Nevin Manimala

J Evid Based Dent Pract. 2024 Sep;24(3):101992. doi: 10.1016/j.jebdp.2024.101992. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: This systematic review aimed to describe and evaluate the caries patterns among the 21st century preschool children globally.

METHOD: Six electronic databases (Pubmed, Embase, Medline, Web of Science, EBSCOhost, and Scopus) were searched using predetermined terms. Dual independent screening of all retrieved abstracts was performed to identify studies conducted after year 2000 and the caries pattern among preschool children was investigated. Data regarding the prevalence of caries by tooth type and surface were extracted. Meta-analyses, subgroup analyses and meta-regression were carried out with the statistics software Stata using the random-effects model.

RESULTS: A total of 2642 records were screened, and 43 observational studies were finally included. Cavitated caries lesions were commonly found in the maxillary incisors and molars in both arches among preschool children. The highest caries prevalence was found in the maxillary central incisors (29.1%, 95%CI: 25.5%-32.7%) and the mandibular second molars (28.5%, 95%CI: 24.7%-32.3%), while the mandibular lateral incisors had the lowest prevalence (1.7%, 95%CI: 1.5%-2.0%). Occlusal surfaces of the mandibular molars were the most frequently affected by caries, whereas caries hardly affected the lingual surfaces of lower anterior teeth. Caries pattern on the left and right sides was symmetrical. The overall caries prevalence was significantly higher in the maxillary teeth. Caries prevalence was higher in the older children, whereas the caries pattern was not significantly different among children from countries with different human and economic development levels.

CONCLUSION: Cavitated carious lesions were more commonly observed in the maxillary incisors and molars in both arches. The prevalence of caries varies significantly with child’s age and primary tooth type. However, preschool children exhibit a similar pattern of caries, regardless of the time, socioeconomic status or geographical location.

PMID:39174169 | DOI:10.1016/j.jebdp.2024.101992

Lancet Diabetes Endocrinol. 2024 Sep;12(9):615-616. doi: 10.1016/S2213-8587(24)00226-2.

NO ABSTRACT

PMID:39174160 | DOI:10.1016/S2213-8587(24)00226-2

BMJ Open. 2024 Aug 22;14(7):e072943. doi: 10.1136/bmjopen-2023-072943.

ABSTRACT

OBJECTIVES: This study investigated sustainability and multimorbidity alongside barriers to employment including health and policy to demonstrate intersectional impact on return-to-work success within a UK welfare-to-work programme.

DESIGN: Cohort study design: The study calculated the proportion of time spent employed after experiencing a job start and the proportion retaining work over 6 months. Employment/unemployment periods were calculated, sequence-index plots were produced and visualisations were explored by benefit type and age.

SETTING: This study used confidential access to deidentified data from unemployed Work Programme clients operated by Ingeus on behalf of the UK Government in Scotland between 1 April 2013 and 31 July 2014.

PARTICIPANTS: 13 318 unemployed clients aged 18-64 years were randomly allocated to a Work Programme provider and monitored over 2 years.

RESULTS: This study has two distinct groupings. ‘Employment and Support Allowance (ESA)’ corresponding to those with work-limiting disability in receipt of related state financial support, and ‘Jobseeker’s Allowance (JSA)’ corresponding to unemployment claimants. Despite fewer and later job starts for ESA clients, those that gained employment spend relatively more subsequent time in employment when compared with individuals without work-limiting conditions (ESA clients under 50, 0.73; ESA clients over 50, 0.79; JSA clients under 50, 0.67 and JSA clients over 50, 0.68). Proportion in permanent jobs was higher among ESA than JSA clients (JSA under 50, 92%; JSA over 50, 92%; ESA under 50, 95% and ESA over 50, 97%).

CONCLUSION: The research demonstrated that returning to paid employment after a reliance on welfare benefits is challenging for people aged over 50 and those with disability. The study found that although fewer older ESA claimants entered employment, they typically remained in employment more than JSA clients who did not leave the Work Programme early. This indicates the importance of identifying risk factors for job loss in ageing workers and the development of interventions for extension of working lives.

PMID:39174073 | DOI:10.1136/bmjopen-2023-072943

BMJ Open. 2024 Aug 21;14(8):e081776. doi: 10.1136/bmjopen-2023-081776.

ABSTRACT

OBJECTIVE: This study aims to further explore the relevant influencing factors of depression and explore the correlation between multimorbidity coexistence and depression to find the goals and methods of early intervention of depression in the elderly.

