Category: Nevin Manimala

Sci Rep. 2021 Sep 28;11(1):19241. doi: 10.1038/s41598-021-97394-1.

ABSTRACT

Behavioral gender differences have been found for a wide range of human activities including the way people communicate, move, provision themselves, or organize leisure activities. Using mobile phone data from 1.2 million devices in Austria (15% of the population) across the first phase of the COVID-19 crisis, we quantify gender-specific patterns of communication intensity, mobility, and circadian rhythms. We show the resilience of behavioral patterns with respect to the shock imposed by a strict nation-wide lock-down that Austria experienced in the beginning of the crisis with severe implications on public and private life. We find drastic differences in gender-specific responses during the different phases of the pandemic. After the lock-down gender differences in mobility and communication patterns increased massively, while circadian rhythms tended to synchronize. In particular, women had fewer but longer phone calls than men during the lock-down. Mobility declined massively for both genders, however, women tended to restrict their movement stronger than men. Women showed a stronger tendency to avoid shopping centers and more men frequented recreational areas. After the lock-down, males returned back to normal quicker than women; young age-cohorts return much quicker. Differences are driven by the young and adolescent population. An age stratification highlights the role of retirement on behavioral differences. We find that the length of a day of men and women is reduced by 1 h. We interpret and discuss these findings as signals for underlying social, biological and psychological gender differences when coping with crisis and taking risks.

PMID:34584107 | DOI:10.1038/s41598-021-97394-1

Bioinspir Biomim. 2021 Sep 29. doi: 10.1088/1748-3190/ac2afe. Online ahead of print.

ABSTRACT

Jellyfish (Medusozoa) have been deemed the most energy-efficient animals in the world. Their bell morphology and relatively simple nervous systems make them attractive to robotocists. Although, the science community has devoted much attention to understanding their swimming performance, there is still much to be learned about the jet propulsive locomotive gait displayed by prolate jellyfish. Traditionally, computational scientists have assumed uniform duty cycle kinematics when computationally modeling jellyfish locomotion. In this study we used fluid-structure interaction modeling to determine possible enhancements in performance from shuffling different duty cycles together across multiple Reynolds numbers and contraction frequencies. Increases in speed and reductions in cost of transport were observed as high as 80% and 50%, respectively. Generally, the net effects were greater for cases involving lower contraction frequencies. Overall, robust duty cycle combinations were determined that led to enhanced or impeded performance.

PMID:34584025 | DOI:10.1088/1748-3190/ac2afe

Open Heart. 2021 Sep;8(2):e001728. doi: 10.1136/openhrt-2021-001728.

ABSTRACT

OBJECTIVE: We investigated the diagnostic performance of semi-quantitative hyperintensity on T2-weighted short-tau-inversion-recovery black-blood (T2W-STIR-BB) images in identifying active cardiac sarcoidosis (CS) in patients, and compared it with that of ¹⁸F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET).

METHODS: This retrospective study included 40 steroid-naive patients (age 63.1±12.9 years, 20 men) diagnosed with CS who underwent both cardiac MRI and FDG-PET imaging. Active CS cases were defined as satisfying at least one of the following criteria for conventional indices: exacerbation of ventricular arrhythmia, newly identified advanced atrioventricular block, greater than 5% decrease in left ventricular ejection fraction on echocardiography, positive finding on gallium-scintigraphy or elevated levels of sarcoidosis-related serum biomarkers. T2W-STIR-BB images were semi-quantitatively analysed using a myocardium-to-spleen ratio (MSR). The diagnostic performance of T2W-STIR-BB and FDG-PET imaging for detecting active CS was investigated.

RESULTS: Thirty-three patients satisfied at least one criterion and were considered as having active CS. Thirty patients (75%) tested positive with T2W-STIR-BB imaging, and 25 patients (63%) tested positive with FDG-PET. The sensitivity, specificity, accuracy, and positive and negative predictive values for identifying active CS by semi-quantitative MSR on T2W-STIR-BB images were 79%, 43%, 73%, 87% and 30%, respectively. These results were statistically comparable to those of FDG-PET (70%, 71%, 70%, 92% and 33%, respectively).

CONCLUSIONS: When using conventional diagnostic indices for active CS as the gold standard, T2W-STIR-BB imaging demonstrated comparable diagnostic performance to that of FDG-PET. The semi-quantitative analysis of high signal intensity on T2W-STIR-BB images using MSR was useful for detection of active CS.

PMID:34583984 | DOI:10.1136/openhrt-2021-001728

Respir Care. 2021 Sep 28:respcare.09130. doi: 10.4187/respcare.09130. Online ahead of print.

