Category: Nevin Manimala

IEEE Trans Neural Netw Learn Syst. 2021 Aug 23;PP. doi: 10.1109/TNNLS.2021.3104896. Online ahead of print.

ABSTRACT

This article proposes a simple yet powerful ensemble classifier, called Random Hyperboxes, constructed from individual hyperbox-based classifiers trained on the random subsets of sample and feature spaces of the training set. We also show a generalization error bound of the proposed classifier based on the strength of the individual hyperbox-based classifiers as well as the correlation among them. The effectiveness of the proposed classifier is analyzed using a carefully selected illustrative example and compared empirically with other popular single and ensemble classifiers via 20 datasets using statistical testing methods. The experimental results confirmed that our proposed method outperformed other fuzzy min-max neural networks (FMNNs), popular learning algorithms, and is competitive with other ensemble methods. Finally, we identify the existing issues related to the generalization error bounds of the real datasets and inform the potential research directions.

PMID:34424848 | DOI:10.1109/TNNLS.2021.3104896

Am J Trop Med Hyg. 2021 Aug 23:tpmd201505. doi: 10.4269/ajtmh.20-1505. Online ahead of print.

ABSTRACT

Hydatidosis is a zoonosis of worldwide distribution with endemic areas in Argentina. The present epidemiological study was conducted to explore the presence of cystic echinococcosis in the rural community of Los Bordos (population 99), in the northern province of La Rioja, Argentina, during March 2018. The study included the search for cysts by abdominal ultrasound and a survey on family risk. Sixty-seven people agreed to undergo ultrasound examination, and five adults showed images compatible with hydatic cysts (7.5% prevalence). A family survey was applied to 29 households (78%), stratifying 24 families (83%) as high risk (95% confidence interval = 64.2-94.1) and 5 (17%) as low risk (95% confidence interval = 5.8-55.7) of transmission of the disease, respectively. The values were statistically different by the McNemar test. The goal of the present study, the first study of its kind in La Rioja, was to assess the family risk of echinococcosis among subjects with ultrasound images compatible with cystic echinococcosis.

PMID:34424861 | DOI:10.4269/ajtmh.20-1505

Sci Prog. 2021 Jul-Sep;104(3):368504211029793. doi: 10.1177/00368504211029793.

ABSTRACT

Strong lockdowns to control COVID-19 pandemic have been enforced globally and strongly restricted social activities with consequent negative effects on mental health. Japan has effectively implemented a unique voluntary policy to control COVID-19, but the mental health impact of the policy has not been examined on a large scale. In this study, we examined the effect of the first declaration on the mental health of affected residents. We used population-level questionnaire data of 17,400 people living under the state of emergency and 9208 who were not through a social-networking-service app and applied a difference-in-differences regression model to estimate the causal effect of the declaration of the state of emergency on psychological wellbeing, stratified by job category. No statistically significant effect of the declaration was observed among all job categories. This suggests that residents’ psychological situation has gradually changed, possibly influenced by other factors such as the surrounding environment, rather than the declaration itself. Given that Japan has a unique policy to control COVID-19 instead of a strict lockdown, our results showed the Japanese-style policy may serve as a form of harm reduction strategy, to control the epidemic with minimal psychological harm, and enable a policy that balances disease control and mental health. Caution is necessary that this study used self-reported data from a limited time period before and after the first declaration in April 2020.

PMID:34424792 | DOI:10.1177/00368504211029793

Can J Psychiatry. 2021 Aug 23:7067437211037125. doi: 10.1177/07067437211037125. Online ahead of print.

ABSTRACT

OBJECTIVE: Child and youth mental health problems are often assessed by parent self-completed checklists that produce dimensional scale scores. When converted to binary ratings of disorder, little is known about their psychometric properties in relation to classifications based on lay-administered structured diagnostic interviews. In addition to estimating agreement, our objective is to test for statistical equivalence in the test-retest reliability and construct validity of two instruments used to classify child emotional, behavioural, and attentional disorders: the 25-item, parent completed Ontario Child Health Study Emotional Behavioural Scales-Brief Version (OCHS-EBS-B) and the Mini International Neuropsychiatric Interview for Children and Adolescents-parent version (MINI-KID-P).

