Nevin Manimala

Noise Health. 2024 Oct-Dec 01;26(123):489-494. doi: 10.4103/nah.nah_83_24. Epub 2024 Dec 30.

ABSTRACT

PURPOSE: This study aimed to assess the levels and sources of noise in the emergency intensive care unit (EICU) of an emergency department and investigate their effects on the sleep quality of conscious patients.

METHODS: A study was conducted on patients admitted to the EICU from December 2020 to December 2023. They were categorised according to their sleep quality with the Pittsburgh Sleep Quality Index. Environmental noise levels were measured using precision sound level metres and environmental noise automatic monitoring instruments. Data analysis was performed using SPSS version 25.0, and Chi-square test, Fisher’s exact probability and t-tests were conducted when applicable. The significance threshold was set at P < 0.05. Regression analysis was carried out for indicators with significant differences.

RESULTS: A total of 200 patients were included in the study. Of them 96 in the ideal sleep group and 104 in the non-ideal sleep group. Patients with non-ideal sleep experienced significantly higher noise levels across various measures (P < 0.05). Additionally, patients with non-ideal sleep reported significantly higher occurrences of noise-related awakening, difficulty in falling asleep, nightmares or vivid dreams and sleepwalking episodes (P < 0.05). Significant differences in staff activities, including staff conversations, equipment noise exposure, cleaning activities, patient interventions and overhead pages, were observed between the groups (P < 0.05). Multivariate logistic regression analysis indicating that the average noise level, conversational speech, equipment alarms, ambient noise, peak noise levels, staff conversations, cleaning activities, patient interventions and overhead pages were significant contributors to poor sleep.

CONCLUSION: The study suggested that high noise levels and staff-related activities affected the sleep quality of conscious patients in the EICU. Targeted measures could improve the prognoses of patients.

PMID:39787549 | DOI:10.4103/nah.nah_83_24

Noise Health. 2024 Oct-Dec 01;26(123):474-482. doi: 10.4103/nah.nah_98_24. Epub 2024 Dec 30.

ABSTRACT

BACKGROUND: The effect of background noise on auscultation accuracy for different lung sound classes under standardised conditions, especially at lower to medium levels, remains largely unexplored. This article aims to evaluate the impact of three levels of Gaussian white noise (GWN) on the ability to identify three classes of lung sounds.

METHODS AND MATERIALS: A pre-post pilot study assessing the impact of GWN on a group of students’ ability to identify lung sounds was conducted. The three intensities were applied to the three classes of lung sounds: no GWN, signal-to-noise ratio (SNR), SNR-40 (medium level) and SNR-20 (high). This resulted with three exams, each containing nine questions. Fifty-two participants underwent a 4-day training programme and were tested on their identification of lung sound classes under the three levels of GWN, but seven subjects were excluded for not completing all three assessments. Statistical analysis was performed on 45 subjects, using non-parametric tests to analyse the data. A P-value of 0.05 was considered statistically significant.

RESULTS: The GWN did not impact the overall lung sound identification capacity of medical students, with consistent scores of 66.7% across the three noise levels for all three lung sound classes combined. However, when considering sound classes separately, GWN affected the identification of normal (NAS) and discontinuous (DAS), but not continuous (CAS) types. Exam scores for NAS varied significantly across the three noise levels, with respective scores of 66.7%, 100% and 66.7%. Scores for DAS also varied, revealing 66.7%, 33.3% and 66.7%.

CONCLUSION: This study introduces a standardised simulation-based approach to investigate the effect of GWN on the accuracy of auscultation amongst medical students. Findings indicate that whilst CAS sounds are robust to background noise, the identification of NAS and DAS sounds can be compromised. The medium noise levels (SNR-40) of noise pollution had the greatest effect on the DAS lung sounds.

PMID:39787547 | DOI:10.4103/nah.nah_98_24

Appl Physiol Nutr Metab. 2025 Jan 9. doi: 10.1139/apnm-2024-0392. Online ahead of print.