ABSTRACT

BACKGROUND: Efficacy of high-flow nasal cannula (HFNC) over noninvasive ventilation (NIV) in severe coronavirus disease 2019 (COVID-19) pneumonia is not known. We aimed to assess the incidence of invasive mechanical ventilation in patients with acute hypoxemic respiratory failure due to COVID-19 treated with either HFNC or NIV.

METHODS: This was a single-center randomized controlled trial performed in the COVID-19 ICU of a tertiary care teaching hospital in New Delhi, India. One hundred and nine subjects with severe COVID-19 pneumonia presenting with acute hypoxemic respiratory failure were recruited and allocated to either HFNC (n = 55) or NIV (n = 54) arm. Primary outcome was intubation by 48 h. Secondary outcomes were improvement in oxygenation by 48 h, intubation rate at day 7, and in-hospital mortality.

RESULTS: Baseline characteristics and P_aO2 /F_IO2 ratio were similar in both the groups. Intubation rate at 48 h was similar between the groups (33% NIV vs 20% HFNC, relative risk 0.6, 95% CI 0.31-1.15, P = .12). Intubation rate at day 7 was lower in the HFNC (27.27%) compared to the NIV group (46.29%) (relative risk 0.59, 95% CI 0.35-0.99, P = .045), and this difference remained significant after adjustment for the incidence of chronic kidney disease and the arterial pH (adjusted OR 0.40, 95% CI 0.17-0.93, P = .03). Hospital mortality was similar between HFNC (29.1%) and NIV (46.2%) group (relative risk 0.6, 95% CI 0.38-1.04, P = .06).

CONCLUSIONS: We were not able to demonstrate a statistically significant improvement of oxygenation parameters nor of the intubation rate at 48 h between NIV and HFNC. These findings should be further tested in a larger randomized controlled trial.The study was registered at the Clinical Trials Registry of India (www.ctri.nic.in; reference number: CTRI/2020/07/026835) on July 27, 2020.

PMID:34584010 | DOI:10.4187/respcare.09130

Cancer Epidemiol Biomarkers Prev. 2021 Sep 28:cebp.0315.2021. doi: 10.1158/1055-9965.EPI-21-0315. Online ahead of print.

ABSTRACT

BACKGROUND: Circulating lipids and insulin-like growth factor 1(IGF-I) have been reliably associated with breast cancer(BCa). Observational studies suggest an interplay between lipids and IGF-I, however, whether these relationships are causal and if pathways from these phenotypes to BCa overlap is unclear.

METHODS: Mendelian Randomisation(MR) was conducted to estimate the relationship between lipids or IGF-I and BCa risk using genetic summary statistics for lipids(low-density lipoprotein cholesterol, LDL-C;high-density lipoprotein cholesterol,HDL-C; triglycerides,TGs), IGF-I and BCa from GLGC/UKBB(N=239,119), CHARGE/UKBB(N=252,547) and BCAC(N=247,173), respectively. Cross-sectional observational and MR analyses were conducted to assess the bi-directional relationship between lipids and IGF-I in SHIP(N=3,812) and UKBB(N=422,389), and using genetic summary statistics from GLGC(N=188,577) and CHARGE/UKBB(N=469,872).

RESULTS: In multivariable MR(MVMR) analyses, the OR for BCa per 1-SD increase in HDL-C or TG was 1.08(95%CI:1.04,1.13) and 0.94(95%CI:0.89,0.98), respectively. The OR for BCa per 1-SD increase in IGF-I was 1.09(95%CI:1.04,1.15). MR analyses suggested a bi-directional TG-IGF-I relationship (TG-IGF-I beta per 1-SD:-0.13;95%CI:-0.23,-0.04;and IGF-I-TG beta per 1-SD:-0.11;95%CI:-0.18,-0.05). There was little evidence for a causal relationship between HDL-C and LDL-C with IGF-I. In MVMR analyses, associations of TG or IGF-I with BCa were robust to adjustment for IGF-I or TG, respectively.

CONCLUSIONS: Our findings suggest a causal role of HDL-C, TG and IGF-I in BCa. Observational and MR analyses support an interplay between IGF-I and TG, however, MVMR estimates suggest that TG and IGF-I may act independently to influence BCa.

IMPACT: Our findings should be considered in the development of prevention strategies for BCa, where interventions are known to modify circulating lipids and IGF-I.

PMID:34583967 | DOI:10.1158/1055-9965.EPI-21-0315

BMJ Glob Health. 2021 Sep;6(9):e006446. doi: 10.1136/bmjgh-2021-006446.

