Nevin Manimala

R I Med J (2013). 2023 Sep 1;106(8):31-35.

ABSTRACT

OBJECTIVE: This study aimed to examine the patterns of complaints filed against physicians in Rhode Island, investigate the factors associated with complaint rates and outcomes, and assess the impact of the implementation of a new Framework for Just Culture.

METHODS: Complaint data from the Rhode Island Department of Health’s complaint tracker and physician licensing database were analyzed for the period of 2018 to 2020. Descriptive and statistical process control analyses were conducted to assess complaint rates, investigation rates, and adverse outcomes.

RESULTS: Over the three-year period, 1672 complaints were filed against Rhode Island physicians, with approximately 40% of complaints being opened for investigation. The implementation of the Framework for Just Culture coincided with a sustained decrease in the rate of complaints opened. Failure to meet the minimum standard of care was the most common allegation, and male physicians and those aged 40-50 were more likely to have complaints filed against them.

CONCLUSIONS: The study highlights the importance of complaint investigations in upholding standards for medical licensure and clinical competence. The Framework for Just Culture may have influenced the investigation process, resulting in fewer investigations opened without compromising the identification of cases requiring disciplinary action. These findings provide insights into physician accountability and the need for ongoing monitoring and improvement in complaint handling systems.

PMID:37643340

Diabetes Care. 2023 Aug 29:dc230617. doi: 10.2337/dc23-0617. Online ahead of print.

ABSTRACT

OBJECTIVE: Nutrition therapy for gestational diabetes (GDM) has conventionally focused on carbohydrate restriction. In a randomized controlled trial (RCT), we tested the hypothesis that a diet (all meals provided) with liberalized complex carbohydrate (60%) and lower fat (25%) (CHOICE diet) could improve maternal insulin resistance and 24-h glycemia, resulting in reduced newborn adiposity (NB%fat; powered outcome) versus a conventional lower-carbohydrate (40%) and higher-fat (45%) (LC/CONV) diet.

RESEARCH DESIGN AND METHODS: After diagnosis (at ∼28-30 weeks’ gestation), 59 women with diet-controlled GDM (mean ± SEM; BMI 32 ± 1 kg/m2) were randomized to a provided LC/CONV or CHOICE diet (BMI-matched calories) through delivery. At 30-31 and 36-37 weeks of gestation, a 2-h, 75-g oral glucose tolerance test (OGTT) was performed and a continuous glucose monitor (CGM) was worn for 72 h. Cord blood samples were collected at delivery. NB%fat was measured by air displacement plethysmography (13.4 ± 0.4 day).

RESULTS: There were 23 women per group (LC/CONV [214 g/day carbohydrate] and CHOICE [316 g/day carbohydrate]). For LC/CONV and CHOICE, respectively (mean ± SEM), NB%fat (10.1 ± 1 vs. 10.5 ± 1), birth weight (3,303 ± 98 vs. 3,293 ± 81 g), and cord C-peptide levels were not different. Weight gain, physical activity, and gestational age at delivery were similar. At 36-37 weeks of gestation, CGM fasting (86 ± 3 vs. 90 ± 3 mg/dL), 1-h postprandial (119 ± 3 vs. 117 ± 3 mg/dL), 2-h postprandial (106 ± 3 vs. 108 ± 3 mg/dL), percent time in range (%TIR; 92 ± 1 vs. 91 ± 1), and 24-h glucose area under the curve values were similar between diets. The %time >120 mg/dL was statistically higher (8%) in CHOICE, as was the nocturnal glucose AUC; however, nocturnal %TIR (63-100 mg/dL) was not different. There were no between-group differences in OGTT glucose and insulin levels at 36-37 weeks of gestation.

CONCLUSION: A ∼100 g/day difference in carbohydrate intake did not result in between-group differences in NB%fat, cord C-peptide level, maternal 24-h glycemia, %TIR, or insulin resistance indices in diet-controlled GDM.

PMID:37643311 | DOI:10.2337/dc23-0617

J Ocul Pharmacol Ther. 2023 Aug 29. doi: 10.1089/jop.2023.0064. Online ahead of print.

