass and the lowest dose in the mouthpiece connection. The largest and smallest mass median aerodynamic diameters were found with Omron NE-U22 and PARI VELOX, respectively. In addition, the output rate and inhaled aerosol rate (IAR) of PARI VELOX were higher than those of other nebulizers. Conclusions: This study showed that the performance of commercially available mesh nebulizers varied. Aerosol particles deposited on different auxiliary equipment directly influenced the output rate and IAR of the mesh nebulizer. Clinical validation of the drug IAR is necessary to avoid overdose and reduce drug wastage.

PMID:34647814 | DOI:10.1089/jamp.2021.0010

J Palliat Care. 2021 Oct 14:8258597211045500. doi: 10.1177/08258597211045500. Online ahead of print.

ABSTRACT

Objective: The aim of this study is to determine the prevalence of and relationship between malnutrition and depressive symptoms in older palliative care inpatients. Methods: One hundred and thirty-six older adults were included in the study. The Geriatric Depression Scale, Mini Nutritional Assessment Short Form, Mini Mental State Examination, Barthel index, and Lawton & Brody index were used to evaluate the mood, nutrition status, mental status, and activities of daily living of the patients. Results: The mean age of the patients was 74.88 ± 8.82 years, and 63.2% of the patients were female. According to the nutritional assessment, 39.7% of the patients suffered from malnutrition, while 47.1% were at risk for it, and depressive symptoms were detected in 79.4% of the patients. A strong negative correlation was found between the scores for nutritional and depressive symptoms (r = -.750, 95% CI = -.834 to -.668). Conclusion: Malnutrition, risk of malnutrition, and depressive symptoms were found to occur often among the patients, and the relationship between them was statistically significant. Our results highlight that the quality of life of palliative care patients could be improved by providing adequate nutrition and psychological support.

PMID:34647838 | DOI:10.1177/08258597211045500

J Aerosol Med Pulm Drug Deliv. 2021 Oct 12. doi: 10.1089/jamp.2021.0006. Online ahead of print.

ABSTRACT

Background: Inhaled drug delivery can be limited by heterogeneous dose distribution. An additive that would disperse drug over the internal surfaces of the lung after aerosol deposition could improve dosing uniformity and increase the treated area. Our previous studies demonstrated that surfactant additives can produce surface tension-driven (Marangoni) flows that effectively dispersed aerosol-delivered drugs over mucus surfaces. Here we sought to determine whether the addition of a surfactant would increase transport of an aerosol between lung regions and also improve dosing uniformity in human lungs. Methods: We compared the deposition and postdeposition dispersion of surfactant (10 mg/mL dipalmitoylphosphatidylcholine; DPPC) and saline-based liquid aerosols, admixed with Technetium 99m (Tc99m) diethylenetriaminepentaacetic acid, using gamma scintigraphy. Deposition images were obtained ex vivo in eight pairs of ventilated human lungs. The trachea was intubated and the mainstem bronchi were alternately clamped so that saline was delivered to one lung and then DPPC to the other (sides alternated). The lungs were continually imaged for 15 minutes during delivery. We assessed transport of the deposited aerosol by quantifying the percentage of Tc99m in each of four lung quadrants over time. We quantified dose uniformity within each lung quadrant by measuring the coefficient of variation (CV = standard deviation of the pixel associated radioactive counts/mean of the counts within each quadrant). Results: There was no change in the percentage of Tc99m in each quadrant over time, indicating no improvement in transport with the addition of the surfactant. The addition of surfactant was associated with a statistically significant decrease in CV in the lower inner lung quadrant at each of the three time points, indicating an improvement in dosing uniformity. Conclusion: These preliminary results indicate the possible utility of adding surfactant to aerosols to improve drug distribution uniformity to lower inner lung regions.

PMID:34647795 | DOI:10.1089/jamp.2021.0006

Psychol Methods. 2021 Oct 14. doi: 10.1037/met0000414. Online ahead of print.