ABSTRACT

Fasting during Ramadan involves abstaining from food and drink from dawn to dusk for 29 to 30 days, annually. Dietitians, experts in food and nutrition, play a vital role in fostering the well-being of Canadians. Given that 1 in 20 Canadians are Muslim, access to culturally safe care is essential for their health. The consumption of adequate nutrients during the non-fasting hours is important for Muslims well-being. It is unknown whether dietitians in Canada feel comfortable and knowledgeable providing safe care during Ramadan. An online survey, was developed using the World Health Organization’s Knowledge Attitude and Practice Protocol, and then reviewed for content validity by 6 dietitians. From March 5, 2023 to April 1, 2023, 159 Canadian dietitians, from a variety of practice areas including acute care, community health, and private practice, completed the online survey. Descriptive statistics, cross tabulations, and chi-square tests, enhanced by post hoc analyses with Bonferroni correction, were employed to determine any relationship between categorical variables and identify significant associations or differences. While most participants demonstrated an adequate understanding of Ramadan fasting practices, including its duration and restrictions, 91% reported not receiving information on how to provide culturally safe care during their university degree. Many dietitians expressed discomfort providing care (43.7%, 69/158) and lacked adequate resources (51.3%, 81/158). Among the 37% of dietitians who did offer care to Muslims (58/157), the majority felt comfortable (72.1%, 44/58). This study reveals a gap in capacity to provide culturally safe care, highlighting the need for training interventions for nutrition professionals, and curriculum for dietetics programs.

PMID:39787537 | DOI:10.1139/apnm-2024-0392

J Perinat Neonatal Nurs. 2024 Oct 10. doi: 10.1097/JPN.0000000000000856. Online ahead of print.

ABSTRACT

BACKGROUND: Noninvasive mechanical ventilation (NIMV), when in synchronized intermittent mandatory ventilation, continuous positive airway pressure, or patient-triggered ventilation modes, is known to be a cause of facial, nasal, head, and skin pressure injuries in preterm infants.

OBJECTIVE: The objective of this study is to examine the efficacy of using a checklist with preterm infants under nasal NIMV in preventing facial, nasal, and head pressure injuries.

METHOD: The study was conducted quasi-experimentally on preterm infants under NIMV. The sampling comprised a total of 104 infants, an intervention group of n = 52 and a control group of n = 52. All procedural steps of NIMV of the infants in the intervention group were performed in accordance with a checklist. The checklist covered: (1) preparation of the ventilation device and cannula placement; (2) care; and (3) monitoring and assessment.

RESULT: There was a statistically significant difference in nasal tip, septal, intranasal, upper lip, and right-left cheek pressure injury scores between the intervention and control groups (P < .05).

CONCLUSION: Performing all procedural steps of nasal NIMV in accordance with a checklist is effective in preventing pressure injuries on the face, nose, and head of preterm infants, reducing the severity of pressure injuries.

IMPLICATIONS FOR PRACTICE: It is recommended to use a checklist covering the ventilation device preparation, cannula placement, care, observation, and assessment steps to prevent any pressure injuries in the face, nose, and head, as well as to reduce the severity of pressure injuries and improve the skin condition of preterm infants under nasal NIMV support.

PMID:39787536 | DOI:10.1097/JPN.0000000000000856

Cir Cir. 2025 Jan 9. doi: 10.24875/CIRU.23000380. Online ahead of print.

ABSTRACT

OBJECTIVE: To report the statistics of complications in gender reassignment surgery (vaginoplasty) observed in the first surgical center in Mexico for public transgender surgery.

METHOD: We conducted a descriptive, observational study of patients treated and postoperatively underwent vaginoplasty surgery in the period 2019 to 2022. Intraoperative, immediate and late complications were evaluated. Intraoperative complications were taken as: rectal perforation and bleeding. Immediate complications: wound dehiscence, hematoma, and necrosis of the vaginal segment. Late complications: urethrovaginal fistula, rectovaginal fistula, and stenosis of the vaginal introitus.

RESULTS: Twenty-two patients who underwent vaginoplasty with inversion of the foreskin were evaluated. Regarding immediate complications, the most frequent were alterations in scarring and tissue integration, being necrosis of the vaginal segment the most frequent. As for late complications, only vaginal prolapse and urethral stricture were found.

CONCLUSION: Foreskin inversion vaginoplasty is the most widely used and safest technique worldwide, above colovaginoplasty and peritoneal vaginoplasty techniques, and fortunately serious complications are rare. In our report, tissue alterations were the common ones and that is secondary alteration of vascular integration and devascularization factors during the dissection.

PMID:39787535 | DOI:10.24875/CIRU.23000380

J Strength Cond Res. 2024 Dec 31. doi: 10.1519/JSC.0000000000005000. Online ahead of print.