ABSTRACT

Purpose: Dry eye disease is attributed to impaired tear production and/or evaporative dry eye. Evaporative dry eye is frequently associated with meibomian gland dysfunction (MGD). The objective of this study was to identify clinical study endpoints related to MGD. Methods: This 22-day, noninterventional, case-control clinical study involved three cohorts with increasing MGD severity: no MGD, mild/moderate MGD, and severe MGD. Symptoms were assessed with an ocular symptom questionnaire grading blurred vision, eye burning, eye dryness, eye pain, light sensitivity, eye itching, eye foreign body sensation, and overall ocular discomfort. Sign assessments included the maximum meibum quality score (MMQS), tear breakup time, Schirmer tear tests, biomicroscopy, and corneal staining. Signs and symptoms were compared between cohorts and study visits. Results: Seventy-five study participants were assigned to the cohorts (25 per cohort). MMQS scores increased with increasing MGD severity, reflecting the selection criteria for the cohorts. Between-visit scores showed a weighted kappa statistic of 0.72 indicating substantial agreement. Mean scores of all assessed symptoms increased with increasing MGD severity. Scores for symptoms showed moderate (κ = 0.41-0.60) to substantial (κ = 0.61-0.80) agreement between visits. Overall ocular discomfort demonstrated the strongest correlation with the MMQS. Conclusion: The MMQS was a reproducible sign of MGD showing good agreement with ocular symptoms. Overall ocular discomfort was well correlated with typical dry eye symptoms and could potentially be used as a single measure of MGD symptoms. The findings from this observational study may inform endpoints for future clinical trials. ClinicalTrials.gov NCT01979887.

PMID:37643299 | DOI:10.1089/jop.2023.0064

Vector Borne Zoonotic Dis. 2023 Aug 29. doi: 10.1089/vbz.2023.0024. Online ahead of print.

ABSTRACT

Background: Pet and feeder rodents are one of the main sources of emerging infectious diseases. These rodents are purchased from pet shops, breeders, and online. Consequently, some of these rodents may subtly transmit diseases as they may be asymptomatic to certain pathogens. Materials and Methods: We systematically searched four academic databases viz. Google Scholar, PubMed, Web of Science, and Scopus to determine zoonotic pathogens associated with pet and feeder rodents globally. Our searches were performed in R statistical software using the packages “metagear” and “revtool”. Results: We found 62 studies reporting on zoonotic pathogens between 1973 and 2022 from 16 countries representing 4 continents, namely Africa, Europe, Asia, and North America. The review identified 30 zoonotic pathogens isolated from pet and feeder rodents, including the African pygmy mouse (Mus minutoides), brown rat (Rattus norvegicus), and the house mouse (Mus musculus). The greatest number of pathogens was reported from the United States, followed by Togo and the United Kingdom. Bacterial pathogens were the most prevalent. However, the Seoul virus and rat bite fever (Streptobacillus moniliformis) were the most studied pathogens, found in more than one country, with reported outbreak cases. Most of the zoonotic pathogens were isolated from rodents acquired from pet shops. Conclusion: We recommend that pet and feeder rodents purchased from pet shops should be regularly screened for potential zoonotic pathogens as some of these animals may not show clinical signs of the illness. There is also a critical need to develop strict regulations and policies, especially in underdeveloped and developing regions for an effective surveillance process, which will include early detection, rapid response, and control of zoonotic diseases globally.

PMID:37643287 | DOI:10.1089/vbz.2023.0024

Proc Natl Acad Sci U S A. 2023 Sep 5;120(36):e2222103120. doi: 10.1073/pnas.2222103120. Epub 2023 Aug 29.

ABSTRACT

Homelessness is an economic and social crisis. In a cluster-randomized controlled trial, we address a core cause of homelessness-lack of money-by providing a one-time unconditional cash transfer of CAD$7,500 to each of 50 individuals experiencing homelessness, with another 65 as controls in Vancouver, BC. Exploratory analyses showed that over 1 y, cash recipients spent fewer days homeless, increased savings and spending with no increase in temptation goods spending, and generated societal net savings of $777 per recipient via reduced time in shelters. Additional experiments revealed public mistrust toward the ability of homeless individuals to manage money and demonstrated interventions to increase public support for a cash transfer policy using counter-stereotypical or utilitarian messaging. Together, this research offers a new approach to address homelessness and provides insights into homelessness reduction policies.

