Category: Nevin Manimala

Am J Perinatol. 2021 May 3. doi: 10.1055/s-0041-1727167. Online ahead of print.

ABSTRACT

OBJECTIVE: The study aimed to examine the incidence of hypertensive disorders of pregnancy in women diagnosed with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2, also known as COVID-19).

STUDY DESIGN: This was a retrospective cohort study of all women who delivered at MedStar Washington Hospital Center in Washington, DC from April 8, 2020 to July 31, 2020. Starting April 8, 2020, universal testing for COVID-19 infection was initiated for all women admitted to labor and delivery. Women who declined universal testing were excluded. Hypertensive disorders of pregnancy were diagnosed based on American College of Obstetricians and Gynecologists Task Force definitions.1 Maternal demographics, clinical characteristics, and labor and delivery outcomes were examined. Neonatal outcomes were also collected. Laboratory values from admission were evaluated. Our primary outcome was the incidence of hypertensive disorders of pregnancy among women who tested positive for COVID-19. The incidence of hypertensive disorders of pregnancy was compared between women who tested positive for COVID-19 and women who tested negative.

RESULTS: Of the 1,008 women included in the analysis, 73 (7.2%) women tested positive for COVID-19, of which 12 (16.4%) were symptomatic at the time of admission. The incidence of hypertensive disorders of pregnancy was 34.2% among women who tested positive for COVID-19 and 22.9% women who tested negative for COVID-19 (p = 0.03). After adjusting for race, antenatal aspirin use, chronic hypertension, and body mass index >30, the risk of developing any hypertensive disorder of pregnancy was not statistically significant (odds ratio: 1.58 [0.91-2.76]).

CONCLUSION: After adjusting for potential confounders, the risk of developing a hypertensive disorder of pregnancy in women who tested positive for COVID-19 compared with women who tested negative for COVID-19 was not significantly different.

KEY POINTS: · There is an increased incidence of hypertensive disorders in women who test positive for COVID-19.. · Characteristics of pregnant women with COVID-19 are similar to those with hypertensive disorders.. · Liver function tests were similar between pregnant women with COVID-19 and women without COVID-19..

PMID:33940651 | DOI:10.1055/s-0041-1727167

Clin Imaging. 2021 Apr 29;79:125-132. doi: 10.1016/j.clinimag.2021.04.013. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: To evaluate the diagnostic performance of abbreviated MRI (AB-MRI) in comparison to a full protocol MRI (FP-MRI) when evaluating common MRI abnormalities of a mass, non-mass enhancement and focus.

MATERIALS AND METHODS: This retrospective reader study was Institutional Review Board approved and Health Insurance Portability and Accountability Act (HIPAA) compliant. AB-MRIs were reviewed from May 2018-December 2019 to identify women with an abnormal AB-MRI, FP-MRI within six months of the AB-MRI and an elevated risk for breast cancer. Six breast radiologists initially interpreted and recorded findings from the AB-MRI. Immediately after reviewing the AB-MRI, the same radiologists interpreted and recorded findings from the FP-MRI. Findings were recorded in an electronic data collection form. Cohen’s Kappa test was used to calculate agreement. P < 0.05 was considered statistically significant.

RESULTS: Of 119 patients who had an AB-MRI, our final study comprised of 32 patients who had 64 breast MRIs (32 AB-MRI and 32 FP-MRI). The amount of fibroglandular tissue for AB-MRI and FP-MRI showed excellent intra-reader agreement [Kappa: 0.89-1.00 (P < 0.0001)]. Substantial to excellent intra-reader agreement [Kappa: 0.74-0.93 (P < 0.0001)] was demonstrated for all 6 readers when identifying abnormalities seen on AB-MRI and FP-MRI. Moderate to excellent intra-reader agreement [Kappa: 0.41-0.87(P < 0.0001)] was demonstrated between the AB-MRI and FP-MRI for the final BI-RADS assessment.

CONCLUSION: AB-MRI has acceptable intra-reader agreement with FP-MRI when characterizing common MRI abnormalities such as a mass, non-mass enhancement and focus suggesting that subsequent FP-MRI may not be needed.

PMID:33940489 | DOI:10.1016/j.clinimag.2021.04.013

Clin Imaging. 2021 Apr 29;79:136-141. doi: 10.1016/j.clinimag.2021.04.028. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the current study was to classify and analyze trends in lumbar disc degeneration across age, sex, and disc level using weightbearing kinematic MRI.

