Category: Nevin Manimala

Pediatr Neonatol. 2021 Dec 4:S1875-9572(21)00230-8. doi: 10.1016/j.pedneo.2021.09.007. Online ahead of print.

ABSTRACT

BACKGROUND: Preterm formulas containing greater protein:energy ratio are beneficial for non-breastfed infants, since protein is critical for promoting catch-up growth and synthesis of lean body mass. Additionally, formulas containing enriched sn-2 palmitate (sn-2) and reduced medium chain triglycerides (MCTs) may support better feeding tolerance and nutrient utilization.

METHODS: The objective of this randomized, controlled, double-blinded clinical trial is to evaluate growth, feeding tolerance and nutritional biomarkers of preterm infants with birth weight ≤2000g and gestational age ≤33wks from one neonatal unit in Vietnam receiving experimental formula (EF, n = 80) containing higher protein level of 3.4 g/100 kcal and improved fat blend with enriched sn-2 and modified level of MCTs or isocaloric control formula (CF, n = 80) containing protein level of 2.9 g/100 kcal and standard fat blend. The differences in weight gain (g/d; primary endpoint) from day 1 (D1) of full enteral feeding (FEF) until D21 between groups was evaluated for non-inferiority (margin = -2.5 g/d) and superiority (margin = 0 g/d).

RESULTS: Mean weight gain was 3.09 g/d greater in EF than CF; the lower limit of 95% CI (0.31 g/d) exceeded both non-inferiority and superiority margins. There was no significant difference in length-for-age and head circumference-for-age z-score. By D79, the mean change in weight-for-age z-scores from D1 in EF group (+0.76 SDs) surpassed the criteria for catch-up growth (+0.67 SDs). Infants in the EF group (vs. CF) tended to have softer stools (EF = 3.2 ± 0.59 vs. CF = 3.4 ± 0.58; P = 0.07) based on 5-point scale (1 = watery, 5 = hard). Difference in blood urea nitrogen and biomarkers for bone mineral status (i.e., plasma phosphorus, alkaline phosphatase and urinary calcium/phosphorus ratio) between EF and CF on FEF Day 21 reached statistical significance (P < 0.05) but all mean values stayed within normal clinical ranges for both groups.

CONCLUSION: Preterm formula with greater protein:energy ratio and new fat blend is safe, nutritionally suitable, well-tolerated, and improves catch-up weight gain of preterm infants. Clinical trial registry identifier is NCT03055052 (ClinicalTrials.gov).

PMID:35000893 | DOI:10.1016/j.pedneo.2021.09.007

Radiography (Lond). 2022 Jan 6:S1078-8174(21)00213-3. doi: 10.1016/j.radi.2021.12.013. Online ahead of print.

ABSTRACT

INTRODUCTION: Recent guidance from the British Institute of Radiology (BIR) and the American Association of Physicists in Medicine (AAPM) focuses on cessation of patient Lead-rubber (Pb) shielding placed within the Field of View (FOV) that may influence image exposure or quality. Furthermore, the BIR assert shielding organs greater than 5 cm from the primary X-ray beam will have a negligible effect to the received radiation dose. Bilateral hand X-rays are frequently and repeatedly requested for the diagnosis and ongoing management of arthritic conditions. There is a lack of literature regarding the effect of Pb shielding during bilateral hand X-ray examinations. This research aimed to investigate the scattered secondary radiation dose to the gonads during a bilateral hand X-ray, with and without the use of Pb shielding outside the FOV at a greater distance than 5 cm from the primary beam.

METHODS: Using an anthropomorphic phantom and constructed upper limbs, radiation was recorded to the male and female gonads. Thermoluminescent dosimeters (TLD’s) (⅛” x ⅛” x 0.15″ TLD-100H) were placed in groups of three upon the testes and within the left and right ovary to record the ionising radiation dose. Three collimated exposures were completed using a standard clinical practice hand X-ray protocol of 60 kVp and 2.5 mAs with a source to image distance (SID) of 100 cm. The mean and standard deviation of the radiation dose was calculated for both with and without Pb shielding. A paired two-sample t-test was conducted to determine statistical significance (p ≤ 0.05).

RESULTS: Data analysis demonstrated dose measured to the testes of 5.3 μGy (SD 0.8) without Pb shielding and 2.3 μGy (SD 0.2) with Pb (reduction of 3 μGy; 56.6%). Left ovary doses measured 40.6 μGy (SD 1.2) without Pb shielding and 28.8 μGy (SD 1.7) with Pb (reduction of 11.9 μGy; 29.2%) and right ovary doses measured 39.5 μGy (SD 1.9) without Pb shielding and 26.6 μGy (SD 1.0) with Pb (reduction of 12.8 μGy; 32.4%). The paired two-sample t-test presented a statistically significant dose reduction (p = 0.0039).