DESIGN: This study adopts a cross-sectional approach.

SETTING: The study population of this project came from the China Health and Retirement Longitudinal Study. Depression was grouped according to the 10-item version of Centre for Epidemiological Research Depression Scale. Chronic diseases, height, weight, grip strength, education, marital status, alcohol consumption, exercise and other indicators were included in the analysis.

PARTICIPANTS: 2239 adults over 60 years of age were included.

RESULTS: The proportion of women in the depression group was higher (p<0.001). The depression group had a lower grip strength than the control group (p<0.05). The sleep duration was shorter in the depression group (p<0.001). There were differences in education, marital status and alcohol consumption in the depression group (p<0.05). The depression group might have more types of coexisting chronic diseases (p<0.001). The depression group was more likely to have hypertension, dyslipidaemia, chronic lung diseases, heart attack, stroke, stomach disease and memory-related disease. Grip strength was connected with the risk of depression in the elderly (0.971 (95% CI 0.959 to 0.984)). Sleep (0.827 (95% CI 0.785 to 0.872) and education level (0.790 (95% CI 0.662 to 0.942) were related to the risk of depression in the elderly. Concomitant chronic diseases could affect the risk of depression in the elderly (1.455 (95% CI 1.243 to 1.703)).

CONCLUSION: The coexistence of multiple chronic diseases and depression is very common in the elderly. The coexistence of multiple chronic diseases is more common in older women and older depressed people. With the increase in the number of chronic diseases, the risk of depression in the elderly is significantly increased.

PMID:39174069 | DOI:10.1136/bmjopen-2023-081776

BMJ Open. 2024 Aug 21;14(8):e085819. doi: 10.1136/bmjopen-2024-085819.

ABSTRACT

INTRODUCTION: HIV drug resistance poses a challenge to the United Nation’s goal of ending the HIV/AIDS epidemic. The integrase strand transfer inhibitor (InSTI) dolutegravir, which has a higher resistance barrier, was endorsed by the WHO in 2019 for first-line, second-line and third-line antiretroviral therapy (ART). This multiplicity of roles of dolutegravir in ART may facilitate the emergence of dolutegravir resistance.

METHODS AND ANALYSIS: Nested within the International epidemiology Databases to Evaluate AIDS (IeDEA), DTG RESIST is a multicentre study of adults and adolescents living with HIV in sub-Saharan Africa, Asia, and South and Central America who experienced virological failure on dolutegravir-based ART. At the time of virological failure, whole blood will be collected and processed to prepare plasma or dried blood spots. Laboratories in Durban, Mexico City and Bangkok will perform genotyping. Analyses will focus on (1) individuals who experienced virological failure on dolutegravir and (2) those who started or switched to such a regimen and were at risk of virological failure. For population (1), the outcome will be any InSTI drug resistance mutations, and for population (2) virological failure is defined as a viral load >1000 copies/mL. Phenotypic testing will focus on non-B subtype viruses with major InSTI resistance mutations. Bayesian evolutionary models will explore and predict treatment failure genotypes. The study will have intermediate statistical power to detect differences in resistance mutation prevalence between major HIV-1 subtypes; ample power to identify risk factors for virological failure and limited power for analysing factors associated with individual InSTI drug resistance mutations.

ETHICS AND DISSEMINATION: The research protocol was approved by the Biomedical Research Ethics Committee at the University of KwaZulu-Natal, South Africa and the Ethics Committee of the Canton of Bern, Switzerland. All sites participate in International epidemiology Databases to Evaluate AIDS and have obtained ethics approval from their local ethics committee to collect additional data.

TRIAL REGISTRATION NUMBER: NCT06285110.

PMID:39174068 | DOI:10.1136/bmjopen-2024-085819

BMJ Open. 2024 Aug 21;14(8):e082495. doi: 10.1136/bmjopen-2023-082495.

ABSTRACT

OBJECTIVES: To investigate the role of comorbid chronic obstructive pulmonary disease (COPD) and symptom type on general practitioners’ (GP’s) symptom attribution and clinical decision-making in relation to lung cancer diagnosis.

DESIGN: Vignette survey with a 2×2 mixed factorial design.

SETTING: A nationwide online survey exploring clinical decision-making in primary care.

PARTICIPANTS: 109 GPs based in the United Kingdom (UK) who were registered as responders on Dynata (an online survey platform).

INTERVENTIONS: GPs were presented with four vignettes which described a patient aged 75 with a smoking history presenting with worsening symptoms (either general or respiratory) and with or without a pre-existing diagnosis of COPD.