MATERIALS AND METHODS: Between January 2019 and July 2019, 1198 cases were retrospectively analyzed with kinematic MRI. Patients were divided into 5 groups based on age (20-29, 30-39, 40-49, 50-59, and 60+) and evaluated using the Pfirrmann classification to assess for disc degeneration at 5 vertebral levels: L1/2, L2/3, L3/4, L4/5, and L5/S1. Trends in degeneration were analyzed with regression and time series.

RESULTS: The L5/S1 vertebral disc had the highest prevalence of severe degeneration across all age groups. The most common multi-level degeneration combinations were L4/5 and L5/S1 for two levels and L3/4, L4/5, and L5/S1 for three levels. All vertebral levels showed significant difference in mean Pfirrmann grade among the age groups (p < 0.001 at all levels). Statistically significant differences in mean Pfirmmann grade among males and females were found only in ages 20-29 and 30-39, in which males showed more degeneration.

CONCLUSION: Our findings using kinematic MRI demonstrate that degeneration increases with age and is most severe in the L5/S1 disc. In multi-level degeneration the most prevalent combinations are those that are contiguous and include L5/S1. Young males were more likely to have degeneration than young females, but there was no significant difference from the fifth decade of life on.

PMID:33940491 | DOI:10.1016/j.clinimag.2021.04.028

Radiat Prot Dosimetry. 2021 May 3:ncab066. doi: 10.1093/rpd/ncab066. Online ahead of print.

ABSTRACT

The purpose of the present work was to evaluate the use of resampling statistical methods for analysis of visual grading data-implemented in the software VGC Analyzer-by comparing the reanalyzed results from previously performed visual grading studies with the results calculated by gold standard receiver operating characteristic (ROC) methodology, Obuchowski-Rockette (OR)-Dorfman-Berbaum-Metz (DBM) multiple-readers and multiple-case (MRMC) and by analysis of simulated visual grading data where the true distribution was presumed to be known. The reanalysis was performed on two multiple-reader studies with non-paired data and paired data, respectively. The simulation study was performed by simulating a large number of visual grading characteristics (VGC) studies and by analyzing the statistical distribution of null hypothesis (H0) rejection rate. The comparison with OR-DBM MRMC showed good agreement when analyzing non-paired data for both fixed-reader and random-reader settings for the calculated area under the curve values and the confidence intervals (CIs). For paired data analysis, VGC Analyzer showed significantly lower CIs compared with the ROC software. This effect was also illustrated by the simulation study, where the VGC Analyzer, in general, showed good accuracy for simulated studies with stable statistical basis. For simulated studies with unstable statistics, the accuracy in the H0 rejection rate decreased. The present study has shown that resampling methodology can be used to accurately perform the statistical analysis of a VGC study, although the resampling technique used makes the method sensitive to small data sets.

PMID:33940628 | DOI:10.1093/rpd/ncab066

Clin Biomech (Bristol, Avon). 2021 Apr 27;85:105364. doi: 10.1016/j.clinbiomech.2021.105364. Online ahead of print.

ABSTRACT

BACKGROUND: Pes planovalgus is common in children with cerebral palsy. Although severity influences treatment, there still lacks standard clinical measurements to objectively quantify pes planovalgus in this population. The comparison of pedobarographic data and radiographic measurements to clinical evaluation has not been reported in this population.

METHODS: 395 feet were identified from a population of ambulatory pediatric patients with cerebral palsy. Each patient initially underwent clinical evaluation by an experienced physical therapist who classified feet as: 136 controls, 116 mild, 100 moderate, and 43 severe pes planovalgus. Quantitative measurements were then calculated from antero-posterior and lateral radiographs of the foot. Pedobarographic analysis included the arch index, center of pressure index, and a newly defined medial index.

FINDINGS: A multivariate analysis was performed on the radiographic and pedobarographic measurements collected. It identified seven variables that improved objective classification of pes planovalgus severity when utilized together. These include the foot progression angle, initial contact force, arch index, medial index, antero-posterior talonavicular coverage, lateral calcaneal pitch and lateral Meary’s angle. While the lateral calcaneal pitch angle statistically differed amongst all severity classes, no pedobarographic value statistically differed between all severity classes.

