Category: Nevin Manimala

Crit Care Med. 2021 Apr 8. doi: 10.1097/CCM.0000000000005044. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine if a restrictive visitor policy inadvertently lengthened the decision-making process for dying inpatients without coronavirus disease 2019.

DESIGN: Regression discontinuity and time-to-event analysis.

SETTING: Two large academic hospitals in a unified health system.

PATIENTS OR SUBJECTS: Adult decedents who received greater than or equal to 1 day of ICU care during their terminal admission over a 12-month period.

INTERVENTIONS: Implementation of a visit restriction policy.

MEASUREMENTS AND MAIN RESULTS: We identified 940 adult decedents without coronavirus disease 2019 during the study period. For these patients, ICU length of stay was 0.8 days longer following policy implementation, although this effect was not statistically significant (95% CI, -2.3 to 3.8; p = 0.63). After excluding patients admitted before the policy but who died after implementation, we observed that ICU length of stay was 2.9 days longer post-policy (95% CI, 0.27-5.6; p = 0.03). A time-to-event analysis revealed that admission after policy implementation was associated with a significantly longer time to first do not resuscitate/do not intubate/comfort care order (adjusted hazard ratio, 2.2; 95% CI, 1.6-3.1; p < 0.0001).

CONCLUSIONS: Policies restricting family presence may lead to longer ICU stays and delay decisions to limit treatment prior to death. Further policy evaluation and programs enabling access to family-centered care and palliative care during the ongoing coronavirus disease 2019 pandemic are imperative.

PMID:33826588 | DOI:10.1097/CCM.0000000000005044

PLoS One. 2021 Apr 7;16(4):e0248583. doi: 10.1371/journal.pone.0248583. eCollection 2021.

ABSTRACT

Adequate diversity and abundance of native seed for large-scale grassland restorations often require commercially produced seed from distant sources. However, as sourcing distance increases, the likelihood of inadvertent introduction of multiple novel, non-native weed species as seed contaminants also increases. We created a model to determine an “optimal maximum distance” that would maximize availability of native prairie seed from commercial sources while minimizing the risk of novel invasive weeds via contamination. The model focused on the central portion of the Level II temperate prairie ecoregion in the Midwest US. The median optimal maximum distance from which to source seed was 272 km (169 miles). In addition, we weighted the model to address potential concerns from restoration practitioners: 1. sourcing seed via a facilitated migration strategy (i.e., direct movement of species from areas south of a given restoration site to assist species’ range expansion) to account for warming due to climate change; and 2. emphasizing non-native, exotic species with a federal mandate to control. Weighting the model for climate change increased the median optimal maximum distance to 398 km (247 miles), but this was not statistically different from the distance calculated without taking sourcing for climate adaptation into account. Weighting the model for federally mandated exotic species increased the median optimal maximum distance only slightly to 293 km (182 miles), so practitioners may not need to adjust their sourcing strategy, compared to the original model. This decision framework highlights some potential inadvertent consequences from species translocations and provides insight on how to balance needs for prairie seed against those risks.

PMID:33826620 | DOI:10.1371/journal.pone.0248583

Environ Technol. 2021 Apr 7:1-18. doi: 10.1080/09593330.2021.1914177. Online ahead of print.

ABSTRACT

Current study addresses a problem of elevated aluminum concentrations deteriorating Khibiny Alkaline Massif groundwater quality. The application of chemometric methods to the field dataset 1999-2018 allows to quantitatively describe the groundwater quality, reveal variability patterns and potential sources of elevated aluminum level in the groundwater. The field dataset contains almost 40% more observations of 12 physicochemical groundwater quality parameters than the dataset analyzed in our previous studies on Khibiny groundwater quality assessment reported in the literature. The results revealed statistically significant (α-level=0.05) associations between Al and pH, Cl^–, NO₃^–, SO₄^2- according to the calculated matrix using distance correlation method. The mathematical models developed with the application of multiple regression and factor/principal component analysis elucidate up to 55.5% Al concentration variability and up to 68.3% of total dataset variance. Calculated for the 19-year period the water quality index values, which changed in early 2000s from fair to a marginal category, still belongs to this category reflecting unsatisfactory water quality conditions. Comparing the current study results to the conclusions drawn in our previous publications it is assumed that the main factors determining substandard groundwater quality have remained the same since last groundwater quality assessment reported in the literature. The examined combination of chemometric methods allows to gain insight into the main features of variability patterns of water quality characteristics and the potential sources of groundwater contamination. This approach forms a reliable foundation for enhancing groundwater quality monitoring and control in the Arctic region of interest and other locations experiencing similar problems.

