Nevin Manimala

JAMA Netw Open. 2024 Dec 2;7(12):e2447797. doi: 10.1001/jamanetworkopen.2024.47797.

ABSTRACT

IMPORTANCE: Use of secure messaging for clinician-to-clinician communication has increased exponentially over the past decade, but its association with clinician work is poorly understood.

OBJECTIVE: To investigate the association between secure messaging use and wrong-patient ordering errors.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included inpatient attending physicians, trainee physicians, and advanced practice practitioners (APPs) from 14 academic and community hospitals. Secure messaging volume was assessed over a 3-month period (February 1 to April 30, 2023).

EXPOSURE: Secure messaging volume per clinician-day, measured as the count of secure messages sent and received by a clinician on a given clinician-day.

MAIN OUTCOMES AND MEASURES: Retract-and-reorder events were used to identify wrong-patient ordering errors, and the presence of any retract-and-reorder event on a clinician-day was the primary outcome. Multilevel logistic regression was used to examine the association between secure messaging volume and wrong-patient ordering errors after adjusting for clinician age, sex, patient load, order volume, and clinical service.

RESULTS: A total of 3239 clinicians (median [IQR] age, 37 [32-46] years; 1791 female [55.3%]; 1680 attending physicians [51.2%], 560 trainee physicians [17.3%], and 999 APPs [30.8%]) with 75 546 clinician-days were included. Median secure messaging volume was 16 (IQR, 0-61) messages per day. Retract-and-reorder events were identified on 295 clinician-days (0.4%). Clinicians with secure messaging volume at the 75th percentile had a 10% higher odds of wrong-patient ordering errors compared with those at the 25th percentile (odds ratio [OR], 1.10; 95% CI, 1.01-1.20). After stratifying by clinician role, the association between secure messaging and wrong-patient ordering errors was observed only for attending physicians (OR, 1.20; 95% CI, 1.02-1.42) and APPs (OR, 1.18; 95% CI, 1.00-1.40).

CONCLUSIONS AND RELEVANCE: In this cohort study of inpatient clinicians, higher daily secure messaging was associated with increased odds of wrong-patient ordering errors. Although messaging may increase cognitive load and risk for wrong-patient ordering errors, these results do not provide conclusive evidence regarding the direct impact of secure messaging on errors, as increased messaging may also reflect greater care coordination, increased patient complexity, or communication of the presence of a wrong-patient ordering error.

PMID:39630450 | DOI:10.1001/jamanetworkopen.2024.47797

JAMA Netw Open. 2024 Dec 2;7(12):e2449005. doi: 10.1001/jamanetworkopen.2024.49005.

ABSTRACT

IMPORTANCE: Understanding exposure to air pollution is important to public health, and disparities in the spatial distribution of regulatory air quality monitors could lead to exposure misclassification bias.

OBJECTIVE: To determine whether racial and ethnic disparities exist in Environmental Protection Agency (EPA) regulatory air quality monitor locations in the US.

DESIGN, SETTING, AND PARTICIPANTS: This national cross-sectional study included air quality monitors in the EPA Air Quality System regulatory monitoring repository, as well as 2022 American Community Survey Census block group estimates for racial and ethnic composition and population size. Bayesian mixed-effects models of the count of criteria pollutant monitors measuring an area were used, adjusting for population size and accounting for spatial autocorrelation. Data were analyzed from March to June 2024.

EXPOSURE: Census block group-level racial and ethnic composition.

MAIN OUTCOME AND MEASURES: Number of regulatory monitors measuring a census block group by criteria pollutant (particulate matter [PM], ozone [O3], nitrogen dioxide [NO2], sulfur dioxide [SO2], lead [Pb], and carbon monoxide [CO]).