CONCLUSION: The study demonstrated dose limitation from scattered secondary radiation to the gonads when Pb shielding was used during a bilateral hand X-ray at distances greater than 5 cm from the primary X-ray beam on anatomy outside the FOV.

IMPLICATIONS FOR PRACTICE: The use of Pb shielding over the gonad area during a bilateral hand X-ray examination aligns to ALARP best practice and provides prospects for patient (male and female) dose reduction.

PMID:35000868 | DOI:10.1016/j.radi.2021.12.013

Radiography (Lond). 2022 Jan 6:S1078-8174(21)00195-4. doi: 10.1016/j.radi.2021.12.004. Online ahead of print.

ABSTRACT

INTRODUCTION: This study assessed the inter-observer agreement of reporting radiographers and consultant radiologists compared with an index radiologist when reporting General Practitioner (GP) requested musculoskeletal radiographs. The potential effect of discordant reports on patient management and outcome was also examined.

METHODS: Three reporting radiographers, three consultant radiologists and an index radiologist reported on a retrospective randomised sample of 219 GP requested musculoskeletal radiographs, in conditions simulating clinical practice. A speciality doctor in radiology compared the observers’ reports with the index radiologist report for agreement and assessed whether any discordance between reports was clinically important.

RESULTS: Overall agreement with the index radiologist was 47.0% (95% CI, 40.5-53.6) and 51.6% (95% CI, 45.0-58.1) for the consultant radiologists and reporting radiographers, respectively. The results for the appendicular and axial skeleton were 48.6% (95% CI, 41.3-55.9) and 40.9% (95% CI, 27.7-55.6) for the radiologists, and 52.6% (95% CI, 45.2-59.8) and 47.7% (95% CI, 33.8-62.1) for the radiographers, respectively. The difference in overall observer agreement between the two professional groups with the index radiologist was not statistically significant (p = 0.34). Discordance with the index radiologist’s reports was judged to be clinically important in less than 10% of the observer’s reports.

CONCLUSION: Reporting radiographers and consultant radiologists demonstrate similar levels of concordance with an index radiologist when reporting GP requested musculoskeletal radiographs.

IMPLICATIONS FOR PRACTICE: These findings contribute to the wider evidence base that selected radiographers with appropriate postgraduate education and training are proficient to report on musculoskeletal radiographs, irrespective of referral source.

PMID:35000869 | DOI:10.1016/j.radi.2021.12.004

J Voice. 2022 Jan 6:S0892-1997(21)00433-1. doi: 10.1016/j.jvoice.2021.12.010. Online ahead of print.

ABSTRACT

INTRODUCTION: In recent years cepstral analysis and specific cepstrum-based measures such as smoothed cepstral peak prominence (CPPS) has become increasingly researched and utilized in attempts to determine the extent of overall dysphonia in voice signals. Yet, few studies have extensively examined how specific voice-source parameters affect CPPS values.

OBJECTIVE: Using a range of synthesized tones, this exploratory study sought to systematically analyze the effect of fundamental frequency (f_o), vibrato extent, source-spectrum tilt, and the amplitude of the voice-source fundamental on CPPS values.

MATERIALS AND METHODS: A series of scales were synthesised using the freeware Madde. Fundamental frequency, vibrato extent, source-spectrum tilt, and the amplitude of the voice-source fundamental were systematically and independently varied. The tones were analysed in PRAAT, and statistical analyses were conducted in SPSS.

RESULTS: CPPS was significantly affected by both f_o and source-spectrum tilt, independently. A nonlinear association was seen between vibrato extent and CPPS, where CPPS values increased from 0 to 0.6 semitones (ST), then rapidly decreased approaching 1.0 ST. No relationship was seen between the amplitude of the voice-source fundamental and CPPS.

CONCLUSION: The large effect of f_o should be taken into account when analyzing the voice, particularly in singing-voice research, when comparing pre and posttreatment data, and when comparing inter-subject CPPS data.

PMID:35000836 | DOI:10.1016/j.jvoice.2021.12.010

J Nutr Educ Behav. 2022 Jan 6:S1499-4046(21)00859-9. doi: 10.1016/j.jneb.2021.10.002. Online ahead of print.

ABSTRACT

OBJECTIVE: To refine a measure of home cooking quality (defined as the usage level of practices with the potential to influence the nutrient content of prepared foods) and conduct a construct validation of the revised tool, the Healthy Cooking Questionnaire 2 (HCQ2).

DESIGN: Two validation approaches are described: (1) a community science approach used to refine and validate Healthy Cooking Questionnaire (HCQ) constructs, and (2) responses to the revised HCQ (HCQ2) in a sample of Amazon Mechanical Turk (MTurk) workers to determine questionnaire comprehension.

