Nevin Manimala

Biometrics. 2024 Oct 3;80(4):ujae130. doi: 10.1093/biomtc/ujae130.

ABSTRACT

Mental disorders present challenges in diagnosis and treatment due to their complex and heterogeneous nature. Electroencephalogram (EEG) has shown promise as a source of potential biomarkers for these disorders. However, existing methods for analyzing EEG signals have limitations in addressing heterogeneity and capturing complex brain activity patterns between regions. This paper proposes a novel random effects state-space model (RESSM) for analyzing large-scale multi-channel resting-state EEG signals, accounting for the heterogeneity of brain connectivities between groups and individual subjects. We incorporate multi-level random effects for temporal dynamical and spatial mapping matrices and address non-stationarity so that the brain connectivity patterns can vary over time. The model is fitted under a Bayesian hierarchical model framework coupled with a Gibbs sampler. Compared to previous mixed-effects state-space models, we directly model high-dimensional random effects matrices of interest without structural constraints and tackle the challenge of identifiability. Through extensive simulation studies, we demonstrate that our approach yields valid estimation and inference. We apply RESSM to a multi-site clinical trial of major depressive disorder (MDD). Our analysis uncovers significant differences in resting-state brain temporal dynamics among MDD patients compared to healthy individuals. In addition, we show the subject-level EEG features derived from RESSM exhibit a superior predictive value for the heterogeneous treatment effect compared to the EEG frequency band power, suggesting the potential of EEG as a valuable biomarker for MDD.

PMID:39504537 | DOI:10.1093/biomtc/ujae130

ACS Appl Mater Interfaces. 2024 Nov 6. doi: 10.1021/acsami.4c14392. Online ahead of print.

ABSTRACT

Two-dimensional ferroelectric materials have emerged as a promising candidate for the development of next-generation photodetectors owing to their inherent photogalvanic effect (PGE) and strong light-matter interactions. Recently, the first-ever elemental-based ferroelectric material, black-phosphorus-like Bi (BP-Bi), has been successfully synthesized. In this work, we investigate the PGE of the monolayer (ML) BP-Bi by using ab initio quantum transport simulation. We find that the photocurrent of the ML BP-Bi in the ferroelectric direction (armchair) is significantly larger than that in the vertical ferroelectric direction [zigzag (ZZ)]. For example, despite the comparable optical absorption rates of BP-Bi in the armchair (ARM) and ZZ directions, the maximum photocurrent (133 mA/W) in the ARM direction is 2 orders of magnitude greater than that (4.70 mA/W) in the ZZ direction. The asymmetry is attributed to the breaking and existence of the mirror inversion symmetries along the ARM and ZZ directions, respectively. Our work paves the way for the research of the low-dimensional ferroelectric photodetector.

PMID:39504511 | DOI:10.1021/acsami.4c14392

Br J Radiol. 2024 Nov 6:tqae227. doi: 10.1093/bjr/tqae227. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the value of conventional ultrasound (US), strain elastography (SE), and shear wave elastography (SWE) in detecting diabetic peripheral neuropathy (DPN) of the tibial nerve (TN), and to establish a predictive model for the diagnosis of DPN.

METHODS: 32 healthy participants, 34 diabetic patients without DPN, and 36 diabetic patients with DPN were recruited for this study. The TN at the ankle and popliteal fossa were selected for examination. US was used to measure the cross-sectional area (CSA) and perimeter of the TN. Additionally, SE was employed to measure the strain ratio (SR) between the TN and the surrounding adipose tissue, and SWE was used to measure the Shear Wave Velocity (SWV) of the TN.

RESULTS: The CSA, perimeter, SR and SWV of the TN at the ankle were significantly higher in the DPN group compared to both the Non-DPN group and control group (P < 0.05). Similarly, the TN at the popliteal fossa showed these differences. At the ankle, the CSA, perimeter, SR, and SWV of the TN in patients without DPN were significantly higher than those in the control group (P < 0.05). At the popliteal fossa, the SR and SWV of the TN in patients without DPN were significantly higher than those in the control group (P < 0.05). However, the CSA and perimeter of the TN in patients without DPN did not show a statistically significant difference compared to the control group. The area under the curve (AUC) for the diagnosis of DPN using SWE is significantly greater than that of SE and US.

CONCLUSION: US, SE, and SWE could be used to diagnose DPN, and they also have good diagnostic value for sub-clinical DPN. Among these methods, SWE has demonstrated superior diagnostic efficacy. Compared to examining the TN in the popliteal fossa, the ankle level offers a better site for examination.