PMID:33826472 | DOI:10.1080/09593330.2021.1914177

Ocul Immunol Inflamm. 2021 Apr 7:1-6. doi: 10.1080/09273948.2021.1900276. Online ahead of print.

ABSTRACT

Purpose: This study aimed to evaluate biosimilar adalimumab’s efficacy and safety in patients with Behçet’s uveitis in Iran.Methods: We performed a study on patients who mostly (79.2%) had a failure on conventional treatment with the mean follow-up time of 19.24 months (95% confidence interval (CI), 16.52-21.96). All the enrolled patients were anti-tumor necrosis factor (anti-TNF) naiive. The primary endpoint was best-corrected visual acuity (BCVA) improvement, and the secondary endpoints were changes in macular thickness, vitreous haze grade, anterior chamber (AC) cell grade, prednisolone dose, and the incidence of adverse reactions.Results: Forty-eight patients were enrolled in the study. After adalimumab use, visual acuity improved significantly (p-value˂.001); vitreous haze grade decreased (p-value˂.001), and AC cell grade improved (p-value = .002). Macular thickness decreased, but its change was not statistically significant (p-value = .1). Moreover, adalimumab showed a corticosteroid-sparing effect (p-value = .03).Conclusion: Biosimilar adalimumab (CinnoRA®) is effective and well-tolerated in Behçet’s uveitis.

PMID:33826486 | DOI:10.1080/09273948.2021.1900276

J Pediatr Orthop. 2021 Apr 8. doi: 10.1097/BPO.0000000000001832. Online ahead of print.

ABSTRACT

BACKGROUND: Radiographic markers of skeletal maturity are vital to the prediction and interpretation of skeletal growth patterns. Accurate predictions of skeletal maturity factor into the management of common musculoskeletal disorders. Bone age is conventionally measured using hand and wrist radiographs. The primary study objective was to optimize skeletal maturity estimates based on the morphology of markers at the hip, knee, and foot rather than conventional upper extremity radiographs.

METHODS: This was a retrospective analysis of children from the Bolton-Brush collection with anteroposterior radiographs of the hip and anteroposterior and lateral radiographs of the knee and foot, and heights recorded at the time of each radiograph. The percent growth achieved (%GA) was calculated as a function of final patient height. Poor quality radiographs were excluded, leaving 50 patients-32 females and 18 males-and 1068 radiographs for analysis. Skeletal maturity was evaluated using the Oxford bone, O’Connor knee, and calcaneal apophyseal scores. Interrater and intrarater reliability analyses were performed for hip and knee scores. Multiple linear regressions were conducted on these scores and chronologic age as predictors of %GA. Mean differences were calculated between actual and estimated %GAs. All analyses were performed in Prism 8.0.

RESULTS: Each lower extremity skeletal maturity score served as statistically significant, independent predictors of %GA, the accuracy and strength of which increased with the addition of chronologic age. The integration of all 3 systems and chronologic age yielded the most predictive, accurate model predictive of %GA, which can be used to determine percent growth remaining. However, this fully integrated system was not statistically superior to the combination of knee and foot scores and knee score and chronologic age, which yield similarly accurate %GA predictions. The hip and knee systems demonstrated good to excellent interrater and intrarater reliability.

CONCLUSIONS: Integration of bone age scores across different regions of the lower extremity has the potential to facilitate orthopaedic decision-making using radiographs already obtained in the treatment of pediatric musculoskeletal conditions.

LEVEL OF EVIDENCE: Level IV.