PMID:37643214 | DOI:10.1073/pnas.2222103120

Proc Natl Acad Sci U S A. 2023 Sep 5;120(36):e2302720120. doi: 10.1073/pnas.2302720120. Epub 2023 Aug 29.

ABSTRACT

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues.

PMID:37643212 | DOI:10.1073/pnas.2302720120

Issues Ment Health Nurs. 2023 Aug 29:1-9. doi: 10.1080/01612840.2023.2246581. Online ahead of print.

ABSTRACT

This study was planned to examine the effects of laughter therapy on the perceived stress and quality of life level of persons with schizophrenia and their views on laughter therapy. This study is a mixed-methods pilot study conducted using a quasi-experimental design based on the pretest-posttest model. Of the participants 68% (n = 17) were male, 92% (n = 23) were single, 56% (14) were high school graduates, 60% (n = 15) were unemployed, 60% (n = 15) lived with their parents, 88% (22) had been receiving treatment for schizophrenia for more than 10 years. The difference between the pretest and post-test means was not found to be significant in participants’ perceived stress (p > 0.05), and the difference between the pretest and post-test means of the Schizophrenia Quality of Life Scale’s Interpersonal Relations, Instrumental Role, and Intrapsychicv (mental findings) subscales was found to be statistically significant (p < 0.05). The main themes of laughter therapy among persons with schizophrenia in the focus group interviews were found to be optimism, coping, health, sociability, motivation, awareness, and functionality. Laughter therapy was found to increase the quality of life of persons with schizophrenia, not affect perceived stress, and positively affect optimism, coping, health, sociability, motivation, awareness, and functionality levels. The researchers recommend using laughter therapy to improve the quality of life of people with schizophrenia during their rehabilitation.

PMID:37643210 | DOI:10.1080/01612840.2023.2246581

PLoS One. 2023 Aug 29;18(8):e0276472. doi: 10.1371/journal.pone.0276472. eCollection 2023.

ABSTRACT

BACKGROUND: Diabetic neuropathy is the most common complication in both Type-1 and Type-2 DM patients with more than one half of all patients developing nerve dysfunction in their lifetime. Although, risk prediction model was developed for diabetic neuropathy in developed countries, It is not applicable in clinical practice, due to poor data, methodological problems, inappropriately analyzed and reported. To date, no risk prediction model developed for diabetic neuropathy among DM in Ethiopia, Therefore, this study aimed prediction the risk of diabetic neuropathy among DM patients, used for guiding in clinical decision making for clinicians.

OBJECTIVE: Development and validation of risk prediction model for diabetic neuropathy among diabetes mellitus patients at selected referral hospitals, in Amhara regional state Northwest Ethiopia, 2005-2021.

METHODS: A retrospective follow up study was conducted with a total of 808 DM patients were enrolled from January 1,2005 to December 30,2021 at two selected referral hospitals in Amhara regional state. Multi-stage sampling techniques were used and the data was collected by checklist from medical records by Kobo collect and exported to STATA version-17 for analysis. Lasso method were used to select predictors and entered to multivariable logistic regression with P-value<0.05 was used for nomogram development. Model performance was assessed by AUC and calibration plot. Internal validation was done through bootstrapping method and decision curve analysis was performed to evaluate net benefit of model.

RESULTS: The incidence proportion of diabetic neuropathy among DM patients was 21.29% (95% CI; 18.59, 24.25). In multivariable logistic regression glycemic control, other comorbidities, physical activity, hypertension, alcohol drinking, type of treatment, white blood cells and red blood cells count were statistically significant. Nomogram was developed, has discriminating power AUC; 73.2% (95% CI; 69.0%, 77.3%) and calibration test (P-value = 0.45). It was internally validated by bootstrapping method with discrimination performance 71.7 (95% CI; 67.2%, 75.9%). It had less optimism coefficient (0.015). To make nomogram accessible, mobile based tool were developed. In machine learning, classification and regression tree has discriminating performance of 70.2% (95% CI; 65.8%, 74.6%). The model had high net benefit at different threshold probabilities in both nomogram and classification and regression tree.