ADVANCES IN KNOWLEDGE: For diabetic peripheral neuropathy, US, SE, and SWE are all promising diagnostic methods with high clinical utility.

PMID:39504467 | DOI:10.1093/bjr/tqae227

Retina. 2024 Oct 23. doi: 10.1097/IAE.0000000000004317. Online ahead of print.

ABSTRACT

PURPOSE: To report the visual outcomes and complications in eyes with retained lens fragments (RLF) following cataract surgery undergoing pars plana lensectomy (PPL) and scleral-fixated intraocular lens insertion (SFIOL).

METHODS: Patients with RLF who underwent pars plana vitrectomy (PPV), PPL, and SFIOL insertion from January 2015 to December 2022 were included. The visual acuity (VA) outcomes and complication rates were compared between those receiving sutured versus sutureless SFIOL insertion as well as those undergoing SFIOL insertion at the time of PPV and PPL versus those undergoing SFIOL insertion during a subsequent surgery.

RESULTS: 65 eyes of 65 patients were included. Median (interquartile range) pre-operative logarithm of the minimum angle of resolution (logMAR) VA was 2.3 (2-2.3; Snellen: HM). The median logMAR VA improved to 0.14 (Snellen: 20/100), at the most-recent follow-up (p<0.001, Hodges-Lehmann estimator:1.56, 95% confidence interval -1.30 to -1.71). There was no statistically significant difference in VA outcomes and the complication rates, including cystoid macular edema, corneal edema, and retinal detachment, regardless of technique or timing of SFIOL insertion.

CONCLUSIONS: In this retrospective study with small sample size, similar visual acuity outcomes and complication rates were observed regardless of the timing or technique of SFIOL insertion.

PMID:39504464 | DOI:10.1097/IAE.0000000000004317

JMIR Mhealth Uhealth. 2024 Nov 6;12:e56027. doi: 10.2196/56027.

ABSTRACT

BACKGROUND: Consumer-based wearables are becoming more popular and provide opportunities to track individual’s clinical parameters remotely. However, literature about their criterion and known-groups validity is scarce.

OBJECTIVE: This study aimed to assess the validity of the Fitbit Charge 4, a wrist-worn consumer-based wearable, to measure clinical parameters (ie, daily step count, resting heart rate [RHR], heart rate variability [HRV], respiratory rate [RR], and oxygen saturation) in patients with chronic obstructive pulmonary disease (COPD) and healthy controls in free-living conditions in Belgium by comparing it with medical-grade devices.

METHODS: Participants wore the Fitbit Charge 4 along with three medical-grade devices: (1) Dynaport MoveMonitor for 7 days, retrieving daily step count; (2) Polar H10 for 5 days, retrieving RHR, HRV, and RR; and (3) Nonin WristOX2 3150 for 4 nights, retrieving oxygen saturation. Criterion validity was assessed by investigating the agreement between day-by-day measures of the Fitbit Charge 4 and the corresponding reference devices. Known-groups validity was assessed by comparing patients with COPD and healthy controls.

RESULTS: Data of 30 patients with COPD and 25 age- and gender-matched healthy controls resulted in good agreement between the Fitbit Charge 4 and the corresponding reference device for measuring daily step count (intraclass correlation coefficient [ICC2,1]=0.79 and ICC2,1=0.85, respectively), RHR (ICC2,1=0.80 and ICC2,1=0.79, respectively), and RR (ICC2,1=0.84 and ICC2,1=0.77, respectively). The agreement for HRV was moderate (healthy controls: ICC2,1=0.69) to strong (COPD: ICC2,1=0.87). The agreement in measuring oxygen saturation in patients with COPD was poor (ICC2,1=0.32). The Fitbit device overestimated the daily step count and underestimated HRV in both groups. While RHR and RR were overestimated in healthy controls, no difference was observed in patients with COPD. Oxygen saturation was overestimated in patients with COPD. The Fitbit Charge 4 detected significant differences in daily step count, RHR, and RR between patients with COPD and healthy controls, similar to those identified by the reference devices, supporting known-groups validity.

CONCLUSIONS: Although the Fitbit Charge 4 shows mainly moderate to good agreement, measures of clinical parameters deviated from the reference devices, indicating that monitoring patients remotely and interpreting parameters requires caution. Differences in clinical parameters between patients with COPD and healthy controls that were measured by the reference devices were all detected by the Fitbit Charge 4.

PMID:39504450 | DOI:10.2196/56027

JMIR Med Educ. 2024 Nov 6;10:e63430. doi: 10.2196/63430.