PMID:33826562 | DOI:10.1097/BPO.0000000000001832

Lymphat Res Biol. 2021 Apr 7. doi: 10.1089/lrb.2020.0132. Online ahead of print.

ABSTRACT

Background: Upper limb lymphedema may be revealed after breast cancer and its treatment. Among different treatment approaches, intermittent pneumatic compression (IPC) therapy and low-level laser therapy (LLLT) are reported as effective modalities in the treatment of postmastectomy upper limb lymphedema (PML). The aim of the current study is to investigate the long-term effectiveness of combined IPC plus LLLT versus IPC therapy alone in patients with PML. Methods and Results: The patients were allocated into two groups in this single-blinded, controlled clinical trial. Group I received combined treatment with IPC plus LLLT (n = 21) and group II received only IPC (n = 21). IPC treatment was given 5 sessions per week for 4 weeks (20 sessions). LLLT was also performed 5 sessions per week for 4 weeks (20 sessions). Clinical evaluations were performed before and after the treatment at the 3, 6, and 12-month follow-up visits. According to within-group analysis, statistically significant improvements in the circumference difference (C_diff) and grip strength were observed in both groups (for C_diff, p = 0.018 and p = 0.032, respectively; for grip strength, p = 0.001 and p = 0.046, respectively). Visual analog scale values for arm pain and shoulder pain during motion were decreased only in group I. Conclusion: Both interventions have positive effects on lymphedema, grip strength, and pain. Long-term effects of combined therapy, especially on pain, are slightly superior to the pneumatic compression alone.

PMID:33826415 | DOI:10.1089/lrb.2020.0132

Hosp Pract (1995). 2021 Apr 7. doi: 10.1080/21548331.2021.1914465. Online ahead of print.

ABSTRACT

BACKGROUND: Hospitalists, comprised of nurse practitioners and physician assistants (collectively, advanced practice providers [APPs]) and physicians, have opportunities to counsel patients and reduce SARS-CoV-2 related coronavirus disease 2019 (COVID-19) vaccine hesitancy. However, hospitalist perspectives on the COVID-19 vaccine and potential differences between APPs and physicians are unknown. Understanding hospitalist perspectives could help to address vaccine hesitancy among patients.

METHODS: We conducted an online survey of hospitalists at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin from December 14, 2020, through January 4, 2021. We collected demographic information and assessed perspectives on the COVID-19 vaccine and, for comparison, on the influenza vaccine. Descriptive statistics were used to compare responses between APPs and physicians.

RESULTS: The overall response rate was 42.7% (n=128/300) and comprised of 53.9% women (n=69/128) and 41.4% APPs (n=53/128). Most hospitalists reported receiving or planning to receive vaccination against COVID-19 (93.7%; n=119/128) and influenza (97.7%; n=125/128). Most hospitalists reported they would advise 100% of patients to receive the COVID-19 vaccine (66% for APPs; 74.7% for physicians) and influenza vaccine (83% for APPs; 80% for physicians). Barriers to recommending the COVID-19 vaccine included patient health status and vaccine safety profile. Hospitalists reported that patients and co-workers receiving the COVID-19 vaccine would reduce their anxiety (~80% of hospitalists), social isolation (~64% of hospitalists), and improve their emotional support (~40% of hospitalists). APP and physician responses were similar. The possible reduction in social isolation was associated with higher odds of hospitalists advising all patients to receive the COVID-19 vaccine (adjusted odds ratio 2.95 [95% confidence interval, 1.32-6.59]; P<.008), whereas hospitalist age, gender, and profession showed no association.

CONCLUSION: Most hospitalists would reportedly advise patients to receive the COVID-19 vaccine. Barriers to this recommendation included patient health status and vaccine safety. Hospitalists are an important resource to provide patient education and reduce COVID-19 vaccine hesitancy.

PMID:33826433 | DOI:10.1080/21548331.2021.1914465

Stat Methods Med Res. 2021 Apr 7:962280221995986. doi: 10.1177/0962280221995986. Online ahead of print.