PRIMARY AND SECONDARY OUTCOME MEASURES: GPs indicated the three most likely diagnoses (free-text) and selected four management approaches (20 pre-coded options). Attribution of symptoms to lung cancer and referral for urgent chest X-ray were primary outcomes. Alternative diagnoses and management approaches were explored as secondary outcomes. Multivariable mixed-effects logistic regression was used, including random intercepts for individual GPs.

RESULTS: 422 vignettes were completed. There was no evidence for COPD status as a predictor of lung cancer attribution (OR=1.1, 95% CI=0.5-2.4, p=0.914). There was no evidence for COPD status as a predictor of urgent chest X-ray referral (OR=0.6, 95% CI=0.3-1.2, p=0.12) or as a predictor when in combination with symptom type (OR=0.9, 95% CI=0.5-1.8, p=0.767).

CONCLUSIONS: Lung cancer was identified as a possible diagnosis for persistent respiratory by only one out of five GPs, irrespective of the patients’ COPD status. Increasing awareness among GPs of the link between COPD and lung cancer may increase the propensity for performing chest X-rays and referral for diagnostic testing for symptomatic patients.

PMID:39174063 | DOI:10.1136/bmjopen-2023-082495

BMJ Open. 2024 Aug 21;14(8):e080607. doi: 10.1136/bmjopen-2023-080607.

ABSTRACT

INTRODUCTION: Sepsis, a condition of global public health concern, is a major cause of morbidity and mortality, especially in patients with underlying HIV infection. This study aims to determine outcomes, aetiology and antibiotic resistance patterns among children with HIV exposure or infection admitted with a clinical presentation suggestive of sepsis who have confirmed bloodstream infections at Arthur Davison Children’s Hospital (ADCH) in Ndola, Zambia.

METHODS AND ANALYSIS: This will be a prospective longitudinal study of 200 children aged <2 years admitted with sepsis at ADCH with two of the following conditions: temperature of 38.0°C, respiratory rate ≥20 breaths per minute and pulse rate ≥90 beats per minute. About 2-5 mL of blood collected from each participant will be inoculated into BACTEC culture bottles and incubated for 5-7 days. Positive cultures will be inoculated onto culture media for subculture followed by species identification followed by antibiotic susceptibility testing. Time-to-event outcomes such as hospital readmission and mortality will be analysed using Kaplan-Meier and Cox proportional hazards. Predictors will be identified using regression methods. All statistical tests will use a 5% significance level with a 95% confidence level. STATA V.16 will be used for statistical analysis.

ETHICS AND DISSEMINATION: Ethical clearance and approval have been granted by the Tropical Diseases Research Centre Ethics Committee (TDRC-EC 092/07/23). Caregiver consent will be obtained verbally for participants presenting as medical emergencies, and written informed consent will be obtained once stable. Findings from this study will be shared with the Ministry of Health Zambia and will be disseminated to the scientific community through peer-reviewed scientific journals.

PMID:39174062 | DOI:10.1136/bmjopen-2023-080607

BMJ Open. 2024 Aug 21;14(8):e078108. doi: 10.1136/bmjopen-2023-078108.

ABSTRACT

OBJECTIVES: Our aim was to identify which patients are likely to stay in hospital longer following total hip replacement surgery.

DESIGN: Longitudinal, observational study used routinely collected data.

SETTING: Data were collected from an NHS Trust in South-West England between 2016 and 2019.

PARTICIPANTS: 2352 hip replacement patients had complete data and were included in analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES: Three measures of length of stay were used: a count measure of number of days spent in hospital, a binary measure of ≤7 days/>7 days in hospital and a binary measure of remaining in hospital when medically fit for discharge.

RESULTS: The mean length of stay was 5.4 days following surgery, with 18% in hospital for more than 7 days, and 11% staying in hospital when medically fit for discharge. Longer hospital stay was associated with older age (OR=1.06, 95% CI 1.05 to 1.08), being female (OR=1.42, 95% CI 1.12 to 1.81) and more comorbidities (OR=3.52, 95% CI 1.45 to 8.55) and shorter length of stay with not having had a recent hospital admission (OR=0.44, 95% CI 0.32 to 0.60). Results were similar for remaining in hospital when medically fit for discharge, with the addition of an association with highest socioeconomic deprivation (OR=2.08, 95% CI 1.37 to 3.16).