ABSTRACT

Causal inference in psychological research is typically hampered by unobserved confounding. A copula-based method can be used to statistically control for this problem without the need for instruments or covariates, given relatively lenient distributional assumptions on independent variables and error terms. The current study aims to: (a) provide a user-friendly introduction to the copula method for psychology researchers, and (b) examine the degree of non-normality in the independent variables required for satisfactory performance. A Monte Carlo simulation study was used to assess the behavior of the copula method under various combinations of conditions (sample size, skewness of independent variables, effect size, and magnitude of confounding). In addition, an applied example from research on the effects of parental rearing on adult personality and life satisfaction was used to illustrate the method. Simulations revealed that the copula method performed better at higher levels of skewness in the independent variables, and that the impacts of lower skewness can be offset to some extent by larger sample size. When skewness and/or sample size is too small, the copula method is biased toward the uncorrected model. In the applied example, parental rejection/punishment predicted less adaptive personality and life satisfaction, with no evidence of confounding. For parental control/overprotection, there was evidence that confounding attenuated the estimated relationship with personality/life satisfaction. Copula adjustment is a promising method for handling unobserved confounding. The discussion focuses on how to proceed when assumptions are not quite met, and outlines potential avenues for future research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

PMID:34647758 | DOI:10.1037/met0000414

Psychol Methods. 2021 Oct 14. doi: 10.1037/met0000429. Online ahead of print.

ABSTRACT

The replicability crisis has drawn attention to numerous weaknesses in psychology and social science research practice. In this work we focus on three issues that cannot be addressed with replication alone, and which deserve more attention: Functional misspecification, structural misspecification, and unreliable interpretation of results. We demonstrate a number of possible consequences via simulation, and provide recommendations for researchers to improve their research practice. Psychologists and social scientists should engage with these areas of analytical and statistical improvement, as they have the potential to seriously hinder scientific progress. Every research question and hypothesis may present its own unique challenges, and it is only through an awareness and understanding of varied statistical methods for predictive and causal modeling, that researchers will have the tools with which to appropriately address them. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

PMID:34647760 | DOI:10.1037/met0000429

J Neurosurg Sci. 2021 Oct 14. doi: 10.23736/S0390-5616.21.05477-1. Online ahead of print.

ABSTRACT

INTRODUCTION: The subarachnoid hemorrhage due to a ruptured brain aneurysm is a neurological emergency with high mobility and mortality. Hypertensive states are related to a bad prognosis and a higher risk of a ruptured aneurysm. However, the relationship between the blood pressure variability with the aneurysmal subarachnoid hemorrhage and its prognosis is quite unknown.

EVIDENCE ACQUISITION: A systematic review was performed across the databases. The following descriptors and related were used for the search: “blood pressure”, “arterial pressure”, variability, subarachnoid hemorrhage, hemorrhage, aneurysmal, aneurysmal subarachnoid hemorrhage. The following data were extracted: Glasgow Outcome Scale or Modified Rankin Scale, and blood pressure variabilities to categorize the prognosis.

EVIDENCE SYNTHESIS: 5 studies were selected. The blood pressure variability and the related outcome were assessed by mean systolic blood pressure and minimum systolic blood. The meta-analysis of mean systolic blood pressure (cut-off >95.3 mmHg) showed an odds ratio of 11.23 (CI 95%: 4,423 to 28,537) (p=<0.001), predicting the good outcome after the aneurysmal subarachnoid hemorrhage. The pooled analysis revealed AUC of the ROC predicting the good outcome was statistically significant (AUC:0.85, p<0.001). The pooled data analysis of minimum systolic blood pressure revealed an odds ratio of 6.43 (CI 95%:2.834-14.589, P <0,001) and AUC of the pooled ROC 0.931 (CI95%:0,851 to 1,000, P <0,001) to predict poor outcome. The funnel plot through Egger’s test for the analysis showed different grades of asymmetry.

CONCLUSIONS: The blood pressure variability (mean and minimum systolic blood pressure) is a good predictor and parameter in the aneurysmal subarachnoid hemorrhage prognosis and outcome prediction.

PMID:34647715 | DOI:10.23736/S0390-5616.21.05477-1

Psychol Methods. 2021 Oct 14. doi: 10.1037/met0000422. Online ahead of print.