ABSTRACT

Latin America has struggled to control the transmission of COVID-19. Comparison of excess death (ED) rates during the pandemic reveals that Ecuador is among the highest impacted countries. In this analysis, we update our previous findings with the most complete all-cause mortality records available for 2020, disaggregated by sex, age, ethnicity and geography. Our study shows that in 2020, Ecuador had a 64% ED rate (95% CI 63% to 65%) or 64% more deaths than expected. Men had a higher ED rate, 75% (95% CI 73% to 76%), than women’s 51% (95% CI 49% to 52%), and this pattern of higher EDs for men than women held for most age groups. The only exception was the 20-29 age group, where women had 19% more deaths, compared to 10% more deaths for men, but that difference is not statistically significant. The analysis provides striking evidence of the lack of COVID-19 diagnostic testing in Ecuador: the confirmed COVID-19 deaths in 2020 accounted for only 21% of total EDs. Our significant finding is that indigenous populations, who typically account for about 5% of the deaths, show almost four times the ED rate of the majority mestizo group. Indigenous women in each age group have higher ED rates than the general population and, in ages between 20 and 49 years, they have higher ED rates than indigenous men. Indigenous women in the age group 20-29 years had an ED rate of 141%, which is commensurate to the ED rate of indigenous women older than 40 years.

PMID:34583975 | DOI:10.1136/bmjgh-2021-006446

J Nucl Med Technol. 2021 Sep 28:jnmt.121.262759. doi: 10.2967/jnmt.121.262759. Online ahead of print.

ABSTRACT

Rationale: COVID-19 has spread around the world. Its effects go far beyond health care: education has to be conducted so as to prevent infection among students and faculty. Accordingly, changes have occurred in Japan’s educational institutions, including methods related to examinations for nuclear medicine. To assess the quality of training for radiological technologists, we investigated the related changes undertaken at educational institutions. We investigated the lecture format for teaching nuclear medicine technology at Japanese institutions during COVID-19 and also efforts to ensure the quality of conventional education. Methods: We sent a questionnaire to 19 Japanese institutions. It addressed the lecture format and initiatives in examinations for nuclear medicine technology in the first and second semesters of 2020. Results: We obtained responses from 17 institutions. In the first semester of 2020, the lecture format for nuclear medicine technology included remote, hybrid (combination of remote and face-to-face), and video-on-demand lectures. To reinforce the effect of the new teaching formats, institutions adopted various methods, such as enhancing the possibility for students to ask questions, increasing the number of quizzes during lectures, delivering lectures to YouTube, and introducing an e-learning system. In the second semester of 2020, the lecture format included face-to-face, remote, hybrid, and video-on-demand lectures. In that second semester, the number of institutions providing face-to-face lectures while taking thorough measures against infection showed a marked increase. Conclusion: The institutions introduced various educational techniques and initiatives. They prioritized students’ understanding of lecture content and applied what they considered the best teaching methods. Sharing information about the changes adopted at different institutions should help promote good radiological technologists-even during a pandemic.

PMID:34583950 | DOI:10.2967/jnmt.121.262759

Hosp Pediatr. 2021 Sep 28:hpeds.2020-005678. doi: 10.1542/hpeds.2020-005678. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies reveal that ineffective communication contributes to patient-safety events. Structured handoffs improve communication during shift change and transfers from outpatient clinics to emergency departments. We aimed to improve the perceived quality of admission handoffs from a baseline of 22.2% to 50% by the end of the study period through use of a standardized template between urgent care (UC) and inpatient providers.

METHODS: We used quality improvement methodology to identify key themes (clarity in illness severity, organization, completeness, and pace) that contribute to decreased quality communication. A survey to evaluate the perception of communication and key themes between the groups was administered. During the 15-month quality improvement study at a tertiary pediatric institution, we implemented a handoff tool with visual aids. Givers of information received formal training. Participants received iterative performance feedback. A control chart was used to monitor fidelity to the handoff tool. We used statistical analyses to compare changes in perceived communication between provider types before and after implementation of the handoff tool.

RESULTS: Both UC and inpatient providers had an increased rate of positive perceptions in the overall quality of communication after 12 months of using the admission handoff tool (22% vs 67.3%; P = .01). Complete fidelity to the admission handoff tool increased over time. There was no change in mean duration of handoff (4 minutes) after implementing the structured handoff.

CONCLUSIONS: A structured handoff during admission of pediatric patients from an off-site UC to inpatient setting improved the perception of the quality of admission handoff communication.

PMID:34583958 | DOI:10.1542/hpeds.2020-005678

Evid Based Ment Health. 2021 Sep 28:ebmental-2021-300287. doi: 10.1136/ebmental-2021-300287. Online ahead of print.

ABSTRACT

BACKGROUND: The effects of COVID-19 on the shift to remote consultations remain to be properly investigated.