CONCLUSIONS: Older, female patients with more comorbidities and from more socioeconomically deprived areas are likely to remain in hospital for longer following surgery. This study produced regression models demonstrating consistent results across three measures of prolonged hospital stay following hip replacement surgery. These findings could be used to inform surgery planning and when supporting patient discharge following surgery.

PMID:39174061 | DOI:10.1136/bmjopen-2023-078108

Neural Netw. 2024 Aug 7;180:106598. doi: 10.1016/j.neunet.2024.106598. Online ahead of print.

ABSTRACT

Multiview learning (MVL) seeks to leverage the benefits of diverse perspectives to complement each other, effectively extracting and utilizing the latent information within the dataset. Several twin support vector machine-based MVL (MvTSVM) models have been introduced and demonstrated outstanding performance in various learning tasks. However, MvTSVM-based models face significant challenges in the form of computational complexity due to four matrix inversions, the need to reformulate optimization problems in order to employ kernel-generated surfaces for handling non-linear cases, and the constraint of uniform noise assumption in the training data. Particularly in cases where the data possesses a heteroscedastic error structure, these challenges become even more pronounced. In view of the aforementioned challenges, we propose multiview twin parametric margin support vector machine (MvTPMSVM). MvTPMSVM constructs parametric margin hyperplanes corresponding to both classes, aiming to regulate and manage the impact of the heteroscedastic noise structure existing within the data. The proposed MvTPMSVM model avoids the explicit computation of matrix inversions in the dual formulation, leading to enhanced computational efficiency. We perform an extensive assessment of the MvTPMSVM model using benchmark datasets such as UCI, KEEL, synthetic, and Animals with Attributes (AwA). Our experimental results, coupled with rigorous statistical analyses, confirm the superior generalization capabilities of the proposed MvTPMSVM model compared to the baseline models. The source code of the proposed MvTPMSVM model is available at https://github.com/mtanveer1/MvTPMSVM.

PMID:39173204 | DOI:10.1016/j.neunet.2024.106598

Neural Netw. 2024 Aug 8;180:106572. doi: 10.1016/j.neunet.2024.106572. Online ahead of print.

ABSTRACT

Person Re-identification (Re-ID) aims to match person images across non-overlapping cameras. The existing approaches formulate this task as fine-grained representation learning with deep neural networks, which involves extracting image features using a deep convolutional network, followed by mapping the features into a discriminative space through another smaller network, in order to make full use of all possible cues. However, recent Re-ID methods that strive to capture every cue and make the space more discriminative have resulted in longer features, ranging from 1024 to 14336, leading to higher time (distance computation) and space (feature storage) complexities. There are two potential solutions: reduction-after-training methods (such as Principal Component Analysis and Linear Discriminant Analysis) and reduction-during-training methods (such as 1 × 1 Convolution). The former utilizes a statistical approach aiming for a global optimum but lacking end-to-end optimization of large data and deep neural networks. The latter lacks theoretical guarantees and may be vulnerable to training noise such as dataset noise or initialization seed. To address these limitations, we propose a method called Euclidean-Distance-Preserving Feature Reduction (EDPFR) that combines the strengths of both reduction-after-training and reduction-during-training methods. EDPFR first formulates the feature reduction process as a matrix decomposition and derives a condition to preserve the Euclidean distance between features, thus ensuring accuracy in theory. Furthermore, the method integrates the matrix decomposition process into a deep neural network to enable end-to-end optimization and batch training, while maintaining the theoretical guarantee. The result of the EDPFR is a reduction of the feature dimensions from f_a and f_b to f_a^‘ and f_b^‘, while preserving their Euclidean distance, i.e.L₂(f_a,f_b)=L₂(f_a^‘,f_b^‘). In addition to its Euclidean-Distance-Preserving capability, EDPFR also features a novel feature-level distillation loss. One of the main challenges in knowledge distillation is dimension mismatch. While previous distillation losses, usually project the mismatched features to matched class-level, spatial-level, or similarity-level spaces, this can result in a loss of information and decrease the flexibility and efficiency of distillation. Our proposed feature-level distillation leverages the benefits of the Euclidean-Distance-Preserving property and performs distillation directly in the feature space, resulting in a more flexible and efficient approach. Extensive on three Re-ID datasets, Market-1501, DukeMTMC-reID and MSMT demonstrate the effectiveness of our proposed Euclidean-Distance-Preserving Feature Reduction.

PMID:39173200 | DOI:10.1016/j.neunet.2024.106572