INTERPRETATION: Overall, the combination of radiographic and pedobarographic measurements provides valuable information for objectively classifying severity of pes planovalgus in children with cerebral palsy by utilizing these values together rather than independently. In a clinical setting, radiographs and pedobarographic data may be obtained to enhance assessment of severity and guide treatment.

PMID:33940478 | DOI:10.1016/j.clinbiomech.2021.105364

Nurse Educ Today. 2021 Apr 24;102:104930. doi: 10.1016/j.nedt.2021.104930. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to compare the effect of question-answer and Kahoot method reinforcement on nursing students’ success and motivation levels.

MATERIALS AND METHODS: This quasi-experiment study was carried out with 65 students studying at the nursing department at a state university in Turkey. The research data were obtained between November 2019 and February 2020. The study sample was divided into two groups as question-answer and Kahoot. In the first stage of the research, 8 h of training were given to all 65 students on the subject “Infection Control and Precautions,” applying the method of teaching by presentation. Shortly after the training, the Kahoot group was reinforced on the Kahoot platform and the Question-answer group in PowerPoint, using the same questions for 30 min. In the second stage of the study, one day after the training, “Student Information Form” and “Instructional Materials Motivation Scale” were filled out, and “Achievement Test 1” was implemented. In the third stage, “Achievement Test 2” was executed two months after the training to test longer term knowledge retention.

RESULTS: The Kahoot group students had a score of 66.63 ± 11.02 in the “Achievement Test 1” and 67.76 ± 15.62 in the question-answer group. It was determined that the total score average of the students in the Kahoot group “Achievement Test 2” was 51.25 ± 13.42, and the students in the question-answer group were 47.03 ± 12.61. Accordingly, there was no statistically significant difference between the “Achievement Test 1” and “Achievement Test 2” mean scores of the students in the question-answer and Kahoot group (p > 0.05). The total score average of the question-answer group for “Instructional Materials Motivation Scale” was 127.88 ± 13.64, while the Kahoot group was 126.28 ± 16.88. It was determined that there was no statistically significant relationship between the “Achievement Test 1”, “Achievement Test 2” and the “Instructional Materials Motivation Scale” total score and sub-dimensions of the students in the Question-Answer group and Kahoot group (p > 0.05).

CONCLUSION: In the study analyzing the effect of reinforcement by the question-answer or Kahoot method on nursing students’ success and motivation levels, it was concluded that no method was superior.

PMID:33940482 | DOI:10.1016/j.nedt.2021.104930

J Exp Child Psychol. 2021 Apr 30;209:105168. doi: 10.1016/j.jecp.2021.105168. Online ahead of print.

ABSTRACT

There is considerable controversy regarding the accuracy and suggestibility of children’s autobiographical memory for emotionally salient life events. Attachment perspectives of autobiographical memory development identify the attachment security of parent-child dyads and parents’ emotional support and coherence during reminiscing with their children as critical mechanisms underlying children’s memory accuracy and suggestibility. In the current investigation, 72 preschool-aged children (M = 4.01 years, SD = 0.85; 44 female) reminisced with their parents about times they felt happy, sad, scared, and angry. Children were then independently interviewed about these experiences by an unfamiliar researcher using free recall, specific questions (i.e., questions about factual details), and misleading questions (i.e., questions suggesting false details). Parents completed an assessment of their children’s attachment security within the parent-child relationship. Results revealed significant indirect effects of parent-child attachment security on children’s memory accuracy through parental sensitive guidance during reminiscing when cognitive (i.e., intelligence) and behavioral (i.e., temperament, behavior problems) covariates were statistically controlled. Parent-child attachment security was positively associated with parental sensitive guidance during reminiscing, which, in turn, was positively associated with the accuracy of children’s independent reports. The findings support attachment perspectives of autobiographical memory by identifying emotionally sensitive and coherent reminiscing as a parenting behavior that explains in part associations between parent-child attachment security and children’s independent memory accuracy for emotional life events.

PMID:33940484 | DOI:10.1016/j.jecp.2021.105168

Sci Total Environ. 2021 Apr 16;785:147134. doi: 10.1016/j.scitotenv.2021.147134. Online ahead of print.