ABSTRACT

The quantile regression model has increasingly become a useful approach for analyzing survival data due to its easy interpretation and flexibility in exploring the dynamic relationship between a time-to-event outcome and the covariates. In this paper, we consider the quantile regression model for survival data with missing censoring indicators. Based on the augmented inverse probability weighting technique, two weighted estimating equations are developed and corresponding easily implemented algorithms are suggested to solve the estimating equations. Asymptotic properties of the resultant estimators and the resampling-based inference procedures are established. Finally, the finite sample performances of the proposed approaches are investigated in simulation studies and a real data application.

PMID:33826461 | DOI:10.1177/0962280221995986

J Am Chem Soc. 2021 Apr 7. doi: 10.1021/jacs.1c00651. Online ahead of print.

ABSTRACT

Cyclodextrins (CDs) are doughnut-shaped cyclic oligosaccharides having a cavity and two rims. Inclusion binding in the cavity has long served as a classic model of molecular recognition, and rim binding has been neglected. We found that CDs recognize guests by size-sensitive binding using the two rims in addition to the cavity, using single-molecule electron microscopy and a library of graphitic cones as a solid-state substrate for complexation. For example, with its cavity and rim binding ability combined, γ-CD can recognize a guest of radius between 4 and 9 Å with a size-recognition precision of better than 1 Å, as shown by structural analysis of thousands of individual specimens and statistical analysis of the data thereof. A 2.5 ms resolution electron microscopic video provided direct evidence of the process of size recognition. The data suggest the occurrence of the rim binding mode for guests larger than the size of the CD cavity and illustrate a unique application of dynamic molecular electron microscopy for deciphering the spatiotemporal details of supramolecular events.

PMID:33826331 | DOI:10.1021/jacs.1c00651

AJR Am J Roentgenol. 2021 Apr 7:1-9. doi: 10.2214/AJR.20.22965. Online ahead of print.

ABSTRACT

OBJECTIVE. The purpose of this study is to investigate the detection rate of transabdominal ultrasound (TAUS) for pancreatic cysts incidentally detected on CT or MRI as well as the factors that influence detection rates. SUBJECTS AND METHODS. Fifty-seven patients with low-risk pancreatic cysts (n = 77; cyst size, 5 mm to 3 cm) that were incidentally detected on CT or MRI were prospectively enrolled at five institutions. At each institution, TAUS was independently performed by two radiologists who assessed detection of cysts, cyst location and size, and the diameter of the main pancreatic duct (MPD). Cyst detection rates based on cyst size, location, and multiplicity and the body mass index of the patient were compared using the Mann-Whitney test. Kappa statistics and the interclass correlation coefficient were used to evaluate interobserver agreement regarding cyst detection and consistency of cyst size and the diameter of the MPD on TAUS versus prior CT or MRI. RESULTS. The detection rate for known low-risk pancreatic cysts was 81.8% (63/77) and 83.1% (64/77) for TAUS conducted by each of the two radiologists. The detection rate for larger (≥ 10 mm) cysts was significantly higher than that for smaller cysts (89.0% vs 63.6% for TAUS performed and interpreted by radiologist 1 [TAUS 1] and 89.0% vs 68.2% for TAUS conducted and interpreted by radiologist 2 [TAUS 2]; p < .05). A higher detection rate was noted for cysts located outside the tail of the pancreas compared with those located in the tail (89.5% vs 65.0% for TAUS 2; p = .01), and the detection rate was also significantly higher for single cysts than for multiple cysts (90.9% vs 69.7% for TAUS 1; p = .02). However, no significant difference was observed for body mass index. Interobserver agreement was excellent regarding the size of the detected cysts (inter-class correlation coefficient: 0.964 [95% CI, 0.940-0.979] for CT, TAUS 1, and TAUS 2 and 0.965 [95% CI. 0.924-986] for MRI, TAUS 1, and TAUS 2) and the diameter of the MPD (interclass correlation coefficient, 0.934; 95% CI, 0.898-0.959). CONCLUSION. TAUS could be a useful alternative imaging tool for surveillance of known low-risk pancreatic cysts, especially single pancreatic cysts and those that are of larger size (≥ 1 cm) or are located outside the tail.

PMID:33826357 | DOI:10.2214/AJR.20.22965