Nevin Manimala

Cancer Med. 2021 Jun 15. doi: 10.1002/cam4.4077. Online ahead of print.

ABSTRACT

BACKGROUND: Sexual health (SH) is an important concern for adolescents and young adults (AYAs). This study determined current SH communication practices, barriers, and additional resources needed among pediatric oncology clinicians who treat AYAs.

METHODS: A cross-sectional survey was developed by the Children’s Oncology Group (COG) AYA Committee and sent to pediatric oncologists (n = 1,987; 85.9%) and advanced practice providers (APPs, n = 326; 14.1%) at 226 COG institutions. Responses were tabulated and compared using tests of proportion and trend.

RESULTS: The sample comprised 602 respondents from 168 institutions and was proportionally representative (468 oncologists [77.7%], 76 APPs [12.6%], 58 unidentified [9.6%]; institutional and provider response rates 74.3% and 26.2%, respectively). Almost half of respondents (41.7%) reported no/small role in SH care. Medical topics were discussed most often, including contraception (67.2%), puberty (43.5%), and sexual activity (37.5%). Topics never/rarely discussed included gender identity (64.5%), sexual orientation (53.7%), and sexual function (50.3%). Frequently cited communication barriers included lack of time, low priority, perceived patient discomfort, and the presence of a parent/guardian. Respondents endorsed the need for further education/resources on sexual function (66.1%), gender identity/sexual orientation (59.5%), and body image (46.6%). Preferred education modalities included dissemination of published guidelines (64.7%), skills training modules (62.9%), and webinars (45.3%). By provider type, responses were similar overall but differed for perception of role, barriers identified, and resources desired.

CONCLUSIONS: Many pediatric oncology clinicians play minimal roles in SH care of AYAs and most SH topics are rarely discussed. Provider-directed education/training interventions have potential for improving SH care of AYA cancer patients.

PMID:34128352 | DOI:10.1002/cam4.4077

Acta Ophthalmol. 2021 Jun 14. doi: 10.1111/aos.14926. Online ahead of print.

ABSTRACT

Preservative-free topical medications have been introduced for glaucoma care to reduce ocular adverse events associated with preservatives. This is a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing the efficacy and safety of beta-blockers, or combination using beta-blockers, with and without preservatives. PubMed, EMBASE and Web of Science were examined. Risk of bias was assessed using the Cochrane Handbook for Systematic Reviews. The primary outcome was change in intraocular pressure (IOP) from baseline to final follow-up. Secondary outcomes included ocular and systemic side effects, and other clinical and quality of life outcomes. Of 242 records identified, seven RCTs (1125 patients) were included. The follow-up period ranged from one to 12 months. Timolol was used in five studies, and two studies used a combination (timolol with bimatoprost or dorzolamide). The difference in mean change (MD) in IOP between the preservative-free and the preserved drugs was statistically significant but not clinically relevant: (MD 0.29 mmHg, 95% confidence interval 0.07-0.51 mmHg, p = 0.010; moderate-certainty evidence). Regarding adverse events: Level of evidence for all ocular surface outcome was low or very low and reported in few studies. No significant difference was observed on ocular surface symptoms. Tear break-up time (TBUT) was better with preservative-free drops (p < 0.001). Schirmer’s test was better in the preservative-free group (p < 0.001). Level of evidence for all ocular surface outcomes was low or very low. There was no difference in other secondary outcomes. We found no clinically relevant difference in mean change in IOP between the preserved and the preservative-free treatments. Data on adverse events used different methods and were incompletely reported. Although some measures of ocular surface health favoured preservative-free medications, more evidence is needed. The increasing use of preservative-free drops may be associated with better ocular surface and tolerability, but strong evidence from RCTs would be welcome.

PMID:34128326 | DOI:10.1111/aos.14926

Stat Med. 2021 Jun 14. doi: 10.1002/sim.9095. Online ahead of print.