ABSTRACT

To evaluate the evolution of river water quality in a changing environment, measuring the objective water quality is critical for understanding the rules of river water pollution. Based on the sample entropy theory and a nonlinear statistical method, this study aims to identify the spatiotemporal dynamics of water quality and its complexity in the Yangtze River basin using time series data, to separate the contributions of human activity and climate change to water quality, and to establish a data-driven risk assessment framework for the spatial (potential risk) and temporal (direct risk) aspects of water pollution. The results demonstrate that the spatiotemporal dynamics of water quality and sample entropy in each monitoring section are closely related to the characteristics of the corresponding location. The water quality of the main stream is superior, and its complexity is less than that of the tributaries. Cascade reservoir operation and vegetation status, agricultural production, and rainfall patterns exert great influences in the upper, middle, and lower reaches, respectively. Dam construction, urban agglomeration development, and interactions between river and lake are also influencing factors. An attributional analysis found that climate change and human activities negatively contributed to the evolution of NH₃-N concentration in most of the monitored sections, and the average relative contribution rates of human activities to changes in water quality in the main and tributary streams were -55.46% and -48.49%, respectively. In addition, the construction of data-driven risk assessment framework can efficiently and accurately assess the potential and direct water pollution risks of rivers.

PMID:33940408 | DOI:10.1016/j.scitotenv.2021.147134

Sci Total Environ. 2021 Apr 26;785:147324. doi: 10.1016/j.scitotenv.2021.147324. Online ahead of print.

ABSTRACT

Despite the growing interest in energy-efficient homes (EEHs), there is still a lack of evidence regarding whether the mechanical ventilation system of an EEH positively or negatively impacts indoor air quality (IAQ) and the health and wellbeing of occupants. This study aimed to evaluate the IAQ level and daily health symptoms of adults and children living in EEHs compared to conventional buildings over the course of one year. A two-way mixed analysis of variance was conducted to compare the level of IAQ between the two housing types. A binomial generalized linear mixed model (GLMM) and generalized additive mixed model was developed to investigate the association between IAQ and daily risks of symptoms. Differences in the daily prevalence of symptoms between the two housing types were assessed using a Poisson GLMM model. Overall, the indoor concentrations of particulate matter (PM₁₀ and PM_2.5), carbon dioxide (CO₂), and volatile organic compounds (VOCs) were lower in EEH after controlling for seasonality. The indoor temperature and relative humidity level were relatively constant in the EEH. We also found that an increased level of indoor air quality parameters, particularly CO_2, which is closely related to the indoor ventilation rate, was associated with the daily risk of eye fatigue, allergic rhinitis, and atopic dermatitis symptoms. Considering that EEH effectively reduced indoor air pollutants and IAQ improvement was associated with a reduction in the risk of individual symptoms, the IAQ improvement of EEH may have positively impacted occupants’ health. Symptoms such as eye fatigue and skin dryness, which have been reported in previous studies as potential side effects of mechanical ventilation, were reported in this study; however, they were not found to be statistically significantly different from those reported in the conventional building.

PMID:33940416 | DOI:10.1016/j.scitotenv.2021.147324

Eur J Obstet Gynecol Reprod Biol. 2021 Apr 24;261:144-147. doi: 10.1016/j.ejogrb.2021.04.031. Online ahead of print.

ABSTRACT

Randomized controlled trials (RCTs) are a cornerstone for the assessment of the effectiveness of interventions. Appropriate randomization, design, sample size, statistical analyses, and conduct that reduces the risk of bias, enhance the chance they will deliver true research findings. The credibility of RCTs is difficult to assess without objective evidence of compliance with Good Clinical Practice standards. Remarkably, no mechanisms are in place both in the initial peer review process and during meta-analysis to assess these, and little guidance on how to assess data where research integrity cannot be confirmed (e.g. where data originated from a setting without established infrastructure or an era preceding current standards). We describe the case of the use of antenatal steroids. When these drugs are used in early preterm birth, their benefits outweigh the harms. However, later in pregnancy, and specifically at term, this balance is less clear. We describe that the four randomised clinical trials that inform clinical practice through the Cochrane meta-analysis, for various reasons, lack clear governance which makes it difficult to verify provenance and reliability of the data. We conclude that transparency and assessment of data credibility need to be inbuilt both at the time of publication and at the time of meta-analysis. This will drive up standards and encourage appropriate interpretation of results and the context from which they were derived.

PMID:33940424 | DOI:10.1016/j.ejogrb.2021.04.031