RESULTS: This analysis included 329 725 481 individuals living in 237 631 block groups in the US (1 936 842 [0.6%] American Indian and Alaska Native, 18 554 697 [5.6%] Asian, 40 196 302 [12.2%] Black, 60 806 969 [18.4%] Hispanic, 555 712 [0.2%] Native Hawaiian and Other Pacific Islander, 196 010 370 [59.4%] White, 1 208 267 [0.3%] some other race, and 10 456 322 [0.4%] 2 or more races). Adjusting for population size, monitoring disparities were identified for each criteria pollutant. Relative to the White non-Latino population, all groups were associated with fewer NO2, O3, Pb, and PM monitors. Disparities were consistently largest for Native Hawaiian and Other Pacific Islander populations, followed by American Indian and Alaska Native populations and those of 2 or more races. An increase in percentage of Native Hawaiian and Other Pacific Islander race was associated with fewer monitors for SO2 (adjusted odds ratio [aOR], 0.91; 95% BCI, 0.90-0.91), CO (aOR, 0.95; 95% BCI, 0.94-0.95), O3 (aOR, 0.95; 95% BCI, 0.94-0.95), NO2 (aOR, 0.97; 95% BCI, 0.91-0.94), and PM (aOR, 0.96; 95% BCI, 0.95-0.96). An increase in the percentage of those of Asian race was associated with slightly more SO2 (aOR, 1.04; 95% BCI, 1.03-1.04) monitors.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of racial and ethnic disparities in the location of EPA regulatory monitors determined that data may not be equitably representative of air quality, particularly for areas with predominantly Native Hawaiian and Other Pacific Islander or American Indian or Alaska Native populations. Integration of multiple data sources may aid in filling monitoring gaps across race and ethnicity. Where possible, researchers should quantify uncertainty in exposure estimates.

PMID:39630448 | DOI:10.1001/jamanetworkopen.2024.49005

Matern Child Health J. 2024 Dec 4. doi: 10.1007/s10995-024-04023-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Almost all parents seek online child-related information. This study focuses on parents’ experience of using information from an easy-to-read parenting website, Naître et Grandir (N&G), specifically parents with low socioeconomic status (SES). SES is correlated with health literacy, a major determinant of child education and health. In January 2019, the Information Assessment Method (IAM) questionnaire was improved and implemented in a smartphone application (IAM + N&Gsmart) to reach more low SES parents.

OBJECTIVES: We measured the influence of IAM + N&Gsmart on the frequency with which low SES parents responded to the IAM survey of N&G webpages and the relative proportions of anticipated benefits of the N&G content. We also compared these benefits among fathers and mothers.

METHODS: This was a 4-year prospective time series. For each N&G webpage, parents were invited to complete an IAM questionnaire and report anticipated outcomes. IAM data were collected before (2017-2018) and after (2019-2020) the intervention (IAM + N&Gsmart launch) from Quebec parents of 0-8-year-old children who completed at least one IAM questionnaire. Descriptive and inferential statistical analyses were applied.

RESULTS: Participants completed 10,362 IAM questionnaires. Low SES participants anticipated more benefits than other participants, and particularly low SES fathers more than low SES mothers. The proportion of responses and reported benefits from low SES participants increased post-intervention.

CONCLUSIONS FOR PRACTICE: Results suggest that increasing literacy-oriented web content can lead to greater benefits among low SES parents, and that increasing father awareness and father-inclusive content can lead to even greater benefits among low SES fathers.

PMID:39630399 | DOI:10.1007/s10995-024-04023-0

J Neurooncol. 2024 Dec 4. doi: 10.1007/s11060-024-04885-y. Online ahead of print.

ABSTRACT

BACKGROUND: Thyroid Transcription Factor-1 (TTF-1) expression in lung adenocarcinoma (LUAD) has been studied for its prognostic value in early-stage and metastatic disease. Its role in brain metastasis remains unexplored. This study investigates the predictive value and association of TTF-1 status with clinicopathological variables in patients with synchronous LUAD brain metastases.

MATERIAL AND METHODS: In this bicentric retrospective study, 245 patients with newly diagnosed, treatment-naïve brain metastasis undergoing resection were included. Patient data were retrieved from electronic records. Outcomes included overall and progression-free survival. Statistical analysis included Kaplan-Meier estimates and Cox proportional hazards regression.

RESULTS: Mean Ki67 index in TTF-1 negative patients was 43% [95% CI 38-48%] compared to 32% [95% CI 29-35%] in TTF-1 positive (TTF-1 +) patients (p < 0.001). Tumor volume was significantly larger in TTF-1 negative (TTF-1-) patients (mean volume 24 mL [95% CI 18-31 mL]) vs. 15 mL [95% CI 12-17 mL] in TTF-1 + patients (padjust = 0.003). Perifocal edema was smaller in TTF-1- patients (mean volume: 58 mL [95% CI 45-70 mL]) vs. 84 mL [95% CI 73-94 mL] in TTF-1 + patients (padjust = 0.077). Tumor and edema volume did not correlate. TTF-1- patients showed worse overall, intracranial, and extracranial progression-free survival. In a multivariable Cox model, positive TTF-1 status was independently associated with improved outcomes. Negative TTF-1 status was associated with increased hazard for intracranial disease progression compared to extracranial progression.

CONCLUSION: In synchronous LUAD brain metastases, TTF-1 negativity reflects an aggressive phenotype with larger proliferation capacity and tumor volume. Future research should explore the underlying cellular and molecular alterations of this phenotype.