ABSTRACT

As the availability of real-world data sources (eg, EHRs, claims data, registries) and historical data has rapidly surged in recent years, there is an increasing interest and need from investigators and health authorities to leverage all available information to reduce patient burden and accelerate both drug development and regulatory decision making. Bayesian meta-analytic approaches are a popular historical borrowing method that has been developed to leverage such data using robust hierarchical models. The model structure accounts for various degrees of between-trial heterogeneity, resulting in adaptively discounting the external information in the case of data conflict. In this article, we propose to integrate the propensity score method and Bayesian meta-analytic-predictive (MAP) prior to leverage external real-world and historical data. The propensity score methodology is applied to select a subset of patients from external data that are similar to those in the current study with regards to key baseline covariates and to stratify the selected patients together with those in the current study into more homogeneous strata. The MAP prior approach is used to obtain stratum-specific MAP prior and derive the overall propensity score integrated meta-analytic predictive (PS-MAP) prior. Additionally, we allow for tuning the prior effective sample size for the proposed PS-MAP prior, which quantifies the amount of information borrowed from external data. We evaluate the performance of the proposed PS-MAP prior by comparing it to the existing propensity score-integrated power prior approach in a simulation study and illustrate its implementation with an example of a single-arm phase II trial.

PMID:34126656 | DOI:10.1002/sim.9095

Stat Med. 2021 Jun 14. doi: 10.1002/sim.9098. Online ahead of print.

ABSTRACT

A reciprocal LASSO (rLASSO) regularization employs a decreasing penalty function as opposed to conventional penalization approaches that use increasing penalties on the coefficients, leading to stronger parsimony and superior model selection relative to traditional shrinkage methods. Here we consider a fully Bayesian formulation of the rLASSO problem, which is based on the observation that the rLASSO estimate for linear regression parameters can be interpreted as a Bayesian posterior mode estimate when the regression parameters are assigned independent inverse Laplace priors. Bayesian inference from this posterior is possible using an expanded hierarchy motivated by a scale mixture of double Pareto or truncated normal distributions. On simulated and real datasets, we show that the Bayesian formulation outperforms its classical cousin in estimation, prediction, and variable selection across a wide range of scenarios while offering the advantage of posterior inference. Finally, we discuss other variants of this new approach and provide a unified framework for variable selection using flexible reciprocal penalties. All methods described in this article are publicly available as an R package at: https://github.com/himelmallick/BayesRecipe.

PMID:34126655 | DOI:10.1002/sim.9098

Am J Perinatol. 2021 Jun 14. doi: 10.1055/s-0041-1731277. Online ahead of print.

ABSTRACT

OBJECTIVE: The study aimed to evaluate the validity of transcutaneous bilirubin (TcB) measurements at three sites in premature infants born at 23^0/7 to 34^6/7 weeks’ gestational age (GA) compared with total serum bilirubin (TSB) measurements.

STUDY DESIGN: A prospective study was conducted at Banner – University Medical Center Phoenix, where informed consent was obtained from the infant’s parent or legally authorized representative. Cohort A was comprised of infants 23^0/7 to 28^6/7 weeks’ GA and Cohort B contained subjects 29^0/7 to 34^6/7 weeks’ GA. Baseline TSB measurements were collected at approximately 24 hours of life, as the standard of care and the TcB measurements were obtained from the sternum, interscapular, and buttock areas at approximately ± 30 minutes from collection of the TSB. Statistical analysis of measurements including sensitivity, specificity, positive, and negative predictive values, and the area under the receiver operator characteristic curve (AUROC) were performed.

RESULTS: A total of 166 infants were included in the study population. Cohort A consisted of 41 subjects and Cohort B contained 125 subjects. The results showed that baseline TcB measurements from the interscapular area were the most sensitive and specific with TSB levels >5.0 mg/dL in Cohort A. Baseline TcB measurements from the sternum demonstrated greatest sensitivity and specificity when the TSB level was >8.0 mg/dL in Cohort B. In general, each of the three sites in both cohorts demonstrated excellent AUROCs and negative predictive values.

CONCLUSION: The use of a TcB meter in preterm infants can be a reliable noninvasive screening tool for hyperbilirubinemia, and it may be beneficial in decreasing painful stimuli and iatrogenic blood loss when used as an adjunct to TSB monitoring.