ABSTRACT

Favro, F, Roma, E, Gobbo, S, Bullo, V, Di Blasio, A, Cugusi, L, and Bergamin, M. The influence of resistance training on joint flexibility in healthy adults: A systematic review, meta-analysis, and meta-regression. J Strength Cond Res XX(X): 000-000, 2024-Joint flexibility is a key component of physical fitness. Despite the large body of evidence regarding the effectiveness of muscle stretching exercises, little is known about the effect of resistance training on flexibility. A systematic search was conducted on 9 academic search instruments; inclusion criteria were as follows: healthy adult participants (age ≥18 years); resistance training intervention (duration ≥4 weeks); at least one flexibility outcome. Risk of bias was assessed using the RoB-2 and ROBINS-I tools. A 3-level meta-analysis was conducted, with multiple outcomes nested within each study. A moderator analysis was conducted by fitting a meta-regression model. Significance level was set at p < 0.05. We included 36 studies (1,469 participants). None of the included papers resulted at a low risk of bias. The pooled effect size for resistance training on flexibility was g = 0.6325, with 95% CI: 0.4762 to 0.7888 (p < 0.0001). There was a substantial amount of heterogeneity between studies. Exercise intensity was a significant moderator (p < 0.0225, high vs low), based on 129 and unique effect sizes, and sex (p = 0.0429). Activity level and age were nonsignificant moderators. Resistance training could be implemented as a strategy to improve joint flexibility, with high-intensity protocols resulting in a magnified effect. However, the high overall risk of bias and substantial heterogeneity limit our ability to draw definitive conclusions.

PMID:39787531 | DOI:10.1519/JSC.0000000000005000

Nurs Educ Perspect. 2024 Oct 18. doi: 10.1097/01.NEP.0000000000001336. Online ahead of print.

ABSTRACT

Part-time clinical nurse instructors teach students in many nursing schools in the United States. They are often unprepared for this role and require instruction in teaching methods. We developed and evaluated an online orientation program to provide the knowledge and skills necessary for nurses to become confident clinical instructors. For this project, 55 nurses completed the program; 28 were part-time faculty. Significant statistical differences were noted after completing the orientation program. Part-time faculty notably benefited from the online program and felt more confident in their ability to work with students.

PMID:39787525 | DOI:10.1097/01.NEP.0000000000001336

Alzheimers Dement. 2024 Dec;20 Suppl 6:e089497. doi: 10.1002/alz.089497.

ABSTRACT

BACKGROUND: Genetic variants in GRN, the gene encoding progranulin, are causal for or are associated with the risk of multiple neurodegenerative diseases. Modulating progranulin has been considered as a therapeutic strategy for neurodegenerative diseases including Frontotemporal Dementia (FTD) and Alzheimer’s Disease (AD). Here, we integrated genetics with proteomic data to determine the causal human evidence for the therapeutic benefit of modulating progranulin in AD.

METHOD: Using AD genome-wide association studies (GWAS) summary statistics, we performed colocalization and Mendelian randomization (MR) analyses with plasma cis-pQTL data in UK Biobank and CSF pQTL data from neurodegeneration-focused cohorts. We additionally performed rare variant analyses using UK Biobank whole genome sequencing data to examine the association of GRN rare variants with AD and dementia. Finally, we characterized common genetic determinants of progranulin levels genome-wide in UK Biobank.

RESULT: We observe consistent supporting genetic evidence that increased progranulin levels associate with reduced AD/dementia risk through GWAS (rs5848, OR = 0.93, p = 2.4e-20), aggregated rare variant associations (p = 9.18e-14), pQTL colocalization, and MR evidence. Genome-wide associations with plasma progranulin levels identify several potential modulators (e.g., SORT1, PSAP, APOE), with SORT1 showing the strongest common variant association (p<1e-300). Given the receptor-ligand relationship between SORT1 and progranulin, we re-scaled MR analyses to estimate the therapeutic effect of modulating progranulin with sortilin inhibitors. Our MR analyses suggest that a genetically predicted 2-fold increase in CSF progranulin levels, as observed in phase 1 clinical trials of a sortilin inhibitor, associates with a ∼46% lower odds of developing AD (OR = 0.54, p = 2.2e-12).

CONCLUSION: Our work demonstrates consistent causal associations of GRN with AD risk. These data provide causal human evidence supporting the potential therapeutic benefits on AD/dementia of inhibiting sortilin to increase progranulin levels.

PMID:39782671 | DOI:10.1002/alz.089497

Alzheimers Dement. 2024 Dec;20 Suppl 6:e090032. doi: 10.1002/alz.090032.