CONCLUSION: The developed nomogram and decision tree, has good level of accuracy and well calibration, easily individualized prediction of diabetic neuropathy. Both models had added net benefit in clinical practice and to be clinically applicable mobile based tool were developed.

PMID:37643198 | DOI:10.1371/journal.pone.0276472

PLoS One. 2023 Aug 29;18(8):e0290812. doi: 10.1371/journal.pone.0290812. eCollection 2023.

ABSTRACT

Osteogenesis imperfecta (OI) is a hereditary skeletal disease characterized by bone fragility. Areal bone mineral density (BMD), evaluated by dual-energy X-ray absorptiometry (DXA), is used to assess bone brittleness. The height-adjusted BMD Z-score (BMDHAZ) is calculated in children and adolescents with OI to reduce the confounding factor of short stature. However, even with the BMDHAZ, severity evaluation in children and adolescents with OI is challenging because certain abnormalities in bone quality cannot be accurately assessed by BMD analysis. The trabecular bone scores (TBS) and bone mineral apparent density (BMAD), which represent the structural integrity of bone and bone-size-associated BMD, respectively, are associated with fracture risk. Recently, age- and sex-specific reference ranges have been reported, enabling the calculation of Z-scores for children. To evaluate which density measurements show the highest correlation with fracture risk, we analyzed the associations between the Z-scores of TBS, BMAD, and BMDHAZ, fracture rate, and genetic variants. We retrospectively reviewed 42 participants with OI aged 5 to 20 years who underwent DXA. COL1A1/2 pathogenic variants were detected in 41 of the 42 participants. In participants with nonsense and frameshift variants (n = 17) resulting in haploinsufficiency and mild phenotype, the TBS Z-score was negatively correlated with fracture rate (FR) (r = -0.50, p = 0.042). In participants with glycine substitution (n = 9) causing the severe phenotype, the BMAD Z-scores were negatively correlated with FR (r = -0.74, p = 0.022). No correlation between the BMDHAZ and FR was observed in both groups. These findings suggest that the TBS and BMAD are useful in assessing children and adolescents with OI with specific genetic variants.

PMID:37643181 | DOI:10.1371/journal.pone.0290812

PLoS Comput Biol. 2023 Aug 29;19(8):e1011393. doi: 10.1371/journal.pcbi.1011393. Online ahead of print.

ABSTRACT

Forecast evaluation is essential for the development of predictive epidemic models and can inform their use for public health decision-making. Common scores to evaluate epidemiological forecasts are the Continuous Ranked Probability Score (CRPS) and the Weighted Interval Score (WIS), which can be seen as measures of the absolute distance between the forecast distribution and the observation. However, applying these scores directly to predicted and observed incidence counts may not be the most appropriate due to the exponential nature of epidemic processes and the varying magnitudes of observed values across space and time. In this paper, we argue that transforming counts before applying scores such as the CRPS or WIS can effectively mitigate these difficulties and yield epidemiologically meaningful and easily interpretable results. Using the CRPS on log-transformed values as an example, we list three attractive properties: Firstly, it can be interpreted as a probabilistic version of a relative error. Secondly, it reflects how well models predicted the time-varying epidemic growth rate. And lastly, using arguments on variance-stabilizing transformations, it can be shown that under the assumption of a quadratic mean-variance relationship, the logarithmic transformation leads to expected CRPS values which are independent of the order of magnitude of the predicted quantity. Applying a transformation of log(x + 1) to data and forecasts from the European COVID-19 Forecast Hub, we find that it changes model rankings regardless of stratification by forecast date, location or target types. Situations in which models missed the beginning of upward swings are more strongly emphasised while failing to predict a downturn following a peak is less severely penalised when scoring transformed forecasts as opposed to untransformed ones. We conclude that appropriate transformations, of which the natural logarithm is only one particularly attractive option, should be considered when assessing the performance of different models in the context of infectious disease incidence.

PMID:37643178 | DOI:10.1371/journal.pcbi.1011393