METHODS: This study draws on independent samples (n = 452) and uses the confidence interval approach to test for statistical equivalence. Reliability is based on kappa (κ). Construct validity is based on standardized beta coefficients (β) estimated in structural equation models.

RESULTS: The average differences between the MINI-KID-P and OCHS-EBS-B in κ and β were -0.022 and -0.020, respectively. However, in both instances, criteria for statistical equivalence were met in only 5 of 12 comparisons. Based on κ, between-instrument agreement on the classifications of disorder went from 0.481 (attentional disorder) to 0.721 (emotional disorder) but were substantially higher (0.731 to 0.895, respectively) when corrected for attenuation due to measurement error.

CONCLUSIONS: Although falling short of equivalence, the results suggest on balance that the reliability and validity of the two instruments for classifying child psychiatric disorder assessed by parents are highly comparable. This conclusion is supported by the high levels of agreement between the instruments after correcting for attenuation due to measurement error.

PMID:34424799 | DOI:10.1177/07067437211037125

J Laparoendosc Adv Surg Tech A. 2021 Aug 23. doi: 10.1089/lap.2020.0812. Online ahead of print.

ABSTRACT

Purpose: We performed a retrospective study to determine the effectiveness and feasibility of articulating linear stapler in laparoscopic total splenectomy (LTS) and laparoscopic partial splenectomy (LPS), focusing on technical laparoscopic skills that could help pediatric surgeons to avoid intra- and postoperative complications. Methods: Retrospective cohort study of children younger than 18 years who underwent laparoscopic spleen surgery between January 2008 and March 2020. Age, sex, indication for surgery, operative time (OT), intra- and postoperative complications, and postoperative length of hospital stay (LHS) were analyzed. Data from parenchymal resection and vessels sealing techniques were obtained. Results: Thirty patients, 19 LTS and 11 LPS, were included. The mean age of the patients was 10.9 years, and 16 patients were male and 14 were female. For hematologic diseases, LTS was the elective surgery, associated with cholecystectomy in 5 cases. LPS was the common procedure for splenic cysts. The stapler was used in LTS to close the hilum vessels and in LPS for parenchymal resection. No statistically significant differences in OT were observed comparing LTS and LPS. Two conversions occurred in LTS; none in LPS. The mean LHS was 6 days in both groups. No recurrence or major complications appeared in both groups at 1-12 years of follow-up. In particular for LPS, there are no relapse of cyst neither reduction in splenic function. Conclusions: This study shows the effectiveness, feasibility, and safety of mechanic stapler in splenic surgery both for hilum vessels sealing and for parenchymal resection. The use of this device can reduce risk of hemorrhagic recurrences or major surgical complications improving the safety of the operation.

PMID:34424747 | DOI:10.1089/lap.2020.0812

J Palliat Med. 2021 Aug 23:1-9. doi: 10.1089/jpm.2021.0121. Online ahead of print.

ABSTRACT

Background: Early, high-quality advance care planning discussions are essential for supporting goal-concordant care among glioblastoma (GBM) patients. Objective: Using mixed methods, we sought to characterize current serious illness (SI) communication practices at our institution. Methods: The electronic medical records of 240 deceased GBM patients cared for at the Abramson Cancer Center in Philadelphia, PA between 2017 and 2019 were systematically reviewed for documented SI conversations about four domains: prognosis, goals, end-of-life planning, and code status. Patient outcomes and SI conversation characteristics were analyzed using descriptive statistics. Standardized interviews about GBM care were held with five clinicians. Interview transcripts were analyzed using grounded-theory coding to identify emergent themes. Results: Nearly all patients (96%) had at least one documented SI conversation (median: 4, interquartile range [IQR] 2-7), mostly outpatient with medical oncology physicians. Median timing of first SI conversation was 360 days before death. SI conversations were not significantly associated with patient outcomes, including inpatient death and hospice enrollment. Seven themes emerged from clinician interviews: balancing hope and reality, anticipatory guidance, neglect of the “big picture,” need for earlier conversations, care coordination, the role of clinical expertise, and communication training. Conclusion: SI conversations were documented early and often in our sample, but their quality was difficult to assess. Contrary to our quantitative findings, interviewees reported that SI conversations were late, infrequent, inadequate, and fragmented across specialties, failing to explore critical issues such as prognosis and functional decline.