SETTING: The Community Scientist Program at the University of Texas MD Anderson Cancer Center facilitated discussion groups to refine the HCQ questions and validate constructs. MTurk workers were subsequently recruited to complete the refined survey so that comprehension and associations with demographic variables could be explored.

PARTICIPANTS: Ten community scientists participated in the refinement of the HCQ. The revised tool (HCQ2) was completed by 267 adult US-based MTurk workers.

VARIABLES MEASURED: Demographics, HCQ concepts, HCQ2, Self-Reported Questionnaire Comprehension.

ANALYSIS: Comprehension items were examined using descriptive statistics. Exploratory analysis the relationships between cooking quality and demographic characteristics, meal type, cooking frequency, as well as patterns of food preparation behavior was conducted on the MTurk sample RESULTS: The HCQ was refined through activities and consensus-building. MTurk responses to the HCQ2 indicated high comprehension and significant differences in cooking quality scores by demographic factors.

CONCLUSIONS AND IMPLICATIONS: This study refined and validated a self-report measure of cooking quality. Cooking quality measures offer critical evaluation methods for culinary programs.

PMID:35000831 | DOI:10.1016/j.jneb.2021.10.002

Am J Prev Med. 2022 Jan 6:S0749-3797(21)00593-6. doi: 10.1016/j.amepre.2021.10.018. Online ahead of print.

ABSTRACT

INTRODUCTION: Research is equivocal about how the social relationship between victims and offenders is linked to the emotional, social, and physical consequences of violence. This study examines the association of victim-offender relationship with the adverse outcomes reported by injured and uninjured victims of violence.

METHODS: The study analyzed 16,723 violent victimizations recorded by the National Crime Victimization Survey from 2008 to 2018. Multivariable quasi-Poisson models estimated the associations between the victim-offender relationship and victims’ emotional distress, social distress, and physical and emotional symptoms. These models also estimated a statistical interaction between victim-offender relationship and violent injury to examine how this association differed for injured and uninjured victims. The analyses occurred during 2020 and 2021.

RESULTS: Uninjured victims were more likely to report emotional distress (risk ratio=1.41, 95% CI=1.33, 1.50), social distress (risk ratio=3.12, 95% CI=2.78, 3.51), more physical symptoms (symptom frequency ratio=1.68, 95% CI=1.51, 1.87), and more emotional symptoms (symptom frequency ratio=1.13, 95% CI=1.08, 1.18) in family member/intimate partner violence than in stranger violence. Victims also reported worse outcomes after acquaintance violence than after stranger violence. For injured victims, these differences narrowed-but were still significant-in emotional and social distress models. However, the number of emotional and physical symptoms reported by injured victims did not significantly vary across victim-offender relationships.

CONCLUSIONS: Relational closeness between victims and offenders is a risk factor for adverse outcomes after violent victimization, and it is more strongly associated with these outcomes for uninjured victims than for injured victims.

PMID:35000834 | DOI:10.1016/j.amepre.2021.10.018

J Nutr Educ Behav. 2022 Jan 6:S1499-4046(21)00861-7. doi: 10.1016/j.jneb.2021.10.003. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate if children of families with a longer duration of participation in the Special Supplementation Nutrition Program for Women, Infants, and Children (WIC) consume fewer sugar-sweetened beverages (SSB) and more water.

DESIGN: A repeated cross-sectional study.

SETTING: Conducted among representative samples of WIC-participating families in Los Angeles County, California, in 2014, 2017, and 2020.

PARTICIPANTS: Children aged 4-59 months participating in WIC.

MAIN OUTCOME MEASURES: Daily servings of total SSBs, daily servings of specific types of SSBs, and daily servings of water.

ANALYSIS: Multivariable count regression models were used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for associations of the duration of family WIC participation with daily servings of total SSBs, water, and specific types of SSBs. Zero-inflated negative binomial regression models were used for total SSBs and specific types of SSBs, and Poisson regression was used for water.

RESULTS: Children of families with 2 years of WIC participation consumed significantly fewer daily servings of total SSBs (IRR, 0.95; 95% CI, 0.93-0.98; P = 0.002), fruit-flavored SSBs (IRR, 0.95; 95% CI, 0.91-0.99; P = 0.02), soda (IRR, 0.86; 95% CI, 0.76-0.98; P = 0.02), and water (IRR, 0.99; 95% CI, 0.98 to < 1.00; P = 0.03) than children of families with 1 year of WIC participation. Protective associations for total SSBs, fruit-flavored SSBs, and soda remained statistically significant and increased in magnitude through 10 years of family WIC participation.

CONCLUSIONS AND IMPLICATIONS: Duration of WIC participation was associated with decreased SSB intake by young children. Given the role that increasing water intake in lieu of SSBs plays in child obesity, improving the effectiveness of WIC nutrition education on parental perceptions and provision of fruit-flavored SSBs and water to their children merits detailed evaluation.