KEY POINTS: · Interscapular TcB is sensitive/specific in 23 to 29 weeks’ GA.. · Sternal TcB is sensitive/specific in 29 to 35 weeks’ GA.. · TcB readings are reliable in preterm infants.. · TcB is reliable when serum bilirubin is >5.0 mg/dL..

PMID:34126648 | DOI:10.1055/s-0041-1731277

Biomed Phys Eng Express. 2021 Jun 14. doi: 10.1088/2057-1976/ac0afe. Online ahead of print.

ABSTRACT

Aim:The aim of the current study was to compare between the deep inspiration breath-hold (DIBH) technique and free-breathing (FB) method in the treatment delivery uncertainty of breast cancer radiotherapy using skin dose measurements.Methods:In a prospective manner, eighty patients were randomly selected for skin dose measurements, and they were assigned to two groups: DIBH (40 patients) and FB (40 patients). The systematic inter-fraction dose variation was quantified using the mean percentage error (MPE) between the average measured total dose per session in three consecutive sessions and the corresponding calculated point dose from the treatment planning system. The random inter-fraction dose variation was quantified using the standard deviation (SD) of the dose delivered by the medial or lateral tangential fields, or the total session dose in the three sessions (SD_MT, SD_LT, or SD_total, respectively). While the random intra-fraction dose variation was quantified using the SD of the dose difference between the medial and lateral tangential fields in three consecutive sessions (SD_MT-LT). Results: There was no statistically significant difference in MPE between the DIBH and FB groups (p = 0.583). Moreover, the mean SD_totaland SD_MTof the DIBH group were significantly lower than that of the FB group (2.75 ± 2.33 cGy vs. 4.45 cGy ± 4.33, p = 0.048) and (1.94 ± 1.63 cGy vs. 3.76 ± 3.42 cGy, p = 0.007), respectively. However, there was no significant difference in the mean SD_LTand SD_MT-LTbetween the two groups (p > 0.05). Conclusion: In addition to the advantage of reducing the cardiopulmonary radiation doses in left breast cancer, the DIBH technique could reduce the treatment delivery uncertainty compared to the FB method due to the significant reduction in the random inter-fraction dose variations.

PMID:34126605 | DOI:10.1088/2057-1976/ac0afe

J Phys Condens Matter. 2021 Jun 14. doi: 10.1088/1361-648X/ac0b20. Online ahead of print.

ABSTRACT

Self-affine rough interfaces are ubiquitous in experimental systems, and display characteristic scaling properties as a signature of the nature of disorder in their supporting medium, i.e. of the statistical features of its heterogeneities. Different methods have been used to extract roughness information from such self-affine structures, and in particular their scaling exponents and associated prefactors. Notably, for an experimental characterization of roughness features, it is of paramount importance to properly assess sample-to-sample fluctuations of roughness parameters. Here, by performing scaling analysis based on displacement correlation functions in real and reciprocal space, we compute statistical properties of the roughness parameters. As an ideal, artifact-free reference case study and particularly targeting finite-size systems, we consider three cases of numerically simulated one-dimensional interfaces: (i) elastic lines under thermal fluctuations and free of disorder, (ii) directed polymers in equilibrium with a disordered energy landscape, and (iii) elastic lines in the critical depinning state when the external applied driving force equals the depinning force set by disorder. Our results shows that sample-to-sample fluctuations are rather large when measuring the roughness exponent. These fluctuations are also relevant for roughness amplitudes. Therefore a minimum of independent interface realizations (at least a few tens in our numerical simulations) should be used to guarantee sufficient statistical averaging, an issue often overlooked in experimental reports.

PMID:34126604 | DOI:10.1088/1361-648X/ac0b20

Respir Med. 2021 Jun 8;185:106495. doi: 10.1016/j.rmed.2021.106495. Online ahead of print.

ABSTRACT

INTRODUCTION: Organ tropism of SARS-CoV-2 to the respiratory tract could potentially aggravate asthma. The susceptibility of patients with asthma to develop an exacerbation when they are infected with SARS-CoV-2 is unknown. We aimed to investigate the symptoms presented in patients with asthma who became infected with SARS-CoV-2.