PMID:34424777 | DOI:10.1089/jpm.2021.0121

Am J Hum Biol. 2021 Aug 23:e23670. doi: 10.1002/ajhb.23670. Online ahead of print.

ABSTRACT

OBJECTIVES: Connecting traits to biological pathways and genes relies on stable observations. Researchers typically determine traits once, expecting careful study protocols to yield measurements free of noise. This report examines that expectation with test-retest repeatability analyses for traits used regularly in research on adaptation to high-altitude hypoxia, often in settings without climate control.

METHODS: Two hundred ninety-one ethnic Tibetan women residing from 3500 to 4200 m in Upper Mustang District, Nepal, provided three observations of hemoglobin concentration, percent of oxygen saturation of hemoglobin, and pulse by noninvasive pulse oximetry under conditions designed to minimize environmental noise.

RESULTS: High-intraclass correlation coefficients and low within-subject coefficients of variation reflected consistent measurements. Percent of oxygen saturation had the highest intraclass correlation coefficient and the smallest within-subject coefficient of variability; measurement noise occurred mainly in the lower values. Hemoglobin concentration and pulse presented slightly higher within-subject coefficients of variation; measurement noise occurred across the range of values. The women had performed the same measurements 7 years earlier using the same devices and protocol. The sample means and SD observed across 7 years differed little. Hemoglobin concentration increased substantially after menopause.

CONCLUSIONS: Analyzing repeatability features of traits may improve our interpretation of statistical analyses and detection of variation from measurement or biology. The high levels of measurement repeatability and biological stability support the continued use of these robust traits for investigating human adaptation in this altitude range.

PMID:34424596 | DOI:10.1002/ajhb.23670

Clin Implant Dent Relat Res. 2021 Aug 22. doi: 10.1111/cid.13044. Online ahead of print.

ABSTRACT

BACKGROUND: Immediate implant placement (IIP) associated with the use of bone substitutes and collagen matrices (CM) seems to reduce the amount of resorption at peri-implant areas. Recently, customized healing abutments (CA) appeared as another solution in order to seal the socket and preserve the original soft tissue contour.

PURPOSE: To evaluate peri-implant tissues dimensional changes after using customized healing abutments compared with the use of xenogeneic collagen matrices as socket sealing options in flapless maxillary immediate implant placement.

MATERIAL AND METHODS: The present study was designed as a prospective, randomized, controlled clinical trial. Patients were allocated into two groups depending on the socket sealing option: in the CM group a collagen matrix was used and in the CA group a customized abutment. Digital impressions were taken prior to extraction, 1, 4, and 12 months after implant insertion and the digital files allowed to evaluate linear buccal changes (MBC) and the buccal volumetric variation (BVv) between the different time points at peri-implant tissue areas. Additionally, mucosa variation was computed assessing the papilla presence and the midfacial mucosa height. Statistical significance was set at 0.05.

RESULTS: Twenty-eight patients were observed during a 12-month period. Significant differences between mean values of BVv at the first month were observed at the CM and CA group (-9.75 ± 6.65% and -4.76 ± 5.29%, respectively) (p = 0.043). At the 1-year follow-up, no significant differences were found in terms of BVv between the two groups, although the thin bone phenotype (≤1 mm) significantly influenced the volumetric variations that occurred in each group. No significant differences were noticed in midfacial mucosa and papillae alteration between groups, after 1 year of treatment.