ABSTRACT

Theories can be represented as statistical models for empirical testing. There is a vast literature on model selection and multimodel inference that focuses on how to assess which statistical model, and therefore which theory, best fits the available data. For example, given some data, one can compare models on various information criterion or other fit statistics. However, what these indices fail to capture is the full range of counterfactuals. That is, some models may fit the given data better not because they represent a more correct theory, but simply because these models have more fit propensity-a tendency to fit a wider range of data, even nonsensical data, better. Current approaches fall short in considering the principle of parsimony (Occam’s Razor), often equating it with the number of model parameters. Here we offer a toolkit for researchers to better study and understand parsimony through the fit propensity of structural equation models. We provide an R package (ockhamSEM) built on the popular lavaan package. To illustrate the importance of evaluating fit propensity, we use ockhamSEM to investigate the factor structure of the Rosenberg Self-Esteem Scale. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

PMID:34647757 | DOI:10.1037/met0000422

J Neurosurg Sci. 2021 Oct 14. doi: 10.23736/S0390-5616.21.05402-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Post craniotomy pain management with opioids is challenging due to their side effects, which might mask neurological deterioration symptoms. Recently, intravenous (IV) acetaminophen has been tested in this population. This meta-analysis aimed to synthesize evidence from published randomized controlled trials (RCTs) about the efficacy of IV acetaminophen in reducing pain scores in postoperative craniotomy patients.

EVIDENCE ACQUISITION: A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. We selected RCTs comparing IV acetaminophen versus placebo for postoperative pain management in craniotomy patients. Data on the visual analog scale (VAS), opioid requirements, hospital stay, and patients’ satisfaction weexretr acted and pooled as standardized mean difference (SMD) with the corresponding 95% confidence intervals (CI) in the meta-analysis model.

EVIDENCE SYNTHESIS: Five RCTs, with a total of 493 patients, were pooled in the final analysis. Patients in the IV acetaminophen group had significantly lower VAS pain scores compared to the placebo group (SMD -0.28, 95% CI [-0.46 to -0.10]). However, in terms of opioid requirement, hospital stay, and patients’ satisfaction, there were no statistically significant differences between both groups (P>0.05).

CONCLUSIONS: This meta-analysis provides class one evidence that IV Acetaminophen can significantly reduce postoperative pain in craniotomy patients with an excellent safety profile; however, there are not benefits in terms of hospital stay, opioid requirement, or patients’ satisfaction.

PMID:34647710 | DOI:10.23736/S0390-5616.21.05402-3

J Evid Based Med. 2021 Oct 14. doi: 10.1111/jebm.12451. Online ahead of print.

NO ABSTRACT

PMID:34647687 | DOI:10.1111/jebm.12451

Minerva Pediatr (Torino). 2021 Oct 14. doi: 10.23736/S2724-5276.21.05896-1. Online ahead of print.

ABSTRACT

BACKGROUND: Cerebral palsy (CP) is the most common cause of physical disability in childhood defined as a group of permanent disorders of movement. The aim of this study was to determine the effects of 12-week aquatic exercise program on gross motor function, swimming skills, and walking ability in children with cerebral palsy.

METHODS: Eighteen children (Mean ± SD age: 12.3 ± 3 years) with cerebral palsy classified at Levels I, II and III on the Gross Motor Function Classification System were allocated to one group, where the first 12 weeks were a control period while another 12 weeks were an experimental period. The participants underwent the same battery of tests focusing gross motor function, swimming skills, and walking ability on three occasions.

RESULTS: Control period was stable with no significant changes in any of measurements. After the 12-week experimental program, a statistically significant improvement was determined in gross motor function (p=0.005), swimming skills (p=0.000), walking endurance and walking (p=0.000). No significant differences (p>0.05) were observed for walking efficiency.

CONCLUSIONS: The 12-week aquatic exercise program (3/week, 60 minutes), combining Halliwick method, swimming and walking activities may improve the gross motor function, swimming skills, walking endurance and velocity in ambulatory children with cerebral palsy.

PMID:34647700 | DOI:10.23736/S2724-5276.21.05896-1