ABSTRACT

BACKGROUND: Recent studies, including those by the National Board of Medical Examiners, have highlighted the remarkable capabilities of recent large language models (LLMs) such as ChatGPT in passing the United States Medical Licensing Examination (USMLE). However, there is a gap in detailed analysis of LLM performance in specific medical content areas, thus limiting an assessment of their potential utility in medical education.

OBJECTIVE: This study aimed to assess and compare the accuracy of successive ChatGPT versions (GPT-3.5, GPT-4, and GPT-4 Omni) in USMLE disciplines, clinical clerkships, and the clinical skills of diagnostics and management.

METHODS: This study used 750 clinical vignette-based multiple-choice questions to characterize the performance of successive ChatGPT versions (ChatGPT 3.5 [GPT-3.5], ChatGPT 4 [GPT-4], and ChatGPT 4 Omni [GPT-4o]) across USMLE disciplines, clinical clerkships, and in clinical skills (diagnostics and management). Accuracy was assessed using a standardized protocol, with statistical analyses conducted to compare the models’ performances.

RESULTS: GPT-4o achieved the highest accuracy across 750 multiple-choice questions at 90.4%, outperforming GPT-4 and GPT-3.5, which scored 81.1% and 60.0%, respectively. GPT-4o’s highest performances were in social sciences (95.5%), behavioral and neuroscience (94.2%), and pharmacology (93.2%). In clinical skills, GPT-4o’s diagnostic accuracy was 92.7% and management accuracy was 88.8%, significantly higher than its predecessors. Notably, both GPT-4o and GPT-4 significantly outperformed the medical student average accuracy of 59.3% (95% CI 58.3-60.3).

CONCLUSIONS: GPT-4o’s performance in USMLE disciplines, clinical clerkships, and clinical skills indicates substantial improvements over its predecessors, suggesting significant potential for the use of this technology as an educational aid for medical students. These findings underscore the need for careful consideration when integrating LLMs into medical education, emphasizing the importance of structured curricula to guide their appropriate use and the need for ongoing critical analyses to ensure their reliability and effectiveness.

PMID:39504445 | DOI:10.2196/63430

J Craniofac Surg. 2024 Nov 6. doi: 10.1097/SCS.0000000000010766. Online ahead of print.

ABSTRACT

To our knowledge, there has not been a review article summarizing the current evidence with regard to perinatal risk factors, and our aim is to perform a systematic review and meta-analysis of the evidence of perinatal risk factors in single suture craniosynostosis to inform our practice and identify any need for further research in this area. Our target population was pediatric single-suture craniosynostosis patients, and the intervention was perinatal risk factors. The comparison group was an age and sex-matched control group without craniosynostosis and the outcome we investigated was presence of single suture craniosynostosis. The literature search was done using OVID MEDLINE, Pubmed, and Embase databases from 1946 to 2023. A PRISMA flowchart was created, and statistical analysis was performed using RevMan pooled odds ratios, and 95% CIs were used to combine results from individual studies. Our initial search identified 625 abstracts and these were narrowed down to 16 articles, which were included in the final selection for the review. Out of these, 13 were used for the quantitative meta-analysis. Our meta-analysis showed a possible association between craniosynostosis and the following perinatal risk factors; presence of maternal thyroid disease, maternal age greater than 29, paternal age greater than 29, maternal smoking, gestational age above 37 weeks, and maternal underweight (BMI<18.5). Further prospective studies are warranted to investigate definite associations. The next step is to set up a multicenter prospective study among a craniofacial unit network.

PMID:39504409 | DOI:10.1097/SCS.0000000000010766

J Craniofac Surg. 2024 Nov 6. doi: 10.1097/SCS.0000000000010841. Online ahead of print.

ABSTRACT

INTRODUCTION: Over the past decade, there has been an improvement in access to gender-affirming surgical care for the transgender population. Even with improvements, this population continues with a high level of inequity among access to specialized surgical care. While multiple studies have previously focused on trends among top and bottom surgery, this study provides trends specifically among facial gender affirmation surgery (FGAS) within the United States.

METHODS: The National Inpatient Sample (NIS) was utilized to identify patients who underwent FGAS from 2012 to 2019. The diagnostic codes for gender identity disorder and gender dysphoria were used to identify the desired patient population. CPT coding released in a medical policy for transgender care coverage was used to identify those who underwent FGAS. Frequency distributions from the patient population were analyzed to determine differences among characteristics.

RESULTS: In total, 660 patients underwent FGAS from 2012 to 2019. The incidence of FGAS has increased by 1433%. Geographically, FGAS was more likely to be performed in the West and Northeast geographical regions (P<0.0001). There was a statistically significant difference in hospital length of stay and the total number of charges when stratified by race (P<0.0001 and P=0.0003), hospital location (P<0.0001 and <0.0001), and insurance type (P<0.0001 and <0.0001). The largest cohort of patients paid out-of-pocket (P<0.0001).