OBJECTIVE: To quantify the extent, nature and clinical impact of the use of telepsychiatry during the COVID-19 pandemic and compare it with the data in the same period of the 2 years before the outbreak.

METHODS: We used deidentified electronic health records routinely collected from two UK mental health Foundation Trusts (Oxford Health (OHFT) and Southern Health (SHFT)) between January and September in 2018, 2019 and 2020. We considered three outcomes: (1) service activity, (2) in-person versus remote modalities of consultation and (3) clinical outcomes using Health of the Nation Outcome Scales (HoNOS) data. HoNOS data were collected from two cohorts of patients (cohort 1: patients with ≥1 HoNOS assessment each year in 2018, 2019 and 2020; cohort 2: patients with ≥1 HoNOS assessment each year in 2019 and 2020), and analysed in clusters using superclasses (namely, psychotic, non-psychotic and organic), which are used to assess overall healthcare complexity in the National Health Service. All statistical analyses were done in Python.

FINDINGS: Mental health service activity in 2020 increased in all scheduled community appointments (by 15.4% and 5.6% in OHFT and SHFT, respectively). Remote consultations registered a 3.5-fold to 6-fold increase from February to June 2020 (from 4685 to a peak of 26 245 appointments in OHFT and from 7117 to 24 987 appointments in SHFT), with post-lockdown monthly averages of 23 030 and 22 977 remote appointments/month in OHFT and SHFT, respectively. Video consultations comprised up to one-third of total telepsychiatric services per month from April to September 2020. For patients with dementia, non-attendance rates at in-person appointments were higher than remote appointments (17.2% vs 3.9%). The overall HoNOS cluster value increased only in the organic superclass (clusters 18-21, n=174; p<0.001) from 2019 to 2020, suggesting a specific impact of the COVID-19 pandemic on this population of patients.

CONCLUSIONS AND CLINICAL IMPLICATIONS: The rapid shift to remote service delivery has not reached some groups of patients who may require more tailored management with telepsychiatry.

PMID:34583940 | DOI:10.1136/ebmental-2021-300287

BMJ. 2021 Sep 28;374:n2134. doi: 10.1136/bmj.n2134.

ABSTRACT

OBJECTIVES: To identify and assess the quality and accuracy of prognostic models for nephropathy and to validate these models in external cohorts of people with type 2 diabetes.

DESIGN: Systematic review and external validation.

DATA SOURCES: PubMed and Embase.

ELIGIBILITY CRITERIA: Studies describing the development of a model to predict the risk of nephropathy, applicable to people with type 2 diabetes.

METHODS: Screening, data extraction, and risk of bias assessment were done in duplicate. Eligible models were externally validated in the Hoorn Diabetes Care System (DCS) cohort (n=11 450) for the same outcomes for which they were developed. Risks of nephropathy were calculated and compared with observed risk over 2, 5, and 10 years of follow-up. Model performance was assessed based on intercept adjusted calibration and discrimination (Harrell’s C statistic).

RESULTS: 41 studies included in the systematic review reported 64 models, 46 of which were developed in a population with diabetes and 18 in the general population including diabetes as a predictor. The predicted outcomes included albuminuria, diabetic kidney disease, chronic kidney disease (general population), and end stage renal disease. The reported apparent discrimination of the 46 models varied considerably across the different predicted outcomes, from 0.60 (95% confidence interval 0.56 to 0.64) to 0.99 (not available) for the models developed in a diabetes population and from 0.59 (not available) to 0.96 (0.95 to 0.97) for the models developed in the general population. Calibration was reported in 31 of the 41 studies, and the models were generally well calibrated. 21 of the 64 retrieved models were externally validated in the Hoorn DCS cohort for predicting risk of albuminuria, diabetic kidney disease, and chronic kidney disease, with considerable variation in performance across prediction horizons and models. For all three outcomes, however, at least two models had C statistics >0.8, indicating excellent discrimination. In a secondary external validation in GoDARTS (Genetics of Diabetes Audit and Research in Tayside Scotland), models developed for diabetic kidney disease outperformed those for chronic kidney disease. Models were generally well calibrated across all three prediction horizons.

CONCLUSIONS: This study identified multiple prediction models to predict albuminuria, diabetic kidney disease, chronic kidney disease, and end stage renal disease. In the external validation, discrimination and calibration for albuminuria, diabetic kidney disease, and chronic kidney disease varied considerably across prediction horizons and models. For each outcome, however, specific models showed good discrimination and calibration across the three prediction horizons, with clinically accessible predictors, making them applicable in a clinical setting.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020192831.

PMID:34583929 | DOI:10.1136/bmj.n2134