METHODS AND RESULTS: All patients over 14 years of age who tested positive for SARS-CoV-2 (by RT-PCR) were included (n = 2995). In patients with asthma (n = 77, 2.6%; 44 females), symptoms, therapy and phenotype were recorded. Seventeen (22%) patients had mild asthma, 55 (71%) moderate and five severe (6%). Twenty-six patients with asthma (34%) were asymptomatic, 34 (44%) developed symptoms but did not require hospital admission, and 17 (22%) were hospitalised. One patient was admitted because of asthma exacerbation without pneumonia or other symptoms. Ten patients (13%) had wheezes (six with pneumonia). Comparison of wheezing between patients with non-T2 asthma and the rest of the patients was statistically significant, (p < 0.001).

CONCLUSIONS: SARS-CoV-2 infection is not a significant cause of asthma exacerbation, although some patients may present wheezing, especially in cases of pneumonia. The severity of asthma does not seem to be associated with symptoms of the disease.

PMID:34126579 | DOI:10.1016/j.rmed.2021.106495

Appl Ergon. 2021 Jun 11;96:103494. doi: 10.1016/j.apergo.2021.103494. Online ahead of print.

ABSTRACT

Industrial passive low-back exoskeletons have gained recent attention as ergonomic interventions to manual handling tasks. This research utilized a two-armed experimental approach (single vs dual-task paradigms) to quantify neural and biomechanical tradeoffs associated with short-term human-exoskeleton interaction (HEI) during asymmetrical lifting in twelve healthy adults balanced by gender. A dynamic, electromyography-assisted spine model was employed that indicated statistical, but marginal, biomechanical benefits of the tested exoskeleton, which diminished with the introduction of the cognitive dual-task. Using Near Infrared Spectroscopy (fNIRS)-based brain connectivity analyses, we found that the tested exoskeleton imposed greater neurocognitive and motor adaptation efforts by engaging action monitoring and error processing brain networks. Collectively, these findings indicate that a wearer’s biomechanical response to increased cognitive demands in the workplace may offset the mechanical advantages of exoskeletons. We also demonstrate the utility of ambulatory fNIRS to capture the neural cost of HEI without the need for elaborate dual-task manipulations.

PMID:34126572 | DOI:10.1016/j.apergo.2021.103494

Gait Posture. 2021 Jun 8;88:240-246. doi: 10.1016/j.gaitpost.2021.06.005. Online ahead of print.

ABSTRACT

BACKGROUND: Barriers to successful return to previous level of activity following Anterior Cruciate Ligament Reconstruction (ACLR) are multifactorial and recent research suggests that athletic performance deficits persist after completion of the rehabilitation course in a large percentage of patients.

RESEARCH QUESTION: Do technology-based biomechanical assessments reveal underneath differences in both recreational and competitive athletes in Return to Play after ACL-Reconstruction?

METHODS: Thirty soccer athletes (26.9 ± 5.7 years old, male) with ACL injury were surgically treated with all-inside technique and semitendinosus tendon autograft. Before 2 years from surgery, they were called back for clinical examination, self-reported psychological scores, and biomechanical outcomes (balance, strength, agility and velocity, and symmetry). Athletes were classified into recreational (n = 15) and competitive (n = 15) according to the self-reported Return to Play Level based on the TALS post-injury. Nonparametric statistical tests have been adopted for group comparisons in terms of age, concomitant presence of meniscus tear, injury on dominant leg, presence of knee laxity, presence of varus/valgus, body sides, and return to different levels of sports.

RESULTS: Competitive athletes showed better in terms of strength (45.3 ± 5.4 W kg^-1 vs 39.3 ± 3.4 W kg^-1, P ≤ 0.01) associated with good self-reported outcomes (TLKS, CRSQ) and low fear of reinjury (TSK). However, all the athletes had a functional deficit in at least one subtest, and a safe return to sports could not have been recommended. Our findings confirmed that demographics, physical function, and psychological factors were related to playing the preinjury level sport at mean 2 years after surgery, supporting the notion that returning to sport after surgery is multifactorial.

SIGNIFICANCE: A strict qualitative and quantitative assessment of athletes’ status should be performed at different follow-ups after surgery to guarantee a safe and controlled RTP.

PMID:34126566 | DOI:10.1016/j.gaitpost.2021.06.005