PMID:39630375 | DOI:10.1007/s11060-024-04885-y

Atten Percept Psychophys. 2024 Dec 4. doi: 10.3758/s13414-024-02976-6. Online ahead of print.

ABSTRACT

Studies suggest that mid-level features could underlie object animacy perception. In the current research, we tested whether ensemble animacy perception is based on high- or mid-level features. We used five types of images of animals and inanimate objects: color, grayscale, silhouettes, texforms – unrecognizable images that preserve mid-level texture and shape information – and scrambled images. In the series of Experiments 1, we asked participants to evaluate the animacy of single images and sets of eight images using a 10-point scale. In the series of Experiments 2, participants were shown two sets of eight images and had to choose a more animate one in the two-alternative forced-choice (2AFC) task. We found that in both paradigms, observers could report the mean animacy of the set of texform images without direct access to information about high-level features. Thus, ensemble animacy could be extracted only based on mid-level features such as shape and texture without access to more high-level information.

PMID:39630351 | DOI:10.3758/s13414-024-02976-6

Biol Trace Elem Res. 2024 Dec 4. doi: 10.1007/s12011-024-04456-2. Online ahead of print.

ABSTRACT

We aimed to explore the role of Indium (In), Terbium (Tb), Yttrium (Y), and Lanthanum (La) in the serum of women with recurrent pregnancy loss (RPL) and compare them to controls. Additionally, the study aimed to examine the relationship between REE levels and oxidative DNA damage, to identify potential risk factors contributing to RPL. This case-control study included 30 RPL cases and 30 controls with uncomplicated pregnancy. Inductively Coupled Plasma Mass Spectrometer was used to evaluate levels of In, Tb, Y, and La in the serum samples in both groups. The relationship between REE levels, Total Antioxidant Capacity (TAC), and DNA damage was studied by correlation analysis. There was a significant increase in levels of In, Tb, Y, and La in the serum of the RPL group in contrast to the control group (P < 0.001). Furthermore, a negative correlation was observed between increased Y, Tb, La, and TAC in RPL cases (significant at P < 0.05), indicative of weakened antioxidant defenses. Moreover, increased levels of Y, Tb, and La exhibited a positive correlation with the DNA damage marker, statistically significant at P < 0.05. These findings highlight the potential role of oxidative stress-induced DNA damage and metal intoxication in the development of RPL, underscoring the importance of further research to clarify underlying mechanisms and develop preventive strategies.

PMID:39630330 | DOI:10.1007/s12011-024-04456-2

Environ Monit Assess. 2024 Dec 4;197(1):19. doi: 10.1007/s10661-024-13495-0.

ABSTRACT

This study investigated the potentially toxic elements (PTEs) contamination of Betoya Bay surface sediments to assess the degree of pollution and identify the source of these contaminants. Average PTE levels as mg/kg in Betoya Bay are ranked in descending order as Zn (22.68) > Cr (8.64) > Pb (7.24) > Ni (6.82) > As (6.62) > Cu (5.78) > Co (2.45) > Cd (0.20). The sampling sites show an increase in PTEs at station 5, probably due to runoff from the wadi, and at the first station, where fishing activity is particularly intense. At all stations throughout the year, PTE levels were unpolluted as evaluated by the geoaccumulation index (I_geo) and the pollution load index (PLI). Almost all PTEs showed a “low contamination factor” according to the contamination factor index (CF). As assessed by the contamination degree (CD), all PTE levels at all stations and seasons were “low contamination degree”. The ecological risk indices (Eⁱ_r and RI) indicated low to moderate ecological risk. In line with sediment quality requirements, the M-ERM-Q calculation suggests there is only a 9% chance that this particular combination of metals poses a threat. The non-carcinogenic health risk assessment showed that beach sand in the study area is entirely safe, presenting no additional health risk to children or adults. However, the carcinogenic risk showed a low to moderate carcinogenic risk for adults and a moderate to high carcinogenic risk for children. In addition, statistical analysis revealed that all PTEs are likely to have common sources, which may be related to the geology of the area.

PMID:39630323 | DOI:10.1007/s10661-024-13495-0

Environ Monit Assess. 2024 Dec 4;197(1):14. doi: 10.1007/s10661-024-13436-x.