CONCLUSIONS: FGAS is one of the fastest-growing GAS procedures. Currently, FGAS procedures are not equally distributed, with higher concentrations occurring among wealthier, white individuals in certain geographical regions. Future studies are warranted to understand further trends within FGAS.

PMID:39504406 | DOI:10.1097/SCS.0000000000010841

AIDS. 2024 Nov 6. doi: 10.1097/QAD.0000000000004054. Online ahead of print.

ABSTRACT

OBJECTIVE: The possible differences in comorbidity burden were examined between people with longstanding HIV infection and those with shorter HIV duration of the same calendar age.

DESIGN: We performed a single-centre retrospective cohort analysis comparing long-term HIV survivors (LTS) diagnosed with HIV before 1996 (pre-HAART), with an age-matched and gender-matched group diagnosed after 2006 [modern ART era (mART)].

METHODS: Demographic and outcome data up to 1 May 2023 were obtained from electronic health records as well as from digitalized paper charts. Nine comorbidity domains were defined to overlook the comorbidity burden as on 1 May 2023: cardiovascular, musculoskeletal, neurological, oncological, liver, pulmonary, renal, psychiatric/cognitive, and metabolic.

RESULTS: Eighty-eight LTS and 88 people diagnosed in the modern ART era were included in the analysis. Median age in both groups was 60 years. LTS had a higher mean number of comorbidity domains than controls (2.6 vs. 1.9; P = .001). In both LTS and mART groups, metabolic and cardiovascular comorbidity was most prevalent (metabolic 70.5 and 52.3%, respectively, cardiovascular 44.3 and 38.6%, respectively). When stratified according to age, the distribution of the number of comorbidities for LTS roughly resembled the 10 years older mART subgroup. In a multivariate analysis, total ART duration and age were found to be statistically significantly associated with the number of comorbidity domains.

CONCLUSION: Our analysis suggests that LTS have a higher comorbidity burden compared with people diagnosed in the modern ART era of similar calendar age.

PMID:39504387 | DOI:10.1097/QAD.0000000000004054

Eur J Emerg Med. 2024 Nov 5. doi: 10.1097/MEJ.0000000000001196. Online ahead of print.

ABSTRACT

BACKGROUND AND IMPORTANCE: Climate change is widely recognised as a critical public health challenge.

OBJECTIVE: The objective of this study was to assess the awareness, preparedness and mitigation plans for climate change threats.

DESIGN, SETTINGS AND PARTICIPANTS: A cross-sectional observational study targeting emergency medical societies in different countries was conducted between 15 February and 15 March 2024.

INTERVENTION OR EXPOSURE: The survey featured 16 closed questions on climate change awareness, preparedness and risks. Focus groups of 4-6 members were organised by country. Results were correlated to income levels, United Nations (UN) regional classification and the World Risk Index.

OUTCOME MEASURE AND ANALYSIS: The questions were ranked using a Likert-like scale from 0 to 9 (9 being the highest). Descriptive statistics used central tendency estimators, and inferential analysis used chi-square and Kruskal-Wallis tests, with the significance level set at P < 0.05.

RESULTS: Forty-two focus groups responded, representing 36 countries: 21 (50%) high-income, seven (16.7%) low-income, five (11.9%) lower middle-income and nine (21.4%) upper middle-income countries, representing 31 of the 22 UN regions. According to the World Risk Index, the respondent countries belonged to the different categories as follows: very low risk, 6 (14%); low risk, 8 (19%); medium risk, 5 (12%); high risk, 8 (19%) and very high risk, 14 (34%). The estimated impact of climate change on national health systems had a mean score of 6.75 (SD = 2.16), while on Emergency Medical Systems was 6.96 (SD = 2.05). Overall, assessment and preparedness measures were reported by just 21.4 and 37.6% of respondents, respectively. Analysis by income did not show significant differences, with the exception of food supply. The main differences in the analysis by region were the risks of extreme weather events, vector-borne diseases and wildfires, whereas the World Risk Index was food and chain of supplies. Education and integration of health services were indicated by all as the main mitigation actions.

CONCLUSION: Geographical position and country risk index influence risk perception among focus groups more than income economy, with vector-borne diseases, extreme weather events and food shortages being the threats with the most variability. The most important actions identified to mitigate Climate Change effects are educational and strategic plans.

PMID:39504385 | DOI:10.1097/MEJ.0000000000001196