CONCLUSION: Both treatment options are predictable solutions for socket sealing in IIP, although a higher volumetric variation can be expected in the presence of thin bone phenotypes.

PMID:34423560 | DOI:10.1111/cid.13044

J Cosmet Dermatol. 2021 Aug 22. doi: 10.1111/jocd.14390. Online ahead of print.

ABSTRACT

BACKGROUND: Major epidemic outbreaks create an increased demand for healthcare workers (HCWs) and pose increased health risk and psychological distress to them as well.

AIM: The aim of this cross sectional study was to find out the prevalence of depression, anxiety and stress among Egyptian dermatologists and their possible predictor factors.

PATIENTS/METHODS: A cross sectional study was designed and data were collected using structured self-administered online depression, anxiety, and stress scale (DASS-21).

RESULTS: The depression scale of DASS was 18.98 ± 9.56 among which 38% of dermatologists had either severe or extremely severe depression and 34.2% complained of moderate depression. Meanwhile, the anxiety scale was 12.92 ± 7.75 and 35.4 % of surveyed dermatologists had either severe or extremely severe anxiety. Thirty three percent of dermatologists were normal on stress score. Female dermatologists possessed more significant depression and stress than males (19.70 ± 9.71 vs. 16.62 ± 8.68, p = 0.003; 21.42 ± 9.53 vs. 17.40 ± 8.49, p <0.001 respectively). On the contrary, male dermatologists expressed more anxiety than female dermatologists however this was not statistically significant (13.26 ± 7.99 vs. 12.82 ± 7.69, p = 0.625).

CONCLUSION: To our knowledge, this is the first study to explore the differential impacts of the COVID-19 pandemic on Egyptian dermatologists. Mental health care and support are of extreme importance to physicians mid this pandemic.

PMID:34423565 | DOI:10.1111/jocd.14390

Clin Teach. 2021 Aug 22. doi: 10.1111/tct.13411. Online ahead of print.

ABSTRACT

BACKGROUND: The Clinical Teacher Training (CTT) programme was originally developed as an interprofessional, blended learning programme, to support health professionals working across health services within Australia, although it has also been delivered internationally. With the disruption of COVID-19, we rapidly moved to ‘online only’ delivery. We sought to modify the programme, ensuring that the constructivist paradigms important for our learner experience through the original blended format were maintained in the online platform.

APPROACH: Consisting of 10 modules on a range of topics, the new CTT online only programme was facilitated online across 6 weeks with asynchronous and synchronous assessable activities, and provision of peer and facilitator feedback. The learning outcomes for each module were similar to the ‘blended learning’ format. The new programme was delivered three times throughout 2020 and completed by a total of 208 health professionals from across 10 metropolitan and rural health districts.

EVALUATION: The focus of our evaluation was on the programme’s final 2020 iteration, for which we had ethics approval. Participants (n = 59) were from diverse health professions, across five metropolitan and rural health districts. We prioritised the learner experience in constructing our evaluation strategy. Quantitative and qualitative data were collected by post-course questionnaire and analysed using descriptive statistics and thematic analysis. Twenty participants (34%) responded to the post-course questionnaire. Participants valued the structure, topics, clear outcomes, timeframe, online resources, small group activities, feedback and the flexibility and accessibility afforded by online only delivery. However, participants identified a need for additional ‘real-time’ engagement in activities. Faculty were surprised by the time required to adequately facilitate online learning, and similarly, valued the real-time interactions.

IMPLICATIONS: The online only CTT programme provided an excellent, scalable framework to ensure continued provision of a relevant and accessible training resource for clinicians working in metropolitan and regional/rural health services. Learner-reported achievement of programme learning outcomes was not negatively impacted by online only delivery. Balancing these resource advantages with learner preferences and our desire to build active teaching networks, we will continue to host the majority of the programme online, while offering short face-to-face sessions within local contexts.

PMID:34423533 | DOI:10.1111/tct.13411