ABSTRACT

This study assessed the surface water quality in Dong Thap province during 2013-2023 using multivariate statistical techniques. Water quality index (WQI), Pearson correlation, principal component analysis (PCA), and cluster analysis (CA) were determined based on monitoring data for parameters. The findings showed that only some water samples had pH values below the permissible standard, while 95.5% of samples exceeded the standard of Escherichia coli in surface water. In some years, 100% samples having BOD₅, TSS, NH₄⁺, and E. coli exceeded the permissible limits. The PCA identified four, five, and seven major potential sources during 2013-2015, 2016-2020, and 2021-2023, respectively, explaining 75.9%, 63.0%, and 63.0% of variation in the corresponding duration times. For heavy metals, the number of water samples containing As, Cu, and Pb exceeding the water permissible limits were 15.5%, 21.4%, and 2.8% samples in 2021, respectively, but no heavy metal was above standard in 2022 and 2023. The evaluation of average water quality based on WQI showed that 79.31% and 76.19% of the sample sites were classified to be average during 2016-2020 and 2021-2023, respectively, and others were bad water quality. However, the water quality showed an improving trend with 70% of monitoring positions considered as good water quality in 2023. The results showed that anthropogenic activities and hydrological regime were the main source of pollution. This study provides guidance to policymakers in developing water management strategies to have proper actions to prevent water pollution.

PMID:39630307 | DOI:10.1007/s10661-024-13436-x

Sleep Breath. 2024 Dec 4;29(1):45. doi: 10.1007/s11325-024-03212-z.

ABSTRACT

INTRODUCTION: Stroke survivors are at risk of sleep disturbance, which can be reflected in discrepancies between objective and subjective sleep measures. Given there are limited studies on this phenomenon and using portable monitoring devices is more convenient for stroke survivors to monitor their sleep, this study aimed to compare objectively measured (Belun Ring) and subjectively reported (sleep diary) sleep metrics (total sleep time (TST) and wakefulness after sleep onset (WASO)) in stroke survivors.

METHODS: In this cross-sectional study, thirty-five participants wore a ring-shaped pulse oximeter (Belun Ring) and kept a sleep diary for three consecutive nights in one week. The effects of various factors on TST and WASO were analyzed by linear mixed models. Systematic bias between two measures was examined by the Bland-Altman analysis.

RESULTS: TST and WASO were significantly affected by measures (p <.001), but not night. TST was significantly lower and WASO was significantly higher in the Belun Ring than in the sleep diary (p <.05). Age was the only covariate that had a significant effect on WASO (p <.05). The Bland-Altman analysis demonstrated positive bias in TST (29.55%; 95% CI [16.57%, 42.53%]) and negative bias in WASO (-117.35%; 95% CI [-137.65%, -97.06%]). Proportional bias was exhibited in WASO only (r =.31, p <.05).

CONCLUSION: The findings revealed discrepancies between objective and subjective sleep measures in stroke survivors. It is recommended that objective measures be included when assessing and monitoring their sleep conditions.

PMID:39630297 | DOI:10.1007/s11325-024-03212-z

J Comput Aided Mol Des. 2024 Dec 4;39(1):2. doi: 10.1007/s10822-024-00581-1.

ABSTRACT

Although small molecule superposition is a standard technique in drug discovery, a rigorous performance assessment of the corresponding methods is currently challenging. Datasets in this field are sparse, small, tailored to specific applications, unavailable, or outdated. The newly developed LOBSTER set described herein offers a publicly available and method-independent dataset for benchmarking and method optimization. LOBSTER stands for “Ligand Overlays from Binding SiTe Ensemble Representatives”. All ligands were derived from the PDB in a fully automated workflow, including a ligand efficiency filter. So-called ligand ensembles were assembled by aligning identical binding sites. Thus, the ligands within the ensembles are superimposed according to their experimentally determined binding orientation and conformation. Overall, 671 representative ligand ensembles comprise 3583 ligands from 3521 proteins. Altogether, 72,734 ligand pairs based on the ensembles were grouped into ten distinct subsets based on their volume overlap, for the benefit of introducing different degrees of difficulty for evaluating superposition methods. Statistics on the physicochemical properties of the compounds indicate that the dataset represents drug-like compounds. Consensus Diversity Plots show predominantly high Bemis-Murcko scaffold diversity and low median MACCS fingerprint similarity for each ensemble. An analysis of the underlying protein classes further demonstrates the heterogeneity within our dataset. The LOBSTER set offers a variety of applications like benchmarking multiple as well as pairwise alignments, generating training and test sets, for example based on time splits, or empirical software performance evaluation studies. The LOBSTER set is publicly available at https://doi.org/10.5281/zenodo.12658320 , representing a stable and versioned data resource. The Python scripts are available at https://github.com/rareylab/LOBSTER , open-source, and allow for updating or recreating superposition sets with different data sources.

PMID:39630291 | DOI:10.1007/s10822-024-00581-1