PMID:35000830 | DOI:10.1016/j.jneb.2021.10.003

Eur J Intern Med. 2022 Jan 6:S0953-6205(21)00437-4. doi: 10.1016/j.ejim.2021.12.027. Online ahead of print.

ABSTRACT

AIMS: In the absence of previous direct comparative studies, we aimed to evaluate the effectiveness of spironolactone and eplerenone in patients with heart failure and reduced ejection fraction (HFrEF) in a real-world clinical setting.

METHODS: Using Fine-Gray´s competing risk regression, we compared the clinical outcomes of 293 patients with chronic HF and left ventricular ejection fraction <40% treated with eplerenone and 293 propensity-score matched individuals treated with spironolactone. Study subjects were selected from a prospective cohort of 1404 ambulatory patients with HFrEF seen since 2010 to 2019 in a single specialized HF clinic, among which 992 received a mineralocorticoid receptor antagonist at baseline. Median follow-up was 3.95 years.

RESULTS: No statistically significant differences between patients treated with eplerenone versus spironolactone were observed with regard to the risk of the primary composite end-point cardiovascular death or HF hospitalization (HR 0.95; 95% CI 0.73-1.23; p= 0.677). However, eplerenone use was associated to lower cardiovascular mortality (HR 0.55; 95% CI 0.35-0.85; p= 0.008) and lower all-cause mortality (HR 0.67; 95% CI 0.47-0.95; p= 0.027). The incidence of drug suspension due to side effects (HR 0.58, 95% CI 0.40-0.85; p= 0.005) and drug suspension due to any reason (HR 0.70, 95% CI 0.51-0.97; p= 0.033) were lower among patients treated with eplerenone.

CONCLUSIONS: In this observational, real-world, propensity-score matched study of patients with HFrEF, eplerenone was associated to lower cardiovascular mortality and lower all-cause mortality than spironolactone.

PMID:35000806 | DOI:10.1016/j.ejim.2021.12.027

Eur Urol. 2022 Jan 6:S0302-2838(21)02216-8. doi: 10.1016/j.eururo.2021.12.008. Online ahead of print.

ABSTRACT

BACKGROUND: European kidney donation shortages mandate efficient organ allocation by optimizing the prediction of success for individual recipients.

OBJECTIVE: To develop the first European online risk tool for kidney transplant outcomes on the basis of recipient-only and recipient plus donor characteristics.

DESIGN, SETTING, AND PARTICIPANTS: We used individual recipient and donor risk factors and three outcomes (death, death with functioning graft [DWFG], and graft loss) for 32 958 transplants within the Eurotransplant kidney allocation system and the Eurotransplant senior program between January 2006 and May 2018 in eight European countries to develop and validate a risk tool.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Cox proportional-hazards models were used to analyze the association of risk factors with overall patient mortality, and proportional subdistribution hazard regression models for their association with graft loss and DWFG. Prediction models were developed with recipient-only and recipient-donor risk factors. Sensitivity analyses based on time-specific area under the receiver operating characteristic curve (AUC) with leave-one-country-out validation were performed and calibration plots were generated.

RESULTS AND LIMITATIONS: The 10-yr cumulative incidence rate was 37% for mortality, 12% for DWFG, and 41% for graft loss. In recipient-donor models the leading risk factors for mortality were recipient diabetes (hazard ratio [HR] 10.73), retransplantation (HR 3.08 per transplant), and recipient age (HR 1.08). Effects were similar for DWFG. For graft loss, diabetes (subdistributional HR [SHR] 1.32), increased donor age (SHR 1.02), and prolonged cold ischemia time (SHR 1.02) had increased SHRs. All p values were <0.001.

CONCLUSIONS: Previously identified risk factors for outcomes following kidney transplants allow for outcome prediction with 10-yr AUC values of up to 0.81.

PATIENT SUMMARY: Using European data, we estimated individual risks to predict the success of kidney transplants and support physicians in decision-making. An online tool is now available (https://riskcalc.org/ktop/) for predicting kidney transplant outcomes both before and after a donor has been identified.

PMID:35000822 | DOI:10.1016/j.eururo.2021.12.008

Am J Infect Control. 2021 Dec 7:S0196-6553(21)00741-0. doi: 10.1016/j.ajic.2021.11.005. Online ahead of print.

ABSTRACT

N95 respirators were reprocessed using vaporized hydrogen peroxide to supplement limited supplies during the COVID-19 pandemic. In this study, we found no statistically significant differences in qualitative and quantitative fit or filtration efficiency with reprocessing. Filtration efficiency remained above 95% even at 25 cycles of reprocessing without statistically significant change from cycle 20-25 compared to cycle 0 (P = .10, P = .05, respectively). Vaporous hydrogen peroxide is an effective option to augment N95 respirator supplies.

PMID:35000800 | DOI:10.1016/j.ajic.2021.11.005