ABSTRACT

BACKGROUND: The presence of multiple comorbid pathologic features in late-onset dementia has been well documented across cohort studies that incorporate autopsy evaluation. It is likely that such mixed pathology potentially confounds the results of interventional trials that are designed to target a solitary pathophysiologic mechanism in Alzheimer’s disease and related dementias (ADRD).

METHOD: The UK ADRC autopsy database was screened for participants who had previously engaged in therapeutic interventional trials for Alzheimer’s disease, vascular cognitive impairment, dementia, and/or ADRD prevention trials from 2005 to the present. Sixty-five cases (out of a total n = 534) were engaged in clinical trials for the prevention or treatment of ADRD. Pathologic features studied included b-amyloid, tau, a-synuclein, TDP-43, and cerebrovascular disease using conventional rating scales.

RESULT: Autopsy cases for those who previously engaged in clinical trials did not differ significantly from those that were trial-naïve for demographic, genetic (ApoE), or clinical characteristics except for CDR global scores that were lower for past trial participants (p<0.05). Comorbid pathologies were common across study types with a mean of 3 pathologic features/participant, 17% with quadruple misfolded proteinopathy (QMP; Ab+tau+synuclein+ TDP43). Yet only 10% of MCI/AD trial participants demonstrated a “pure” disease state that was targeted by the study intervention.

CONCLUSION: In our study, approximately 2 out of 3 ADRD trial participants had comorbid mixed pathologic features. Understanding the heterogeneity of pathologies seen in clinical trial participants may allow improved inclusion/exclusion criteria based on clinical features and the rational use of antemortem biomarkers to stratify the likelihood of mixed comorbid pathology. In addition, the recognition will allow the usage of combination therapy for future interventional strategies. Such insights may also enable improved power analyses and statistical designs that may be able to adjust for the confounds of such mixed pathologic disease states that are common in ADRD clinical trials.

PMID:39782666 | DOI:10.1002/alz.090032

Alzheimers Dement. 2024 Dec;20 Suppl 6:e089155. doi: 10.1002/alz.089155.

ABSTRACT

BACKGROUND: CT1812 is an experimental therapeutic sigma-2 receptor modulator in development for Alzheimer’s disease (AD) and dementia with Lewy bodies. CT1812 reduces the affinity of Aβ oligomers to bind to neurons and exert synaptotoxic effects. This phase 2, multi-center, international, randomized, double-blind, placebo-controlled trial assessed safety, tolerability and effects of CT1812 on cognitive function in individuals with AD.

METHOD: Consenting participants with confirmed brain amyloid and baseline MMSE scores of 18 to 26 were randomized equally to receive oral placebo, 100 or 300mg of CT1812 daily for 6 months. Exploratory efficacy outcomes included ADAS-Cog11 and 13, Neurophysiological Test Battery, ADCS-Clinical Global Impression of Change and ADCS-Activities of Daily Living. The primary statistical analysis is treated (combined 100 and 300mg CT1812) versus placebo change from baseline in ADAS-Cog11. Canonical AD biomarkers were assessed in CSF and plasma.

RESULT: One hundred fifty-three participants were randomized. An interim analysis of the first 24 participants was performed where baseline demographics included mean age of 71.7 years, 15 females and a mean MMSE of 21.1. In the interim analysis there were twenty-two TEAEs (7, 8, 7 in the 100, 300mg CT1812 and placebo groups, respectively) reported and in the CT1812 groups, all TEAEs were mild or moderate and there were no treatment related SAEs. There was a trend within these 24 participants for slower progression at six months in the CT1812 treated group with ADAS-Cog11 improved 3.1 points relative to placebo according to the prespecified statistical model. Complete data from all participants including AEs, cognitive performance and canonical biomarkers will be presented with the ADAS-Cog11 change from baseline relative to placebo for the pooled CT1812 treated group prespecified as the first cognitive assessment with ApoE4 status as a covariate.

CONCLUSION: CT1812 is an oral sigma-2 modulator that displaces Aβ oligomers from neurons. Encouraging trends have been observed in previous studies (NCT03493282, NCT03522129, NCT04735536) and in an interim analysis of this phase 2 trial (NCT03507790). This trial will provide proof of concept data indicating if CT1812 can slow progression in people with mild to moderate AD. This study was supported by a grant from the NIH (AG058660).

PMID:39782655 | DOI:10.1002/alz.089155